Eight months ago, I left practice as a critical care surgeon in favor of homeschooling my kids. As part of the “day in the life” linkup on Simple Homeschool, I’m sharing a glimpse into life before I left practice, and how the days appear now.

Myriad factors influenced my decision to leave clinical work, but paramount among them were the call I felt to infuse my kids’ days with learning, and my inability to do so while work —  although intended for good — governed my time and thoughts. Caring for critically-ill patients was a privilege, but I struggled to separate work from home, and my family suffered. Deuteronomy 6:7 convicted my heart, and I knew that if I continued on the same trajectory, I would sacrifice my family’s well-being for the sake of my pride.

Dallas Willard said, “You give to God not through your accomplishments, but through the person you become.”  Through this journey, the Lord has compelled me to confront parts of myself that I esteemed above Him. The road has humbled me, frightened me, convicted me, exhausted me, and drawn me closer to Him in spite of my unworthiness. For His mercy, and for the gift of so many moments with my children, I thank Him and praise His name.

THEN

Background: I worked in the surgical intensive care unit of an academic hospital. My job was to care for critically ill patients who were either recovering from surgery, or who had a problem that could require surgery. I also performed emergency surgeries in the operating room.

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I wake up at 1:00 AM to the sound of my infant Bean crying. I stumble into her room, replace her pacifier and rub her back, and then trudge back to bed and collapse. I check my phone, and then regret doing so when I discover an automated email from the emergency department (ED). One of my postoperative patients has arrived in the ED; the email gives no further information. He could be there for a problem related to my surgery, or for evaluation of nasal congestion. Worry keeps me awake an extra hour.

My alarm sounds at 5:00 AM. I hit the snooze button, and finally crawl out of bed at 5:15. Then I shower, dress, and gather my things in the dark. I awaken my husband Scottie with a kiss on the cheek. Preschooler Pip is such a difficult sleeper, and baby Bean awakens so frequently, that I’ve learned not to sneak into their rooms to kiss them goodbye, although I ache to do so. I climb into my car at 5:45 AM.

Traffic plods into the city. I usually delight in the sunrise during my commute, but another email preoccupies me. A critically ill patient who has a terminal diagnosis was admitted to the ICU  overnight, and his goals of care are murky. “You’ll need to talk to his family in the morning,” the email says. I’ve never laid eyes on this patient before, but I recognize the scenario. I dread witnessing the confusion and heartbreak his family will endure as I discuss details of resuscitation while their loved one is dying.

At 6:45 AM I park the car, run into the hospital, and head for the elevator. I fight my impatience when the elevator stops on every floor up to the 12th. When I arrive in the ICU, I find the overnight intensivist (ICU doctor) not at the nurses’ station as per usual, but rather hovering at the bedside of a new patient. She clutches a cup of coffee in one hand, and stands with her arms crossed in front of her. Her posture is tightly wound.

“We’ve been busy,” she says, raising her eyebrows.

The patient before us is drowning in his own fluids. An infection in his bloodstream made his lung capillaries leak, and despite high ventilator settings, his oxygen levels are dangerously low. I will spend the morning at his side.

The overnight physician and I quickly walk around the ICU to discuss the other patients. I note other complicated cases — a few patients on ventilators for pneumonia, a postoperative liver transplant patient, two trauma patients on a bleeding watch, a head trauma patient with vague goals of care, a patient recovering from a massive spinal tumor resection.

I return to the bedside of the patient in respiratory distress. The nurses, residents, and I adjust sedation, paralytic agents, vasopressors, and ventilator settings. We increase the airway pressure from the ventilator to “recruit” areas of collapsed lung, with no improvement. We then flip the patient face-down in the hospital bed to redistribute pulmonary blood flow and improve oxygenation. This intervention requires the concerted effort of no fewer than eight nurses, who meticulously ensure no lines or tubes dislodge.

In the midst of the commotion, my phone chimes. I glance down to see Scottie’s first distress text of the day. He cares for both the kids and works from home as a financial analyst. Pip has broken a chair, or climbed atop a dresser, or is half an hour into a tantrum with no sign of stopping. I don’t know the circumstances, but can guess. Whatever the issue, it has to wait. I swallow my guilt.

