Lizzie Wortley, Paediatric Registrar

One person’s experience of returning to work and what I learned from it

I’m on the phone at night, discussing a case with the consultant and going back to the bedside to review the patient. And I just keep thinking, “my boobs really hurt, I hope I don’t get mastitis. I really need to pump.” I nip to the toilet, take my top off, pray the crash bleep doesn’t go off, and tip a load of milk down the toilet. “Ok,” I say to myself “that’s done, now get your head in the zone and back to work.”

Welcome to the world of the mat-leave mum returning to work.

People have babies, and these little rascals need someone willing to shift their life around their needs. Often, culturally (and if you’re breast feeding, biologically) this job falls to the mother, and so maternity leave was born (now parental leave). For those of us who feel these bundles are awesome and yet still either financially or mentally need to spread our own wings again, the return to work becomes a hurdle that must be faced.

And so it was for me. In March this year, I returned to work after 12 months, or more precisely 54 weeks away. With recent furore over the treatment of Hazida Bawa-Garba and the situation in which she was working (new job, 13 months out on mat leave, short staffed) plus the ongoing reports over the winter about the NHS in crisis, my initial response to knowing I’d have to return was rising panic.

After discussing with friends and colleagues, I decided to write about our experience, reflecting on two elements. The personal impact on us as a family – for the little man (LM), my husband (a solicitor (TSM)) and myself; and managing the return to clinical work.

So I kept a diary for 5 weeks before going back, and once I had returned. Here I summarise our experience.

Some background:

I write this as a married mother to one little boy living just outside London. We have not followed a particular parenting philosophy & I’ve been lucky enough to breast feed. I am a paediatric ST6 currently working 60% in a London DGH doing clinic and research-based job with evenings and nights acutely. My average commute is 60-90 minutes.

I started work one week, went to RCPCH conference in Glasgow the following week (for three nights) and then did nights the following weekend (7 days later for 3 nights) – life has changed big time!

(Disclaimer – to those dads who take prolonged time out – hopefully you can find something here that helps you. To those with different experiences, I hope the next piece with universal advice helps – this was about my personal reflections and so I write from the above perspective).

Our family:

I start with this because in the months preceding the return to work, this was my biggest concern. Am I able to do the super-juggle? What is the super-juggle? How organised do we really need to be? And will we still enjoy life?

Our reality is now this: I work 60% – 3 days a week. LM goes to nursery. TSM drops him 2

days and picks him up once. I drop him once and pick him up twice. This is our arrangement because it has to be. I do clinics and need to be at work early. TSM is meant to work until later than me, but I do some evening shifts, so we have built in flexibility to the evening pick up. It turns out that knowing there are long days in the mix saves us from a trap many women returning from mat leave end up in – being the main carer even on work days and thereby never having free evenings. The one evening a week allows me to do evening courses, work related events and see my friends in London. This is more than just returning to work, this is getting some sense of my old life back.

So how has it been? Well, we are one-month in. And I depending on the previous day, the way I have written this changes, i.e. it’s been an emotionally fickle experience!

For me: The diary has hardly been written in since my return. I hate the cry during drop-off, though this is getting better. There are also more tears at home, despite otherwise seeming very happy. Sometimes I think it’s just frustration at me and my inconsistent presence which is hard. I feel guilty that I love being at work and having space back to myself. I have to justify to myself dropping him off pre- and post-nights which is ridiculous as I need some sleep. I am reassured that he does seem to love nursery once there, but there has been the odd day of wondering if it’s right, or if it’s fair.

For LM: There have been tears; there have been many cuddles. In the last month I have been back and forth and away for a few days. Are tears at night teeth, cuddle requirements, more desire to breast feed or just another viral illness? As I was writing this, he has decided to stop breast feeding, just gave up after I did some nights. Is this independence or protest? A week later and he’s decided that he does like it again. Bed times are taking longer, and we’re all tireder. As far as ‘good’ parenting goes or following rules and routines – we’ve really tried, but it’s been variable. Most of my brain just thinks he needs cuddles and security and so have been fairly relaxed about night feeds, him staying in his cot etc. But we regularly discuss addressing this– sooner rather than later. I tell myself I’m just waiting for the dust to settle.

