Integrity with Shilpa Shahani

In this episode, I talk with Shilpa Shahani, a pediatric oncologist who shifted to a remote career in cancer pharmacology when she found herself dealing with the stress of infertility treatments.

We talk about what it means to her to serve her patients, what it's like to work while navigating infertility treatments, and much more.

Get in touch with Dawn:

• On Instagram @practicebalance
• On the web practicebalance.com
• Buy the book Lean Out

Transcript

Dawn 0:00

Welcome to the lean out podcast. I'm your host, Dr. Don baker. Are you looking for a new approach to finding work-life balance? You've come to the right place. Listen, as I interview amazing women professionals, who've taken the steps to lean out. And find balance on their own terms.

0:19

Hello. Hello. Thanks for joining me today. I'm going to be talking with a physician named Shilpa Shahani. She's a pediatric oncologist who reached out to me as someone who was willing to discuss her experience with infertility and how it has affected her work-life balance. It was really important to me to include a discussion of infertility in my book, lean out. Presently the incidence of infertility among couples in the United States is 12 to 13%, depending on what metrics you're looking at and the data we have for women professionals, which is mainly women physicians at this point. Reveals that the incidence is about double that number. Which is crazy. This is something Sheryl Sandberg, and the whole lean in movement fails to recognize when encouraging women to go, go, go until quote, a break is needed. That quote is taken directly from her book, lean in. Embracing these statistics. We have to take our fertility into our own hands, a design work situations that are both flexible and accommodating. Or there will be no future generation. Shilpa story is included in chapter three of the book. You'll see, in our conversation that Shilpa just starts right in talking about IVF treatment. So there's not a lot of context in our conversation there. And that's why I wanted to tell you about it in the intro here. I did not title this episode, infertility. 'cause it's about so much more than that. Our conversation ended up being much different than I expected. And you'll see why about halfway through. Shilpa is not the typical infertility patient, but nonetheless, her IVF journey is something that inspired her to shift her career path away from the typical always on call oncology practice, and she had to navigate some major identity crisis. And changes. Due to that. I hope you enjoy this conversation.

SS - Dawn 2:19

Welcome. I would like to start by asking you about what your work life situation is now and how it's different from other people in your particular medical field.

SS - Shilpa 2:34

Sounds good. So pediatric oncology is, a relatively intense area of medicine. We take care of people in the hospital, outpatient and in the icu, wherever they are, we take care of them. Even if they're at home and they need to come in as a mommy call, we'll take care of them. So as long as they, they're there and they're ours, then throughout their. Cancer, diagnosis through treatment and follow up. We were the primary point person for them. So it is, a serious commitment that is only really feasible to do if you have a strong enough support network to take care of people, in a way that doesn't prevent you from being able to take care of yourself. I currently work for a pharmaceutical company and I work remotely. So my day-to-day gets to happen at home. And that is a huge benefit for me in terms of how I imagine, this fertility process has gone compared to how it was before I went to pharma. It's a huge difference in my ability to go to I v F appointments, my ability to take calls related to I P F or schedule things. And also, I hope that if I am successful, that it'll help when I'm pregnant and not having to be on my feet and then afterwards when I'm breastfeeding. So all of those things are a huge benefit, getting to work remotely compared to when I had to be in the clinic or in the hospital every day of the week.

SS - Dawn 3:59

So it's, uh, oncology, but it's specifically what, what is the area of research?

SS - Shilpa 4:05

It's with immunotherapy. So I've loved immunotherapy ever since I first learned about it. I feel like immunotherapy has changed the landscape of cancer therapy for many different cancers and, there are a couple things that are kind of novel in the oncology space right now, and hopefully like a synergistic approach in the future will be, will lead to the best outcomes. But we've gotten, it feels like our bang for our buck with chemotherapy and now the areas that are, hopefully areas that can lead to improved outcomes compared to what we are now our immunotherapy. Precision medicine and targeted therapy with small molecules. So those are the three areas where I think that we can still learn so much that can help improve people's lives. And this specific area that I've been fascinated with for the longest time and have really spent a lot of dedicated time studying as immunotherapy.

SS - Dawn 5:01

Wow. I think that sounds so awesome that it is an area that you already had a passion for while you were doing clinical work, and then now you're working on it just in a different capacity.

SS - Shilpa 5:12

Yeah. So that makes my life much easier, and I'm lucky in the work that I get to do is something that I really love. It's an area of science that I've been fascinated with for years and have been wanting to pursue. So I feel like I'm getting to do work that I love doing anyway. And I am inspired by, so I, I am really happy with my job and the work that I get to do. I do miss taking care of patients. But I also think that the value from a fertility perspective is so great because taking care of patients also means of being available for patients. And sometimes I need to be there for myself and not be available for others.