We position the patient prone, and fix our eyes on the monitor. I hold my breath. His oxygen saturation climbs from the 80s into the 90s. My jaw, which I was unaware I had clenched, relaxes, and relief washes over me. He remains the sickest patient in the ICU, but for the moment, we’ve made progress.

It’s now 9 AM. Rounds — the routine of examining each patient and formulating his/ her care plan with the team — should have started an hour ago. I seek out my ICU fellow to begin, when my pager goes off. It’s the resident in the ED, paging about my postoperative patient.

“He’s here with nausea, but I think it’s medication related,” the resident says when I call back. “His exam is benign. We got a CT scan, and everything looks fine. Labs all fine too.”

I review the data myself, and it reassures me. “I can be down there in hour to see him, once I’ve seen the sickest patients here. Sound good?”

“Um. . . ” There’s a pause. “Actually, the ED has discharged him. He might still be here, if you want to come now, but I don’t think I can keep him here another hour.”

I grit my teeth. My patient entrusted me with his life in the operating room. After he’s spent the night on a stretcher in the ED, he at least deserves a visit from me. Yet I consider the long line of critically-ill patients whom I’ve not yet examined in detail, and I know I can’t leave the ICU. Bleeding, ventilators, and shock take priority.

Finally we begin our rounds. Nurse practitioners, physicians in training, and I congregate with our portable computers in front of each patient’s room. With the patient’s nurse in attendance, we review the recent medical history, followed by data for the past 24 hours (vital signs, lab results, etc). Then we examine the patient, talk with any family at the bedside, ask for the nurse’s input, and determine the plan for the day, stratified by organ system to ensure completeness.

During rounds the residents often need coaching to integrate new data, but the ICU offers some of the best teaching opportunities in medicine. The issues at play derive not only from basic physiology, but also from the most difficult situations in medical ethics. It offers fantastic science, and even better lessons in being human.

We finish rounds at 12 PM. I take a moment to reply to Scottie’s texts. “I love you,” I write. “Thank you for being you.”  I try not to dwell on the questions troubling me. I also try to ignore how much I miss the kids.

We spend the next hour completing procedures — a bronchoscopy, two central venous lines, a point-of-care cardiac ultrasound.  Afterward, I return to to the room of the patient in respiratory distress syndrome. He’s continued to improve. I dial down his ventilator settings.

At 1 PM, the third-year medical students in my tutorial group trickle into the unit with eager eyes.We retreat to a conference room, where we discuss fluid resuscitation. I love to guide them through patient scenarios, and to watch their faces light up as the basic science from their preclinical years clicks with what they witness at the bedside.

At 2 PM, I usher the students out in anticipation of a family meeting.The team and I confer beforehand on the situation. The patient is an elderly gentleman with advanced, untreatable cancer, who now has a devastating brain hemorrhage. His neurosurgeons say there are no surgical options. We need to clarify the next steps with his family.

The meeting is tragic. We lay out the medical details carefully, but reality strikes the heart. His wife breaks down into tears. His son, a lifelong Bostonian with rough edges, peppers us with questions. His daughter stares at the floor and wrings her hands. In every case, grief unfolds to expose raw wounds.

I can offer little consolation. “I’m so sorry,” I say. I abhor the insufficiency of my words. My own tears come.

It’s 3 PM. The meeting concludes, and I am emotionally depleted.  I walk around the unit to ensure all are well, and then steal away to the cafeteria to grab a moment of solitude (and food). I stare at the wall of the elevator on the way down, and struggle to regather myself. I don’t notice a friend standing beside me until she exits.

At 3:15, lunch in hand, I head back upstairs. Now more composed, I scroll through emails pertaining to academic obligations that loom over me. I tally them in my head — a chapter nearly due, a textbook I’m editing, a paper, a research protocol.  I furrow my brow. I had planned to spend my next nonclinical day at home with the kids, but with the mounting pile of work, I’m doubtful I can.

I arrive back in the ICU, and a commotion diverts my attention.  A patient’s surgeon is shaking his finger in our resident’s face.

I rush over. I know this surgeon well. He cares deeply about his patients, but his depth of concern sometimes manifests as anger and inflexibility.

The conflict arose from misinformation. We review the data together, and everyone calms down. We are all striving toward the same goal. We all want to help people get well.

