On New Year's Day, 1961, Charles H. Epps celebrated the completion of his training as an orthopedic surgeon by taking a rare day off. At eight o'clock that morning, he and his wife Roselyn, a pediatrician, were in bed watching television when their 18-month-old son toddled into the room and stared at them in amazement.

"Mommy, what is Daddy doing in your bed?" he demanded.

"We laughed," Epps recalled. "Then I realized he had never seen me in bed in all his life. He didn't think I had a bed."

After 35 years of marriage and medicine, Charles and Roselyn Epps have proved that a dual-doctor couple can have rich professional lives without sabotaging their marriage or neglecting their family. Charles Epps is dean of the Howard University Medical School; Roselyn Epps spent nine years running the D.C. health department. They raised four children, three of whom became doctors.

It has been a delicate, often exhausting, balancing act. Savoring the "second wind" that comes to many couples when children leave home, they look back now and marvel that they did it all. Roselyn Epps has a simple explanation: "One, I was young. And two, I was tired. I didn't know I was tired until I stopped being so tired."

A few decades ago, the typical "doctor's wife" worked to help put her husband through medical school, then stayed at home to tend the children while her husband cared for his patients and earned a comfortable income. But today, the doctor's wife is increasingly likely to be another doctor.

Nationally, 36 percent of medical students are women, and at some schools -- including Howard -- women now constitute more than half of each entering class. About half of all women doctors marry other doctors. By the year 2020, predicts psychiatrist Carol Nadelson, "30 percent of doctors will be married to each other." How such couples balance their professional and personal lives may have profound effects on America's health care system.

Few studies have examined dual-doctor marriages. Physicians have long been said to have higher divorce rates than other Americans, but a recent study based on census data from 1970 and 1980 found that both male and female physicians actually had lower divorce rates than other occupational groups, including other professionals.

But just because doctors tend to stay married doesn't necessarily mean their marriages are happy ones. People who enter medical training have to be good at postponing gratification, and some psychiatrists suggest that doctors may use that capacity to endure marital discord, rather than divorcing. A much-cited 1972 Harvard study found that 47 percent of a group of male physicians reported "bad marriages or divorce," compared with 32 percent of a non-physician control group. For some couples, noted Nadelson, "divorce can be a positive solution."

Nadelson, a professor of psychiatry at Tufts University Medical School, and her husband Theodore Nadelson, chief of psychiatry at Boston's Veterans Administration Hospital, have written extensively -- both together and separately -- on the subject of medical marriages. Carol Nadelson believes that dual-doctor couples, even more than other professionals, face extraordinary stresses posed by competition with each other, demanding schedules, a hidebound academic and professional system and guilt over conflicting responsibilities to their patients and to their families.

"Change in medicine is very slow," she said. "I think people think things are going faster than they are. Everybody talks egalitarian, but then they don't do it."

Women's advancement into the top ranks of academic and organized medicine has been much slower than their entry into the profession as a whole. Nadelson said women doctors tend to make compromises that sidetrack their own careers for the sake of their families or their husbands' advancement -- and that medical schools and other employers have made few adjustments to encourage the promotion of more women. Most female physicians still take primary responsibility for arranging child care and managing the household, and Nadelson said they frequently feel they are neglecting either their children or their patients.

"What do you do when a suicidal patient calls and you have a baby screaming and you're cooking something?" she asked.

Major social changes, like the changing role of women in medicine, are the sum of separate choices made by individuals. Here is how three couples have made medical marriages work.

Charles Epps remembers the first time he saw his future wife. She caught his eye one day during their freshman year at Howard University, when she showed up for the class picture wearing a bright red coat. But they did not meet until they were juniors, when she sat behind him every day during a required philosophy class.

Both were determined to be doctors. Roselyn Payne had wanted to be a pediatrician since she was 10 years old, and she had strong emotional and financial support from her family. Charles Epps's father was dead, his mother was ill, and he was putting himself through college by driving a cab during every free hour.

They fell into the habit of eating dinner together after class, and the friendship ripened over six years as classmates -- first in college and then at Howard Medical School. Right after their medical school graduation in June 1955, they were married. Five days later, they moved into an apartment three blocks from Howard's Freedman's Hospital and started their medical internships.

"We were friends," said Roselyn Epps. "All along, we've tried to be considerate of each other. I don't think either of us has been selfish."

During the year-long internship, they worked every day and spent every other night in the hospital, trading "on-call" nights with other residents so that they could arrange to have the same night off whenever possible. Their combined salary was $90 a week. After internship, Roselyn Epps entered Howard's three-year pediatric residency, and Charles Epps began four years of training as an orthopedic surgeon.

