I thought it would be interesting to profile Heidi Murley for this website not because she's representative of typical mothers of three, but because, in many ways, she isn't. Very few of the mothers of three who took my survey worked at all; none reported being the primary source of income for the family. I couldn't imagine what it would be like to juggle three young kids, one teenager, and a demanding career as a surgeon -- so I asked Heidi.

JEW: So what's it like being a pregnant surgeon?

HM: Pregnancy offers unique challenges to a surgeon. The physical aspects of the job are demanding even for those in good health. The nausea, sciatica, bladder infections, fatigue, congestion, leg swelling, hot flashes (shall I go on?) added a few degrees of difficulty with my first pregnancy.

I learned that it's more efficient to operate for half of the morning, start an IV for personal hydration, have your anesthesia staff administer anti-nausea medicine, then finish the morning’s cases than it is to reschedule operations for a day when you may or may not feel better. As an added bonus, your OB can check on you between cases if he happens to be operating at the same hospital that day.

Also, two lead aprons protect the baby better during procedures requiring radiation, but they add at least 40 pounds to the lower back strain and raise body temperature by one degree per ten pounds per hour of surgery.

It doesn’t matter how important you are at work. It doesn’t matter how tired you are and how much everything hurts. At home, a pregnant surgeon is still "Mommy" to the ones she already has, and someone always needs juice.

JEW: Surgery is pretty male-dominated; how did your colleagues react to your successive pregnancies?

HM: Interestingly, I made my way through medical and surgical training without feeling the faintest pang of sexual discrimination. Granted, I brought to the table a deep sense of appreciation for the opportunity, so I wasn’t looking for trouble. I encountered my first "discrimination" of sorts after I returned from my second maternity leave. I was advised that the prime office hours would be reserved for those who weren’t "dropping in and out of the call schedule." The implication was that those without functioning ovaries were more reliable surgeons.

The man who offered this insight was the father of five, with a stay-at-home wife. I might add that when working similar schedules, I was consistently more financially productive than he was. We no longer practice together.

I chose to take 12-week maternity leaves with each pregnancy, and took 48 hours off after a miscarriage on one occasion. The miscarriage occurred between the second and third child. I informed my partners that I wanted three kids, would not be dissuaded, and would try again. All of my colleagues were supportive with the above exception. I appreciate my partners immensely, and I know that they appreciate the tubal ligation I had when Sophie was less than an hour old.

JEW: Did you always plan on having children?

HM: As a career-oriented young physician, I seriously considered remaining childless. I knew that I’d have to make sacrifices to have a family, and making career compromises after so much training seemed to steal the validity from my professional accomplishments. My husband, however, was a great example of a dedicated parent.

He'd moved from Ohio to California a few years before we met, and then learned that his girlfriend (in Ohio) was expecting his child--Zachary. Although the romantic relationship had ended, he established legal paternity and began providing child support. During our years in California (while I completed my residency), I watched him travel monthly from California to Ohio to visit his child, and I listened to him carefully weigh the impact his professional decisions would have on his son and on me. I left for Ohio the day after I completed my surgical training; Jay had moved several months earlier. By then, Zachary was seven years old. In the end, Jay’s example led me to choose to have a family.

JEW: How did you decide to have three kids?

HM: My decision to have three kids was almost predetermined. I knew that I either wanted no children, or at least three. I appreciate the opportunities I enjoyed as an only child, but I feel somehow a lack of genetic connection to my own generation. I’ve created family in the shape of in-laws and outstanding friends, but I don’t have the emotional safety net of siblings. I realize that siblings can be a blessing and a curse, but the knowledge that there are peer witnesses to your childhood, to your life, is powerful.

I saw the way my husband’s family (four siblings) interacted in their adult lives, sharing history, raising children in the company of cousins, and starting new family traditions. I wanted that experience for my children, and three seemed the minimum number. Having delayed childbearing into my mid thirties, three also seemed the maximum number.

JEW: How did you and Jay decide that he would become a stay-home dad?