Two new patients arrive in the ICU. One is a gentleman who just underwent a liver transplant. His surgery was uneventful, and he appears stable, but he’s still on the ventilator, and we’ll need to monitor closely for bleeding over the next few hours. The other patient underwent a colon resection a few days before, and suddenly developed respiratory distress while recovering on the floor. He is working hard to breathe. We STAT page our anesthesia team to intubate him. His chest X-ray suggests that one of his lungs has collapsed, and so we perform a bronchoscopy that reveals a plug of infected mucus blocking his right mainstem bronchus. We suction it free, increase his ventilator settings, and watch his oxygen levels improve.

At 4:30, we make our afternoon rounds, and briefly discuss the major updates and overnight plan for each patient. The lack of progress we’ve made on some patients troubles me, but I’m relieved that others, like our patient in respiratory distress, have steadily improved. At 5 PM the night coverage arrives. We review the patients and their care plans in detail.

About seven times a month, I take in-house call, i.e., I stay in the hospital overnight (until 7 AM) to staff the ICU or to manage patients in the operating room emergently. Tonight, I’m thankful to go home.

I leave the building at 5:30 PM. The evening rush leaving Boston seems worse every year, and tonight I stare at tail lights for 90 minutes. I try to listen to a Ravi Zacharias podcast while I drive, but as is my pattern, concerns about the patients whom I’ve left behind distract me.

When I arrive home at 7 PM, Bean is already asleep. I’m lucky if I see her twice a week. This week, I won’t spend time with her until Sunday, after I return home from a 24-hour call.

When I enter the house, Scottie is so exhausted he can barely make eye contact. Toys, books, a ripped up magazine, a soup pot, and my (stolen) scarf litter the living room floor. Pip runs toward me and leaps into my arms. I fight my tears as I hold him close.

He wriggles away, and I can tell from the ruddiness of his face, and from the shadows beneath his eyes, that once again he has fought naps all day (a problem since birth). He is sleep deprived and irritable.

He urges me to chase him around the couch. I reluctantly comply. He really needs to sleep, but I only see him an hour a day.

I sit on the floor. “Bubs, it’s bath time.”

“No! I don’t want bath!”

A tantrum follows. I ignore it, but he escalates, and loses control. I hold him. I carry him upstairs while he writhes and screams. I sit with him in my lap and sing to him. Then Bean, whom Pip has awakened, starts to scream in the next room.

I leave Pip, and rush into Bean’s room. She nuzzles into my shoulder as I hold her. We rock for a while, and she nods off again. Then I return to Pip, who by this point is so exhausted he stumbles over his own feet. During bathtime, he jabbers with me about all the characters Beatrix Potter ever invented, followed by a list of every country in Africa. Then he panics about the feel of water dripping on his face.

Pip bids Scottie goodnight, and we read a book together. He points to short vowel words and says them aloud. When he first started doing this, I thought he had memorized his books, but now he is clearly sounding them out. He’s not yet three. As I tuck him in for the night, I wonder how we can send him to preschool in a year when he already demonstrates reading readiness now, and when he responds to boredom with wild misbehavior.

At 8:30 PM, Pip is asleep. Scottie and I collapse onto the couch in the living room. He rubs his forehead; the corners of his mouth are drawn downward.

“I just don’t know what to do anymore -”

I raise my hand to interrupt him, as my phone rings. One of the residents is calling me about a patient. I leave Scottie alone with his desperation for another ten minutes.

When I return, I yearn to hear about the milestones I’ve missed, about the incredible things Pip has observed and said, about how Bean interacts with the world. Instead, Scottie laments the struggles of every hour. He recounts how he had to hang up the phone during a conference call because Bean awoke screaming from her nap. He relates how Pip rages when he does not get his way, and how he requires continuous engagement to keep him focused. He describes no joy, but only constant frustration, and the ever-present sense of failure in every moment. He is wrung out.

The conversation strips me of my reserve, as it does every night. I want so much to help, but don’t know how. How can I teach my children in the ways of the Lord, when I’m *never* around to help them in the basics of every day? How can I honor my husband, when every day I abandon him in his despair?

Tonight, I have no answers. We surrender to bed. Before sleep comes, I check my email again. I respond to a few messages about patients.

Just before I fall asleep, I pray for forgiveness for my failings, and ask the Lord to guide us.  I pray for Him to make clear to me His will for my life, and to illuminate the path He would have me walk in service to Him.

