Thriving or Surviving with Dr. Malika Sharma

“The fact that I am a mom makes me a better doctor and the fact that I'm a physician helps me be a better mom in some ways” - Dr. Malika Sharma 

In this episode, we chat with Dr. Malika Sharma, an Infectious Disease specialist and Assistant Professor in the Department of Medicine at the University of Toronto, about her journey with family planning and family building during residency and fellowship. Join us as we talk about healing your inner child, the dual stigma of being a physician-parent and a little bit of magic. 

We appreciate your feedback - please leave a comment and subscribe so you never miss a new episode!

----------------------------------------------------------------------------------------------------------

Contact Information

Dr. Malika Sharma, M.D.

Email: malika.sharma@utoronto.ca

Dr. Malika Sharma is an HIV and Infectious Diseases physician and Clinician Teacher at St. Michael’s Hospital. Clinically, she focuses on caring for people and communities who are often marginalized and oppressed by our healthcare systems, including those who use substances and people living with HIV. Her teaching and scholarly interests center on anti-racist and feminist practices within medical education, harm reduction, and the structural determinants of health.

#InfectiousDisease #UniversityofToronto #Parenting #InternalMedicine #Relearning 

Transcript

Radha Sharma: Welcome to Season 1, Episode 2 of Family Planning for Docs - Thriving or Surviving. This podcast is an extension of our platform at www.familyplanningfordocs.com, a website created for Canadian medical trainees to highlight useful information about family planning in a medical career. Our group has a mission to inform medical trainees about their options regarding family planning while navigating training, career, and personal life. Our research has demonstrated that personal stories are highly impactful, and we hope to provide access to a diverse number of stories, to current trainees on our podcast we hope to capture the stories of medical professionals who have navigated the training process and a medical career career while planning, parenthood, parenting and the support along the way.

Radha Sharma: In this episode we have Dr. Sharma. We are thrilled to have you on our podcast today and thank you again, on behalf of our entire team for taking the time to sit with me and chat. 

Malika Sharma: Thanks so much for having me. 

Radha Sharma: I'm going to start with the first question today. Can you tell us a little bit about your job, what does a day in the life of a doctor look like?

Malika Sharma: Yeah, so I am an infectious disease doctor at St. Michael's Hospital, and I'm a clinician teacher there. So a day in life looks really different, depending on whether I'm on call or not. But if I'm not on call, it might look like going into the hospital in the morning, and maybe observing a medical student doing a history and physical on the wards, and then coming downstairs to my office, maybe having a meeting or 2 and then preparing for my clinic in the afternoon, and then my afternoon is spent seeing patients in the infectious disease and HIV clinic. And then, you know, charting and writing all those things up. And then, when I'm on call, it's basically just seeing consults in the hospital all day, all evening, sometimes all night. 

Radha Sharma: Oh wow, that sounds like a very busy schedule there.

Malika Sharma: Yeah, it's definitely busy. But then there's other times when I'm not on call and I can have some flexibility. So you know, if I know I'm gonna be there late on my clinic days, or whatever. Then, on some days like today, for example, I was able to spend some time with my daughter in her classroom, which was really fun.

Radha Sharma: That's so fun. It sounds like there is flexibility in not just your tasks on a day to day but it in your schedule, which sounds kind of awesome. How many years of training did it take you to become an infectious disease doctor? 

Malika Sharma: You know I knew you were going to ask this question, and I still didn't add it all up. So, I'm just going to tell you the things, and then the listeners, I guess, can add them up in their minds. So I did 3 years of undergrad, 3 years of med school because I went to Mac. And then I did my internal medicine training, and I did a chief medical resident year, which is like a one-year position at St. Mikes. It's like a one whole year thing. And then I did my infectious disease training after that. But I took maternity leave there, so it was like an extra year. And then I actually did a masters of education kind of as part of my residency training. So I was still a resident. So I think by the time I finished I was like a PGY 10 or 11 Pg. 

Radha Sharma: Wow, PGY11. You know, I read about being a PGY 11 online sometimes and I'm like, I wonder if I'm going to talk to people that have done that. But that's incredible. 

Malika Sharma: Maybe I was PGY9. 

Radha Sharma: I will let the audience add it up. 

Malika Sharma: They can figure it out.

