Of all of the wisdom that my women mentors have passed on, the caveat "there is no good time to start a family when you're in medicine," has perhaps been the most helpful. Rather than striving to stick to some arbitrary timeline, I have allowed this advice to free me to become a mother when the time was right for me and my family and to craft my career around my personal priorities. Through my training, I watched babies arrive to a few medical school classmates, covered maternity leave for friends in residency, and watched with great interest as one of my fellow child psychiatry trainees raised her preschooler. Last year, when my husband and I began our quest to become adoptive parents through domestic open adoption and moved quickly to match with our son's birthmother, it was my turn to negotiate some of the twists and turns I'd seen my colleagues move through. First the announcement to my co-workers, clinic managers, and medical director to prepare for three months leave from my county mental health position. Next, discussions with my private practice patients about planning for my upcoming absence. Finally I initiated communication with the department where I was teaching on the volunteer faculty and with the AACAP committees I was serving. My announcement was met with varying degrees of congratulations, celebration, anxiety, and thinly-veiled resentment. We patched together coverage through the generosity of my CAP colleagues. I discovered that I did not qualify for any paid leave from my county position and launched into some creative financial planning to make it all work. As the excitement mounted and our son's due date got closer, I was amazed to see how easily I could walk away from my offices after coverage arrangements had been made.

When I stepped out of my busy professional life and into the world of the tiny boy who came home with us, I suddenly understood why highly trained professionals sometimes take more than a decade to return from maternity leave. As much as I loved my work as a child and adolescent psychiatrist, nothing could have prepared me for falling in love with our baby and the shift in priorities that have come with motherhood.

Now as I celebrate our son's first birthday and all of the events and transformations that have marked our first year as a family, I see the incredible web of support made of my supportive husband, extended family, friends, neighbors, and colleagues. This web of support made it possible for me to transition out of one child psychiatry position that was no longer a good fit and into another where I have found new professional challenges and warm collegial support from other physician parents. There may be no "good" time to have children during a medical career because of the inherent complexity in this juggling of roles, but I am finding my way as a mother, wife, daughter, sister, early career psychiatrist, and member of my community and would not trade any of it.

Susan Milam-Miller, M.D.