Tuesday, December 9, 2014

A Letter to My Son's Doctor: A Real Life Superhero!

Dear Dr. C:

I want to sincerely express my thanks for helping my son 3 years ago. I can’t remember if I have thanked you since then and want to remind you how highly regarded you are in our family.

It was a Tuesday afternoon in September 2011 and you just happened to see our family in a hospital room on the pediatrics floor. You didn’t know my son or me but you recognized my husband, a fellow pediatrician. You were probably on your way to your usual spot in the intensive care unit but something made you stop. You must have thought things didn’t add up. You saw my husband, looking worn and worried, with an equally worn and worried wife at the bedside of a little 3-week old baby, together with a silent and scared grandma in the wings. There was a flurry of activity with nurses and doctors and technicians and alarms and phone calls and talking and crying.  You saved my son’s life by peeking your head in our room at that exact moment. It must have been a split second decision, but one that I am so grateful for.

I don’t remember many details about my son’s first weeks of life, like most mothers, it is usually a blur. But I remember the moment so clearly, when you walked in and greeted my husband. I saw something change in your face when you absorbed the story of the baby lying there in front of you. Your face changed from a friendly one, to an instinctive, inquisitive and firm one. The admitting doctor in the room recoiled, letting you take charge with more questions and orders for the staff.  I knew I needed you there. You were at the foot of the bed with your arms crossed, discussing a differential diagnosis of what could be going on with my husband.

After watching you for what only could have been a minute or so, I turned back to my child, moaning, writhing, exhausted on the exam bed. Everything else was drowned out in that moment. I didn’t know if he was hungry but I wondered, because my breasts were leaking and painful and that is when he would usually eat. I grabbed his small wrinkled hand but that was no comfort to him. I had uncontrollable tears as I looked at all the lines and tubes and tape and fluids going in your little arm. I rubbed my eyes and looked up at his cardiac monitor. His heart rhythm was changing. And he was dying.

You started shouting out orders for medications to be given stat. You said loudly that our son was too sick for you to even leave the room. You wanted him to be in the ICU as soon as possible. My mom told me she got a chaplain who could help us. I remember timidly asking if we could take a moment for a prayer because I had this sick feeling in my stomach that it might be our only chance. Your demeanor changed and I saw you quickly weighing the options. You chose to give me the moment and even prayed with us. It was absolutely gut-wrenching to see my child so helpless, to know what was going on as a doctor myself, and to have a glimpse of that deep visceral soul-crushing feeling that a parent must have when she loses her child.

Thankfully, we didn’t lose him that afternoon. You came just in time. He might have had minutes or hours left with us if your instinct to help had not taken over. I remember talking with a specialist later that evening, while rocking my son in my arms, still attached to lines and a urinary catheter. She knelt down beside me and told me that my baby’s kidneys were very damaged and that he will need a kidney transplant. Thankfully because of the good care that day, he would not need one yet. There wasn’t anything that could have prevented this, seeing as he was born with a rare congenital urethral malformation. A small membrane grew where it wasn’t supposed to be while in utero and hence, caused a lifetime of damage. In doing research later, I learned this condition could have been much worse, requiring dialysis right away or needing a transplant immediately. Some kids don’t even make it very long.

While none of this is what I planned or hoped for my child, I am so grateful he is still here with us.  He is joyful, beautiful, energetic and smart! He has such vitality and strength now that I don’t think anyone remembers how ill he once was (except his parents, of course).  He has been through several surgeries, painful procedures, countless blood draws, therapies, and doctors appointments…and yet you could never tell by looking at his toothy smiling face.

Thank you, Dr. C! I am sure you are not told this enough. You care for many children everyday and you should know that you are a superhero in our eyes. And so is our son!

Monday, December 1, 2014

Pumping at work...caution, some graphic details here

I discussed in a prior post about how difficult it was being a pregnant resident. So moving along chronologically, we should discuss post-partum life too. It was certainly no walk in the park. Women don't seem real open to talking about the difficulties with post-partum life, the technicalities of nursing and pumping and trying to return to work. How do we juggle babies with any job, much less a professional career? I hope to open up the discussion here.

