Discerning God’s Call in a Lean-In or Opt-Out World

I apologize for my long silence! My teaching load at church is particularly heavy this season. I’ve needed to devote the rare moments when I’m not covered in peanut butter or embarking on adventures through Middle Earth to study and prep!

Earlier this month, I was privileged to join the student chapter of the CMDA at the University of Oklahoma College of Medicine for an evening of discussions, some on end-of-life care, others about struggles of women in medicine. It occurred to me that my talk on the latter might help some of the readers here.

It’s been my experience that mainstream discussions about working motherhood often undermine how deeply the problem runs, troubling not just our schedules and our egoes, but our spiritual core. Furthermore, advice — solicited or not — from church and secular sources alike offer blanket solutions that ignore who we are: image bearers of God, each with a unique purpose. The only “right” answer in these dilemmas, is to look to who you are in Christ, and walk faithfully in Him.

Below are the thoughts on this I shared with some lovely ladies in Oklahoma. I hope you find them encouraging.



Good evening! To start off, I wanted to ask you, what are the challenges that you’ve encountered as a woman in medicine? What conflicts do you struggle with? What do you worry about? What do people tell you that lingers on your mind as you labor into the night?

Just hearing all of the concerns within this room alone, you get a sense for how real and heavy the burden is upon us. A lot of messages from popular media and the greater culture tell us who we should be and what we should do, and these voices only exacerbate the stress. Sheryl Sandberg, the author of Lean In, urged women during a graduation speech at my alma mater to “have the ambition to run the world, because this world needs you to run it.” In contrast, Anne-Marie Slaughter, in her 2012 essay featured in The Atlantic, asserts that women cannot “have it all” until our economic and societal framework prioritizes families. Research from Harvard Business School, with a counterpunch, reassures us that children of working mothers grow up to earn higher incomes. In Christian circles, discussions of working motherhood can quickly veer toward emulation of the woman in Proverbs 31, and crush us with the imperative to follow her example. The church families that should be building us up sometimes criticize us for our singleness, which cuts deep when we’re not married because we’ve sacrificed some of our best years to care for others. Discussions devolve into disputes about complementarianism and egalitarianism, which ultimately stir up only resentment and bitterness.

It all makes your head spin. And ultimately it only deepens discouragement, because while these philosophies promise prescriptive answers, they all contradict one another. They promise that if we only prioritize better, or push harder, or work smarter, or delegate better, we could be the perfect, professional, superwoman the world wants. Or they promise that if we leave everything, give up the gifts God’s given us to steward professionally, and fully embrace a life in the home, we’ll be what the church wants. And at the end of the day, none of these prescriptions brings peace. The heaviness still lingers. We try, and we strive, and yet when we get home too late to kiss our kids goodnight, or leave our partners to take extra calls for us so we can attend to our families, or miss a patient’s critical lab value because we are stretched to the brink, the guilt swallows us up.

I learned this the hard way. I was a hardcore trauma surgeon with my dream job. I was working in academics, at a busy hospital with high complexity cases, and devoting my academic time to teaching students and residents. I loved it.

I also loved what my job said about me. I’d attended a women’s college, and was raised on a hearty diet of feminist mantras. I took great pride in the fact that I was the only female trauma surgeon in my division. I loved running with the boys, and I thought I had everything figured out. When I was pregnant with my first child I was doing laparotomies and thoracotomies well into my third trimester, and even sleeping under a desk when I stayed late for cases despite not being on call. In a way, I arrogantly thought I was immune to the issue of mom guilt.

Then, my son was born on Valentine’s Day in 2013. My first day back from maternity leave was to be April 15th. A Monday. Throughout most of the country, an ordinary Monday, with work proceeding as usual. In Massachusetts, however, it was Patriots’ Day, a state-wide holiday to commemorate the first shots of the Revolutionary War fired at Lexington and Concord. It’s also an excuse to have a day off to stroll through streets trimmed with apple blossoms, and to watch the Boston Marathon.

