There is nowhere to begin but in the middle.

In two weeks, we will be moving across the country with our five-month-old so I can start my residency in pediatrics. I will go from spending all but twenty hours of my week with my daughter to spending eighty hours a week at work. My partner, who has been in graduate school thinking about art full time, will become the primary caregiver. We will be in a city where we know no one. Clearly, this transition will be seamless.

Now you might be thinking: Surely, you knew this day would come. It’s not like I had one too many drinks in Vegas and woke up with a medical degree. I went through a six-month application process to secure a residency spot and six months of fertility treatment to become a mother — no surprises there. So yes, I did know this day would come, in the same way that you know death will come. But as with death, you always feels like you probably have one more day.

When I was thinking of having a baby, I asked every woman I met in medicine who has children when is the best time in training to take the plunge. I even met a woman who had had a child in medical school, one in internship, one during fellowship, and one as a new attending — a one-woman data set. The consensus from everyone was threefold: There is no good time. Not during intern year. The best time has already passed. So we decided to go for it during a gap year between medical school and residency. I looked around at all the residents, fellows, and attendings in the hospital with their breast pumping bags and I figured “If so many people are doing it, it must be possible.” And so is born hard-won-wisdom #1: If everyone is doing it, it is probably possible, but no one will tell you the truth about the costs. Because women are rarely honest about a) their weight, b) how much childbirth really hurts and many other puerperal realities (more on that to come), or c) how &*%@ing overwhelmed they secretly feel (more on that also to come).

So now we have an absolutely stunning daughter, and I say this with all the objectivity of a mother — I mean pediatrician. She is a happy, curious, active child who miraculously fit in from day one with the rhythm of our family. She can really work a room–lighting up everyone in her path with her full-face smiles and piercing, wise-before-her-years level of awareness. (Where she got this natural social talent, I cannot tell you — yes, over here, I’m the one asleep on the couch because I drank half a beer too quickly.) In short, Little E is a gem. When they say “It’s all worth it” (second only to “They grow up so fast” in terms of aphorisms most often heard as a new parent), they do not lie.

To put it simply: I do not want leave her to begin residency. I REALLY do not want to do this. It feels unnatural, violent, insane, like traveling back in time to have dental work before novocaine. But there are other simple truths: I am in a hole of student loan debt that only a medical career can fill. And more complex truths: I love working. I love medicine. I am at my best when I am in the hospital, and then better as a mother when I come home — sharper, softer, more able to attend, more grateful and humble and in awe. I miss her so much when I have to be away, but feel restless and unused when I go too long without exercising my doctor muscles.

I don’t know what the right answer is to this conundrum, just that for the moment, I have to move forward and try to give myself as fully as I can to both endeavors. I’ll be honest: I don’t know how I’ll do it. I don’t know if I’ll be able to do it. It’s not that I doubt myself, just that I can’t imagine it. But soon enough, there will be no need for that–the pendulum of doctor-mommy will be released and I’ll either be swinging it, or getting knocked repeatedly in the head. I hope you’ll join me on the ride. I promise to be honest about how great it is and how much it sucks.