Motherhood and Medicine: "Doing It All"

A few months ago, a woman posted an anonymous article about infertility in medicine. Well, at least that was the title. The content was about much more than infertility. It is about the struggle almost any woman pursuing medicine has debated at some point of her life.

The presence of women in medicine is not new; many strong, intelligent and brave women forged this path decades ago when they were the only ones in their medical schools and residencies. Still, women in medicine is newer than the presence of women in the home.

Many of us, myself included, grew up with a mother that stayed home or worked part-time. The mother managed the home, even if she worked, and was responsible for many of the day to day items that allowed life to run smoothly.

The mom planned meals, cooked meals, cleaned the house, did the shopping, helped with homework, coordinated schedules for extracurricular activities, did the laundry, tidied the home, and so much more. While those same moms may have empowered us to follow our dreams and expand our view of the role of women, words are just words if they don’t align with our beliefs.

We often don’t realize this until our thoughts start creeping in and confusing us. Around our mid-20's we think about our future and realize our beliefs and views around what makes a mother are directly in conflict with our goals to become a physician. With the growing number of nontraditional medical students, this is even more of a concern.

In the midst of training, these strong women who decided to follow their dreams despite a more indirect path begin to see their fertility slowly dwindling away.

The message to many of us is to follow their dreams and focus on our careers; family can happen later. And while it can, it becomes increasingly more difficult, as outlined in the article I referenced above. While I agree 100% that women should follow their dreams and do whatever profession they feel aligns with that, I think we need to step back and address these deeply held beliefs about what it means to be a mom and a physician before it is too late.

Being a woman in medicine has unique challenges men will never fully understand.

Medical education was created in a traditional way with mainly men going into the field, so pregnancy and child rearing wasn’t an issue.

Even outside of the child itself, there are unique challenges to women. Many of us grew up seeing our mothers doing everything around the home and we have internalized this as “good.” This can translate into the idea that we need to do it all - keep a perfect home, prepare fresh and healthy meals, raise doting and obedient children, and be an outstanding doctor. Sometimes to the point that we try to overdo these things just to prove we can.

I have never heard a male physician express concerns that they struggle with doing it all at home and at work. They seem much more at ease with balance. Maybe this is because they saw their own fathers busy away at work and didn’t think twice that they were only home for 30 minutes before bedtime. Maybe they don’t feel they need to prove themselves at work and at home, finding a way to do the best they can given the situation. Maybe they haven’t even thought that deeply about it, and just show up one day at a time.

Our society's perpetuation of “supermom” and “hustler” paired with our intense drive for success (which is how we became doctors, after all) leaves a segment of the population torn. We begin to see our limits.

We know we will want to give 100% in anything we do and see it would be unsustainable to be both a stay-at-home mom and full-time, successful physician. Even if we don’t desire to be a stay-at-home mom, what we believe we should be doing as a mom is equivalent to that role as it is being deeply immersed into the intricacies of our home and the lives of our children. And we struggle without any consideration of compromise. We yearn for a glimmer of hope that maybe there is another way to view our roles as physicians and as moms.

I was in this place 8 years ago and would like to tell my story here, as I feel some other female physicians can relate. I began medical school after working for a few years as a dietitian. I was 26 years old instead of 22 years old like most of my colleagues. I was still young but I began to contemplate if and when I would have children. Prior to this, I had just assumed I’d have children. It seemed to be what you do after you get married. I married young- a month after turning twenty-two, to my high school sweetheart. We hadn’t really talked about children prior to this point.

I contemplated whether I really wanted children. I knew my drive and debated about whether I could be the mom I desired to be.

I grew up in Wisconsin, a place with strong family values and roots in a more traditional way of life. My idea of the “perfect” mom was someone who did all of the following (without any hired help):

• Emotionally present at all times

• Calm and never yells

• Cooks all meals from scratch, preferably from the garden

• Cleans with homemade, natural products

• Manages the finances

• Makes everything possible from scratch (soap, canning, hand-knit hats, etc…)

• Is avidly involved in school functions

• Is healthy, exercising daily and eating well

• Keeps a tidy and impeccable home

I’m not totally sure where these ideas came from. This wasn’t my mom. It was a mix of many moms I met throughout my childhood. As I reflected on these things, I knew I would never live up to this standard. I began to consider not having children. My husband didn’t feel strongly about children at the time, but also felt like it was the right thing to do, since everyone we knew was starting to have kids.

