Abstract
Dear Editor:
It's 4 A.M. Five metallic beeps signal a page from the Oncology floor—my patient's pain isn't well-controlled. Groggily, I stumble to my home computer to log on remotely through a secure Internet portal. One hundred fifty micrograms of Fentanyl were not enough, and I amend the order to 200 μg. I lie down and my eyes fall closed. Down the hall, my five-month-old son, Asher, sleeps in his crib. The twin sentinels of the pager and baby monitor stand guard on my bedside table, wordlessly watching, waiting, silent for now. One minute clicks by, then another, and suddenly I hear a piercing “Waah!” over the baby monitor. I plod down the hall to feed and soothe him.
“Whatever you do,” quips my husband, “Don't give Fentanyl to the baby and milk to the patient.”
“You have a good point,” I reply, “But it would help both of them sleep!”
For the past two months, I have been back at my full-time job as an academic palliative care physician, seeing patients as a consultant and acting as the attending-of-record for inpatient hospice patients. Daily, I am immersed in the beginnings and ends of life. As meaningful as this time has been, it has brought unexpected challenges as I attempt to re-engage in my career.
A large cross-sectional study in 2017 demonstrated that 35% of female physicians experienced “maternal discrimination,” or perceived discrimination due to pregnancy, maternity leave, or breastfeeding. 1 Concerningly, experiences of maternal discrimination were linked to high levels of burnout among this physician cohort. It affects our children, as well. Studies show that being a female physician is a risk factor for prematurely curtailing breastfeeding before the American Academy of Pediatrics-recommended time frame of at least six months.2,3 We are in a new era as Marcus Welby, MD, never had to figure out where to discreetly clean his breast pump parts at work.
This is another hidden curriculum. I urge my learners to question unspoken messages, confront implicit bias, and disrupt the notion that death is defeat. We are failing, however, to address an insidious problem. Although women constitute >50% of U.S. medical school classes and constitute >60% of current fellows in hospice and palliative medicine (HPM), there is scant attention given to the unique challenges of returning to a demanding physician career after becoming a parent. Institutions now hold sessions on “work/life balance,” but there is more to be unpacked in the line between “work” and “life.” Discussions about burnout are missing a crucial element: We do not experience bright lines between our personal and professional lives. The pager pierces the air where my son sleeps; I have an uncomfortable need to pump milk in the last minutes of a family meeting about a hospice transition. The realities of life are inconvenient.
How should we support HPM trainees who are new parents? I believe that speaking openly about our experiences can be powerful. This includes frank discussion of the physical aspects of being an HPM clinician while feeling nauseated, fatigued, or conspicuous. We must learn measured responses to remarks from patients and families about visible pregnancies, for example, “Your husband must be so happy that you're having a boy!” I am honest with my trainees about the quality-of-life trade-offs. There is real beauty in the struggle to care for our patients and society while raising these little ones. I hope that Asher will one day recognize the tinkling beep of the pager as a clarion call that someone else's son or daughter needs mommy's help to feel better. Until then, I will draw on the strength of our community and extend a hand to those earlier in training to find their way.