Belonging

by Eunice Stallman, MD

Motherhood, by Andrei Yushcenko. (C) Creative Commons.
Motherhood, by Andrei Yushcenko. © Creative Commons.

I had just received a call that I had been accepted to medical school. The first thing I did was to call my significant other to share the exciting news. The second thing I did was pull up google to search, “best time to have children in medical training?” I was certain that this was not how most people celebrated news of their acceptance to medical school. There was also a nagging voice in my head that questioned my hopes to have medical training and childbearing be two parallel, co-existing paths. This voice was made louder by a quick scan of the results of my google search, filled with anonymous but strong opinions and advice with a unanimous message, “Don’t do it”.

I now chuckle as I reflect on how my 22-year-old-self decided to go forward with this information. She did two things that then defined the course of the next decade: She x’ed out of those google pages. She called back the admissions office and accepted the offer. Her thoughts were along the lines of, “I’ll show the naysayers. I’ll change the system, I’ll pave a road, a large cement highway kind of road, for my future daughter. I wanted to show that I belong in medicine, in motherhood. I have something to contribute. I belong.” Something like that. And because she loved writing and advocacy, she thought “I can’t wait to write about it on the other end. I can’t wait to speak about it, loudly and publicly.”

I now look back over the last 9 years, now toward the end of training, with a mix of pride and sadness. I recognize the thought patterns. The want to prove. The need to belong. I recognize the spirit. Now having had the years of experience, the years building and cultivating these two parallel roads of medicine and motherhood that I am lucky enough to have, the sadness comes from a slightly bent spirit, a more nuanced view of the messages that we receive and perpetuate as a system and society, and finally, from the disparity between what I am writing now compared to the story of unabashed triumphant trailblazing that I had hoped to share.

I don’t belong. The years have brought an onslaught of messages that I don’t belong, from the moment I expressed interest in having kids, to when I was noticeably pregnant, to the moment I have needed to excuse myself to pump. I look back and wish the story were different, the messages different.  I am a married, non-white, young female doctor with 3 wonderful kids –  a med school baby, and internship baby, and a residency baby – and I don’t belong.

I got into medical school on my first attempt. Ambitious, strong, dreamer, I could do it all, those were all things I told myself and believed in. I got a 253 on step 1 while planning a wedding. We got married, and a week later I was in the surgical wards pre-rounding at 4 AM. We wanted to become parents. One day I almost threw up and fainted into the sterile surgical field, and I knew a new journey was about to start. And I did,  I worked 80 hour weeks while pregnant, I woke up at 4 am for surgery rounds and took breaks between OR cases to throw up in my first trimester. I helped counsel women on their abortive options and perform these procedures while being acutely aware of the moving growing life within me during my second trimester. I rounded for 7 hours in heme/onc service as my feet swelled from standing for so long late into my third trimester.

The messages came early in my pregnancy, from my classmates, from my residents, from attendings.   “You can’t be a dedicated doctor if you’re also trying to grow a family…” “How can you learn patient care in your…state?” “That’s not fair to your patients”. Resident evaluations said, “Eunice was great, dedicated, DESPITE being pregnant.” Female attendings said, “I waited until I was an attending, years out from residency…it was much better” and “are you thinking about quitting after you have your baby?” And many male attendings walked very fast or sat in chairs without acknowledging my hugely pregnant presence, or shared how nice it was to have their partners be stay at home moms so they could work the long hours they needed to.

I had my baby, a healthy baby boy. I never knew I could love someone so much, that all my previous areas of interest, my previous ambitions, could instantaneously pale – vanish — in comparison. I thought 6 weeks maternity leave was plenty of time, decided upon months ago, so that I could graduate on time. And besides, what would I do with all that time, I had never had 6 weeks “off” since I was 12. I soon came to realize that 6 weeks was far from enough. A baby pushed me beyond any physical and mental limits I had endured thus far in medical training, in a completely redefining, fascinating way. 6 weeks later, bawling, packing my pump parts, 3 hours of sleep under my belt, filled with regret for the first time about choosing medicine as a career, I was going back to work.

