I’m brushing my teeth in preparation for bed, long before my children, since I am coming off of a string of late-evening shifts and am somewhat sleep deprived. My two teenagers pile into the bathroom and loom over me. “Aw, Mom is going to bed. Are you tired?” They draw out the word, t-i-i-r-r-r-ed, in a good-natured imitation of my complaining. As I fall into bed, they come over and ruffle my hair, kiss me goodnight, and tuck the covers under my chin in an echo of a bedtime ritual long ago, when the roles were reversed.

Ten years ago, I wrote about my struggles trying to balance my doctoring life with my life as a mother of two small children.Reference Murray ¹ My small children are big teenagers now, and, although I still struggle with my dual roles as a mother and a doctor, life is now easier. My children are beginning to break away and forge their own paths. They are pushing away from my mothering and making their own decisions. They don’t need me constantly anymore. While this is poignant, it is also freeing. I can put in longer hours at work when needed without feeling frantic and guilty. I can go out and exercise or see a movie after having worked all day, and no one cries or clings to my leg.

The fact that I am a doctor is now a source of pride for my children, rather than something they don’t understand that takes me away from them. I hear them saying: “My mom is an emergency doctor.” Their friends ask me about my job, and my children laugh knowingly or chime in to contribute their own perspectives. “Yeah, Mom needs a nap when she works at night or she gets really grumpy!” They know that I’m missing the soccer game or horse show not because I’m uninterested, but because my job sometimes requires me to be at the hospital when they have activities. They also know that if it is important, I will make the time, but that they have to tell me in advance.

I worried tremendously about my regular absences in their lives when they were small, but these absences do not appear to have affected them. Our relationship remains loving and mutually sustaining. My working absences have even had a few unanticipated bonuses, including that my husband was our children’s sole caregiver during countless evenings, weekends, and holidays. It was hard for me to give up being “special” to our children in many ways that my friends were—mothers who always put their children to bed, whose children couldn’t fall asleep or wake up and get ready without them. But sharing those responsibilities allowed my husband to be an equal partner in our parenting, and our children’s relationship with him is enriched as a result.

There were so many days when I yearned to be a stay-at-home mother, grieved at my forced absence from my children, and envied my friends who had taken time out from their work or left their jobs altogether. I worried that my children were paying the price of my career choice and training, and that I was abandoning the most important part of my life for more “days at the office.” On reflection, I don’t think that my career has damaged my children, and it may even have been beneficial. My time at work has shown them that although they are a huge priority in my life, they are not my only priority. They have had to problem-solve forgotten school items, negotiate public transportation to after-school events, and, occasionally, feed themselves in an empty house. They have delayed opening Christmas presents all day, waiting for me to come back from work and sometimes greeting me with concern, asking if there were any sick children at the hospital on Christmas Day. My work-related absences have helped create self-sufficiency in my children as well as an appreciation that other people might need help, even on days that others view as sacrosanct. I think this is a good thing. I wish someone had told me this when they were babies and toddlers, while I was miserably wondering if I could stick it out.

A female colleague of mine, a talented and dedicated physician-educator, wondered recently out loud whether she had made the right decision for her children by staying in medicine. Her children have become lovely, talented adults with interesting careers and a warm relationship with their parents. Yet she wonders whether she made the right choice. All that I could think about was the thousands of patients whose lives were improved or saved through their encounters with this fabulous doctor, and the hundreds of medical students and residents whose careers she has influenced. The cost of this woman choosing not to work in order to raise her children would have been astronomical—and the gain to her own children? Unknown. But the decision haunts her, nonetheless, and those feelings would no doubt be magnified if her children were travelling a rockier road.

When I teach the medical students at our university, I look out at the bright young faces in front of me and wonder how they will fare. More than half of them are women. We invest so much time and energy into their future careers as physicians, and they have seemingly limitless potential. But I fear that, once they have children, they will become conflicted, worried that their career will prevent them from being “good mothers.” When women doctors have children and then feel compelled to leave medicine in order to care for them, that is a tragedy for our profession. We need to talk about it.

At the end of nearly two decades, as both a mother and doctor, I’ve concluded that there is a fair bit of blind luck involved in what happens to our kids, whether one works full-time, part-time, or not at all. I had lots of ideas about how things would work before my kids were born, and exactly none of those ideas have transpired as I imagined. My children have certainly had struggles of various kinds, and some of them have been agonizing. I might wake up tomorrow and find myself embroiled in yet another crisis, wondering (again) whether I should take a break from doctoring in order to get by. When female doctors who are also mothers get together, this is what they talk about. Even those with adult children still discuss how to manage, how to stay sane, how to survive the challenges in our demanding dual roles. I don’t have the answers, but the struggle seems easier and more worthwhile than it did 10 years ago. The kids are all right, for today.