As it was an operative holiday, my colleagues told me not to come in. “Take one more day at home with your little one,” they said. “Nothing will be going on.”

That Monday morning, the day I was supposed to return, two pressure cooker bombs exploded at the Marathon finish line. The entire city mobilized to help the victims. Paramedics raced toward the explosion. Physicians met ambulances in the street to triage patients. At the hospital where I worked, my partners scrawled on victims’ extremities with black marker to catalogue their injuries. They clamped bleeding arteries, shouted orders, and rushed patients to the operating room.

Meanwhile, I was oblivious to the catastrophe. While my partners scrambled to save lives, I sat cross-legged on a chair in my kitchen, with my two-month old baby asleep in my lap.

When I learned about the bombings hours later, long after my partners had saved lives and salvaged limbs, the news halted me mid-stride. Guilt washed over me and twisted in my heart. I should have been there, I thought in self-rebuke. As a trauma surgeon in Boston, I had trained for a decade to care for the injured. Yet when terrorists attacked my own city, I had failed to show. In my earnest desire for one more day at home with my baby, I’d inadvertently abandoned my colleagues. The realization sickened me. Meanwhile my son, doughy and vulnerable, wailed at my shoulder.

In the days that followed, I threw myself into care for the bombing victims. I tended to wounds, adjusted ventilator settings, performed bronchoscopies, and counseled family members into the evening hours.

My little boy, who from his first moments on earth knew only the sound of my voice and his need for me, bawled all night at home in my absence.

 I introduced the governor to victims in the ICU. The entire city went on lock down as police searched for the Dzokhar Tsarnaev, and I couldn’t leave the hospital.

My husband called me in a panic because my son had a fever. While scrubbed into a case, a nurse held up my phone, and I squinted at the screen to determine over Face Time if he needed to go to the emergency room.

I dressed wounds and removed shrapnel under local anesthesia.  I took extra calls to make up for the extra work I’d heaved onto my partners when I was away on maternity leave.

I couldn’t keep up with pumping, and my milk supply dried up.  My baby boy started to lose weight.

Then I stood before M&M, guilt weighing down my shoulders as I recalled details of the patients whom I’d failed, the lives I couldn’t save.

Back and forth, and back and forth it went. Throughout, guilt took deep root within me. And it would persist for months and years beyond. It never let up, it only became more complicated. My son started to have daily meltdowns of epic proportions, and could never fall asleep. My husband was exhausted and overwhelmed. And I felt irresponsible whenever I ducked out of the hospital on time, because my responsibility for people’s lives was so great, and the welfare of my patients had to come first.  

The slogans and the glib advice our culture so generously doles out, don’t do justice to the burden we feel as women in medicine. The elusive work-life balance for which we all yearn isn’t just a dilemma of time management. The answers hurled at us by popular media, even by our own families and colleagues, fail us because they undermine the struggle. Questions of vocation, identity, and motherhood so unsettle us not because we don’t have the right black leather planners. They trouble us because they strand us between Romans 12, and Deuteronomy 6. The conflicts of the working woman are deeply spiritual.

In Romans chapter 12, Paul encourages us to use our God-given gifts to build up the body of Christ. That’s why we devote so many of our child-bearing years to long nights on call, or to hours spent poring over textbooks. We choose medicine because we’re called to love our neighbors, and what more beautiful way to love a neighbor than to heal him? What more lovely, fragrant offering can we give the Lord, than to employ our talents toward shepherding others from death to life?

And yet, we read in Deuteronomy 6 about an equally weighty, diametrically opposed calling. As Christ’s disciples, we’re to teach our children in God’s ways. Not just on Sundays. Not just in the car on the way to church once in a while. Rather, discipleship in the Lord should be infused into their days, when they rise, and when we walk in the way with them. All the time!

This, friends, is why the guilt cuts so deep, and throbs for so long. Work-life balance isn’t just about logistics. It’s about a clash of spiritual callings. It’s a tension between two equally consequential vocations to which God has called us, and to which we feel driven to devote our last fiber.

