Wednesday, August 13, 2008
Then, slowly, it became obvious that my job was not as lifestyle friendly as it had promised. Instead of a 1 out of 3 call, I became a default solo practice Ob/Gyn physician (something that I never, ever wanted to be). In the last 3 years, not much has improved. I have managed to eke out 2 weekends off call every month, but it seems this is all the leeway with lifestyle that I am going to get. Our family life is severely affected by my call schedule, and I always feel like I have to have one foot ready to run out the door. It is time for a change, and, for us, that means moving....again.
Of course, all of the joy that comes with moving is expanded with small children, especially in the arena of finding reliable child care. Then I worry about putting them through a move and how it will affect them emotionally. For Bean, I am not so concerned, as he is small yet and likely won't remember the change. For CindyLou, this move is going to be hard. This is the only home that she knows. She loves her house, her play set, her room, her teachers, and her friends. I remember all too well the hurt of having to leave my friends and everything that I had known behind for the unfamiliar. Most of all, we want to have a stable place where our family can grow and thrive. As long as I am on call as much as I am, we will never be able to pursue extra curricular activities for the children, and I really can't bear the thought of not making it to baseball games and/or dance recitals.
Logically, I know that as long as we are together, we are home. A house and a town are just places, but a family is your true home. I just wanted to give my children the opportunity to graduate high school in the same place that they went to kindergarten. It is this little fantasy that I have entertained ever since I was a girl, having to move time after time. I am starting to worry that my childhood and schooling has triggered some kind of wanderlust, set to go off every 4 years or so! I never pegged medicine as a nomadic career, but I am taking careful steps to try to make this next move our last one for a very long time. How do you ease the transition of a move on kids that are old enough to understand?
Monday, August 11, 2008
My three-year-old broke his arm this weekend.
Technically, he fractured his left radius and ulna, but when I saw him running toward me with a sickeningly unnatural curve to his forearm, I said only, "He broke his arm." I immediately noticed that I didn't use medical language, but at that moment I was solely a mother.
We were visiting family, and Leif had fallen from a four-foot slide. As we headed to emergency, minutes up the road, he kept insisting through his sobs that he needed nothing more than a band-aid. "That always made it feel better before!"
Lying on the gurney in the emergency bay, much more comfortable now with his arm draped carefully over his chest, Leif's chief concern was that the IV not interfere with the (temporary) tattoo on the back of his hand. "Why don't you put it here?" he suggested to the nurse, gesturing to his shoulder.
Hooked up to the monitor, he announced cheerfully, "That's my heart. Did you know it made that little beeping sound?"
I don't think he's ever been cuter. Of course, at home his running commentary has to compete with his two sisters', and we're often distracted by making dinner or driving the van or whatever activity we're engaged in. But lying on the cot, with both his parents directing their full attention and concern at him, the kid streamed charm.
The physician arrived and asked Leif what colour cast he preferred: "Blue? Green? Soccer balls?"
Leif considered the options and replied, "Pink." The lad doesn't have two sisters for nothing.
"Your father will be relieved to hear that we are out of pink casts," replied the physician. "But we do have red."
Leif had to be put under conscious sedation to have the fractures reduced, and as they prepared for the procedure the nurse measured a tiny blue airway against Leif's jaw. "Do you like the colour blue?" she asked him pleasantly.
"What's that for?" asked Pete.
"In case he stops breathing," she replied matter-of-factly.
Once Leif was sedated, hooked up to monitors with on oxygen mask on, his little arm being manipulated by the doctor, I heard Pete make a small distressed sound behind me. I was thinking purely medically at that point, watching the effects of the ketamine and noting the doctor's technique.
I didn't volunteer that I was a physician, as I didn't see how it would influence Leif's care, and there was no natural way to do it. But eventually the physician asked casually, "So, are one of you in health care? Nurse? Doctor?"
"I'm a physician," I admitted.
There was a chorus of Aha!'s, and the remark that we were unnaturally calm.
In fact, I felt grateful throughout the visit. Grateful that in six years of parenting this was our first emergency visit; that the injury was relatively mild; that there was no one to blame for the accident; for the family that visited during our short stay and took care of the girls; for the availability of excellent medical care (working with refugees makes me especially appreciative of our system).
