Monday, June 16, 2008

Babymaking in residency

I promised an entry about when is the best time to have a baby during residency. In answer to this question, I would like to tell a little personal anecdote that still grinds my teeth two years later:

During my last month of internship, I discovered that, much to my delight, I was nearly two months pregnant. About week or two after my positive pregnancy test, after a particularly rough call, I started bleeding. Then cramping.

Those of you who have been through this (or even those who haven't) will probably understand how rough this was for me. Physically, I was in a lot of pain. Emotionally, I was a wreck. I won't get into the details, but there was crying. And I was unfortunately in the middle of a two week stretch with four calls and no days off. (Ah, internship...)

When the pain got unbearable, I talked to my senior resident about it and she suggested I ask the chief resident for help. I had one short call left the next day with a doctor's appointment in the afternoon, and I asked if I could have coverage only for the admissions until 10PM. The chief agreed. An intern was pulled off their cardiology elective for that day and would cover my admissions from 1-10PM, then have most of the next day off as a reward (while I covered the post-call issues). I spoke to the covering intern, told him what was going on, and he told me he was glad to help me.

I wish the story ended there. I mean, it's not a GREAT story, but at least I was given help when help was needed. That day, I came home from work to an email from the roommate of the intern who would be covering me, who was a transitional intern in our program. Someone I had actually considered my friend. (Also, incidentally, a Harvard-educated doctor.) The email began:

I'm sorry to hear that you are sick...

Silly me, I first thought that the email was to wish me well. Instead it was a nasty email, criticizing me for not taking that call. Saying that I was imposing hardship on his poor roommate, who was studying for the Step 3 boards. (I was actually pulled to cover for someone close to my boards too.) It ended by saying that he wanted me to "reduce my leave".

Even though everything worked out in the end, I will never forget that email for the rest of my life. Even when I'm old and senile, this will be the story I'll be telling my bored family members over and over. I finally emailed the resident a year later and told him (politely) how hurt I was by what he said to me. He wrote me back, saying he wished me well, but did not offer an apology.

All this for taking ONE NIGHT off while in the middle of a threatened miscarriage. Not even a whole day off. Thus is internship.

I hoped I was an exception, but I recently spoke to another resident who had an almost identical experience. After a particularly difficult call while she was pregnant, she started bleeding and cramping. (This seems to happen a lot... we should start a Bleeding Pregnant Residents Club.) She was allowed to take one call off, but all the other residents were suspicious and critical of her. And she had to make it up by working the next six weekends in a row or something insane like that.

So that is my experience with pregnancy in residency. Proceed with caution.


  1. Wow, that's an awful experience. I'd be bitter for a LONG time too. Another resident started hassling me when I was at the hospital to see my 2 week old baby still in the NICU -- are you really going to be out for so long? How are you going to make up all your calls, pay back the people who covered for you when you were gone for that family thing? (sibling's death the month before). I'm still uncomfortable around this resident now.

    Add me to the Bleeding Pregnant Residents Club -- in comparison, though, I have an enormously supportive program (though it's small enough that my absences certainly caused problems). It probably helps some that we treat any amount of blood as a possible hemorrhage :) so when it started during a case, I told my attending who immediately called L/D to alert them and sent me up there. The OB sent me home to rest for 2 1/2 days, then I came back to work.

    One week later, it happened again on a Friday (both times right after intubating and helping to position the patient). Back up to L/D, sent home again to rest at least through the weekend -- I was supposed to be on call that Saturday, and one of the senior residents who was to be done in 2 weeks (so I couldn't even pay her back) immediately offered to cover for me. After passing a 500cc clot overnight I went back over to L/D in the am to confirm that I'd passed everything and we were *shocked* to discover that I was still pregnant.

    So at that point, with my placenta in a precarious position, the OBs kept me off work a few more days, then let me go back without any call for 2 weeks, and then I was on what they termed "limited duty" for several months -- no trauma call (but plenty of OB call to make up for it), unable to lift anything, push stretchers, even intubate. And even when I started back up again "doing stuff" everybody was highly suspicious and questioned whether it was really okay.

