Category: Working mama

My nanny is drinking pregnancy tea

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This hurts my heart because she’s preparing for her second round of IVF and I feel like a terrible person for having two children already and now being pregnant with a third (and I haven’t told her about this yet, although I’m pretty sure she’s figured it out). It hurts my heart because I remember those days very vividly – wondering why everyone seemed to get pregnant so easily and why it was taking me forever. What was wrong with me? Would I ever be a mother? I wore fertility bracelets, temped, took supplements, checked CM, joined a yoga for fertility group, set up a meditation corner in my bedroom to relieve stress, started acupuncture, and on and on and on. And I think: how much harder would it have been if my job was to take care of small children? And how conflicting it must be when that job is paying for your opportunity to have your own child.

In addition to my nanny, I haven’t told a lot of people I’m pregnant yet, but there are two people in particular who I should have told but I have not. They are very dear friends to me. One recently miscarried in her first trimester after deciding to have a second child, and the second is undergoing her second round of IVF, having failed a first in an attempt to have a second chid. I should have told them, but didn’t know how to break the news directly after they announced what they had been through. And, to be honest, distance and our busy lives make it easy to evade. But I am 15 weeks tomorrow, so it’s time. And eventually I’ll need to tell my nanny, who likely already knows. I only hope that in a few weeks to months she shares the news that she’s expecting as well.

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!

Resolutions

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I have always loved reflecting, writing, and making resolutions. I remember New Year’s Eves in my childhood, curled up on a couch, writing furiously in my journal. I still love new beginnings, blank slates, a clean notebook.

My only problem now is time. How can I work on resolutions if I never sit to reflect and collect my thoughts? Most days now are split between racing around like a madwoman trying to get the most salient items on my to-do list completed and slowing down to enjoy time with my husband and little ones. But there is no in-between. There is no journaling while the kids play, reading the newspaper while they play with Legos, checking things off of my to-do list as my little cherubs entertain themselves. Because most tasks can’t be completed at work (unless it is a day when I am not scheduled to see patients) I spend my nights doing these things, go to sleep late, and am constantly on the verge of sleep deprivation.

Gosh, I realize this sounds pretty pessimistic, but it’s actually not. I enjoy being busy, and I’m very happy. But overall I’d like to be more intentional, despite the many directions I am pulled in.

I don’t put too much pressure on myself when it comes to resolutions, but here are a few things I’d like to focus on this year:

  1. Getting our house ready for a third. We have a few home improvement projects (some quite large) on the agenda and we now somehow need for these to be completed by August.
  2. More date nights with my husband. Since we don’t live close to family, this is always a challenge. Fortunately, we have great friends who have volunteered to mom-sit, and we need to take advantage of this a bit more.
  3. Launch a side biz. My husband and I have a specific idea in mind, in the works now for a few weeks, and we will hopefully bring this to fruition in the new year.
  4. Work out. We have struggled to fit this into our schedules since our first was born. And I have always been worried about the return of hypothalamic amenorrhea. But now, especially for purposes of a healthy pregnancy, I’m going to start working out 2-3 nights per week. We’ll probably start off taking advantage of our home exercise equipment before considering another splurge.
  5. Blog more intentionally. This has been a very sporadic endeavor in the past year, but I’ve quite enjoyed it, and need to focus my efforts a bit more.
  6. Move into more leadership roles at work.

Hoping for a healthy and happy New Year to you all!

Grateful for

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My parents grew up poor. Rationing food, wearing hand-me-downs, and walking to school in broken shoes poor. On Christmas Day, the well-off kids would show off their fancy toys and my parents, ashamed, would hide their knick-knacks and knock-off toys for fear of being teased.

To this day, my mom (now well-off), still hoards plastic bags from the grocery store to re-use in the home. She clips coupons and visits five different stores to find the best deal. She keeps clothing from twenty years ago because, who knows, she might wear it one day.

My father used to collect any money he could to buy a candy bar at the store. Years later, one of my earliest memories is stopping at a gas station to buy a Snickers bar, simply because he could. We snacked on our bars at 11 o’clock at night (this was the 80’s, people, there was less judgment around child-rearing) and listened to music on an 8-track player.