At 1 AM, I awaken to the sound of Bean crying.

NOW

Background:  I have a toddler daughter Bean, and a preschooler son Pip who is an asynchronous learner, i.e., uneven in his development.  He started reading on his own when he turned 3, now reads (and understands) chapter books, and dabbles with 1st and 2nd grade math, but he struggles with fine motor skills, and he has some sensory processing challenges. He’s also a very intense kid, who is easily overwhelmed and who acts out when he’s bored. Homeschooling has allowed us to individualize learning to his variant needs, and his emotional lability has improved dramatically, although the journey continues.

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On a good day, I’m up before 6:30, refreshed and ready before the kids stir.

This is not one of those days.

I awaken to the bang of Pip’s door as it flies open and strikes the wall. At first I’m relieved; for months, our first morning encounter has defined our days. If he goes potty on his own, it will be a good day. On the other hand, if I discover him engrossed in a book while marinating in soaked underpants, and if he insists, “I will NOT go potty!” when I interrupt his reading, the entire day will be a struggle.

He heads not for the potty, but for my room. His face appears two inches from mine.

“Mum Mum, Bean took off her pajamas again.”

I throw off the covers and bolt into Bean’s room. The last time she played Houdini, she did so in a dirty diaper and needed a bath. I flip on the light and discover her footed PJs crammed between the slats of her crib. Thankfully she is still clad in her diaper. She grins at me from beneath a mop of tangled hair.

I change Bean into a clean diaper and dress her for the day, then slip away to shower. I say “slip away,” because if she sees me leave the room she howls.

I remind Pip to get dressed when he hears the shower turn off. With a towel around my head, I check on him, and he’s proudly dressed himself in a T-shirt and shorts — in February, in New England. I can’t bear to deflate his excitement, so I praise his efforts. I’ll urge him into warmer clothes later, before we head outside.

Pip reads on his bed or plays the Lego Junior game on the iPad, while Bean and I head downstairs to make breakfast. Pip has requested purple scrambled eggs (Dr. Seuss inspires us to rotate colors), which personally I’d recommend against, because they resemble brains.

I turn on some classical music, start a load of laundry, and empty the dishwasher as the kids tuck into breakfast. At first they eat calmly, but as hunger pangs lessen, they pretend they are “helicopters with blue feet” — a hilarious stunt on the swings, but not so much at the kitchen table. To prove my point, Pip whacks his shin and starts yelling. I kiss him, tousle his hair. To help him focus, I place our storybook Bible in front of him and ask him to open to today’s reading.

We use World Vision’s God’s Love for You, a book I love as much as the kids do. Each story includes a summary statement to help children understand what the lesson teaches about God. Stories of God’s work all throughout the world also intersperse the Scripture passages. Pip loves to locate the setting for each story on his world map placemat.

Scottie joins us in the kitchen ~8 am, and we all pray together. Then he grabs his breakfast and heads upstairs to work in the office. The kids and I move on to our Bible verse memory work. This week we study a verse from Proverbs 15: “A gentle answer turns away wrath, but a harsh word stirs up anger.”  The rationale for this choice involves a recent history of sharp retorts from Pip (especially when I call him his name, instead of the dinosaur identity he’s adopted for the day), and brittle patience on my part (in dealing with dinosaur nomenclature ridiculousness). Finally, we end our devotions with a reading from a character building book. I dislike the legalistic stance such books often espouse, but the scenarios provide good springboards to discuss the Gospel.

After breakfast we begin lessons. We cover reading, math, and handwriting every day, and then alternate a fourth subject — history, music, science, and art — depending on the day. Our aim is not to drill academics at such a young age, but rather to dazzle their minds with the diversity, richness, and beauty of God’s world. We rely heavily on a dry erase calendar posted in our kitchen (see below), that we update with the week’s events and our basic plan. This concrete guide has tremendously helped Pip with his frustrations.

Lessons happen more smoothly when both Pip and Bean burn off their morning energy beforehand, so we start with “exercise.” In our house of ill-athleticism, and in mid-winter,  exercise involves running laps around the living room while imitating animals. We jump like bunnies, slink like cats, and run like wildebeests. Pip declares today he wants to run like a struthomimus, an acrocanthysaurus, and a styrocosaurus. I have no idea what these dinosaurs look like, let alone imagine how they might walk, so Pip takes the lead. I learn that a struthomimus sounds like a howler monkey.