Since I was in an educational setting, the standard FMLA 12 weeks required unpaid leave wasn't exactly the case. I was a hospital employee but was also undergoing a rigorous educational program at the same time. I did not insist on 12 weeks off, but took 8 weeks and still had to make up some time after graduation. I had a colleague in a similar position who took only 6 weeks off. Maybe it never feels like enough time? I had a mushy mommy brain (it's a real thing, guys) but had to resume work with the same physical/mental/emotional rigor that was standard before my new mommyhood.

Mommy brain

I think here begins my dissolution with medicine. There is no way to have a work-life balance in this state. My wonderful mother moved in with us for 6 months so my husband and I could both finish our difficult residency schedules and she was my daughter's main caretaker. I think I still wanted to be important and vital to my daughter so I chose to breastfeed. But I'm not sure where I found the strength to do this. I wanted to try it and experience that special bond between mom and baby. I didn't want my work to take away everything special about having a baby. Emily was my first child and fortunately I had a lot of support at home. I felt some obligation to try nursing, too, since I was in the medical profession and we always speak about the numerous benefits of breastfeeding to patients.

In retrospect, I probably should have been nicer to myself and just used formula. But after my maternity leave, I returned to work with the black Medela pumping bag around my shoulder. I was also armed with a ton of disposable breast pads and scribbled notes/encouragement from my lactation consultant in my pocket.

How do you keep nursing at home when you have a demanding job, over 40 hours per week? I had to pump at work during my 8-12 hour shifts. How do you do that when you have no scheduled breaks and typically feed your child every few hours at home? It just was not possible to take a pumping break every 2-3 hours. So...I remember a lot of pain, leaking, mastitis, and misery. Suffering in silence...while covering my wet scrubs and trying to talk to sick and distraught patients in the ER. I somehow managed to carve out one pumping break per shift. But as you know, the less you pump, the less your milk supply, and you inevitably don't provide enough milk to exclusively breastfeed. Overall, I felt that some breast milk was better than none, and did my best with breastfeeding and pumping for about 6 months.

There are other details here, like, where do you pump when you get a chance?
How long of a break do you get to pump?
Who covers your work while you are gone?
How do you deal with the stress of it all?

I ended up finding a small locked room in the ER, officially called the grieving room, where we would tell families about their sick or dead loved ones. Not a great ambiance there, but it was all I had.  I would sit on the floor and put the pump on a chair in order to reach an electrical outlet. I had quite the system down for doing things as efficiently as possible and it took 16-18 min or so. Setting out the equipment, applying the various hook-ups, trying to RELAX, pump, wrap up, put away. No one really did my work for me, but I let my (usually male) attending know I was on a pumping break (insert blank, red face, hushed voice reaction here) and would be back ASAP. You can't control who walks in the door of the ER, so sure, I missed some interesting patients and procedures while on break. But it never really bothered me. Did it bother my attendings? I guess I'll never know. And regarding stress, I'm sure I didn't deal with it very well, but I was in a very pressured setting and was literally just taking it a day at a time. It has taken 6 years to get motivated to finally talk about this, so I am probably working through some PTSD!

I personally and completely understand why some women don't breastfeed. But I was surprised with the statistics here on the CDCs 2014 breastfeeding report card. The majority of women try, but significantly fewer succeed past the 6 month mark. I view this to represent a general desire to breastfeed in many women. But there are a lot of barriers to success. Perhaps a good topic for next time. I am glad I tried and am in awe of my prior self finding the strength to stick with it. But it probably came with a cost-a growing disinterest in medicine because it took me away from my family and good mental health.

Do you have any embarrassing/good/bad pumping stories?

Do you remember when you first learned HOW to pump? (My husband and I had to watch a YouTube video, which was absolutely horrifying as a first timer...)

Thanks for reading!

Here's the picture I carried in my pump bag way back then:

Tuesday, November 25, 2014

A New Thanksgiving

Yeah, right.
Are you tired just looking at this picture? I sure am! 

Maybe some people really enjoy shopping for, defrosting, prepping, and cooking a turkey all week.....but I am not one of them.

Is turkey even that good of a food? 

I suppose once my kids are old enough to enjoy turkey, potatoes and all the fixins that maybe this holiday will be more enjoyable. But right now, they would rather eat chicken nuggets. There's no way their 3 and 5 year old palates will touch any icky sticky mashed or sweet potatoes, or goopy beans with crispy onions. 