How do we bear it?  How do we endure? How do we press on, when the pat answers from our culture fail us, the guilt continues to nag, and the hurt throbs in our chests?

My friends, first, remember that we too are born in sin. We are limited. We are not God. We can’t manage this muddling of callings perfectly, because only our Father in heaven is perfect. We won’t find answers in studies and opinion pieces. We find them, only, through Christ. Only through that grace. Only through his love.

 Our hope lies not in the promise of kids perfectly raised. It doesn’t reside in the accolades of the cath lab or the operating theater. If I could inspire one idea today, if you take away nothing else from this dialogue, my hope would be that no matter what people tell you, no matter what advice you receive, no matter what pressure or guilt you feel as you juggle everything that goes along with being a woman in medicine, you remember first and foremost that your primary identity isn’t as a doctor, or as a wife, or a mother, or a researcher, or a daughter. Your true and foremost identity is as an image-bearer of God, loved by God, and made new through Christ. And your primary purpose in life, no matter what circumstances you find yourself, is to know God, to glorify him, and to enjoy him forever. And by definition, that path to knowing, glorifying, and enjoying God is unique to you, and will look different for you than for any of your colleagues. It won’t fit a mold for the perfect women. It won’t neatly fit into modern-day philosophies. Because God doesn’t care about how well we have it together, he cares about us turning to him.

He cares about how much of our heart he occupies.

Three years after my dramatic introduction to mom guilt, I left clinical practice to homeschool my kids. The reasons were numerous, with the primary one arcing above them all being that I knew it was where God was drawing me. I’ve received a dump-truck load full of opinions about this decision. Colleagues of mine who witnessed the struggle and endured it themselves understood the weight of this change, the heartache involved, and supported me. Others said, predictably, that I was wasting my education. Still more accused me of setting a bad example, and worsening guilt among those who didn’t have the means or privilege to quit professional work. Complaints that I was indoctrinating my kids by homeschooling them circulated in backhanded whispers.

What these commentators didn’t see, was that when God fanned that flame of guilt in my heart on Marathon Monday, he began to refine me. Before that day, I idolized my identity as a woman surgeon. I repeatedly remarked to my colleagues with disgust that I could never be a stay-at-home mom, because the monotony would drive me crazy, and because the impact seemed too small. The thrill and adrenaline of trauma was for me, not the mundane stuff of homemaking.

And then, on Marathon Monday, the day for which I’d feverishly prepared for over a decade, God said, “No. I don’t want you in that trauma bay. I don’t want you chasing after something you treasure more than me. Because your work has crowded me out of your heart. And because my grace is sufficient for you.”

Over time we’d learn that the infant squirming on my lap in that kitchen had a neurological condition that makes every mundane thing in life hard. God told me to stay in that kitchen, and it soon became clear that he gave me a baby who needed me to stay. In drawing me home, away from what I’d mistaken for the fount of my worth, God provided for my little boy in ways I wasn’t prepared to otherwise. And he also blessed me. He humbled me, changed me, and showed me that his love covers even our most desperate striving. True joy comes not from what we accomplish, but from our relationship with him, the one who knows every hair on our heads, the one who gave his son for us so we might know him.

God knows each one of you too. He knows you, and loves you, and he has a purpose for you already laid out. In Ephesians chapter 2, Paul says, “We are God’s workmanship, created in Christ Jesus for good works, which God prepared beforehand, that we should walk in them.” He’s already prepared the good things you’ll do. He’s already paved the way! And that way will look entirely different for you than it will for the one sitting next to you. To presume that my walk with the Lord, will look like yours, will look like Sheryl Sandburg’s, is foolish and myopic. Perhaps he aims for you to work part time. Perhaps his will is that you devote your gifts whole-heartedly to research, and forego the distractions of family. Perhaps he draws you into a different field entirely. Whatever the specifics, God has crafted each of us to be unlike any other on earth, and he has a unique purpose for each of us, with the chief goal that we know him, love him, glorify him, and enjoy him.