As for Leif, he disregards the cast completely. He's not the least bit frustrated to be constructing forts with one hand, and has been climbing the furniture as usual and threatening to break the other arm.
When I gave him his grape-flavoured ibuprofen this morning, his baby sister asked for some.
"This medicine isn't for you," Leif told her, "It's only for little boys with busted arms."
Sunday, August 10, 2008
Ever since we started Melly in day care six months ago, I've been sick more than I ever have before in my life. People are beginning to think there's something seriously wrong with my immune system and the jokes about sequestering myself in a germ-proof bubble really aren't funny anymore.
"You're sick again?"
"But you were just sick like two weeks ago."
"Yes, I know."
"Boy, you get sick a lot."
"Thanks for noticing."
Aside from some more minor viruses, I've completely lost my voice on two occasions and had two pretty bad stomach viruses. I haven't had a stomach virus since I was four. And now I've got a runny nose and cough in the summer, which hasn't happened to me since I was twelve.
I understand that babies get sick a lot because their little immune systems are still developing, but why do I (presumably with a mature immune system) have to catch every single one of her colds? And how come my husband NEVER catches ANY of her colds? (As if we really need to ask why the resident who barely sleeps is more likely to get sick. Hint: it's not because I'm drinking cups of baby saliva.)
I could deal with being sick, except for how it affects my work. I always try to at least show up, no matter how awful I'm feeling, but I can't dictate or interview patients if my voice is gone. And patients don't want me to touch them, even with gloves on, if my nose is running. I try to hide it the best I can, but every now and then I can't take it anymore and actually do the unthinkable and blow my nose in front of the patient. I got thrown out of the room for that little stunt.
Too bad I don't work in a field where it's possible to call in sick. (As if it's possible for a mom to EVER have a real sick day.)
Saturday, August 9, 2008
A birth mom chose us. We don't know the baby's gender. It was so easy, really fell into place with minimal effort (but a lot of stress) on our parts.
How to plan our FMLA has been a nightmare. If she goes early, the following will have to be adjusted.
She is due 12/3, but it is a planned section, so we think she'll probably be scheduled at 38 or 39-ish weeks and her state is half the country away from ours. If we are lucky, they'll deliver her 11/24, the Monday before Thanksgiving. I'm off from 11/24 through Wed 12/3 and then start a week of nights on 12/4. We have to stay in the state of the birth for 7-14 days for legal shenanigans before we could bring the baby home. I could, if need be, fly back a.m. of 12/4 if we still aren't allowed to leave the state and leave Husband there with the kids (pleural...neato!).
We think Husband, whose job is in accreditation, will work from home in December, something he is able to do in around the holidays. I will go ahead and work through my current schedule, which is set through January 4th, then take eight weeks of FMLA.
Why, as an adoptive mother, do I feel guilt for taking FMLA? If they were to cut this baby out of my own uterus, I wouln't think it extraordinary to stay with the baby for awhile. I haven't gotten a lot of flack for it at work, but the discomfort I feel is totally self-inflicted.
As Mothers in Medicine, sometimes we have to be better, stronger, faster than our colleagues to avoid being judged. And sometimes, we do it for ourselves, as in, "Look at me. I'm still a good doctor even though I have a new baby."
Meanwhile, please pray this goes through. The birth mom is mature and intelligent and already has three children, but we know this could go wrong anytime, even after the baby has been born.
Isn't it amazing that we could be so attached to a person we've not met, who hasn't even been born, who isn't our blood relative?
Love is amazing.
Thursday, August 7, 2008
Wednesday, August 6, 2008
Tuesday, August 5, 2008
Monday, August 4, 2008
I managed to retrieve most of them from her, but she's managed to hang on to a few of her favorites, including several of my medical "pocket guides". They're small enough to easily fit in a baby's hands and usually are brightly colored. I've kind of given up and decided to just let her have them.
So as a result, right now I'm looking at her bookcase and some of the books I see are Peekaboo Kisses, Little People Go To The Zoo, Internal Medicine Pocket Guide to Critical Care, and Where's Baby's Mommy. Typical one year old reading.
