'Watching Your Toddler Drink Bathwater From a Hotel Tub', and other sordid tales of OCD exposure therapy

I've always been slightly more than casually OCD.  Not the flip-the-light-switch-seven-times-then-tap-dance-thru-three-choruses-of-I-Could've-Danced-All-Night-before-leaving-the-house kind, but more like the picks-stray-hairs-from-my-pillow-before-laying-down-and-always-on-the-lookout-for-dead-bodies kind.  I can't explain away the hair thing, but you try working for the body pickup service contracted to the medical examiner's office of a major metropolitan city for a year and *not* look for corpses on the side of every road and behind every hydrangea.  They're there, people.

Now, this has always been sort of quirky and cute to most that know me, and those that may have thought otherwise have largely been kind enough to at least refrain from open mockery.  "Oh, that TheUnluckyPath, she sure is hilarious, over there picking microscopic lint fragments off of her dinosaur print Boden top".  But let me tell you, shit got real when Punky arrived four weeks early.  I had what turned out to be straight up post-partum OCD/anxiety that might blow your mind.  I had no idea that this was even a thing.  You learn some (but not near enough) about post-partum depression in med school.  But I swear I had no idea that you could get heightened OCD associated with the perinatal and/or post-partum period.  It was absolutely heinous.  I've never been so terrified in my whole life.  I spent the first eight weeks of my daughter's life expecting to find her dead, in any and all manner of common and/or obscure/tragic/horrifying/violent ways, every single time I left her for a snooze.  And, presumably because I've seen some serious things in my life, I could picture in excruciating detail every single aspect of the fictional scene.  I became nearly-paralyzed by stairs, where I would clutch her to my body and get an iron-grip on the banister like I was free-climbing Half Dome every time I walked out to the garage (down four steps.....just four).  I would imagine that she, at four weeks old, had somehow freakishly developed musculature, climbed out of her crib, and rolled underneath only to suffocate on a blanket that she had carelessly wrapped herself in.  I visualized her tiny electrocuted body lying next to a wall outlet, no joke.  My heart was repeatedly broken day in, day out, every time that I left her and cautiously returned to see what I would find.  Because, even though she was perfectly fine every time I came back(if not sometimes poopy), I imagined her dead in more ways than anyone could ever believe, and it felt so real to me each and every time.  And a little bit of me mourned her faux death, so many times a day.

But that actually wasn't the worst of it.  The worst of it was that, in the majority of instances, when I imagined her death, it was me inflicting it.  It was me hurting her in all of those ways every time.  In the bath tub.  In the kitchen.  In her nursery.  It was so, so shocking and terrifying to have these scenes playing through my fractured, sleep-deprived mind.  The shred of myself that I was still clinging on to still knew that I did not ever want to hurt a single tiny spiky hair on my perfect little peanut's head, but it was so, so hard to reconcile this with the visions that I was constantly having.  I was beyond terrified.  I was so afraid to tell my husband about any of these things, for I didn't know if he would be afraid to leave me alone with her.  A few weeks in to this guilt-and-shame-filled struggle, I remembered an episode of the podcast Invisibilia that I had listened to the year prior.  It was called The Secret History of Thoughts, and it had made quite an impression on me at the time, especially the story about a young, just-married couple.  They had a relatively carefree and easygoing life, until one day out of the blue the guy started having obsessive thoughts of his wife being stabbed to death in their kitchen.  And he was the one doing it.  On one hand, he just *knew* that he had no desire to harm his wife in the least.  But on the other hand he was terrified that he must want to kill her, on some subconscious level, else why would he have such terrible visions?

Turns out, he had a specific subtype of OCD called Harm OCD, in which "an individual experiences intrusive, unwanted, or distressing thoughts of causing harm, and this is inconsistent with the individual's values, beliefs and sense of self.  These obsessions typically center around the belief that one must be absolutely certain that they are in control at all times in order to ensure that they are not responsible for a violent or otherwise fatal act." (that's a nice definition provided by the website of the OCD Center of LA)

So, I went back and listened to the episode again, and I felt an immediate sense of relief.  I remembered identifying with it to some degree the first time around, and feeling so deeply sorry for the poor bastard experiencing this terrifying thing.......but now I was was reasonably sure that I had become that poor bastard.  However, at least I had some hope that perhaps I could fix this somehow.  So I committed right then and there to myself that I would admit that I was having these thoughts to my lovely, compassionate therapist at my next appointment.  And, I did.  And doing so was the first step in my journey toward recovery from my post-partum Harm OCD.  And now that Punky is 2.5 years old, I'm back to my slightly more than casual OCD, right where I'm comfortable.

And that brings me to watching my daughter drink hotel bathwater in a borderline sketchy extended stay motel during our cross-country move a few months ago. Having a toddler is a long-haul treatment course of exposure therapy for OCD, which turns out to be very effective for me in dealing with my issues.  Identify the intrusive thought, analyze it and decide if it's valid and why/why not, then accept it or dismiss it as it's happening.  Gives me the sense of control that I need to feel comfortable and safe.  And then I can go about my quirky day.

