Thursday, March 21, 2013

Guest post: Cardiologist, interrupted

Combining motherhood and medicine is no small challenge. When attaining motherhood itself became the challenge, I felt lost. It seemed as if I was the first MD ever to find herself in this situation. Nobody I knew personally had gone through infertility. Lots of cardio fellows I knew had had pregnancies during their training, and there were even some who had been seriously ill needing frequent medical treatment. But all that just isn’t the same. The overwhelming feeling of loneliness and having no one to turn to for advice in the difficult decisions that needed taking is why I really wanted to do a guest post here. I hope my story can help someone out there navigate the rough seas of infertility and pregnancy loss.

Our story of trying to conceive started when I was 27. I was in residency then, and had just gotten married. I was looking forward to a year of rather cush rotations. I happily tossed my pill in the trash. The first six months were not so bad. We hardly gave it a second thought that I hadn’t gotten pregnant yet. After all, we were both very fit and in excellent health. My cyles were regular as clockwork. It was bound to happen in the next few months. Except that it didn’t.

After a year, we had some very basic testing done. Gynecological exam and ultrasound for me, sperm analysis for my husband. Everything came back stone cold normal. We were back to the drawing board. By then, our marriage was definitely suffering under the strain of TTC (internet messageboard speak for Trying To Conceive). All the temperature charting, ovulation predicting and sex under duress were taking their toll. I was completely micromanaging it all, and my husband told me in no uncertain terms that I was driving him up the wall.

In the meantime, I had finished residency and moved on to a cardio fellowship in a prestigious, somewhat malignant program. In hindsight it was never a good fit. I was the only woman on the service, and the attendings and other fellows were as macho as they come. When I chose to go there, I was completely blinded by the prestige of the place. When I started work, I was told in no uncertain terms that they wouldn’t appreciate me getting pregnant. I just let the remark slide, thinking that it all wouldn’t be so bad if I just worked hard enough.

A few months in, when I least expected it, I realized I was two days late for my period. That had never happened before. I finally unwrapped one of those pregnancy tests we had optimistically bought 18 months before. And yes: pregnant. We were madly happy and naively optimistic. I didn’t announce, because I was afraid of the repercussions. I just double leaded and kept on cathing. I treated myself regularly to sneaking into the echo lab after hours, looking at the tiny flickering heartbeat and dreaming about the future.

When I was seven weeks along, I was rounding the ICU with the whole team when suddenly I felt the worst pain I’d ever had in my life. I ran to the bathroom and collapsed on the floor of the stall. This could not be good. I went over to L&D, where the OB confirmed my worst fear: the little heart had stopped and I was having a miscarriage.

To say that I was devastated is an understatement. I can’t find the words to describe the grief, depression, emptiness and hopelessness of that period. I couldn’t eat. I had horrible nightmares about having to resuscitate my tiny baby. I contemplated suicide to be with my child. I had such overwhelming guilt about staying in the cath lab, thinking my baby died of irradiation. It’s completely irrational, but it took me over a year to shake off that guilt. Physically, I was crippled by anemia after a serious hemorrhage.

When I returned  to the hospital, I was in for a nasty surprise.  Everyone knew what had happened to me through the hospital grapevine. But no one understood. I was expected to pull as much weight as I had before the miscarriage. It didn’t occur to any of my collegues or bosses that I would need an easier time. And I just couldn’t take it, physically and mentally. Another thing that had changed, was that I no longer gave a flying f*ck about anything at the hospital. I lashed out like a wounded animal at anyone who gave me a hard time. Fellows, nurses, attendings, it didn’t matter anymore. I alienated a lot of people during that period.  I wish I could say that I could have done things differently, but I just didn’t have any strength left for diplomacy. My attendings behaved like jerks, and no-one showed the least bit of compassion during the most difficult time of my life. I was so out of it with grief and depression that I couldn’t have done it differently, even if I had realized the consequences at that time.

Several months after the miscarriage, my husband and I had a long talk about the future. We’d been trying to get pregnant again the whole time. It was clear that if we ever wanted to have biological children, we’d need treatment. We consulted with a fertility specialist. He stressed that that the single most important factor determining the chance of success in infertility treatment is the age of the woman. We had no time to waste.

It was very clear at that point what the priorities were. The hospital I was working in didn’t have a  fertility clinic, and taking any amount of time off work for IVF was out of the question. It was time for an organized retreat.

