It is 6:08 p.m. on a Monday night, and I am sitting in an unlocked patient exam room, my uneaten lunch opened in front of me, clicking through a patient’s chart, all to the constant whir of my breast pump. I last breastfed my infant at 6 a.m. this morning, and the discomfort in my chest has only amplified as the 12th hour has gone by without time to express myself.

Normally, I would make the 40-minute commute home at this time to spend just a few precious moments with my 3-month-old baby before he entered his first stretch of every 2-hour sleep, but I can’t bear the thought of the painful fullness in my breasts on the car ride home. Apparently this is my new normal.

I knew entering motherhood as a physician would be challenging, but I never imagined it would be this disappointing. I had the “luxury” of taking five weeks off with my newborn, more than most mothers in medicine. My parents gave up two months of their lives to travel across the country and stay in our small ranch home in order to watch my son and bridge the gap between the earliest possible start time at daycare and my short maternity leave.

I remember vividly responding to emails on the day of my delivery: “I will get the manuscript to you in a few days, but I apologize if you don’t hear back from me this afternoon as I am in labor.” What is this life?

Part of this is my responsibility. I have always been dedicated to a fault to my work and my profession. I never want anyone to think I am less than the best. Most physicians are this way, and most women physicians often go even further to prove themselves against their male peers. When you add into this bringing a child into this world, a true honor and blessing, the desire to continue to prove your worth and distinguish impressions of weakness and misaligned priorities becomes even stronger. I am not sure that this is how it should be.

Let me be clear, there is no maternity leave in my program. There is family medical leave. There is vacation and sick time. And you can combine all those things, take no vacations, ensure you do not admit sickness prior to your delivery, to make a reasonable 30 days off to be with your newborn.

However, remember that I am a fellow, and the Accreditation Council for Graduate Medical Education (ACGME) does not want me to take more than 30 days off, and if I do, I owe that time back at the end of my fellowship. The ACGME does not care that during my 25 “days off” I continued to take care of my patients, prepare my clinic, perform my research, submit manuscripts, and call my patients in the middle of the night with my newborn attached to my breast when a “covering” physician did not give them the answer that they needed. The ACGME feels I owe them back for any additional “time off” beyond 30 days and would slap those additional “relaxing days off” to the end of my fellowship to extend my 6th year of postgraduate training even further.

But that is all said and done. I came back early from my 30 days because my patients needed me, or that is how I felt. It was challenging enough to arrange clinics in my absence, hoping that requesting help from other fellows would not make peer evaluations of me turn sour. I cannot believe this is a worry that I had, but this is a true reality of my fellowship. At one point early in my fellowship, I was told that my priorities seemed misaligned to the priorities of my fellowship. I was not entirely clear what this meant. This surprised me because I did nothing other than work, research, study, and spend a few minutes with my husband each night (in that order). This was before I spent 10 months making a human, and then bringing this human into the world. I am certain that the fellowship would be disappointed in my priorities now because I can tell you, it does not come first (God, family, patients, fellowship … sorry, you are fourth). When I reflect on this, it does make me sad.

Now back at work, I am thrilled to be back with my patients. I am excited to be making strides in my research. However, I am still disappointed because I don’t have the time or the energy to pump for my child. I am down to one session a day, at the end of the day, wherever I can, and I hook up begrudgingly, exhausted from the long day. I do not want anyone to think I am inefficient, but my clinic schedule has not changed; no allowances are granted to ensure I can pump. I do not expect this “luxury” but physically, it can be very challenging. I experience real jealously when my best friend, who works in insurance, tells me she has 3 blocked off hours a day to pump. I really become disappointed when she gripes one day that she had to pump during her lunch break. I am not even sure what a lunch break is! I suppose this is the life I have chosen, but I have to be honest, I think we could do this better. We just have to exert the energy to try. We have to care enough to make a change. Unfortunately, those of us living it don’t have the energy left to exert the force needed to bring about change. It is way down an ever lengthening to do list, and I am afraid we will never get to checking it off.

We need change. I am not that important to my fellowship. I acknowledge that, but if I am not that important, then let me be with the person and people I am important to (my son, my husband). I promise I will come back and work harder than ever because the value of life is so much more now that I have brought life into this world. Give me enough time to adjust to this, preferably a bit longer than 25 days, and I can assure you, the person coming back to you on the other end will have figured out the sleep deprivation, the schedules, the inadequacies of new motherhood, and I will be a better physician for my patients and colleague for my peers. I promise you will not be disappointed, and perhaps more importantly, neither will I.

The author is an anonymous physician.

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