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Neurologist couples discuss how the pandemic has impacted dual neurologist families and how they have managed during this crisis.

Even before the coronavirus pandemic struck, negotiating family duties between two married neurologists was no small feat. But when COVID-19 led to stay-at-home orders, children transitioned to homeschooling, and neurologists were faced with new work challenges and responsibilities, the compromises took on epic proportions.

Neurology Today caught up with six neurologist couples to hear how the pandemic has impacted dual neurologist families and how they have managed during this crisis.

In the Esper family, where finding the right childcare had proven impossible, Christine Doss Esper, MD, elected to considerably reduce her work schedule at the Emory physician group practice for almost eight years to raise their three children: now 12-year old, Julianna, 10-year old, Nicholas, and 8-year old, Christopher.

During that time, her husband, Gregory J. Esper, MD, MBA, had worked his way up to become the associate chief medical officer of Emory Healthcare and professor and vice chairman of clinical affairs for the department of neurology at Emory, positions that required 12-hour days and occasional travel, including to AAN Health Services Research Subcommittee meetings, for which he is the chair.

It was not until three years ago that Christine began increasing her schedule at Emory, where she is an assistant professor of neurology in the division of movement disorders. She became the director of the Emory motion analysis lab and continued her role in the deep brain stimulation program at Emory. In 2019, she received an opportunity to focus research efforts on predicting the rising incidence and prevalence of Parkinson's disease in the United States with the Centers for Disease Control (CDC). She now spends the majority of her time as the senior neurology PI for the National Neurological Conditions Surveillance System with the CDC while still maintaining her clinical activity at Emory.

In March, when the pandemic arrived, their carefully-orchestrated division of parenting duties began to show some cracks. Since the whole family was suddenly on computers at home, the first problem was connectivity. With three children engaged in virtual learning during the day, and occasional gaming activities or movie streaming on their off-time, each parent found themselves bumped off of videoconferences or telemedicine consultations at inopportune times. For Greg, who was responsible for ramping up Emory's system telemedicine platform, and Christine, who serves as the Brain Health Telemedicine physician lead in her division, this was far from ideal. At one point, a total of 32 devices (phones, tablets, laptops) were connected to their limited network. So, they improved their Internet download speed to one GB and hired an electrician to snake two direct lines to each of their work laptops.

An even more significant problem turned out to be logistics. Each child had his or her activities: Christopher and Nicholas took virtual violin lessons, and Julianna took virtual piano. The boys took part in a small chamber music group. During the summer, they were tasked with selecting and participating in various online campsincluding science camp, Lego camp, financial management camp and stock market camp. There were meals to plan and cook, laundry and other household tasks to divide. Once school resumed in mid-August, there were also lunches to pack or order, and drop-offs and pickups to coordinate between two different schools.

By the summer, Greg, who also serves as vice president of Lean Promotion at Emory, decided with Christine to implement lean guiding principles at home. He told the kids, You have to own it, and Greg and Christine partnered with them on meal planning, laundry, and lunch preparation and packing, among other tasks. Christopher learned how to make quesadillas, grilled cheeses and prepare eggs. Nicholas or Julianna became responsible for cooking dinner when both parents were working into the evening. Before long, the children began learning the concepts of reducing waste, situational awareness, continuous improvement, problem-solving, and teamwork.

The lean board at home records each Esper's activities and responsibilities for every day of the week, and they all refer to it regularly. Things still go wronglike when a child's knapsack ends up in the wrong carbut they now have a new name for that: defects, and they adjust the standard work, reflect it on the board, to try and prevent it from happening again. The pandemic and its consequences have caused some challenges, but this new structure seems to work; the kids have shown remarkable growth and have become more mature and more responsible, Greg said.

In the Khoury household, in Jenkintown, PA, managing responsibilities has always been tough, said Carla Lopita-Khoury, MD, an epileptologist who at one time thought that being employed by Drexel during its bankruptcy would be her most difficult professional hurdle. Still, she was able to start a new position as associate professor in neurology at the Lewis Katz School of Medicine at Temple University in November of 2019, along with six of Drexel's neurology residents.

Working nearly full-time had meant an intense juggling act, which she shared with her husband, John S. Khoury, MD, who specializes in sleep and is one of nine neurologists in private practice at Abington Neurological Associates. In early 2020, their daughters, aged 4 and 9, were in pre-school and third grade.

There were normal glitches, despite using a shared Google calendar, but fortunately, we could rely on both sets of grandparents who live nearby, said Carla.

Then the pandemic struck, and their childcare system fell apart. The Khourys were reluctant to expose their parents to the virus, and their backup would not work. By late March, Carla's department had been drafted as COVID hospitalists, and they were both working a mix of telemedicine and hospital coverage. Their daycare had closed, but they were able to recruit a babysitter from that facility who watched the children between March and June.

We taught her technology so she could oversee homeschooling, and I worked from a guest room while John took over the office, said Carla. They were able to find an outdoor, socially-distant day camp for July, but the 9 AM to 3 PM schedule meant they had to find a new babysitter from 3 PM to 6 PM.

John, who did more of the drop-offs and pick-ups, said, There were times when I ran late when we had to rely on the help of a neighbor or one of my partners, who graciously stepped in, he said.

