key: cord-0068284-l3brsx15
authors: Alam, Sarah
title: Motherhood and Endocrinology Training: Diary of a Female Resident
date: 2021-09-08
journal: Indian J Endocrinol Metab
DOI: 10.4103/ijem.ijem_24_21
sha: 66b944365b72f76c455221b594c40746a3acfd3c
doc_id: 68284
cord_uid: l3brsx15

Motherhood is tough and life-changing for every woman and even more so for females doing residency training. Pregnancy in itself was challenging and took a physical and mental toll on the body. Long and demanding work-hours with unrealistic expectations from oneself added to severe stress. If pregnancy part was difficult, then juggling the responsibilities of a child as well maintaining work–life balance was like walking the tight-rope with insecurities and self-doubts creeping in at several occasions. It required a great deal of motivation to carry on. It was the support of my ‘village,’ which made me finally achieve things that seemed impossible in the beginning.

When as a young girl, I thought of becoming a doctor, there were dreams in my eyes and a burning desire in my heart to change the world for the better. So, years of hard work resulted in achieving the goal of completing MD in General Medicine and becoming a physician. I planned on studying further and applied for DM (Doctorate of Medicine) Endocrinology program. I specifically remember the rush of excitement I felt on being selected in the premier institute of India through one of the toughest entrance tests. DM Endocrinology course in India is a 3 years' training program. In my fourth month of endocrinology residency at All India Institute of Medical Sciences (AIIMS), New Delhi, in 2017, I got to know that I was pregnant. Residency requires remarkable grit, determination, and hard work but pregnancy along with it makes it additionally challenging. Being pregnant is indeed a wonderful and an unexplainable feeling, but it has several physical and emotional impacts on the body. As the story goes, the unbearable nausea in the initial part made me go to my Head of Department and reveal the news. He was tremendously supportive and after discussing with him, I took leave for a few days. I also informed my Chief Guide (Research Mentor) and rest of the consultants in the department, who were also immensely considerate. I managed the day duties, but I found 24-hour call duties quite demanding at times. Most of my colleagues were caring and helped me a lot. The attitude of patients towards me was considerate and patient care was not compromised in any way. Long-clinic hours made my back excruciatingly sore and prolonged standing in the ward caused swelling in the legs. Bringing healthy snacks for uncontrollable hunger pangs and eating in between work helped me, but I could not do it regularly and often neglected myself. I even forgot to take iron and calcium tablets prescribed by my gynecologist.

As the proverb goes, doctors make the worst patients. I often thought of wearing compression stockings for my pedal edema, but somehow could not do it. There is sometimes this sense of guilt due to excess work on colleagues, unrealistic expectations from oneself, and 'callous indifference' of some people, which may lead to severe stress. Verily, similar issues have been faced by pregnant female residents throughout the world and have been extensively reviewed by Finch. [1] In the third trimester, I had difficulty in walking and shortness of breath even on routine activities. I was working till 34 weeks of gestation when an episode happened that really scared me, and still gives me goosebumps whenever I think about it. I had gone for a routine ultrasonographic scan and I was lying on the table, when I felt an unbearable heat sensation followed by a feeling of impending doom and then everything turned black. I was surrounded by a pool of residents from gynecology and everything seemed to be happening in slow motion with someone repeatedly saying my name in background. I then came back to my senses, like groggily awakening from a deep slumber. It was followed by admission for a few days in ward and all the routine tests were done, which thankfully came out to be normal. Rest of the pregnancy went unremarkably well and my little angel was born after 1 month. I took maternity leave for 6 months that went by uneventfully and soon it was time to resume my duties.

If you feel pregnancy is tough, spoiler alert, the tougher part is yet to come. There were two times during my residency when I seriously thought about quitting it all as I was not able to handle the pressure. It was unflinching support from my parents and husband, which kept me going. It is shocking that common themes run throughout the world and in a study by Rangel et al. [2] nearly 40% of pregnant female residents think of dropping out.

'It takes a village to raise a child' -goes an old African proverb which broadly exemplifies the role of an extended family including grandparents, uncles, aunts, and family friends in the upbringing of children. Remarkable women in my family including my mother, my sister, my mother-in-law, and my sister-in-law were available for babysitting and guidance whenever I needed. I was indeed fortunate as my 'village' was there to take care of my child. My cousin, who is a pediatrician and had recently become a new mother like me, was available for advice any time and provided me unwavering support.

One of the hardest experiences was to deal with self-doubts, which crept in my mind after I resumed work. I discussed about my apprehensions with a very dear colleague how I often thought that I am neither a good endocrinologist nor a good mother and it is tearing me apart. My colleague told me, "You are a hero, Sarah. Just believe in yourself." It is when you are feeling down, motivating words can really pull you up and prepare you to bounce back. In a large nationwide survey across US involving 844 physician mothers, similar return-to-work experiences with difficulty in work-life integration have been described. [3] Children fall ill and they do so quite frequently and leaving a sick child at home is even tougher. I particularly remember one incident when my daughter had fever and I could not take leave because of professional commitments. One of my professors and I boarded the same elevator and she casually enquired, "how is your daughter?" without having any idea about my daughter being sick. My eyes suddenly welled with tears, my throat parched and I could not come up with any word to reply to her. She was extremely kind and sympathetic.

It is strangely terrifying how you become overly emotional especially when there is an issue relating to your child. But embracing your vulnerabilities makes you stronger. It reminded me of lines from the poem "If" by Rudyard Kipling that says: And so hold on when there is nothing in you except the will which says to them: 'Hold on!' [4] I have to agree that all my professors were more than kind and understanding. Despite this, the workload of a tertiary care institute is humongous and it can be excessively intimidating and strenuous. Obviously, it teaches you a lot and prepares you in the best possible way. After all, 'the finest steel has to go through the hottest furnace.' So, finally, I reached the end of my 3 years' residency training program. Preparing for Exit exams was another gigantic challenge and in the early part of 2020, I was dealing with that. I spent almost whole of my days studying in the library burning the midnight oil. Then came another unprecedented threat in our lives, which was unfathomable in the form of Covid-19. So, the time went by and I passed my residency exams. After passing the exams, I was posted in the Covid-ward. I would remain eternally grateful to my parents who were taking care of my daughter, and she was living at my parents' place. This was a grim reality for innumerable healthcare workers who remained separated from their families, rightly being honored with the term 'Covid-warriors'. So, before joining my 'Covid-duties,' in an overdramatic Bollywood movie fashion, I told my mother to take good care of my daughter if something happens to me and bid good-bye as if it was my last and felt like a 'warrior' in the true sense of the term. Covid-19 indeed made everyone doubt their sanity. [5] But time flies and residency does come to an end, and there is always light at the end of the tunnel. So, when anyone feels that things are overwhelming and thinks of quitting, I would just say to them, "Hang in, there." A great author has rightly said, "Rest if you must, but don't you quit."

Nil.

There are no conflicts of interest.

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