a heavy heart

Warning: this is a sad post involving postpartum depression and physician suicide.

I had a friend from medical school come visit this weekend with her husband, which was absolutely wonderful and much needed for all of us. They played with my kids and cheerfully put up with a quick park stop (because lord knows a 3 year old can never pass a park without stopping). Unfortunately, she also shared with me that one of our medical school classmates and a friend of ours had recently ended her life after a struggle with severe postpartum depression. She had a daughter a few years older than my son, a newborn son, and a husband. I checked her Facebook to see if there were any updates there - and all I saw was a glowing maternity photo of her husband’s arms wrapped around her, and a warm photo of her snuggling her daughter and newborn infant. I couldn’t imagine how much pain she had been in to leave these faces behind. 

It made me think back to earlier this year when I found out one of my very best friends also had postpartum depression - she posted it on Facebook that she was seeking help, and I was ashamed that I hadn’t called or texted or done anything to see if she was ok in the last few weeks. We talked on the phone afterward about how the loneliness of COVID made pregnancy and the postpartum period so difficult, and how so many people had reached out to her after that Facebook post, opening up about their own personal struggles. And of course it made me think about my own recent maternity leave. 12 weeks of maternity leave in the winter of COVID was the loneliest thing I have ever experienced. It was both lovely and awful in its monotony -  it felt like one long day of sitting on the couch with a newborn and watching a preschooler play legos. I was lucky to have my husband working from home and a support network that was open to late night zoom calls with a bouncing baby on my chest. I had to frequently remind myself that this was a time like no other, a time to shelter my children from the rising COVID trends, and I would never get this much time alone with my children again - but there was definitely more than a little relief in returning to my job and a more consistent schedule. 

This is not the first physician suicide in the medical school classes surrounding mine - and I really haven’t been out that long. Learning of my friend’s death was a harsh reminder of the terrible frequency of physician suicides and how deadly postpartum depression really can be. 

Last night, I spent the evening snuggling with family and holding my little ones a little tighter. I wanted to make some space for my friend, but really didn’t know how - so I’m sharing her story here in this community, where my fellow mothers in medicine can help remember her and hold space for her with me. So if you’re reading this, light a candle, say a prayer, close your eyes and send warmth to her family - but most importantly, check in with the moms around you, because sometimes people are just not okay.

Love to all,

Kicks

Standing ground

 On the way to practice, Coach called my daughter.

"Are you headed to practice?"

"Yes."

"Is your mom driving you?"

"Yes."

"Will she be around in practice?"

Me on the speakerphone: "I can be. What do you need?" 

Coach was in traffic and would be late. She would have my daughter and the team captain start dynamic warm-ups and a full-field game. I would hang around until Coach arrived, just in case.

I'm the travel team manager. This a role that I secretly love. Not that I need more things in the day, but to have a job with discrete roles the I can do like a boss is a point of great joy for me. My other roles are complex with difficult success metrics and involve a lot of thought. Being team manager is something I can do relatively easily and really well. That feeling of accomplishment and easy service is hard to beat. I am team manager and team photographer and coach supporter and logistics queen.  I can provide information for the weekend's games and COVID protocols of our opposing teams like nobody's business. I can provide a game day roster with our guest players' information without breaking a sweat. I can book a hotel room block at the right distance from our tournament. I have my team binder that I put together lovingly with sheet protectors, player cards, extra rosters, medical releases--and it rocks.

I can't say that I'm so smooth with the girls and prefer a back seat role on the team. Don't get me wrong. I cheer like a former competitive cheerleader - individually and for the whole team - but I'm not fist bumping each girl as they come off the field and not one of those parent managers that everyone chats up. I do my thing and let them do theirs.

So this day, I let the team captain start the team with dynamic stretches and hung back under the tree next to the field, surrounded by the foul-smelling cicadas.

I noticed that the club team who had the field before us were wrapping up and a group of men were standing by the side of the field with pop-up goals, looking as if they intended to take over the field. The field that we had for practice.

I started walking towards them as a family came on to the field with their soccer balls. I told the family that our team was about to practice on the field and they stepped off to find another place. The men, though, they hovered nearby and started to take steps onto the field. This was an imminent takeover.

This was the only soccer field in the park, although there was a grassy area beside it. This field, though, was flat and clearly marked off for soccer. I saw the girls start filing on to the field at the north end and the captain was starting to mark the goal boundaries for the north end. The men near me, a gaggle of 10 or so men in their 30s-50s, took some more steps onto the field.