At the end of the clinical year, I continued my training in another hospital. I had rotated there before and knew a lot of people in the staff. Among them were several women, all with families. The group of cardiology fellows was almost 50% female, the atmosphere was pleasant and collegial. This hospital has a large fertility center, and I became a patient there. For the next 8 months we did back-to back cycles. First stimulated IUI, later IVF. The funny thing is that I hardly missed any work time for all this. The other fellows knew what was going on, and they simply covered for me for the duration of whatever test or procedure I had to undergo. In exchange, I took some late shifts for them so they could pick up their kids from daycare. It was a great deal for both sides. Working in this environment made the contrast with my previous place all the sharper. It’s not about working less hard, it’s about not giving people such a hard time about work.

And then, at the second IVF cycle, we got our lucky shot: I got pregnant. I have to admit that I was completely paranoid about miscarrying again. I put the ultrasound probe on my belly for a quick heartbeat check almost every day. I became uneasy when I was away from the ultrasound machine for an entire weekend. I struggled with traumatic memories of my miscarriage. But I’m out of the first trimester now and things are progressing well. Slowly, the sun is coming out again.

The extent of the career damage from my miscarriage-depression didn’t come out until later. I got a lot of bad rep from my previous hospital, and was passed over as a candidate for a job I really wanted because of it. The people I rubbed the wrong way are quite influential. I’ll have to find a new track in my career, where references from those people don’t matter as much. But I don’t worry about it. It’s never too late to reinvent oneself professionally. I’m an excellent cardiologist, and I will land on my feet no matter what. I just had to do the really important things first.      

9 comments:

  1. Wow, congratulations! That is quite the story. Having been through a miscarriage and now almost to the end of my first trimester of my second pregnancy, but minus the years of trying/IVF that you have been through, I sympathize with your plight. I certainly hope for a successful pregnancy for you! And congratulations on finding a much more supportive fellowship. It is amazing the difference that makes. I have no doubt you will land on your feet and find the right job when you are done.

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  2. That is an amazing journey of courage and strenght....life is tough but i guess as long as one knows what they want .....its good!
    the baby will spread sunchine in your life i am sure

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  3. Thank you for sharing. I myself am a medical coder and educator. I have done different things through the years in the medical field but this is my love. Regarding miscarriages, first let me say I have six children from ages 25 down to 7. That being said I have had 13 miscarriages. No one seems to know why really. Most likely because of a lack of hormone was the prevailing thought. Nothing we tried helped except, right after a loss I was able to maintain the next pregnancy. Depression is a common factor. It felt like falling into a well. In fact I would describe it as literally feeling the hormone leaving your body and dragging you down with it. I don't think if one had not experienced it they could possibly understand. I feel lucky that I knew what was going on and it was short lived. For me this feeling never lasted more then a week or two. Only one time did I feel differently. My cousin was pregnant at the same time I was. I lost my baby and she had hers. I didn't feel up for the baby shower and made a lame excuse. Still my Christmas I was fine.

    My last child was born when I was 38. I think we would have kept going if my health had not gone down hill. My last two pregnancies and deliveries were harder. They were the only ones I had an epidural with. The physician insisted since my BP was so high. My husband had a vasectomy. Now I am ready for grandchildren.

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  4. Heart-wrenching tale. I know so many friends who struggled with fertility for years and IVF was the key. Good luck to you!

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  5. Infertility is a special hell (I have had the misfortune of visiting). Best of luck with everything professionally & personally. You are absolutely right that you will recover from this setback and find yourself in a better position for yourself and your (growing!) family.

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  6. So many nurses go through miscarriages and infertility, I find it just insane that none of them reached out to you. Sounds like the political aura of the hospital prevented even the smallest human kindness. This will make you a better doctor and definitely an :"every day is a blessing" kind of mom. I have no doubt you will reshape your career and emerge from all of this. Sharing your story has just made a lot of women grateful for perhaps an easy pregnancy and more empathetic to their colleagues who may not have even let on they are struggling.

    I am an NP who has a lone IVF/ICSI/FET baby (after 2 failed IVF cycles...this was our one frozen embryo left!). I gotta tell you that motherhood after going through everything like that is just an amazing experience. Congrats and a healthy pregnancy to you!

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  8. Thank you so much for sharing! Congratulations on your marvelous little person growing inside you! I wish you the best and know you will find the job that is perfect for you just how you eventually found the fellowship that was perfect for you!

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  9. I read your post a few days ago, and have been thinking.
    It was such a rough and lonely journey...
    You braved it, and shared so candidly - Thanks!
    Best wishes for a healthy pregnancy and a motherhood full of contentment!!

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