SS - Dawn 5:52

So tell me a little bit about how that transition occurred. What incited you to lean out and take this journey that was different than other people that are working in zog?

SS - Shilpa 6:04

I tried doing. I V F while I was in clinical medicine, I went through two cycles of Agri Travs and. It was really challenging. It was challenging because the schedule can be a little unpredictable. As you're doing an egg retrieval, you don't know the day of the egg harvest. It can vary depending on how well your follicles grow, and that can change cycle to cycle because of different regimens you're on or you know, just. The inherent variability that exists in I V F. So, it makes it really difficult to schedule, days off or time off. And, I was working in a smaller group of pediatric oncology group, so it was a lot harder to be able to make sure that my patients were getting the care that they needed while I was. Going for my visits and going for my procedures. And then when you get an egg retrieval under anesthesia, so the whole day I wasn't supposed to work. I wasn't supposed to go back to the hospital. It's challenging when you know that you have a patient in the hospital that may or may not need your attention, but you just wanna make sure they're okay. So, um, I felt. Like I wasn't able to give my patients the quality care that I wanted to give and still pursue the I V F path. And I had to think about what that meant for me. Like, would I be okay if I gave my patients less than my all? And the answer there was no, uh, would I be okay? Not pursuing I V F, because there are many women in medicine who decide that they, that having children isn't for them. But I already knew that I wanted children in my future. So I knew that I wanted at least to try. You never, even when you start an I V F journey, there's so many, Limitations to the process of no guarantees until you're actually holding a baby. So, I knew that even if I were to change my path, it didn't mean that I was going to have a child. But if I, at the end of my life knew that I had never even tried, would I be okay with that? So the answer for me was, I was not gonna be okay with it if I had never even tried. Um, And then there were some possibilities at work, cuz my group that I worked was really like, they're good people. And you know, everyone in the group was busy. So it is not like it's easy for all of them to just pick up slack, but, For me, I was thinking like, what's the best case for me, the best case for me is that I go through a couple cycles of egg retrieval. I have a baby, then I'm pregnant, I'm breastfeeding, I want like two biological children and I wanna adopt a third one. So that's what I want for my family. So I was thinking what kind of ask am I making of my group? I would want them to support me through like, Five, 10 years of going through this process of, you know, having a baby and then like the early period when a kid is a toddler. That's also challenging as a parent. So like there's a long time that I was gonna be asking for help of my group and I felt like it wasn't fair to their group and I felt like it wasn't fair to my patients. So then I had to, Changed my work environment, um, so that I felt like I could do what I wanted to do, what would make me happy at the end of my life, in a way that made me feel like I could do with integrity.

SS - Dawn 9:33

Yeah. And you had mentioned to me when we talked offline about how your identity as a physician, the way that it was, was going to change Do you feel like that's the hardest part of what you've done? I.

SS - Shilpa 9:49

Um, probably and there's also a gap between agreeing to something cognitively and feeling it emotionally. So I had to go through that process cognitively and then after that, feel okay with it emotionally. I have this identity with being a physician. I. Have ever since I was a little girl, wanted to be a doctor, and when I graduated high school, I had stayed in the same school district the whole time I was in school. And apparently when I, when I graduated high school, they had compiled a, bunch of things that I had, Created or done as I was a kid, especially stuff from elementary school and they gave it to us. And in that packet there was one thing, apparently when I was six years old, there was a prompt and then I had to reply. So it asked, what do you wanna be when you grow up? And I wrote doctor. And then why? It says, because it is nice at the people. And I spelled everything wrong, but I was sick. So, when I graduated high school, I was still on the medical path and I still wanted to be a doctor and I just had this perception that it's a real service to. People and humanity. And I felt like that was something that, was part of who I was for the longest time. And I remember also like when I was younger asking my mom, how do you make God happy? And my mom said by taking care of his children. And then suddenly in my very young brain, that morphed into becoming a pediatrician. So I think that's how I ended up going into pediatrics. So, yeah, so many of these things are, are me a part of my story and what got me through the calls and got me through all the training and all the frustrating experience that go with that. Then to shift and stopped being, a physician in a way. Like, I didn't, I not, didn't really understand what pharma was. I hadn't done any pharma, so I, I didn't really know what it was, but I knew that I wasn't gonna be taking care of patients directly anymore. Um, and I had to cognitively process that. There's this philosophy that you really shouldn't identify with your profession. You really shouldn't identify with things that are external to you because, they can change. Like if I got into an accident and was no longer able to practice medicine, that would be a huge blow to me. But who I am intrinsically wouldn't be any different. I need to identify with myself intrinsically. So I leaned on that as I was cognitively going through the process of thinking about leaving practicing medicine.

