I was asked to reflect on the accomplishment of being a “Young Urologist of the Year” and what it meant to me. I would like to use this platform to tell my story in the hopes that it will provide reassurance and fortitude to others. There are a limited number of people in the field who can attest to the veracity of my story, and that is because it was tightly held for a number of years.

There was a singular moment when I knew my mother would decline from early dementia just as my grandmother had. I was a neuroscience TA at the end of my second year of medical school. When she could not map between 2 malls we went to for years, I knew her parietal lobe was suffering and that her cognitive capacity was in danger. As I entered third year clerkships, I tried to dissuade myself from my love of surgery to choose a less strenuous specialty. Chief among my fears was the looming prospect that, if I used my grandmother’s trajectory, my mother’s health would decline and crash somewhere in the middle of a long surgical residency. Another variable is that my brother is bipolar and my mother cared for him in his adult life, so there would be not 1 but 2 people to care for. Uncertainty is perhaps the most difficult thing to weigh on the pro/con list of a specialty choice or rank list.

I chose with the reckless stubbornness of youth to follow my dreams and pursue urology. Further, I chose New York City, so far from my Florida home. Midway through I knew I wanted to be an academician and pursue fellowship. Simultaneously, my mother was declining substantially and my brother, incapable of independence and saddened by the impending loss of his mother, went into a tailspin. There were fewer women in urology at the time, and we did not speak about the challenges women face. In fact, family obligations were openly considered a detriment and “distraction” from work—usually evidenced by the messaging not to have children. So, I made the decision to keep my own challenges a secret. As I decided on male reconstruction, a burgeoning specialty with almost no women, I thought my gender would make it tough enough to get a fellowship. I thought, and still think, if I added to that the struggles of my family life that no sane fellowship director would have taken me on and trained me. To be fair, if I put myself in their shoes and weighed myself as a candidate, reasonable but not from a pedigreed background and with no research to speak of, it would have been a risk to take me even without knowing my personal struggles.

I decided no matter how difficult it got that I would keep my family issues a secret (and it did get difficult). At 28 years old, as I was grappling with the diagnosis and my mother’s decline, I found a support group in the city. I told 2 trusted coresidents close to me in the junior call pool. Once a month they would cover my pager for 2 hours if I happened to be on call so I could go to this support group. I am forever grateful for the added work they put in to make that possible. Nearly as soon as I felt comfortable in this group though, I divulged too much about my own situation in an emotional outpouring of grief, and the response made me realize that I would have to be cagey in my support as well as at work. Mandated reporter laws make it such that there were things I could not say in regards to my family, and my status as a physician made me all too aware of them. Later, in desperation, I found a counselor, who to his credit knew I needed help and had nowhere else to turn. He made me his last patient of the day and let me stand him up quasi-regularly knowing that I was scrubbed. By this time, I was going through the application cycle, and ironically, it was the absolute worst year of my life. My brother made regular threats, my mother was having paranoid delusions, and the power structure of the residency shifted, upheaving the status quo. Yet, I flew hither and thither sleeping in 4-hour increments to put on a suit, a smile, and charm people. I matched into a new fellowship and was grateful for the opportunity to train in a subspecialty about which I was and am deeply passionate.

Two months shy of graduating after a 6-year residency, I walked into the new chairman’s office and broke down sobbing. I had to go home to get power of attorney so I could pay the family bills or there would be consequences. I think my announcement was a shock to everyone. I was so openly chatty about my husband, my dreams, and the plan to be a daytime reconstructionist and weekend hobby farmer that the idea that I hid this incredibly huge personal chunk of my life for 6 years was jarring. The thing is, I wanted everyone to say, “she was a great resident,” full stop; not “she was a great resident, despite all the challenges she faced.”

To be honest, the situation has never gotten easier, but what has made a tremendous difference is the shift in culture that happened around me. Even in my first year as an attending, when I moved my mother in with me for about 6 months (the first attempt), I did it quietly. I told perhaps 2 people in the department about my situation and worked rigorously so that people would know I deserved my job. But as time passed, the culture has shifted to talk not only of work/life balance, but to acknowledge that family obligations are a thing that happen to everyone, though perhaps disproportionately.

The reason I want to share my story now is to live by example. I want to show students—especially women, who will often be caretakers— that it is possible to navigate difficult situations and be successful in one’s career. While I would not wish my struggles on anyone else, these hardships have been deeply formative in who I am as a person and physician.

This is a call to action for all in surgical education. It is time that we acknowledge that life does not happen in a vacuum. Students, residents, and even faculty need to be able to acknowledge openly when one of these life challenges happens without fear of retribution or career consequences. We need the support of our colleagues and departments. We cannot and should not penalize trainees for the things that happen to them or around them—that is literally insult added to injury. Parents will age and die. Residents will have children. The health of spouses or children will falter or fail. Not to mention that a trainee’s mental health will suffer under the strain of residency. This is real life. It happens in tandem with training. If the goal of mentoring is to maximize the potential of each student or trainee, that includes helping them weather the storms that life will inevitably bring.

I am elated to see the changes that are occurring with mental health, parental leave, and more. However, there is still much work to be done changing surgical culture. I would like to think that a resident now in a similar situation to mine might have the time to seek counseling by the light of day, or negotiate long weeks off to see family without fearing for their career prospects. I hope that what was viewed as a weakness then, is seen as a strength now: the perseverance to endure despite hardships, rather than a distraction from the work one ought to be doing.