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Month: December 2018

Working In Medicine–Experiences of Pregnant Physicians

“I lied and said I was busy. I was busy; but not in the way most people understand. I was busy taking deeper breaths. I was busy silencing irrational thoughts. I was busy calming a racing heart. I was busy telling myself that I am okay. Sometimes this is my busy, and I will not apologize for it.”

–Anonymous

 

So, here I am, taking time off to rest before my delivery. I have been advised to do this by my physicians, but it still feels rather unnatural. I am struggling with the ‘down-shifting’ required, as I think I function best when I have a lot of things to do. When life is slower, I am uncertain what I should be doing, because I am not always comfortable relaxing. It feels too much like I am wasting precious time. Then I judge myself, and I (usually mistakenly) think others are judging me too.

It has been helpful to have my Department be fully supportive of this time off, as well as hearing the support from my husband, my family members and my friends. But I am still uncomfortable, despite all the reassurance.

This experience has caused me to worry about my fellow pregnant colleagues. As I have grown in my own personal awareness, I have subsequently become concerned that my sisters in medicine are also struggling with trying to figure out not only how to put their families first, but also how to advocate for oneself when pregnant.

I got lucky, I had a doctor tell me I couldn’t work anymore. How would I have managed a similar situation if I felt as though my activity and/or stress level was putting my pregnancy in jeopardy? What would I have done if I was in residency or fellowship, where there is much less buffer in the system to support time away?

During my first pregnancy, I was 37 weeks when I started bleeding, so the plan was just to deliver the baby. I went to the hospital and didn’t leave. The thing that has haunted me is that I was on the schedule to work back to back overnights, single coverage the following two evenings. What would have happened if I had started bleeding the next day at 4 am instead of 7 pm? Would I have been able to stand up for myself and call in back up? I can honestly say I don’t know the answer to that question. Now, I think I could do it, but I am not sure I could have done it 2 years ago. The fact that it was even a question terrifies me. It makes me so much more sensitive about the environment we are in, and it also made me incredibly pro-active about my schedule this time around.

In my current pregnancy, I had been working a lot. I was concerned about working too much close to my due date, so I scheduled myself to work almost 50% more in October and November, late second trimester, early third. The day I started bleeding, I had been taking care of my two-year old all day, took a nap before my shift, and then went in at 7 pm. I essentially worked from the time he got up at 6 am, until I got home from work at 230 am. That is a very long day, and those hours aren’t that different that hours I kept as a trainee. Is it possible that working contributed to my symptoms?

We are taught to believe that we are not to blame when things like this happen. However, there is a part of me that thinks we are absolutely responsible for taking care of ourselves and our babies. Motherhood starts early, and it is important for us to realize when we don’t take care of ourselves, it is not an ideal environment for our fetus either.

As a physician, data is very important. There is minimal actual data regarding physician work hours and pregnancy complications. Most of the studies have looked at resident physicians, and have found positive correlation between work hours and complications, from preterm labor, miscarriages, and other issues like high blood pressure. I personally had no knowledge of this data until I started looking into whether other women in my same situation were having similar experiences.

In addition to doing a mini-literature search, I also knew that I could probably find other women physicians struggling with these concepts. Considering that training and school take up a large portion of our most fertile years, I knew there would be other women with their own stories. Their own challenging and heartbreaking moments of wanting to be strong and resilient physicians, yet working under conditions that make being pregnant really challenging.

So I decided to reach out to the one group of women I knew could identify with my feelings.  Physician Mom’s Group (PMG) is a group of momma physicians on Facebook that is currently 80K strong. It was started by Hala Sabry, DO, MBA, who practices emergency medicine. Dr. Sabry was looking to create a female physician community for support around fertility and raising children. It has grown tremendously since inception in 2014, and has also become a place where doctor moms talk about everything, from aggravating patients, favorite scrubs, what to buy your husband for Christmas, to personal health concerns, death, depression, and childbearing.

While I was in the hospital, I asked the group if anyone had struggled with working while pregnant. I asked if anyone else felt a sense of needing to work to the point that they might be putting their health at risk, and what that was like.

