Walking Tall

This month I’m traveling around the country to check out fellowship positions. It is exhausting, trying, lonely, and often confusing. Most of all, I miss my kids.

I spend a lot of time trying to figure out how fellowship and moving to one of these places would fit into the current, ideal, little life of mine, but it’s hard to do.

This morning, as I walk to the clinic, I am in awe of my own strength. This is not an easy task

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In My Absence

It’s been weeks since I’ve been here… and three weeks have passed since I’ve been back at work.

It’s been months since I’ve been at work… and it’s taken 3 weeks to get back to some kind of normal. 

I’m happy to be back at work, but I miss my baby. I also miss my “free time” and I miss everything else that is important to me. 

The last three weeks have been a whirlind of breastfeeding in the night, pumping milk between surgeries and baby deliveries, leaking breasts, making bottles, sleeping, cuddling with baby El, and maybe some sleep somewhere in there.

I still have mixed emotions about my decision to return to work early. I love my job and it feels great to be back, but I miss my baby – even more than I imagined I would. 

In my absence she seems to be doing well. So far I have been able to continue breastfeeding. Although, I can sense her getting impatient at the breast when the milk doesn’t come as quickly as the bottle. My milk supply is having a hard time keeping up and I’ve had to start some supplements. Hopefully it will pick up in the next little while. 

She is excited to see me when I finally get to her after a long day of work. Even at 5.5 months, she had begun to give little hugs and bury her face into my shoulder. Then she opens her mouth wide and dives into my face – her idea of a kiss. It doesn’t take more than 5 minuets before she is suddenly pushing to lean back and rooting for her comfort. She still loves her special mommy and El time, and for that I’m so thankful. 

Identity Crisis

For almost 6 years, I have been a mother.  For almost 6 years minus 13 weeks, I have been pursuing a career in medicine.  Neither of these tasks are particularly easy on their own, let alone together.  No one gives out medals and prizes to the Mom who “accomplishes” the most with her kids, or who “does it all right,*” or who raises the best kids.  It’s different in medicine, though.  In medical school there are awards for many aspects of study.  There is a constant, hidden agenda, enticing students to be better than their peers, to be the best student they can be, and at the end of it all, to compete with each other for the best residency positions.

*What does “doing it right” mean as a mother, anyway?

For 6 years I have struggled to be the best mom I can be, despite the overwhelming time and energy commitment that goes along with medical training.  Along the way I have received little recognition for my hard work (like every mother out there).  For 6 years minus 13 weeks, I have struggled to be the best medical student and then resident that I can be.  Fortunately, that role always came with significant recognition: Scholarships and Bursaries, conferences, accolades from my peers and preceptors, and the all too often phrase: “I don’t know how you do it.”

We all thrive on positive re-enforcement and recognition for our accomplishments.  As a result, I felt more reward from excelling in my work life because the rewards were tangible.  Even as recently as being pregnant at work, I had people telling me that they couldn’t believe how hard I was working, or how dedicated I was to be working so late into my pregnancy.  It made me feel good to know that other people noticed my effort, how much I loved my job, and how well I performed.  But now that I am off work, at home and being a full-time mom, all of that is missing.

I’ve been home for 2.5 weeks and I really miss work.  I feel guilty because I should be happy to be home spending time with my kids – I never get this opportunity.  I would argue that staying home with three kids (while one if a newborn) is tough work – tougher than my actual job.  The worst part of it is that I feel like I don’t know how to be this person… the mother who gives all of her love, attention, and effort to her kids all the time.  It makes me sad to realize that for the entire time I’ve been a mother (minus 13 weeks), I don’t know how to fully identify as a mother.

I have, somehow, let my life as “medical trainee” define my identity to a greater extent than my life as “mother.”  I feel like this is so wrong – like I have it all backwards.  I mourn for my children, who have never completely had a mother who knows what it means to be their mother.  They have always been competing with my other identity – an identity where they have merely been accessories to my apparent success.  And now I am home all the time and I feel lost.  I am having an identity crisis, and I only have 5 months to sort it all out.

