On Family Medicine

I wondered during undergrad if I could do medicine and "have a life". I didn't have a lot of first-hand contact with physicians, and had just started to consider a career in medicine, so I really didn't know what a medical lifestyle was like. I knew it could be incredibly demanding and busy, but I wasn't sure how much flexibility there would be. In the end I suppose I still didn't really know, but I figured if others did it, I could figure it out too.

We had the chance to get early clinical exposure at my medical school. I had always planned to do family medicine, so every Wednesday afternoon in my first year, I would take the bus to the family medicine clinic of Dr. B. Dr. B's patients adored her. She truly listened to them, and was clinically excellent too. Seeing patients -- real people with real problems! -- was thrilling. I get a reminder of this from time to time in my office when I have early medical students join me. Looking at a tympanic membrane is exciting to them! It's a great boost. 

During medical school, I went through the "cardiology! neurology! infectious diseases!" rotation in my mind, until it was clear that being a generalist was what I wanted. Internal medicine was tempting, as I actually enjoy learning minutiae, but I loved women's health, pediatrics, and doing preventative care. The flexibility of a career in family medicine was unmatched in my eyes. So from clerkship onward, I continued to feel that family medicine was the right fit for me. 

I now have a family practice of about 1200 patients in a small group practice, and see patients for about 30 hours per week.  Charting, results and other paperwork takes about 8-10 hours a week.  I block one day off every month for self-care or catch-up time - with young kids, if I have to cancel a clinic due to their or my illness, it’s nice to have a day available to re-book patients. I can book off in advance for appointments for the kids or myself, or fit in local CMEs or meetings related to some community health work I do. The demands of my practice - and of home - fluctuate from week to week, but generally it feels like a good balance. 

I ran into a lovely, well-meaning non-medical friend a little while ago. "How's work going?" she asked. "Ah, it's been a long week." I said. "Lots of coughs and colds?" she mused. "If only!" I thought. I tell this to students a lot: family medicine can be very challenging, medically, and very draining, emotionally. So rather than things like a chest cold or plantar wart being boring and mundane, they can be a very welcome break from the challenging things we see at times.  The medically complex cases are invigorating, and the emotionally draining cases, highly meaningful; the "mundane" cases act as a much-needed foil. And above all, when you know your patients like you do in family medicine, it becomes much more about caring for the person in front of you than about the particulars of their issues. 

MiM Mail: Challenges of being a working parent of school-aged children?

I'm a resident and a mom, with two kids in elementary school. As my kids have gotten older it has gotten a lot easier to "balance" medicine and home life, but I am still quite frustrated with some of the residual things I'm unavailable for. Specifically, it's tough feeling out of the loop regarding school and extracurricular activities, such as having someone else do their homework with them, not being there right after school to hear how their day went and meet their friends, and not getting to observe many extra-curricular activities to determine their quality/worthwhileness. How are you moms of older kids staying involved with those important aspects of their schooling and overall life? When I attend parent-teacher conferences I seem to get positive feedback about how things are going but it's also somewhat generic. I was also wondering in general what some of the challenges of being a working parent of school-aged children and teens are and how you've counteracted those? It seems most of the advice online is for moms of younger kids. Thanks!

Waaaahhhhhhh

(Warning: serious serious whining and verbal diarrhea ahead, but I will blame it on not getting more than 5 hours of continuous sleep more than twice in the past >11 months. Admittedly, entirely my fault.)