I received close to 100 responses, women of all stages of life recounting their stories of struggle as they navigated being a working physician with being pregnant. One fellow physician shared her already published account. Some of the stories were horrifically tragic, like losing 17 week old IVF twins to miscarriage after a previous loss at 10 weeks, or stories of women saying that they knew they were straining themselves and working too hard, only to miscarry a few days later. Other women shared they had to sit while rounding at the hospital so they didn’t pass out, to having to return to work post-birth as soon as two days. TWO DAYS.

There were stories of women being asked to come in to work by their supervisors despite being told by their physicians not to, or women who were forced to continue working after their back-up refused to relieve them. Like anything, there were also stories of hospitals and training programs that were very accommodating to any requests to slow down, but most shared the opposite experience.

What was striking was the number of stories women were sharing, as well as the general knowledge that we as a collective have early babies, small babies, poor fertility, and we miscarry more often. I don’t think I was ever told that information, which now adds an element of increased risk  in my mind, for all of us choosing to have children.

Most of the women who responded talked about the struggle between feeling the need to work with feeling the need to take care of themselves. Almost all shared that they wished they would have slowed down, advocated for themselves more, or had someone advocating for them.

I identified with every woman that responded, and although most stories ended with healthy babies, there was palpable agony in the ones that did not. It was also common for many of these women to have had miscarriages and then grieve in silence. We as a community have a lot of work to do, and I feel that with advocacy and information, we can start to change the way we care for ourselves and our colleagues. Hopefully, we can pave the way for those coming behind us.

Do you have a story that you would like to share?

 

Next week–Working In Medicine–How to Support Pregnant Women

Working In Medicine–How I Learned to Ignore My Health

“Learning to treat ourselves lovingly may at first feel like a dangerous experiment”—
Sharon Salzberg

 

This begins a three part series about working in medicine, how we have a hard time taking good care of ourselves, and what happens when we don’t. 

“I don’t think you should go back to work. Being on your feet all day could cause this to happen again. What would you do if a sick child came in at the same time you started bleeding? No one wants to make that decision.”

This is the conversation I had last week with one of the doctors that was taking care of me after I was admitted to the hospital for pre-term bleeding. I feel like I am repeating myself when I say, I was 30 weeks and had just finished a long shift in the ED when I started bleeding. Unfortunately, this is exactly what happened.

It was a very similar experience to the one I had during my last pregnancy. I was feeling good, I had no pain, but after working all day, I started to bleed. This time it was 3 am. I was getting ready for bed, and right before I left the bathroom, I felt liquid down my leg. I thought to myself, “please don’t be blood, please don’t be blood.” Then I turned on the light, and there were large red drops spattered on the tile.

There was no way I was waking my son up at 3 am to go to the hospital, so my husband stayed home, and I drove myself. After evaluation at our closest hospital, I was ambulanced to the tertiary care center—this time because my baby was only 30 weeks, last time it was because he was profoundly tachycardic. Thankfully I have had no additional bleeding and after 5 full days in the hospital, I was discharged with instructions to ‘take it easy, don’t go back to work, and if there is more bleeding,  we will keep you in the hospital until baby is big enough to come out. Also, if you bleed and don’t stop, we will deliver the baby.’

What has been so shocking to me is my reaction to this chain of events. I, like many of my colleagues, pride myself on my resilience. I am also proud of the amount of ‘grit’ I have developed throughout my career and my ability to “power through” challenging situations. I am a hard worker who is passionate and I truly love my job. I do not see myself as weak or incapable or often needing help.

But this, this was different.

The first night I was in the hospital, I thought, this is no big deal. We will be able to go home, I go back to my normal schedule, everything will continue as planned. I had developed an intricate, well thought-out work schedule to slowly decrease my clinical time as I got closer to delivery. This included me working close to resident hours during my second trimester to get all my clinical hours in. However, in the hospital, each day passed and every doctor that I saw (there was a different one every day) used increasingly urgent language to give their professional opinion and recommendations about my plan. They all recommended I didn’t go back. That was not the message I wanted to hear.

When the conversation was put in the context of my health vs. that of my patient’s health, I had a bit of an internal crises. I certainly hadn’t thought of it like that. Up until this point, I still was thinking about what I was comfortable with. About how I was going to communicate the fact that I would need to slow my life down a bit, how I was going to advocate for myself and how uncomfortable that made me.