For TSM: He has been brilliant and unfazed. So flexible and never complaining – particularly with how little I have been around this month. He and LM have a great relationship and the last few weeks only seem to have enhanced it. He now has to work much later some evenings because of delay in getting to work on nursery drop off days and recent increase in responsibility at work. We have to grab our time when we can; weekends for TSM especially becoming more sacrosanct. This has been a major downside of the back-to-work experience.

Clinical work and being a professional again

Generally I have loved being back at work, but I’m aware it only took one general paediatric clinic for my low-level anxiety to return. My concern about a family resulted in a Friday afternoon call to CAMHS and the whole weekend being spent trying my hardest not to worry about them.

Without going into the ins and outs of anxiety in our profession, there are two elements to this that I learned that first weekend back. Firstly a one-year-old is too all consuming to think much about other things; and secondly how helpful it was to acknowledge I worry about it, send a couple of emails, write myself a note and then put it to bed.

Other than that, being back in clinic has been a joy. Laughing with the kids, chatting to the parents, working out what could be going on and doing something about it is a thrill I had

forgotten about. I even looked forward to my first weekend of nights, especially as I sat in a café enjoying some leisurely breakfast. I did start to wonder if baby brain really existed and a year out had blanked how busy this departments nights used to be. Was I in some weird Stockholm syndrome phase? Whatever it was, I somehow managed to keep down the usual pre-nights terror.

But then sick kids are sick kids, and the reality was some parts of it were hard, and always will be. If they didn’t put my heart rate up and send my brain whirring, then maybe I would miss something and helpful adrenaline sharpens the mind. I was slow, my brain felt foggy initially and I looked everything up. My usual mantra of “Don’t medicate the bronchiolitis kid” turned into questioning myself about nebs, inhalers and all that junk.

I have found this set of nights, whilst not clinically easy, easier to come to terms with than others. My expectations of myself were less, my mind was distracted when I left work by the LM and TSM and there was less time or opportunity to overthink my decisions once home. Again – what I thought would be a weakness (distraction of having a child) has turned into a great asset for my mental health so far.

With regards to my level of both clinical competence and confidence – I am not necessarily the one to comment. I am lucky that we have a pre-clinic in depth discussion about all patients and this makes a huge difference to my confidence, and I can get all my letters checked as well. Acutely ill patients I have discussed at least with another registrar if there is anything outside of the norm, probably as I would have done before. In fact, no one has minded discussing anyone – always a nice reminder.

I would say that whilst both my confidence and competence may be at a natural nadir, the year away has brought me another positive. I have realised that sometimes it doesn’t all need to be fixed, diagnosed or resolved there and then – a common problem for myself and a by-product of so much acute work, and very little clinic experience. I can be kind, supportive, listen and then start us on a path to what one hopes is a satisfactory conclusion.

In summary – The last month has been interesting, educational and emotional.

Positives:

• I have a job that stretches, interest and revitalises me intellectually.
• Clinically, I have more empathy with the parents and more patience with the kids.
• I’m reclaiming my ‘brain space’ that had been so hard to un-fog in the last year.
• I have been lucky enough to have a whole year off, therefore naturally coming to a point where LM would benefit from interactions with others and I was ready to return.
• I have a son who is naturally chatty and so whilst drop offs have been hard, otherwise appears to love nursery and the staff there.
• I have a husband who has been both financially, emotionally and practically supportive during both my time off and return to work and allowed me to jump back in both feet.
• LM has grandparents, extended family & friends who are willing to give up their time to fill in the random care gaps that have occurred.

Downsides:

• Seeing less of TSM & fewer evenings to catch up
• Seeing less of LM and the facetime where he walked across camera in the background so confidently and I realised how much he changed in 3 days
• Being home late and knowing LM won’t see me for 24 hours
• It’s hard to hear baby voices and crying when doing procedures (which before I was so good at blocking out) – they make my chest physically hurt.
• “Use it or loose it” – both clinical knowledge and practical skills are rusty and need practice to polish them up again.
• I can no longer just go home and sort something out, if it’s not done at work, it’s really hard to find the time and energy to complete it.

Overall, this has been a better experience than expected. It’s different, but it’s not bad. There is still time for cuddles and stories. There are still smiles, from all of us. I think this is going to be ok, and may well be brilliant.