My Fourth Child

  • Ruchi Kaushik
    Address correspondence to Ruchi Kaushik, MD, MPH, Department of Pediatrics, Children's Hospital of San Antonio, Baylor College of Medicine, 333 N. Santa Rosa St, San Antonio, TX 78207
    Department of Pediatrics, Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, Tex
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Published:January 16, 2020DOI:
      We always wanted 4. My husband and I each have 3 brothers, so it seemed natural: the chaos, the commitment. Or perhaps the commitment to chaos. And, yet, I found myself, in my mid-30s seated in a graduate school classroom in one of those desks attached to a chair with a metal frame basket underneath. The room was bubbling with the unjaded chatter of 20-somethings. Mostly women. My youngest daughter was an 18-month-old at this point, my oldest in second grade, and we often quipped that our 3-year-old was the only adult in the house.
      I was in my seventh year of pediatric practice, and I was tired. An almost full-time physician, part-time student, and overextended mom. My husband was in his eighth year of postgraduate training. A mortgage in one state and a rent check in another. Child care. Grad school tuition. But we always wanted 4.
      I knew before kindergarten that I would be a doctor, primarily because this was an expectation of immigrant Indian parents. Medicine proved to be a good career choice however, as I grew to learn that I needed to be needed. Raised in southern California, I went to medical school in India at the age of 18, where Social and Preventive Medicine was my favorite course and going door-to-door to administer polio vaccine drops in every child's mouth was my favorite activity. We got married during my third year of residency in Buffalo, and then traveled the training trail as many physician couples do. Queens, Omaha, Minnesota.
      In Nebraska, we bought our first home, brought 2 tiny girls into the world, and grew our village. When my littles were born, I held them constantly. As soon as my pregnant belly had grown enough for me to put my arms around them, I did, and once born I really didn't put them down until crawling was delayed. Their hairy little heads always cradled in the nook of my neck. To this day, nothing has brought me more joy than parenting. When my oldest started school, I volunteered with the Parent Teacher Association and tried to make it to her events and performances.
      I practiced general pediatrics with a faith-based organization whose mission aligned wholly with my values. I cared for children with diverse socioeconomic backgrounds and, on some days, I would speak in 3 languages at work before I came home. Caring for over 30 patients per day and addressing both medical and social problems was rewarding; I felt needed. I read journal articles advocating for social determinants of health screening and became inspired to apply for a grant for an on-site social worker. I designed a fluoride varnish application instructional video for rural family practice physicians that won 2 national awards. As we moved north for my husband's fellowship, I decided to pursue a master's degree in public health.
      Given the recession, we could not sell our house.
      Perhaps it was financial insecurity; or that I lost my village; or the exhaustion of being a physician mom; or the endlessly gray days; or that, as a hospitalist in my new workplace, I missed the socioeconomic diversity and wasn't needed like I had been in primary care; or it was the news of a horrific school shooting. Regardless, I felt joy slowly slipping away from my body.
      In the wake of horror, many in our country quickly came upon the realization that if nothing could be done after 20 young children and 6 brave educators were senselessly gunned down, then nothing could be done. Ever. Hundreds of miles away, I, nevertheless, took ownership and accepted accountability. Why could I not protect these children?
      The vernal equinox of 2013 had come and gone, but Minnesota gripped the February page of the calendar tightly, resistant to let the pages turn or the snow to melt. During those relentlessly gray days, I felt both the cold and failure, as a pediatrician and as a mother, bite at my bones.
      One morning, in my post-Sandy Hook fog, we were hurriedly donning winter outerwear, when my daughter said, “Mommy, I'm almost done with the last Harry Potter book.” I was so pleased with my voracious reader, but then she said something that haunts me still today, 6 years later. “But I'm sad because when I'm done reading it, I will lose my only friend.” Her only friend? How did I not know more about how many friends she had (or didn't have, apparently)? Consumed in my own numbness, I had disengaged. Moving from one state to another and changing elementary schools could not have been easy for her either.
