It is a little after 9 a.m. I am about to start the second of a long list of endoscopy cases when my phone rings. I glance briefly at the caller ID to confirm it isn’t my office or the hospital calling about another patient, and am quickly overcome with dread as I see the screen reads, “daycare.”

Intuitively, I know why they are calling. My four-month-old must have a fever. He had received his scheduled vaccines the previous day and had been febrile all evening. In the morning, he seemed his usual self, so my husband and I sent him to daycare, fingers-crossed.

“I am very sorry,” I tell the patient and the circulating nurse, “this call is about my son. I have to answer and will be back in just a minute.”

I step into the hallway, answer the phone and am not at all surprised when the daycare director tells me my usually calm baby has been crying inconsolably all morning and is febrile again. I feel terrible but am not surprised.

“OK, yes. I understand,” I say, “let me call my father and he will pick him up right away.”

My father, a retired engineer who lived the first half of his life in a different country and a different time where men worked while women raised children, currently helps me with childcare. My husband and I are both physicians who need to be at the hospital before daycare opens and often after it closes, so my father takes our boys to and from daycare, stays with them until we get home and watches them on weekends that we both have to work. He is a tremendous help, but, understandably, has little clue about what to do with a sick baby.

I peek into the procedure room — the gastroenterologist is not ready yet. I breathe a quick sigh of relief and dial my dad. The call goes directly to voicemail. I curse silently, remembering that he had an appointment this morning and must still be unavailable. Aware of my limited time, I call my husband and say hurriedly, “Daycare called, Benjamin has a fever. I can’t reach my dad. Please call and tell them he will be there as soon as he can, and then keep calling him until he answers. I have to start my case.”

With that, I am back in the procedure room. I apologize again to the patient. In the meantime, the endoscopist has slipped in unnoticed and is ready to start. I scan the monitors, prepare my syringe, complete the timeout and initiate the anesthetic. Once the patient is sedated, the procedure begins.

Everything is as it should be, yet I feel unsettled. A hundred questions cross my mind simultaneously. Will my baby be OK without me? What about the busy lineup? How can I possibly tell my father everything he needs to know in a hurried phone call? How can I leave my patients? Will he know what to look for if I don’t tell him? Will there be anyone available to cover for me today? What if he makes a mistake? Will worrying about my son affect my patient care? I find myself wishing I could be in two places at once.

After some internal debate, I reluctantly decide to call my office. I tell my scheduler about the situation, and she promises to work on it. “What time will you need to leave?” she asks. “I will stay until someone can get here,” I say, “whatever time that is.”

Moments later, I hear that my colleague, whose original cases canceled, is on the way. He arrives before the end of my case, and I thank him profusely. I finish my case, take my patient to PACU, thank the endoscopist and circulator and apologize again for the last-minute change. Everyone is understanding. On my way out, I inform the endoscopy scheduler, who is already aware, of the change and apologize again. “No need to be sorry, ma’am,” she tells me, “you’re a mother first.”

These words resonate with me in a way I find surprising. Am I mother first? I became a physician long before I become a mother, even before I knew I wanted to be a mother. Upon donning my white coat, I accepted an obligation to my patients. Holding my babies in my arms for the first time, I took on an equally demanding commitment to my children. Yet, I feel that neither role defines me more than the other; I am neither physician nor mother first — I am both. Must one role automatically demote the other?

Navigating this dilemma is the essence of being a physician-mom. Every day, women physicians with children struggle to strike a balance between two equally demanding roles without feeling that success in one indicates failure in the other. It is a difficult and dynamic balance that requires constant flexibility and, ironically, an understanding that a balance is not always possible. Some days one role must take precedence. For me, an emergency or a late add-on case means I help my patients while missing dinner and bedtime stories. My patients may not know that my children miss me — and my children may not yet understand why I cannot be with them every evening — but in prioritizing both of my roles equally, I fulfill my obligations to each in their own time.

As I drive, I worry about my son, but simultaneously feel riddled with guilt over leaving my work. Did I make the right decision? Maybe I should have stayed longer? Am I a mother first?

Mid-morning, I arrive home, where my baby is waiting for me. I scoop him into my arms, give him medicine, rock him gently, and he falls asleep. I feel his little body radiating heat against me as he breathes softly into my neck. I kiss his forehead, and suddenly my guilt is gone. Yes, today I am a mother first.

Kelly G. Elterman is an anesthesiologist.

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