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The American Society of Anesthesiologists is an educational, research and scientific association of physicians organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient.

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April 1, 2013 Volume 77, Number 4
A Working Mom in a Busy Private Practice Group Vivian J. Tanaka, M.D.


Motherhood during a career in medicine is in some ways a time of Dickinsonian great expectations: It has the potential to simultaneously be the best of times and the worst of times.

For many women, the question arises: “when do I have kids?” I looked to my peers and my predecessors. There wasn’t a clear-cut answer, except the repeating mantra of there is never a perfect time to have kids. I recalled the increased rate of genetic conditions with increasing maternal age. I knew I didn’t want to put it off too long. My husband and I decided to let nature take its course. We were excited to discover I was pregnant while in my CA-2 year of residency.

Joy and happiness quickly degenerated into a state of severe hyperemesis gravidarum and sheer misery. Dehydration, uncontrolled weight loss, a PICC line and TPN quickly ensued. I think returning to the rigors of training after a prolonged medical leave and a new baby was equally jarring. I had a healthy new baby girl. She was my proverbial “heart moving around outside my body.” After months of physical deconditioning, occasional runs of SVTs, seemingly endless nausea and vomiting, I instantly returned to a normal resident case load and call schedule. The last year of residency, whilst preparing for a new job and juggling the new baby, were all a blur. It was just about survival. I looked and felt like a zombie.

When I was first seeking a job, I doubted I would find a work environment that completely embraced motherhood. I expected to work hard and to continue building my newly acquired anesthesia skills. In my path through some interviews, I was struck by how marginally some practices operated. “How do we know you will not just go on maternity leave in six months’ time?” With less than 10 people in a group, one person on leave severely hampers the group from functioning optimally. Whether it was legal to ask such questions during a job interview or not, they had a point.

My first job was with a private practice group of about 20 anesthesiologists doing level 2 trauma, obstetrics and occasional pediatrics. It was a wonderful place to learn and grow. I realized I had to become more flexible and efficient in my preoperative assessments without compromising patient safety. I learned how to set up for big cases on the fly. Somewhere between the chaos of calls and a fussy infant who still refused to sleep through the night, I passed both my written and oral boards. Also, I succeeded in building trust with the surgeons and staff.

After two years, I had settled nicely into my first job, but was ready for more. A position in a desirable and highly regarded local practice opened up. This thriving private practice offered the additional challenge of high-risk pediatrics. If I was looking for a challenge, I truly got it. I had honed my anesthesia skills in the previous job. However, a typical call night here involved vacillating between a 600 gm micro-premie requiring an urgent ventriculostomy, to a 98-year-old hip fracture with severe aortic stenosis, back to the NICU for a septic premie on high-frequency oscillatory ventilation with a perforated bowel. Ironically, both these extremes of age require very little anesthesia with extremely vigilant care! One of my colleagues alluded to the “white knuckle effect” of starting with this group, and this was the state I was in every day for the first few months. I did not see my daughter for days at a time, only peeking a glance at her sleeping face, wondering if she would grow up holding this against me.

Childcare is like a delicately balanced house of cards. One tiny shift, and the whole thing comes tumbling down, your nerves unraveling with them. Some of the most agitating moments occurred while walking to meet my first scheduled patient of the day, only to be interrupted by frantic messages from the nanny stating that my daughter was developing a fever. Twenty minutes later, I hear she is also vomiting and wheezing. I must start the case, which requires lines, intubate the patient with a difficult airway before calling the nanny back to triage the situation at home. Do they need to go to the ER? Can she stay with my daughter for the full day? If not, can she call my husband?

I hear my daughter crying out for her mommy in the background. I verbally walk the nanny through putting the nebulizer and meds together to treat my daughter’s asthma. Now the surgeon is closing, and I try to catch up on my documentation.

Sometimes, women can be their own worst critics. I once watched an “Oprah” episode on the work-life balance debate that terrified me. By the end of the discussion, mothers from both sides (working versus stay-at-home) were hysterical, full of anger, emotions and tears. What I have come to believe is that one’s work-life balance is highly personal. You need to set your own standard.

I am coming to accept that I draw much satisfaction, meaning and identity from my work. I would be miserable if I could not work at all and cared for the kids exclusively. I would be equally discontent if I could not care for my child because I worked all the time. I instead consider the concept of my work-life sum. One can achieve mental and emotional harmony when the sum of work needs and life needs is less than a certain threshold, or wellness capacity. In reality, the two functional parts are in a constant state of flux. I find myself continuously re-evaluating this work-life sum. I’m in a constant state of tweaking.

There is no doubt being a mother has made me a better doctor. I feel better connected to my patients on more levels. I have more empathy not just for their disease states but also as humans experiencing incredible challenges. A passerby once asked my 5-year-old daughter what she wanted to be when she grew up. She immediately replied, “I want to be an anesthesiologist!” My ears perked up. “Because I want to WORK HARD.” My heart sank. Was this her main impression of what I did? Did she feel this was her mother’s only passion in life – to work hard? She then continued, “So I can help sick and poor people.” I felt elated. Maybe, just maybe, I am doing something right.






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