Women's March on Washington

When Trump was elected into office, a small movement began on Facebook, one that resulted in the largest march in history. When I texted KC, it was still in its infancy. I had the time blocked off for a conference in Vegas. I've never been to Vegas, but decided it could wait another year. "KC, do you want to march?" "Yes." I booked plane tickets to D.C.

I know KC doesn't want this blog to be political. Neither do I. I've read all the perspectives, Trump garnered many of the votes. I've read lots of essays and novels: I get why so many women and men voted for him; it's a vote to try to change a corrupt system. His presidency is a blip in history; albeit one causing a lot of anxiety. While there were many signs that were anti-Trump, there were many more that were pro-women. That's why we gathered. For Democratic principles.

My friend Ramona knitted us the requisite "kitty-kat" hats. I think we looked adorable. Her daughter, age 12, got the third one and wore it better than we did Saturday night at dinner in their home.

KC and I, in front of the Air and Space Museum, Women's March, day after the inauguration.

For those of you who think we even knew where the speakers were, kudos, because we couldn't figure it out. There were so many women. At one point, we tried to get next to the Jumbotron, and regretted it when we were squashed and shoved and it took us thirty minutes to travel thirty feet to the freedom of the Washington Mall. I watched the speeches the next day on YouTube. 

Nothing lost in missing the speeches though. We saw lots of women and men with posters. We took pics. We found a high perch, relaxed and ate almonds and Cliff bars. When it was time to March at 1:15, we traveled to the marching site nearest us.

At 2:00 we still hadn't moved. A few women and men started chanting: "Forget the March on Washington, we are taking a Stand. This is the Stand on Washington." I got defensive. "I'm marching, if only in place. It's still a March. My feet are cold. It counts, right?"

At long last we eventually joined the March. It was everything my pulmonologist friend from Philly, one who I tried to meet but missed, raved about on text. "This is amazing and energizing! I'm so happy to be here. I'm sad I missed you."

There was lots of signage, but I decided to skip doing it myself so I could take lots of pics. There was one in particular, one of 50-100 that I took, that touched me the most.

And though she be but little she is fierce.

G2 P1011: life after loss and D&C

This post may be a trigger for those who have had an abortion, miscarriage, or fetal loss. I wanted to share my experiences because in the weeks following our fetal demise, I read several blogs by mothers but couldn’t find a single post written by a physician mother. This post is also part of my healing process. In it, I will share some of my challenges and also will explain my D&C*. I have found over the past months that many of my friends and colleagues have experienced pregnancy loss. Almost every single friend I shared it with have experienced their own loss. We are not alone. I hope that this post helps someone in need.

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It’s been 2 weeks since my D&C, over a month since we learned that our little kidney bean sized fetus-baby had died, and 3 months after finding out we were pregnant with our second child.

Thankfully, the nausea has resolved, the fatigue has ended, and the waves of grief are less intense and less severe. But sometimes the grief washes over me and I can’t breathe. And I fall into my husband’s arms or I call him or my mother or my best friend A and I weep. And then I wipe my face and I go on.

Zo asked enough questions for us to know that we needed to tell him something. So, I recalled my time during residency with the Palliative Care Team and did my best at providing a 5-year-old appropriate explanation of miscarriage. “Mama, there is no baby anymore.” “No, there was a baby growing but it stopped growing and then it died and the doctors helped my belly feel better and now I’m feeling a lot better.” He pauses, looks around. Says “okay” with a smile and a hug and then “I’m going to go find my Wolverine so we can play.” And then we move on. Now that my belly has started to rapidly deflate, I’m not exhausted or nauseous anymore, his questions have become less frequent. He is satisfied with our answers.

One of the hardest parts of this process has been all of the changes my body underwent that feel downright wasted. Big old breasts that won’t nourish a baby and that sadly have deflated just like my belly. A big old belly that poked out immediately and still makes some strangers pause. I pray incessantly that no well meaning elder asks “are you pregnant?” because I have stopped telling friends about our miscarriage (I am allowing the message to be passed by osmosis because at this point, I’m tired of retelling it and everyone who needed to know now knows) and I’m not sure I won’t either curse them out or start crying. New stretch marks that show my body underwent a change and unlike my breasts and belly, they are permanent. They will always be with me.

The hardest places to go for me have been the gym and the Ob-Gyn office. The gym because all of the mirrors show me exactly what I look like. I tend to sit in the car for 30 minutes before going in. I usually have my worst cries there building up the courage to go inside to work out. Losing weight after having Zo was so easy. He nursed like a champ and I weighed less than my pre-pregnancy weight within 4 weeks. This time. No such luck. At the gym there is no cute baby to tell other people about. I see the eyes on my belly (folks probably thinking “this pregnant lady knows she needs to be at home). I see the bulge in my shirt. The popped out belly button. The widened hips. I know I have to work extra hard to fight the flub without the help from breastfeeding. It hurts. All of this good chunk and no cute baby to show for it.

The Ob-Gyn office because there are cute waddling pregnant women. After finding about about the demise, I transferred my care from a midwife community practice to an Ob-Gyn practice recommended by one of my friends. I literally could not go back to the old practice; when the office called to follow up, I quickly thanked them and hustled them off of the phone. I had to let them go, they are the practice where I was hoping for a happy, uncomplicated pregnancy. I just can’t go back there.

