This is a topic I never thought I would champion – being a female physician. I think gender is only one small part of who we are in the world, but there are some clear themes that come along with being a female physician. Many of these, I’m sure, apply to other physicians who are not phenotypically consistent with their field. So while most of this blog is focused on female docs, I hope that many others can relate to the concepts.
A lot has changed since I started training and social media has been a big driver of this change. It has allowed groups who previously were the minority to reach out to one another and form communities (albeit electronic ones) that plug in like-minded people and allow them to communicate, commiserate, vent, and support one another. I think this is great progress. I was subscribed by a friend to the Facebook group PMG (Physician Mommy Group) and was surprised by how much support these women were offering to one another. The topics posted range from weird rashes and clinical questions to advice on marital troubles, critically ill children, how to negotiate your contract, etc. The members represent a disparate group of women, but ones who share a common profession and a common life experience as mothers. It’s really great that this group exists and I can see the positive impact it has in allowing doctor moms to support one another. We get each other in ways the parents of my daughters friends never will understand me and I’m glad there’s a forum like this.
Another new trend, facilitated by social media has been the movement led by a female trainee who began the tweet phenomenon of #ILookLikeASurgeon. It’s clear that there is a growing need to address the broad expanse of who we, as physicians, are. The stereotypes have begun to be broken down. Our work force is becoming more heterogeneous (although we’re not done working on this yet!) and technology has allowed us to reach one another and acknowledge our similarities. As a young, female academic surgeon mom, I realize on a daily basis that I don’t fit the stereotype of a surgeon that many people have. But moments like this, when a community comes together to declare ourselves – boldly and joyously to celebrate our diversity – this is a moment that I love. We are owning our differences and distinctness while joining with one another to raise awareness that things have changed. The world has changed. I have found great comfort in the comeraderie of these internet groups. I may not know these people personally, but I definitely relate to them. I hope we can continue to raise awareness amongst ourselves and others as to who the physicians and surgeons of the current generation (and our trail-blazers) really are. So keep it going!
These trends got me thinking, and I started this current blog to revisit the topic of being a female physician and a surgeon-scientist mom. I can only speak from my own experience, but I hope that some of what I’ve been working to figure out will be applicable to others who may not feel that they represent “the norm” in their field. I wrote an article several years ago about my own personal crossroads during fellowship after the birth of my daughter. I had a shocking realization that this abstract concept of work/life balance actually had some meaning to me since bringing a little human into the world. I wanted more time for myself and my family – something I had willingly given up when choosing to pursue intensive and lengthy surgical training. I posted the following: http://www.kevinmd.com/blog/2013/04/lean-subtle-complexity-medicine.html and got great feedback from many female physicians (and doctor moms). I’ve been asked several times for an update, to fill in the blanks as to what happened to me in the interim, and I finally feel like I’m in a place that I can take a moment to comment. I do not pretend to have all the answers. I am still figuring things out for myself each and every day, but I can list a few things I have learned along the way.
- I am doing the best I can.
This statement sounds ridiculously simplistic and in many ways it is. But over the last year, this statement has become my mantra. I don’t know how many times I have found myself saying aloud (or silently to myself) that I am doing the best I can at any given moment. That’s not to say that each moment is a lesson in success – that is an absolute lie. But I can honestly say that at a minimum, I’m doing the best I can in each particular situation.
I left fellowship and started my first attending job pregnant with our second child (and mother to a 2 year old). I finished my training, packed up our apartment, moved across the country, bought a house, moved in, started my 2 year old daughter in her first school (shockingly stressful), started my first job as a (pregnant) attending, and had a son three months into the new job. I can honestly say that we packed a whole lot of life-altering changes into a ridiculously short period of time. I’m not sure how graceful and easy each transition was, but I can certainly say that I got through it and am still breathing. Nothing critical was lost. No patients were harmed. My children appear by all benchmarks to be happy and thriving. And despite some crankiness and bickering due to sleep deprivation, I think my husband and I still love one another. But the only way I got through many of these days was by telling myself that despite all my perceived inadequacies, I was doing the best I could. That is all that we can strive to do. I will never be perfect. I am human. At some things I will succeed and at others I will fail, but I’ll keep going.
- It’s ok to fail. In fact, you will fail. It’s a fact.