The very thought of taking my health and well-being and putting it to the top of the list was agonizing. I struggled to sleep, and for the first two nights I woke up crying, thinking about how I would never forgive myself if something happened to the baby while working. These thoughts were juxtaposed with my compulsive feelings to finish what I started, to not ask for help, to ‘soldier on,’ as I was used to, as I was trained. It also was apparent to me that my personal self-worth was inextricably linked to my ability to perform my job.

These intense feelings have led me to consider their origin and to subsequently trace the trajectory. Somewhere in the medical school, residency, fellowship training and then as an attending I stopped caring about my own personal health. You hear this all the time. Doctors are very good at taking care of others, but few of us have regular doctor’s appointments, and few of us take our own health seriously.

Until we can’t ignore it anymore.

To be honest, I am not sure when it started. In my experience, in training, we are never told that it is ok to be sick or that it is ok to take a day off. Instead, the culture is one of reprimanding us and in combination with being judged for time away makes us never want to take time off, and also to be fearful of needing it.

As a medical student, this manifested itself as I worked through cough and cold season…priding myself on finding just the right combination of medications to get through the day without coughing on everyone or passing out, and doing it while not needing any additional rest.

In residency, I prided myself on my near perfect work schedule and never needing to call in sick. Co-residents who struggled with the schedule or with being pregnant during this time were labeled as ‘weak,’ and were whispered about behind their backs. During this same time, when I made a mistake and mis-scheduled my vacation time (as I have detailed before), the hard work and dedication to my job didn’t matter. I moved mountains to get my schedule covered, but my program director didn’t care, and I had to live with traveling across the country to see my family for a weekend instead of a week. I realized in this moment that my needs didn’t matter, my mental health didn’t matter, the job was more important.

When I got to fellowship, I do believe the system was more forgiving, but I had already learned some pretty significant behaviors about caring for myself. One early morning before a shift, I was vomiting, and came to work anyway. I continued to vomit every 30 minutes to an hour while on shift which I mitigated by getting IV fluids and anti-nausea medications from the nursing staff in the back between seeing patients. Eventually I was told to go home, but not before being admonished by the attending that was replacing me, she said she was having bad diarrhea, but “I guess I’ll come and replace you.” As if I was weak for leaving.

As an attending I had a miscarriage and an overwhelming feeling as though I couldn’t tell anyone. My D&C was scheduled on my day off, and my emotional recovery was put on the back-burner. I didn’t know how to prioritize my health and well-being. When my second miscarriage happened I used the only 24 hour period I had off consecutively to take misopristol, which induces bleeding. The next day I returned to work, still bleeding, still cramping, and emotionally numb.

When we are pregnant, however, we are no longer only in charge of our own health. We now have the health of the baby to think about as well. The problem is that this way of being feels so out of alignment with our core self that it feels wrong. I believe we can intellectually understand that slowing down or listening to our bodies will help the health of our baby, but it doesn’t translate into our actions very often. We have been able to force our bodies and selves to do amazing things, like 30 hour work days, 80 hour work weeks, living on little sleep and poor nutrition. We don’t understand that this is wrong, or that it should change when we are pregnant.

Our babies need us to take care of ourselves, which we aren’t used to doing.

In the hospital I desperately needed another doctor to tell me I couldn’t go back to work. Actually, I needed 4 doctors to tell me this. And I needed them to tell me this after I bargained with them about only working half shifts, and only at times when I would be surrounded by other physicians, so if I did start bleeding, I could leave. My trusted OB/GYN peers said ‘No.’

And I breathed a sigh of relief, and I cried with gratitude that someone else had made the decision for me.

So now, I am taking the month of December off. I am eternally grateful that I won’t be anxiety-ridden walking into the hospital. That I won’t spend my time working a shift and worrying about whether or not today will be the day that I start bleeding. I won’t spend my time thinking if I do start bleeding, whether I will call an ambulance or drive myself to the hospital, hoping I don’t hemorrhage on the way there.

I know I am not the only one who has struggled with this. Do any of you have stories to share?

Next week….Part 2–Experiences of Pregnant Physicians