Wednesday, July 30, 2008
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I had it all planned out.
I got up that morning and thought, “I’ll have my baby in 2 days.” Such a strange feeling to know when you will deliver. My baby was breech so I had a scheduled C-section for that Saturday. The Fam all had their plane tickets. It was all set up. I would work that day, take my CREOG’s the next day, and have our little Genius on Saturday. Then we would discover whether it was a boy or girl. BTW, not finding out the sex of the baby is so much fun... it drives your family CRAZY!
I had clinic that morning and 2 abdominal hysterectomies that afternoon. I remember the first hyst I did that day. She had fat tubes. I'll never forget her tubes. She was a heavier lady, though I’ve certainly operated on much larger women. But she had a thick layer of fat between the leafs of her broad ligament and fat hanging off her tubes. I’ve never seen that before. Anyway it made the case particularly tough.
It was during the first case that the headache started. The scotoma appeared during the second. I stopped by triage before leaving and my blood pressure was through the roof. The urine dip (yes, I dipped my own urine) was a pretty shade a purple protein. Luckily, one of my fellow residents and close friends observed these things and called my doctor. I had no insight. Intellectually I realized I had pre-eclampsia, but it didn’t compute emotionally. It was strange. I was flabbergasted that things would happen out of order. My baby was to be born on Saturday. I realized I was terrified of the “unknown” despite doing 100’s of c-sections my self. Several blubbering phone calls later, they set me up for delivery. The spinal hurt like hell, but my husband and 4 friends who were fellow residents were there to support me. The whole room cheered when he was born. “It’s a boy” some one said. They announced it over the loud speaker on L&D, too. I remember them holding him up over the blue sheet and I thought they should really get him to the warmer. Myself, my husband and my friends (who we’re running various videos cameras) we’re all crying and cheering. It was an amazing day. I had practically lived at this hospital for 3 years, so it was awesome to have my baby among family.
The next day was exhausting, my parents arrived, I was on Magnesium and Demerol. I still managed to nurse and stick with it for 6 months. Half the hospital came by to see me. My nurse finally put up a sign and kicked everyone out (including my mom) so I could get some rest. She’s my hero forever.
Anytime I do a primary c-section, I try to tell a shortened version of this story to my patients. It’s OK to be scared and to cry. Things don’t always go like you planned.
At 31 and 3 days, I had a headache and was short of breath. I was in clinic, so I took my blood pressure at about 8:30 and it was high. Really high. As a doctor, I knew I should talk to my own doc, who also happened to be my residency director and was down the hall in her own clinic, but I had patients to see.
If you are not an inpatient in the hospital, you are not sick. I pushed through, knowing I could rest during the didactic session planned for all of the afternoon.
During the didactic session, I became more and more dyspneic, even while sitting still. Panic, I thought, and I willed myself to calm down. I wondered if I would make it to the second week of October for my due date. It's because I'm fat, I thought, cursing myself for intentionally getting pregnant at 280 pounds.
After the lectures, at about 4 p.m., I found my residency director and told her about my symptoms and my a.m. blood pressure. She got out a cuff, sat me down and took it herself. It was the same as in the morning, 220/110.
She put me in a wheelchair and sent me directly to L&D for admission, where I insisted on writing my own admission orders. Stupid, but I'm a control freak and writing orders was something I could control.
The BP had improved somewhat by the time I got to L&D. My doc consulted the perinatologist, who examined me and ordered a biophysical profile. The score was OK, so he recommended a 24h urine, a renal consult (I'd been seeing them as an outpatient), steroids and aggressive BP control. No mag yet, he said.
August 7, 2004, day three of my hospitalization. The BPP was not good, and a followup doppler ultrasound showed that the blood that should go toward the fetus was actually reversing flow. The perinatologist recommended c-section right away. I asked if an induced vaginal birth would be OK. He actually laughed.
This is not what I had planned! I'd planned an epidural and a beautiful vaginal, family-centered birth experience in October.
My favorite OB senior resident did the surgery, and my favorite family med intern (who happened to be on her gyn month) assisted. My husband must have wanted to die, but he sat calmly at my side, stroking my face, telling me he loved me.