I stepped in their direction. "We have the field from 6:30 - 8:00." I said this with confidence and authority. We had been practicing at this field for months at this same date and time and I knew our club had a permit. They kept advancing. "Show us the permit or we'll just split the field."

They were bold and undeterred. The Other Coach from the prior practice (our same club), came to support me. "You guys will need to practice somewhere else. Our club has the field until 8." The men, one by one, walked up to challenge The Other Coach and me. 

"Show us your permit or we take the field."

What was this? This was ridiculous! These grown men looked incensed. Did they not see the 16 yo girls on the field practicing?

The Other Coach kept fending them off and the men were irate. I got in the fray. 

"We have a permit. We've been practicing for months here at this time and day. See our schedule." I showed them our TeamSnap schedule which didn't seem to sway any minds.

"I pay $20,000 in taxes to this county!" yelled one man who seemed moments away from a stroke, forehead veins bulging, "I own this field!"

Okay, dude.

The girls had spread across the field taking their positions, looking nervous and not starting play as we were taking space on the side of the field still. I stood facing the men, my back to the girls, positioned as to prevent them from advancing further.

I said calmly, "Can we all be adults, gentlemen, and be a good example to these girls? Let's be adults here."

"Yes!" shouted one of these men, approaching me. "I told them let's not be like this. Let's be gentlemen. Just let us come on the field and show us your permit."

The Other Coach was on the phone with the club administrator who was going to send a copy of the permit.

The men took turns shouting in my face, like ridiculous babies. I stood my ground. I was not at all afraid of them. I was defending our team and our girls and our space. Eventually Old Coach convinced them to start playing on the adjacent grassy area since the permit was coming, and he'd show them. Old Coach waited with me. 

Our actual Coach then showed up and was like - what is happening here? She was trying to figure things out and as she was walking to the field, she saw one of the men yelling at me and wildly gesturing. We gave her the short story.

Old Coach got the email and showed it to a couple of the men, who eyed it suspiciously and finally accepted begrudgingly that we were allowed to be there. Note, they did not have a permit!

Seeing everything was tucked away and secure with practice going full steam, I thanked Old Coach and both us walked off the field. He would go home and I would start my run.

Later at home, I got a text from Coach.

"Thank you for being Security today...I was thinking on my way home that I never asked you if you were okay after that guy was yelling at you. I apologize for that. I hope you're okay and I'm going to get you a SECURITY shirt!"

I wrote back: "I'm so glad I could be there. That's so nice of you to think about that. I am totally fine and found it ridiculous that these grown men were acting like babies. I hope the girls saw the importance of standing your ground in the face of rude bullies. I also had nice workout afterwards. :)"

And that, folks, was practice.

Guest Post: Has Pandemic Living Caused You Stress or True Distress?

When I turned forty, I tumbled slowly into a deep hole. While caring for a six-month-old infant, two older children, and starting a new job in a new city, I was expectedly busy, some days nearly frantic.  I had always been full of energy and drive, able to handle anything that either my NICU practice or my children hurled at me. We transferred to a new city and new jobs four months after my third child was born. Then I turned forty and everything changed.

Despite taking night call in the hospital twice a week, and pumping at work, I continued to enjoy nursing my last baby. She had been easy from the start, and I planned to cling onto nursing (and oxytocin) for as long as possible. At first, I noticed my sleep pattern changing, but assigned it to my workload, the stress of moving, and fatigue. I could not go to sleep, and when I did fall asleep, I awoke at 4:00 or 5:00am each day, ruminating over all my worries (call schedules, a new school, new teachers for the kids, a brand-new nanny). Despite running in overdrive, I rarely felt hungry, began to eat less, and lost some weight.

 

When I became grouchy and short tempered with the kids, I attributed it to stress and my workload. There was always so much to do, both at home and at work. However, sometimes I erupted in anger at my children for no good reason. They were adjusting to big changes in their little lives, too. I observed myself continually furious at my husband and resented his enjoyment of his new job (when I was not). Yet, because I continued to work full-time and take night call in the hospital, the fatigue I felt was extraordinary. Some days it felt like the typical “post-call” funk, and other times it felt much worse. I literally forced myself to drive into work for my night shifts.

 

Then one morning while in the NICU attending to sick babies, I noticed that I was unable to make the most straightforward of clinical decisions. Should we treat the patent ductus arteriosus with indomethacin or move straight to surgical ligation? My thinking had slowed until my brain felt foggy. This was noticeably different, since my pattern of practice had always been decisive, even borderline impulsive. I began to have terrible throbbing headaches, and my poor husband complained about my lack of interest in sex. I was so busy with work and the stresses of my new life, not to mention goings on with the children, that I had not noticed my lack of interest in intimacy.