We end with some floor stretches, and then I read picture books with Bean while Pip chooses his reading lesson. As he already reads fluently, my goals at this point are to help him to expand his vocabulary, to enhance his comprehension, and most importantly, to give him a rich exposure to great writing and stories.  He loves to read Geronimo Stilton books on his own, but for lessons I encourage him to pick a fairy tale from an Usborne anthology, some children’s poetry, or a classic chapter book.

Today he picks Beatrix Potter’s “The Tale of Tom Kitten,” which fits for its creativity, whimsy, and unusual language. He snuggles onto my lap while wearing a plastic basket on his head. We alternate reading paragraphs together, and talk about the story along the way.  Bean eventually clambers onto the couch next to us, and points out the cats and the ducks. A good book on my lap, both kids snuggled in and engrossed in a story, inspiring music in the background — it’s a lovely moment.

Next we move on to math, which for us consists of games and manipulatives, supplemented with silly word problems we invent. We love Sum Swamp for addition and subtraction (we swapped out the 6-sided dice for 10-sided ones), Dino Math Tracks for place value, and Money Bags for coin values.We also play a variant of Yahtzee as an introduction to multiplication.

Today, Pip chooses Pizza Fraction Fun. Bean frequently disrupts our homeschooling routine with her impulses to grab everything.To avert disaster today, we give her turns with the spinner, and help her to pick out pizza slices. Once she feels a part of our routine, she makes it through the game without stomping Pip’s pieces in anger.

After playing, we practice math facts with flash cards. I’ve avoided this approach until now, because I worried it would stamp out Pip’s enthusiasm. However, he’s now so comfortable with the concepts of addition and subtraction that the cards feel like another game. Every time he gets a correct answer, he does a donkey kick. If he can’t compute it in his head, he figures it out using math cubes. Then he does a donkey kick again.

After math we take a snack break. While I’m changing over another load of laundry, Pip drags my relic of a trumpet out from beneath my bed and experiments. I’ve let him play with it since he was two, and taught him how to buzz his lips to produce sound, but as he’s playing today he hits a clear, real note for the first time

He’s beaming. “Mum, can I please play in a dinosaur band?” he asks. I can only guess at the vivid imagery tumbling through his head.

“Absolutely! That was a great low C you just played. Do you remember the scale?”

He surprises me by singing the notes correctly. Today is history day, but Pip’s sudden enthusiasm for music is too awesome to brush over. I guide him through both low C and G, and show him how the valves produce additional notes.

“Mum, what does the bell do?” he asks. We look up the answer in this book . He asks about mutes, and we watch some example videos on You Tube. (I’m grateful he tolerates this well — TV overwhelms him to the point of tears.) With wide eyes, he asks if he can have a wow wow mute for Christmas. Then he inquires about trombones; we read that section in the book, and watch examples of “glissando” on You Tube.

At 10:30 AM, we move on to handwriting. The transition makes Pip grouchy, as he struggles with fine motor coordination. He’s perfectionistic, and he becomes frustrated when he can’t reproduce the elaborate images in his head. His passion for Legos has seemed to help. For a while I’ve backed off paper and pencils in favor of a tray of uncooked rice, into which he writes the letters with his index finger. He’s shown significant improvement in the past few weeks, and I’m tempted to try paper today, but his sudden scowl dissuades me. Instead, I ask him to write a few letters in rice, and then I add spoons, bowls, cups, and toy trucks to his tray. He and Bean play with the rice as if it were sand, and I pack snacks and water for our excursion.

At around 11 AM every day, we stop lessons and head out somewhere. Sometimes the destination is as banal as the supermarket. We head to the library once a week, and to a park or farm once or twice weekly. We also visit with friends often, and once a month we’ll go to a museum. Today is library day.

Library trips used to frustrate me because Bean would destroy everything in sight. Now, however, the outing is a joy. Pip has rediscovered Richard Scarry and Rosemary Wells, and plops himself onto the floor with a pile of titles around him.  Bean cozies up next to him, with her own stack of board books. After a while, I coax Pip to select his favorites, which is always an ordeal.  I used to set a limit of a dozen books a week, but after repeated pleas, I’ve relaxed on this . . . and to the chagrin of the library staff we now have between 30-40 books checked out, on average. I urge Pip to choose only 10 this time. He renegotiates for 16. We haul them into a duffle bag that tears into my shoulder.