They won't even touch pie! So why put in all this effort only to fail? For Thanksgiving, I want some peace and sanity so I am trying something new. Tossing aside the roaster pan! 

I decided that this year, we will take a break from the craziness of the big holiday meal. I will try some easy and 'clean' recipes, in reasonable portions, kind of how I do it every day. I'll keep trying to feed the kids new things but am not going to stress over this meal. 

*How do you feel about cooking Thanksgiving dinner?*

Whatever your meal of choice, I hope you have a peaceful and cheerful holiday!

Monday, November 17, 2014

Baby planning

Joyful peanut!
If you can believe it, I had this little peanut during the last year of my residency. Saying it was difficult would be a understatement, for sure.

I learned I was pregnant while I was working in the surgical intensive care unit (ICU). Obviously I was exhausted but figured it was from the demanding schedule. There was overnight call duty every 3rd-4th night. I was stressed, sick, and not eating much. Definitely not the most ideal conditions to gestate a little human.

The news was jolting-while something I wanted desperately, I couldn't imagine worse timing for starting a family.

What got me thinking about this was an article I found floating around Facebook recently, written a few years ago by an anesthesiologist, Dr Karen Sibert. It is titled, "Give yourself a break-Don't have a baby during residency."

The link is HERE

While Dr Sibert did not have a child during residency, she did have one before and after. She witnessed other residents go through this process and noted the difficulties as an onlooker. Her article has been controversial because of its judgmental tone towards women residents. It really hit a sensitive spot for me (and others) because we each have the right to decide when having babies is best for our own families. Having one in residency is extremely difficult as you will see in my personal experience. BUT it was my choice.

But Dr Siebert touches on some ways that having a baby during residency affects the mom's professional career. Having a new baby is tiring and distracting from your career. You are 'looked down on' by others and certainly by the others that have to cover you while you are gone. Your board scores are likely lower. Your chance of getting a top job is  jeopardized because you have 'other priorities.'

There are more personal ways that the baby process affected me. I basically had to pretend I wasn't pregnant in order to get through those following 8 months.  I got really good at pretending I was ok. 

It was very hard to ignore a pregnancy. There was no time to be tired or rest. No time to eat or take a bathroom break. No time to take care of my worsening back pain. No time to sit down during a long procedure or while leading a code or caring for many sick patients. I had to pretend I was fine because if I didn't, it would make a lot more work for the others around me. And those others were not going to jump in and help easily. Admittedly, they had a lot on their plate too. There was always plenty of work to do in the ER.

Can you believe I only had ONE attending tell me, during the entire 8 months, to take a lunch break and rest? Once I even had a combative patient kick me in the abdomen when I was 6 months along, and no one took any notice. I felt invisible and just kept trucking along. I had to make it to Dec 1st, where I could shift gears and do an 'easy' elective rotation which involved a lot of sitting. No codes, no trauma, no night shifts. I was very worried that I wouldn't make it since shift workers are known to have higher rates of miscarriage and preterm delivery. (Nice summary of shift work effects: LINK)

Somehow I made it to Dec 1st. I cried a lot with relief (and hormones), put my stethoscope away, and started putting the nursery together. But in a BIG twist, I was forced into working an extra shift in the ER during the first week of my elective. Mentally, I was completely devastated even though it was just one more shift. So I pulled my stethoscope back out and worked an awful shift on Dec 3rd. I think I was visibly steaming the entire time.

Later that evening, during a classic midwestern snowstorm, I was in bed eating cookie dough ice cream. (Hey, I deserved it!!) And then they started.....those darn contractions. It was the real deal! I texted my husband to come home (because he was working overnight in the hospital) and we rushed to the hospital. I still remember the bumpy, slick, frigid ride in the snow like it was yesterday.

I am so thankful that my daughter was born healthy and happy. And technically, just made it past the premature period. She is an amazing kid and about to celebrate her 6th birthday. I think the timing of her arrival was extremely difficult but having her in my life was, and is, such a joy. Her presence in our family changed my job opportunities, like Dr Siebert gets at in her article.

More on that later! What was your pregnancy experience? Did you feel like you had to hide your 'disability' because of your job, professional or not?