I feel like I’ve maxed out. I want to “cry uncle” to life right now. I am tired. I need a break. Break from work, break from kids, break from the baby, break from my boobs, break from dishes, break from the cycle of daycare-work-evening marathon getting everyone fed/bathed/sleeping-passing out while putting my older daughter to bed and feeling guilty for not being able to get a couple more hours of work done afterwards. Then waking up all night, feeling like a wreck in the morning, and doing it all over again with no end in sight. Break from my husband being so busy too. Break from taking a raincheck on every holiday that comes around (birthdays, Christmas, Valentine’s day, anniversary) because it feels way harder to actually plan something or think about gifts. Break from feeling constantly broke and not being able to get help around the house, babysitting, etc. Break from feeling too tired to have sex. Break from making dinner and planning meals. Break from being the one who plans everything, even if we were to have some sort of vacation. I don’t even want to go on a vacation because that would mean more work. Break from feeling like I never am on top of my lab work or studying. Break from feeling more exhausted and depleted over the weekend and at times longing for Monday morning to arrive. Break from absolutely everything.

I think what I really need is to travel back in time and enjoy a weekend when I was 10 years younger. Because if I went to a hotel overnight and slept for 12 hours, I would think about the kids and miss them. I would feel bad that my husband wasn’t getting rest too, because he needs it just as much as me (well, maybe I do a little more haha) or that we weren’t using the opportunity to reconnect and have some special time together.

I always remind myself that this is all self-imposed. I had unprotected sex. I chose to have kids. I chose medicine. And I wanted both at once. I am a sucker and never stopped nursing my now 11 month old to sleep and have created a monster who wants me every few hours all night, every night. But I am too tired to resist going to him, because the sooner I do, the sooner we are both back to sleep. It’s terrible. This phase of life isn’t easy for anybody. I know some people never can ever even entertain the idea of taking a break because of life and financial circumstances so I should be grateful for the theoretical possibility.

Deep breath. It’s okay. One day at a time.

I think I just need to sleep.

I Am Her Doctor, and Her Friend

I have a good friend named Mary.* We met at 15 (she was 14), volunteering at a camp for severely handicapped children. The weekends were called Respite for the full time caregivers. The campers ran the gamut - Cerebral Palsy to Prader-Willi to Down's Syndrome. We both excelled at our task - this was before service hours were a college application box to checklist. We believed that what we were doing would make a difference.

We became fast friends. In spite of our lofty aspirations, we were also teenagers finding ourselves. She was and still is gorgeous, I was drawn to that. She was also lots of fun. I had a hardship driver's license, and we headed offsite one night to buy a Playgirl magazine at a local convenience store. We got back to camp, looked through the pages, and were profoundly disappointed in the staged pics of men in thongs. "Who gets turned on by this?" we wondered. The Playboy's I snuck from under my Dad's bed when I was a tween were much more interesting than this.

Once we double dated in her small town of Salem - she set me up. Let's call them Dusty and Dylan. I was the only licensed driver. I decided to be the sober driver. They were all drinking Purple Passion. She and I had to use the restroom, so we stopped at the local grocery store.

While we were in the bathroom, the boys were up to no good. We climbed back into my 1983 Oldsmobile Toronado convertible.  I stuck the keys in the ignition, and saw blue lights flashing in my rear view mirror. Seems the boys had decided to steal beer from the storeroom without telling us - stashing it in my backseat. We sat in the grocery store high box, surrounded by plexiglass (remember those?) until we were finally told we could go home sometime well after midnight. Thank God, I told Mary. They are honest.

Mary and I are the kind of friends that while staying the course move in and out of our friendship for years at a time. It's our norm - we both have big circles. I will never forget her support after my divorce. She invited me to everything for a year - her parties, her Florida vacation home. It was a respite for me and my kids. She also recommended her storeroom floor designer to be my decorator, who helped me with my home after my divorce. When I was married last fall, her store's event spinoff furnished my beautiful reception at the Clinton Library.

We hadn't caught up much in over a year, so I was surprised when she texted me last week. "I'm having surgery next week. A cyst the size of a grapefruit. I told the surgeon to send it directly to you."

I texted the surgeon immediately. "I've got this, you don't have to do anything. I've called the gross room."