And now with the new Ob, I don’t want to go for my follow up visit (but I do, on time!) because I know I’ll have to tell the Tech who gets my vitals that we had a miscarriage. And then the sad response, the averted eyes. I want to yell “I’m not a leper” but all I say with a smile to make her feel better is “we are okay! I’m feeling much better and the procedure went great!”. And I don’t want to hear the Ob tell me “you can start trying again next month.” And when I say “we are taking a break, this was a lot to handle” he says “yeah, yeah, yeah, you’ll be back soon pregnant with the next one. You two are healthy, you can have 3 or 5 more kids if you’d like” I have such complex emotions that I can’t mount a response. I just sit and nod. I literally am too scared right now to think about getting pregnant again. So I read books and I read blogs and I talk to friends who have lost babies and they tell me I am feeling exactly how I should feel right now. Confused. Scared. Hopeful. Encouraged. Sensitive. Fearful. Apprehensive. Angry. Loved.

It is 1pm and I have been putting off going to the gym since 9am. It’s time to get up and go. Hopefully writing this post means that I won’t spend any time sitting in the parking lot. Time to work on this belly bump.

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G2 P1011. Gravid 2 (meaning I have been pregnant twice), Parity: 1 term infant delivered, 0 preterm infants delivered, 1 abortion/miscarriage, 1 living child.

*D&C - dilation and curettage. This is a procedure where the cervix is dilated and a curette, almost like a spoon or a scraper, is used to remove contents from the uterus.

My D&C:

• In my D&C a small vacuum was also used.

• I received conscious sedation during my procedure, meaning I did not require respiratory support. I was in the pre-operative area for several hours until a c-section was completed and then I was taken to the Operating Room and it was over within 15 minutes. The Anesthesiologist provided midazolam and propofol and I was awake within minutes after with no cramping. I was very hungry and ate lots of yummy snacks and a big lunch and then came home and was promptly sent to bed by my family.
• The Obstetrician performed an ultrasound before to confirm the demise and an ultrasound after to show that the products of conception had been removed. I asked for them and have them in my files.  
• I had light spotting for 3 days after. Then only spotting with exertion (embarrassing but this means after pooping) for 2 weeks, then it stopped.
• I have had intermittent cramping and just like my Ob promised, I dind’t need any medication stronger than ibuprofen 600mg as needed.
• I had a follow up appointment 10 days later and was cleared for all activities.

How did you manage pregnancy symptoms at work? Share your stories!

Pregnancy is not an illness. It’s usually a joyful time in one’s life. But man, can it make you feel AWFUL. Morning sickness, fatigue, swelling, brain fog... Everyone experiences these things differently, but almost everyone is going to have something. Rare is the mom who can rosily exclaim “Gee, I felt WONDERFUL throughout my entire pregnancy!

Even in the same person, pregnancy can present differently. With Babyboy, I had very little nausea; rather, I had weird intense cravings for salty things (like sardines). So, when I learned I was pregnant with my second, I went out and bought cans and cans of sardines. Surprise! Not only did the mere whiff of sardines make me nauseated, that’s how I felt for the whole nine months.  

“Morning sickness”, which, in my experience, can last all day, is different for everyone. It can mean queasiness, or hurling. I have friends who required admission for hyperemesis gravidarum. All the ginger tea and Zofran on the planet doesn’t help, sometimes. 

I got through by only eating what I could tolerate: carbs. Sixty pounds later...

Swollen legs, incredible fatigue, brain fog... these are some of the other symptoms I experienced. I finagled "pregnancy parking" close by work at the end of my first pregnancy, when the summer heat made walking unbearable. I've heard of doctor-moms who managed to steal naps here and there... And for brain fog? I don't have any ideas what can help. 

What about you? Share what symptoms you had, and how you managed them. The info can help another doctor-mom!

MiM Mail: Neurosurgery and "accessory" mother?

Hello writers/readers of MiM,

I have been a long-time reader of this blog and I absolutely love the content — thank you for being honest about both the highs and lows of being a physician-mother. I am currently a medical student, and intent on pursuing a career in neurosurgery. I would also like a (small) family, though currently I’m very single (other than my books ;) ) so any possibility of a family is at least a couple years down the road.

I come to you wonderful ladies asking for advice/encouragement/hard truth —whichever you feel is most appropriate. I was talking to one of my attendings today about my interest in neurosurgery and consideration of various residency programs/sub-i rotations. He gave me a lot of good advice about preparing for residency applications; however, he also brought up the lifestyle of neurosurgery and the difficulties being a female in neurosurgery entails.

I have long realized that having a career in any medical specialty, yet alone neurosurgery, will make the experience for my (future) children different than what I experienced growing up — I had a stay-at-home mom. I had (almost) completely accepted that, but today one of my attending’s choice of words really hit me — he said that I would be an “accessory” to whatever family I have, rather than playing an integral role. This has been quite distressing emotionally as I try to process both 1) if this is truly the case, and 2) if so, if I’m okay with that. I really cannot see myself doing anything other than neurosurgery and so it’s hard to reconcile both my love of this field and my desire for a family.

I appreciate any thoughts you take the time to share. Best wishes for 2017!

Gratefully,
Perplexed Med Student

Have you encountered assumptions/ prejudice/ racism/ sexism/ intolerance/ harassment/ discrimination at work?

Genmedmom here.

Let's talk about sex, sexual orientation, race, religion, and disability, and being judged by those things, in the workplace. Have you encountered assumptions/ prejudice/ racism/ sexism/ intolerance/ harassment/ discrimination at work? 