    I then had PPROM at 33 wks so put everyone out yet again. Not looking forward to having to ask for pumping breaks when I go back too...

    I owe people BIG TIME.

    And wow, that's super long... little man's actually been asleep for 20 minutes this morning. :)

  2. Wow, you had a really rough experience, thanks for sharing. After my internship, I was in a residency program that was definitely a lot better, but I could still tell a dozen other stories like the one I just told. It's just the nature of residency, especially in a program that isn't huge.

    I was actually going to post an entry on my experience with pumping when I returned from my leave, so you've motivated me :)

  3. Wow indeed, that is heartwrenching and then heartless. Have you considered sending that emailer a link to this blog!

  4. No, I probably wouldn't do that. I already emailed him and told him in detail everything that was going on and how bad he made me feel. If he felt that didn't warrant at least a simple apology, then he's a lost cause. My intent wasn't to embarrass him, but just to make him a little more sensitive.

  5. Hi there,

    I'm not a mom or mom-to-be (yet!) or a physician, but I've enjoyed reading this blog, sort of in preparation for getting pregnant (as a 38-year-old first time mom, this may be a bit of a struggle).

    I guess because nursing for so long was a female-oriented profession, nurses (and our bosses) are more sympathetic when pregnant coworkers are having trouble. In the extremely busy urban ED where I work, we have several pregnant nurses, two who are about a month away from delivery (which basically means they're ready to go, because ED nurses traditionally deliver up to a month early...someone should do a study...). When someone starts spotting in the middle of a shift, or has cramping or pressure, we send her right up to L&D (or the ED docs take a look with ultrasound in an empty room) and rearrange things to cover her area.

    It's a culture thing, I guess.

  6. Good luck with the pregnancy-to-be!
    I think for nurses, it's both easier and harder. Easier because of what you said about nurses mostly being young females who almost expected to get pregnant, and also because it's shift work, so even if you end up with a busier shift, the shift will end at the same time. (I suppose maybe you can be forced to take extra shifts though.) However, I think it can be harder for nurses cuz they do a lot of patient care that is labor-intensive. One nurse told me that after transferring a heavy patient while pregnant, she started gushing blood. I never had to do anything like that.

  7. I think it may have more to do with lack of personal experience than true callousness. Relatively few interns have been through a pregnancy; they do not understand the near-terrifying feeling of a possible miscarriage, or understand that this is suddenly the most important thing in your life.

    To offer a more positive experience, I have had two pregnancies during my first 4 years as an attending; during the last I was scheduled for some overnights quite near the end. The chair of our dept called me and told me he would be splitting shifts with me, and he worked the graveyard end for me once or twice.

  8. I had positive experiences too. I also had to take some calls from home in my last month of pregnancy, and without my asking, my chief called me and told me that if they called me in, he would go in for me. "No big deal, I live near the hospital."

    But that was residency, not internship.

  9. Fizzy, do post about your pumping experiences. :) I pumped once a day, around lunchtime for the first 3 months of my internship, but it wasn't a big deal. Going back to work shortly with a super allergic baby with swallow issues who's totally reliant on me and my milk, plus my being in a position where every pumping break I take means that somebody else has to physically cover for me, is going to be a completely different experience!

    Still pissed off for you for your non-existent support during your threatened miscarriage.

  10. It is sad that there are so many stories about being mistreated should you dare to procreate during residency. I have a long story, too, if you don't mind me sharing?

    During my third year of my OB/GYN residency I was pregnant with my first child. This was a planned pregnancy, and I actually planned to get pregnant exactly 2 months after my good friend (a year ahead of me) so that we could alternate maternity leaves. She got pregnant, but unfortunately miscarried. I got pregnant 2 months later, and it stuck.