I scoured two pre-ops on her surgery day, before finally finding her. When in the second one, I asked some nurses to help me find her. One challenged me. "Are you family or friend?"  I answered, "I'm her friend." "Well then you need to check in at guest services. All family and friends must go to guest services. Leave pre-op, you will find it around the corner to the left." I felt taken down a notch - my doctor coat meant nothing to her but a challenge to beat down, and since she didn't recognize me she put me in my place. I was so shocked I just did what she said - I have been in pre and post op many times over the years and have never been treated that way. I vowed, in the future, to assert myself more. I'm not only her friend, I'm her doctor. Albeit one behind the sidelines, but important nonetheless. So if I need help finding her in pre-op, you can direct me to her instead of sending me outside to a queue.

Luckily the cyst was benign - her surgeon ordered a frozen so she and her family were assured right away. But the surgery was complicated, so she was inpatient for almost a week. Affording me to visit her often, share gross and micro pics of her specimen, support the anxieties of her and her family. Catch up. I miss the hell out of our teenage selves. But in our long conversations we proved that we are both still here. Same people, future incarnations.

"Thank you so much for spending time with me this week."

"Seriously? I should thank you. I am normally buried in my scope. Well, except for when I interact with Dr. Woods and Dr. Music. But really you are a breath of fresh air. I am sorry for your circumstances, but proud to support you. I sign out 65 cases a day, and there's no way I could give each person behind them all the attention I have given you this week. But sharing your path, the gross and microscopic pics - makes me feel like a real doctor. I don't do this for other patients. This week makes me wish I could on occasion. And last week, this would not have been possible. I was super slammed. This is a crazy slow unusual week, and I am glad."

Texting her surgeon the day after her surgery made me realize how touch and go it was. She texted back, "It was like someone poured cement into her belly. There were so many adhesions from previous surgery. My partner and I felt like residents again. It was the hardest surgery I have done in practice. I can't imagine her pain tolerance - it must be huge. We freed up a lot of her bowel, she should be much more comfortable."

I hung out with her one afternoon while I was waiting to go to a late meeting. "They said it might be awhile before I can use stairs. I'm thinking of getting a bed delivered to the house."

"Well, that shouldn't be a problem. You are a furniture mogul, after all. Just call your peeps and have them deliver."

"LOL. That's exaggerating."

"Not at all." She and her family have many stores throughout the South. "I'm headed out early. Treadmill/yoga night for me - no kids. Hope you get a good night sleep. I'll visit in the morning, if you are still here."

Luckily she went home the next day. I got to celebrate the good news with her and her husband during an early morning visit by her doctor. When I went back to check on her late morning housekeeping was already scouring her room. I texted her, "I'm glad you are gone but I'm going to miss you so much - let's catch up soon over dinner and wine." She texted back, "Thanks again Giz, definitely soon." I may be her doctor, but I am definitely her friend first.

*Posted with her permission. And her appreciation. She's my first and best audience, and I'm so happy she likes this essay.

How Many Balls Can I Juggle?

I've been trying to dig deep and reflect on my own work-life balance... I feel like I'm living in a world in which my mantra to my learners and advisees is "Do as I say, not as I do."

I love to teach. I'm in an academic position because I thrive on teaching while working clinically. I teach medical students, residents, fellows and am engaged in faculty development. I'm encouraged by my mentors to "be academically productive" however I'm not entirely clear what that means. Write, publish, be educationally innovative, do research, stay sane and be a good mom and a good doctor. 

I need a new organizational scheme. My most successful portion of my organization is my google calendar. I literally cannot do anything without it. I've got it color coded and labeled. My week in view is dizzying with color coordination and notes. My to do lists, however, are scattered between different notebooks, notes on my phone, loose pieces of paper that find their way into the ether. I need a new work flow solution. I need to find a way to keep track of things and move my academic work forward in meaningful ways.

I sat down in a coffee shop the other day to try to make sense of it all and stratify things into columns and was overcome by this subtle feeling of butterflies and anxiety in the pit of my stomach. I've never really been ridden with anxiety, however this discomfort is rearing its head more and more frequently... feeling like I'm missing something, am forgetting something, am going to drop a ball, be found out as a fraud who cannot "do it all."