We are women in medicine. Some of us are mothers. Some of us wives. Some single. But first and foremost, we are all image bearers of God, created to ally with men to steward his vast creation. And we are loved in Christ.

And as you consider the way forward, God has entrusted you with a calling that far surpasses petty arguments of leaning in or opting out. He’s called you to know him, and to enjoy him. As you struggle, and as you worry, and as you strive, remember first who you are. Draw hope from it. And walk forward in the path he’s laid for you – a path that no philosophy or cultural slogan can dictate, a path crafted for you alone. A path to draw you closer to himself.

27 Comments Add yours

  1. TNKNT says:

    I love everything about this. What a story. As a mom, wife, surgeon, and follower of Jesus I resonate with all these emotions. It is truly a clash of vocations. What a privilege to work it out in life.


    1. Katie Butler says:

      Elizabeth, you’re a gift both to your family and to medicine. I’m grateful for how He’s working through you for His glory!


  2. Erica says:

    Thank you for sharing this, friend! What an encouragement. I pray those who heard you were also encouraged as you pointed them to Christ. Blessings!


    1. Katie Butler says:

      Thank you, sister! I continue to pray for your — burgeoning! — family! 🙂


  3. Tmj says:

    Thank you! As a woman who has struggled with balancing motherhood and medicine, I so appreciate your thoughtful words on this topic. Keep writing and keep encouraging!


    1. Katie Butler says:

      Thank you so much, TMJ! I’m grateful my ramblings are a source of encouragement! Blessings to you.


  4. shauna says:

    This stirs me to my core. As an RN who has worked various areas and struggled to make the right decisions for my family, I can relate to the huge feeling of
    responsibility to patients and coworkers and children and spouse…not always in that order. But when I made choices without praying about it, I regretted the outcome. Thank you for your honesty and for sharing your journey in this thing called life with Jesus.


    1. Katie Butler says:

      Amen, amen! Absolutely have gone down the wrong path by relying upon my own mind and will, rather than the Lord. Thank you for this wise reminder!

      Liked by 1 person

  5. JOHN O'CONNOR says:

    I’m a Believer, Husband, Dad (of 3 now grown up), Software Engineer etc. etc., and this has to touched me.

    Going to share it with my home group if that’s ok.

    Regardless of who we are it speaks so strongly that “or chief goal that we know him, love him, glorify him, and enjoy him”.

    Katie thank you so much for sharing this – we have previously corresponded as like you our family has also been touched by depression and you have shared so well on this also.

    God bless



    1. Katie Butler says:

      John, yes, I remember! I’m touched to know this has encouraged you, as well! May God spur on you and your family.


  6. allison425 says:

    Thank you so much for this. I woke up struggling with these things today. A few months ago, my husband and I made the decision to pull two of our kids out of public school to homeschool them. It was a hard decision, and one based primarily on the need to get our son who struggles with ADHD out of an environment that had him stressed and overstimulated to the point where he seemed to live his life in constant trouble.

    One reason the decision was so hard is because I’m am RN and I *love* what I do. I had hoped this would be the year I could finally work more hours and even get off night shift (I’ve been on it way too long). I still work PRN, but my schedule is pretty limited and I feel guilty that I’m not at work more. And I feel guilty when I’m not home more too! It’s a very delicate balance, but I know that it’s where the Lord has me at the moment. Thank you for the encouragement to place my identity in Christ as I live out the callings he has put in front of me.


    1. Katie Butler says:

      Allison, I deeply empathize. It really is a clash of callings. My the Lord guide you through the journey.


  7. I haven’t been on-line the last several months, but popped on for a moment and clicked over. Thank you for sharing this. I’d like to share it with my best medical school friends.–Terri


    1. Katie Butler says:

      Wonderful to hear from you, Terri. I hope your trip to the islands this summer was refreshing! Blessings to you and yours.