Being the person who has to challenge the norm from time to time, I decided I would not have kids. I announced it proudly.

I told myself I couldn’t be the professional I wanted to be AND the mom I wanted to be.

The decision was made. I felt relieved to not have to live up to the standard I created for myself. I would have the space to work on becoming a doctor; a pursuit that was already filled with enough self-doubt and unrealistic expectations as it is.

But then I saw a few of my classmates become pregnant. They managed life and school. They found a way to make it work. My non-medical friends continued to have babies. I began to question my decision. Maybe I did want kids. How do I know if I am supposed to have kids?

My husband and I talked about this decision a lot. We weighed the pros and cons. He agreed that he would be happy to stay home so I could pursue medicine and he could help manage things at home. We thought about our future - 20 years from now - and dreamed about what it looked like. Every time it included kids. We couldn’t imagine not having them in our life. At the time of our talks, life was busy and complex. It was filled with uncertainty and aspirations.

It was easy to say no kids when we were too busy to consider what they would bring to our lives. But when we really thought about our future, we knew we wanted them.

Not only did we want one, we wanted at least three, maybe four. We dreamed of a large family filled with love and friendship. Around that time I started to learn that “advanced maternal age" began at 35. That’s when it reality hit me. I was 28. If I wanted four kids, each at least two years apart, I needed to start now! I grappled with how to do this. There was no way I could wait until after training. I’d be 34 years old when I started having kids and over 40 when I had my last child. I was scared of infertility, I knew friends who struggled at even younger ages than 40 years old.

With that, we decided to start trying during my 3rd year of medical school. After 6 months I was pregnant. This is when the real challenge began. Largely a challenge you put on yourself to prove something. But also a challenge from the nature of our training. I was working 80-100 hour weeks (medical students' hours aren’t regulated the same way as resident hours) while 20+ weeks pregnant. The exhaustion of the reality that was coming hit me and I was scared.

Some days I felt like superwoman, powering through and impressing everyone. Other days I felt defeated and exhausted, wondering if I made the right decision to be a doctor.

After my son was born, I struggled. My struggle was around my perfectionism, which I can see now but was oblivious to at the time. I was so used to being valued for what I did, that I couldn’t bring myself to just sit still and be with myself and my son. When I look back, there are many moments that I wish I had just been still with him. One moment in the hospital was especially telling of my state of mind. My husband was with our son and he encouraged me to take some time for a bath. I got into the tub and couldn’t sit with stillness for more than 2 minutes. I had gone into labor at work and only had a few things with me. I grabbed the only book I could find - geriatric medicine.

I sat in the tub, 18 hours postpartum, reading about caring for the elderly. Because to me, rest and recovery were a waste of time. I needed to be doing something to feel valued.

This uneasiness continued during my maternity leave. I wouldn’t allow myself to rest when he napped. I cooked over a dozen freezer meals in my first week home from the hospital. I felt I wasn't valuable unless I was doing things. I was grateful to go back to work where I felt useful. My approach to parenting and life at that time was rooted in perfectionism.

I enjoyed being at work because it was familiar and stimulating.

Being with the unknown of a newborn and motherhood made me uncomfortable.

I read all the books, kept the schedules, and tried my best to do everything perfectly. We were cloth diapering and I was making enough milk for twins. It worked and everyone praised me for my efforts. On the outside I was “supermom.” Inside I was suffering but I still didn’t have the awareness to know why.

Over the next three years, I was in a family medicine residency and had two more children. The uneasiness grew greater with each additional child and as each child grew up. I didn’t know how to be the calm, caring parent I wanted to be. I knew the traditional way of things - obedience, yelling, and discipline. I would try to stay calm but with how tired I was and how uncertain I was with motherhood, I often found myself with a short fuse, snapping at little things that I see now as normal child behavior. This made me feel more uneasy.

My third child was born with just 6 weeks left of residency. Because of the timing and a variety of factors, I was left with about 3.5 weeks off. I looked back and realized that between all three children I took a total of 12.5 weeks off (many of which were still filled with light work). After my youngest was born I knew she might be the last. In the year leading up to her birth, I had begun doing some personal work and was seeing that the way I had lived up to that point was not sustainable. I was more reflective and introspective. I gave myself permission to do nothing during my time off and just be with her and the kids. I slowly began to feel some ease with motherhood. But then I was thrown back in to my previous reality less than 4 weeks postpartum and it all unraveled.

