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Doing Time in the Neonatal ICU

‘What hurts you, blesses you. Darkness is your candle.’ —Rumi


It is hard to believe it is already December. I can’t think of a time when I felt as though so much had happened in the space of 12 months as it did this last year. My husband and I recently ‘got away’ which means we left our Au Pair with the kids for one night, escaped off to a nearby remote island for a night alone.

On our journey I felt as though it was the first time I could breathe in a long time. I had gotten caught up in the ‘doing’ that occurs with life, that I completely forgot to reflect, to process all that happened this last year. I realize now that I also wasn’t writing as frequently, which has made me feel as though all my thoughts and feelings have been bottled up, waiting for an opportunity to come out.

Last December I had to stop working because I was at risk for placental abruption. I had some bleeding after a shift one night, needed to be in the hospital for a week as I waited to see if it returned. Fortunately it did not, but I was stuck in this strange place, of no baby yet, feeling relatively ok, but needing to slow down. The mere fact of taking time away for my own rest felt unnatural and unnecessary, but when I considered the possibility of tragedy, it was the only option.

Unfortunately, I did not make it to 38 weeks. On December 16th we had friends over for dinner, and just before they left, I went to the bathroom. In the bathroom, blood seemed as though it was pouring out of me. I could hardly control it enough to be able to get to the dining room, to tell my husband and friends we needed to go to the hospital. By an amazing coincidence, my friend is a doctor, she works in the emergency department of the hospital I was headed to, and boldly and calmly drove me to the hospital.

If any of you are familiar with Seattle geography, know that getting from Bellevue (where I live) to Seattle (where my hospital was) can be a feat. You have to drive over water to get there. I believe she is the only person who would have done that drive, all others probably would have made me call an ambulance. But ER doctors are gutsy. They weigh risk/benefits and worst case scenarios in their heads all day.

I tried not to panic, remembering what my own doctor had told me, that if I started bleeding, it was MY blood, not the baby’s, which had a weird calming effect. At least I could be comforted with the knowledge that my baby was not bleeding out. The time it took to get to the hospital seemed like an eternity, but we arrived and I was not soaked in blood, or fainting from loss of blood either.

I am always so surprised at the amount of ‘non-surprise’ or calm that the labor and delivery unit has. I thought for sure I was in trouble, but when I arrived, they put my in a room, to have me wait 20 minutes or so until I was fully evaluated.

What most people don’t understand, at least those who have never given birth, or those who have had seemless, uncomplicated pregnancies and deliveries, is that we as women are closer to death during this time than any other time, at least until we are older and actually dying.

Pregnancy and childbirth is scary. There is also no guarantee that you or your baby will come out alive. We walk this fine line of wanting a family, feeling invincible as we carry an additional human for 9 months, but then are faced with some very scary health conditions like pre-eclampsia, placental abruption, and others. I know women who have had uterine ruptures, causing them to be in the ICU for blood transfusions, I have known women with heart failure and sepsis, and I have known countless women who have lost babies to miscarriages or even as tragic as having a stillborn. We walk this journey with our spouse, but also alone, as the growing of the baby is inside only our body.

I was terrified. I also had a bit of PTSD from my last pregnancy (in which I also had some bleeding, baby had a very high heart rate, and I did not progress when the physicians tried to induce labor). The last thing that happened before I delivered my firstborn was that his heartbeat was lost. I was wheeled very quickly and unceremoniously to the OR as I fought back tears, calculating in my head the amount of time it would take to get the baby out. I figured that if there was truly no heartbeat, my baby would have significant loss of blood to the brain, and there was a very real possibility that we would be delivering a baby with no brain function. In the OR prior to starting with the C-section, they checked again and baby’s heartbeat was back, loud and stronger than ever. We continued with the C-section and baby came out screaming. I was extremely thankful, but acutely aware at how close tragedy had been.

This time, I thought we were prepared. Baby was 33 weeks, the bleeding had stopped upon arrival to the hospital, and it was going to be a planned surgery the next day. I am a pediatrician, so I know what 33 week babies are like. I knew things would be ok, maybe we would even be able to go home relatively quickly (1-2 weeks maybe?)

What I was not prepared for was the combination of the unique stressors. It was December, so Christmas was looming. I also had a 2 year-old at home, who didn’t have the capacity to understand what was happening. I also had never experienced being in the hospital for days on end…..as a patient.

What came next was three weeks of hell. Baby Cole was delivered via C-section, which is major surgery. Ambulation was painful and challenging. I was instructed not to drive or lift anything heavy. Couple that with needing to pump every 4 hours to keep up milk supply, figuring out how and when to be at the hospital, but also to try and be home for my toddler.

The NICU became our ‘home away from home,’ but I hated every minute of it. I remember as a resident in the NICU not seeing moms very frequently, also judging the fact that they weren’t there the exact minute the medical team came by to round.

