In medicine, we were taught to anticipate, diagnose, and predict conditions. Examining our patients allows us to assess the problem and make a plan. We generally know what is coming next unless some action or treatment is taken.

Personal and professional transitions are unlike medical conditions because we can rarely predict what will occur. Our life transitions can seem demanding, often onerous, because we female humans do not like change. In addition, as physicians, we especially do not like loss of control. Our transitions place necessary transformation front and center in our lives. Change is difficult since it requires not only our full participation but also our ability to adapt.

Before a significant life transition, we tend to give ourselves so much negative self-talk. What do I really want? Am I capable of doing this? Am I good enough to accomplish the change I anticipate? Can I overcome my previous limitations? Sometimes it is difficult to know exactly what we need to be successful and feel fulfilled. In addition, each transition requires our analysis of totally different things, things that we may not have anticipated.

Getting your first real job after residency or fellowship is one definite challenge, and one we anticipate and prepare for via education and degrees, yet once we begin to work for someone or something we learn that others have expectations of us. Are we clear on what those expectations are exactly? Do we have a boss, or supervisor who communicates clearly and provides feedback in a helpful way? I finished my fellowship in neonatology seemingly prepared to practice as attending faculty in the NICU without help. During that first year, I called upon several of my professors many times just to make sure my clinical decisions were sound. Did I need to do that? Probably not, but knowing they agreed made me feel more confident.

Changing jobs will always seem like a daunting task. You may be unhappy where you are and can put your finger on your grievances – money, time, schedule, colleagues, working conditions, or all the above. We change jobs for many reasons, knowing mostly what we do not like and hoping to find a job that will be a better fit for us. Yet, leaving one job for another can feel like stepping into the unknown, abandoning the comfort of routine for the uncertainty of change. The familiar faces, the rhythms of our practice and workplace, and the sense of belonging will fade as we adjust to our new environment.

In my forties, during a period of midlife burnout and upheaval, I jumped ship from the NICU to a medical director position at a small HMO. That new and different “executive physician” job was so easy – eight to five and no weekends. I only had to conduct phone conferences, meet with groups of physicians, and conduct data review. It was a heavenly change from being up at 0200 in the NICU many times during each month. But I found myself having to say no to another physician who was attempting to arrange for some treatment or medicine to be approved for his or her patient. I did not enjoy finding myself in this position, nor had I anticipated the feelings that situation engendered. I felt like the enemy! A great schedule with weekends off is not everything in a job, so I carefully bounced right back into clinical care in (a different) NICU, knowing that it was busy, tiring, challenging, but oh-so fulfilling.

Any major job change might be helpful. Alternatively, it might be harmful unless we know what we are getting into ahead of time, unless we have a thoughtful mentor or advisor, loyal friends, and a supportive partner or spouse. Listening to trusted friends, partners, and colleagues is paramount in importance during life’s greatest transitions, especially for our midlife challenges. Your mentor can guide you through this. If your spouse or partner is not onboard, you are generally sunk.

Getting a divorce is the most awful transition that some of us ever deal with. Divorce signals a transition fraught with emotional upheaval. The dissolution of a marriage brings with it a cascade of emotions -loss, grief, anger, and sometimes relief. I cannot imagine the pain that is attributed to this process. Recently, I read Maggie Smith’s memoir, Maybe You Could Make This Place Beautiful, about her divorce and recovery, and now I have a clear understanding of the struggle and suffering that she endured during this process. She kept her two children firmly rooted with her and underwent a metamorphosis into an independent, thoughtful, loving, and creative person married to herself. You may enjoy her fabulous poem, “Bride,” published in The New Yorker magazine, in which she writes beautifully about being married to herself.

Becoming a mother, or matrescence, is huge for nearly all of us. Whether you want to get pregnant, have trouble getting pregnant, or became pregnant inadvertently, once you have your baby, your life is changed forever. We all become mothers in different ways, depending on the health of our pregnancy, the health of our baby, and our own mental health. Matrescence is one of the most challenging transitions for women physicians as we learn the boundaries between being a mother and practicing medicine.

Before having children, we come to realize that our practice does not fill those parts of us that need human connection, love, and intimacy. We evolve to want more from our lives than just medicine, yet things do not always work out as planned. One survey study found that nearly one-quarter of female physicians who had attempted conception were diagnosed with infertility. Navigating IVF has become a minefield for many of us who postponed childbearing until after the long hours and sleep deprivation endured during our training. The clear reproductive cost we pay when we delay having children is described accurately in this recent article in the New York Times.

One of my mentors, whom I greatly admired, was a consummate academic physician with several NIH grants and an active research career. She remained single and childless, forever devoted to her career. Much later, while we were catching up at a meeting, she told me that she wished she had married and had a family like I did. She was the academic star who felt she had missed out on something vital that, over many years, she had watched me enjoy. Such a sad testimony.

Having a second child is a transition that many of us desire, but once it occurs, we look around for the reasons we ever wished for such an upheaval. As a mother of two, you are outnumbered, especially if your spouse or partner is of little help. But the burdens lessen as the first few years proceed, and the first child becomes less threatened, more independent, and even helpful. Two children are the perfect pair, unless like me, you look at your spouse and say, “They will only have each other, and they need another sibling.” Both my husband and I came from large families, so we literally talked ourselves into a third child. It has been bedlam ever since. Perhaps if I had not worked full-time, three kids would have been controllable, but life at home never seemed truly manageable for me.

Transition periods are often marked by uncertainty. When we’re faced with a significant change, we often feel a loss of control, and this loss can be disorienting and anxiety-inducing. We may feel anxious about our situation and the possible choices that lie ahead. We may be unaware of what we really need to feel good about ourselves. This is the perfect opportunity to lean on your support systems. A discussion with a trusted friend, mentor, or advisor can help greatly. Finding validation from a close colleague can be crucial prior to embarking on a big change. Does she agree that you need this change in direction? If so, it helps you to hear that from her.

As physicians, we all want to predict, confirm, and understand our experiences as fully as possible. However, in navigating a transition period, we often don’t know what is going to happen next, and that invites our fear, anxiety, and worry. It is okay to feel all the complex emotions during your transition periods. Despite their difficulties and challenges at the time, our life’s transitions have two things in common: our lives were never the same, and we evolved.

Every transition teaches us about our strengths and our weaknesses, especially during midlife. In passing through each of life’s transitions, we are rewarded with learning so much about ourselves. I urge you to take some time to pause and truly reflect on your situation and to consider what you really want. Remember that the pause is that space between the stimulus and the behavior. The pause is the place where we really grow. We pause so that we can give ourselves time – time to rest, time to relax, and time to quiet our negative self-talk.

Susan Landers is a retired neonatologist with 34 years of experience and has practiced both academic and private medicine. She can be reached on her website, Instagram @drsusanlanders, Facebook, and Substack.

She is an expert in burnout, breastfeeding medicine, and human donor milk banking. Her memoir, So Many Babies, is a realistic look into life inside the NICU and recounts many of her travails as a professional working mother. Her new eBook is Defeating Burnout: A Guide for Working Mothers. She publishes a popular newsletter called MomsMatter on Substack and a blog for parents on her website.