Category: anxiety

Pandemic Pregnancy

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When I became pregnant, COVID-19 wasn’t even a thing. It was mid-December and I don’t recall hearing anything about what was happening in Wuhan until January at the earliest. So it was probably a thing, and there were cases, but the thought of closed schools, clinical work on hold and shelter-in-place were not on my radar. I was honestly mostly focused on the application process for private school for my two oldest kids. They were (and I recognize how ridiculous this sounds) applying for entry to pre-K and K, and my biggest worry was where they would be going to school the following year. Now I’m doubtful that they will even get to attend said school in person, but that’s a topic for another day.

On February 25th I screened positive for Trisomy 21 and perseverated over that for a week until my normal cell-free DNA results.

We slowly began to take precautions at work to screen for COVID-19. It began with questioning patients prior to their visit to see whether they had recently traveled from Wuhan (this eventually expanded to all of China, and as everyone knows that question soon became obsolete). We also asked about cough and fever. Carts with PPE were positioned outside of these patient rooms.

I developed a cough on March 6th, which was terribly awkward to have while everyone was on high alert regarding COVID (for the records, I have had a negative COVID-19 PCR and also negative IgG and IgM antibodies). One of my patients even sent me a personal note saying that he was worried about me because I had been coughing (I wore a mask in every patient room during this time) and seemed short of breath. I had to, with some embarrassment, tell him that I was short of breath due to climbing 3 sets of stairs while pregnant. Fortunately he was a patient I knew quite well.

I had an ob appointment March 10th and my ob was pretty close to 0% concerned about COVID. She told me the reports out of China were reassuring. Pregnant women seemed to fare well and there were no cases of vertical transmission. She also told me to drink a glass of wine, which was interesting because she usually errs on the conservative side (also for the record, I did not drink a glass of wine).

My close colleagues, however, were more concerned and ended up encouraging me to drop one of my higher-risk duties – seeing patients in the hospital. I stopped doing that the week of March 2nd. The week of March 9th I made a huge pivot in my career and left one of the clinics I had worked at for 6 years. Too many things weren’t working out. I was losing staff, knew I wouldn’t have any when I returned from maternity leave again (it was a drawn-out nightmare the last time) and was so exhausted from pregnancy and turning 37 that I knew it was finally time to call it quits.

March was a month of major upheaval. Our world paused in March – with school canceled starting March 12th (initially only for two weeks but that eventually progressed to no school for the rest of the school year) and shelter-in-place coming 5 days later. Everything was being canceled. It was such a crazy time.

We largely stopped seeing patients in person, with my last real clinic held on March 16th. Everything has been virtual since. To be honest, it’s been challenging. Some conditions in dermatology are easy to treat virtually (acne, for example). Other things, like checking over someone’s skin to look for skin cancer, are impossible. I have been seeing 1-2 patients a week for skin biopsy and evaluation of more serious rashes, but always wearing ample PPE (I have my own that I cycle through). We have just started talking about opening up clinic more robustly, and I am concerned about the plan (or lack thereof). It doesn’t sound like anything is changing, other than spacing out clinics and appointments to encourage social distancing. Of course, we are asked to wear PPE, although it is unclear whether this is readily available.

Normally, I wouldn’t be too concerned. But last week, at my follow-up ob visit, my doctor was suddenly very concerned. She told me there had been new reports of COVID-19 found in placentas, IgM antibodies in newborns, vertical transmission (from mom to body), second trimester miscarriages, stillbirths and premature births. The numbers of reports were small, but there was definitely more alarm. Moms are tested at the time of delivery at our hospital and COVID-19+ moms are recommended to separate from their newborns. Having had three kids, I can’t imagine how heartbreaking that would be.

In sum, I’m starting to worry about ramping up capacity to see more patients. I’m not reassured by the plan currently in place and now I’m much more anxious about doctoring while pregnant. At the same time, I feel a bit silly, because I don’t work in an emergency room or ICU, and certainly don’t do any high-risk procedures (any biopsies I do near the face are usually relatively quick and nothing compared to an intubation). I also feel a strong obligation to my patients. I know how scary it can be to have a spot that you are worried could be a skin cancer, or a rash that keeps spreading. Our patients have been so wonderful these past few weeks, understanding that we are taking every precaution to keep them safe, but I certainly don’t want anyone waiting months to be seen. Since I am taking maternity leave, I would be gone until early 2021. Finally, I care deeply about my colleagues. Although they might not be pregnant, they could have co-morbidities or take medications that make them immunosuppressed, live with elderly parents or in-laws or immunosuppressed children and spouses. I don’t want to burden anyone else with having to see my patients because it seems to imply that my pregnancy is more important than their personal circumstances.

It’s an uncertain time for all and I don’t envy our management who has to make some tough decisions moving forward. For now, I’ve reached out to my ob to see if she can give me some clarity on making a decision. If need be, I’ll reach out to my colleagues to see how to best mitigate risk. I’m taking leave at 35 weeks so essentially only 13 more weeks to go. Hoping those 13 weeks are as smooth and uneventful as possible!