Watching a toddler eat peanut butter off the floor of an airport.  Standing idly by while my daughter puts her hand in the toilet to retrieve a toy that needed a quick and refreshing swim.  Suppressing a scream as the kid covers the wall in crayon, grinning and singing with unabashed joy.  It's a constant barrage of borderline-horrifying acts of depravity, packaged in an adorable little bundle of cuteness and light.  And on that day a few months back, as I sat back on the yellowed and cracked tiles of that supposedly clean bathroom, I forced myself to let her be a toddler, feeling her way through the world around her and delighting in the new experience.  It was a super gross experience, but she thoroughly enjoyed it nonetheless.  And the reason that I finally got around to writing this five months after the fact is that it dawned on me a couple of nights ago that I haven't checked my pillow for stray hairs before falling (mostly happy and always exhausted) into bed at night since we moved to this new job and house.  There are tons of other stressors in life, including some new ones about kind of hating this new city, but overall life is pretty damn good.  And the older I get, the better of a handle that I have on my weird brain.  It's actually pretty interesting in here most of the time.........  :0)

Why haven't you had your second child yet?

This is a topic that I'm sure other moms with only one kid can relate to--it's the never ending questions of why haven't you had your second child yet? It seems as if you have two children, every one assumes you're done and then if you have four, people start to question why you aren't on birth control. First of all, it's nobody business the number of children your family should have. But I feel compelled to share my thoughts so here goes.

I was beyond clueless when I got pregnant at the age of 27. I was 9 months into my internship, general surgery no less! and soon after about to start my 4 years in radiology training. At the time, my husband was in his third year of his 6 year orthopedic residency program. We were about the enter the monster of hot messes but we just had no idea. So come January 2013, 6 months into my first year of radiology residency came C. She was perfect. I was not. That is the short version of the story.

I was the epitome of hot mess. I cried a lot. My husband had to go back to work in less than week after her delivery. I was with my parents. I had help but I still couldn't get my act together. C was a good baby. She slept 3-4 hour stretches from birth. I could not sleep at all. I was overwhelmed with anxiety, guilt and basically a state of "WTF did I get myself in?" I was an emotional zombie. I was in a cycle of nursing, crying and attempting to sleep but never really getting any. It took about 4 weeks to realize that maybe I have post-partum depression.

I had all the symptoms. Feeling overwhelmed. Check. Feeling guilty. Check. Feeling empty and not bonding with baby. Check. Feeling even more guilty about that. Check. Not knowing why this is happening. Check. Check. Check

Even though, I was aware. I couldn't get myself to do anything about it. I just powered through the end of my seven week maternity leave. I went back to work. I pretended like nothing happened. But these feelings did not go away. Given the schedule of residency and the shame of postpartum depression, I did not tell anyone nor did I get the proper treatment. I went to a maternal health psychiatrist once, who talked to me after hours, off the record. She wanted to start me a low dose antidepressant but I never took it. I think these feelings never really went away. They did fade over time as I adjusted to my schedule of constantly driving back and forth between San Diego and Orange County (1 hour commute) and doing residency in between that time. I was so busy that I didn't really give myself to process my emotions. I just kept chugging along and watching C grow up was the silver lining. She transformed from this tiny infant to a toddler who was a force to be reckoned with.

When she finally moved to live with me, we encountered several other hot messes but I do believe that is what it took for me to rid of these postpartum blues. I still have the occasional feelings of working mom guilt and anxiety especially when it comes to big changes in my life (such as moving and starting my first attending job!). But I do feel "cured" but for the most part. It took time but I was finally her person. I was the one that she wanted in her time of need. I was the one that could figure out what was in that little head of hers without her saying anything. I knew then that I was definitely put on this earth to be her mom.

So yes. That is why I don't have my second child yet. I knew what triggered my postpartum depression with C. I was overwhelmed with a husband in training, my own training and my feelings of inadequacy as a mom. I told myself if and when we have another child, I will do it when I'm ready so my mental health isn't at stake.

My husband had to leave for the east coast for his fellowship training right after C moved and now he works in LA. We've done long distance for two years now. We are finally at the end of this long distance journey. I will be moving up to LA in less than 6 weeks after I complete my fellowship in breast imaging. I knew I could not handle a pregnancy, C and another baby while he was away. I learned from my first postpartum experience that  a lot of my anxiety was not having my husband around. I understood why he wasn't there but it didn't change how I felt. So I knew that time was not an option for child #2.

And right now is still not a good time. My poor C has not lived with her father yet. She spent the first 7 weeks of her life with me and grandparents. She then lived until 2 and a half with her grandparents in Orange County with seeing me almost every weekend but her dad maybe twice a month. She then experienced life with me in San Diego. She suddenly had to do full time pre school, new home and a new primary care giver. She went from being the center of the universe to being a toddler of a "single" working mom in residency. She saw her dad maybe once a month while he was on the east coast. Now that I'm in fellowship and her dad is an attending in LA, she spends most weekends with both of us. She's gotten used to that now and every Sunday, she hugs her daddy and says "see you next weekend!" It breaks my heart at times that she thinks this is "normal." I want her to experience life with both parents. every single day. before we add any more changes.

