Mothers in Medicine

by Danielle Ofri
Foreword to “Mothers in Medicine”
(Katherine Chretien, ed.)

Much of medical school orientation was a blur. But there is one presentation that I remember so clearly, even all these years later. A stern-looking geneticist told us that she and her husband wanted to have children while they were in medical school. But life was too hectic, so they decided to wait until they graduated. But then they were in residency and things were way too crazy, so they decided to wait until fellowship. But research overwhelmed them, so they decided to wait until they were attendings.

You probably know where this story is going. When they were finally safely ensconced as attendings, they decided to start their family and they were not able to conceive. The moral was, clearly, don’t wait. But that’s not the message that I took from this presentation. As a newbie medical student about to plunge into an MD-PhD program that seemed to have no end in sight, my take-home was, “Shit, that stuff is way too complicated and way too scary. I’m avoiding it at all costs!”

Despite the geneticist’s warning to us, though, almost no one had children during medical school and residency. Other than a few orthodox Jewish couples, I didn’t see anyone pregnant during my training.

Fast forward two decades when I was now an attending. The medical ward was practically a maternity ward! Everyone was pregnant—residents, fellows, students. I was blown away, but I was also impressed. People were choosing to have kids at whatever time was the right time for them, and they’d figure out the details later.

For me, the right time had turned out to be when I was a new attending. In fact I was early in my second pregnancy when I was making rounds with a new team one July. I noticed that the third-year medical student was quite noticeably pregnant. Rounds were long, and it was hot, so I offered to let her sit down. I thought I’d be able to offer my great wisdom, both as an attending and as someone who had been through the pregnancy-childbirth-daycare ordeal before. She smiled and shrugged off my offers of help. “It’s okay,” she said. “I have triplets at home, so this is nothing.”

That’s when I realized that we really had come a long way. Medical training was no longer the seventh circle of hell that you had to get safely behind you before you could start your life. It was your life, and you could make choices about what you did and didn’t want to include in that life.

I don’t kid myself that these vaunted choices aren’t acutely framed by finances, family support, workplace support, and random chance. But the idea that you were actually living during those years, not just biding time until you could make your debut as a bonafide adult, was a radical conclusion. And it applied not just to having children, but to all aspects of life.

A medical school classmate of mine confided in me that he’d always wanted to play the saxophone. There was clearly no time for music lessons during medical school, but he realized that if there was no time during medical school, there certainly wouldn’t be any time in residency or fellowship. He didn’t want to wait a decade to see if he actually liked the sax, and so he scraped up time to play (usually in lieu of meals.) He ultimately concluded that is was really only the low mournful notes of the saxophone that appealed to him, so he switched to cello.

His story stuck with me for years as I took up the cello in mid-attendinghood. I now had three kids, a full-time academic job, plus a writing career. I certainly had no time for cello lessons. But until when, exactly, could I put this off: Emeritus? Retirement? Nursing home? Post-mortem?

And so I just did it–bought the cello and signed up for lessons. I fell in love and the cello has become an essential part of my life. I don’t miss my lessons or practice unless someone is actively hemorrhaging or in status epilepticus—patients or family! It’s grown now to the point where we’ve formed a string quartet that practices in the hospital on Thursday nights after my evening clinic session.

Having children, pursing music, taking up writing—these are all things that have come to define how I live. There are still only 24 hours in the day, of course, so we all have to prioritize and inevitably give some things up. I’ll confess that my medical journals pile up in the bathroom unread and that I’ve never seen a single TV series after “ER.” My children remain eternally embarrassed that I know nothing of pop culture and they don’t want to be seen in the presence of my thrift-shop clothes or 10-year-old shoes. They’ve resigned themselves to the fact that we have only three different dinners and these have been in rotation for 15 years, with little prospect of changing in the next 15 years. Those are the trade-offs I’ve chosen to make to create a livable life for me. Every person will figure out their own trade-offs.

The experiences of those who’ve contributed to “Mothers in Medicine” are frustrating, rewarding, agonizing, creative, exhausting, and illuminating. They are as varied as the individual personality types multiplied by the different medical specialties multiplied by the range of resources available. What they have in common, though, is the recognition that life is lived in real time.

We in medicine are inculcated in the culture of deferred enjoyment, of sacrificing our lives now for some distant rose-colored, board-certified future. But here’s the breaking news: No chapter with unlimited time and resources is ever going to magically open up in our lives. No fairy godmother will miraculously graft 8 hours onto your day or stock your house with groceries or impress the 16 kinds of vasculitis into your cingulate gyrus.

Postponing “until” turns out to be a futile exercise in continually moving the goalposts northward. At some point, we all have to accept that we are living in the here and now. Our life is not a staging ground for the real life that starts at some undefined moment in the future. What we have is what we have.

I admit that this could be a depressing thought, especially if you are working a 36-hour shift right now and sleeping in a call room that smells like an adolescent’s socks. However, shedding the burden of “waiting until” could also be liberating.

I encourage all of us to accept that our life—warts and all—is now. At the very least, this gives us an honest knowledge of what our life is. And it is certainly easier to plan around an imperfect reality than around some fuzzy future idyll, which may or may not ultimately bear any resemblance to what we’ve been counting on.

Carpe diem may be an over-used chestnut. But the current diem is the only diem we have, certainly the only one we know. It pays for us to choose what we want to do in this diem. If we leave everything to a future diem, someone else—or some other circumstance—may end up making those choices for us. The music is starting now….