While I'm not junior in life, being a "non-traditional" physician, prior career as a nurse, I am early in my career as an academic physician. As such, I feel this pressure to continue to do things which further my personal and professional development. At the same time, I want to be sure that I am giving my son the time and dedication he needs from his mom.

As an ER doc, my schedule is widely variable, shifts in the day, evening, night, weekends, holidays. Sharing my son with his father affords me the opportunity to work academically without interruption about half of the time. There's still work which needs to be done when I have him. So, I try to balance it by not working while he's awake. Sometimes I'll have a random Tuesday free and we do arts and crafts, read, go to the park, ride bikes, run around playgrounds, run errands. These are the precious moments I hope he will remember and treasure... I know I do. We make meals together, he shares his days spent with my nanny and daycare and at night, I tuck him into bed, sometimes dozing with him. He looks at me beforehand, puts his little hand on my face and says "Mommy, I love you bigger than the Earth." After drifting off with him for a bit, I get up and set my sights on my late evening tasks... emails, curriculum development, evaluations, mentoring grand rounds presentations via chat mediums or Google Hangouts or FaceTime. 

I sit here sipping my chai tea, reviewing important dates for the next academic year, the next evolution of my growth and development as an educator, curricula which need updating and modification to be in line with current educational methodology, exploring alternative ways in which to teach and engage learners in an overall curriculum which has less and less "time" for what I feel needs to be included. 

I feel fortunate to have been given some incredible opportunities to take on leadership positions and influence our future doctors. How many of these am I capable of managing? Am I giving each of these precious opportunities the time and dedication required? Am I being the best educator and physician that I can be? Am I being the best mom I can be? Am I seeking out mentorship appropriately to optimize my productivity? Am I interfacing with the right people? Am I serving my learners to the best of my ability?

My life is a concept map.

Unreliable Moms

I'm going to come out and say it:

It stinks making plans with other mothers of young kids.

They are never free.  It's either date night or a soccer game or a kids birthday party.  And if I do manage to make plans with one of my mom friends for a playdate or girls night out, there's a 50/50 shot that someone will start throwing up and it will get canceled.

I used to think it was just me.  That my friends were particularly unreliable or they didn't think I was fun enough to make time for.  Then I joined the Facebook group for my town, and it opened my eyes. Women will make a post saying they are desperate to make friends and they will set up a playdate for a bunch of kids at the park.  Then the very woman who complained she didn't have any friends will flake and say she can't make the playdate!

I had a conversation with the woman who started the Facebook group.  She told me she organized an event for the moms in the group, multiple people RSVP'd, she reserved a location, and then she was the only person to show up.  I told her the same thing happened to me when I tried to organize a book club for the moms.

It honestly makes me want to just have friends who don't have kids.

Well Intern Exam: Half-way through Intern Year

Do you have difficulties falling asleep or staying asleep? – No. I can fall asleep anywhere at any time. While I’m waiting for the garage door to open at home after a night shift. While my husband is telling me about his day. My kids have taken to telling me to drink coffee as soon as I get home so I don’t fall asleep while reading to them. The act of sleeping is not a problem. The time to sleep is the problem.

Do you engage in 150 minutes of moderate exercise per week? – Ha. I’m laughing to hard to formulate an appropriate answer. I run once a week for 30 minutes. On a good week I go to an exercise class. My fingers have become very nimble at typing.

Do you make time for family and friends? – My list of thank you notes to write is piling up. Nobody outside of immediate family got Christmas gifts this year. A rushed photo on Christmas morning texted to friends and family was our Christmas card. My kid has a birthday party coming up and I have no idea what we are going to do for it or how it’s going to get arranged. My kid’s teacher has introduced herself 3 times to me because she “doesn’t think we’ve met before.”