As a mom, I hated the medical team, for rounding without me, feeling like I was a bystander as they cared for my infant. I disagreed with the initial refusal to let me hold him on the first day due to his “tubes and such,” and that it was “too hard” to put him on my chest.

When I was scolded for being ‘too loud,’ as my husband and I lovingly whispered about his nose, or his little hands, I lost trust in the team, as I felt inappropriately reprimanded. This worsened as baby Cole progressed, quickly becoming the ‘least sick baby’ in the unit.

I remembered those days of seeing 33 or 34-week babies as a resident, dismissing them for their lack of pathology, blithely talking about how they are just ‘feeders and growers,’ and totally not understanding their parent’s stress. Those babies do FINE. Looking back, I am embarrassed by my lack of compassion.

Baby Cole WAS doing fine. But the stress, the emotion and the total lack of support I felt by the medical team, and those around me, definitely took its toll. Nothing in my world was making sense. My toddler hated me for not being around. My baby was alone for most of the day, and I felt as though I was doing everything wrong. I felt like a terrible mother.

Coming home from being at the hospital, my son would run away from me, coming back to the hospital, the nurses made snide remarks about how they couldn’t believe they hadn’t met me yet. Or that I should know fresh breast milk was the best. Or that they are sorry, they fed the baby before I got there, even though I moved heaven and earth to be there for the 3 pm feed.

I was frustrated that every day I was told how to feed the baby differently, or to try or not try to breast feed because it would take all of his energy. It was like they purposefully told me conflicting information every day.

I remember having these achingly sad thoughts of my poor baby alone in his bassinet, and wondered why I couldn’t be trusted to take care of him at home. He was just a feeder and a grower, right??

I also felt like being a doctor was a liability, as if by having a degree automatically put me in the ‘difficult patient’ category, although I had done nothing to deserve such a label. I was just a mom, trying to make it work, missing my baby, feeling deficient that I couldn’t just make it all better, and feeling to my core that everyone was working against me.

Baby Cole spent 21 days in the hospital. We took him home on January 6th, 2019.

I thought that once we were home, everything would be normal. Some things were, no more traveling to go see the baby, no more pumping and freezing, transporting, and making sure that my older son had someone taking care of him. But we also had to start all over again, we were integrating a new person into our family, so our routines changed, the way we traveled changed.

He was a different baby because he was premature, and I felt more anxious. I worried about how much he ate, about putting him down to sleep without me right next to him. I worried about taking him out in public because I was more worried about him getting sick.

Since I had to take time off at the beginning of my pregnancy for the bleeding issue, my ‘at-home’ maternity leave was cut short. I went back to work exactly 6 weeks after he came home from the hospital. I felt robbed of the time that should have been spent snuggling with my baby, and will forever be frustrated by the lack of compassion from the ‘system.’ In addition, sleep-deprivation ruled my life at this point, as baby was waking up every 90 minutes, so my ability to handle life’s obstacles was greatly diminished.

There were things that were good. We matched with an Au Pair, Melissa, from Colombia. She brought a joy and compassion to our lives that I was unable to provide at the time. I feel so lucky she was the person to come into our home less than a week after Baby Cole came home. When I cried after I spilled an entire container of breast milk, she and my husband cried with me, knowing that it wasn’t about the breast milk. She also consistently offered to take the baby at night, so I could get some sleep.

I also have found that in challenging times, my husband and I grow closer. We definitely feel friction and struggle, but in the end, our bond is stronger. I think we love each other more as we see more clearly we are each trying our best, and that matters to us. I also think that we realize there is no one in the world we would rather go through such hardships with. Things can be awful, but awful can be enshrouded with love, care, and empathy.

So here we are, the last 12 months was a blur, filled with many heart-breaking lows. 

I’m happy that the year is coming to a close and I am grateful that life is much easier than 12 months ago. I am also grateful for the experience, as I think it will forever make me a better doctor, mom, wife, and friend.

This morning my one year-old woke up crying, way too early, around 530. I brought him into bed with me, stroked his head as I sang to him and fed him a bottle. My 3 year-old came in soon after, slipping himself between my husband and I. We listened to “Let It Go,” at my older son’s request, and for the moment, I realized, this is happiness.

Being Pregnant–4 Things Every Woman Should Know

“That first pregnancy is a long sea journey to a country where you don’t know the language, where land is in sight for such a long time that after a while it’s just the horizon – and then one day birds wheel over that dark shape and it’s suddenly close, and all you can do is hope like hell that you’ve had the right shots.”
–Emily Perkins

Pregnancy. By the time I was pregnant with my first baby, I was ecstatic to finally be carrying a baby for longer than 8 weeks. I had longed to be in this place for what seemed like forever. What I promptly realized was that I knew a lot about babies, but I knew nothing about being pregnant. No one talked much about this phase. For some reason, I think women avoid this topic altogether. Maybe it is because we forget so quickly how hard being pregnant is, or maybe it is because we don’t want to admit that it isn’t entirely easy.

