With long nights, early mornings, and weekend shifts, medical fellowships require a lot of time commitment; it can be challenging to balance personal and professional responsibilities as many fellows start families, pursue additional degrees, dive deeply into new subspecialties, or even adopt pets. When Rachel Butler, MD, clinical assistant professor in Pulmonary, Critical Care, and Occupational Medicine, had four children under the age of four during her Pulmonary and Critical Care Medicine fellowship, time management became critical.

“That was incredibly, incredibly challenging. I was pregnant most of my fellowship, which sort of on top of being sleep deprived, there was like a different level of sleep deprivation that occurred,” Butler said. “There were actually nights when I would look forward to being on call because I knew that being on call, there was always a small chance I could maybe get a nap or sleep for more than three hours.”

“It was doable here at Iowa”
Butler had her first child prior to her first year of fellowship and gave birth to twins her second year. Nine months after her twins were born, Butler became pregnant with her fourth child during her third year of fellowship. Thankfully, she said, her youngest child was much calmer than the previous three.

“I incredibly love my work, and so it was a lot of juggling and handoffs and also a lot of learning how to ask for help,” Butler said.

While Butler struggled to balance young children with her fellowship schedule, the help she received from her husband and the Pulmonary division made it possible.

“You know, whenever I see young moms that are sort of working and trying to get through their medical training, I think about how it was doable here at Iowa,” Butler said. “My division was so incredibly supportive. Our program director was supportive. My co-fellows were supportive. In a different place or a different environment, I don’t know if I would’ve been able to make it through, but it was really doable here.”

She is especially grateful for Jeff Wilson, MD, clinical professor of Pulmonary, Critical Care, and Occupational Medicine. Wilson was director of the Pulmonary Disease and Critical Care Fellowship Program during Butler’s training.

“Rachel was the type of fellow every program director hopes for – bright, conscientious, enthusiastic, and hardworking,” Wilson said. “She is very kind to her patients who think very highly of her. When Rachel finished her fellowship we were really happy she stayed on as a faculty member. It has been a real pleasure to watch her professional maturation and contributions as a valuable member of our division. She is a wonderful example of how one can balance a successful professional career with a busy home life.”

The secret gem of Iowa City
With these support systems, Butler completed her fellowship and earned her faculty position. It was this support and her love for Midwestern people that kept Butler in Iowa. Before joining faculty, Butler completed her entire medical training in the Midwest, beginning with medical school at the University of Illinois. After completing an internal medicine residency at Barnes-Jewish Hospital, Butler and her husband, Nicholas Butler, MD, moved to Iowa City. Nicholas completed a fellowship in Geriatrics at University of Iowa Health Care, while Rachel worked as a hospitalist for a year. As Nicholas’ graduation approached, the family decided to stay in Iowa City, and Butler began her Pulmonary fellowship.

“We had kind of gotten settled in Iowa City,” Butler said. “We were just sort of learning the city, and it didn’t feel right to leave at that time. Iowa is actually incredibly beautiful. It’s a different type of beauty in that you can drive outside Iowa City, and suddenly you’re sort of in this beautiful rolling hills of cornfields. But you also have the university, which brings so much diversity and so much opportunity. It’s like a hidden secret gem. I get to see all these amazing things that people from all over the world bring here.”

For Butler’s young family, Iowa City offers many great opportunities and is only two hours away from her extended family in Ottawa, Illinois.

Learning to give comfort despite uncertainty
Growing up, Butler did not have any physicians in her family; her mother was a kindergarten teacher, and her father was a machinist. Yet, science intrigued her, and she saw medicine as a rewarding challenge.

“I’ll be honest; I don’t think I really knew what I was getting into,” Butler said. “I didn’t really have a real accurate view of what medicine was just because I hadn’t really seen it.”

Like many physicians, Butler wanted to help people. She describes feeling “starry-eyed” and believing she would be able to offer her patients healing.

“I don’t think we ever lose those good intentions, but I think sometimes you have to sort of change your expectations a little bit,” Butler said. “Part of those expectations were that you’d be able to fix a problem, and sometimes we do have that luxury of restoring someone’s health.”

Throughout her years of medical training, Butler began to acknowledge that many conditions did not have simple solutions. In fact, especially in Pulmonary, Butler finds that many of the conditions cannot be quickly resolved.

“And then you have to learn how to walk with someone when they’re suffering, and how to help, while at the same time, realizing that you maybe don’t have a solution,” Butler said.

She found this mindset especially helpful in her fellowship, which requires fast, critical thinking. Although she had originally been drawn to the critical care component of pulmonary and critical care medicine, she found the pace to be unsustainable, and she eventually transitioned to outpatient pulmonary. Now, Butler works at the Pulmonary Therapy clinic at Iowa River Landing and in the Medical Intensive Care Unit. In addition to the patients she typically sees in her clinics, Butler also staffs the fellows’ clinic and has a partial appointment at the VA Medical Center in Iowa City.

“There’s a lot of emotional energy that it takes to be with people in that critical stage,” Butler said. “I’ve really learned to treasure the fact that I get to know people in outpatient. I get to see them multiple times over the years. And you get to know them, you get to know their family, you get to kind of see how their illness affects their life.”

Thomas Gross, MD, professor in Pulmonary, Critical Care, and Occupational Medicine, and director of Pulmonary Outpatient Clinical Services, has seen firsthand the compassion Butler brings to each of her patients.

“Things I stress with my trainees as central tenets for job satisfaction include being true to yourself, taking pride in your craft, and letting your own voice come through in medical communication,” Gross said. “I hear Dr. Butler in every note of hers I read and can feel her passion and dedication shine through.”

As a mentor and colleague, Gross believes that you should assess a physician based on whether you would let them care for your family.

“I would be very comfortable letting Rachel take care of me,” Gross said. “Though, I suspect terms like curmudgeon, balding, and obstinate might be sprinkled in the history.”

The ‘20% rule’ for the division, for the patients
When she needs to give herself a break from the clinics, Butler finds solace in the outdoors. She especially enjoys spending time in the woods, unplugging from the outside world, and silencing her pager. Butler especially enjoys connecting with nature while spending time with her family. The Butler family likes to unplug together through outdoor activities such as biking, gardening, swimming, and fishing.

In their two-physician family, Butler dedicates a portion of each week to organizing and scheduling to ensure all shifts and activities are accounted for in her young family of six. However, Butler and her husband can bond over the pressure that comes with pursuing a career in medicine.

“What I’ve learned is that you have a finite amount of energy, and when I was younger, I didn’t really get that. I thought I could do everything,” Butler said. “I’ve realized there’s only so much of me, and so if one of us makes a decision to pursue this or to pursue that, then it’s kind of a team approach.”

Butler knows a thing or two about teamwork. Growing up in a small town, she played lots of sports, but she especially found an interest in softball and baseball. She still watches lots of baseball to this day, so when the former Cubs president Theo Epstein revealed his “20% rule,” Butler adopted a similar rule.

“You find the 20% of your boss’ job that they don’t like, and you learn to do it really well,” Butler said.

Applying this to medicine, Butler tries to take up the less exciting responsibilities to help out the division and grow as a pulmonologist.

“I try to do the things that nobody really wants to do that the division still needs to do,” Butler said, listing a couple less exciting, but still important, tasks. “I try to show up for patients, both emotionally and physically. Give a lot of care and a lot of love.”