Bad news

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This month has been hectic. It started with a lovely get-away (without kids!) for my husband and I. It was lovely. We were away for a week and were able to sleep 10-12 hours per day, finish both our conversations and our meals, lounge leisurely by the pool (under an umbrella, of course), walk along the beach, read, and simply be.

As always, I returned home with a desire to incorporate some of that into my daily life: taking a few minutes per day to just be together, reading more for fun, enjoying leisurely meals, exercising. Except we came home to a 1 year old and a 3 year old and two full-time jobs so none of the above happened.

It’s also a busy time. I’ve been taking advantage of my second-trimester energy to complete a few projects, including submitting plans for a minor home renovation. I’ve also had a pesky cough since our time away and though it would go away but it didn’t, and the coughing would often rob me of my energy and cause me to feel even more tired than usual. To top things off, my oldest came down with hand foot mouth disease (HFMD) and was home the entire week prior to a flight I was taking solo with both kids. He was in pain and cranky the entire week (apologies to all of the moms I counseled on HFMD by saying it was merely viral and would blow over) and, the worst part of all was that he wouldn’t sleep through the night! So the first few nights my husband and I stayed up with him. And then my youngest got a fever (but fortunately did not erupt into HFMD) and then HE wouldn’t sleep through the night.

So I set off with both kids in recovery ALONE on a 6 hour flight and it was by far the worst flight we’ve ever had. My kids have traveled a lot because even though we don’t live close to family, I think it’s so important for them to spend time with them. They are usually shockingly well-behaved. I come prepared, keep them entertained, and they generally keep their crying and tantrums to a minimum. But last week was a different story. Both kids were on the mend, I felt like crap from a combination of not sleeping as well as fighting off this cough (oh and being pregnant), and they wouldn’t nap! So we kept things pretty together until the last 30-45 minutes. And then when the plane landed, all hell broke loose. Both kids wanted to be carried but I only had two hands and had to carry the carry-on bags (we only had travel backpacks with us but it was a lot to juggle!). Then my oldest started throwing a tantrum about everything – he didn’t want to let me into the aisle to organize our bags, he didn’t want his brother to sit by the window, and on and on and on. Meanwhile, I’m frantically trying to organize everything while his little monkey of a brother is climbing over the seats. My oldest won’t move from his spot so I tell him “I’m going to pick you up and sit you down here so that I can grab everything” and do just that. He loses his **** and starts yelling “Mommy you HURT ME!”. Meanwhile, I’m dying.  As calmly as possible, I tell him it’s time to get off of the plane. A very nice lady helps with one of our bags, I carry my youngest off the plane, and my oldest begrudgingly drags his bag and follows behind, complaining all the way.

At the gate, I have to find and unfold our stroller, which was a waste of effort because neither kid will sit in it (but at least I can pile some bags on it). The oldest is crying and blocking people as they walk off of the plane while the youngest just wants to be held. I hightail it out of there with the oldest hitting me on my backpack and throwing the world’s greatest tantrum. We are the last people off the plane and the pilots are begrudgingly walking behind us because (I learned on another trip) they can’t leave anyone behind when they leave the plane. Awesome. And then, to top it all off, I have to walk approximately 20 minutes with one kid in my arms and one kid whining the whole way because we have landed at a huge airport, at possibly the furthest airline!

It was a total disaster. I saw my parents at the exit, handed the kids off to them, and then walked off to baggage claim to burst into tears. I could tell the security guard knew I was going to lose it because he let my parents follow me to the baggage claim to help out with the bags.

Until yesterday, I thought that was the worst thing that had happened. Then, my ob called me. Before I left, I had a few third trimester labs drawn. Apparently, one of those labs was toxoplasmosis. I had already had this checked in January (at 7 weeks) and both IgM and IgG were negative. For some reason, my ob rechecked it. She admitted that this was controversial – that many people don’t recommend rechecking due to low likelihood of infection in our area and false positives. But then she told me that I had a new positive (IgM, with IgG still negative). She wasn’t sure what to make of it. She had spoken to the high-risk obstetrics group at my hospital and they would follow up with me and likely have me return for an ultrasound, as well as labs, maybe an antibiotic, etc. She told me not to freak out so I promptly did just that – freaked out.

Toxoplasmosis!? That’s one of the terrible infections we learn about in medical school that can cause a slew of problems in newborns. WTF!? But I don’t own any cats…and I’m a vegetarian! I couldn’t believe it. I did what I always tell my patients not to do – turned to Dr. Google, and PubMed, and every person I know who is an obstetrician or infectious disease expert. I received a slew of responses: it’s probably nothing/a false positive, you definitely should not ignore this, you need serial ultrasound monitoring, they need to test the baby, there’s nothing you can do anyway because you’re 24 weeks along.