Radha Sharma: My mental math is not that great, I will admit. So, you mentioned that you did take maternity leave and part of this podcast is you know, talking to medical professionals about what their family planning kind of looked like. What inspired you to start a family like, what was your motivation?

Malika Sharma: Yeah. I mean, thanks for the question. I think the motivation is probably different for everybody. I have known for a long time that I wanted kids. I really, really enjoy playing with kids. I enjoy kind of getting to be a kid. I really like babies. They're very cute. In residency, I think I was voted like at the end of the year, some silly graduation event. I think I was voted most likely to steal a baby, which is somewhat embarrassing. So I think everybody knew how much I liked babies.

Malika Sharma: So it was always something that I had hoped would be something that I'd be able to do, but I think that the biggest thing about family planning is it's almost a bit of a misnomer, right? Because there's only so much planning you can do. Babies gonna have their own timelines, right? So, so you can have what you think you want to do, and then there's sort of what they want to do, and when they want to show up.

Malika Sharma: I got a really good piece of advice from a friend who wasn't in medicine when I was sort of thinking through, you know, when's the right time and residency, and you know how long after you like for me like, how long after I'd been married, did I want to start trying, and all these sorts of things. And I remember her giving me the advice. She'd had her kids a little bit younger. And she said, you know, if you think that it would be okay if you had a baby tomorrow. Not necessarily that you're planning it. But like, if it would be okay that there was a baby in your life tomorrow. She's like, then it's probably a good time to start thinking about it, to start trying. And she said, 'cause there's no perfect time right. There's no oh, when I'm a first year faculty, or when I'm a you know, when I'm a resident or whatever. And I found that actually really helpful advice, because I'm very grateful for the way that my family has turned out, and I think I wouldn't necessarily have started at that time if it hadn't been for that advice, because I was still a resident. I was still, you know, in the middle of my training, and I think a lot of people sometimes discourage you from doing that. But for me it was, it was perfect. I was really happy to have done it during that time.

Radha Sharma: It sounds like there's no perfect time, and it really depends on the person. 

Malika Sharma: Yeah, exactly. And I really think the other piece of that is that we train for so long right? I was joking about being a PGY 9 or 11, or like who, you know, who's keeping track anymore at that point. But, I think that there's so much delayed gratification in medicine that we often get into this mindset that you know, when X happens my life will start. Once I'm done medical school my life will start, or once I'm done residency, or then, once I'm done, my first year of residency, because that's when I'm on one in four call for the whole year. Once I'm like new staff or okay, once I've passed my 3 year review, like it's always you know, bumping it down the line, and I think for me, for a whole host of reasons, including the fact that I had my son in the middle of my infectious disease fellowship, like life, is happening now, right? Whether you're a med student, whether you're a resident like this is this, is it? This is our life. This is our one shot here and if we keep kind of waiting for these career land posts or signposts, or whatever the word is like. If we keep waiting for those. I think we actually are like missing life that's passing us by, and that's not to say that you have to have a kid now or later, or whenever. But it's just that we tend to think about our jobs as kind of the thing that's driving our clock and really it;s just all part of our life. 

Radha Sharma: Very well said. I love the way that you described that. It's reassuring to hear as a trainee to be honest like from previous guests actually, in the episode we had with Andrea, Dr. Simpson, she kind of shared a similar sentiment, in that because there's so much delayed gratification in medicine, you can't wait your whole life until the opportunity presents itself, and that might not just be for family planning, but really a lot of other things like mental health, or taking care of yourself.

Malika Sharma: Absolutely, I agree. 

Radha Sharma: You mentioned that you had one of your kids during your fellowship, what did your timeline sort of look like, when did you have your kids?

Malika Sharma: Yeah. So I have 2 children. I have a 10 year old. Well, almost 11 year old, son, and I have a 4 year old. Oh, my gosh, she's going to be so mad! She just turned 5.

Radha Sharma: That's okay, hopefully, she's not listening to this one. 

