I (Really) Don't Know How She Does It

Karen's daughter gets to see what work is like for mom.

I spent five full days in an ICU with one of my kids a few years ago. I never left. Just sat there and stared for 5 days waiting through the healing process. Having a child in a hospital is something many of us have to go through, whether it is for major or minor reasons. And I think every parent agrees it is something you want to be over fast. No sleep, stressful decisions, late night updates, and just a general feeling of worry that sinks right to your stomach, all while you wait and wait.

For Karen Kamholz, the mother of three young kids, and a doctor in the newborn intensive care unit (NICU) at Georgetown, that is her job. I thought back to the doctors and nurses that cared for my child. They all seemed so even-keeled and relaxed, while I pulled my hair out and asked 100 questions about every little thing based on information I’d read on the internet, which I am sure drives doctors crazy. To this day I don’t know how doctors deal with sick children on a day-to-day basis, not to mention the frantic parents that come along with them.

With all the late night calls and weekend-long shifts, and three kids who want her attention when she is home, is being a NICU doctor a profession Karen would choose again if she could do it all over? And how does she manage to keep parenting and working separate after a long, stressful day?

Tell me a little bit about your job as a doctor. Who is a typical patient? What is the pace at which you are required to work and how high/low is the stress level? What hours do you work? 

I work in newborn intensive care. The patients are newborns, either born at my hospital or transported in from another hospital for more intensive services. Some are full-term and stay for only a few days. Some are born 3 to 4 months early and can stay with us for 6 months. We get pretty attached to the long-term players. The stress level is pretty high, but the pace is actually not so fast the vast majority of the time. Much of what we do is to support babies who were born prematurely until they mature, i.e. can breathe without support, maintain their temperature without the help of an incubator, feed by mouth, etc. You can try a change in support, see how they respond, and adjust accordingly. There are the intermittent, more rare, emergencies that get your adrenaline going. Though frightening, most NICU docs/nurses like this part of the job. Procedures on small babies also get us excited, oddly enough.   

The hours are highly variable. Some weeks I am "on service" and working 8 am until 7 or 8 pm or later. Those are hard weeks for everyone! Kids, husband, me, laundry..... Some weeks I am doing research/administrative work, and those weeks are much more flexible. Those weeks, I try to fit in normal "mom" things -- volunteer in the kids’ classrooms, go on a field trip, etc. I honestly find this a much better schedule for balancing my two lives than a typical Monday-Friday work schedule. I do not know how I would take the kids to the doctor, make appointments for myself, deal with the many school vacation days, have work done at the house, etc. if I worked all day Monday-Friday each week. I do work about every fourth weekend [both] days and nights plus about one night a week. Night and weekends are call from home -- i.e. I go in to the hospital if I am needed, but if all is quiet, I can stay home. We have neonatology fellows who are "in house" to manage things. They stay at the hospital when we are at home.

I imagine dealing with sick babies can pull at your heartstrings. How do you deal with that on a day-to-day basis? And has becoming a mother yourself affected how you see your job? How about how others see you in your job?

From the time I was in college, I wanted to become a pediatric oncologist,  [for] kids with cancer. I wanted to work with kids and families dealing with life-threatening diseases, to develop strong bonds with them over time, and not to restrict myself to one organ system, such as cardiology. I started my residency and I suddenly found this field very sad. It was difficult to leave work at work and to have a separate outside life. I think I would have burned out after a year. Then I had a month working in the NICU. Babies there, as a general rule, start out very sick, gradually get better, and go home with their families. It is very rewarding to help babies and families through that. There are cases that pull at your heartstrings, but they are less common.

I had my first child when I was in my last year of neonatology training. Becoming a mother changed my approach to my job more than I ever thought it would. I never understood a parent's love until I had my first child. I felt that I could relate so much better to the parents of the babies after becoming a parent myself. I frequently tell the residents and the fellows, pediatricians and neonatologists in training, to consider what they would want if this were their child. I will let families know that I am a parent-- and I think it does help me support them on a different level. 