 

For two months, my anger, irritability, and general unhappiness progressed until one day at lunch while whining about my situation to a colleague, also a critical care physician, she opined that I was depressed, and recommended I see a psychiatrist friend of hers. Fortunately, this physician worked me into his schedule quickly, put me on an effective medication, and over the next six months, I gradually recovered. Thank goodness I never felt hopeless or suicidal, as some women do.

 

As a neonatologist I knew plenty about postpartum depression but never considered that diagnosis for myself. It is amazing to me now that I was unable to identify what was happening. My symptoms of depression were both classic and comprehensive: fatigue, poor sleep, foggy thinking, inability to focus or concentrate, headaches, lack of interest in food, weight loss, irritability, inappropriate anger, and lack of interest in sex. I quite simply assumed that I was transitioning poorly to my new job and ruled out postpartum depression since my baby was already six months old when my mood changed.

 

During this period, my feelings of guilt and self-doubt were inexorable. I felt like the worst mother and wife ever. It is only because I saw a good psychiatrist, and because medication and psychotherapy worked for me, that I recovered. These last fourteen months - this stressful pandemic living - have been difficult for many working mothers. Our jobs and our home lives have changed dramatically.

 

If my story resonates with you, and you recognize any of these feelings or symptoms, please talk to someone – a counselor, a therapist, a social worker, a pastor. Feeling this way is not normal despite how much we may convince ourselves otherwise. These symptoms indicate a severely depressed mood, which may occur anytime within the first year after giving birth. Or you may have a major depression unrelated to childbirth.

 

You are not a bad mother if you develop depression. Mental illness is a genuine biological illness, like diabetes, or asthma. Moreover, depression is treatable. With medication and psychotherapy, you can feel better. I am living proof of that.

 

Susan Landers, MD

https://susanlandersmd.com

Her new book, “So Many Babies” can be found here. 

Lack of Headspace: Mind Mapping

 Recently, a blogger/influencer I follow on Instagram introduced me to the concept of a mind map. Basically like a giant plan of what is going on in my life, what is taking up my headspace, what I am thinking about, worrying about, need to accomplish, hope to accomplish. 

Basic Idea linked here

I have just been so mentally exhausted lately. My mind has so many "things" going:" passion projects, work projects, home projects, relationship projects, mom projects. In addition to the mental load of end of school year/ camp/ summer/ moving/ COVID testing/ travel etc that takes place on a daily basis. I was told in the beginning of medical school that training is like a treadmill. You just have to keep going. Well, now it's going just a little too fast for comfort. 

The mind map helps me see it all laid out. It helps me prioritize, create and construct a to do list, allows me to cross things off that are complete, or are deemed unnecessary once written out in a bubble on a piece of paper. It helps transition the sensation of "busy" to "productive." It is definitely something I plan on using going forward, and wish I would have known about it sooner. 

Tonight, instead of crossing off a bubble, I chose to write. Reaching out is a passion, sending good vibes to this community of supportive people is my way to refocus and set the tone. What do you do to decrease or organize your mental load? 

My 12-15 year old son

 

Hi, yes, I have a two lovely children, a 17 year old daughter and a 12-15 year old son.

As a mother in medicine, emphasis here on in medicine, I was offered the COVID vaccine and jumped at the chance, way back in 2020.  Yes, it was December 2020 when it was first available to health care providers like me.  Then came the tiers and the categories.  It’s been a long wait, as various extended family members obtained their appointment slot (some more and some much less easily than others, but that’s another story for another day).  My daughter became age eligible for the vaccine and is now presumably immune, but what about my son?

My son.  How old is he?  I could only think of him as a 12-15 year old!   Not 14 but 12-15, indeed.

And what joy it was to see the many sizes and shapes of  "12-15 year olds" lined up last week to get vaccinated on the very day it became available.    

We’re getting there.  #ThisIsOurShot

Broken Glass

     That seems to be the theme of Mother's Day this year. First I called my Mom at the crack of dawn and somehow hurt myself on a piece of broken glass. Ignored it, and walked around in my right tippie toe finishing the conversation. I haven't sent anything yet, which I regretfully told her, but she assured me that my undivided attention for a half hour was way better than any gift. After I got off the phone I pulled the piece of glass out of my heel - I was bleeding on the floor at this point - and where it came from is still a mystery.

