Krystal Cascetta, Lindsay Clancy, and the impossibility of being a mom in American medicine

In Igbo-Nigerian culture, new moms receive exquisite care from their own mothers, mothers-in-law, or surrogate mothers for the first few months postpartum. After each of my daughters was born, I was blessed to participate in this tradition, called omugwo, which allowed me to be nurtured by the mothers who came before me. They cooked and cleaned. Massaged my belly and taught me how to breastfeed. They took care of my newborn overnight. These women were my village. This nurturing helped me recover from childbirth and grow into my own role as a mother.

While I was pregnant and postpartum with my two children, I was a chief resident and fellow in training to become a reproductive psychiatrist. I saw the ways my Nigerian heritage protected me from the harshness of the American maternal experience. So many of my patients were mothering alone. While struggling to free themselves from the grip of depression, anxiety, OCD, and trauma, they were juggling the herculean task of caring for a newborn. They didn’t have the protection of my cultural cradle, and their American individualism had health consequences. Running on no sleep with little to no support, many of these patients were also burdened with the inability to afford diapers, housing insecurity, abusive partners, or jobs that were trying to fire them while away on leave.

Motherhood, I’ve learned, is a constant tug of war between the needs of the mother vs. the needs of the baby. Being an American mother is hard. Being an American mother in medicine — with its third opposing force, the pull of patient care — can feel untenable.

I don’t know the intimate details of the highly publicized postpartum tragedies this year in Massachusetts , where labor and delivery nurse Lindsay Clancy is accused of killing her three children and then attempting suicide, and New York, where oncologist Krystal Cascetta reportedly killed her 4-month-old baby and then herself. But it’s not lost on me that both of these mothers were also in medicine.

Medical professionals find it hard to seek health care. We rarely take sick days to tend to our own bodies because we don’t want to let down patients who booked to see us months in advance and rely on us. Illness or any perceived inability to keep up with the long hours and heavy workloads feels like weakness. Medical systems encourage and exploit a culture of self-sacrifice, and workloads are unsustainable. Asking for help can burden your colleagues.

For me, having children intensified these feelings. I had even less capacity to care for myself because I needed to care for my children.

Prior to my first parental leave, I combed through the list of all the patients I was seeing in the clinic. I needed to reassign them to my co-residents who would be caring for them during the three months I was away. I outlined all their ailments and color-coded their severity of illness to make it easy for the doctors that were filling in for me. I scheduled follow-up visits for each of these patients at clinically appropriate intervals and worked hard to give a warm handoff to my co-residents to ensure good continuity of care for my patients, whom I cared deeply about.

But the first message I opened when I returned from my maternity leave was one chastising me for not doing enough. Through no fault of my own and a few scheduling changes, one of my patients had some changes to her appointment. She complained to her primary care physician, who sent me a message detailing the dissatisfaction with my care plan and said she wanted “to advocate for more consistency of care.”

I was already flustered with my return to work — I was separated from my baby for the first time, learning how to navigate lactation and pumping between appointments, and catching up on three months of patient care. I felt gutted. I didn’t know how to respond to such a cruel message — one that pitted my medical needs against that of my patient — so I never did.

That incident was in my head when, at 8 months, my eldest daughter was hospitalized in the ICU and I had to get emergency coverage for my weekend on call. I was distressed by both my baby’s ailing health, the burden of my responsibilities shifted onto others, and the patients that would suffer because I had been sidelined.

As a first-time mom, I remember the only attempts to evaluate me for postpartum depression occurred at my daughter’s pediatrician visits. In the reception, I was handed a clipboard that contained the screening forms I was meant to fill out. Both times I had my hands full with an infant, baby bag, and stroller. I felt so clumsy with everything I had to carry around and didn’t have time or literal space to fill out the forms. No one ever followed up with me about the missing information. I was the chief resident in women’s mental health at the hospital where I had my baby. As I walked out of my daughter’s pediatric visits, not assessed for mental health issues, I saw how easy it was for my patients to slip through the cracks.

That’s something all new parents might experience. But there are unique challenges for doctors.

Perhaps counterintuitively, we may also be less likely to seek medical attention ourselves. We see the worst-case scenarios every day. As a medical trainee rich in avoidant coping strategies and poor in time, I struggled with a chronic cough for three years and secretly worried that I had developed lung cancer. After graduation, when I finally brought myself to the doctor, it turned out to only be allergies and with an antihistamine, my cough quickly went away.

Seeking help can also have consequences. I completed my psychiatry residency training program at Cambridge Health Alliance. As trainees we were encouraged to seek therapy ourselves to better understand what it was like to walk in our patient’s shoes. But when I applied for disability insurance policies, despite the fact that I had participated in therapy for my education, I found that my policy proposal excluded disability for any mental health condition.

According to a study published by Mayo Clinic Proceedings, 4 in 10 physicians avoided mental health care due to the fear that their employer or state medical board would find out. When your livelihood or ability to repay multiple six-figure student loans depends upon your ability to work, the inclination is to protect that capacity at all costs. This has devastating repercussions for women in medicine. According to a 2005 study published in the Journal of the American Medical Association, suicide is 250%-400% higher among female physicians than our peers. Nurses, who account for the lion’s share of the American medical workforce, also face unacceptably high suicide rates. Mothers in medicine face significant mental health risks, especially because suicide is a leading cause of death in the first year following childbirth.

Mothering is done best in community, and I’ve been wondering why in this country we don’t hold collectivism as a core value. Individualism, I’ve learned, is a legacy of colonialist countries. The zero-sum game of colonialism upheld, and continues to uphold, the power of white men through the exploitation, oppression, and exclusion of all others. The ways in which we are failing all female physicians and patients in medicine can be traced back to this practice. Perhaps the movement to decolonize medicine in favor of creating more equitable and inclusive practice will be essential to setting up health care systems that serve all women, including medical workers.

In my practice as a reproductive psychiatrist, my personal and professional experiences have given me the conviction to lean into collectivist ideals. I now encourage my pregnant patients to proactively cultivate their own villages and replicate the omugwo practice of postpartum care. In the entrepreneurial space, I love that women of color are returning to our roots as villagers as well. I’m inspired by the ingenuity of Boram Nam, who is using South Korean postpartum traditions to improve the care of American mothers, and Kimberly Seals Allers, who founded an app to reduce the impact of racism in maternal medical care by tapping into the collective experience of Black and brown women.

In my practice, I help my patients think about the practicalities of self-care. I encourage them to get explicit about the support they can get around the unrelenting tasks of adulting that become challenging when an infant demands all of their energy. I also encourage patients to tap into collective wisdom and the power of connection by exploring various types of groups in their communities or online.

As a psychiatrist, I treat patients one-on-one. I recognize how unfair it is that individuals bear the burden of illness when, in fact, it is our society that is actually sick. Our society shares responsibility for the Cascetta and Clancy tragedies and the suffering of families of color whose losses don’t make the news. While my omugwo is long gone, I am still cared for by the mothers in communities I’ve cultivated over the past four years. I’m part of groups for Black moms, psychiatrist moms, and rare disease moms. All of them have taught me a lesson I’ve learned over and over again: Whether or not we work in medicine, we can’t and shouldn’t do the difficult but divine work of mothering alone.

If you or someone you know may be considering suicide, contact the 988 Suicide & Crisis Lifeline: call or text 988 or chat 988lifeline.org. For TTY users: Use your preferred relay service or dial 711 then 988.