It's definitely an appropriate political climate to be discussing this issues. Even aside from the blistering rhetoric of the past year, let's face it, for many folks, a "real" doctor looks like Marcus Welby, M.D. You know, a white, gray-haired, suited man who exudes experience and wisdom. Not that there's anything WRONG with that...

These negative attitudes can manifest differently, and span a wide range of experiences. 

The way I see it, assumptions can be innocent. These can be sort of insulting things said by well-intentioned people. They may be based in inherent bias and unconscious attitudes. Like, for example...

How many times during residency training did I walk into a patient's room, and they assumed I was anyone BUT the doctor? I was asked to clear the cafeteria tray more than once. Even after introducing myself, I was often referred to as [insert non-M.D. staff title here] and asked to fetch things: a glass of water, blankets, a urinal.

Sometimes, those assumptions annoyed me, and I acted annoyed. Other times, I tried to be cheerful and helpful regardless. I have also been guilty of making assumptions about others, and have had to retrieve my Dansko-clad foot from my mouth...

Then, there are more obviously negative/ hurtful/ damaging experiences.

During residency, a senior physician (a Marcus Welby type) whom I respected greatly and had been working with for some time chose a younger, more inexperienced, pretty unreliable male trainee to lead an endeavor that I had been interested in leading. Oh, that hurt. I wondered and fretted, Why didn't he choose me? What secret glee I felt when the young lad never followed through, and the project collapsed! Karma, man. Karma.

A woman I trained with had a miscarriage, and the supervising physicians would not allow her any time off. It was a first trimester loss. "Think of it like a heavy period," they said. "Would you call out for that?"

What I observed throughout all of my medical training was that women received very little understanding, consideration, or flexibility during pregnancy, maternity leave, or breastfeeding. The prevailing attitude was "suck it up, buttercup."

Then, I remember as a fellow, when I was interviewing everywhere for jobs. I was singled out by a senior physician (Yup, Welby again) for being half Latina. I was asked to take on a faculty position in part "because then we'll be closer to meeting the requirements for minority recruits. You can really help the department to look more inclusive. That'll be such a bonus."

That felt weird. I did not take the position.

In that job search almost ten years ago, I sought out a flexible position in a positive environment at a progressive institution, and I am satisfied that I found all of that and then some. The few negative experiences I had prior definitely informed my decision, and helped me to recognize what I didn't want as an attending.

I'm aware that many of you have had much worse and many more negative experiences than I did, and I'm wondering:

What did you encounter?

How did you manage, supercede, overcome?

What did you learn from the experience?

Do you see things getting better, or worse?

I Want To Hear Your Voice

I had a dream when you were only six months old that your first words were the complete sentence, "You can't tell me what to do!" You babbled so early and so prolifically that I figured you'd be talking by the time you turned one year. But now here we are two months past that, and I'm still in the dark. At least you've started pointing, but many times I still don't know what you want.

Why are other babies your age using words when you're not? Aren't you the child of a doctor and a lawyer who speak to you constantly in both English and Baby-ese? Who read you books every night? I Google the milestones, and you're definitely lagging in the language department. Have I done all the right things? What did I miss? Is this how it's going to be, you giving the overachiever but unsure parent in me an anxiety attack at every developmental step? I know comparison is futile, but I still fall prey to it sometimes. It's going to be a long parenthood if I don't learn how to stop now.

My thoughts of worry really are just fleeting; all I want is to hear your voice. Your real voice. Not just "mamama", "dadada" and "uh oh". As your mother, I keenly know your cry and your coo, but I want to know what you sound like when you express yourself with words. The lilt in your voice when you're delighted. How the words come out when you're angry. The tones you release when you're sad. I want to talk to you, to hear your thoughts and feelings and desires. Right now all I can do is wonder, but I'll bet it's going to be a beautiful voice.

Mandatory meeting...CHILDCARE PROVIDED

I have posted before about how much I love my job.  I am honored to work with so many amazing people.  Quite recently a revolutionary change has occurred for our late departmental meetings…childcare is provided (as well as dinner).  Such a simple offering means SO much. These special surgeon kid playtimes are now one of the highlights of my daughter’s social calendar!

Below I have posted (with permission) the beautiful and inspiring blog post of our amazing Clerkship Coordinator after the first childcare night. I am so proud of us.  I am so proud of who my daughter (the 6 year old described below) is becoming.  I am proud of this department, of my profession and the future that we are creating for our girls as Mothers in Medicine…

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From the blog of JP -

When I was a kid, about 25 years ago, I overheard my mother repeating a riddle that had been told to her. In short, a young boy and his father were in a car accident. The father died immediately upon impact. The boy was rushed to the hospital. Once in the OR, the surgeon stands over the boy and simply declares, "I cannot operate on this child. He is my son." So the riddle goes, if the father was killed in the accident, how on Earth is this possible? Keep in mind, the riddle is at least 25 years old.

I listened as folks stumbled over themselves with the most absurd answers, "The dad hadn’t really died." "The surgeon was the boy’s step-father!" "The father was not his biological one and the surgeon must have been the boy’s sperm donor." The answers came and went and when the person finally threw their hands up in defeat, the person telling the riddle simply replied, "It was the Mom! The boy's mother was the surgeon!" Gasped responses immediately followed; these gasps were made as if to imply extreme bewilderment that a woman, A MOTHER, could be a surgeon. Nonetheless, the folks on the receiving end of the riddle felt embarrassed for not offering the most overlooked obvious answer even if they could not fathom a female with a scalpel.