As thrilled as I was to be pregnant, I also found it very challenging. Now in my second pregnancy, I am quickly remembering the parts that were particularly difficult, and reminding myself so I am not surprised when these issues come up. I want to share what I struggled with for all my female friends, and for all the men who have no idea what we deal with. I am hoping to broaden basic understanding so we all have a little more empathy and compassion for the pregnant women in our lives.

1. Pregnancy forces you to take care of yourself. This is a very hard thing to swallow for those of us who have been conditioned to ignore our needs. Particularly in the first trimester, pregnancy is very tiring, and to my surprise, it elicited an exhaustion that I had never experienced nor expected. In medicine, we learn to beat ourselves and our bodies into submission throughout our career. Eighty-hour work week in residency? Learn to function on less sleep. Busy day in the ER? Don’t eat (save time), and don’t drink very much so you don’t have to go to the bathroom (also save time).

It sounds kind of crazy, but it is exactly how we physicians think. I did not expect pregnancy to be different–meaning I fully anticipated powering through any problems. But it didn’t work that way.

When I got pregnant, for the first time in my life, I could not force myself to do anything. My body needed rest so badly that it did not allow me to press my ‘over-ride’ button, as I had so frequently done in training. It was incredibly frustrating, but also really eye-opening. I actually needed to rest when I was tired. I could no longer wake up at noon after an overnight shift and expect to function. I also needed to eat when I was hungry, if I didn’t I would feel so ill that I couldn’t function at work. My previous tactic of not eating during a busy shift became impossible. The hard and profound lesson I learned was that I had become accustomed to ignoring my body and it’s needs, and that I had abused myself in this way since medical school.

This experience has totally shifted my perspective on how we function and cope as physicians as well as our expectations of our trainees. At this point, I really do not want my students, residents, and fellows to develop my habits or my complete obliviousness to this as a problem. I am embarrassed that it took me getting pregnant to be more aware of my own needs, and subsequently the needs of my team.

In addition, being pregnant as an attending physician was hard enough, but I work and have worked with dozens of women that were pregnant in training, ie residency or fellowship. I am not sure how any of them have done it, with the insane work hours and all the needs of the pregnant body. I have developed so much empathy and respect for my female colleagues as they experience pregnancy. We should all be working toward better conditions for them, as well as giving them a break whenever possible.

2. Pregnancy is really hard, and during this time it is common to develop self-doubt and self-judgement. You are actually growing a tiny human! The thought of this alone is insane. The inability to seemingly do everyday tasks due to exhaustion often creates feelings of inadequacy and self-judgement, with statements like,  “what is wrong with me?” I know that I felt as though I wasn’t doing my job as a mom when I was too tired to cook dinner, or when I needed to go to bed really early, letting daily household tasks go undone. In addition, our mood fluctuations can be daunting and overwhelming.

Being unable to fully control or understand our emotional responses creates a feeling of “why do I feel so crazy?” Which can also create more self-judgement as we feel as though no one else is experiencing pregnancy in this way. I cried probably every other day during my first trimester, sometimes it was because my toddler didn’t hug me in the morning, or because my husband forgot to make me coffee. All very insignificant things, that elicited what I felt to be a overreaction in me. In order to help one another through these challenges, I think it is important to share as many stories as possible. If you are talking to a pregnant woman, let her know what you struggled with during this time. The last thing we need to hear is how painless everyone else’s pregnancy has been. What we do need is to be empathized with.

3. Body image issues are alive and real. For me, I had pretty much maintained the same weight during my adult life. I had also worked hard to eat right and exercise frequently. Then came pregnancy. This is a special time, when you are supposed to gain weight, which is good and healthy. Unfortunately, due to long-standing messages about weight gain, this process didn’t feel good and healthy, it felt wrong and inappropriate.

Being pregnant and gaining weight that first time was totally destabilizing to everything I thought about weight and health. Seriously. I know my body and every inch of me. I know exactly how tight my jeans are, and when I need to cut out the chocolate and replace it with an extra hour at the gym. In pregnancy, we are supposed to get big and gain weight and it all happens in a very short period of time.

During my first pregnancy, I realized how obsessed our society is with weight. I also realized there was quite a bit of self-judgment on this topic as well. I scrutinized the amount I gained, compared myself to others, and hoped that I would be able to get ‘my body back.’ I think there is too much unnecessary pressure around weight and pregnancy, and a lot of the pressure is self-induced based on our upbringing in a image-obsessed society. It is important for women to take a deep breath, stop looking at the scale, and realize your body is doing an amazing thing. When I struggle, I remember what my husband tells me, which is ‘Pregnancy is beautiful and feminine. You should not worry about your weight.’ Love that guy.