    Then my husband woke up and headed to Kroger after emptying the dishes while I reclined on the back porch reading. He brought back flowers (candles and flowers are my fave) and Jack wandered up - he's 15 now and towers over all of us - and wished me a Happy Mother's Day - things went awry from this point. The flowers my husband brought were originally placed in a too big vase and I asked Jack to help me transfer them to a smaller more appropriate vessel. 

    There are things I regret in my life. One, I once tried to stand upright after a fainting spell (blood pressure meds too much after I lost some weight) and I passed out and broke my jaw in three places. Two, I peed in the waiting room before my colonoscopy - first one - last week and they unfortunately require a negative preggo test if you are under 55 - it took a whole bag of saline and an hour and a half to pee. Three, I almost told Jack to move the vases to the sink but didn't. There was a lot going on on the counter. An entire candle spilled and broke on the floor. It took a lot to clean.

    Cecelia, now 18 and a force to be reckoned with (I'll talk more in a future blog) was spinning positive. She said broken glass ceilings is a good thing right Mom? I've got to go study now. Let's do brunch at 2:30 (something I am currently highly looking forward to). But Jack said he cannot go he just got a job at Cajun Sno he has a shift from 1-5. And he's three weeks out of turning 16 so he cannot legally drive yet she has to take him. He's a gem. Maybe at 15 not the best  on Mother's Day but love languages are different and his is wonderful if not on point for the holiday.

    I hope everyone out there is having a wonderful Mother's Day. We are breaking the glass ceiling, as C said. I couldn't wish for a better community. Stay tuned for more. Below is an image from a vacay in the Dominican Republic pre Covid. Much love, Gizabeth.

Hope in a cloud

I recently attended a virtual conference and one of the sessions centered on wellbeing during the pandemic. The session organizers had participants engage by contributing to word clouds.

In one word, describe how you felt during the pandemic? Not surprisingly, the words that grew largest were anxiety, stress, isolated, uncertainty. 

The next prompt was, In one word, what is the way that you coped? For me, hard to capture in one word but I think it was a combination of the words I saw populating the screen: family, colleagues (leaned on each other), exercise. On that last one, I've completely fallen in love with yoga over this past year and the wonders it has done for my body and mind. Especially on days when my almost-16-yo daughter joins me and we do it together. This is the best bonding. It's almost spiritual sometimes, and at others, it devolves into laughter when one of us falls or does yoga very wrong.

The last word cloud prompt was, In one word, what are you most hopeful for this coming year?

Just looking at these words in this image makes my heart rate and breathing slow. I can't wait to travel with my family again and explore a new country. Reconnecting. Being with people. I miss hugs. (Who said netflix?). I'm feeling hope again - a clearing, a light, better days with more joy and more of all of this.

The Hamster Wheel

 This year has been a hamster wheel. An asterisk. A toss-up.  Now that we are a year into the pandemic, many are vaccinated and starting to re-enter society; thought-pieces abound about seeing the silver lining, recognizing the many blessings that go unnoticed, appreciating family, home, the small things. I associate with all of it. 

But today, I'm writing to procrastinate. To feel useful. To send a message out there into the world of moms in medicine asking if you feel the same or for any words of wisdom. There was so much give and take this year, but I feel like the world kept taking and I have little left to give. Between spotty childcare, the disaster that is virtual learning, and trying to be a useful and productive fellow entering a job market that is abysmal, I feel like I have loose ends at every turn. Laundry undone, projects have finished, articles partly read, emails never sent. I gave myself permission to take a full 2 week spring break- no shifts, no teaching responsibilities, nothing-  the first real vacation in a while, as during residency traveling was hard, there was always more to study,  and I had saved up vacation for maternity leave. 

Maybe this is just post vacation blues, but the feeling of so many mountains to overcome is overwhelming. I plan to just chip away at all the responsibilities one thing at a time. Prioritizing work this week, home life the next. I'll take any tips you have.  

Materni-tine

It was the best of times and it was the worst of times to have a baby. 

For starters, I don’t want to be a pregnant healthcare worker in a pandemic again. No thank you.

We tried to induce Baby Girl early in November when the COVID was really hitting the fan here in the Midwest and we didn’t know if it would get worse. Didn’t matter, she didn’t budge. She ended up (as her older brother) needing a for-real induction a week after her due date. After the delivery, we struggled with a retained placenta so it seemed like the never-ending pregnancy - even though we had a baby, we still. weren’t. done.