Their first child was born in 1957, and life immediately became more complicated. The couple was constantly juggling night duty so that one of them could always be home with the baby. At that time, few women entered medicine, dual-doctor marriages were rare, and they knew no other physician couples.

Roselyn Epps finished her pediatric training, had another baby, spent a year as Howard's chief pediatric resident and then did a year of research on sickle cell anemia. Formal maternity-leave policies for women physicians did not exist -- and still do not at many hospitals -- so she had to negotiate a maternity leave with each pregnancy.

In 1960, when Charles Epps finished his surgical training and accepted a faculty appointment in Howard Medical School's department of orthopedics, the couple collided with the university's nepotism rules. Roselyn Epps was already on the faculty as an instructor in pediatrics. They were told that one of them would have to leave. They decided she would be the one.

Even now, Roselyn Epps is a little defensive about that decision. "We talked about it in terms of a team," she said. "He was actually being groomed to be the {department} chair. I was willing to say, 'Fine, you go on.' "

They were to face the same dilemma -- and make the same choice, 20 years later. In 1981, Roselyn Epps had been allowed to rejoin the Howard faculty and then, in 1988, Charles Epps was offered the post of dean of the medical school. As dean, he would become her superior, which the rules forbade. Again, she left Howard, this time joining a program at the National Institutes of Health to train physicians to help patients quit smoking.

She expresses no bitterness about the impact of these two choices on her career. "There was a lot of concern," she recalled, "but you can spend time being concerned or you can find something constructive to do."

Added her husband, "If she had been the dean, I would have retired from orthopedics."

The first time Roselyn Epps left Howard, in 1960, she took a job as a public-health physician in one of the District's well-child clinics. "I don't look at it as a sacrifice," she said of her years with the D.C. health department. "During that time, I got two master's degrees, and I was acting commissioner of health when I left" in 1980.

Roselyn Epps's job in the health department also offered the advantage of regular hours. Charles Epps, in solo practice as an orthopedic surgeon, had to make hospital rounds every day of the week and was "on call" for emergencies every night and every weekend.

"The children couldn't always count on me, but they could always count on their mother," he said.

The couple's third and fourth children were born in 1962 and 1963. Charles Epps rarely took time off during the day for school trips or teacher conferences, but he drove the children to school most mornings, and he made it a rule to stop working long enough to get home at 6:30 for dinner. Often, he returned to the hospital to operate or to finish rounds. "The kids always knew we'd be seeing him for dinner," Roselyn Epps recalled.

When the children were small, he got into the habit of taking them grocery shopping every Saturday afternoon. His wife gave him the choice of either going to the store or staying home with the children while she shopped.

"For 12 years, I did all the grocery shopping," he recalled. The youngest child would ride in the basket while the older ones scampered down the aisles picking out cookies and cereal. "People would say, 'Where is your wife? Is Roselyn sick?' "

"If I had to live my life over again, I'd try to do a little more. I'd have my secretary block out time on my schedule" to spend with the children during the week, he said. "Otherwise, it doesn't happen."

Since Roselyn Epps was a pediatrician, her husband let her handle the children's minor illnesses and decide when they needed to see their doctor. When they were injured, he took charge. Once, he recalled, he bought his children a dirt bike, and his daughter fell off and cut her lip. "We took her to the emergency room. I looked at the young intern and said, 'Maybe I'll suture this myself.' "

Neither of them urged their offspring to become doctors, but three of them did. One son is an ophthalmologist, another an orthopedic surgeon, and their daughter is a pediatrician. A third son is a chemical engineer.

"As we lived our lives and practiced medicine, I'm sure they could see it brought us a great deal of satisfaction," said Charles Epps.

Added Roselyn Epps, "I still think it's the best thing I know."

Most weekday mornings, Pamela Parker is in her Silver Spring office by 8, ready to take calls from worried mothers, peer into the ears of screaming toddlers and run a busy four-woman pediatric practice. She takes Wednesdays off, but you won't find her on the golf course.

"I do Mom things," she said. "I take the kids to the swimming pool. I drive the carpool. I take them to doctors' appointments."

Practicing medicine is demanding enough, but as the owner of her own practice, Parker is also a businesswoman, routinely facing decisions such as whether to computerize her office and whether to hire another secretary. At home, she organizes babysitting and figures out the schedules of her sons Adam, 9, and Joshua, 4.

Housework? "I don't do any. I asked my babysitter once if she would mow the lawn."