This is a natural transition from the previous point above. If you aren’t failing, then you aren’t trying hard enough. It’s ok to put yourself out there, to take (calculated) risks, to allow yourself to stretch. And it is totally expected and acceptable to fail at these tasks or not reach every goal that you’ve set. Do not despair – keep trying. Challenges only keep you growing. But use the failures to teach yourself something. The old adage that insanity is doing the same thing over and over and expecting a different response is true. Don’t make the same mistakes over and over. Use each failure to modify your approach to the next problem. Each moment will not be your most amazing, but eventually the lessons from each failure come together and allow a sudden leap forward. So forgive and remember (this is a book worth reading: http://press.uchicago.edu/ucp/books/book/chicago/F/bo3622913.html ).
Today I read this piece and it really resonated. http://opinionator.blogs.nytimes.com/2015/08/12/murderer-in-the-mirror/?smprod=nytcore-iphone&smid=nytcore-iphone-share&_r=0. Part of what we sign on for is to manage difficult situations and to take responsibility for people’s lives. Most days this is gratifying, but some days it just sucks. I am half way through one of my toughest work weeks so far. I was responsible for a surgical complication and it’s still keeping me up at night. I’m sure it has taken at least a year off of my life. This is the responsibility we take on as physicians who are entrusted with people’s lives and health. It’s an awesome responsibility and we can only do the best we can (see #1 above) and we all know that at times, we will fail. This same lesson goes for our family lives, for our academic lives, for our personal and private goals. And to these I have the same response: repeat #1 above, dust yourself off, and keep going. We’ve all been there.
- If you think other people have it all figured out, you’re wrong.
Although I started off this diatribe thanking social media, it is also to blame for propagating misconceptions about others and their success. The selfie-stick driven culture, which feeds off the need for social acceptance is the downside to this increased connectivity. More and more people (and children, which terrifies me) are feeling pressure to be perfect and live up to an idealized expectation that is sold to them through cherry-picking of life moments as presented through Facebook, Twitter, or Instagram. Everyone wants to present their best, well-groomed, curated, cropped and retouched self-images. Do we post ourselves with bad skin, messy hair, in a dirty house wearing pajamas? Not as far as I’ve seen, but I’m sure that I have many more of those days than I do as a well-groomed, effortlessly happy mother with beautiful kids on a sandy beach. The lives we see in the media and on our own social media feeds are well-intended, but misleading half-truths. No ones lives this impossible dream. We are all struggling, we all have worries, and every day is not an amazing photojournalistic spectacle. Don’t be drawn in – you can never win. This game is rigged.
- You can not do this alone – we all need help.
Many of us are tough ladies/gents. We are the people others look to for answers. Sometimes this makes us believe we actually need to have all the answers or must be strong for everyone else. This is not true. Even heroes and leaders and “triple-threats” need help, guidance, and support. This comes in many flavors and will vary as a function of time. Sometimes we need emotional help, intellectual help, physical help. If you try and do it all yourself, you will fail big time (more than the allowed failure I give you for #2). There are only so many hours in the day and days in the week. Each of us needs to figure out what is critically important for us to deal with and what we can get assistance with. Outsource jobs. Ask for help when needed. Support can come from many directions and need not be the same for everyone. It can be in a tactile and physical way (e.g. hire a housekeeper) or it can be remote and via strangers (e.g. join a support group). Help doesn’t have to come from family or immediate friends. Find what works for you. But seek out the help that you need and never be afraid to ask. We all need it.
- There are always creative solutions to every problem. Don’t get stuck in patterned ways of thinking. Don’t lose hope.
Part of what leads to despair and hopelessness is the feeling that we have no options or solutions to a given problem. As a life-long optimist (on the majority of days), I believe that there is always a workable solution to most problems, but you may have to think outside of your usual scenarios to find it. This is when #4 above comes into play – others can help you see solutions you might not find for yourself. One of the biggest gifts my parents gave to me was non-linear thinking. They instilled in us a belief that there were many ways to get to a given goal and there was never a point at which something became impossible. It was up to us to find new and creative ways to solve the problem. When my career counselor in college told me not to apply to medical school because I wouldn’t get in, I actually became more dedicated to doing it than ever before. Do not let people set your limits for you and don’t believe that if you can’t do it the traditional way then you can’t do it at all. Be creative. Find others who think the same and enlist their help. You can do this.
- Hard work feels good. You are making a difference.