There are definitely pros and cons to taking maternity leave during a pandemic. It has been so nice to keep my entire family at home for twelve weeks, although twelve weeks at home with a fussy baby and a three year old with minimal visitors has been trying at times. I am somewhat of a germ-a-phobe with small babies even in non-COVID times, so COVID gave us an easy out of crowded holiday family gatherings. It did get lonely. We made a grandparents-only visitation rule which worked out great until one side went south for the winter and the other actually came down with COVID so stayed away. I had to be intentional about Zooming everyone from college roommates to high school besties - and I definitely found some solidarity in their loneliness as well. It’s hard for everyone here as winter in the Midwest doesn’t really lend itself to outdoor socially distanced gatherings. My husband and I don’t feel like we’re missing out on anything by staying at home with our kids - because that’s what everyone else is doing too.

I will be ready to go back to work in the next couple weeks. I’m a little nervous about jumping back in at full speed with an extra little body to coordinate, but I’ve decided to “give myself grace” (a phrase I stole from one of my patients) and remind myself that it will be messy and it will still turn out OK. I got my second COVID vaccine which is reassuring. I did decide to vaccinate and continue breastfeeding which is consistent with AAP/ACOG/Academy of Breastfeeding Medicine guidelines. The doctor in me reviewed the evidence, weighed the risks and benefits, and made the decision to vaccinate. The mother in me called my mom immediately after my first vaccination to get reassurance I was doing the right thing. 

This is how I know I did maternity leave right: I rewarded myself with a post-COVID vaccine haircut (10+ inches gone! Hello mom cut!). My hairstylist asked what I’ve gotten done during my maternity leave and I couldn’t think of a single thing outside of snuggles and legos. And I wouldn’t have it any other way.

Kicks

The Match: It will all work out

 It's been a while. Hope you are all staying safe and sane and welcoming a new year with a sense of optimism. I know it's tough, but all we can do is hope, right?

I found this blog over 10 years ago. I was newly married, pregnant, furiously google searching "mom in medicine" and "can you be a mom and a doctor." Luckily, I stumbled upon this blog, read archives and old posts, and mustered up the confidence and gumption to take on medical school with a newborn. It was not easy. I recently celebrated my 10th wedding anniversary, and, as someone who got married right out of college, my husband and I realized that for the entirety of our dating life and marriage, I have either been studying for the MCAT, applying to medical school, in medical school, in residency, and now in a fellowship. The third wheel of responsibility and demands on my mind, emotions, sleep, and time, was not anything like we could have imagined bringing in to our relationship. But as I can see the light at the end of the tunnel, I'm amazed at how far we have come. 

Thinking back to January 4 years ago, I remember the fear with which I submitted my match list. I knew the programs near my hometown were notoriously competitive, especially in my chosen field. Being 8 months pregnant with my 2nd during Step 1 did me no favors and I had an unlikely chance to match at my medical school's program or the other local programs. So we looked around America. We kept an open mind. And I submitted a list that was part hopeful, part practical, and part prayer. 

I didn't invite my parents or anyone aside from my husband to match day. I was dreading it, honestly. I didn't want to move away, I didn't know how I could possible do residency without that supportive backbone my parents gave me throughout medical school. I knew that I would most likely end up on the other side of the country, near my husband's 1 relative, and without the support of my family and parents and friends and everything I knew. 

When I matched at a smaller program 3000 miles away from home, at first I cried. It was confusing. I loved the program and knew in my heart it was the best fit for me. It was family friendly, supportive, great staff, respectful of the lives and time of its residents, and an unbelievably rigorous place to train. But in the beginning, those feelings were hard to reconcile. I hated the match process, doubted medicine, and questioned what the purpose of the whole thing was. It was hard. But now, looking back, I am so so glad I did it. 

My mentors in medical school and various blogs tell residents to "trust the process." Trust that "the match works itself out." For some, it doesn't. But for me, those words rang true. We created a community in our new city, explored a different climate and culture, and really had a wonderful adventure. I am now doing fellowship in the midwest, slowly inching closer back to my home in the West Coast. But I am fortified in my relationship, as a parent, and have learned to lean on community and friends, not just family. My kids are resilient and adaptable. The feeling of "us" in a little bubble- amplified by the pandemic- has only made my relationship with my husband stronger. Had I quit or compromised my goals during match, I don't think I would be as fulfilled, happy, and motivated as I am now. 

Good luck to all the applicants submitting their rank lists. Stay open minded. I'm sending good vibes that it works out.