Tuesday, December 30, 2014

Chronicles of a Sleepless Mama

Here is a glimpse into my 3 years of sleep deprivation, due to a disorder known as “sleepless baby syndrome.” It's been a rough few years- my son has had a very hard time sleeping through the night due to constellation of reasons I won't get into right now. Perhaps they are "excuses" not reasons? In any case, here you go...

During the first 6 months:
What you think: This is totally normal, right? All the other mommies talk about their fatigue too so we must be on the right track. Just give it some time.

What you feel: A mixture of exhaustion, joy, and love. You love this bundle with your whole heart figure that sleep will come eventually.  Everyone keeps telling you it will work out and you believe them.

What you do: You kindly take in advice from others and try techniques to help baby sleep. You have hope that those swaddling and shushing methods actually work.

What you look like: A proud mama, with the sleepless badge of honor. Hair in a ponytail, rocking the yoga pants because you are tired with a baby, of course.

At 12 months:
What you think: Wow, nighttime is really hard. I didn’t think it was supposed to be this hard. Every other baby seems to be sleeping well at this point. Maybe I’m doing something wrong. Maybe I have the wrong color night-light or the sheets are too scratchy? 

What you feel: Tired, but probably within the normal limits for a mom of a 1-year old.  After all, you are caring for your family and it is hard work.

What you do: You start investigating baby sleep a little bit more and realize you need a temperature monitor in the baby’s room and maybe some room-darkening shades. You get a night-light with a red hue because that’s shown to help. You double-check your white noise machine since we know if it’s TOO loud, it can hurt baby’s sleep. You rub baby down in lavender oil because, why not? You play music that is clinically shown to induce sleep. You know a routine is important and have it posted on baby’s door for all to see. You know this HAS to work.

What you look like: Not quite put-together. A little behind the rest of the mommy crowd, most of whom can manage to shower and get dressed these days. 

At 18 months:
What you think: Maybe I just have a stubborn baby. I have tried everything. Everyone tells me I need a good nighttime routine and I want to punch them in the mouth. I KNOW, OK! It’s posted on the door!

What you feel: Exhausted. Resentful. You hate other moms not for their beauty, but because they are sleeping a LOT more than you. You regret your husband putting you in this position in the first place. You aren’t sure how he can keep going, but you are spiraling out of control.

What you do: You seek out doctors’ opinions and start looking into more extensive sleep programs. You pay people to help you at night. Even if you DO get a decent stretch of sleep time, it is impossible to sleep because of your anxiety about NOT sleeping. You are just waiting for baby to wake up.

What you look like: It’s starting to really show now, the bags under the eyes and a slight grayish tint to the skin.

At 2 years:
What you think: None of my friends have this problem. All the babies in the world are sleeping except mine. The universe hates me. I might as well get some work done instead of lay down because I will be up again in an hour or two anyway.

What you feel: You dread the nighttime. Most days, it is hard to put one foot in front of the other. Your shoulders are heavy. Your body hurts all the time.

What you do: You want to give up. Motor skills are altered, slower. You know you should get outside and wear the kids out so they sleep bett….oh wait, that doesn’t work. You want to exercise to feel better, but can’t muster the energy. You look to take any pain reliever or sleep aid because you have run out of inner coping skills. You consider counseling.

What you look like: Now you look pale and grey from the sleep deprivation and stress. You try to hide it, but usually don’t make it past the concealer. Nothing fits because you can’t exercise so you buy cheap, ill-fitted clothes for the time being.

At 3 years:
What you think: I really can’t take this anymore. Friends, family and doctors don’t even try to help anymore because this is hopeless. I have a cranky kid who doesn’t nap and keeps waking up all night. There is no way I am having any other children. This is ridiculous. I guess I have to hang in there until he’s 18 and then kick him out so I can recover, if I live that long. (Really, it gets this bad.)

What you feel: The word exhausted doesn’t even cover it. It’s really hard to smile with any bit of authenticity.

What you do:  You seek out new doctors. Consider getting your baby (now in preschool) a sleep study or having his tonsils out. Maybe that will help, right? You pay a lot to have other people watch your kid. You get counseling. You stay up all night on the Internet, oh, and soothe your kid back to sleep every other hour.

What you look like: In a word, ragged. In a list of synonyms: frazzled, fragmented, shoddy, broken, dilapidated, frayed and rough.

I will stop at the 3 year mark, and notice, how large the font is at 3 years. Because it is RIDICULOUS. I wonder if any of you can relate to my condition. If so, please comment and I will send you personal condolences. The only comfort I can give my fellow zombie moms is that I FINALLY found the magic formula for my son's sleep. OR, he was just finally ready for it. OR, it was just pure luck. I'm not really sure. But things are getting better right now and I am embarking on a healing journey to restore sanity to my brain, rest to my muscles, and love back into my heart. True sleep deprivation is an awful feeling and has all sorts of horrible medical consequences that maybe we will explore later. I will also share the advice I got from my child's sleep specialist in an upcoming post...IF it continues to work, that is!


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: