“I’m taking another job,” said our nanny after my husband and I returned home from a rare date night.

My immediate numbness was a sign that my mind, body, and soul knew what was about to change in my life.

I had thrived over the past three years as a mother and a physician, despite the many expected challenges of early parenthood. I had started a new job as I found out I was pregnant with my second baby. I breastfed and raised two young kids throughout a pandemic in which people did not want to wear masks to protect kids and worked as a child and adolescent psychiatrist committed to serving those most affected by the hateful racism and ableism affecting their everyday lives.

Every childcare transition was hard, adjusting to new nannies and daycares. Every time, the toll was heavier for me. If the nanny was out sick, I would cancel my clinic or staff patients on the phone while medical residents ran the clinic. As a passionate clinician, I felt defeated about the care I was able to provide patients on these days, yet knew my heart was at home ensuring my kids were taken care of.

After the nanny left and we tried desperately to find a replacement, I talked through all the options with my husband, with my employers, who were all men, and with friends. I kept trying to make the puzzle pieces fit, playing with them in my head over and over again… the number of hours I could have backup childcare coverage, the work duties I needed to fit into when school would be out, and whether my benefits would be affected. I tried to make it all fit in a way that made any sense. But I couldn’t make it make sense.

The anger, grief, and helplessness were overwhelming for several months. Sadness, fatigue, social isolation. Yet I felt motivated and hopeful. I’ve been depressed before; this was not depression but the result of oppression. I’m a passionate child and adolescent psychiatrist who has always gone above and beyond to expand education and mentorship to others. I am no less qualified, talented, or experienced for putting my kids first. In fact, I am wise and strong as I push boundaries our current system does not support.

Symptoms worsened when I had no outlet to process these feelings with the people who are supposed to be there for me during tough times. Then they got better as soon as I clearly voiced my concerns and needs to my husband.

“This happened to my mom, your mom, my sister, aunts, and friends,” I told my husband, who struggled to understand why I was having such a hard time making a decision on where to let go of my dreams, my voice, my power. This was my bleak attempt to explain how collective, historical, and transgenerational trauma unfold for women.

As if things couldn’t get worse for women, the Uvalde Elementary School mass shooting happened, requiring a full reassessment of risks vs. benefits of sending our kids to school. A few months before Uvalde, we had toured a new school we hoped would be a better fit for our child, who did not do well in traditional daycares. I walked in, surveying where the guard was, whether the front door was locked, how quickly a person could get to students and where students could hide. “Does the front door lock?” I asked the person leading the tour. “No, why would we lock it?” She asked. I felt silly bringing up the possibility of someone walking in with a gun, so I didn’t. We live in Texas, where we have an average of 30 mass shootings per year. These are the worries we endure as mothers, powerless as politicians continue to delay legislation to protect our children and communities.

Then came the U.S. Supreme Court’s decision to overturn Roe v. Wade. Women around me were sad, angry, and helpless, while men couldn’t fully grasp why. “My mental health is off this month,” I heard from other women. When I pointed out the relationship to national politics, most were surprised to recognize that it could be impacting them that way.

I’m an adult, child, and forensic psychiatrist. My worldview is shaped by years of medical, psychological, and sociological training and education exploring the relationship between human psychology and social structures, such as racism and the legal system. I have 14 years of medical training after college. Yet, losing our nanny has quickly taken away my ability to attempt to take space in the currently viable workplaces created by and for men and those willing or able to fit into those molds.

“How have we not figured out how to keep women in the workforce in a way that uplifts and sustains their power?” I keep asking everyone who listens. The U.S. Chamber of Commerce notes one million women are still “missing from the workforce.” One-third of women reported not returning to work due to the need to take care of their children or family, and one-third reported they needed to prioritize their health. Most women I know are figuring out creative ways to keep their voices and power in our current social structures called workplaces. Many turn to consulting, creating small businesses, and finding ways to share their knowledge, expertise, their value. Our value.

I don’t yet have an answer. I’ve spoken with many women dealing with this struggle, some of whom have succeeded, or at least are for the moment, to make things work. To the outside world, I appear to be succeeding. Perhaps I am if I redefine what success means.

“It’s so nice to see a Latina and a mom doing so well,” a medical student texted me after I gave a presentation to a regional Latino Medical Student Association last Fall. With a lump in my throat, I “hearted” her message, knowing I was not sure how long I could keep it up. Knowing I may one day disappoint her too.

Barbara Robles-Ramamurthy is a psychiatrist.

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