Pregnant at Work

“Oh wow, look at you! How many weeks are you now?””30 weeks already!? It sure is going by fast! How much longer are you planning to work?”

Indications: This 36 year old G3P2 woman was admitted to hospital with a history of a missed first trimester abortion. She was referred to our care after a community ultrasound performed on [date] at 17 weeks 5 days gestational age revealed a fetus measuring 11 weeks 6 days with no fetal heart rate activity. She was recommended to have a D&C by aspiration. The risks of the procedure, including infection, bleeding, and uterine perforation with injury to adjacent pelvic viscera were discussed with the patient, along with the benefits, and she gave informed consent.

“You’re having a girl!?! Oh, I didn’t know that! What do you have at home again? 2 Boys – oh, you must be so excited!”

“You must be getting tired now, with all these hours that you work. Are you done call now?”

Procedure: The patient was taken to the operating room and received a general anesthetic by Dr. X. She was placed in the dorsal lithotomy position and prepped and draped in the usual manner. Examination under anesthesia revealed a 13 week sized uterus and no palpable adnexal masses.
“Well, you look great! It is your third after all, everyone looks a little bigger the third time around.”

“I had a boy and two girls, and let me tell you, it was the time of my life! This time will go by so fast!”

A weighted speculum was placed into the vagina and the anterior lip of the cervix was grasped with a double toothed tenaculum. The uterus was sounded to a depth of 16cm. The cervix was dilated without difficulty to accommodate a size 14 suction curette. We then proceeded with the suction curettage. Tissue was obtained and sent to pathology. We then proceeded with a gentle blunt curettage and no tissue remained.

“Are you all ready at home yet? Oh, the boys must be excited to share a room, no?”

“They must be thrilled to be having a baby sister! Do they understand what’s going on? Maybe they’re still too young yet…”

The patient tolerated the procedure well and was returned to the recovery room in stable condition. Estimated blood loss was 100cc and there were no apparent complications. The patient is requested to follow up with her practitioner in 6 weeks time.



“I don’t think they’re too young, they know exactly what’s going on… for sure.”

“I should get going and eat some lunch, you never know what the afternoon will bring.”

And, so I walked briskly out the of the recovery room.

End of dictation.

Late Termination

1.
I punched the 5 digit number into the phone and waited for someone to answer… “Hi, this is the gyne resident, you paged?”

“Yes.  The induction is here. Can you please come and write orders and get things started?”
I wasn’t aware of any induction, nor was I in the right frame of mind to initiate an induction.  Where I live, “late terminations” by induction of labour can be performed for lethal or life threatening fetal anomalies up to 24 weeks.

I went to the ward where the patient waited for me.  She was likely not expecting the person about to initiate her induction to be just as pregnant as herself.  Her chart was clear – her due date only 2 days before mine.  Her unborn baby the same size as mine… moving and kicking and full of life, just the same as the one inside of me.  The only difference: my baby had a normal heart, and normal kidneys, and a normal bowel.  Hers did not.

I went into the room to find her laying still on the bed.  I hoped my scrubs were loose enough to disguise my swollen belly, even though I knew it wasn’t likely.  I explained to her the procedure – how I was going to giver her some medication that would make her cervix soft, and that I would put a small balloon inside her cervix to help it open up.  Essentially I would be inducing her labour, and then she would give birth to a pre-viable fetus that would not survive.  My baby in.  Her baby out.

I sat on the cold, metal stool between her trembling, spread out legs.  I placed the speculum and opened to find her swollen, closed cervix.  “You might feel some cramping now,” I said as I slid the catheter into the opening.  I began filling the balloon.  She winced.  Bright blood started to trickle from the end of the catheter.  I slid the speculum out and placed the medication in its place.  “We’re done.”
I felt my own baby kick me from the inside.

