Post-call days, or the days off following overnight shifts, are great for taking care of tasks that can only be addressed during normal business hours.  Which is why, after a recent night of work in the pediatric ICU, I found myself, still clad in scrubs, reclining in the dentist’s chair.  Seeing this, the dental assistant asked about my job and I told her I was a resident and worked with kids, from newborns to those in their early twenties.  She began to tell me about how she had always wanted to be a delivery room nurse, to be there as babies are born.  I made some enthusiastic grunting sounds, as the dentist had entered the room and was now poking around in my mouth, and she continued, saying that she had thought about going back to school to pursue that career, but she had young children at home and just couldn’t endure the time away from them.  In her current position, she raved, she could work just a few days a week, and spend the rest of the time with her family.

And there it was.  The to-work-versus-not-to-work-  . . . –versus-to-work-part-time-while-the-kids-are-young conundrum.  And the guilt that I have already begun to feel as my husband and I contemplate just when in my training will be the best time to try to start our family, and I consider the hours that I work as a resident and those stretched before me in my plans to pursue fellowship and a career in academic medicine, blossomed just a little further.

Yes, I have read Sheryl Sandberg’s Lean In.  And I have read various commentaries, some of which celebrate it as a long-overdue examination of why too few women hold leadership positions and what changes we can make as individuals and as a society to shift the balance, and some of which harangue it as the musings of an out-of-touch woman of privilege, full of suggestions that it would be impossible for the typical working mom to employ.

Either way, it has turned the public’s consciousness toward a well-established challenge that many women face.

Brené Brown, a social scientist who does fascinating work, writes that motherhood – both the state of having children versus not having children, as well as how we handle our families and our careers, and how hard it looks like we are trying – is an overwhelming source of shame for many women.[1]  And I can feel it even now, before we have even started trying to add children to our lives.  How will I possibly find a way to be a good-enough, present-enough mother to my future children while meeting the demands of caring for gravely ill children and developing my skills related to that calling to the best of their potential?

Although many of the words of Sandberg and Brown rang true for me, their acknowledgements that women face difficult choices and their offerings of solutions that apply more to the boardroom than to the hospital left me wanting something more.  If one doesn’t perfectly hone and maintain her skills for working at Facebook (Sandberg’s place of employment), no one will die.  If I don’t push myself to learn more, do more, experience more to capitalize on my training and sharpen my medical acumen, someday someone – someone’s child – might.

Then I happened upon the blog post Am I more than my gender? by Genevieve Boland, an oncology surgeon and mother, and felt, for the first time since considering the future of my career in the face of the decision to have children, completely understood.  In her words, “Unlike the typical, post-baby female dilemma I read about, my decision is not will I or won’t I work. The question is what will I do.”  Referencing Sandberg, she continues on to say that “the choice now is not to lean in or out, but which lateral direction to bend.”

Boland humbly and thoughtfully explores the myriad choices that continue to plague women in medicine even after they have decided to continue working, namely whether to shift their focus to more predictable and flexible areas within their fields and how this might affect their views of themselves and their careers.  She also ponders what it is about medicine (and especially certain sub-specialties) that engenders a culture of prioritizing – or at least, prioritizing on the surface – one’s work over one’s family and if and how we might go about trying to change this.

Each time I revisit this debate, this still-hypothetical but no less tortuous for me, debate, I think back on a woman I met years ago, when I was an eager pre-medical college student doing a summer research internship.  At the time, she was a twenty-nine-year-old resident, younger than I am now.  I remember a short lull in one busy day during which she recounted with frustration a conversation she had had with the department secretary.  The secretary, a woman, had encouraged her to have her children at a young age, insisting that it would make her a better mother.  The resident was in a relationship, but by her own assessment nowhere near ready to have a child.

Years later, when I was finishing medical school, I needed to see a doctor and noticed her name listed on a local practice.  I was sure she wouldn’t have remembered the wide-eyed college student who followed around some doctors that summer more than ten years before, so I didn’t bring it up during my appointment.  But we chatted about the medical school where we had both trained and compared notes on some of the faculty members who were still there.  She gushed about how much she had enjoyed her time there, and how much she now loved her career.  As I sat in her office, I saw among the degrees and certificates framed photos of her with a husband and two beaming children.

I think it is naïve and misguided to expect to find a right answer, or even a tenuous balance, between family and career.  I can’t project into the future to determine just how I will feel if I am lucky enough to have a child of my own, but I do feel the pull between hospital and home as I try to nurture both my training and my relationship with my [incredibly supportive] husband.  Perhaps the real right answer is the one that works for an individual woman in an individual span of time, be it a week or a month or a year.  Or even a single day.  Maybe the answer will shift dramatically as she progresses through her life.  And maybe that’s ok.

But I think that the most powerful thing in seeking the rightness of the moment, regardless of what and how you choose to prioritize, is having other women to look to, women who will not judge your decisions but who will help you find the one that is right for you at that time, just as they work to find a right balance of their own.  I think that’s why I always remember that resident from years ago, and why I was so relieved to find the words of Genevieve Boland.  All I can do, as I push forward in my years as a physician and a wife, and maybe someday as a mother, is to let go of the guilt and strive for what is right for me and for my family in my moment, and to support the women around me who are struggling to do the same.