SS - Dawn 12:24

I actually talk about that in the book a little bit. I had to have brain surgery for a benign brain tumor that was pituitary and that caused me to have permanent infertility. And I was studying before that happened to me. Eckhart and some spiritual, readings about the ego separating from the ego and the de-identification with form, which is what you were talking about. And I thought about that before it even happened to me. The whole, like, what would happen if I got in an accident? What would happen if I was sick and I couldn't do these certain things that I already identify with? Part of who I am. And so I think it's wonderful that you used that as motivation to navigate through, some of the uncertainty of what you were doing.

SS - Shilpa 13:11

Yeah, I think that that body of work has been really helpful. I'm sorry that you went through that, and I'm glad that it was there to support you as well.

SS - Dawn 13:18

Thank you very much. The hard part is doing the work but I really want to also know. What the best part of this transition has been for you?

SS - Shilpa 13:31

I think for me, I love the work that I'm doing right now and I feel like I'm able to help people on a much larger scale than I was before. And as a pediatric oncologist, I definitely, use the best that I had access to. But we are limited in the clinical arena by what we have access to. And in pharma, we're able to push that boundary and. Improve the toolkits that are available on the clinical side. So I really love the getting to do this work. It feels like it's still, in some ways, in service of my patients and patients around the world because this work that I get to do now can impact millions of people's lives and, and their families. So I. I really feel honored getting to do the work that I am doing right now. And I would never have had this opportunity if I didn't go through that process and separate myself from my identity of being a physician. The skillset that I learned as a physician, as an oncologist and understanding this value, absolutely translates to the work that I'm doing right now and I am only able to do the, the b the quality work that I'm doing because of my training as a physician. So I still have gotten to use those years of, and decades of, of work that I put into becoming who I am now. But it took kind of stepping into a void before realizing that that was, what my future was.

SS - Dawn 15:08

Yes. Great quote. I love it. If you don't mind me asking, what is your infertility diagnosis or the surrounding, Circumstance that you figured out that you had infertility.

SS - Shilpa 15:23

Uh, that is a great question. And this is what makes my story unique. I am not doing I V F because I have diagnosed infertility. I'm doing I V F because I carry a genetic condition that I don't wanna pass on to my children.

SS - Dawn 15:40

Ah, okay. And so is this something that you knew about, even when you were in training or, is this something that you found out about later?

SS - Shilpa 15:49

I found out about it, I guess maybe like five-ish years ago. I found out about it before I met my husband. So before we even like, became serious. I told him about it. I told him that I would need to do I V F, and we've never tried to get pregnant naturally. So the whole time I knew that this was going to be an element of my life.

SS - Dawn 16:12

Yeah.

SS - Shilpa 16:14

yeah. My, my genetic condition, it's an autosomal dominant one, which means it's a 50 50 chance of passing on to my children. It's a cancer gene, which I didn't know I carried a cancer gene when I went into pediatric oncology. I found it out after. Um, and it also means, that I carried my family carries it. I learned that I had it because my mom was diagnosed with it and, um, Then my mom, she had four different cancers over five years, and I was a pediatric oncologist, in my final year of training with her first diagnosis. So I became a primary caregiver. I moved her into my home. I took care of her while I was completing my training and, um, I, I went through that with her and I love her so much. Um, Her fourth cancer was a treatment related a m l that she died of two years ago, so when she died at 64. Um, so I, I inherited that gene. I don't know like what my lifespan is gonna be. And I didn't want my children to have it. And this was another thing that I also thought about in terms of my group, like my best case scenario is I have these kids, but then also I still have to go through like surgeries and, I can still get cancer and then I can still die early. What does that mean for my group? They're just gonna support me for the rest of my life. But in pharma, I don't feel like I could potentially be a burden onto them. I feel like I just add value. And being able to do this in giving my children the best chance of a future that I can imagine is. Especially as a pediatric oncologist, like you see so many parents who would do anything to have prevented their children from getting cancer. And I am fully, like, I get it. And you know, if I, my child got cancer, and I didn't do this, then I would be devastated. So, yeah, that's, that's why I'm doing I V F.