Those weeks back were trying. Horrible actually. I was on service, working 80 hours for 2 weeks. I felt alone and broken. But since I created the persona of “superwoman” no one seemed to notice. When people would ask, “How are you?” I’d be honest and say “tired,” “exhausted” or “hanging in there.”

No one pressed further. They smiled and commented on how great I looked or how well rested I appeared despite being just a few weeks postpartum. Even being surrounded by some of the most caring professionals, not a single person sat down with me and said, “This has got to be so hard. How are you holding up?” I felt completely alone.

Around the time I went back to work, my oldest experienced an episode of bullying at preschool. He took a shovel in the sandbox, as 3 year olds do, but one boy didn’t like it. I don’t know the specific details aside from what I was told by my son (who told it like an action movie scene). After taking the shovel, two boys held him down so he couldn’t move. The other stole the shovel and proceeded to hit him in the face with it multiple times. That was the day I lost it. I felt as if everything was falling apart. I was not performing well at work. My son was being bullied. My newborn was without her mother at 4 weeks old. My middle child was transitioning to a new normal she could never have expected. And my husband was there trying to be the steady rock he always was in the midst of my chaos. It was then I knew I needed help; something had to give.

I called a counselor through my Employee Assistance Program. I had to call a dozen places to find one that was taking new patients. The wait was 8 weeks. I was shocked. I needed help now and there was no one to help. But I sucked it up and persevered like I always did. I was done with residency and just working part time at a local urgent care to pay the bills until I started my full time job. I had 22 days off a month with my kids and I spent most all of them nagging or being short. I tried to have fun but I felt so lost that I didn’t know how to relax.

Life with 3 kids ages 3 and under is tough as it is. But paired with an exhausted, perfectionist mom- it was a nightmare.

I was conflicted - this was my time off with my kids before starting my job. I should enjoy it! But I was in such a bad place I couldn’t sit with myself long enough to know where to begin. Finally my appointment came. I showed up with a newborn in tow only to be told my appointment had been cancelled. They swore they called but I never had a call or text message; only reminder calls to be sure to not be late. They said the wait would be another 6 weeks. I was numb - what was happening?

I persisted the following 6 weeks. Existing and trying to work on myself the best I could so I could enjoy my children. I was so grateful when I had my first appointment. That day was the turning point of my life. I found hope. She heard me and empathized. She introduced me to a form of therapy, EMDR which would become my crutch and cure over the following year.

After a few months I noticed a difference. I noticed the way I viewed myself shift. I better understood why I was a perfectionist and how I could change the beliefs I had about my worth. I better understood my beliefs about motherhood and began to give myself more grace.

My parenting improved and thus my relationships with my children improved. Slowly but surely I began to feel alive again.

Now that I look back, I see all of the false beliefs that led me to feel broken and inadequate along the way. But in the midst of it all, it’s impossible to truly see. The one thing I can say for sure is that you can do it all. You just need to change what “it all” means. When we begin to realistically reflect on what we desire out of life, we can begin to shift our beliefs. These beliefs keep us small, broken, and restricted, but we can change them. Everyone has 24 hours in a day. We all make compromises. When you think someone is doing it all without help, I’m certain you’re mistaken. It’s easy to view others through a rosy lens and believe they are there because they have something you don’t. The truth is they likely have help as well as a healthy view of themselves.

You can’t be a stay at home mom and a full-time physician.

But you can be an amazing mother and physician if you desire.

Letting go of perfectionism was the best thing I could ever do. I am still actively working on this each day and I know I will continue to improve with time. My kids are the best thing that has ever happened to me. First, I love them more than anything and finally, truly enjoy being with them. Second, they helped me get my life back at just 34 years old. I can’t express how grateful I am to know what I know now.

To end, I have a saying I made about my kids. I can’t imagine life without them and am so grateful I stepped outside of my comfort zone and did something challenging that I knew was right deep down.

My oldest has taught me how to love - I've never loved the way I do as a mother and am so grateful for experiencing this capacity for love.

My middle has taught me how to live - she is the freest spirit, so full of joy. She is living into the child I believe I could have been if I had a mother like me. I love experiencing life through her eyes. Plus she’s my mini-me.

My youngest has taught me how to let go - because of her I have been able to let go of decades of harmful beliefs and trauma. Because of letting go of these things I have the capacity to be the mother they need and live the life I desire.