Parker's husband, Bernhard L. ("Bud") Wiedermann, works at Children's National Medical Center, where he specializes in treating children with serious infections and does research on cystic fibrosis, meningitis and experimental vaccines. Parker's workday typically lasts 10 or 11 hours; his can stretch to 12 or 13. As doctors drawn to pediatrics by their love for children, they often feel conflict about being away from their own so much.

"You spend so much time with other people's kids," said Wiedermann. "I could probably do with a little more {time at home}. I guess it's a balance of guilt feelings."

At the same time, People tend to repeat patterns that they grew up with.END NOTES

"I had no guidance as to how to put career and motherhood together," said Parker. "As a resident, I had a woman who was a very good teacher and a well-respected researcher who had no family life at all. It wasn't until I was out of residency and could look back that I saw that her life was not normal."

Both Parker and Wiedermann had previous marriages that ended in divorce. They met at a time of extreme stress during a grueling month spent working together in the intensive-care nursery when both were pediatric residents at Texas Children's Hospital in Houston.

The intensive-care nursery is to the pediatric resident what the battlefield trench is to the foot soldier. Residents spend their days and nights struggling to keep a hospital's smallest, sickest babies alive: threading catheters into tiny veins, watching for sudden infections, poking tubes into infant chests to expand a suddenly collapsed lung.

By the end of that month, the pair were close friends. But it was not until four years later, when Parker was working in a Houston pediatric practice and Wiedermann was finishing his training as an infectious-disease specialist, that they decided to marry.

They soon came to Washington. Wiedermann had a job offer from Children's National Medical Center. Parker hated Houston, so she did not mind leaving her old job to join a woman pediatrician's practice in Silver Spring. Six months later, her new partner announced that she was leaving to work overseas and persuaded Parker to buy the practice.

Five and a half years later, the practice is thriving and Parker considers her schedule comparatively relaxed. Parker makes a little more money than her husband, even though she works only four days a week. She gets home to cook dinner at 6, and is "on call" for emergencies two weeknights each week and one weekend a month.

Wiedermann spends much of his time on research, but three months a year he is responsible for running the hospital's infectious-disease service -- caring for children with pneumonia, meningitis, AIDS and other severe infections. Those months, he works every weekend and takes emergency calls every night. "I'm inhuman for a month," he said.

One advantage of being married to another doctor is that neither has to explain the work or justify a commitment to it.

"If one of our patients gets sick in spite of what we do, it makes it easier to understand those feelings of helplessness," said Wiedermann.

But sometimes being doctors makes it harder to ask for help when they need it -- for instance, when a child of their own is sick. Wiedermann recalled a night when their son Josh had croup and was turning dusky blue whenever he cried. The couple discussed whether to take him to the emergency room, but because they were doctors they knew that the tests and injections he would receive in the hospital would only make him cry harder.

Wiedermann took the first watch, sitting by Josh's bed and listening to his breathing. "One of my early memories is of being hospitalized with croup," he said. "The zippers in the croup tent would be unzipped, and this hand with a syringe would come in and jab me. I'm sure subconsciously I wanted to save Josh from that.

"Most pediatricians would probably have said, 'Bring him to the hospital,' " he said. "I think that's the one time we overstepped our bounds as parents."

Sailing back to the mainland last summer after a weekend on Martha's Vineyard, psychiatrist Theodore Nadelson flipped idly through the latest issue of Psychiatric News. He paused to show his wife a photograph of the new board of the American Psychiatric Association.

There on the wall, in the background, hung a portrait of Carol Nadelson, who served in 1985 as the APA's first woman president.

Ted Nadelson turned to another psychiatric newsletter, and there she was again, smiling from yet another group photograph. "I didn't know you were on the board of that organization," he remarked.

"Oh, yeah," his wife replied.

In the last 25 years, Ted Nadelson has grown enormously comfortable with a marriage that breaks all the unwritten rules about whose job is supposed to matter most. His wife is in some respects his boss, since she heads the psychiatric training program at Tufts Medical School, of which he is a part. Although both are highly respected psychiatrists, it is Carol Nadelson who is near the zenith of their profession. Ted Nadelson says he is content to watch her star ascend.

"I'm much slower, much more content with passivity," he said. " Carol keeps on rising to more and more occasions. When somebody asks her to do something, her response is to nod her head. It's almost reflexive."

