“I solemnly pledge to consecrate my life to the service of humanity.” Standing with my medical school colleagues, we continue; “I will respect and hold the secrets that are confided in me. I will exercise moral integrity.” I easily agree. But then, “The health of my patient will be my first consideration.” I’m 40 weeks pregnant, with swollen feet and raging heartburn. My baby kicks wildly. With certainty, I know that living this part of the oath will be much more difficult than saying it.
My first son is born soon afterward and my thoughts are only for him—this beautiful, completely dependent new life in my arms. Formerly fully capable and competent, brushing my teeth before noon is a huge accomplishment. Days and nights are consumed with breastfeeding and diaper changes. The demand is incompatible with nearly anything else, let alone patient care.
Twelve full years fly by. Our family grows. We move a few times. Babies become children and their needs change. Medical school and residency ends. My career evolves. The question remains: how do I place the health of my patient first when I have other responsibilities? How do I care for my loved ones but also meet the needs of medicine? Where is that line between success and failure? Is it even possible to meet my obligations when the two main competitors for my time and energy—motherhood and medicine—know no upper limit. Both are without boundaries as to what they need and deserve.
In secretive moments, my colleagues boast about working shortly after their own surgeries, working without sleep, working with IVs in place, working while in pain and infected, and even while battling cancer. Extreme self-sacrifice is admirable. There is judgment for those who are distracted, those who don’t appear committed. No physician boasts about taking time off to care for a spouse or to help their troubled teen. Stay focused. Such disruptions must be taken care. You took a vow, after all.
No one can tell me how to juggle what I have taken on. There are as many answers as there are mothers in medicine. Some stages are more difficult. Some specialties are more or less compatible with being a primary caregiver to young children. Children have varying needs that affect whether a parent can focus on other things. No one can define for me how to walk this line, especially when the line changes.
My current answer is this: “The health of my patient will be my first consideration” means it’s up to me to set healthy limits on a profession that values extreme devotion and that knows no upper limit. Staying well trained and fresh takes an ongoing commitment. Being available to the needs of patients is noble. Designing a life that is unbalanced, unhealthy and without limits is not.
Living the oath means I cannot blissfully throw in myself into medicine with disregard to other responsibilities. It means setting boundaries even when it is not popular to do so. It means letting go of the shame that accompanies such boundaries. It means making time to live a healthy life.
Our patients deserve our best. Living the oath requires it.