What is it like dealing with the parents of the children? And has becoming a parent changed how you approach talking with them? 

Dealing with parents is actually one of the most rewarding parts of my day - from simple daily updates to bigger family meetings. I like making sure that they are up to date on what is going on. I like encouraging them to ask questions and DC parents are very educated, so they search the Internet and ask lots of questions. I like celebrating their children's successes with them. I also think it is important to share any concerns that we have with them. All that talking keeps me at work longer, but it's worth it. Being a parent has changed my approach in some ways. It has made me more focused on keeping the families in the loop. It has helped me take those extra few minutes to speak with families. It helps me to reassure the parents of the baby with short-term issues. Yes, a NICU stay was not in the "birth plan," but their baby will get better and we do not have long-term concerns. I had a baby recently who was being treated for jaundice. The father told me he was very concerned that the bilirubin level, which causes jaundice, had risen and required treatment. I told him the jaundice was treatable and that this problem would be resolved in a few days. What he needed to worry about was the child's college fund because that was a much more difficult problem to deal with than jaundice. The dad's mother loved that response! I will share with families, especially families of the long-term players who I interact with often, that I am a parent. It does help me relate to them on a different level. There is something so special, so indescribable, about the love a parent feels for a child!

At what point in your life did you know you wanted to work with babies? Is this something you see yourself doing for the long haul?

Neonatology is a subspecialty of pediatrics. You have to train in general pediatrics first. I began to consider neonatology when I was an intern in pediatrics. The field had everything that I liked about pediatric oncology without the same "sadness" factor. I do see myself in this for the long haul. Folks have told me that I would get bored of "just taking care of patients," but it has not happened yet. I am at an academic institution, so I am involved in resident and fellow education, which is also rewarding.  

You have three kids. Tell me a little about each of your kids. If you ask them, "What does Mommy do?" how do they understand/interpret what you do for work?

I have 3 kids who I love more than words can explain. My oldest is sweet and loving, but can also be stubborn and wants things done his way, which I have to admit, he got from me. He is talkative, outgoing, and has lots of friends. He loves to read and he loves Legos. He can make amazing Lego structures without directions. As a toddler, he liked to figure out how his electronic toys worked. I call him my "little engineer."  My middle child is full of life and drama. She has the world's best laugh, but she is also rather sensitive and can get devastatingly upset about something that seems so small to me. She thrives on individual attention. Middle child! And can be a bit of a troublemaker in a good-hearted kind of a way. She is kind and generous, but can be somewhat shy in new situations. She is the most likely to be a future doctor. She is fascinated when she sees people with visible differences. She loves to come to work with me. She cannot come see the babies, but she will color in my office and hang out in the nurses' lounge. My youngest is a baseline happy, glass "half-full" kind of a girl. Thank goodness! She is super cuddly. She likes to run with the "big kids" but plays the role of "baby in the family" quite well when it suits her. She’s adaptable, outgoing, and makes friends easily. She is happy hanging with the boys or the girls. She has a frighteningly good memory. This morning when she picked out her shirt she told me what color band-aid she had on her arm the last time she wore that shirt-- which was last winter! She is very verbal and she amazes me with all that she has to share. She loves dressing up, singing and dancing, and pretend play. When the other kids are not around, she is able to entertain herself.  My kids know that I "take care of babies." I don't think they are particularly impressed by this. They know that there are other doctors taking care of the babies when I am not working. They will ask me why I have to work on a given day. "Can't someone else take care of the babies today?" My 4-year old recently told me that pre-K is fun because you get to play. Being a doctor is boring because you have to sit at a computer and write notes all day. : )

How do you balance work and home life?  How difficult is it to keep the two separate? For example, if you have had a particularly draining or upsetting night, do you try to switch to happy mom or do you explain to the kids that what you do is sometimes tough and collapse on the couch? How do you wind down?