When they briefly showed him to me on his way to the isolette, he seemed bigger than I'd expected. I heard his cry and immediately gave a prayer of thanks. Two hours later, I got to hold him in the NICU. He was 3 pounds 7 ounces and doing well on a CPAP.
Back in my room, I developed four beat clonus and got to experience mag sulfate for 24 hours. Yeah. That sucked, but now as much as not being able to see my kid.
Husband stayed with the baby and visited me every now and then to give me updates and share the digital camera with me so I could see my boy. Mom and my mother-in-law, both RNs, provided personal bedside nursing.
Another senior resident came and physically removed my beeper from the room. "Don't worry about us," she said. "We'll be fine." And they were...turns out they didn't need me at all. Go figure. And here I thought I was the center of the universe.
I went home on day three, then went with Husband to the NICU every day, 7 a.m. to 9 p.m., to care for our new son. He was a "feeder-grower" and never required intubation, antibiotics or other special care. Sister went nightly at 9 p.m. to rock him and feed him until midnight. On day 28, he came home.
His birth, while scary at the time, is the best thing that ever happened to us. Next week he'll be 4. He's still beautiful... and now bright, funny and well-adjusted. There is not a day of his life that I would trade for anything.
When I was 37 weeks pregnant with my second child, we moved one block up the street. The day we moved, my husband flew to
I spent the next few days hauling boxes around and arranging furniture. After a particularly vigorous session wrangling the couch, contractions began. When they persisted for six hours, I called Pete and he arranged a hasty return flight.
Once he was back on Canadian soil, the contractions ceased. I was embarrassed and hoped desperately that the baby would arrive in the next day or two so that I might redeem myself. I didn’t want Pete showing up at his office on Monday without something to show for cutting short a business trip.
I was relieved when labour began in earnest two days later. We headed off to bring our three-year-old to our friends' place, but I was so uncomfortable in the car that I asked Pete to swing by the hospital and drop me off first. I brushed off his offers to assist me inside and made my way up from the parking garage alone, stopping every two minutes to lean against the wall and breathe.
Now, I’m a polite and reserved person, even in labour. I don’t scream, I don’t curse and I take pains not to let anyone else feel awkward witnessing my discomfort.
As I made my way into the maternity ward, I ran into my obstetrician, with whom I had an appointment that day.
“I don’t think I’ll be able to come in to see you this morning,” I told him apologetically.
“You have a woman in labour to attend to? No problem, we’ll rebook your appointment,” he replied pleasantly.
“I’m in labour!” I corrected him.
As he looked at me skeptically, a contraction began and I excused myself and turned towards the wall.
He gave me a keen look, murmured, “The leaning-against-the-wall sign,” and directed a nurse to show me into the assessment room.
I lay on the exam table, in the standard light yellow gown, waiting for the resident, with the contractions steadily becoming more painful. When a junior and senior resident stepped into the room, I asked politely for analgesia.
They were busy manoeuvring a portable ultrasound. “First the ultrasound, then the exam, then we talk about pain control,” the senior replied briskly.
“Ultrasound?” I asked.
“We had two undiagnosed breeches recently,” she explained. “So we’re doing an ultrasound on every patient to establish presentation.”
She ran the probe over my belly. With supreme effort, I kept from writhing in agony with each contraction.
She began a detailed teaching session with the junior resident, reviewing the operation of the machine and the findings on the screen. “There’s the back,” she explained, gliding the probe down my abdomen and over my pelvis. Then, muttering to herself, “But where’s the head?”
The nurse, who was clearly annoyed by the residents on my behalf, noted that my face had turned white and announced that she was going to fetch the obstetrician.
“Could I please have something for pain?” I asked the resident again, more urgently.
“Ultrasound, exam, analgesia,” she repeated, irritated. Then, swooping the probe over my belly once more, “Spine . . . where on earth is the head? That is just the strangest thing.” The residents were puzzled.
I knew exactly where the head was. Crowning. I had no choice but to be rude. “I have to push,” I announced. At that moment the obstetrician walked into the room.
“How dilated is she?” he asked the resident.
“I haven’t examined her yet,” she replied. “We can’t find the head on ultrasound.”
He berated the resident for not doing the exam first, and she defended herself, “But I had no idea she was so far along!”
