I made a mistake.

I almost failed out of undergrad as a premed. Yet this wasn’t the greatest mistake, the one that’s only now dawning on me as I stand at a crossroads in considerable decision-making despair.

Growing up in a loving yet highly dysfunctional home, I turned down a full presidential scholarship to attend a highly coveted college to make my parents, who grew up impoverished, proud. Yet the lingering trauma from my unstable home caught up with me in a highly competitive and unforgiving environment. I was living in the dorm like so many. Yet not like so many, every shout, every bang of a door sent a shock wave through my system, and I’d have to beg my body for hours to let me drift off once again. I was barely balancing a premed double major, waitressing, unspoken family trauma, and untreated crippling anxiety and depression. I tried to seek help from numerous avenues, but I was just another tuition at my rich institution that touted a 96 to 98 percent medical school acceptance rate. While girls in my classes were off buying Louis Vuitton purses at Boston’s elite shopping centers, I was working double waitressing shifts coming off an all-nighter for a biochemistry exam and walking an hour home in the freezing cold, my depression finding solace in the pitch-black darkness of winter’s night. My insomnia was so severe that I failed a final exam in my genetics class and received a D overall because I could not stay awake long enough to complete a question. Yet I soldiered on as I was taught to do as a child and initially told no one.

Just beneath the painful challenges, the inner resilience burned alive. I was damn sure I had the capability to succeed, despite the assurances by that genetics professor that I would never go to medical school.

While en route to recovery, I also began my ascent out of the academic hellhole that stripped me of considerable future opportunities. I was hired to work in a world-renowned cancer lab and was published for the first time; I was accepted into a post-bac program at an Ivy League institution where I achieved a 4.0 against all odds, and I started my own tutoring business upon discovering that medical schools were still completely uninterested in me (turns out it would take many, many 4.0s to rebound from the 2.29 premed GPA that made me sweat each time I sat down with an academic advisor). Finally, I learned that I could create a sexy new master’s level GPA to complement my still-pathetic undergraduate one. Aha! Finally, a tangible solution to my tainted record! I jumped into a highly competitive master’s in biomedical sciences program, rose to the top of my talented class, achieved above the 90th percentile on the MCAT, and was finally accepted into medical school—my long-awaited dream come true.

Since I worked throughout these years of school and in between them, by the time I was finally accepted, I was 32 and married to the incredible man with whom I wanted to start a family. I remember the night I was accepted, I was ecstatic. But as I tried to go to sleep, the panic set in: what about having a family? How would I have a baby and go to medical school? Could I just wait it out until I finished my MD?

Turns out, my body couldn’t wait. There were early indicators that my fertility was more fleeting than I had imagined, followed by diagnostic testing supporting the same conclusion. After succeeding during my first two years of medical school and on the USMLE Step 1 board exam, I put my health challenges front and center and took a leave of absence just as the pandemic reached paralyzing heights for medical academia. I was told by some mentors it was a good time to be out anyway, and that medical students were frustrated by their lack of involvement. I endured two miscarriages followed by a tenuous pregnancy and physically traumatic childbirth with complications landing me in the ER twice. Yet the purposeful passion and the burning resilience carried me through a difficult postpartum period during which I worked remotely in public health while also trying to keep up with my arsenal of medical knowledge.

Now, I am within months of my return to clerkship with a baby, no family help, and a loving and supportive husband who works exhausting hours as the owner of a brick-and-mortar business one state away from where I attend medical school. My baby doesn’t like to sleep, securing reliable childcare is now excruciating, and we are not sure how to juggle this financially (the demands of clerkship mean that for the first time, I won’t have the luxury of keeping a side income gig going), and we long to try to give our daughter a sibling. Yet I have maxed out my school’s generous leave policy. I need to make my return but am taken aback by this sudden overwhelming desire to be consumed by motherhood, to embrace each moment with my child, and to even try for another.

It took almost a decade of tremendous sacrifice for me to compensate for my academic transgressions of undergrad, but beyond the unrecoverable academic debt and the loss of potential earnings, the greatest cost is the family I had once envisioned and can no longer attain. Before pregnancy, I channeled the pain of the fertility challenges towards creating a nonprofit to serve first-generation, underserved undergrads so they could avoid my mistakes. I’ll soon be working to prepare my daughter (and myself) for painfully long hours of separation. I’m burying my deep desire to go all in on motherhood and try to conceive another, to have the family I’ve yearned for all my life.

And I’m finally realizing that my greatest mistake was to dedicate my heart and soul, my blood, sweat, and tears to a totally unforgiving profession.

Emily Kahoud is a medical student.