HM: Two competing careers and two competing adult work schedules were impossible to maintain. My schedule included night and weekend work, while Jay’s included overnight travel. The logistics of balancing my work hours and call schedule with Jay’s work and travel plans created a childcare nightmare.

We needed to make a choice: Either have other people raise our children, or become a single career family.

At that time, in early 2005, Jay was stressed and unhappy at work. I loved my job, but hated the guilt of rarely being home. We both knew that our kids were growing up learning the rules and routines established by a third party. The choice at that point seemed clear, and Jay retired after 21 years with NCR Corporation.

I don’t mean to imply that the chaos of three kids mandates a stay at home parent. As a career-oriented adult, I strongly support parents who both work, out of either financial necessity or personal choice. However, our family faced specific challenges that made maintaining two careers untenable. And late nights at the hospital just feel different when it’s my children’s father tucking them in than it did when it was a babysitter doing the job. We’re fortunate to be able to have made this choice.

JEW: How would you characterize yourself as a mom? Do you think there are specific personality traits that help in being a mother of three?

HM: I’d love to characterize myself as a patient parent, but if even a casual acquaintance reads this, I’ll be outed for the uber-impatient control freak that I am. Thank God for my husband.

I believe that the single most important personality trait for a mother of three is an appropriate sense of perspective. At the end of the day, if everyone's breathing and no one is in the emergency room, then the day’s a success. Many parents of one or two children don’t understand this "damage control" model of parenting.

When Sophie took to nocturnal stripping and diaper flinging, I resorted to securing her warm weather pajamas with duct tape to ensure she’d remain clothed at night. She’d come to me, diapered and dressed for bed, lift her arms, and rotate to allow me to securely tape her in. With two others to manage each morning, I couldn’t chance leaving the flung diaper devastation for the exasperated nanny -- again.

I have a dear friend with an only child who enjoys a laborious and comforting hour-long bedtime ritual nightly. I feel certain she was horrified witnessing the duct-tape ritual, not to mention my casual inquiries as to brushing teeth, my cursory sniff of breath (hmmm, smells more like Oreos than toothpaste . . .), and my "OK, then, off to bed, all of you." I choose my battles.

JEW: How has becoming a mother affected you as a physician?

HM: Knowing how it feels to love a child helps me understand how hard it can be for family members to let go. Knowing how it feels to love a child also makes me glad I didn't choose a career in pediatric surgery. I can't imagine operating with the weight of all those parental hopes and fears on my shoulders.

JEW: In what ways is being a surgeon compatible with motherhood, and in what ways is it not?

HM: Surgeons tend to be control freaks. People cater to us. We say "knife," and someone hands us a knife. We say "I’m so hungry," and someone says "Can I get you something to eat, Doctor?" However life-threatening and complicated, however overscheduled and overworked, my life from 8AM until I get home is fairly simple. I deal with other people’s problems, and I draw on years of training and experience to guide me.

At home, I’m questioned for asking someone to brush his or her teeth. "But why, Mommy," they ask, with Oreo stains on their lips. "We don’t want to brush our teeth. We brushed them yesterday. They’re only baby teeth anyway, Mom." Hard to argue with that logic. "Ummm, ask your father," I mumble.

On the other hand, I’m a problem-solving, perspective-maintaining, crisis-focused individual. Give me blood or an unstable fracture, and I’ll remain calm and know what to do. Physically restrain my shrieking child while a colleague stitches a nasty cut? No problem. Bring home my own flu shots and line up the frightened brood like it’s a firing squad? You bet. Give me massive property destruction without bodily harm, and I’ll try to focus on the fact that all involved are still breathing and neurologically intact.

JEW: How has your surgical background affected your relationship with the kids' pediatrician and teachers?

HM: One advantage to being a physician is that you do have a bit of an edge at the pediatrician’s office. More often than not, I can call with a symptom complex and my physical exam findings; I’m rewarded with the coveted antibiotic prescription without having to make an appointment.

