Month: February 2018

12 or 13 weeks

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So I just wrapped up the first trimester. I can’t believe it’s already almost March! I went in for my nuchal translucency ultrasound (part of the first-trimester screen) last week and it is always so amazing to me how much babies change between the 7 week scan and the 12/13 week scan. At 7 weeks, you see a small fluttering heart, but otherwise nothing that looks like a baby. By 12-13 weeks, the baby is skeletal but all there – head, arms, fingers, legs, toes, etc. It’s amazing! I always feel a bit out of the woods once baby is still there at 12-13 weeks, but there is still a long way to go.

Another thing that happened during the scan: they’re pretty sure it’s a boy (for reference: I have 2 boys)! It is still so early in the game, but I know that if all goes well with this pregnancy, the 3 boys will have a blast. It will be chaotic, messy, and definitely a strain on our grocery budget – but they will have a great time together. Since I will be 35 when this baby is born, I also opted for noninvasive prenatal testing, so the boy/girl question should be confirmed later this week.

Since finding out the gender, I have had a few friends ask me if I’m disappointed I’m not having a girl. I honestly have to say that I am not. My main wish for this baby is that it be healthy. And after that, a very selfish wish (two actually) is that it be easy-going and a great sleeper. As a mom of two boys, I know boy. I have everything ready to do the boy thing over again. They can room together for longer than I imagine siblings of mixed gender would be able to, and my job will be much easier when they’re older and can do activities with their dad. Also, I was really nasty to my mom (who is a saint and whom I love dearly) when I was an adolescent, so I am not excited about the possibility of being on the receiving end of that treatment (as much as I do deserve it). I imagine teenage boys are not a walk in the park, but they must be easier than teenage girls! So my greatest concern in this department is: what are we going to name him!? So tough to think of a third boy name.

As for me, I’m feeling a bit better. I’m still pretty tired, and sometimes still feel nauseous. My belly definitely popped this weekend so I look more pregnant and I officially pulled out some of my maternity gear. Now comes the awkward (for me) process of letting people know about my pregnancy. I actually told a few people at work very early on (7 weeks!) because of some changes to the maternity leave policy and updated schedule requests for fall of 2018. This is very unlike what I have done in the past – previously waiting until 14 and 20 weeks respectively. I told a few close girlfriends from high school/college very early on and just this weekend told a few close local girlfriends. And slowly other people will learn about it and then my patients will start asking me about it (some have stuck it out with me through 2 pregnancies already!) and all of the necessary planning will unfold.

I have to be honest with you, after going through infertility with my first, every moment of every pregnancy feels like a dream and a great blessing. Sometimes I feel like pinching myself. There was a time when I seriously doubted that we would ever have one child, and here we are, parents to two healthy children with a third on the way.

Vulnerability

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I don’t write much about being a doctor because I do it every day and I prefer to write about non-medical topics, but my absolute favorite part of doctoring is meeting different people and hearing their life stories. I’m admittedly slower than I should be because I love hearing about people’s families, childhood, histories, etc. With my return patients, I always ask for updates and love to learn about what’s new.

Doctoring is a lot like waitressing – another job I really enjoyed. It can be tough on an introvert and draining after a long day of multiple patient visits. It can be taxing not only because of volume and patient turnover, but also because of the heaviness of the stories I hear. I am so honored that my patients share with me the things that they do. I keep these stories with me and often recall snippets years down the line.

Many years ago, one of my patients gave me a shark-tooth necklace. He was dying and making necklaces during his time in the hospital. I still keep this tucked away in my jewelry box, almost a decade later. It was my first gift from a patient, and he was one of the first patients I encountered during medical school.

Similarly, snippets of conversations weigh heavily on my mind. I think about my treatment plans – was everything correct? What will that one outstanding test say – will it change my management? How is my patient who just left the hospital – has she improved? Being a doctor is a tough job to leave at work. I can rarely escape it.