“I’m going to push,” I warned.
As I was rushed down the hall on a gurney to a labour room, I was so focused on refraining from pushing, that it only briefly registered that Pete was not among the mass of people swirling around me. Frankly, that was the least of my concerns at the moment. In Room 11, the nurse fumbled with the nitrous oxide, only to announce that the mask was missing.
Then, with not even a Tylenol on board, with my husband missing in action, I pushed out my son with two pushes.
Ten minutes later, as I lay with a bundled 6-pound 5-ounce Leif Jacob nestled in my arms, blissfully happy that baby and I were well, Pete tentatively entered the room. If he hadn’t said anything, I would have assumed he had had trouble with traffic. But he felt compelled to admit that he had thought he had time to spare, and had popped into Starbucks for a latte and a chocolate croissant as his son entered the world.
(Cross-posted at www.freshmd.com)
Best wishes to all,
1) Am I having contractions? It feels like bad menstrual cramps. I don't remember learning that in med school.
2) I'm on call for the gen peds practice right now and in labor.
3) Are these contractions 3 or 6 minutes apart? Perhaps we should go to the hospital now. But first, why don't you set up the pack and play, Honey. OH that's another one .
4) Why am I being escorted to the room where I am told "all the doctors and lawyers" deliver? I am ready for a suite on Kauaii, but alas it is in sunny (hot/humid) Local Hospital room (with a good NICU, which is what every pediatrician wants but wants not to see). Fortunately we find no need for a NICU, no malpractice, no lawsuits.
5) The epidural hasn't helped at all... more anesthetic.
6) Oh (too much). Now I can't feel my legs. Then a quick nap.
7) Wow, having Husband count to 10 while I push actually matters/helps.
8) There she is!
9) Let the breastfeeding begin. (Room in and post "no formula" signs)
10) Life changes as we know it (for the better)...
Laborious thoughts and sequence of events Part 2:
1) What will we do with Precious First, while we're having Second? Grandparents take shifts awaiting the big day.
2) I need two doses of Amp for GBS so no waiting around at home this time.
3) Why is there no air conditioning in this hospital?
4) Wondering why my systolic is down to 75. Glad the senior attending decides to stay.
5) I hope Precious First is enjoying her time with Grandma, french fries and all, and is ready for her whole world to change (for the better, we hope).
6) Were those practice pushes or the real thing?
7) There he is! 9 pounds!
8) Let the breastfeeding begin. (Room in and post "no formula" signs)
9) Get me out of this room so I can see Precious First and introduce her to Second, NOW.
10) Life changes as we know it again (for the better)...
When I woke up in the middle of night to feel a steady trickle of fluids, I was ready to do a little jig out of joy. Upon inspection, it looked like what I always imagined amniotic fluid to look like. I mean, I thought I could see vernix. This was a grand slam, home run. Labor and Delivery advised us to come in right away.
By the time we got to the hospital, I had already started having contractions, 7 minutes apart. The senior resident in triage seemed kind and capable. He asked me if it would be alright if a medical student followed me and examined me.
Being a clinician-educator myself, I didn’t hesitate. Sure. Why not? I didn’t work with students at this school (I would feel uncomfortable if there would be any chance of becoming this student’s supervisor someday after him performing a pelvic exam on me).
The resident talked the student through the exam and they took a swab of the fluid to examine it under the microscope together.
A few minutes later, the resident returned and informed us that I was not actually in labor and that we should go home and follow up for our already scheduled appointment in the OB clinic later that day.
WHAT? Was this a joke?
He said that the fluid was not amniotic fluid.
What is it then? I asked in a perturbed way as I lay in a growing pool of amniotic fluid on top of the paper sheet.
It could be urine.
I’m not urinating on myself! It’s amniotic fluid, I’m sure! At this point, I was feeling like I might hurt someone if they didn’t admit me right away and get me some pain meds. Can you check another sample? (said with a wee amount of bitterness)
He looked at me as if dealing with an out-of-hand customer at the customer service counter. Okay, he said, placating me, we’ll check another sample.
This time, he did the procedure and when he came back into the room, his look was sheepish.
Welcome to Labor and Delivery.