Malika Sharma: She'll be so mad. So, I have an almost 11 year old boy, and a 5 year old daughter. So, my son, I had him right at the end of my first year of my Infectious Disease (ID) fellowship, and so I took a nine-month Mat leave with him and I came back to join training kind of off cycle and I joined the year below me. So I kind of left my cohort and joined the year after when I came back to residency. And then, my daughter I actually had when I'd graduated. There's, you know, there's about a 5, 6 year gap between them. So at that point I'd already graduated and I kind of like left academia for a bit, and I was working at Casey House, which is an HIV hospital in downtown Toronto. And so I took a one year Mat leave with her.

Radha Sharma: You mentioned something about off cycle. Could you just talk about a little bit about what that means? Just for our listeners that may not know. 

Malika Sharma: Yeah, absolutely. I don't even know if they still use that term. But what that meant was that kind of, instead of graduating in July or finishing kind of June, you know, thirtieth or whatever. I was off cycle, meaning that my graduation dates were slightly different than my my peers. 

Radha Sharma: Were there any specific challenges that came up with you know, planning to have a child or having a child during the times that you did?

Malika Sharma: I think, with anything where we're trying to to wear lots of different hats, or be lots of different things to different people at different times. I think there's lots of joys that come with that and then there's also lots of challenges. I think you know, when I had my son during my residency training, there was this real sense of, “Are you sure you're gonna want to be off cycle or like? It's a long time to be away from your residency training?” I remember, you know, planning to take 9 months, and I would get lots of mixed comments. So there were some particularly women who, you know, had trained maybe at a different time, who were really happy, that I was taking 9 months because they had taken such little time because of the pressures that they had felt, you know, 20, 30 years prior. So they were really, really supportive of me, being truly on mat leave not working while I was on mat leave, not feeling obligated to like, submit a paper, or whatever, but to like really getting to be with my baby. And then there were other people who were like, you know, good for you, for choosing your family over your career, and I was like, is that a compliment? Is that an insult? Is it both? I don't know.

Malika Sharma: So you know, I think that there was some of that I felt you know. So both a lot of support and then also, kind of feeling like, maybe I'm making this decision that's gonna impact my career in some way or whatever. I think things have changed a little bit now, but I will also say like it doesn't matter like in the sense that you know we we have this one life, and you know work brings me a lot of meaning, and it brings me a lot of joy at times, too, and I really love patient care, but it's also not the soul of my identity, and a lot of other aspects of my life, and in particular for me, not for everyone, but for me, for sure, being a mom is a really important part of my identity. And, you know, no one else is having those babies for me right now. Right, like I gotta take the time to do what I need to do, and the biggest supports have been people who kind of recognize that and have been like, “Yeah, good like, do what you need to do”.

Malika Sharma: And I think then, you know, the chips will fall where they will, and I know that's maybe not such useful advice for people trying to navigate it. A lot of the challenges are not even necessarily put upon us externally. But it's anticipatory. Because of the ways that our systems and our structures and our institutions have been set up, we feel unsupported. And I think we need to accommodate in all of these ways. And I think for me the most liberating thing was to sort of say, you know what? Sure, if those things happen, I'll deal with them. But also, maybe I'll be able to lay the ground where, for other people being able to do things in a similar way.

Radha Sharma: I think that that piece of resiliency and you just saying, you know what, I’m going to do whatever I want to. It's refreshing to hear, because we as trainees often hear these stories of, you know, you're gonna face resistance when this happens. But I think it's really inspiring that you wear those multiple hats. And as someone you know, listening to your story, I  feel inspired by the fact that you can, have it all, is maybe not the correct phrase, but make your life what you want it to be and be identified by those things. You were able to just say, you know, I'm going to do this, and that's okay.

Malika Sharma: Thank you. I think it's also only because I've also seen it modeled and and have had people who've kind of inspired me to to say, you know what, this is important for me to feel happy. And this is important. This is how I want to build my family. This is what we're going to do. We need to be supported by our institutions. But we also need to recognize that our institutions are not necessarily always going to give us everything we need. And then we have to maybe also work at changing our institutions. And sometimes you change it by just doing it.

Radha Sharma: Exactly. Were there any mentors that you had that kind of helped you along that path? Or was it more so just friends and colleagues t?