When I was growing up, my father would say: “Don’t become a doctor to make money.”

When I was in medical school, people would say: “Medicine isn’t what it used to be.”

I have known people who have dropped out before medical school, during medical school, after medical school, during or after residency. It’s not for everyone. You don’t clock in at 9:00am and clock out at 5:00pm. My husband will ask “How come if your last patient was at 4:00pm you didn’t come home until 6:00pm?” and it’s because medicine is messy and patients can’t be tucked neatly into 15 minute appointment slots. Also because there’s a load of electronic documentation that has to be done – but that’s a story for another day.

It’s rarely easy but I love what I do. The hours fly by in a blur. The patient encounters invigorate me. I learn something new every day and I come home with the knowledge that I have had a positive impact on someone’s life as well as their health.

What I would say to someone choosing a career in medicine: it’s so hard to know whether you will love it. And it’s true that so much has and will continue to change within medicine. But if you love science, interacting with people, and healing, it’s a great career choice, so don’t focus too much on the naysayers.

 

Updates from the 1st trimester

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I’ve been thinking of all of the things I want to remember from this first trimester. With my first pregnancy, I journaled all the time. With my second, I journaled less. This time around I forgot the password to access my (very sophisticated) Word doc journal and haven’t written anything since before becoming pregnant.

So first I’ll start with early pregnancy symptoms. I hate early pregnancy symptoms because they can literally be anything, so when you’re trying to get pregnant every little twinge becomes a reason to obsess over whether you could be pregnant.

I honestly didn’t feel any different than I have during my last few cycles. A bit of back pain a few days prior, but I’m pretty sure that’s more related to my 40 lb 3 year old and 25+ lb 1.5 year old. We flew for the holidays and I felt incredibly nauseous on the descent, but didn’t think much of it as I had experienced nausea with some prior cycles. What really tipped me off was this: no hormonal acne. Around the time of my menstrual cycle, I develop a few cystic acne lesions. I had zero by day 30 and this definitely piqued my interest. When I went to bed that night, I thought I felt something developing on my chin, but it was gone by the next morning. And that was it-I took a pregnancy test the next time.

During these first few weeks, I’ve felt:

-general stomach uneasiness

-nausea, usually worse in the early evening

-cravings for: carbs, juice (orange and mango), pineapple

-no desire to drink coffee (usually a staple of my diet) and no real desire to eat chocolate (another staple of my diet)

-intense moodiness

-incredible fatigue

I’ve also felt great worry, which is a staple of my pregnancies. I honestly wish women didn’t start showing until ~week 20, after the anatomy scan. With this pregnancy, I am showing EARLY. A handful of people know for a number of pragmatic reasons, and this makes me even more nervous! With my first, we didn’t even tell my family until I was almost 12 weeks pregnant. I didn’t notify my new employer until I was 14 weeks pregnant, and my colleagues at the time didn’t know until almost 16-18 weeks! With my second, I didn’t say anything until honestly around 20 weeks+ (although our families knew right away). I was negotiating a new contract at the time and didn’t want my pregnancy throwing a wrench into the plans.

I had one bit of good news at 7 weeks: baby had a heartbeat. But this is only minimally reassuring. The miscarriage rate on a population level is still 5%, and I’m sure we all know people who returned for their second check-up to find that the baby’s heartbeat was gone. So I am trying to stay sane until my 11 week appointment. And the week after I have my nuchal translucency/first trimester screen and my appointment with a genetic counselor (I’ll be 35 when this baby is born so I’m adding Harmony/Panorama/non-invasive prenatal screening test onto my routine prenatal testing). I think if I can get past the next 2 weeks (which are also riddled with work deadlines), I’ll be able to breathe a little more easily. Although then I’ll have the anatomy scan hanging over my head.

Well, I feel fortunate to be pregnant for now, and will try to keep my anxiety in check while I count down the days! The crazy thing is that in just 2 weeks I’ll be done with my first trimester, and then there are only two to go!