I know many of us would not have pursued medicine if we hadn’t already internalized this lesson. It is no accident that we chose this profession, a marathon of delayed gratification. So I am not trying to preach to the choir, but rather point out that nothing in life worth having will come easy. We chose this road to help patients, to add value to the world, to make a difference. Each of us is doing this in many small and large ways each day. I cannot guarantee that every day a patient is going to say you saved their life or made the quality of it better or will even say thank you. Many days you will feel beaten up, bruised emotionally and physically. But know that you are doing meaningful and good work. And that the hard road is still a good road. Find friends to help you along the way, find mentors and guides. And keep going. There will be days where your patients give you flowers and cards with gratitude. There will be days that someone knits a sweater for your newborn child. There will be days you are awarded the grant you’ve been working on. There will be many days you send patients home free of their disease or relieved of their symptoms. Not every day is amazing, but the overall trajectory is. Remember the good days.
- Release the burden of other people’s expectations. Answer only to yourself.
This one is really hard. Many of us have chosen this path because we like challenges. We enjoy breaking boundaries and exceeding others expectations of us. I am not at all proposing that you lower your expectations. That is an absolute mistake. Don’t modify your goals because certain days are hard, but make sure you stay true to your soul and your own goals/mission. And start to tune out the external voices and listen to your own voice more. Check in with yourself regularly. After having my daughter, I realized that it was critical for me to find some balance between this career I had chosen (and love) and this small person who embodies my unfiltered and unmeasurable love. For my own sanity, I needed to find a way to make peace with these components of my life. And I realized that there were parts of my chosen career I could live without in order to make my home life work. I realized I could be very happy if I narrowed my clinical practice somewhat. This was not the job description I set out to find, but it’s one that works perfectly for me. I took an academic surgery faculty position with a dedicated research component and a more narrowly focused clinical practice. There are parts of a complex general surgical oncology that I miss – the big cases were fun. But I am happy. I love my patients, I sleep well at night, and I see my children every day as much as humanly possible. Through my research I have a chance to change the way we practice and I am exceedingly grateful to have found this opportunity. But find what works for you and forget what you think others expect of you. Their wishes and expectations are transient, you will live with the life you choose.
- Learn to live with guilt.
This lesson is true for most of our lives, but really becomes a palpable reality after having children. And this lesson is not just true for physicians, but for all parents. The stay at home moms are going to feel guilt for their inadequacies, while we feel guilt for the amount of time we work and are not with our children. If you care enough, you will carry this baggage with you. And no matter what road you choose, this emotion will plague you. The good news is that is stems from the fact that you care. Recognize it is there, that it is natural, and move on. I reassure myself every time I find myself going down this rabbit hole of guilt about my children that (see #1) I am doing the best I can each and every day. That is all I can reasonably do.
- Life is a series of compromises. You can’t have everything simultaneously.
I remember the day my residency director explained this to one of the new attendings, a recent graduate from our program. He made this statement, slowly and pointedly with his characteristic southern drawl. “You know all that sh*t in life that you want, that people tell you you deserve to have? Well you can have it all……(long pause)……But you can never have it all at once. You will get it, but it will be averaged over your life. You need to accept that you are only going to succeed at a few things at any given time.”
Amen. I hold this lesson close each and every day. You must choose what matters to you most and make the best of the rest. The only advice I can offer is to check in with yourself routinely. Because what is most important to you is going to change over time. Do not make a decision and then set your life on autopilot. Stop and reassess constantly. It’s ok for your goals and priorities to change, just make sure you allow your life to change with them. Don’t get stuck doing the job you wanted 5 years ago, do the job you want today.
- Enjoy the small moments and successes.
None of us would have succeeded if we sat around congratulating ourselves each day. Most of us are self-critical, which has allowed us to challenge ourselves to keep growing and evolving. Continue to do this. Please. But now and again, stop, breathe, look at your kids, think about the patients you have helped. And allow yourself a moment of satisfaction. Not everyone has the fortitude to do what we do. I am so lucky to have the opportunities that I have, the support (both at work and at home) that I do, and to have healthy, happy, lovely children. My fortune is not lost on me, but I have to remind myself to cherish these moments and be grateful. Because my life is better than I deserve. I can only try and live up to it and give value back. So allow yourself to be happy, to appreciate your life, and then try to use that energy to get up and go another day.