 I honestly feel like I have two separate lives - my mommy life and my work life. I love them both and I would not be happy doing just one or the other. I miss my kids terribly when I am at work, but I miss work if I am with the kids for weeks at a time. I officially work 75% time. Though it ends up being more than 40 hours a week, it gives me a bit of flexibility to arrange my work schedule around our home life, school vacation days, etc. Plus most weeks I can get to the grocery store or get other errands done during the week [which is a] benefit of both a "part-time" position and of some night/weekend work. But work/life balance would be impossible without an amazing husband. I honestly cannot say enough about the support he gives me or all that he does for our family. We arrange our schedules so that one of us is always free to deal with any kid issues that arise. He will manage the kids solo while I work an entire weekend with no complaints. He will manage dinner, homework, and sometimes bedtime routines solo for days in a row on my busier weeks. He will make sure the kids are up and dressed and lunches are packed in the morning if I had to leave to go to the hospital in the middle of the night. Even if I am at home, he will let me sleep in if I had a busy call night. As a result of this "daddy time" he has a wonderful relationship with the kids. He also does most of the cooking though neither of us does a ton of cooking, and he helps with cleaning and other household needs. Amazingly supportive! I try hard to keep my two lives pretty separate. When I have a bad night, I don't really let the kids know. They will hear, "Mommy worked last night and Mommy is tired," but I don't really tell them any more than that. I will stay at work an extra 30 minutes in order to get home after they have left for school. A good cry in the car is my best emotional release - that or doing a bit of work in the yard, weather-permitting.   

Is there a particular case or two that will stay with you forever and can you describe it?

There are definitely a number of them. The hardest cases are the ones where no problems were anticipated, those cases that were supposed to be happy, healthy full-term deliveries. 

What do you do in your free time (if you have any!)?  

I feel like I have no free time, but this is mostly due to overscheduling on my part! I really enjoy low-key hanging out with friends and doing activities with the kids and as a family or with friends. I used to exercise, and I would love to get back to that. I enjoy walks. 

Why did you decide to become a doctor? Are the reasons you stay in the profession the same or have they changed and if so, how?

I first said I wanted to become a doctor when I was in 5th grade. That is because my sister who was in 7th grade at the time said that she wanted to be a lawyer, so naturally I had to pick something that was the complete opposite of that! I liked math and science in school much more than reading/writing. I needed a profession that would keep me moving and interacting with people. It just seemed to fit, so I stuck with it. I always enjoyed working with kids, so pediatrics was a perfect fit. If I was not a doctor, I would probably have been gone into early childhood education and become an elementary school teacher. The reasons I stay in the profession are the constant challenges. I am always learning something new and the interactions I get to have with babies, who really are individuals with personalities, and their families. 

Do you think the general public has the right idea about what a doctor in your position does? Most of us get our information from Grey's Anatomy and ER.

True story. I was at Massachusetts General Hospital as a third-year medical student on my internal, adult, medicine rotation. The team walked into the room of an older woman. She looked at us and said, "I know what this is. I watch ER. This is rounds. You are going to talk to me and then you are all going to go have sex in the closet." My resident kept his composure. I had to leave the room because I could not stop myself from laughing! I think most people think that taking care of sick babies must be sad. I have a hard time explaining how rewarding it is. The best part is hearing back from families after they have gone home. We love receiving Christmas cards. The NICU also has a reunion each year and invites all of the "NICU graduates" back. They have face painting, moon bounces, and lots of treats, so my kids love it! It is one of my favorite events-- and one of the rare places where my work life and my home life meet. 

Can you tell me a little bit about where you came from?

I am 41. I grew up in Shreveport, Louisiana. I was the middle of three kids with typical "middle child syndrome." My dad was [and still] is an adult endocrinologist at an academic hospital, i.e. one with a medical school, but he rarely spoke of his patients, frequently spoke of his colleagues, and had an office that was not in a clinical area, so for many years I did not think he was a "real" doctor as in the kind who takes care of patients. He worked pretty long hours and was a great teacher. My mother was a high school math teacher and was in charge of managing the household. She was able to drop us at school, pick us up from school, and was home for the summers. 

By Suzette McLoone Lohmeyer

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Karen spends one of her free Saturdays with her family and friends apple picking at a local farm.