      These thoughts streamed in the background of my mind, like B roll, as I sat in the classroom, quietly listening to the verbalized, unfiltered thoughts of millennial public health students. The topic of physicians came up. Doctors are not worried about prevention...doctors do not spend time with patients...doctors are most worried about their pocketbooks. I bristled. I carried the weight of the world's problems daily. I could not believe that anyone would blame me of greed or selfishness. I had always let empathy and humility guide me through my journey as a pediatrician; why would anyone think otherwise? Was I angry because these comments were simply not true or because, recently, they had become true for me? Was this burnout? Perhaps this is why I couldn't find my voice to launch an adequate rebuttal. Instead, I unleashed my frustration in writing on my keyboard.
      I am a Pediatrician
      I am a healer. I serve your child and family to heal both her physical and nonphysical ailments.
      I am an educator. I provide anticipatory guidance regarding growth, development, and safety daily.
      I am a learner. I approach innovative research and updated policy recommendations with an open mind and apply them to practice daily.
      I am a parent. I, too, struggle with similar issues in my own home.
      I am a friend. I listen to your frustrations and fears as a caregiver, and support your strengths and successes.
      I am in marketing and sales. I sell children's health.
      I am in research and development. I investigate today's health topics and how addressing these issues can benefit the health of our children.
      I am a travel agent. I help families to plan their journey and how they would like to experience it.
      I am a liaison. I bridge the gap between primary care and public health.
      I am a lobbyist. I collaborate with policy-makers to place the future of our children at the top of legislative priorities.
      I am a journalist. I contribute informative articles to various publications to educate our parents and caregivers.
      I am an attorney. I represent and advocate for innocent and eager young minds.
      I am a confidant. I provide young adults with a safe environment to discuss their choices in health behaviors.
      I am a mediator. I often help settle disputes among caregivers about parenting methods.
      I am an advocate. Amidst family dysfunction, I stand up and carry vulnerable youth.
      I am a Pediatrician.
      I read and reread words written in frustration. I'm not sure if I was frustrated because my intentions were being questioned by those who had no practical comprehension of my life or if I was already feeling out of touch with my own mission as a result of burnout and disillusionment. Staring at the words, I knew that I had, at one point in the past, fulfilled these roles, not only professionally, but also personally, in my own home, as a parent. How did I get here? And how do I get back to where I used to be?
      I was blessed to have had a support system that helped me move through my pain and reconnect to my earlier vision. At times I needed to be needed, but at that point I needed a cause. To again find meaning in medicine. Despite the grueling surgical fellow's schedule, my husband noted my emotional decline. He planned a screen-free weekend getaway to one of Minnesota's 10,000 beautiful lakes and we walked in the sun. He reminded me of the dreams I once had to save the world's children and reaffirmed his support for my career goals. We rejuvenated as a family.
      At home, I began to ask my daughter more pointed questions about her day, listening intently for the words she wasn't saying. I started to exercise outside again as the sun began to peek out more through the gray. Once disillusioned by the lack of political will to keep our children safe from firearms, I attended the American Academy of Pediatrics Legislative Advocacy Conference in the spring of 2013. Commiserating with my cohorts, who were just as horrified by our nation's gun violence public health crisis as I, was validating and reenergizing. It was as though I had the opportunity to grieve with my “work family.”
      Moving to a warmer climate in 2014 also contributed to my improved mental wellness; however, positioning advocacy as central to my practice of medicine gradually led me back to my mission: To “save the babies” and to teach others to do so as well.
      Alongside tens of thousands of pediatricians in our country, I adopt the children of the world. I know now that the children I serve every day in clinic and in my community are, collectively, my fourth child. I will celebrate their successes, and share in their sorrows. I will forever worry for their safety and well-being. I will cry while driving to work and listening to their stories on National Public Radio. I will lie awake at night wondering if they will ever see a life better than my own. And I find solace in knowing that, although I can't make their world perfect, I will stay engaged, I will fight for their best interest, and I will join my fellow Fighters of the Good Fight in educating and assembling an army of future child advocates. For me, this has brought meaning back to medicine.