The messages came again, “pumping distracts from your learning.” “You’re missing 15 minutes of rounds”, “pumping distracts from patient care, and you can’t respond to emergencies.”  And from classmates, “lucky you, cutting out on work.” I learned to pump while driving, while writing patient notes and putting in orders, while tucked in the back corner of a lecture so that I couldn’t be criticized about my “lack” of learning or my “disinterest”.

Residency applications opened, and wanting to be close to family, I applied to the only two programs that would land me near our parents. That would help me do it! I was the issue! I wasn’t strong enough without family help. My backup plan if I didn’t match was to stay at home for a year, a possibility that didn’t make financial or professional sense, but actually filled me with excitement and happiness.  So I sent in my applications while fielding questions from my classmates and medical school deans alike, “You’re willing to not match??!” “You’re not taking training seriously.” “So, are you committed to medicine, OR to your baby?”

Did it have to be either or? Was there room for both?

“So, are you committed to medicine, OR to your baby?”

I matched. I proved them wrong, all the people who applied to 20 or 30 or 100 residency programs, the deans from my medical school who said it was “career suicide.” I wasn’t sure if I was happy about it, but the external praise and validation was enough to keep going.

I took step 2, two days of 8-hour tests each, and because there were no pumping accommodations, I was forced to pump publicly in the lobby the proctors could ensure I wasn’t cheating. “In all my 10 years working here, we’ve never had to deal with this before” said a puzzled and defensive proctor. I got the message, people who take this test, people who are serious doctors, wouldn’t need to be pumping too.

I don’t belong. Internship started, a new beginning, near family, and I felt energized again to prove that I belong, now an MD behind my name proving that I am a serious doctor.  I was pregnant with my second baby, and nursing a young toddler at the same time. I tried to get to my prenatal appointments, but the message from my chief residents on internal medicine were the same: a mix of puzzlement, defensiveness and dismay I knew dearly, “no, you don’t have coverage for those, not while on inpatient medicine”, “we don’t have coverage for interns…what about your patients?”, “we haven’t had to deal with this before…” I missed several appointments, trudged through my inpatient months, missing days, weeks, from my son’s life.  I didn’t establish with prenatal care until late in pregnancy, all the while counseling my patients on self- care and making their prenatal appointments and hating the irony and hypocrisy of it all.

Resilience. This word came up a lot. I internalized that I was something I lacked, otherwise I wouldn’t have had such a hard time returning to work as my first, otherwise I wouldn’t need to pump while taking a test, otherwise I wouldn’t be crying in call rooms riddled with guilt missing the 4th bedtime for my son that week. Maybe this journey was just a long lesson in becoming more resilient.

I don’t belong. I was over 40 weeks pregnant in the middle of winter, asking for a parking spot closer to the entrance since it was getting harder to walk the 20 minutes on icy roads where the only available parking spots were left every morning. When I asked our leadership at the site, the message I received was, “sorry we can’t accommodate, those spots are for attendings. You could apply for disability, which takes 6 months to process. Or, there are plenty of curbs along the way that you could rest along. Arrive early to allow for time to walk and rest along the street so you get here in time for clinical duties.” Another message from my male attending at the time, “Do you want to do this, go through your training? Seems like it’s hard for you to balance being a doctor and mother. Have you considered quitting?”

He suggested that I take some time off to “think about it.” Think about if I wanted to keep being a doctor, because I was already a mom. He was puzzled by how I could commit to patients if I had babies to commit to at home. And because he was a highly respected attending, in a position of power, someone who’s advice was venerated by other residents, and because I missed my son, I took a leave of absence. I applied to other jobs. I had time to think, to reflect, to convince myself that I didn’t belong in medicine…and then time to convince myself out of that. I returned.

I don’t belong. My second baby came, and again the familiar feeling of regret of having chosen medicine. 10 weeks later, I again returned back to work, back to 14 hour shifts night float, while my daughter flat-out refused a bottle while I was gone and lost weight for weeks. As the only one responsible in those night hours for over 90 high acuity inpatient psych patients in a level 1 trauma hospital, it was hard to pump for longer than 5 minutes without being interrupted. I had mastitis. I had no sick time left, having used it all on maternity leave. If only I were more resilient.