Fast forward 25 years, I just spent my evening at work doing arts and crafts with two children of surgeon faculty members so that said parents could engage in an after-hours faculty meeting.  I brought all of my craft items from home so the young girls could make various winter holiday crafts. At one point I noticed one of the girls (6 in age) was making a gingerbread man. I quickly praised her on her great artistry, "Hey! That’s a great gingerbread man!" I pointed out. "That's not a gingerbread man!" she quickly declared. I was caught completely off guard. Y'all. I'm telling you. It was a gingerbread man!  Before I could ask her what it was (since I was so offensively incorrect), she proudly exclaimed, "It’s a gingerbread GIRL!" Immediately, a grin washed over my face. I'd only met this child within the hour. Our time was consumed with learning each other's nicknames, teacher's names and favorite colors. Feminism 101 had yet to make it to our arts and crafts agenda. I wanted to high five her. I wanted to spin around in circles and dance giddily in only the way excited 6 year old girls do. But instead, I nodded, and told her it was the most amazing gingerbread girl I'd ever seen.

Within the next hour, the other little girl (8 in age) casually announced that she was creating a top hat for her snow woman. SNOW WOMAN! Did I hear her correctly? Snow woman!! Yes! And she'd said so, so nonchalantly. It's as if Frosty the Snowman wasn't the first... the only...the standard! “Every snowwoman needs a top hat!” I replied.

If I'd told that 25 year old riddle, now, to both of these young girls, they would have quickly and without hesitation answered that the boy's surgeon was obviously his mother. I am confident of this.

It was in that moment, and for the rest of the evening, I stood proud; proud of the progress women had made in the last 25-30 years. Proud to have been able to witness, in my lifetime, such dramatic change, albeit long overdue and with still so much progress yet to be had. I was proud to be a female working in surgery education. I was proud to work for a team with so many female surgeons. I was proud to work under the leadership of a successful woman, whom not only was a General Surgeon, but also the Program Director of the General Surgery Residency program.  I was proud to work for and with a group of smart and successful women who greatly value their profession and equally, their role as a mother. I was proud that these young girls were exemplifying everything I’d known to be true as a child, but always felt so disconnected with. Perception was no longer reality. The reality had finally become perception! These mothers, these brilliant successful female surgeons, they are paving the way for the next generation of gingerbread girls and snow women to achieve greatness.

This is how we lift each other up. We create an environment in which we welcome one another's children so that we and they grow enlightened, encouraged, educated, inspired and excited by possibilities. We embrace the difficult balance. My God, the balance is difficult. We dispose of the box that which we were placed in and we become assertive in our ideas of becoming both brilliant and successful professionals as well as invested mothers. And it doesn't just begin and end with women, my friends. We must embrace our professional fathers as well! We are only as good as our counterparts. Our strengths are magnified when we surround ourselves with other strong, confident and supportive human beings.

I am grateful to be able to contribute to their (our) mission.

Happy 4th Birthday C!

Little C is turning 4 tomorrow. I am not quite sure how that happened but I just wanted to share a letter I wrote for her.

Dearest C,

I seriously cannot believe you are now 4! There are times it feels that these past 4 years flew by but it also seems like you've been with us forever and what was life before you?

If there was one word to describe you, it would be that you are a fighter. I knew from the very beginning when you were in my tummy. Being my first pregnancy and all, I wasn't sure if what I was feeling were your kicks in my second trimester. However, when I went into the ER at 26 weeks for abdominal pain and you went in with me to get a MRI, you let me know you hated it! I didn't blame you as it was so incredibly loud for an entire 60 minutes and the images were being taken right where you were! But you definitely let me know that you were pissed off. You kicked me the entire 60 minutes and it was then I knew what they meant by fetal kicks.

At the time, I was so worried about what would happen to you while I went under general anesthesia but you nailed it. You were literally there when I had my appendix removed and you did exactly what you were suppose to do. You stayed inside and cooked for another 14 weeks.

When you were born, you were perfect. I was not. Tears still come to my eyes when I think back on that period of your life and I feel this insurmountable amount of guilt of what I put you through. I had no idea what I was doing. Instead of focusing on my perfect and healthy child, my mind kept going on how the heck I was going to balance motherhood and my career, which was in its infancy as I was only a PGY2 in my 6 years of training.

You nailed it again. You were the most perfect baby. You went from 7 pounds to 17 pounds by the end of my 7 week maternity leave! By the time, I had to go back to work, you were basically sleeping through the night except waking up once to eat and would right back to sleep. You thrived under the care of grandma. As I watched you grow into a happy healthy baby and eventual toddler that guilt started to lessen but never completely. You let me know in your way that you were doing well even though, I wasn't your primary caregiver and I knew my decision to keep you with grandma was the right one.

Fast forward to June 2015 and your move home. We only had about 4 weeks as a family of 3 until daddy had to go away to the east coast for fellowship. It was our first year as just the 2 of us. Once again, you were beyond patient with me. I struggled with balancing my last year of residency with being your primary caregiver. It wasn't easy for you to go from being the center of the world at grandma's house to going to pre-school full time and having a full-time plus working mom. But once again, you nailed it. You shut down all my fears in 2 months. You thrived at pre school. You learned English in a matter of weeks. You made friends. You formed bonds with your teachers. It was one of the most hardest years of my life but it was beyond gratifying to finally be your "favorite" and the one you wanted in your times of need.

