A student emailed me last week. New baby at home. A career question I recognized immediately — because I'd lived a version of it.

Where do you decide to live, work, and build a career when there's a child waiting for you at the end of the day?

No HEOR program teaches you how to think about this. No textbook addresses it. Most mentors won't bring it up unless you ask. And by the time it matters, the decisions in front of you have already been narrowed by the ones you made before you understood the question existed.

So I'll share what I told her. Not as advice. As one person's journey.

When I was just starting out, one of my early mentors told me something I've come back to almost every year since:

Solve for your personal life. Make decisions around family. The professional will always fall in place.

He had teenagers when he said this to me. I had nothing — no spouse, no children, no mortgage, no clue. I filed it away.

I'm so glad I did.

Decision 1. Out of grad school, I had an offer from a major west-coast pharma. It was the obvious career move on paper. My then-girlfriend, now wife, wanted to stay east coast. That's where family was.

I took a consulting offer instead. Not my first choice.

In retrospect, one of the best decisions of my career.

Decision 2. A few years later, pandemic hit. We were cut off from family. We were planning our first child. The math wasn't math-ing.

The conventional move was the pharma corridor — where the big employers cluster, where in-person networks live, where industry careers are conventionally built.

My wife wanted to be closer to family.

I argued for the corridor. She didn't.

As always, she was the wiser one.

We landed somewhere most career advisors would call a gamble.

Decision 3. This is the big one.

By the time our child was old enough for school pickup, I was running US HEOR at Novo Nordisk in rare disease. By every external measure — title, scope, compensation, influence — it was the peak of my career to that point.

And I left it.

For a fully remote role at Jazz Pharmaceuticals. So I could wear a hoodie. Work from my basement. Skip the commute entirely. Pick my kid up from school at 4:30 every afternoon. Be home for bedtime, every night.

On paper, it looked like a step down. Title compressed. Scope narrower. Authority handed back.

I thought it might not work. There is always doubt when you make a move like that.

It has worked out better than I imagined.

Here's what no one tells you about decisions like these.

Every single time you make a family-first move, the world will tell you it's a mistake. Recruiters. Colleagues. Senior leaders. Friends. The internal monologue that runs in your own head at 2 a.m.

You will doubt yourself. You will second-guess. You will wonder if you've just cost yourself the next rung, the next title, the next big swing.

That is exactly when the thumb rule earns its keep.

When the runway is dark, when the math doesn't seem to add up, when everyone around you is making the conventional move — the family rule is the guiding star. It points you home. Literally.

Every decision I would have made for my career alone, my wife pushed back on. Every time, she was right.

In retrospect, I'd do some things differently. I'd get an MBA. I'd go the VC route. I'd be a professor.

Life is strange. It brings you on weird journeys.

What I would never do differently is make decisions around family.

This is not advice. It's my journey. It's been awesome. Not always pleasant. Always fun.

Because the job only pays you for the time you get with your kids before they fly away.

Buy back time, not money.

Money will come in plenty.

If you're a graduate student or early professional — and you're tempted to follow the dollar, the title, the city, the brand — pause.

Ask the family question first. Decide that well. Then build the career around it.

That sequence matters.

The other way around almost always blows up. I've seen it. You probably have too.

And when the doubt comes — and it will come — let the thumb rule guide you. The runway gets dark sometimes. The family rule is the only star bright enough to navigate by.

I picked up my kid from school today at 4:30. We came home. Had a snack. Built a Lego set. She went to bed on time.

I would not trade that for a corner office on any continent.

— Sanket

P.S. Hit reply with the question you've never been able to ask anywhere else. I read every one.