I’m A Surgeon. I’m Also Child-Free — And 6 Words From A Colleague About My Life Left Me Stunned.

I was sitting with a group of my colleagues in a physicians’ meeting, hammering out policy changes and standards for patient care. The conversation wound down as we neared the end of the workday, and chatter shifted from business to our weekend plans. Others in the group shared their family plans for kid’s activities and dance recitals. I shared that I was going to Las Vegas.
“It’s because she doesn’t have kids,” one of the doctors said. Those six words fell out of his mouth with little effort and hung in the middle of the room in the hospital where I had worked for nine years.
Laughter broke the silence, and the conversation moved back to the business at hand. People packed up to leave, but I kept turning over his words, which felt big and heavy.
My reproductive choices had been casually brought up and then discarded in the middle of our otherwise collegial conversation. In an instant, my joy had been made small. My child-free life was the butt of a joke.
As a woman in my 40s, I was no stranger to unsolicited comments about my choice not to have kids. Since these judgments were familiar to me, I usually shrugged them off, but this moment hit differently. Over the next few days, I pondered the tone of my colleague’s words and what they implied. Did he mean that because I didn’t have children, I didn’t have any responsibilities at all, so of course I could run off to party in Vegas?
I’ve frequently encountered the notion that a woman without kids is somehow absolved of all life’s burdens and efforts. A lack of children, apparently, is the only reason I can have fun. Sure, there are perks to not having kids, but the assumption that my autonomy comes without the normal weight of human experience is flawed. As an academic surgeon at a major medical hospital, I have plenty of responsibilities. I also have people I care for outside of work and many who rely on me. My free time is filled with travel, friends and so much love. My life has incredible value. So why, to the world, isn’t my life enough?
“When a woman can’t have kids she is often portrayed as sad and damaged, but if she simply won’t, she is either deluded, destined to regret it, or written off as a cold hearted, narcissistic, and career obsessed,” Ruby Warrington writes in her book, “Women without Kids.” Though I have an advanced educational degree, a house and a life partner, I have often felt the need to minimize or defend my life choices to mere acquaintances. Even more frustrating, when I am frank about the fact that I don’t want to have kids, I have been made to feel selfish or warned I will regret my choices. I have been given multiple warnings that my career will never be as fulfilling as motherhood — that my life, in general, could never be “full” without children.
With every unsolicited comment made to me over the years, the lens through which the world sees my life has been made increasingly clear: A woman’s worth is based solely on her willingness to reproduce — not on her intelligence, her work or her contributions to society. My ability to perform lifesaving surgery, my community, my family and all my other aspirations — seem to count for little when I answer “no” to having kids.
I’ve tried to explain the way I am perceived by my women friends with children, some of whom are also professionals in high-powered fields. But even in these circles of sisterhood, I have found it hard to convey the unique perception women without kids face.
“I’m really sorry that I talk about my kids so much,” one friend responded after I tried to explain the static I heard from others when stating that I would not have kids. I was so confused and painfully aware of the huge disconnect between us at that moment. While I was attempting to detail the blanket judgment by society on women without children — and how much I have struggled to overcome other people’s assumptions that I must be distraught about the life I so enjoy or the idea that my freedom is somehow conditional and temporary — the conversation with my friend had apparently only aroused guilt in her for the many times she shared sweet memories or minor complaints with me about her kids. She couldn’t understand that her life — her choice — did not make me sad. My comments weren’t about her life. They were about mine.
Once, at a meeting about improving the workplace for women, I asked a group to identify what else, outside of pregnancy and motherhood, we could work on to help advocate for all professional women in the hospital. The responses were empty and confused. What other issues could there be, they wondered.
Over time, I’ve come to believe that this singular maternal focus for progress and improved support in the workplace is isolating and narrow. In the medical field especially, while much has been written about the working mother’s perspective and the lack of support she is likely to receive — all true and worthy of our collective attention — there are so many other issues women face in the workplace that are minimized as a result of beating this single drum. What about pay differences, delayed promotion and professional advancement, and lack of adequate support and mentorship for all women in the workplace? The sole focus for the advancement of women professionals seems to be not increasing their success professionally but instead how to create boundaries with work to get them back to their “true” calling and purpose: motherhood.
Conversations about my reproductive life have come in all shapes and sizes, but the most common one has been with both men and women who have tried to convince me that I am wrong. I would be “so good” at it, they say, especially given that I work with children every day.
At 43, I’ve been told numerous times it’s not “too late” to become a mother. Someone once even tried to convince me to have children by telling me that I wouldn’t ever experience the depth of love that exists in the world without them. While I applaud the scientific advances that exist that allow women who want to have children later in life to do so, for those of us who don’t, the data that shows these later pregnancies are complex are worth more than a passing glance. Women physicians are also more likely to delay childbearing, and they experience increased infertility, miscarriage and pregnancy complications at higher rates when compared to the general public. None of these aspects of childbearing ever seem to factor into conversations with people who prefer to think I just need some “convincing,” nor does the idea that, perhaps, I have done my research and made an informed and confident decision.
The truth is I didn’t always feel sure I didn’t want kids. There was a time when I wanted to be a mother, a fact I usually keep to myself for fear that others will interpret this information as hard evidence for the secret, closeted uncertainty I must have about not having kids.
But I will tell you this: I once thought a bright light would flip on in my head and heart, and I would know beyond a shadow of a doubt that I wanted to be a mother, like the world said I would. That light did turn on a few times but was never quite as radiant as I expected. Then, in 2020, I watched as the world was ravaged by COVID-19, and I recommitted myself to my work, which had always given my life so much meaning. As I witnessed the rise of increasingly hostile policies around women’s bodies and choices, I also remembered that all these interactions I had with friends, strangers and loved ones were the result of a larger cultural belief about the path a woman’s life should take, rather than about what she wants. And when I really thought long and hard about what I wanted for my life, rather than what I was told would give it the “most” value, the light switched off for good.
Caitlin A. Smith is a surgeon and writer in the Pacific Northwest. Her personal essays on surgical training and experiences have appeared on Doximity. She is currently writing her first book, a firsthand account about life and experiences of women in medicine. Find her at @miseducationofaknife on Instagram and Substack.
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