My tortuous journey to joy

The end of 2021 was a welcome closing to many life and world events, the most important of which for me was the completion of my fellowship after 11.5 years of medical training. The beginning of 2022 marked my arrival as a reproductive endocrinology and infertility (REI) specialist in a position that I am passionate about, that brings me immense contentment and satisfaction in my work life, and that complements my home life as a working, yet attentive and engaged partner and mother to my children. I’d like to say that my journey to this moment was laid out before me with smooth, well-paved paths, clearly marked signs with big arrows, and lined with colourful wildflowers swaying gently in the sun-kissed breeze. The truth, though, is that my arrival here was the culmination of mislaid plans, burnout, mental collapse, deep introspection, a push beyond my breaking point, and a calculated investment in an almost “leap of faith” strategy. I started medical school shortly after giving birth to my first child. Although I didn’t have an interest in a specific specialty, my experiences throughout my pregnancy and delivery, and my interactions with my obstetrician drew me toward obstetrics and gynecology. I immediately fell in love with the specialty and was an ob/gyn “gunner” from the very beginning. By clerkship, I had welcomed a second baby and I was struggling with balancing the demands of medical training with family life: I wanted to be the best student and the best mother, yet I felt like I was failing at both. On the eve of the CaRMS application deadline, I was genuinely torn between choosing a career that fulfilled me (a surgeon who delivered babies), or one that I knew would be a better fit for my family goals (a family physician who practiced obstetrics). That night, a trusted mentor said to me: “You can train anyone to be a good physician and surgeon. What you can’t do is train someone to be a passionate, caring and compassionate human being. No matter what you choose, it will be the right decision for you. If you love your job and it brings you joy, that will radiate into the rest of your life.” I took her words to heart and the next day I wholeheartedly committed to ob/gyn. Ob/gyn training started out well. I was happy in my specialty, I was flourishing, and learning so much. However, I struggled to find an appropriate balance in my life, constantly feeling guilt for not giving enough to my training while also not giving enough to my family. Seven months into residency, my oldest son was diagnosed with autism spectrum disorder, and I took a month off training to manage the implications of the diagnosis. During that time, I realized that my family needed me more than I knew, and I wanted more in my life outside of medicine. I wanted another child and being off work for a month made me realize that my commitment to residency was preventing me from taking this step. Despite that realization, I went back to work with the same vigour and commitment as before, convincing myself that if I loved my job and enjoyed what I did while I was at work, the sacrifices at home would be worth it. And, I also decided to have that third baby During maternity leave following the birth of my daughter, I no longer recognized myself: I was depressed, angry, cynical, exhausted, uninterested and detached. I dreaded my return to residency. I realized that while I enjoyed my specialty, it was not the right fit for me and the life goals I had. I wanted a change, but I was scared to look for it. I feared that not going back would mean I was a failure. In the end, I went back to training only because I felt trapped by the need to finish residency and my overwhelming medical school debt. Return to residency As I returned to my training, I convinced myself that the change I needed was to transfer out of ob/gyn and into a specialty that felt more appropriate for me: a family medicine residency. When my transfer to family medicine was accepted, I felt empowered and excited to be taking control of my life. However, I didn’t accept the position right away. That initial excitement was a thin, tenuous sheet of ice covering a turbulent mix of anxiety and fear that I was making a short-sighted decision for the wrong reasons. How could I know this was a decision I wouldn’t regret? How did I know I wasn’t running away instead of towards? Around the time the transfer was offered, a bright spot in my training emerged. I had just started a rotation in reproductive endocrinology and infertility (REI), an area that I had not previously considered as a career. I found pleasure and enjoyment in the consults and in helping people achieve a pregnancy they thought would never happen. The rotation was less demanding of my time, giving me the opportunity to delve deeply into the subject while also having more time for my life outside of training. As the two-week window for the transfer acceptance was quickly dwindling away, I was discovering a new sense of pleasure and happiness in my current residency program. Interestingly, one of my REI preceptors also happened to be someone who interviewed me when I applied to residency. One Friday afternoon he said something that served as a pivotal moment in my career journey. He said: “Ginevra, I have noticed that you are not the same person today as you were when I interviewed you. I am so disheartened to see that somewhere in the past three years, residency training has taken away the best part of you. But this week I saw that passion in your eyes again and I wanted to tell you not to let this difficult residency take away what you want in life. This part of your life is finite and when it’s over, you will go back to being that person I met in your interview. Don’t give up on yourself.” I spent this one weekend, the fulcrum of my career path, re-evaluating the chaotic storm in which I now found myself. Should I stay in a residency program that made me unhappy, or should I transfer into family medicine? And what about this newfound passion for REI, reinforced by the intuitive and impactful feedback from my preceptor? There was only one thing I knew for sure, and that was that I didn’t want to keep doing what I was doing, paralyzed by fear of change and uncertainty, and hope that one day I would stumble upon contentment. I also came to the realization that my decision to pursue ob/gyn was likely made for all the right reasons, and so I declined the transfer into family medicine. Switching gears I instantly switched gears and followed my newfound passion for REI. Although it was only a three-month rotation, I was quick to set up electives and research projects, and with every passing week, I recognized that this was where I was meant to be. The aspects of my residency training that led me to seek change did not go away, and in fact, only intensified as I neared and entered my Royal College year. But finding a spark of joy, listening to that voice inside of me, and being able to find a path to attain that goal allowed me to persevere and complete my residency training with a new and determined outlook. The remaining road to completing residency and fellowship was not without ongoing challenges and setbacks. REI is a very competitive specialty and my late interest meant I wasn’t well-positioned as a competitive candidate. I was unsuccessful in securing a fellowship position during the first round of applications. However, I quickly regrouped and refocused my efforts on finding creative ways to apply again. When I was offered a fellowship position on the other side of the country from where my family was rooted, I again questioned whether I was making the right decision for me and my family. But, I accepted the position and we took a family road trip across the country to settle in Montreal. Although I am only at the beginning of my career as an REI subspecialist, I have spent the last five years working passionately toward this goal. I am delighted to be here, and I am thankful I made the decision I did on that one weekend. The challenges of balancing residency and fellowship training with raising my family never got easier. Though the adjustment in my mindset— which came when I decided to actively make a change in my life—set me down a path of self-exploration that ultimately reformed my understanding of myself and my career and life goals. Along the way, this quote helped me to be vulnerable, accept the uncertainty and to find my truth: “Our willingness to own and engage with our vulnerability determines the depth of our courage and the clarity of our purpose; the level to which we protect ourselves from being vulnerable is a measure of our fear and disconnection.” —Brené Brown, Daring Greatly Dr. Ginevra Mills is a reproductive endocrinologist based in Victoria.

My tortuous journey to joy

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