SS - Dawn 18:12

Yeah. Oh my gosh. Um, I, you know, we didn't really even talk about that in the beginning, and I wanted to back up, but I, I didn't realize this whole other part and the stuff about your mom and I'm so sorry about that. I. And it sounds like it, that really informed also, uh, the way that you approach life knowing that it's not, Something that we should be taking for granted no matter how old we are. Um, and that your life is precious and the things that you do, you need to be, living in your purpose right now and not thinking about it later when you're older.

SS - Shilpa 18:51

Yeah,

SS - Dawn 18:52

Any advice that you would give to other women that, see themselves facing, fertility treatments for whatever reason, and also are trying to navigate living your professional life and balancing working life.

SS - Shilpa 19:08

I would say that. The earlier you do it, the better because the earlier you are, then the more ovarian reserve that you will have. So if you're thinking about it, going through at Lisa's first step with the ever travels is worth it. I think that in the past the procedures that used to freeze eggs were not as good as, freezing embryos. But now the. That technology has improved. So, it's still worth it to try to freeze eggs if you don't know who your future partner will be. And I think that e even if you freeze eggs and you go through a cycle of egg retrievals, it doesn't mean that you have to use them. You can still try to have children. Naturally there's no, this is just more of like an insurance that you can have that helps improve the likelihood that you can have a child. A biological child if you want one in the future. The message I would give is, if you're thinking about it and you think that having a child is something that you want in your future, even if you don't want to have one now, even if you don't have a partner, it's still worth it to go for an retrieval or two and seeing what your fertility reserve, like, what your egg reserve looks like, and then just having that banked for yourself.

SS - Dawn 20:28

Yeah, I agree. When you were in your challenging clinical work environment and you were doing I v f, you had a couple of egg retrievals, and I think you said one of them was very unsuccessful even, and then you took some time off and you did another one and you had some success I'm wondering what part of stress you think really played into that.

SS - Shilpa 20:56

I think it was huge. I mean, I know that there's, there's literature out there that says stress impacts fertility, and then there's also literature out there that says it doesn't impact fertility. For me it, I saw a big difference. There's like this mind body connection. Maybe if I had other, like mental resilience, maybe it wouldn't have had as much of an impact on me. Who knows? But I did notice that for myself, my first egg retrieval, I got one euploid. My second egg retrieval, I got zero. My, and those were the two that I did while I was in clinical medicine. And then, every cycle of egg retrieval is expensive. It's the medicines, it's the clinics, it's not just the time expenses. It's actually expensive. And especially when you're in pediatric subspecialists, then you don't have that much money blowing around. So, it is expensive to do and to do that, you lose time. You are using financial resources, you're using non-financial resources and the help that you're asking for your colleagues and the demands that you are placing on your staff and yourself. So it, it's a lot to do. Um, and it's emotionally really use emotional resources. So, I. Took two months off, and then, and started my new job. And, as I started my new job and realized that I was able to recover while I was in this job, it wasn't as demanding as my prior one had been. Then I went forward with another cycle of IVF or another egg retrieval and I got five fertilized eggs three of which were euploid and it was amazing.

22:37

So at this point in our conversation, I cut the recording because we went on to talk about a couple of really personal things. I have to admit that I was surprised by Shilpa situation. It's very unusual. And yet it really demonstrates the need for all of us to treat each other like human beings in the workplace. We all get sick. We all experience death of loved ones, and we all need medical treatments from time to time. She'll pose original vision of her career did not mesh well with the genetic cards that were dealt to her. Here are my takeaways from our conversation. Number one life throws us all curve balls, and that's the reality. It's great to love your current situation. Whether that's your dream job, your dream house, your dream family, but things change. And we must adapt. I was struck by the irony of Shilpa situation, being that she's an oncology doctor who found out that she has a deadly cancer gene. Number two. Consider your work style when evaluating your job satisfaction. And this might change over time because of those curve balls. I'm talking about. Ship a recognize that she wasn't going to feel good about her clinical work. If she was not able to give it 100% for her patients, if she was not going to be able to be present at all times and give a plus work, maybe you feel this way too, but. Maybe you're okay with B plus or even C plus work. There's no shame in that, but be honest with yourself about how you roll. Number three. Your identity as a person does not have to be tied to your job. You are a beautiful human being unchanged by any external circumstances. Remember this as you navigate. Life change and loss. My parting question to you today is do you know who you are when you're stripped of all your possessions? Appearances and titles. Thanks for listening to the lean out podcast. If you like what you hear, please leave a review for this podcast on iTunes or Spotify. So other people needing this kind of community and inspiration can find it easier. Also, you can support this podcast and learn more about the ideas presented by buying my book, lean out a professional woman's guide to finding authentic work-life balance. Lastly, if you want more information about working with me. Please visit my website@wwwdotpracticebalance.com.