And here we are today on your 4th birthday. We survived the first half of mommy's fellowship. Daddy is finally back on the west coast but he's still 2 hours away. (On a side note, we are so incredibly proud of him!) It's still just the two of us but we have so much to look forward to as in 6 months, we'll be joining daddy and mommy will be starting her first attending job. We have a lot of firsts to look forward to this summer as we start a new chapter in our lives. But until then, I'm going to enjoy these next 6 months of just you and me. I will always look back at these times and the difficult memories will fade but the memories of picking you up from school while you run to me, the memories of eating dinner just the two of us and the memories of all the mommy-daughter dates after school will always remain be in my heart.

I know I say this all the time. But I had it all wrong. You continue to teach me something new every single day. You show me a love that I didn't I know I was capable of and you show me that love is not finite. My heart grows in places that I didn't know existed. Life has never been the same since you entered 4 years ago and I am beyond blessed to be your mama.

It is truly an honor, C. Thank you and happiest birthday to my firstborn!

Love, mama

In the dark quiet of the last day of 2016

Oh, no. Not a New Year's Resolution post. Who needs another "Live healthier, Be a better doctor, Be a better mom" post?

Well, I do.

Genmedmom here.

It's 6:30 in the morning on Saturday, December 31st, 2016, and I'm sitting typing in the quiet dark of our house. No one is stirring except for our two big spoiled cats, who relentlessly knocked things off of my nightstand until I got up.

You know how you get really busy, barely any downtime to even answer the texts from old friends, never mind call them, and all the very small spaces in your life are stuffed with overflow tasks, like making shopping lists on your phone on the train, and never going up or down your stairs without having something in your arms that needs to go up or down, like dirty laundry down and folded clean stuff up, empty tea mugs down and toilet paper rolls from the basement up, wrapped gifts down and unwrapped stuff up, so many goddamned toys and factory-new clothes and the boxes, tissue and gift bags that you can't bear to toss that will clutter your home until next year too, and even with your superior physician multitasking skills you realize you're screwing up, like forgetting to RSVP for that thing and being late paying that bill and getting lame last-minute crap for the important staff member you totally spaced out, and then even the doctor stuff starts slipping (which is always last to go, right?) like that you promised to personally get back to your longtime dear patient on a result that wasn't critical but it was important to HER and you totally intended to check that on the holiday weekend and simply send her a quick message through the online portal and you just did not do it.

Then the kids get sick, and you get sick, and any delusion of control you had goes down the toilet with the first bowl of vomit. Your Christmas agenda: poof.

Barf.

But life marches on and there's still things to do and when everyone is (mostly) better you try to keep going, get yourself and the family to rescheduled gatherings and pick up where you left off with the gifts and the cards and the outings for school vacation. Maybe you start losing track of what's really important and what's just life and lose your cool, show your frustration, yell at your kids when the situation just doesn't merit a freakout. No one is running towards a busy street or about to drink drain cleaner, they're just jumping on the couch and throwing pillows and wrestling and, well, not listening to you when you order them to get their shoes on because you're late or pick up that banana peel and take it to the trash or SETTLE DOWN already. And when they react to your red-faced temper with sass and disrespect, maybe you throw the remote control across the living room and when it lands on the hardwood with an unexpected clatter, your kids stare at you with a sad, silent combination of shock and wonder and fear that you hope you never see again.

You know you're out of balance and that this is not right and this is not you.

So in the dark quiet of a holiday weekend morning when, miraculously, there is no event planned nor pressing task nor other thing of perceived great import, you sit and breathe and resolve:

This year, I will live healthier, be a better doctor, be a better mom. I will do this by uncluttering my headspace. I will leave the little breathing spaces empty. For breathing. I will remain thoughtfully committed to my medical practice and remember the high standards I hold for myself. I will love my family, my children,  always reflecting on how blessed we are, how much we have and enjoy in this very difficult modern world. I will pray for those who are struggling and suffering, every day, I will not forget them.

Happy New Year and God Bless.

(all is not) lost

There was a heartbeat. I saw it on the ultrasound, but I knew immediately something wasn’t quite right. Was it too slow? Yes, the ultrasound tech said she noticed that too and gave me the wise, all knowing look of a Black grandma who can’t quite tell her granddaughter that something is wrong.

And then there was none at the ultrasound 2 weeks later. I asked the next ultrasound tech to angle the screen when I didn’t see movement. Saw the look on the Radiologist's face and then the Fellow. No heartbeat. The tears began to flow. My body began to shake. I held in the sob knowing if it began here with these strangers it wouldn’t end until I was safely tucked away at home.

You were there. I saw you. You were there. And now you’re not. When did you leave me? My heart breaks. I type through my tears.

I am at home. Grieving. Surrounded by loved ones.

I cry now as I type.

“Mama, are you crying? Did you have a nightmare? Are you frightened?” I stifle my tears. Say to Zo through closed door “I’m okay. Mama’s okay.” He calls out for me and O from his room after bedtime. O goes and comforts him and calls me into his room.  I gather myself, wipe my tears, blow my nose. Zo rushes into my arms “Mama, are you okay? I was having a good dream but then I woke up. Why are you crying? Everything will be okay.” As he gently rubs my face with his amazingly soft 5-year-old hands. As he pats my back. As he rubs my belly. As our family holds one another.

All is not lost in spite of this major loss. You were there. I saw you. You were with me. Now you are not there. But my husband is here. And my Zo is here. Their hearts are strong. My heart is strong.

