Early Career: A New Look at the Sunday Scaries


My typical “Sunday scaries” showed up one day early this weekend, after spending a day furniture shopping with my husband for our new home. When I got home on Saturday night, I realized that I was going to have to spend my entire Sunday doing homework. Yes, real homework! I just started a Master of Science in Clinical Research and learned the hard way that looking up patients in Epic does not require the same brainpower as doing biostatistics questions or learning to program in R. It has been daunting, to say the least, to sit down with textbooks, to watch and participate in virtual classes, and to keep up with a mound of reading, problem sets, and group projects.

Despite this new workload (did I mention I have a grant due this week?), there is something different about this rendition of Sunday scaries: I am in a good mood. I just finished revising a paper that one of our fellows wrote, and I feel good. Not because I think it’s going into a major journal, but because I had the opportunity to give meaningful feedback. I remember the first time my mentor, Meryl Cohen, reviewed our paper. I didn’t recognize it. But I read her edits, and the edits of the many mentors who have followed, all of whom took the time to share wisdom about good writing, about clarifying your ideas, about explaining why your findings are new and different. I remember realizing that I had “caught the research bug,” as Laura Mercer-Rosa once told me. And now, I have the opportunity to get someone else on the hook. And tonight, that is enough to put me in a good mood.

As a junior faculty member in an incredibly large and busy program, it is easy to get swept up by the clinical needs of the program. My joint position as a cardiac intensivist and heart failure/transplant specialist means that I have two jobs. I usually joke that “it seemed like a good idea at the time” to do a DIY fellowship combining two fields. That comment typically comes up when I am on service for long stretches, like when I am transitioning from covering the transplant service to a week of nights in the CICU and parents say, “don’t you ever have a day off?”

Most of the time, I feel lucky. I feel lucky that I get to see patients transition from ECMO to VAD, to floor, to home, then back for transplant. I love being able to say, “I can’t wait to see you in transplant clinic,” to families that have been waiting for a heart for six months. I feel fortunate when I can tell families that we have gotten children through worse cases of rejection, that we have a world-class ECMO program, that I am one of 12 cardiac intensivists in our program, and that we are a true team, all fully committed to their child.

But there have been times when the clinical load takes its toll. When it feels like my voice, young and new to the program, does not feel heard. And that’s when the Sunday scaries aren’t just scary…they’re paralyzing. When I have trouble sleeping for an entire week of CICU service, fretting that I am not giving the best care to my complex congenital patients. When I stay up late reading articles about VAD options in single ventricle patients, hoping for a window in which my opinions are sought and valued, and then feeling defeated when my insights are ignored.

In those times, I have learned that I should not jump back, or dive in…I should just lean. During my first year as an attending, I dived in, trying to be taken seriously. In my second year, I jumped back and may have missed opportunities for growth. This year, I am leaning on my work family, the most amazing group of colleagues I could imagine, who reassured me about my clinical acumen, who guided me on “picking my battles,” who supported me as I crammed more service into less time so that I could do the MSCR, and who cheered me on as I planned a destination wedding in the middle of a pandemic.

The support of my work family has been as immense as that of my family at home, allowing me to be absent from the CICU and transplant schedules for months at a time. And that support has given me time to reflect on why I love having two jobs and to remember that this MSCR is worthwhile. Ultimately, it’s not about me. It’s about us, and what we provide, from patient care in the ICU, to family support, to mentoring fellows, to new and exciting research questions. And when I remember that, nothing seems too scary.


Arene Butto, MD

Assistant Professor of Pediatrics, Emory University School of Medicine
Pediatric Cardiac Intensive Care & Advanced Cardiac Therapies
Sibley Heart Center Cardiology, Children’s Healthcare of Atlanta
Atlanta, GA, USA