Malika Sharma: I think support can look like a lot of different things. I am a big fan of tangible, you know, concrete actions of support. I often reflect on how many, you know, usually female staff, whether or not they'd had kids, you know, so it wasn't necessarily that they'd had to have that experience to to know. But how many women let me pump in their offices right? Because they knew I didn't have a place to pump breast milk and so they were like, oh, you're back from Mat leave? Okay, here's a key to my office anytime you need you can go in there and pump in my office. That was a really tangible thing that I needed. It’s interesting. We do these things as a collective sometimes, because our institutions aren't necessarily doing them like at the time,  there wasn't really a set place for us to pump, and a lot of people have done some really important advocacy, including like organizations like yours to say, okay, this is what trainees need when they come back. Sometimes part of it is like, you know, you're teaching your institutions like, Hey, I didn't have a place to pump. This needs to be like, not be the case for the next person. But you know that that meant a lot to me.

Malika Sharma: You're talking about this idea of having it all and I've often thought like, I don't think you can have it all at the same time, but I think it can maybe have it all over the course of a lifetime, maybe, just not all at the same time. And I think particularly being a physician and being a parent, and I can really speak to the experience of being a mom. And so that's kind of what I'll focus on. You know, you mentioned this idea of stigma, and the stigma is really in both directions, right? Because, on the one hand, people perceive you as a physician, and then they see you as a mom mom. And maybe they think she's less dedicated, or she's got to leave early to go see her kids, or you know, maybe she's she's not going to be as as committed to this, or she's, you know, she's gonna be leaving early with, like all these ideas about what they think we're gonna do. And then on the flip side of it, you know, sometimes you aren't able to come to the field trip because you're in clinic, right? Or like you're not able to come to that evening event because we're finished late, or whatever. And so you kind of feel it on both sides. Sometimes you feel like you're not not a good enough doctor, not a good enough mom. And I think for me, what I've really been working on for myself is to remind myself actually, well, I am not only a good enough: mom and a good enough doctor, but actually, I think the fact that for me and again, not that you have to be a mom to have this, but for me the fact that I am a mom, I think, makes me a better doctor, and the fact that I'm a physician helps me be a better mom in some ways. And I just kind of keep trying to remind myself of that. Especially when you know there's lots of guilt. I have lots of guilt all the time. I think I think it'll be OK.

Malika Sharma: I picked up my daughter once and actually my son. But I think it's happened with both of them. I picked them up once from daycare and saw my son playing with like this Doctor Kit, and I overheard him telling his friend, like my mom is a doctor, too. You know my daughter sometimes pretends that, like a calculator is her pager. And so, you know, I try to remind myself that maybe when they're older they'll be proud of kind of what I did at work, and they'll also say, like, Wow, you know, Mom worked really hard to make sure. She made muffins for us. Yeah, like both, both things are true.

Radha Sharma: I was gonna ask you, because you have children that are like 5, 5, not 4, 5 and almost 11. So, do you see differences in challenges that you face as a parent as they get older, like what has kind of been a constant challenge? And what's been changing as you see them grow up?

Malika Sharma: I think the constant challenges are probably some of them are. I don't want to say they're self made because it's like me taking individualistic responsibility for getting stuff that's, I think, that is organizational or structural. But guilt is, I think, constant. It was there when there were babies. It's there now. So that's been a bit of a constant challenge. I think their needs change as time goes on. And so you know in the beginning it's very labor intensive, you know. not a lot of sleep, it's like, in a way, it's almost like physically more challenging when they're little, because I'm so tired all the time. But you know now that my son's getting a bit older, it's more, you know, wanting to be present in a different way where you're kind of around, so that when they want to tell you things you're actually there for the telling as opposed to, some of the like in the middle of the night stuff that you're doing with with the younger kids. And I think also, you know, especially as he's getting older, but even with her, I try at least to be kind of transparent about how I'm feeling. It’s really hard not to bring work home and feel stressed. It's also really hard to, you know, if you're feeling like you're trying to do 15 things at once. Maybe you're more snappy or more irritable, and I try to be more verbal about that, too. And just sort of say, like, you know, this stressful thing happened in clinic today. I don't necessarily need to share details, but like that's why I'm feeling this way, or I had a patient death a few weeks ago that was really hard, and you know I was sad. And they were asking me. And I said, you know I'm sad because my patient died, and this is, you know how I'm dealing with it. But also, like, you know, I got to talk to the patient's son, and it was really nice and kind of almost like taking off like the veil a little bit, and just like trying to let them in a little bit to work.