A disadvantage to being a surgeon is that I am accustomed to being around people in the throes of death. With this frame of reference, it takes a lot to get my attention. High fever? Tylenol's in the cupboard. Severe whole body rash with wheezing? Yeah, Benadryl's next to the Tylenol, and it’s sedating to boot - see you in the morning. I’ve been chastised (gently) by the kids' real doctor on a few occasions for ignoring a rip-roaring ear infection simply because my feverish child was still breathing without visible respiratory distress. I can be a symptom minimizer.

As for teachers, I try to stay closeted about my profession unless my beloved child blurts out "My mommy’s a doctor." It just puts everyone on edge. They think I’m "special" somehow, perhaps high maintenance, and in turn I’m convinced they’re judging me by how many hours I work, with work hours inversely proportional to my success score as a parent.

JEW: What do you enjoy most about having three kids?

HM: Despite my grumbling, having three kids is great. I love that they love each other, even if they don’t remember that all of the time. We have three stools at our kitchen counter, and I love the way their three heads look lined up there, waiting for pancakes. Two kids were fun, but three feels more like a family somehow.

I love that having three kids makes each one more independent. My first grader rises before me in the morning, makes her own breakfast, either packs her lunch and snack or ensures that she has lunch money, showers, dresses, combs her hair and brushes her teeth. When the parents' attention is divided in too many directions, then kids learn to fend for themselves. I like to think it gives them useful skills for adulthood, but I may be rationalizing now.

When the whole family is together, it’s fairly easy to carve out time alone with each child. Working with homework or playing a game with one child leaves a nice pair that can play together or be separated by the alternate parent/referee.

JEW: What's a typical day like for you?

HM: For me, a typical day includes balancing other people's life-threatening illnesses with my kids’ homework. I rise at 6:30, if I'm lucky enough to not have been on call through the night, and then I show up in the operating room around 8AM. I perform three to five operations, send administrative emails, review credential files, see patients on hospital rounds, then make an appearance in my office around two. I see post-op patients and new referrals for surgical diseases for the next three to four hours.

Then I spend an hour on paperwork, return to the hospital to finish rounds, call my husband to apologize for missing dinner again, then (if I’m not on call) make a cameo appearance at home before bedtime. I can usually get at least fifteen minutes of quality time with each kid (Ok, ten per kid –- come on -- we're talking three, here!) before they’re asleep. Then I may have a glass of wine, read a book or write a bit, and finally fall asleep comatose, generally before 11PM.

JEW: Do you feel that you have enough time with your kids?

HM: Absolutely not. I am the prototypical absent parent. I will usually try to make an appearance before bedtime, and when I'm on call I will occasionally stage a fly-by, where I stop at home for a brief visit before heading out again to stamp out surgical disease. It’s a difficult choice for me to make, but the right one at the moment.

I rationalize my absences with the knowledge that Jay is better equipped than I am for parenting multiple kids. Having him at home means that a parent is present for most daily events, even if it’s not me. I love the fact that when I do come through that door, everyone drops what they’re doing with the yell "Hey, Mom’s here!" I get three hugs in rapid succession, and then start fielding requests for juice, reading, bedtime snacks, movies, etc. I feel welcome and appreciated.

I know that when the kids are grown, they’ll remember that I was rarely home. But they’ll remember that they had Dad around, and that my career gave us the financial ability to have a one income household without many material sacrifices. I hope that my girls can see a woman who succeeded in the career of her choice, and still tried to love her kids as well as she could.

Most of all, I want my three kids to know that they’ll always have each other. After all, that was the point of all this, right?

She cast a birthday shadow barely
four feet
tall but she lived larger in the
land of
kindergarten where she towered over
others who also struggled to make
S’s forward and not
backward

In a breathless clear but cold October
birthday afternoon she spun like
wishes frozen
on a still green blade of
summer’s grass

She spun with fingers open grasping
for her childhood the
ethereal spray of pure
potential streaming from her hands

And as she spun past laughing she
cast a pattern in the air that
seemed as if her
grown up
self was looking back at this moment and
remembering it