    My pregnancy was not an easy one. I vomited every day until I was 37 weeks pregnant. I lived on Zofran, and was therefore constipated as hell. I had plantar fascitis and symphysis pubis diastasis, so moving around was uncomfortable (but I still covered all of my responsibilities). I did complain about how tough the pregnancy was (not that I wasn't thrilled to have a pregnancy, but I was miserable), which rankled my colleague that miscarried. She was my closest friend, and she completely turned her back on me.

    Then, the kicker, while serving as the senior resident on night float at 32 weeks, after a particularly busy night, I noticed that maybe I was having contractions. I hooked myself up in triage, and indeed, I was contracting every minute. Of course I was extremely dehydrated, and let the nurses give me a fluid bolus. The next morning I had an appt. with my OB. I told her about the contractions, and she wanted to take me out of work. I nearly had a breakdown and *begged* her to let me *at least* do "part time" at 40 hours/week. She reluctantly agreed, because my cervix was still closed, and I called the appropriate people about my hours adjustment, went home to sleep so I could come back for night float.

    Unbeknownst to me, one of the chief residents *called my OB* (one of our attendings!) and questioned her if cutting my hours was absolutely necessary...had she done a cervical length or fetal fibronectin, etc. etc. This infuriated my OB, and she told him she had never had anyone (much less a resident) question her clinical judgement, and right then and there stated that instead of cutting my hours she was pulling me completely out.

    I got accused of getting dehydrated and generating contractions "on purpose" to get out of work. My whole program was pissed off that I dared have complications since they had to cover my missed calls. I was nearly hysterical, and cried for 2 days (likely depressed, now that I look back at it). I was devastated that people that were OB/GYNs, who took their own patients out of far less demanding jobs for much less, were so callous. I tried to tell them that I fought to cover some calls, but my former friend said icily, "Well, did you cry?"

    I came back at 36 weeks for 40 hours a week. The cheifs made me cover odd hours of call on the nights and weekends to make me pay them back. I worked "part time" at 40 hours/week until the day before I was induced for preeclampsia. My friendship with the girl that miscarried did not survive the pregnancy (she did go on to have a successful pregnancy, and I wondered if she ever felt bad for how she treated me), and my view of residency and people was terribly damaged. I still carry the emotional scars.

    Long story short, pregnancy in residency was hell. I fared far better in my second pregnancy (solo private practice as an ob/gyn with only 4 days off/month). Thanks for letting me share, and, as a fellow mother in medicine, I am enjoying your blog very much!

  11. Dr. Whoo, that is a really horrible story. I'm so sorry there was such a lack of understanding... stories like that makes me feel guilty complaining about my own pregnancy because IN GENERAL, for a residency, my program was pretty supportive of me. But I'm in PM&R, which is a lighter residency. When I rotated through OB/GYN, I saw some of the things you're talking about... one of the PGY1s was hospitalized for an infection and everyone was talking about her behind her back, that they didn't think she was sick enough to be in the hospital and that she ought to be working.

  12. As a psychiatrist, I had an easier call schedule than you obs out there. And despite a supportive residency director who had a physician wife and 4 kids of his own, the only trouble I had was from a female co-resident who outright refused to cover any of my patients while I was out on leave. I had already made up my missed call ahead of time (trading the time with a resident from a far away country who preferred to take all of her vacation in a clump). Why the attendings did not intervene in the coverage fiasco, I will never know. In retrospect, that angry female resident likely had had infertility challenges.

    The supportive co-residents were men from traditional religious backgrounds because they thought a woman should be home with her new baby. They were always asking after my nutritional status and sleep schedule and glad to cover.

    My subsequent children were born of post residency practice and the experiences were great. So hang in there!

  13. I was admitted at 31+3 weeks for severe pre-eclampsia during my chief resident year. I was (luckily?) admitted to my own hospital.

    So there I was, headachey and pukey on a mag drip, fielding calls from residents on the verge of a breakdown. "What do you mean you are in the hospital," one of them said. "You aren't supposed to be due until October and we need you!"

    Finally, when I begged for help, one of my classmates took the call pager from me. "Have a healthy baby," she said. "That's your only responsibility now."

    I could have kissed her on the mouth, except my head really, really hurt.


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