It took everything I had to finish intern year. Second year was comparatively much better and we wanted to complete our family. Pregnant with my third baby, with a nursing one year old and rambunctious three year old at home, I again returned to night float this time at another hospital notorious for not having a call room or bed for psychiatry residents. That is against the ACGME contract, and citing this violation, I raised this concern. The messages came, “other residents have been resilient for years with doing night float without having had an issue. How can we help you build resiliency?” “Maybe pregnancy is making you sensitive to this issue”. “Consider bring a beach chair and sleeping bag for the work room.” For 15 nights, I brought a Tommy Bahama beach chair and a sleeping bag, and rested my aching pregnant body in this chair in between caring for patients.

This training system perpetuates a cycle of self-blame that I was familiar with and my voice said, If I had my “priorities straight” and “truly committed to patient care”, I wouldn’t be pregnant, and if I weren’t pregnant, I wouldn’t find it half bad sleeping in a beach chair, right?  If I was more resilient. And, maybe this situation of 14-hour night shifts without a call room or sleeping accommodations would be bearable if only I weren’t a sensitive pregnant woman.

I don’t belong. On my last day of night float, I received a page to evaluate a non-urgent patient who had already been waiting in the Emergency Department for hours before the start of my shift. After ensuring no safety concerns, I needed to feed my baby prior to coming in. I rushed her feed. I rushed in, and was there within the 30 minute requirement to evaluate a patient, even though it was now after my shift ended. I worked long after my shift. I discharged the patient. I let the team know about the plan as I apologized for feeding my baby, as they took notice of my simultaneously pregnant frame. Little did I know, they would report me and I would be put on disciplinary action for delaying patient care and for having “lack of remorse” about doing so. I didn’t speak up. And, I always stayed silent when I listened to my male colleagues boasting about “getting away” with showing up late or pushing back on an appropriate request to evaluate a patient without repercussions.

My third baby came in the middle of third year, again with a mix of raw emotions about returning to work but this time knowing there was a light at the end of the tunnel. Then the pandemic began and like everyone else, life turned upside down. When I became sick at the beginning of the Covid pandemic, a male colleague questioned my motives for being sick. He cited that it was likely a routine illness from my kids, and it was not a reason to work from home. When we all started to work from home due to the pandemic, attention was paid to whether the mothers in the program were distracted or whether there was a whisper of a child’s cry in the background, while other sources of distraction were not questioned. I took to doing zoom visits locked in the closet behind 3 sets of closed doors to minimize any possibility of colleagues hearing my children and questioning my “professionalism.”

“When we all started to work from home due to the pandemic, attention was paid to whether the mothers in the program were distracted or whether there was a whisper of a child’s cry in the background, while other sources of distraction were not questioned.”

As I approach this last stretch of residency, still entrenched in the rigors of training and the intensity of raising 3 young children under 5 years old, I am in a unique position of being able to reflect back on the years and look ahead at what I want to continue to shape and build at the same time. I have straddled two roads, one of my medical training, and one of early motherhood for years now; often these roads were directly perpendicular and clashing, rarely they were neatly parallel, and mostly they were just messily interwoven until the two blurred into one unpaved road. It has been a lonely, emotional, seemingly endless journey at times.

There have been many road signs along the way, many messages that I do not belong- and underlying that, messages that I do not have my priorities straight, that I am not resilient, that the system cannot be changed, trails cannot be blazed. And the work of dismantling these messages will be impossible for any one person, but the cumulative work of many women and mothers before me have started to pave a road and will continue to do so. And for future young women who are budding doctors and hopeful mothers, perhaps even my daughter someday, I hope their search for answers and advice results in them finding a large community of support and belongingness, different results than what I found. And I will continue my part to advocate, to mentor, and dismantle systems, to speak about out and question these messages of what priorities “belong” in medicine, until finally we greatly expand this radius of belonging. Despite all that I have encountered, my spirit is not broken. I have work to do.

Eunice Stallman completed her BS in neurobiology at the University of Washington, her MD at The Ohio State University College of Medicine, and is currently a 4th year psychiatry resident at the University of Washington-Idaho Advanced Clinician Track. Her interests lie in maternal mental health, gender equality, and advocacy for residents, and she spends much of her non-work time exploring beautiful Idaho with her three young children and her husband.

 

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