Do you wear sunscreen regularly? – I have the best skin cancer prevention practice - I don’t see the sun.

Have you had any unintentional weight changes? – Clinical medicine has been great for my midline. I can fit into all my old pants I outgrew in medical school!

All in all, Intern year is a rollercoaster of emotions and stress. Some days I love what I do and feel so lucky to be part of this profession. Other days, I look at the MA’s in the clinic and envy their ability to work regular hours with loads of time for pursuing interests outside of work. Some goals I’ve succeeded at this year, such as getting more efficient with day-to-day activities, working on research, reading everyday. Other goals have fallen terribly by the wayside, such as writing on Mothers in Medicine, being more involved in the kids’ school or seeing my non-work friends. I have a new forehead wrinkle (particularly unfair given I’m never in the sun). I’m lucky to have a supportive husband and awesome kids that (mostly) don’t make me feel guilty for working long hours. And my hairdresser lets me nap while he does my hair.

Now a little more than halfway through Intern year, I’m still happy I choose to switch careers and go to medical school. I’m still happy everyday (most days) I get to be a doctor. I’m taking that as a good sign. Now, to figure out the getting more exercise bit . . .

Let it Go

Let it Go has been stuck in my head, oh, maybe 3 out of 7 days of the week. On a good week. For at least a year. More? (This has to be causing some sort of permanent brain damage.) Despite anyone’s intentions to shield their children from Disney and princesses (including mine), Elsa, Anna, and the gang are a nearly inevitable part of toddler/preschool life these days (Mommy? Why do all my friends wear sparkly blue dresses every day?). My 3.5 year old daughter hasn’t even seen Frozen in its entirety, and actually doesn’t seem to really want to. She doesn’t even like Elsa in particular (She is firmly a Paw Patrol girl- she wants to be Skye when she grows up- yes, a puppy pilot. I encourage her to shoot for the stars, even if that means becoming a dog!). But there is something about Let it Go and the music video… she loves singing along and copying Elsa’s movements of shooting snow darts and letting her sumptuous braid down (which is hilarious by the way). And, as ashamed as I am to say this, I love it too- I think we’ve contributed to at least 1000 of the nearly 1 billion views on Youtube. Watching Elsa transform into this powerful, stand-up-straight, confident, unapologetic, gorgeous, and very sparkly woman is actually very enjoyable- she clearly loves her newfound boss-status.

The other night, she requested to watch Let it Go yet again, and I tapped the wrong video on Youtube- it was a short interview with Kristen Bell and Idina Menzel while they recorded songs from Frozen. I really loved what Idina Menzel said about the song. “It speaks to anyone holding back anything that makes them special and unique… What a relief to find those points in your life when you’re just able to let go and be completely who you are.” Nothing mind-blowing I guess, and very literally what the lyrics of the song say haha.

But I found myself thinking about it today as I hummed the song in my head while doing my tissue culture work. I think this past year has been my Queen Elsa metamorphosis. As Anna said when she first encountered Elsa in her ice castle, “Elsa… you look… different.” I, too, feel like a different woman than I was a year ago. I don’t feel like a terrified junior resident. I don't feel like a scared mom. I took a year out of residency to go back to the lab and do bench work and, thankfully, still love it and have found my stride. I got my first real grant where I am the PI. I chose my subspecialty training path and secured a fellowship position. We had a second kid almost a year ago and are all still alive. I no longer feel like everything is hypothetical in the future, but that there is now a path… that I’ve finally differentiated into the physician-scientist and woman that I want to be. I am owning it, standing up tall, and proud. It feels good. This is who I am and this is my life’s work. (I do wish it was something more exciting, like being someone like Beyoncé, but maybe I can one day make biomedical research sexy) I realize that it is very sad and pathetic to be extracting profound life lessons from a Disney song, but hey, this is about as cultured as I get these days. May I hold onto this feeling for more than a fleeting moment (or at least remember that I once felt this way)…  

Marching with my middle schooler

Wasn't going to make her go, but was thinking it might be the experience of a lifetime.  I wasn't sure how safe it would be, but I decided I'd ask her to think about whether she wanted to go along with me and a few of my out-of-town friends who would be coming to DC for the Woman's March on Washington.  My middle school daughter thought about it for less time than it takes to eat a spoonful of mac and cheese and said, "YES, I'm definitely coming!"