So there you have it. I know I'm getting older. My ovaries may be shriveling. My uterus is crying every time I see another baby. But I am grateful for these experiences. It made me stronger in the end. It made me a better mom, wife and physician. It taught me what I needed to know to grow as a mother and maybe one day that will be a mom of two. But for now, I am perfectly content as a family of 3.

Doctor, Heal Thyself!

Who here hasn’t needed to lose a few pounds? Well, I am a bit beyond needing to lose a “few”…

Babygirl is officially a month old, and I am officially a month postpartum. For two pregnancies now, my usually healthy diet slid into more of a “everything in moderation, and I mean EVERYTHING” diet. I don’t binge, and I don’t even like junk food or fast food… BUT I love me some dense whole wheat toast with tons of butter for breakfast, and high-quality dark chocolate for snacking, and a cup of premium ice cream after dinner, and… you get the picture. Two years of this kind of snacking, and I was bound to gain some weight.

Especially since I used to be very active. Like, distance-running, cross-country-skiing active. BUT for two years, that whole part of me has been on hold. During my pregnancies, I maybe did some prenatal yoga, and took some walks here and there, but basically, I became a slug. I did hire a trainer after Babyboy, and I did lose 15 pounds then… But as soon as I was pregnant with Babygirl, I slid right back into snacky-snacks and slugginess.

So, this week, I finally stepped on the scale to see what the damage was. Ouch!

I am a full 40 pounds above my normal healthy weight, with a BMI of 30. That means, I am obese.

And so, horrified, I decided to take action.

I have NEVER in my life been so fat. Sure, I gained a lot of weight during med school, and then residency, due to lack of sleep/ time/ stress/ poor diet. But never THIS much. Both of those times, I shed major pounds by eating low-carb and exercising.

Now, I am a huge fan of diet and lifestyle changes towards better health. I counsel all my patients over and over again on the merits of a diet high in fruits and veggies and lean protein, combined with regular vigorous exercise. I ask my obese patients to come back every 3 months for weigh-ins and blood pressure checks, and I spend a lot of time with them, describing what is a healthy diet and what is real exercise.

In our practice, we have a diabetes nurse who helps counsel patients, and I send her my pre-diabetic patients, as well. If I were my patient, I would probably send me to her. Diabetes runs in my family, and I did have a sort of high-normal glucose tolerance test in this second pregnancy.

And so, because I recognize that without some major changes, I may be headed towards a bad health outcome; and because I need to follow my own advice; and because I really don’t want to have to buy a whole new wardrobe (!) I got started right away.

As soon as hubby got home that day, I asked him to watch the kids so I could go running. Luckily, he is also really into fitness and eating healthy, and he was totally supportive. Shocked, but supportive.

I found and pulled on a (very tight) jog bra OVER my nursing bra, laced up some stiff sneakers, and headed out the door. There was about 4 inches of slush on the ground, and it was drizzling. YES! I love this. I imagined that drivers saw me as the intrepid warrior, determined to run in spite of the elements. Really, they probably saw a mooselike creature in ill-matching baggy pants and her husband’s rain jacket toodling up the hill like a manatee on land. BUT, I pulled down my baseball cap and ran harder.

I had not run in almost a year. I made it maybe a few blocks, then walked. Then ran, then walked. I did this for about a mile and half, total-- a laughable distance for me who has run three marathons. BUT, it is a start, and it’s better than nothing!

Hubby also dutifully went to the grocery and bought me my list of South-Beach-Diet-Style foods. (I don’t get any money from them, BTW, the diet just works for me is all). He came home with my veggie juice, Canadian bacon, eggs, cheddar, ricotta, almond butter, and tons and tons of veggies.

That was three days ago. Since then, I have been sticking to the diet, albeit with probably bigger portions and more snacking than is intended (I am breastfeeding, after all).

The late nights up breastfeeding are very tough. I HAVE to eat something when I am up feeding Babygirl at 3 am. Just, now, it’s less likely to be a huge bowl of Cheerios, and more likely to be a cup of plain ricotta sweetened with Truvia.

And that’s OK. The diet, plus exercise- with the goal of getting back to my previous level of active—WILL work.

The diet is meant to stabilize blood sugar swings and reduce craving for carbs. It’s amazing to me how I feel when I drop the carbs and go to this type of diet. At first, for a few days even, there’s a slight woozy feeling, and some intense carbs cravings. After a few days, the wooziness is gone, and there’s almost a buzz of energy as my body starts to burn fat. It feels really good, especially after exercising.

And so starts my effort to get healthy—and slim down.

Now that I’ve blogged about it, I really have to stick to it!