Tall and brooding, with an intense, dark-eyed gaze reminiscent of portraits of Freud, Ted Nadelson's style contrasts sharply with his wife's. She bubbles with radiant energy, leaping from one idea to the next and drawing rapid parallels between her own experience and the politics of American medicine and of women's lives. He focuses inward, musing with quiet enjoyment on the discoveries that come with growing older.

"What we've discovered is that we like each other a lot more than we did at the beginning," he said. They still argue -- over the best way to treat their two grown children, for example -- but they do not clash as often as they used to. "When I forget my keys, she doesn't nail me with it anymore," he said. "She accepts it, and I accept some of her foibles. Psychiatrists are famous for saying what's on their minds, but I can tell you that a lot of marriage depends on not saying what's on your mind. You can tell your analyst everything, but you shouldn't tell your wife everything."

In the conservative Boston medical community, their marriage has stood out for years as an unusually equal partnership. Carol Nadelson has always traveled much more than her husband, and when the children were younger, Ted Nadelson routinely took care of them when she was out of town. Both recall enduring subtle criticism from colleagues for the way they ran their marriage.

"Ted got a lot of hostility, mostly from men in the department, about his being the babysitter," Carol Nadelson said. "If he had not seen it the way he did, it could have been very difficult. Instead, it made him angry at them."

"There was a certain kind of mixed attitude," her husband agreed. The message seemed to be, "Somebody like you must be very strong to have such a strong woman. On the other hand, what kind of wimp are you?"

Carol Nadelson said she worked half-time for a while after her children were born, but that she soon felt she was being "sidetracked" professionally. So she resumed her full-time job as a psychiatrist at Boston's Beth Israel Hospital but tailored her schedule so that she had several hours off in the late afternoon and early evening, then went back to seeing patients after dinner. She discourages younger women colleagues from working part-time, assuring them that if they get their work done no one will object to a flexible schedule. These days, she often breaks up out-of-town trips to spend a night at home so that her husband will not feel abandoned. "When I used to go away when the kids were little, Ted was very busy giving them dinner and helping them with homework," she said. "The issue of being lonely wasn't even a question."

Carol Nadelson believes her professional success has only been possible because her husband was unusually willing to compromise: He did not need or demand a traditional marriage in order to bolster his masculinity. "The old-time stuff, male importance, trying to be in charge -- that's gone," he said. "If I ever had any part of it, thank God I'm free of it."

Part of his self-confidence came from having had a varied life before becoming a doctor and a husband. He had been in the Army, knocked around as a writer in California, studied experimental psychology in graduate school. "I wasn't on a straight line, I wasn't vectored toward medicine," he said.

But he does not consider himself especially self-sacrificing. "Maybe I have to make dinner at night, or I have to be without her when she goes off. I've always been supportive of her, but that's no acknowledgement of any particular virtue on my part. When we married, I recognized what she was like.

"If she were in advertising, a trial lawyer, an actress, it would have been a different experience," he continued. 'We've both been psychoanalyzed. I have to assume that provided some kind of rational position in the midst of the storm of emotion that we all live through."

They met at an early morning lecture on hysteria at Massachusetts Mental Health Center, when both were training as psychiatrists in Boston. They quickly learned that they came from similar backgrounds and had grown up in the same Brooklyn neighborhood.

"We both had had relationships before that had not gone so well, so we both were very determined to make it work," Carol Nadelson said. "The idea that you have to do everything together can get a little out of hand if you're two different people. Within the family, "we have certain rules for privacy."

Sometimes, the Nadelsons clash over medical issues, like whether to prescribe a medication for a relative or over job conflicts. But their stormiest arguments have been over what he called "turf issues," and, as psychiatrists, the biggest turf issue of all was raising their children. They have two: Robert, 24, and Jennifer, 22, both college graduates and who are intermittently living at home.

Carol Nadelson was the lenient parent, while he often tended to take a tough, idealistic stance. He worried that his children would grow up soft and spoiled. "I turn into a U-boat commander," he said. "Sometimes, I'm unnecessarily harsh because that's the way you are if you have an ideal."

They continue to disagree even now that the children are grown. "When it comes to child-rearing, there isn't any right," she said. "You may have very different points of view about what they should be doing, whether to give them money or not, whether they should live at home."

As psychiatrists, they should know. "We've had the experience of listening and talking and understanding," he said. "God, we should just have perfect kids, shouldn't we? Well, thank God we don't. They would be looking for perfect parents -- and we'd be in trouble."

In spite of their differences, the marriage has gotten easier. "The crises that have occurred, they've been difficult," said Ted Nadelson. But as he noted: "In the end, we've got each other, and it has really been a very nice fit."