No more cornflakes

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Today is Day 38 of no school for my kids and Day 33 of shelter-in-place. It’s 1:48am and I am up again. We’ve been battling bedtime with one of my kids for what seems like an eternity (a year perhaps?). With the extra time at home, less need to be at work first thing in the morning, and generally more exhaustion, I have started falling asleep on the floor of his room (his preferred sleeping arrangement) more often than I would like to admit. After sleeping a good 3-4 hours, I find it tough to seamlessly transition to my own bed. Thus why I am up right now – writing for the first time in ages.

The past few weeks have been an adjustment, to say the least. Before I go into details, I first have to say that we have been very fortunate. My husband and I are still employed and no one we know or love has been ill with COVID-19, despite much of our family living in New York and New Jersey.  I work at a hospital but my department has made patient, faculty and staff safety a priority, and this has helped to relieve a lot of exposure anxiety. I am also 19 weeks pregnant and my colleagues immediately volunteered to take over some of my riskier patient care responsibilities, as the evidence regarding COVID-19 and pregnancy continues to evolve (fortunately, it has been mostly reassuring, but we are learning more each day).

We are very blessed and acutely aware of this, but also affected by the monumental change that occurred in our lives these past few weeks as well as the uncertainty regarding the future. What began as a two-week hiatus from school after there was a confirmed positive in the larger school community was gradually extended, until they just recently announced that school would be out until the fall. Summer camps have started to cancel. There is talk of the 2020-2021 school year looking dramatically different.

I do feel fortunate that my children are young (1, 3 and 5). Mostly they have reacted to the news with glee. For them, it is an extended vacation and their parents are home all day on most days (I am currently going into the office one day a week for essential procedures). They say they do not miss school or their friends. We live in a warm climate where they can go outside each day – even if it is only in our backyard or a short trip around the neighborhood. But I do worry about the change in structure. This week in particular was tough became it came with some change in behavior. My 1 year old is undergoing a sleep regression – often crying before bed, waking up in the middle of the night (he woke up as I was typing this), and a few mornings waking up before 5am. My 3 year old finds his way into our bed more often than not (perhaps related to my falling asleep on his floor most nights?). My 5 year old, who is generally very well-behaved, started to act out this week. Small things, for sure, but they pile up quickly when my husband and I are home all day, trying to fit work into any snippets of time we can find, and generally exhausted/operating on fumes. Parenting 3 kids 5 and under while both working full-time was hard at baseline and then COVID happened and it seemed almost impossible. (But I remind myself daily that at the height of my struggle with infertility I would have prayed for this conundrum. No matter how many kids I’ve had, there is no way to forget that burning desire for motherhood, the disappointment that came with every negative pregnancy test, and the fear of it never coming to fruition.)

And yet. Today was a hard day (also a hard night, it seems, with 2/3 of the kids already up 2 times each) and I started thinking about one of my favorite books from childhood – No More Cornflakes by Polly Horvath. I had forgotten the general plot and had a good chuckle when I read the Amazon synopsis: “Hortense seeks the advice and friendship of her eccentric Aunt Kate when her mother spends her days eating cornflakes and hopping around in public, pretending to be a rabbit”. It is about a girl growing up in a changing household – her mother is pregnant (and apparently losing her mind?  I should go back and read this now that I am an adult), her older sister is out more/becoming more independent, and she finds solace in a deepening relationship with her quirky aunt. The one thing I vividly recall, even decades later, is her aunt’s advice to find an “oasis”, a small ritual you have for yourself each day – one that is yours and only yours, one that brings joy always.

I love this concept even more now. As our world has become smaller – confined largely to the walls of our home – as our social interactions have become non-existent, as our opportunities for experiences, vacations, etc., have dissipated before our eyes, how do we find solace in our day? What can we do to bring a sense of peace, calm and fortitude into our lives? I’ll be thinking about this deeply in the next few days, as we continue to refine our daily schedules, to bring small rays of sunshine into our lives.

For now, I am trying to focus on the positives. I have had the opportunity to experience staying at home with my children (I went back to work with all 3 when they were ~4 months old). They have had the opportunity to experience a different childhood (I sometimes joke that it is my childhood) – one without planned activities, playdates, structure. We, as parents, are working on encouraging more creativity and independent play. We are trying to find small pockets of time for ourselves while the kids are awake, so that we don’t have to cling so desperately to the post-bedtime hours. My 1 year old’s language has taken off exponentially now that his brothers are home full-time. My 3 year old rode his bike for the first time today without training wheels. My 5 year old has been reading on his own and doing math. We are eating at home every night (we always ate together, but did often eat out) and I am so incredibly fortunate that my husband cooks for us every day. We are finding the time to complete random items on our to-do list that always fell to the bottom of our busy days.