I’m also a bit annoyed at my ob. Why did she check it if it’s controversial? Her exact words were “I’ll probably change my practice after this”. And I am not entirely sure she knows exactly what to do at this time. She referred me to the high-risk ob, and that person called me, but I’m traveling and can’t be seen tomorrow, and she’s going to be out of town next week. The ID expert I spoke with told me to get labs ASAP, but the ob told me it wasn’t time-sensitive. Her exactly words were “I’m going to be blunt with you because you’re a doctor: if this is a true infection, there’s not much you can do at 24 weeks”. But shouldn’t it matter if it’s a true infection?

So I’m just waiting here, anticipating the worst. And it’s made me realize that I’m done having kids. I always thought I wanted a fourth, but pregnancy is too tenuous and stressful. I think about the experiences I’ve had with my kids – my pre-eclampsia scare with my first and him being in the NICU after birth (the briefest NICU stay ever, but seemed like the longest to me), my positive first-trimester screen with my second and having to see genetics for additional screening to rule out a chromosomal abnormality, and now this with my third. I pray that he will be healthy. That this is either a huge misunderstanding (false positive) or that he does not catch this infection. I’ll have an ultrasound in one week and hopefully will have some additional information at that time – and hopefully it’s all good news.

Charley horses and baby kicks

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A few days ago I woke up with a terrible muscle cramp in my right leg. It woke me up from my sleep, which was aggravating because I really love my sleep. But it was also incredibly painful! I had completely forgotten about Charley horses during pregnancy, but yes, it is a thing that happens.

(Speaking of things that happen: here’s another one no one told me about. After my second delivery, I experienced terrible uterine contractions – almost as bad as pregnancy – whenever my newborn nursed. This is apparently a thing. When you nurse, oxytocin is released, leading to uterine contractions. Because the uterus has less muscle tone after your first delivery, this contraction is often quite mild – it definitely was for me. However, with each subsequent pregnancy, they become more intense (as uterine muscle tone increases). I was literally doubling over in pain after my second was born, so I am NOT excited to experience this again!)

I have also started to feel this baby kick. At first (around week 17) it felt like very light flutters. It still feels light, but I am certain now that it’s the baby. This makes everything feel more real. We bought baby’s first outfit yesterday. I can’t go too crazy (I already have 2 kids’ worth of boy clothes) but I definitely wanted him to have a new hospital outfit.

I also have his anatomy scan this week. I am always so worried about this test, but trying to stay calm before the ultrasound.

 

What I Ate Wednesday

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When I had an eating disorder, I would relieve the anxiety of said eating disorder by writing down all of the things I had eaten that day, or was going to eat that day. I would be in lecture – college, medical school, residency – and start scribbling on the side of my notes: banana 100 calories, cereal 120 calories, soymilk 80 calories…and on and on and on. I would write different permutations depending on what I thought I would eat that day. I had most foods memorized by caloric content and was pretty proud of that fact.

I would also read a lot of blogs by people who had “recovered” from disordered eating or who were advocates of “healthy eating”. These blogs would undoubtedly have a What I Ate Wednesday (or WIAW) feature. These bloggers would write things like “spoonful of dark chocolate chips” or “tablespoon of cashew butter” to show how indulgent they were in their eating. All of it was insane.

I also remember thinking: “After I have kids, I’ll still eat healthy and work out. I won’t let myself go!” Well, that was also an insane thought, because I can barely manage to pack a lunch these days, much less make sure that it’s nutritionally sound.

And so I thought it would be interesting to write down what I really ate today, this Wednesday, mostly as a parody but also so that if anyone with disordered eating or hypothalamic amenorrhea were to read this, they would hopefully realize that most people don’t measure out what they eat, and that’s actually normal.

Breakfast: I have no idea. I know, this is a terrible way to start WIAW. But the main point here is: when you don’t obsess about eating all day, it actually takes quite a bit of effort to think about what you ate. I know I drank coffee w/ soymilk (Yes, coffee is not great during pregnancy, but I just now in the second trimester starting craving it again and only have 6-8 oz on the days that I do drink it). Oh wait, now I remember: a scone from Trader Joe’s – not sure what type.

Lunch: PB&J sandwich, Strawberry Fage yogurt

Mid-afternoon snack: biscotti, hot chocolate, apple

Dinner: tortilla chips, TJ’s meatless patties x 2, baked oven fries, bites of the veggie burgers I made for my kids. Most of this was eaten standing up.

Dessert: chocolate chip cookie, vanilla ice cream

The best part about having recovered from disordered eating is that I can write everything down and feel nothing – no joy if I ate “well”, disappointment if I ate “badly”. That list is just facts. I don’t feel good or bad about it, and that’s an incredibly liberating feeling. Honestly, there was a time in my life when I thought that I would never feel that sense of freedom around eating. I feel so fortunate to have overcome it and hope that anyone struggling with disordered eating will soon overcome it as well.

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.

What people are saying

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I am finding that the reaction you receive when you tell someone you are expecting your third baby is quite different than the reaction you receive when you tell someone you are expecting your first baby.

When people found out I was pregnant with baby #1, they were ecstatic. There were congratulations all around, experienced moms waxing nostalgic about those early days, huge baby showers to be had, and overall excitement. Everyone was thrilled.

