This week I return to work after my third, and final, maternity leave.

With my first, I dutifully went back to work when she was about three months old, feeling grateful and guilty for the time I had taken and very eager to prove that women could indeed have it all. I had not yet heard the popular saying, “women are expected to work as if they don’t have children and raise children as if they don’t work”.

As a young attending after the birth of my first child, I was subconsciously living by that lie.

This time, I took my maximum allowed leave by the state of California, still woefully short of standard parental leave across European nations. I continue to feel a strange mix of gratitude and guilt, but this time there is a healthy dose of dread tainting the waters as well. 

As a general surgeon, complications happen. An oft quoted surgery adage states, “every surgeon has complications, and those who claim otherwise are either lying or not operating enough”. They are inevitable, rarely avoidable, typically singular, and wholly devastating.

I assumed the crushing lows of being a surgeon would become easier to stomach as I progressed in my career, not harder. But the despair remains a constant. A colleague pointed out that this is because of the cumulative trauma we collect as surgeons, a growing list of tough cases that haunt us even as we perfect our craft and improve our skills. This is the part of the job we are not trained for, and that I did not anticipate. I knew that no surgeon is perfect and to err is human, but I did not foresee the emotional toll that would take. 

I had not yet heard the popular saying, “women are expected to work as if they don’t have children and raise children as if they don’t work”. As a young attending after the birth of my first child, I was subconsciously living by that lie.

Especially in the midst of a global pandemic, where healthcare worker burnout is at an all time high, returning to work after maternity leave feels more daunting than ever. The Great Resignation has shown us how unhappy Americans are with their work-life balance, and medicine is far worse than most fields. I found myself struggling with burnout before I left, eager for time away from medicine with its complete shift in focus onto family life. 

Now as I look to return, there are so many unresolved (unresolvable?) elements that no longer feel as oppressive, the trauma having faded into the background. But my pervasive fear remains how to continue to feel empowered despite the inevitable lows that will come. How do you prepare to face the onslaught?

I wrote this poem shortly before I went on leave. It encapsulates so much of what I was feeling, what led to burnout, what I will surely experience again at some point in this career, and what I will again struggle to grapple with someday.

I do believe this makes me a better physician. I agree that the day you stop caring for your patients is the day you should quit being a doctor. But at what cost does that come? 

Death in the ICU

I left the house without makeup this morning,
an odd oversight even during these masked times.
My body must have known not to bother,
somehow foreseen the trauma ahead.

Futilely fought tears spilled,
aftershocks of sorrow bringing them
unbidden back to the surface.
Despite my skill at compartmentalization
the day was a struggle
the clinic shot through with sudden stabs
of despair, sobs silenced in the bathroom.
I did not see her death coming
I wasn’t ready to give up on her,
but the family knew we were only
prolonging the inevitable.

The call from the ICU broke me,
because it’s been a long haul
because we are imperfect humans
practicing an imperfect art on imperfect people
and death is inevitable.

The responsibility for outcomes
yoking me forever to a personal graveyard of losses
never gets lighter
as the years tick by they are the ones I remember.

A cumulative trauma filled with headstones
and faces I will never forget.

-ZH