The stories from friends poured in over the last few years. We are all in our 30s. Gut-wrenching stories of second trimester terminations due to fetal diagnoses incompatible with life. The heartbreaking call telling us of a stillborn nephew. Friends with years of infertility. A family member with seven losses. Stories of rainbow babies after loss. Countless miscarriages. Flashbacks from medical school of being present with sobbing women in the antepartum unit when their ultrasounds showed the absence of heartbeats. I didn’t understand then how the loss of something (a baby? A fetus? I didn’t know what to call it then) not yet realized could cause these women to sob uncontrollably. But I do now. From the moment I saw the positive sign I was hooked. Head over heels. Then the heartbeat. My growing belly. Zo’s “mama, is there a baby in there cuz I think there is.”

I was so excited to tell him he was going to be a big brother but I didn’t because I knew things weren’t quite right and it was all too soon, too early, too many things could go wrong - and they did. But he knew. He knew yet we feigned ignorance.Told him I would go to the doctor to find out.

All is not lost. You were there. We were together. Our family is still here and you will always be with us. We will go on. For we are not lost.

MiM Mail: Fourth year pregnancy?

Hi there!

I am currently a MS3, married to an amazing husband for the past three years, and strongly considering pathology. We would like to have a child in my fourth year. The question for us is when to start trying and hopefully have the baby, and to maximize our chances of having the child before intern year.

Our original plan was to start trying this summer, with the hopes of having a child sometime between March and May. But I'm not sure how that would work out with having a newborn as an intern. I would really like to avoid being pregnant during my intern year (or just residency in general) as well, and so I'm also worried about the short window that gives us to try for a baby.

I do not have any familial support where I live, and I'm not considering residencies that will be near family (they live in an incredibly expensive city and have very few programs around them). Our plan for childcare is my husband quitting his job and becoming a stay-at-home dad - any money he would make by keeping his job would probably not cover the cost of daycare.

At my school, we get two months off for vacation, one of which is mandated in the winter months for interviewing. I believe I can also have two more months of light rotations as well, giving me a total of 1-3 months to spend between my interview period and infant-recovery time.

So here are my current pros and cons for having a baby earlier (Fall-Winter) vs. later (Spring).

Pros for having the baby earlier:

Will have an older infant by the time intern year starts.
May be able to avoid interviewing pregnant.
More time to get pregnant.
May be able to still use my vacation months during interview season if I have my child around that time.

Cons against having the baby earlier:

May have to interview very pregnant or be at risk of giving birth.
Will probably be very pregnant during possible audition rotations.
Will probably need to have my husband quit his job (or scale down to part time) to take care of the child while I am on rotations.
Will be taking Step II pregnant.

Pros for having the baby later:

Husband can keep his job at full time for longer, maximizing our income.
Might be able to stack my rotations so that I can have 3-4 months "off" or with light rotations to be with the baby until residency.
Avoid being pregnant while taking Step II.
Will be less pregnant during interview and possible audition rotations.

Cons against having the baby later:

Will have to interview pregnant.
Stacking my light rotations and vacation at the end of the school year may make it so I have less flexibility when interviewing for residency.
May not get pregnant in the short window we have.
Would go through intern year with a <3 br="" mon="" old.="">

I would love any feedback on my tentative plans - which of these are important vs. not so important? How difficult is it having a 3 month old vs. a 9 month old baby during intern year? - and what you would recommend for my husband and I. Thank you!

Silent Day

Silence.

It’s golden right?

Silence.

I’ve craved it. Haven't we all?  As a busy doctor and mom, there’s always something in the background of daily living -- kids arguing, kids playing, kids giggling (my favorite!), the hustle and bustle of the life in the clinic, a shout of “mooooooooom” from upstairs or downstairs, the radio, the stove, the washing machine, the beeper, the pitter patter of fingers on my keyboard.  But, this minute, it’s silence. This hour, and for all the hours of today, it’s silence.

Right now, it’s feeling deep, dark, and deafening. I’m sitting on my couch in my house alone. It’s Christmas Day. I’m Jewish, so it shouldn’t feel sad or lonely. But, this is my first Christmas alone. I’m divorced now and my kids are with their dad. For the past decade, I adopted Christmas and it’s tradition of bringing families together. I cooked and baked and decorated a tree and made new traditions for my then-husband and kids. In those days, when I left work the day or two prior to Christmas, I said ‘goodbye’ to colleagues, wished them happy holidays, and looked forward to making my house warm for my loved ones and kids.  This year, I left on that last day of the work week with dread.  I savored the last few hours I had with my kids before my ex picked them up on Christmas Eve morning -- we snuggled in bed, watched tv, tickled and laughed. And then, they were gone.  And the silence set in.

That morning, I went to work as the ‘on call doctor’, seeing patients in urgent care, fielding pages from the answering service. And then about 1 o’clock, I left the office, got in my car, and wasn’t sure where to go. Others were out and about, finishing last minute shopping, or on their way to see friends and family (I presumed).  I stopped for coffee. And then I went home to The Silence.

Today, Christmas day, I slept in a little and woke to an empty house. I should be rejoicing. Free time to nap and read and sew and listen to music and clean my house is mine for the taking. Except, it just feels sad and lonely. The world is shut down today -- the stores are closed, there is no traffic on the roads, I have no where to be and I feel like an outsider again on Christmas.  My kids aren't with me on a day that is about family.