So we reviewed over the next few days a few key concepts.  

• We learned some words.  Words for body parts.  Words of pride, and words of power.
• We learned in one night to knit, as we readied ourselves to join in the pink parade, and we discussed the rationale for the name and shape of the hats.
• We reviewed what choice over one's body means.
• We discussed the notorious RBG.
• We packed and shared assorted protein bars and water.
• We went to stand among many of all shapes, colors, sizes to "march" and to rally (without peeing) for about 8 hours.
• We read the cleverest signs!  And saw lots of versions of the uterus.  Having already reached the Mother in Medicine with a middle schooler milestone of syncing up our menstrual cycles (has happened once thus far in our household) and having made it through all matters of pubertal hormones thus far, we joined so many many many other women and supportive men in solidarity. 

Oh, and later that night, she said, her exact words, "It was the experience of a lifetime." 

Indeed, I hope she (and all) have a lifetime of equality and choice and freedom and diversity and democracy.

*though we eventually got separated, was wonderful to take an "MiM Metro" to the March with Gizabeth and KC!

Witness the Sickness

I am so sick. Like miserable, no energy, hacking cough, congestion, achy muscles type of sick. Who knows what it is, but does it really matter? At work the other day I desperately had one of the X-ray techs do an AP on me. No pneumonia. That would have been too easy. How did I get this? From my 14 month old daycare attending daughter. Only she's moved on and is back to her normal, playful self.

The same thing happened around Christmas, but my husband was the innocent victim. She brought something home that knocked him down with a viral malaise that turned into a raging sinus infection. The babe got better in a few days; he lingered on with "man cold" for a couple weeks. We all know how painful that is for everyone!

I hear that what my household is experiencing is a thing. People tell me, "I've never been as sick as I was my first winter with a child in daycare." I hear, "Every time they change classrooms you'll get deathly ill." I have also heard, "It gets better once they turn two." Please God, let this be the case.

So Mothers in Medicine, my question is, what are your strategies for dealing with this? Is there any preventative magic I should be invoking? Because I don't know that I can go through something like this (two plus weeks of feeling like utter crap) again. We all know how hard it is to take care of our patients (and our children) when we are the sick ones, and we as a profession are the absolute worst at staying home and nursing ourselves back to health! What do you all do?

Reverberations

March 20, 2003. I stand with other students, staring at a television in my university's student union building, watching Baghdad being bombed. Explosions light up the screen. "Shock and awe". I'd spent many hours in the preceding months organizing, marching, due to the pressing need I felt to do whatever my small part was to stop the impending attack on Iraq. In the end, not surprisingly, it went ahead. I was grateful that Canada wasn't a part of it, but still, here it was. I stand watching war on television. 

In the strange happenstance of life, I now spend my days in family practice, seeing Iraqi refugees resettled in my city, still reeling from the effects of the war. Crippling PTSD pervades some of their lives. Yes, they have built new lives in Canada and many are thriving, but the ones who aren’t take up most of my attention. Layers upon layers of trauma. And for all of them, the sense of loss remains. I think of these effects as the reverberations of those initial explosions - rippling out across the world and the Iraqi diaspora, for years. 

This is, of course, not unique — the longstanding, multi-generational effects of trauma are felt within many communities.  But it’s one that’s close at hand to me, almost every day. During the student and community campaigns that I worked with to urge non-violence, I strove to think of the individual men, women and children who would be affected on the ground in Baghdad. Today, I know some by name.

  

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.

____________________________________________________________________________

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.

_____________________________________________________________________________

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