One day, as long as everyone stays healthy and safe, we may look back on this time with some degree of fondness. I wonder if it is the closest we will ever be as a family. Soon, if we are still sheltering in place and socially isolating when this fourth baby arrives, we will be even closer!

Nervous Nellie

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I’ve had anxiety most (if not all) of my life. Some of my earliest memories are anxiety-laden:

  • sitting in my father’s car while he was outside talking to my uncle, feeling worried about being alone in the car
  • in elementary school, feeling worried about a state project due in May…during the month of December
  • the night before I turned 10, feeling intense worry that I would never be 9 years old again

I could go on and on.

There were times in my life when my worry worsened. A few weeks to months each year during my childhood when I would be exponentially worried – we began to call these episodes “La Etapa” (a stage of my life). I remember the worry intensifying in high school. I moved to a new school district during my freshman year and I would feel intense dread in the morning when people loitered by their lockers since I didn’t (really) know anyone. I remember hiding in the bathroom during this time, as this was preferable to socializing. I experienced intense anxiety during freshman year of college- fear of meeting new people/would I fit in/etc. I drank too much and gained a ton of weight which only made things worse. My anxiety worsened in medical school, especially on rotations where I had less control over my schedule/time. One way of dealing with my anxiety was through food restriction and overexercising – I could have control over one area of my life, even when everything else was in disarray. I started dieting in high school, so that need has been there for a long time.

I did speak to a few people during these years. In college, someone tipped off a counselor that I may have an eating disorder, and so I started seeing her. She would weigh me facing backyards so that I couldn’t see how much I weighed. I lost more weight when I stopped weighing myself because I was afraid of gaining weight, so clearly the anxiety was still there. I then met with a psychiatrist in medical school, during my surgical rotation, because I was incredibly moody and would break down over the smallest things. I remember running to the first appointment so that I wouldn’t miss my workout that day. He started me on Celexa. I took this for a few weeks, maybe 1-3 months max? My husband (boyfriend at the time) thought it helped, but I wasn’t so sure and stopped shortly after starting. The third time I reached out to get help was when I was struggling with infertility due to hypothalamic amenorrhea. I met with a therapist a few times near my residency program, pretty much crying the entire time through those sessions. That also did not last long.

Why did I “quit” so many times? Probably because I have pretty high-functioning anxiety. It never stopped me from accomplishing my goals or having (mostly) healthy relationships. It’s an ever present background hum, but in many ways it has driven me to succeed. I excelled in school, attended an Ivy League college, graduated medical school and matched into a competitive residency. In other words, even though I personally suffered, my goals did not. I was still able to interact normally with others, connect with/take great care of my patients, and perform daily activities with little interference. However, I have recently started wondering whether things could actually be better. For years, I thought being thin had led me to succeed. Part of the fear of gaining weight was that I would lose everything I had worked for. This was obviously a lie I had been telling myself and the world did not end when I gained weight. And so I started thinking: what if life could actually be better with my anxiety under better control? What would it be like to live in the moment, to not have the ever present buzz of worry, to not feel imminent doom over every little thing?

The other tipping point was this: my 4 year old has started to show signs of anxiety and it is heart-breaking. Yes, it could be hereditary. My whole family deals with anxiety, so maybe it would have been passed on anyway. But I also wonder whether an anxious milieu of the womb or anxious parenting (my husband, too, would factor in here; although normally a very calm person, he is quite an anxious parent) had any effect. I feel intense guilt over this. Although I can’t change anything I’ve done, at the very least I can do my very best to control my anxiety as my kids begin to grow and understand more.

Finally, I think it will be good for my marriage. My husband and I love each other dearly, but our differing personalities (mine characterized by anxiety) have definitely led to some repetitive arguments.

And so I scheduled an appointment with a psychiatrist specializing in women’s health, particularly around birth and motherhood. I met with her last week and she agreed I had generalized anxiety disorder and recommended three pillars of treatment:

  1. Medication
  2. Psychotherapy
  3. Self care

She said we could do any combination, so I am started with medication and trying to incorporate self care into my life. I opted for medication because, if I am truly honest with myself, I am dog-tired. I’m tired of always worrying about everything, of making to-do list after to-do list, of constantly playing out scenarios in my head. It is absolutely exhausting. And I want to get better as fast as possible. My father, a psychiatrist, always said that medication could be incredibly helpful to patients, to normalize their brain chemistry while they utilized psychotherapy to change their thought patterns. I picked up Zoloft right after the appointment and felt a huge sense of relief as I swallowed it. Obviously all of my feelings were still there, but I was relieved to finally be doing something about it.

I am holding off on psychotherapy for now because of the time commitment, but I am trying to do some self care. My family is in town this weekend so it’s a wonderful opportunity. I am taking the time to write this, and I also scheduled a couples massage for this evening. In the past week I’ve made time for mom/baby yoga and a stroller workout class.

And so I am trying and hoping for the very best outcome here.