A small playground sits nestled among the trees about two minutes from the library. We tuck our book stash into the car, and then walk over. The kids take off running the moment their feet cross onto the grass, and they spend the next hour on the swings, slides, and climbing structures. A chipmunk scampers nearby, and both kids halt their play to watch. Pip runs toward the critter, and when it vanishes beneath a pile of leaves, we talk about an animal’s instincts, and how to respect hem. Then Pip tackles a bouncy contraption with a giant spring. While he flies upon it, he asks about its mechanism, and we remember a book on energy we’ve read together at home. Later, Bean freezes when she hears a squirrel in the brush. She edges toward the woods, and her gaze absorbs the shifting light, and the tree branches arcing in the wind as she listens for another rustle. Thank you Lord, I whisper to myself. Thank you for these moments.

After the park, we return home. Pip’s whining increases in frequency, and he complains about lunch. Bean repeatedly turns around backward in her chair. My impatience mounts.

I pull out The Wind in the Willows. The poetic language and quirky descriptions of Mr. Toad’s antics capture the kids’ attention. I aim to read from a chapter book over lunch every day, both to inspire us, and also to help focus the Pip and Bean when they’re tired and prone to misbehave.  Other lunchtime titles we’ve enjoyed this year include The Cricket in Times Square, The Mouse and the Motorcycle, and Stuart Little.  

After lunch, Bean takes a nap. Usually Pip has the rest of the afternoon free to play. He’ll often spend a few hours building with Legos, reading his new library books, or creating elaborate scenarios with animals or blocks. Today, however, he asks me to type a story on the computer as he narrates. He weaves a tale about an adventure to the park astride a backhoe.

I spend the rest of Bean’s nap time on my computer, finishing an article review for a surgical journal. I’ve found that if I sacrifice this time, my ability to remain calm, patient, and fair evaporates.  Some days I’ll use the hour to write, other days I prepare for Bible study, and still others I’ll review curricula and plan lessons. Whatever the case, if I don’t carve out a modicum of space to collect my thoughts, bitterness creeps into my words. My hope is to model grace for Pip and Bean, and so the last thing I want to do is to respond to them with anger or abrasivness.  Yet, I do. It’s the stuff of my constant prayers.

I start preparing dinner between 3:30 and 4. Bean usually awakens from her nap with a scream. Fresh air calms her, so she, Pip and I venture out to the mailbox together, an adventure you’d understand if you saw our quarter-mile long driveway. Pip has named all the mailboxes in our neighborhood, and has dubbed ours “Ametta Metta.” We strut down toward the street calling that name in croaky voices.

The time just before dinner is the most unpleasant of the day. Both kids are tired, tightly wound, and low on self control. Today is no exception. While I’m cooking, I hear Pip hooting wildly in the living room. I issue a litany of warnings to them both, probably too many. Then I hear Bean scream. I rush in to learn that he has rocked her so roughly in the rocking chair that it nearly tipped over. I send him to his room until dinner, where he’s free to play, but restricted from inadvertently clobbering his sister. He barks back in protest, but trudges upstairs all the same.

Scottie joins us for dinner at 5 PM. After bellies are filled, behavior continues to devolve, and so we clean up and start the evening routine as soon as we can. Lately, bath time with Pip involves existential discussions for which I’m just not prepared — tonight, as he floats in sudsy water, he asks, “Mum, when we die, will we get to meet the dinosaurs?” From down the hall, Bean and Scottie laugh together as they watch videos of domestic foxes in Japan.

After an elaborate ritual involving a precise number of books, lullabies, and counting, both kids fall asleep. At 8 PM, Scottie and I collapse onto couches in the living room. The days drain us, but laughter and connectedness lace our conversations. We have devotions together. We pray together. We talk some more, and reminisce, and dream.

Just before I fall asleep, I pray for forgiveness for my failings, and ask the Lord to guide us.  I pray for Him to illuminate the path He would have me walk in service to Him. I give thanks for His abounding mercy, for His grace, and for His love so apparent every day in Christ Jesus.