2.
It was 5pm and my night shift was just getting started with handover.  “The woman in room 6, she’s  an indiction for cardiac anomalies.”  I cringed.  It had been less than a week since the last induction.  I didn’t think I could handle another one so close.  “The patient and her partner are not coping well, just so you know.”
This time the baby was already gone – the family had chosen an intracardiac injection prior to induction.  This time her due date was the same as mine.

I decided not to meet the patient – unless there was a medical issue that needed attending, there was no need for me to go in.  I hoped that it would be a slow process and that I could get through the night without being called to see her or her stillborn baby over the next 14 hours.  It almost came to be.
But 30 minute before the end of my shift the nurse called me: “I’m really sorry, but her foley came out and Dr. X called and wants you to break her water.”  It would have been “inconsiderate” for me to leave that task for the person coming on after me.  So I went.

Again, I was too conscious of my own pregnant belly – of my own live, healthy baby who is perfect and who is still alive.  I pulled the scrub gown I was wearing backwards around and over my swollen-ness.  I introduced myself with trepidatious confidence and then sat at the end of her bed.  I proceeded to do what I do so often for women in labour with babies that they are going to bring home with them.  I felt her cervix and stretched it open.  With elegant ease I slid the hook up against my fingers until it reached the tough, premature membranes.  I felt sick at the thought of my hand being so close to a dead baby, the same size as mine.  I almost said that I wasn’t able to reach, even though I could.

I tore the membranes apart and watched as the clear, straw coloured fluid poured from her body.  Suddenly my fingers felt vast space and openness.  I felt my heart skip a beat as I was unable to tell if her cervix fell from my grip and I was feeling her vagina fill with fluid, or if her cervix was suddenly wide open and at any moment I would catch her baby with my fingers and deliver it right at that moment.  The water seemed to gush forever and my hand was paralyzed in place.  I feared that I would feel the delicate touch of her baby’s hands or feet or head and I wanted that moment to be over.  When I could no longer handle the thought of delivering a stillborn baby the same age as mine, I pulled my hand out and tried hard to stand without fainting.

It was the end of my shift.  I went home to sleep.  I woke up hours later and decided that I was done doing late terminations as long as I am still pregnant.

  Something To Treasure

“If you are not happy, you had better stop worrying about it and see what treasures you can pluck from your own brand of unhappiness.”
~Robertson Davies

I had a difficult week at work.  I was tired from waking up early every day, putting in long hours at a mentally challenging job.  I had some patient cases that challenged me beyond my limits and made me feel like I’m not smart enough to be doing what I’m doing.  And worse, I felt like I will never be smart enough or capable enough to do this job I’ve picked for myself.  Saturday was no better, when I still had to get out of bed, put on my blue scrubs, and cart myself to work and do it all over again for another day.

The day started out with a difficult case: a woman who was sick and only getting worse.  The baby inside of her also showing signs of not thriving well.  The decision was made to deliver her baby and we wheeled her into the operating room.  A 27 week baby that looked more like a 24 week baby that was difficult to deliver… a lifeless baby that I handed to the nurse… a baby that needed CPR before being intubated and whisked away to the NICU.  And the a tattered uterus to put back together.

IMG_6458I left the OR feeling more tired and deflated.  The feeling of the baby’s brittle bones between my fingers and his heavy doll-like head bobbing in my hands was etched in my mind.  I walked back into the delivery room waiting for the next disaster but instead found a large bouquet of flowers on the desk… and it was for me.  A rare and unbelievable gift from my husband – something to keep me going for the day.  The card simply said, “Have a great day, Beautiful.”

And therein are my treasures: A loving husband, who might not always seem to “get me,” but he loves me nonetheless.  Two healthy children who will never know the difficulties of the baby I had just delivered.  Another growing child inside of me – one that I came by rather easily.  A job that I love, despite how much it exhausts me.  And, all the opportunity and ability that anyone in the world could wish for.