Then the camp closed abruptly, which created another crisis, said Carla, adding, We had always planned our childcare so carefully, but with COVID, we had one short notice after another, making every day stressful; planning during a pandemic simply doesn't work.

For now, an hour-by-hour paper schedule supplements their Google calendar, and they are keeping their fingers crossed that their daughters' school, which opens soon with outdoor tents and masks, will hold.

Having dual careers has also meant finding jobs in the same cities and negotiating career decisions. Nicole Chiota-McCollum, MD, MEd met her husband, David McCollum, MD, while they were both trainees in neurology at the Mayo Clinic in Jacksonville, FL. Upon graduation, Nicole, who was in the military, received orders to go to Keesler Air Force base in Biloxi, MS, and David was able to secure a job as a neurohospitalist nearby for those three years. They were fortunate to find positions at the University of Virginia (UVA) together when her military service ended.

Raising two sons, Alec, who is 5, and Owen, now 7, while managing our dual-physician household means life is hectic, said Nicole. But we are incredibly fortunate to have a multigenerational household in which my mom provides a lot of support for our family. She came to live with us three years ago after my father passed away, and it has been a blessing for all of us, Nicole added.

When our governor issued stay-at-home orders on March 16, we pulled both of our children out of school and daycare. Having multiple adults at homemade that feasible while also trying to work from home, she explained.

At work, UVA neurologists were all pulled into a platoon, a military term that has been adapted during COVID to describe keeping teams together and minimizing risk. The department of neurology afforded the couple the opportunity to stagger their schedules so that Nicole, a stroke specialist, could work in the hospital week one, David, who is a neuro-hospitalist, could work week two, and they could quarantine at home together during weeks three and four before repeating the cycle. We were so grateful for the efforts to keep our family together, said Nicole, who values the camaraderie in the department.

Recently, the McCollums were able to enroll their sons in an all-outdoor school, which will be held at a local campground, which they hope will continue. Although Nicole is grateful to have her mother's help, she had promised her that she would not be just the nanny and cook, and before COVID, she made sure that her mother had enough free time for an active social life.

Our conversations are three-way negotiations to meet everyone's needs, said Nicole. She admitted that there are often times (especially on weekends) when one of them needs to round earlier or later to make the household run smoothly.

Working at the same place also means they set ground rules. One is that they try not to talk shop around the dinner table and avoid speaking about patients at home. But even so, the boys probably know more about neurology than they should, Nicole admitted, confessing that bedtime stories are sometimes interrupted by stroke calls. She discovered a couple of years ago that their younger son, then 3, had picked up the fact that if her iPhone showed a RAPID CT perfusion scan image that was more-green-than-pink (indicating a thrombectomy candidate), Mommy would often need to make an urgent phone call.

At the Hartford Healthcare Medical Group in Connecticut, Neurology Today found not just one but three neurologist couples. Catherine M. Hosley, MD, a stroke specialist, also serves as director of in-patient neurology, where she creates the in-patient coverage schedule. Holiday, vacation, and school schedules can be quite a challenge at times, she said. Her husband, Justin Montanye, MD, practices outpatient general neurology four days a week.

One of the benefits of having a weekday off is that it's now much easier to manage any kind of routine service work on the house, our cars, etc., said Catherine, adding, From a work-life balance perspective, it has reduced stress for both of us!

Two of their former residents at the University of Connecticut/Hartford Hospital, epileptologist Sarah Meira-Benchaya, MD, and neuromuscular specialist, Lucas Meira-Benchaya, MD, returned after fellowships to practice as epilepsy and neuromuscular specialists, respectively.

Being from another countrywe are both Braziliansthe family-friendly environment felt like home, said Sarah. When she gave birth to their daughter, Rachel, in January of 2020, her initial plan was to be on maternity leave for 12 weeks and return to work in April. But her mother, who had planned to care for the baby and help with their older son, Shlomo, now 4 years old, was stuck in Holland (with a Brazilian passport) when the pandemic struck and borders closed.

I kept delaying my return in hopes the situation would improve...and we were afraid that having someone come to our house would expose the kids to the virus. By July, when it became clear that her mother would not be permitted to return, they hired a nanny, and Sarah came back to work three months later than she had anticipated.

The delay in return meant that Swetha Ade, MD, an epileptologist, had to take an extra week of callas Sarah's schedule was divided among the remaining nine epilepsy specialistswhile also dealing with the closure of her own children's daycarewhere she and her husband, Ajay Mohan Tunguturi, MD, a vascular specialist, were sending their 3- and 5-year old daughters, Aradhya and Aria. For five months, they relied on piecemeal coverage by physician neighbors and babysitters and discovered that fear of COVID made it difficult for a two-physician family to find people who were willing to come to their house.

It was very tense, said Swetha, comparing the stress to what she experienced during her residency when she was raising two small children alone, while her husband was training in another city. The family finally found a live-in nanny in mid-July and is now trying to determine if she can help with virtual learning while their 5-year old's new school alternates in person and online classes every other week. As with all the couples, and many working parents across the country waiting for the pandemic to end, they have learned to roll with the punches.

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