Because my parents grew up poor, they never wanted my brother and I to grow up wanting for anything. We lived in a working class suburb in my early childhood and my parents scrapped together jobs – delivering pizzas, working overnight at a factory, serving as senior home aides – to make money until they could obtain their professional licenses and move into the middle class.

Now that I have kids, my parents spoil them as well. My kids have too many things and we do our best to dwindle down the piles, to explain to our kids why they can’t buy everything, to have them understand that there are children out there who don’t have the opportunity to own allofthethings – ultimately, to have them understand that things are just things, and there is no end to the hedonic treadmill.

In my experience, it’s easier for someone who comes from modest means to understand why they can’t have everything, and to be grateful for what they do have. I wonder how I will teach my children, who are being raised in a bubble, the art of gratitude, grace, modesty.

(Barely) pregnant

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So this happened today, on Christmas Eve. I honestly can’t think of a more perfect present!

IMG_0410

Yes, I am barely pregnant at this point. And really just maybe pregnant. Maybe it’s a false positive, maybe I’ll miscarry, maybe the baby will have a birth defect that’s incompatible with life, and on and on and on. There are so many unknowns right now, at literally only 4 weeks pregnant, but part of me is already trying to wrap my head around what life could be like in August of 2018. Three little ones – 3, 2, and a newborn. Our house will be packed to the brim. The financial plan we created this week will need to scrapped and redone. My current baby will no longer be a baby – he’ll be a big brother. Will it be (our third) boy or a girl?

Right now, I’m just praying that this barely-there pregnancy sticks and that our baby is healthy.

Merry Christmas!

Trying to conceive

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My two attempts at becoming pregnant went something like this:

Pregnancy #1: Got married, starting trying to conceive (TTC), started to think that I most likely had hypothalamic amenorrhea (HA), was diagnosed with HA, underwent fertility treatment and became pregnant almost 21 months after we started trying. Those are the facts. The reality is that it was an emotional rollercoaster – hope, anxiety, disappointment, anger, sadness. And most of all, terrible fear that I would never be able to have a child.

Pregnancy #2: Oldest was 11 months, period came back naturally (hurrah), and the next month it didn’t come. I naturally thought my HA had returned (especially because I had a negative pregnancy test at 35 days), but I was actually pregnant. Second hurrah! I literally had to do nothing and I pretty much worried 0% about getting pregnant that time around.

And now, here I am. 16 months post-partum (!) and I had expected to be pregnant by now. Although I initially thought my second should have a few more months of being the baby than my first did, I really did want them fairly close together. But now, if we do get pregnant, my last two would be >2 years apart. This bothers me.

It probably bothers me because I am a Type A person and want everything my way. But it also bothers me because I am afraid that maybe it will not be easy for me to become pregnant again. I’m conflicted on this point. First, I feel somewhat selfish for wanting a third child. Is this normal? I have two perfectly healthy children! Our lives are FULL. It’s not like we have oodles of time to fit a third child into the mix. I think about people who are going through infertility struggles for the first time, and I feel terrible for having this blessing and wanting more. How greedy of me! Second, it’s giving me more time to think about logistics, and I don’t want to be dissuaded from our decision to have a third. Financially, emotionally, etc., does it make sense to have a third child?

What it boils down to is this: if we can’t become pregnant naturally (and if we are not able to, I am not sure that I know the reason because I am nowhere in HA land and cycling naturally), would we go down the infertility work-up/treatment road? I don’t know the answer to that.

But this third attempt is bringing up a lot of emotions from my first attempt, and the synopsis of my month is as follows:

Week 1: period is here, wah(!), lots of negative emotions closely followed by attempts at positive thinking and planning for the upcoming cycle (fertility window is X and baby would be born on Y)

Week 2: TTC

Week 3: More TTC, then the 2 week wait begins. This week feels like the calm before the storm – anything is possible but nothing can be done to change what’s coming down the pipeline.