When we were pregnant with #2, people were also excited, but perhaps a bit worried. They seemed pleased that our son would have a brother, but did sometimes comment that the less than two year difference in age was a bit aggressive. Overall, however, there was excitement.

With this baby, baby #3, we have definitely received a number of congratulatory comments. But we have also heard quite a bit of:

  • “Was it an accident?
  • “Was it planned?”
  • “What?”
  • “OMG, why!?”
  • “Let me guess – you’re pregnant” (in response to: “I have something to tell you”)

So, it’s been a bit different. But we ourselves are very excited for this third baby, for whom we did plan!

 

 

 

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!

The first trimester

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The first trimester sucks. Of all 3 trimesters, it is by far the worst (for me at least). First of all, I always feel like crap. Nauseous, tired, cranky. During my first pregnancy, I would come from work, crash on the couch, and binge on Scandal until I passed out at 9pm. Now I have two kids under 4, so I can’t just lay on the couch watching TV.

Second of all, it is fraught with worry. Once a positive pregnancy test erases the worry of “will I ever get pregnant?”, I start worrying about whether this pregnancy will stick. So there’s the worry up until the first ob appointment (will there be a heartbeat?), the worry at every subsequent appointment (is there still a heartbeat?), the first trimester screen, and on and on and on.

To top it all off, you can’t even explain to your family, friends, colleagues, etc., why you have a short fuse. They just assume you’ve turned into a bitch. And then there’s the awkward turning-down-drinks component, when everyone is dying to ask you whether you’re pregnant but of course they don’t want to because you don’t quite look pregnant, do you?

My husband took the boys out for a bit so I could finally sit down and rest today (kids woke up at 5:30a this morning and it’s 4:00p). We are both wiped, but he’s taking one for the team, and that’s why I love him.

So I’ll go back to reclining horizontally on the couch, reading my book, and trying not to worry about this trimester.

The worst date I ever had

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The worst date I ever had was in my early 20s. It was even worse than that one first date where, within 10 minutes, this particular gem told me that he didn’t drink alcohol because he was a recovered alcoholic and, by the way, he was married.

I had been dating someone for approximately one year. It was essentially a long-distance relationship since he ended school one year earlier than I did. Perhaps this is why it lasted a year – we had a brief honeymoon period in college and the following summer, then spent most of the year shuttling back and forth, but not necessarily doing the day to day drudgery of dating life. So it never got old…until it did.

I was finally moving to the same city – hurrah! I was so excited, and assumed he must be as well. I distinctly recall making a reservation at a well-known steakhouse recommended to me by one of my best friends, who’s father was in the meat industry. This is probably a good place to mention that I am a vegetarian. So, in essence, I was setting up a date at a place I would never step into by my own volition, because I knew how much this guy liked meat, and I wanted one of our first dates in the city – our city – to be special.

The dinner was very awkward. He was more reticent than usual, and I had a feeling something was going on, but wasn’t quite sure what. At the end of the dinner, he managed to spit it out: this wasn’t working, he didn’t feel the same way he had, I deserved better, blah blah blah.

I was shocked. Time felt like it had stopped. I couldn’t believe my ears.

In retrospect, our relationship had very little substance and mostly involved drinking and hanging out with his friends, but I was in my early 20s which resulted in my being completely shocked that two completely incompatible people weren’t going to result in forever. After the shock, came sadness and anger. I remember standing outside of the restaurant trying to fight back tears – I couldn’t believe what was happening. I recall him stumbling over his words, not really sure what to say and I’m sure just dying to escape from this awkward situation.

It’s funny, the details are so fuzzy now, but at the time it felt like the world was ending.

I remember crying all of the way to the subway. Fortunately, one of my best friends was hanging out in the city and I called her to meet me at the train so that we could ride home together. She later told me that I was crying so hard she could barely hear a word I said, but knew it had to be bad.

And that was our breakup. I never quite had the closure I wanted but time slowly erased the need for closure. His best friend told me that was just the way he was, she was sorry. His sister told me she liked me better without him. And one day, many months later, we met for a drink. I don’t recall the details of that meeting so well, but we had a nice conversation and it overall ended on a good note, although I never received any straightforward answer as to why he had broken up with me.

Years later, I found out that he was an alcoholic. In reality, he was an alcoholic when we dated but we were in college and drinking irresponsibly didn’t exactly raise any red flags during that time. He faced some significant medical problems as a result of his alcoholism and years later died quite young. I still don’t know the exact cause of death (I never felt like it was my place to pry) but I do hope that his family and friends have the closure they deserve, as they are all wonderful people, as was he. He did me a favor when he broke up with me, by ending a relationship between two utterly incompatible people before I felt ready to do so. At the time, I didn’t see this, but now it is clear as day.

The point of this story is this: hindsight is 20/20. The worst date, the worst day, the worst event of your life may, in certain cases, be blurred into just another story on a page by the slow passage of time.