I was driving in the rain, taking in all the abundant Carolina greenery around me, reflecting on how wonderful it was to be out of the hospital and experience this current moment. I started to wonder when was the first time I ever felt burned out in my journey as a physician, and then it hit me like a ton of bricks. Like a scarring memory deeply suppressed, rising to the surface. My exposure to physician burnout and moral injury started way before medical education. It started at home. It started in infancy. It started watching my physician parents. It seeped into my relationship with my mother. It started in the womb and the cradle. I had to pause and reflect on this.
I was born during my mother’s obstetrics and gynecology training intern year. She worked her entire pregnancy, as is common for all pregnant physicians. The day I was born, she was working. She is a dedicated, compassionate, and utterly hardworking doctor whose entire universe revolves around her patients. It was a daunting task to manage both the demands of an OB intern and the needs of a firstborn child. Eventually, medical training and active parenting were struggling to coexist and shine. The concepts of protective time and work hours where she was training (outside of the U.S.) were non-existent. My mom had to choose. Medicine or active motherhood? Juggling both felt like persistently failing. At that moment, she had to choose medicine, and I moved about a one-way five-hour drive away to live with my grandparents. Any mother reading this knows how that feels. The gut punch of mom guilt bathed in a female physician’s imposter syndrome.
I stayed with my grandparents in a quiet village till I was almost five years old, while my parents finished their training and moved around the country. They would visit, and I would visit with my grandparents as much as possible, but yes, I didn’t see my mother daily till the age of five years. The visits were brief, and there were a lot of tears. It was way harder for my mother than it was for me. To this day, it has affected our relationship. When I did move in with my parents, it wasn’t that much changed. I saw firsthand my mother going hours without rest, hours without relaxation. I saw her care for her patients night and day as well as carry all the invisible work that women do. As a child, I used to be furious and enraged and would feel abandoned. My young mind and heart, oblivious to her struggles, would feel that she choose her career over me. I also started cultivating an innate dislike for procedure-driven medical specialties and wondered why she did not have a “normal 9 to 5 job” like everyone else or better yet, why didn’t she stay at home.
Sometimes I feel that I passively absorbed and later acted out the same overworking and perfectionist tendencies. Did I subconsciously opt to practice primary care, looking for the “mythical 9 to 5 job,” only instead to find my deep abyss of burnout? Did I carry an even heavier burden of mom guilt because I presumed to know exactly how my children feel and decided to go on anyways? The irony is that my mother still thinks she just worked hard, and the buzzword “burnout” was never truly used. Meanwhile, I saw her hit energy depletion, over-exhaustion, social withdrawal, and variable periods of decreased productivity. My argument is if it looks like burnout, depletes like burnout, and exhausts like burnout, then it is probably burnout.
The research on maternal burnout and its effects on children’s well-being is extensive and growing. Multiple studies have found that maternal burnout is associated with negative outcomes for children, including increased levels of emotional and behavioral problems, lower levels of academic achievement, decreased parent-child relationship quality, and lower levels of child well-being, such as life satisfaction, self-esteem, and resilience.
But as is life, it teaches you. It heals you in its wise ways. From the day I entered medical school to the day I became a mother, I have only grown to appreciate more, the perils my mom had to endure. The tough choices at home, the physically and mentally draining decisions at work. And how she carried all of these with such grace and poise. And she never seemed for a minute to stop loving medicine, or ever stop enjoying delivering babies and never provided anything but compassionate care to her patients.
In those moments, I lean into my inner child, hug her, and imagine embracing my mother’s younger, early-career doctor version. I tell them all that we are OK now. I did recognize, seek help, and stop the fire of burnout from completely engulfing my life and those of my children. I am reaching out now to others and doing the same. I advocated for myself, learned tools for betterment, and that I’m no longer a depleted shell of a person when around my children. That I play with them, and I feel their joy. And yes, it’s OK now.
I wonder, however, for all the other children of burnout. How are they doing, and what healing do they need? And how has my burnout impacted my children, and what can I do next?
Amna Shabbir is an internal medicine physician.