Week 4: Time to type every symptom into Google to see whether it could herald a pregnancy (AND I’m a doctor AND I’m been pregnant twice!). Is nasal congestion a sign of pregnancy? How about back pain? Cramping? Bloating? What about spotting for 5 days…oh wait, that’s just my period.

And the cycle starts again. What else can I say except that it sucks. I think about myself ~5 years ago, feeling so dejected and low. I remember sitting on my “meditation” mat where I was supposed to relax with incense and practice Yoga for Fertility, except I was sobbing. It was a hard, hard time. This time, it is not as hard because the stakes are lower and part of me does feel crazy for wanting to add a third to the chaos of my life. I also do feel incredibly fortunate to be cycling naturally (without birth control) for the first time since high school!

But I am still sitting here wondering whether the new acne I’ve noticed and the low-grade back pain I’m experiencing could have anything to do with pregnancy…and what will I do next week if it is instead a sign of my period?

On the eve of your third birthday

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On the eve of your third birthday, I sat besides your crib*, singing to you and rubbing your back because you had a cough and a runny nose and were so frustrated that you couldn’t get the ‘boogies’ out and were having a hard time breathing.

This brought me back to all of the days** and nights I spent besides your crib, rubbing your back and singing. I remembered your last sleep regression, when you were 18 months and I was 8 months pregnant and sleeping on the floor besides your bed just to get a bit of sleep. I remembered how long it would take me to put you down for a nap because you would wake up the moment the hardwood floor creaked as I tried to sneak out of the room. I remembered the months of you waking up between 4:00-5:00am, how sometimes I would just load you up in the stroller when you got up and head out for a (slow) run and then to grab some coffee, letting your dad sleep. Although most of the time I would try to coerce you to fall asleep again and, when that failed, I would make some coffee and bumble through the morning like a zombie. I could go on and on – so many memories of little you.

When you wake up tomorrow, you will be 3. I can hardly believe it. Where did the time go? You have zoomed into toddlerhood before my eyes. Your words, your ideas, your compassion – I have no idea how the helpless newborn I brought into the world in 2014 has grown to be this loving, imaginative, and awe-inspiring child. You amaze me every day, little nugget.

Love,
Mom

*We are not quite ready to move X to a toddler bed. Mostly we’re afraid that he’ll recognize he has the freedom to roam outside of his room in the middle of the night/early morning.

**Naps were also not easy for this kid.

The Morning Hustle

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Google “working mom” and this is the first image that pops up:

Screen Shot 2017-10-25 at 8.59.58 PM Newsflash: this is not reality. I have 0% of the time ever sipped leisurely on a cup of coffee while wearing a clean suit and holding a quiet cherub in my arms.

Let me use this morning as an example. I wake up at 7:15am to the sound of my oldest (X, almost 3) screaming “Mommy, I’m awake! Mommy, come get me! Mommy, I’m awake! Mommy, come get me!” Pro: it is 7:15am. This is definitely sleeping in for my children. Con: he is not going to stop until I get out of my warm, cozy bed and head to his room. I check the Nest cam and see that my youngest (Y, 15 months) is also up. Time to start the day!

I make a pit-stop at Y’s room and take him into his brother’s room. They play while I get their milks and then we read a few books. Wednesday is one of my nanny’s earlier days, and she arrives at 7:35am. Neither kid wants to go to her (I should add: our nanny is awesome, we have known her for 3 years, and she is wonderful with the kids. However, they are both going through super clingy phases at the moment-even when their dad tries to take over-and this makes it difficult for everyone, but mostly for me). Noticing that it is now 7:45am and I have to be out the door at 8:15am to drop X off to school and then head to work, I start trying to motivate the little ones. I am able to hand Y over, but not before he sheds a few tears. X is another story. He can’t be persuaded this morning (although I am certain I will have to drag him out the door when he finally decides he’d like to play with her) and ends up hanging out in my room while I shower and get ready. This translates into water dripping all over the bathroom floor as he repeatedly pulls back the shower curtain, every item on our counter being perturbed by tiny toddler hands, and general inefficiency. Once I am showered and half-dressed, he decides that he does want to play with our nanny after all. I drop him off in the playroom, at which point Y jumps into my arms and refuses to be put down. So now I have another child in my room while I attempt to finish getting dressed, apply make-up, and style my hair (“style” is an overstatement: I have curly hair and 100% of the time wash it, apply product, and scrunch it). Y entertains me by attempting to throw everything down the toilet (succeeding only once), teetering on top of a step stool (clearly not a great idea) and repeatedly slamming the cabinet doors (only miraculously keeping all fingers).