Late morning, I left the house for a bit to meet a friend and her family for lunch -- they are ‘in between’ religions, unsure how to celebrate this year after she lost both her parents in the last several months. I was glad for the company and an excuse to leave my house, and The Silence, for a little bit.  Her family welcomed me with kindness and warmth with an undertone of understanding that I am feeling like a woman without a country this year. Their hugs were warm, and lingered just a little longer than one might expect -- a subtle acknowledgement of the suffering they knew was behind my smile today.  

I have always known that the holidays are a hard time for people. Facebook feeds and tv ads are filled with the perfect storybook moments of families coming together on the holidays.  They don’t make commercials about the hearts of single parents breaking when their kids leave for the holidays.  They don’t tell you what to do all day when everyone else is home celebrating, and you are alone. No one posts a ‘’selfie” on facebook with a comment, “here I am all  by myself on Christmas. Happy Holidays everyone”. When I got a group text from a friend today, “Merry Xmas to all of you! Hope you are enjoying the day with your families!” I chuckled a little when I read it, and then felt nauseous, forcing myself to ‘stay positive’. My fairy tale family is split up and we don't fit into that cookie cutter holiday description anymore.

I don’t write this with self pity. It is more of a conscious exploration of this uncomfortable state of being. I am in a new chapter of my life. There are new realities that I need to accept about my life and my kids and my former relationship. I’m trying desperately everyday to be a mom who is present, navigating these treacherous seas for my kids and helping them get through it all, with all the usual background noise of work and schedules and a busy life.  While I should welcome today’s silence, I fight it and argue with it, and sit with it uncomfortably.  We are not friends.  

In a few short hours this day will end. We will all slowly get back to our routines. At the end of the week, I expect my house to be loud with the usual noises of kids and this heavy loneliness will abate for a time.  I’m hoping it gets easier someday.  

If you were lonely this season, I know how you feel.  No one has said that yet to me, but I'm going to say it to you. May the New Year bring warmth and light, joy and happiness. May we continue to harness our courage and strength to get through difficult times, and find ourselves better on the other side of them.  May silence someday feel golden and welcome, and envelope us with the promise of self care rather than with the dread of loneliness. I wish that for me, and I wish that for you, if you are out there and you know what I mean.

Celebrating with Gizabeth

Of course I had to attend Gizabeth's wedding party. I mean, the proposal was on this blog! Sure, I had only met her one time before in person, but through the blog and our communications, it's like we have been long friends. So, my husband and I took a quick trip to Little Rock to help her celebrate. We wouldn't know a soul besides her and her husband-to-be, and perhaps that just contributed to the adventurousness of it all. Plus, it would be just us, no kids -- bonus.

We went straight from the airport to lunch with her and her daughter. (This makes out of town guests feel very special!) She was glowing with joy; her daughter was smart and gorgeous. After lunch, we had the luxury of many hours before the big party, luxury to be work-less and child-less.  This included: a run, walking through downtown Little Rock, a pedicure (+trashy magazines +wine) and enjoying the southern sunshine.

Gizabeth and her husband were married quietly and privately at their house and then threw this massive party to celebrate at the Clinton Library.  My husband and I decided that weddings for more established adults are done right: it was so beautifully done from the white tufted banquette seating, to the flowers, to the great music.

In fact, the DJ was so good that after years of being dance-floor inhibited, I could not resist getting out there and dancing! I totally reconnected with my prior dance-loving self on that dance floor. Husband and I had a major blast. It may have helped that we didn't know anyone and thus had zero self-consciousness. (And I have a photo that is witness to this that perhaps should not be shared publicly.)

Gizabeth was stunning. And everyone was so, so happy.

For the send-off, guests were given sparklers and lined the exit. NB: Do NOT put out sparkler by stepping on it since you will burn a hole in your shoe. Note to self: buy husband new shoes.

All in all, I had such a wonderful time celebrating with a MiM sister. Congratulations, Giz! May your joy and love cup overflow.

Richard Michael Nestrud: A Retiring Pioneer

I remember my Dad telling me of those days: the ones in which no blood was screened. A NICU doctor. He said when a baby needed blood, they would just find a health care worker whose type matched up, and would get the necessary vital life source to the baby, siphoning it.

I spent my college days writing checks at gas stations. Occasionally, a worker asked if I was related to my father. I would nod in the affirmative, and they would regale me with stories of how amazing my Dad was. "He saved my baby."

He saved my baby too. My son was born six weeks early. My water broke while I was walking on the treadmill. I mistakenly thought my bladder failed me, but soon realized it was amniotic fluid. I received surfactant on bedrest in the hospital. It definitely matured his lungs. When he was born, my dad kept him from entering the NICU - arguing with his partners to keep him by my side, nursing. I took him home, and when his jaundice required a bili lamp, my dad smuggled one home to me. I remember spending nights bathed in the blue alien light, marveling at my son.

The stories told by the nurses and doctors tonight, at his retirement party, were awe-inspiring. He and his partner were inspirations to his health care workers and patients and their parents. Their methods were unconventional, but vanguard. They saved many lives, some a testament in the room.

I never thought I would see this day. The man that kept me on my toes throughout my life is closing a chapter in his. He told a story, one that I didn't know, that brought me to tears.

Before surfactant, babies were trached, and became toddlers, and spent close to 16 months in the NICU. Many were destined to spend their short lives with that community. He told of a moment when his co-workers became a team. One child spent 16 months fighting for his life. The NICU adopted him, and they all became his parents. His death was inevitable, his life inspiring. They all mourned the outcome, and in their grief they became a team. A vital community that lives on to this day.