4. Pregnancy elicits a lot of fear. So much fear. Fear of miscarriage, fear of genetic abnormalities, fear of going into labor early, fear of still-birth, postpartum depression and SIDS. The funny thing is, fearing the inevitable or the uncontrollable, is a waste of time. So instead of sitting in fear, I choose to bask in love for my baby and hope that none of the unfortunate happens.

I also had a deep fear of our quality of life going down. I really love to sleep, and I really like my down time. Someone told me I wouldn’t sleep for weeks after delivery. That was a scary thought. People also were not very encouraging with statements like, “so sorry for you, life is going to change…” Especially when the ones making these comments were people with children! I was afraid that maybe we were making a huge mistake. Maybe we were just supposed to be the really cool aunt and uncle. Not like we could have changed the trajectory, but I was terrified. Then I had a friend who told me, ‘people are going to tell you all this stuff to make you so nervous and afraid, but in reality, it’s the best thing ever.’ Lucky for us, having our son was the best thing ever.  Instead of instilling dread in expectant mothers, I have chosen to be encouraging and share my excitement. Isn’t that what we all wanted when we were pregnant?

The thing is in the end, all the fear, moodiness, changes, body issues become inconsequential once the baby is born. Maybe that is why we don’t talk about it as much. My body changed back, but I also became less concerned about whether my jeans were too tight. The emotions stabilized, and the fears slowly subsided.  I became better about taking care of myself, and then better at taking care of others as well. I developed a new-found compassion and empathy for other women, other pregnant women, and all of their struggles.

Judgment is unavoidable in society these days. But you can choose to internalize that judgment or not. I remember hearing someone say once, ‘someone else’s judgment is none of your business.’ Which is true, right? Think of a situation where you have judged someone else silently. Aren’t our judgements of others really just fears about ourselves that we project? So stop worrying what others are thinking. It’s actually none of your business because it is really about them, and when push came to shove, they would never want you to know anyway.

Anything else? Is there anything I missed that you think I should have included in my advice?


I Have a Secret to Share…

**I wrote this blog post on May 31st, hoping that I would eventually feel comfortable sharing my thoughts and publishing here. Today is the day. 😉

“Hope is being able to see that there is light despite all of the darkness”
–Desmond Tutu


I’m pregnant.

I am terrified of saying this phrase aloud or seeing it written in black and white, for fear that doing so would somehow tempt fate.

Meaning, if I wrote this down, the universe could say, ‘Wow, she sure is overconfident. I think we need to remind her that this is entirely out of her control. Let’s show her who is boss.’

And then tomorrow, of no fault of my own, I start bleeding and cramping. Which is then inevitably followed by grieving and shamefully blaming myself for being unable to stay pregnant. The one thing it seems every other female I know does effortlessly.

The truth is, not all women I know stay pregnant effortlessly and without fear or anxiety. I know this intellectually, but when my hormones are high, and life feels so incredibly out of my control, I feel really alone. I also feel incompetent and almost ‘less of a woman’ because of my struggles and failures.

I am pregnant.

If I don’t say it, then maybe I can keep it a secret for a while. I can live in the space between acceptance and disbelief. This is the space where I don’t have to commit to a stance, it’s the grey area, the unknown. In this space it feels that it is possible to suspend time, to breathe, to allow hope and to allow faith to enter. Then I can make room to allow the little embryo to figure it out for themselves. I can press ‘pause’ on my fear of having tragedy strike again, which feels like being the object of life’s cruel joke.

In this space I don’t have to explain to anyone how that little faint line on the pregnancy test means looming disappointment more often than not. If I keep my pregnancy a secret and I miscarry, then I don’t have to apologize for making anyone feel uncomfortable for showing my grief.

Ironically this situation can often feel lose-lose—If I acknowledge it and something bad happens, I have to deal with having to explain grief in a palatable way to the public. On the other hand, not openly showing excitement somehow feels like I am abandoning my own child by withholding love. This dynamic can become an emotional prison.

So I’m just going to wait a little longer. I am going to live here for a bit– spending my evenings silently cheering on the cluster of cells that made it to day 35 and going to bed early so my body can rest. I will be sneaking moments of quiet to myself so I can feel the love for this little person rather than sitting in fear of the worst case (and unfortunately common) scenario. I will allow myself to move through my fear rather than allowing it to encompass me and know that it is ok to shed a few tears for this little embryo, fighting in its own way for survival.

I’ll let you know how it goes.

For the record, I choose love.


UPDATE—We are at almost 16 weeks. Woohoo! Things are going well and hope and faith are high..:)