Malika Sharma: I try to keep really clear boundaries in a lot of ways, because I feel like I have to really protect those boundaries. But then, sometimes like just, you know, letting there be a little bit of crossover can sometimes be helpful.

Radha Sharma: I think having honesty, and seeing that in your parent is such a beautiful thing to transpire. And I think that's great that you're setting those boundaries. But then, also showing them a little bit about what you're feeling and why. You have to keep us updated, 

Malika Sharma: Fingers crossed it plays out.

Radha Sharma: Fingers crossed it plays out! I know I've been talking about some of the challenges, but what would you say is the best thing about being a mom or a parent to your lovely children?

Malika Sharma:  You know it's funny. I went to the farm with my daughter and asked her what was your favorite thing? She's like everything, not an answer. But I guess maybe everything. you know each phase is so different, and you think it's the best phase. When they’re babies, you’re like OH THIS IS THE BEST, they're so cuddly. And then they start talking and you're like, OH THIS IS THE BEST, they can like converse with me. And then, you know, then they're like 9, and reading on their own. And you're like, yeah, this is the best we can discuss books. So there's always some part that's really great. I think for me, maybe the part that I like the best is, it's kind of like you're reparenting yourself, too, like you're you're getting to enjoy kid things again. And so I really, I just you know I love. Our jobs are hard, they're very intense emotionally. Sometimes they're intense, physically, you know, like, when you're doing call. A lot of stuff happens at our jobs where it becomes normal to us. But it is so profoundly strange to hear people's deepest stories, you know, to hear people's most private details about their lives, to be with some people on their worst day.

Malika Sharma: Right? A lot of the people you're working with OB’s. So sometimes you're with people on their very best day like it's a lot right. There's things that are great about being a parent in general, but maybe specifically about being a parent who is also a physician. When I'm with my kids, then I can in some ways be this totally different person who's like making arts and crafts and cutting and pasting, and you know. I like to read the same books that my son is reading, and then we can talk about them. So sometimes I'm sitting here reading like a young and an adult love, with 12 year old kids in school.

Malika Sharma: So I you know, I really, I like that part that I get to be a kid.

Radha Sharma: Your inner child again, a little bit which I love. 

Malika Sharma: Yeah, and that maybe that’s a bad approach to parenting, your listeners will tell me.

Radha Sharma: It's gonna work out in the end.

Malika Sharma: Fingers crossed. 

Radha Sharma: Fingers crossed. What does your son read at this time? I don't even know what if they read the same stuff that we did growing up.

Malika Sharma: I mean, like, there's some stuff that's like, you know, they're still reading, and I think there's all sorts of conversations we can have about the writers. But, Daniel Radcliffe, who was the guy who played Harry Potter made a really beautiful statement about how you know, the relationship you have with the story is the relationship you have with the story. It’s separate from what the authors may be doing. So my son has definitely read Harry Potter and enjoyed it. It's interesting. They're reading lots of different things. I, personally, am very proud, because he is also into the Babysitter's Club.

Radha Sharma: I love the Babysitter’s Club! If I was at my mom's apartment right now, she still has all the books on that shelf, and I refuse to throw them out, and I'm going to keep them for my future children. Hopefully. 

Malika Sharma: You know what good for you, because I am like an over aggressive cleaner. So I got rid of all of my childhood like books. And now I'm like, basically re buying all the Babysitter’s Club books.

Radha Sharma: I'm just a hoarder, so there's that. I guess this sense of magic that's kind of in the podcast right now, I'm feeling the, I don't know the joy of being a child again. So if you had a magic wand somehow, if you were Harry Potter, let's say, or any of the other ones. Why can't I remember their names? 

Malika Sharma: Hermione Granger! The most doctor mom out of all of them. 

Radha Sharma: YSo if you had a magic one, somehow in Potterland you could go back and change something about your life. Would there be anything? If there was, why? If not, why?

Malika Sharma: I don't know if I would. There's definitely been times where I've felt dissatisfied with work or thought to myself like, Why did I do this? It's so late. I'm so tired like, how is this my job? So you know, I think that we have moments of that. But then we also have other moments where it almost surprises you right, like what you're able to do or the connection you're able to make with people or you know. Sometimes you make a really good call right? And sometimes you miss stuff. But sometimes you make a really good call. I'm an HIV physician as well, for example. And so, you know, last year I was working with a patient, and it was actually me who gave them their diagnosis, which is actually not that common, because usually people are already diagnosed when they come to me.