The man that I spent my whole life in awe of, aspiring to be like, closes a chapter of his life this week. I sat at a table with his partners - ones that told me I was garnering praise from the leadership of the hospital. After ten years, I am finding time to reach out and give back. "They say you are doing wonderful things. You are just like your Dad."

 I hope to continue the legacy. And I hope my Dad continues his legacy. He's young by current standards. He does and will continue to inspire me. The apple doesn't fall far from the tree. His roots are worth nourishing. He has my love, my adoration, and my aspiration, forever and always. Love you, Dad. You have saved many lives, including my son's, and will continue to inspire me throughout my career and yours, which doesn't end with retirement. You are my favorite doctor. The one that I modeled myself after, the one I will spend the rest of my life trying to emulate.

Maybe Later We'll See

I could go on and on about the ways that becoming a mother made me a better doctor. It's much easier to build rapport with families when you can throw a genuine, understanding "yup, my kids do that, too!" into the conversation. It helps me to give much better, more realistic, advice, especially to parents of very young children. (How I wish I could apologize to every new mother whom I advised to just "sleep when the baby sleeps.") Not to mention the fact that I didn't need to study developmental milestones for my General Pediatrics boards.

But until recently, I felt hard-pressed to list any ways in which being a doctor has made me a better mother. It has made me a more tired mother, a more guilt-laden mother, a mother who excels at multi-tasking, though I'm not entirely certain that that's a good thing. Because of my specialty, my kids are growing up with an exorbitant emphasis on safety (Safe sleep habits! Rear-facing car seats past age 2! No riding down slides on grown-ups' laps!). This will likely make their lives slightly less exciting than they would be otherwise, and might even be a detriment to their social skills; at two and a half, Bean regularly points to people biking through our neighborhood and shouts, "Ridin' bike not wearin' helmet! Need get helmet!"

The other day, however, I witnessed an interaction that shook me and has already changed, in no small way, an aspect of my parenting. As a fellow in Hospice & Palliative Medicine, I frequently participate in family meetings and discussions surrounding goals of care. I'm there when people learn that their health or that of their loved one is declining, that the remaining time is likely measured in weeks to months; when they hear for the first time that their end-stage organ failure isn't simply a chronic condition but one that will drastically shorten their life. When they learn that they are no longer a candidate for cure-directed treatment. Oftentimes I am the one to deliver these emotional blows. Regardless, whenever I am involved, my job is to help patients and families understand their clinical conditions and the options that remain - the pros and cons, best- and worst-case scenarios. Their decisions and goals don't have to make sense to me or coincide with my own values and beliefs, but my job is to try to ensure that the choices they make are well-informed.

I recently met a man and his family who quickly became one of my favorites that I have worked with. The couple were in their seventies, with several grown children and young grandchildren living nearby. His diagnosis was one that most in the medical community would consider devastating, though he and his wife maintained an upbeat attitude and an intention to pursue any form of treatment offered, no matter how severe the side effects or how slim the likelihood of benefit.

The first steps in his treatment knocked him down hard. He suffered debilitating side effects. He began to recover bit by bit, but then, still miles away from his pre-treatment baseline, he landed in the hospital with another complication.

I began to explore with him and his wife the potential paths that lay ahead. There was always the possibility of declining aggressive treatment and focusing on comfort, though he insisted over and over again that he would keep fighting his disease. But after yet another complication, it became clear that he might not, in fact, even be a candidate for any further treatment.

They had many appropriate questions, and I tried for days to get the primary team to sit down with this couple and give them some answers about what might lay in the patient's future. When they finally did, the meeting began before I could arrive, and I entered the room to hear them discussing a plan to wait one more week and then meet to assess whether or not he might be able to tolerate further treatment. The patient and his wife pressed the physician further. "How likely do you think it is that he will be strong enough to get more treatment?" the wife asked.

"Well, we'll have to wait and see," replied the physician.

And there it was. The line that I had been using as of late to side-step Bean's requests, to put them off in the hopes that he would forget, to deny without officially saying no. As he rounds the bend from two and a half to three years old, he has become quite a skilled negotiator; a frequent refrain is, "Later, nappy time over, do good listening, watch Cars [his current favorite movie]?" He'll ask even if he's just seen it the day before. And because I feel bad denying his request - and also because I would prefer to avoid a meltdown - I use a variety of stock Mom-phrases that I hadn't even realized I relied on until he began repeating them back to me in response to requests of my own: "We'll see." "Maybe later." "Wait and see."

When I heard it from a fellow physician in such a loaded setting, I grew angry. Of course nothing is certain in medicine and our prediction skills are often poor. But when I looked at the patient before me, knowing his course and his current condition, I knew that I would be utterly shocked if he recovered to the point of being able to press onward with treatment. And the other physician - as he admitted later when we spoke outside of the room - knew it, too.

It made me think hard about the responses that I present to my own child. Yes, it's easier to give some hand-wavy answer in an attempt to move on, change the subject, dodge the thing staring you in the face. And yes, a toddler's request for more screen time is exponentially less serious than a family's request for a clinical prediction. But in both cases, I think that we as humans should show one another the respect that comes with an honest answer, no matter how uncertain, no matter how difficult to deliver and to hear.

So I have started explaining to Bean what we are waiting to see. "It depends on how much time we have after we shop for groceries and take baths," I'll say. Or, "Well, let's see if it's nice outside; if it's sunny, we should go to the park instead." He doesn't always love my answer, but he knows where things stand and what it is that we are waiting to see.

*Cross-posted at The Growth Curve (www.thegrowthc.com).*