I then head into the kitchen. My husband has already prepared X’s lunch, so I only need to pack it into his lunchbox with an ice pack, water bottle, and utensils. Meanwhile, Y (still in my arms), starts looking around the kitchen and pointing at everything he sees. I place a few Cheerios in a bowl for him to nosh on, and although he initially protests to being set down to eat (in this awesome kitchen helper), he is eventually quiet. I then try to pack some semblance of a lunch for myself, which ultimately ends up being yogurt, an apple, Goldfish, a Clif bar, a fig bar, and cashews. Nutritional fail but it’s 8:25am and I am definitely running late! But I do find time to fill up a water bottle and take coffee (+soy milk and sugar) to go.

My wonderful nanny has already dressed X (thank goodness) but he is NOT ready to go because he wants to play longer – of course! So I drop Y off to play and give X 5 more minutes as I pack everything into the car: X’s backpack and lunchbox, my work bag, my lunch bag, my water, coffee, and white coat (thank goodness I’m no longer lugging along pumping supplies!). Time check: 8:30am. Crap.

I hustle back in and X is now ready to go. Y senses that I am leaving and begins to cry again – so tough to hear this! I have to take a deep breath and remind myself of how happy he is when I come home and how well-cared for he is during the day. We step outside but X insists on lining up his pumpkins in a row, so we are 5 more minutes behind. He finally gets in the car and we’re off to school – 8:39am and 21 minutes to drop X off and drive to work before my first patient arrives at 9:00am.

We get to X’s school and he doesn’t want to go in. He says he wants to rest on the porch. Seriously kid!? He finally agrees to go in but then doesn’t want to sit with his friends during circle time (side note: X has been at this school for almost a year. He was initially in the 2’s class and now graduated to the 3’s class. He delays leaving in the afternoon to the point where we have waited 30-45 minutes while he plays! But he recently has started to try to delay in the morning.) Finally, he decides to sit with his friends. Phew!

Back to the car. Time check: 8:55am. Crap. Fortunately, my entire life is within a 2-5 mile radius, so it is a 15 minute drive to work during rush hour (clearly, this is the only way I can function given the above). Don’t worry – my first patient will be in good hands because my resident will be seeing her and will be ready to present her by the time I arrive (although yes, I do prefer to arrive a few minutes before clinic, hence the 8:15am goal estimated time of departure). I park in the garage and am upstairs by 9:10am. I find out that my first patient is late (maybe her morning schedule looked like mine!) and settle into the crazy rush of morning clinic.

If I had to add 3 things to my morning, they would be:

  1. Meditation/relaxation/thinking
  2. Working out
  3. Taking a look at work and preparing for the day

 

I am just not sure where to fit this. I don’t want to take time away from the kids, and I also can’t imagine waking up before 7:15am (I usually go to bed between 11:00p-12:30a. Maybe one day I’ll write a post about evenings!).

But I love many things about my mornings. Although this and 1-2 other mornings per week are my earlier ones (leaving between 7:45am-8:30am), I leave later 1-2 mornings per week (depending on the week) and generally have no clinic one day per week. I usually ask our nanny to come later on those mornings so that I can spend more time solo – reading, playing, eating breakfast together, etc. Whenever I have a later day, I always think: I should go to the gym, I should head to the office earlier, but then I remember that soon enough the kids will be in real school and they’ll have to go in early, and we won’t have time to spend leisurely mornings together. So I don’t work out, and I don’t meditate, and I don’t think about the day until I’m in it. And I definitely don’t sip leisurely on a cup of coffee with a peaceful babe in my arms. In sum: being a working mom is messy, so don’t believe those stock images!