We welcomed our sweet baby girl into our family in late September, and the fall was a busy and challenging season. The weeks of maternity leave passed in a blur, and then it was time for my follow-up appointment with OB. I was nursing my newborn when I palpated a firm, elongated lump. As a general surgeon, I had palpated similar masses in patients undergoing lumpectomies and was concerned enough to mention it to my doctor. She examined me and to my surprise found a second mass. She referred me or workup of both areas.
At this point, Josh was in his final months of a year long neurosurgery chief service assignment. He was exhausted and burned out. He left daily at 6 and came home around 8 to 10 pm each night. I was doing morning and evening routines with the girls alone most days, and he was heartbroken from missing out on this time with the girls. I tried to shield him from domestic stress with varying degrees of success. Some days I would throw my own pity party and fuss about how much was on my plate, but mostly I really tried to get the chores done and let him enjoy quality time with the girls. Nevertheless, he was maxed-out, and I just couldn’t bring myself to burden him with the news of my appointment in the Breast Clinic.
I had completed several rotations on the Breast Surgery service in residency, and it was surreal to sit as a patient in the waiting room. When my name was called and I was ushered into a room, I saw one of my former consultants down the hall. She smiled and waved, and then a flicker of inquisitiveness crossed her face. I smiled one of those acknowledging, pursed lipped grins and ducked into my exam room. The result of that appointment was a recommendation for an ultrasound the following week.
I debated telling him about my upcoming ultrasound, but I just couldn’t. I felt like it would be selfish to tell him, but I had never kept anything from him before. Since med school, we have lived, studied, and worked in the same building. We have the same groups of friends, the same gossip. No detail is too mundane for us to discuss together. But here I was omitting something rather major. On the other hand, maybe I was just being melodramatic; this notion was compounded in my mind by thoughts that I was going to need a biopsy, maybe had cancer, maybe would need chemotherapy and surgery, maybe wouldn’t be able to keep nursing my newborn, maybe wouldn’t be there for my girls as they grew up…I had to keep reigning in my imagination from these dark ramblings.
I didn’t tell him that week. I called my sister and my mom, venting my stress to them. I called my best friend and asked whether I was doing the right thing. I got various bits of advice from each of these trusted confidants, but I didn’t know what to do. That weekend, we had to drive 3 hours to South Dakota for my weekend locums assignment. I waited for Josh to get off work, and he didn’t get out until after 9 p.m. I picked him up and tried to gauge his mood…Not good. He quickly shared with me that he had made an uncharacteristic mental error that day; no one was hurt, but he was very shaken by it.
I felt a rush of adrenaline pump through my body and inwardly panicked thinking that I had nearly made a huge mistake. This was one of those profound, “Oh Shit!” moments in life. If I had told him about my breast lump the day before, if he had to donate a thought to the scenarios floating around in my mind, if he had to spend an ounce of energy on the stress of thinking through the possibilities, I would have thought that this mistake was MY fault. If someone had actually gotten hurt, I definitely would have felt responsible. This was a new reality of having a surgeon spouse that I had never before considered.
On the drive and throughout the entire weekend, Josh oscillated between ruminating over his error and trying to enjoy the long weekend being “just a Dad.” He took the girls for fun activities while I worked, and we enjoyed some family dinner dates. I never told him about the lump or my upcoming appointment.
My stress the following week compounded. I wasn’t sure that I had cancer, but I was sure that I would need a biopsy. I had other locums assignments coming up, and I was imagining trying to reconcile my schedule. I wondered how long it would take me to recover. I wondered if I would develop a milk fistula from a needle or surgical biopsy. I imagined being exposed in front of my mentors and resident colleagues. I had tremendous guilt over the hysterical idea that I wouldn’t be there for my husband and children. I vented more to my mom, sister, and friend. My impatience for the ultrasound appointment was almost unbearable.
Then, finally, the day came. I dropped off the toddler early at daycare and then trudged through the clinic carrying my newborn in her car seat. I changed into a gown, nursed the baby so that my ducts would not be dilated, and waited for my turn. She fell asleep in her car seat. I climbed onto an exam table and stared at the ceiling while the radiologist searched for the lumps. When she had finished her exam, she gave me the excellent news that she had a very low suspicion that these were dangerous; one was just a very dilated area of normal breast tissue and the other was what she called a “lactation adenoma,” which I had never heard of, probably because those never have to be surgically removed. She recommended 6 month follow-up ultrasound and released me from the appointment. I was elated.
Josh came home from work at a reasonable hour that evening in a good mood, and I had dinner ready. I told him then about the entire situation, quickly cutting to the point that the result was reassuring. He stared at me with wide eyes and a crestfallen expression. Then he looked worried and asked again if everything was ok. He couldn’t believe that I would hide it, but I explained it to him and he didn’t give me a hard time about keeping it from him.
So here we are, a married couple deeply in love, but who have to consider the safety of one another’s patients in the news we reveal to one another. This was a new facet to our relationship, but one I can’t deny is important. We have to calculate if the stress of concealing a difficult situation outweighs the risk of burdening one another with it. As a two surgeon family, the personal and professional lines do get blurred sometimes, and I can only imagine this will become even more true working in austere environments where we don’t have stacked teams of surgical colleagues to rely on for support in the OR.
Anyone who has a spouse dealing with burnout might relate to the precarious balance of being a life-partner while protecting them from stress. I’ve also learned how it feels to be the “homemaker,” while my husband finishes an all-consuming training program. Particularly back then, while I was still on maternity leave, I experienced for the first time the stresses of being a stay-at-home parent with an over-worked spouse. I have to say, anyone fulfilling that role for an extended period of time deserves praise for the amazing amount of work and mental energy that is required. It was a humbling experience for me.
At that point in time, we were definitely operating over the line of what was healthy for our family. As physicians, ww hear about the consequences of burnout routinely, but this scenario was one I had never before considered. When I recovered from my own burnout in 2015, I realized that not even having time for a dog was my personal red-flag that I was giving up too much for work/training, and so I coined the motto, “If I’m too busy for a dog, I’m too damn busy.” Well, that was a much cuter illustration of this principle. I discovered just how much training was requiring of us, and it was tremendously more that I had previously estimated. Still, if we reach that goal of being able to truly relieve the suffering of many others, is it not worth it?
What would you have done in this situation? How can we establish healthier boundaries professionally? I would love to hear your perspective in the comments section below.