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FORUM On Becoming a Doctor--and a Mother Photo by Graham Ramsay "Should we recheck it?" I asked my husband, glancing over to see his expression. The second line, shadowy at first, had deepened to a distinct rose. "Could it be true?" We had been trying for nearly a year to get pregnant. I anticipated another negative test, just like the half dozen other spot checks we'd already done. In my rural clinic on the Navajo Indian Reservation, the birth rate is high, so I diagnose pregnancy routinely. Hyperaware of all the symptoms, I scrutinized myself. Could that have been a little nausea after breakfast? Perhaps my stomach was sticking out a little extra. But each time the test was negative. When it finally happened, I was taken completely by surprise. "Isn't it great to know there's still mystery in the world?" my OB asked when I recounted my diagnosis. A part of me still thought there was a reasonable possibility the test would turn out to be a false positive. Just when I had slipped into a somewhat uncomfortable realization that motherhood wasn't going to be as automatic as I'd always thought, here it was. Surprising and baffling, mysterious, and, honestly, a bit unnerving. Scheduling Motherhood Pregnancy was the first deadline that I ever missed. After choosing a kid-focused and family-friendly career like pediatrics, motherhood seemed inevitable. It was not a question of whether, only when. But by the end of residency, I wanted an adventure. I wasn't ready for a comfortable pediatric practice, the home in the suburbs, and a baby on the way. At 29, I thought I had escaped the academic grind early. I didn't take any time off, speeding through the required four years of medical school, doing the minimum three years of residency, and taking an early exit into the professional world. Many of my friends were just beginning subspecialization fellowships that would take several more years to complete. I was ready to play, and the months seemed to stretch invitingly, even luxuriously, ahead of me. Thirty seemed the perfect age for childbearing. I would have nearly a year to recover from residency and still have plenty of time to squeeze in a few kids before my genetic risk went up at age 35. I'm not even sure why I ever settled on that age, only that it seemed reasonable and right. Every other aspect of my life to that point had a deadline, so it seemed only natural that childbearing should, too. The Limits of Supermom I suppose it's a bit odd that I even considered a pregnancy deadline. My generation of women grew up with the ideal of supermom--the career-oriented, workaholic mother, somewhat less than nurturing, but eminently capable, and managing it all with aplomb. We learned never to sacrifice the dream of self for the future promise of children or for the success of a spouse. This seemed to be the paragon of self-fulfillment, satisfying all personal and procreative goals simultaneously. Even when I was 29 and 10 months, I somehow anticipated this "mommy switch" that would flip on and create instantaneous baby craving in time for my 30th birthday. But over the years, I have come to see working life as a tenuous balance of competing expectations. What woman would want to miss out on having a career or raising her small children? We want it all, so the real challenge falls to proportions. The supermom ideal feels too proscriptive, dictating no choices rather than offering space to allow for some choices. I think my deadline grew unconsciously from this supermom framework. I've always wanted children, but when to fit them in? In college, I thought perhaps never. By medical school, I thought definitely, but just not now--and, of course, I'd be back to work within hours of delivery. By the time I entered residency, I envied the stay-at-home moms completely invested in their children. But I also recall warning my residency colleagues in advance that if I turned up pregnant on the wards, it was definitely an accident. By the time I completed my training, I just assumed that maternal instincts would take over. But by the end of residency, I still clearly wasn't ready, so ... age 30. Thirty became the compromise. Even when I was 29 and 10 months, I somehow anticipated this "mommy switch" that would flip on and create instantaneous baby craving in time for my 30th birthday. Finally, 30 was not the magic deadline after all. The goal then turned out to be running a sub-four-hour marathon. My husband and I ran together, and we realized during the last two miles that we were going to best our time goal. I remember passing the 25-mile marker and thinking, OK, now I can get pregnant. It wasn't a particularly fast time, but somehow it quantified and satisfied the sense of adventure I craved. There was no mommy moment. There was no epiphany. But at last I'm an expectant mom, and finally, I'm thrilled. --Ellen Rothman, HMS '98, now practicing in northern Arizona on the Navajo Reservation Opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.