Malika Sharma: And this was something that I had been taught about as a resident. I was involved in this project around telling people about their initial HIV diagnosis, and so actually kind of doing it. And, all things considered, this was maybe the best way that this could have gone for them and for me right like. So this is a really long-winded way of answering your question of is there anything I would change that, despite the times where I've felt really frustrated, or burnt out, or just feeling you know, upset that I got home really late one, you know, 1 one night on service, and like missed out on all these things that it happened, and my son had a really bad day at school, and my daughter was missing me, and like not sleeping, and, you know, just feel like such a bad mom. But I actually think that, like all of the things that have happened up until now, is kind of what brings us to this moment.

Malika Sharma: I recently read this quote by this poet Hafes, that said (I'm misquoting a little bit), but like this exact place that you are at right now, God has drawn a map to put you there. And, so I don't think I would change anything.

Radha Sharma: Magic wand not needed. Is there any advice that you have for other medical trainee as you kind of reflect on your own story here?

Malika Sharma: Yeah, I think the advice is, maybe that there's no set advice. so always be a little bit cautious if people are telling you like this is the right way to do this. This is what you gotta do, because I don't think there's any one way that you gotta do it. But I think that the one piece of like actual, real advice that I'd give is I think there are going to be times particularly, you know, specifically thinking about being a physician who's thinking about becoming a parent, or who is a parent, or about to be a parent. There's going to be times where it's hard, and there's going to be times where you feel like you're not good at anything. And so I think the advice would be to remember that it's relational, and that building community and solidarity is kind of how we get through those things. and how we can also kind of create systems that make it better for all of us.

Malika Sharma: My advice to trainees would be, you know, find the people who you can go to for advice, not even necessarily big picture advice. But like, okay, I'm starting work next week, and I need to figure out which breast pump to buy. I’m starting work next week, and you know what daycares do you recommend? Don't plan it the week before - that's not going to fly.

Radha Sharma: Noted. 

Malika Sharma: Finding out who the people are that you're gonna go to for support, find out who the people are that you're gonna go to for advice, find the people that you're gonna go to for encouragement and actually like, do it like, actually go to them for encouragement. Because when it's hard, that's kind of what it'll keep reminding you like, it's okay. I'm doing a good job.

Radha Sharma: Yeah, it sounds like it’s building your own network of people that you can call, like a little registry.

Malika Sharma: Yeah. And I think, like at an interpersonal level. But then I also think, if people you know like you're doing it, for example, right like you're you're doing the work to raise awareness, to give trainees opportunities, give them advice, give them encouragement. Just give them resources, and I think also, you know, champion our institutions to change and make our environments more supportive for trainees or for parents who are, you know, faculty. We're trying to do 2 things at once. We're simultaneously telling people how to navigate a system. But I think that that's important because people are in the system now, and it needs to be navigated.

But I think then, the other side of that coin is also thinking about, how can we change the system to make it more supportive for people?

Radha Sharma: Thank you so much for sharing that and for just emphasizing the whole reason that we're doing this podcast in the first place. wWe appreciate the stories that you have to bring. I just feel like anecdotal things, and storytelling is such a powerful way to just showcase information or disseminate that knowledge. So we thank you for doing the work as well. 

Radha Sharma: My final question today, in the name of the podcast is, are you thriving or surviving?

Malika Sharma: That's such a hard question. I know I'm supposed to say thriving, but I go back to my principle of I think you can have it all just not all at the same time. So I would say that I'm both right. There's some days where it really feels like you're thriving, and you know I'm doing great. And then there's other days that feel more like surviving. And I think that that's okay. So both.

150

00:32:18.900 --> 00:32:47.429

Radha Sharma: I love this honest and raw response. It's exactly what this podcast is for. We just want to give you another. Thank you. Again, Malika, it was an absolute pleasure chatting with you today. I learned so much from what you shared, and I will take it with me. You can find Dr. Sharma's contact information in the notes from today's show, And, this is Radha and Malika signing off.

Malika Sharma: Thanks so much.