Tag: doctor

Waiting

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Well, we somehow made it to mid-August and I will be 37 weeks tomorrow. 37 weeks is technically term and I finally feel like I can take a deep sigh of relief. We’ve made it to this point!

I have checked most of my nesting tasks off of the to-do list. My hospital bag is packed, newborn clothes are washed, two bassinets set up (one in nursery and one in our room). The car seat and base are the in the garage for my husband to install last minute.Our 3 boys have been sharing a room for a month or more and it’s going surprisingly well. The nursery closets have been rearranged and our bedroom has been reorganized to double as a nap station. Postpartum supplies are stocked for me, newborn diapers and wipes are stocked for the baby. We have hand sanitizer and hand soap galore. Tomorrow I’ll have help with the kids and plan to review my list to see if there are any last-minute items to tackle.

I feel ready. I’m anxious about going into labor, of course. As an obsessive planner, it’s difficult for me to NOT know when something will happen or how exactly it will happen. This time around we’ll have the added stress of needing to coordinate childcare quickly. Our families ultimately decided not to fly out. I totally understand their rationale. They are being incredibly cautious – not socializing at all, working from home for the most part. The idea of being on an airplane doesn’t jive with me either. At the same time, it’s difficult not to have family around for this. I’m super pregnant and my husband is working frantically to wrap things up before paternity leave. The kids are also a handful at the moment. It would be nice to have family in town to spend quality time with them and to offload some of our exhaustion. The situation is sad but I can’t perseverate over it – there’s literally nothing I can do. Our plan is to have our amazing nanny (who has saved us over and over again these past few months) “on call” to come over when I go into labor and we are very fortunate that she moved closer to our home earlier this year. I had originally planned to drive myself to the hospital while my husband coordinated childcare, but my ob vetoed that idea. So now, if things seem to be happening quickly, we’ll load all of the kids into the car and have her meet us at the hospital. I am hoping that my contractions start during the day or that I make it to my induction (39+3). I REALLY do not want to have a baby at home or in the car!

So there’s the unknown component to contend with now. But there is also the fear component – what is something goes wrong? What if I have a postpartum hemorrhage? What if baby has some unknown birth defect or there is another complication? Obviously, I have no control over these things and am trying not to fret about them. I am mostly at peace – trying to enjoy these last few days/weeks with my three little boys, with our family of five – loud, crazy, chaotic – but at least it is our normal and well-known. The first few weeks with our newest addition will be a period of constant adjustment.

We have tried our best to prepare for the postpartum period/fourth trimester. We will both be taking parental leave. Our nanny will help out during the day. We hired a night doula for the baby as well. I am still a bit torn on this. Some of my favorite memories are the sleepless newborn nights. I have usually slept alone with the newborn, nursing all night, watching the clock tick towards morning, waiting for the sun to rise, snoozing on the bed or couch whenever I am able to set the baby down. But, in truth, it has always been exhausting. Some nights my husband would have to watch me sleep w/ the baby cradled by my breast because we were unable to get him into his bassinet. Mornings I would be so exhausted. And the truth is, we are going to need all of the energy we can get to parent 4 kiddos through a pandemic. So we hired a night doula five nights per week. I think it will be great to have the help and two nights out of the week I can enjoy solo evening parenting! I am also hoping that working with a night doula will instill good sleep habits early on, because we have always struggled with this and only just sleep trained my youngest at 18 months!

The other huge thing happening during this waiting period is that school is finally starting for my older two. My oldest is entering kindergarten and the first trimester will be all virtual for now. I am torn on this. I don’t feel any emotional need to have him attend in person. He has been in a preschool-like environment since age 2, so I don’t feel like entering kindergarten is a huge momentous occasion. That being said, I worry that he will have a long, intense virtual schedule. The draft they sent show kids “in school” from 8-3. I am hoping this is modified for the younger kiddos because that is a LONG time to be in front of a screen. He’s also a social kid and I worry that he’s going to miss out on that aspect of school this year. And, finally, because we transferred him to a private school, I’m not thrilled to be paying tuition to have him at home! But, alas, this is the situation we are in at the moment and the most important thing is obviously keeping him, our family, his teachers, the school community and our general community healthy and COVID-free.

My second oldest is entering pre-K at this school and, because they are under different state regulations, he will be able to attend in person. I am also a bit torn on this. On one hand, he is harder to teach at home than his brother was and he is also more shy and introverted, so a place where he has rules to follow and friends to play with would be beneficial for him, I think. I also worry that he will get lost in the shuffle at home. Even with our nanny here, if one person is directing online learning all day and one person is trying to make sure our (almost) 2 year-old doesn’t crack his head open jumping off of furniture and one person is tending to a newborn, what happens to our second oldest? Will he get enough attention? Will he learn anything? These worries are counterbalanced by the very real concern that he might get or be exposed to COVID. So ultimately I can’t say that I am entirely at peace with our decision, but for the reasons listed above and some more, we have decided to start his year in-person and continually re-evaluate.

So this is the world we are bringing this baby into. Fortunately, I was able to stop seeing patients in person early on (34 weeks). I completed 2 weeks of telemedicine and then took my earliest maternity leave to date at 36 weeks. I was fortunate to not get COVID and to not be exposed to any COVID + patients during this time. Despite having just started leave – and the baby not even being here! –  I am already stressing out about going back to work. In normal times, it would be sad but doable. In pandemic times, it seems impossible. Who’s going to sit with our oldest to do distance learning if that is still happening in the new year (I believe that the whole school year will likely be remote)? How will we balance that with my second child’s pick up/drop off schedule? There is a very real possibility that I will have to scale back or modify my hours to work around these schedules.

But, for now,  I am going to try to remove worries and outstanding questions from my mind. I am going to try to enjoy one more night of sleeping through (I hope – the kids do still get up sometimes for one reason or another!) without having a newborn to feed. I am going to enjoy this next week of productivity, nesting and time with my three boys. The next time I write anything, I anticipate that our new addition will be here!

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!

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.