  8. Mimi says:

    Brilliant piece ! Just brilliant. Thank you for carefully crafting your words that touched my soul. You are such a brilliant and wise person ❤️


    1. Katie Butler says:

      Thank you so much! I’m so glad it was encouraging.


  9. jsmith1054 says:

    More beautiful thoughts that touch deeply. Your willingness to continue to seek God’s will for your life is encouraging. May God continue to bless the choices that seek his will and may it sustain you on the days when you think you must be crazy. With love and gratitude.



    1. Katie Butler says:

      Jan, dear friend! Thank you. Please let me know how you’re doing when you find a moment! Blessings to you.


    2. Ese Sekegor says:

      So, so true. Whatever one’s path is, you’ll know it’s where you ought to be when you find you are growing in love of Him and being transformed into who He has called you to be- His. The peace you find is like no other because you not only love Him in that place but feel His love at every moment in time.
      Having walked similar paths with you Katie I truly bless God for letting yourself be used as His instrument to reach the hearts of so many with your gift of writing . God bless you dearly.


      1. Katie Butler says:

        Thank you, Ese! Blessings to you and your beautiful family in the New Year.


  10. You did it! You said hard things without preaching or lecturing. You didn’t even give an algorithm (medicine’s favorite) to follow. As a former flight nurse, I resonated with every word. Your post freed me to not judge or decide for others. Point them vertically.


    1. Katie Butler says:

      Thank you so much for this kind feedback! May the peace of Christ sustain you.


  11. Rachel DiSanto says:

    This post is beautifully written and resonates so much with my own journey over the last 13 years. I love mentoring young women through CMDA and my favorite thing to tell them is “you can have it all, you can’t have it all at once”. Our culture in and outside of the church has led to this perfect storm of damned if you do/damned if you don’t as women in medicine, and our own sin nature and tendency towards idolatry only compounds the issues. My mom guilt, failures at home and work as a family physician, and ultimately my nearly failed marriage taught me where my biggest idols were, and taught me this lesson you share so cogently, that our first and only true calling is to know and love God and to enjoy Him forever. Once we get that, we can truly have perfect peace in our unique calling and path. That is when my guilt disappeared and my path became crystal clear. Now instead of praying “what should I do?”, I pray “Lord, what most glorifies You?”, and the answer is never in doubt when looked through that lens. Thank you for your courageous choices and sharing this much needed message!


    1. Katie Butler says:

      Amen, amen!!! Thank you so much for sharing your own experiences with such sincerity and humility. I’m grateful for the Lord’s work through you!


  12. JD says:

    What sounds better “My mom the stay-at-home mom” or “My mom the amazing surgeon.” Our young women and little girls deserve role models that will shape their lives. As an educator, our young girls need to understand how to work 80 hours a week, have time for community and civic activities, and squeeze in family life. You can live life in a tunnel helping yours and your own, or changing the world and helping humanity resolve the world’s toughest problems.


    1. Katie Butler says:

      Thanks for your comment, JD. My point is that what “sounds better” is whatever choices are faithful to the Lord in the unique circumstances, responsibilities, and gifts he’s given us. That will look different for every woman, amazing surgeons and amazing stay-at-home moms alike. Let’s move away from disparaging the choices of women in hard situations, whatever those happen to be.


  13. SSJ says:

    Hi Dr. Butler, I was one of your residents in the trauma ICU 7 years ago, and remember your amazing grace under pressure and excellent teaching – I’m glad to see that those skills are still very much in play in your current life outside of the hospital! Thank you for your honesty and your experiences. I also found my career path in medicine to be so altered once children entered the picture. In response to your last commenter, I have corrected resident/fellow applicants when they have stated that their mom was “only a stay at home mom”, and recommended that they re-phrase/think of their mother as someone who “worked within the home.” Because as someone who has had a foot in both worlds, I am certain my time at home can be much more challenging than taking care of patients. And the stress re: raising good human beings can be much higher than what work outside the home entails… Thank you again for sharing your story, and for being an example of how we can and should be building each other up, regardless of our own beliefs/individual decisions and choices!!


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