Maternity Leave

Believe it or not, I didn’t forget that I have a blog.  I think about it often.  Mostly I miss the days when I had time to write.  These days I find I have a lot more on my hands, and blogging just seems to fall further and further down on my to-do list.

I have been blessed again to be mama to another beautiful baby girl.  Ayla Grey was born on July 13 via successful VBAC.  For those of you who don’t know what a VBAC is, it stands for “vaginal birth after caesarean.”  I’m not sure why having a vaginal birth was so important to me.  I was devastated after having a C-section with Anika and felt like I had missed out on some important experience of motherhood.  I’m so glad I was able to experience it, but it was no cake walk.  The recovery has been so much easier this time around than after my C-section, so that is really the best part.

Ayla is such a wonderful baby.  She is much more laid back than her big sister, but insists on being held (mostly by me) pretty much at all times, which makes it hard to get anything done.  I’m not the type of person who does well just sitting around when there is work to be done, so maternity leave has been a bit of a challenge for me.  It’s also been a huge struggle trying to be a parent of two children.  Anika has adjusted well to being a big sister, but I can’t be in two places at once, so I often find myself torn between helping Anika and feeding the baby.  And Anika loves to give her baby sister hugs and kisses, but tends to pick the worst times to do so – while Ayla is sleeping or in the middle of a crying fit.  Nonetheless, I am so blessed to have two such amazing daughters.  Every day I enjoy seeing them interact, and I hope they will grow to be close sisters.

The biggest challenge for me with having a newborn is breastfeeding.  I feel like this takes up all of my time and energy.  It keeps me up most of the night, sometimes only getting an hour or two of sleep total.  I worry about going back to work.  Pumping will be hard, especially during my busier rotations.  The sleep deprivation will get worse when I can’t nap during the day and I’m working 60+ hour weeks.  And it will be very hard for me to continue to eat and drink enough to keep up my milk supply, especially when I’m burning more calories running around the hospital.  But I’m slowly building up my freezer supply so I will be ready with milk for Ayla when she starts daycare.

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I’m also officially in my final year of residency.  It has been such a long haul, it seems crazy that in a year I will be able to get a real job as an attending hospitalist.  I turn 30 years old this week and some people have asked me if I’m sad to be getting “old.”  Frankly, I sacrificed my 20s to become a doctor, and after all that hard work I am excited to enter my 30s when I can finally start reaping some of the benefits! Nick and I have had a lot of discussions about our plans for the future.  It has always been my dream to move back to the Midwest.  Although it will likely mean commuting for Nick, we are hoping I can find a job somewhere closer to “home.”

Nick FINALLY got off the waitlist to be based out of Phoenix.  It couldn’t be better timing.  I’m not sure I could handle him being gone as much as he has been for the past year now that we have two kids.  It’s much more work than I anticipated, and it’s so nice to have him back.

I’m almost halfway done with my maternity leave.  It’s going by too fast.  It has been a nice break from residency.  I enjoy snuggling with Ayla and watching her grow every single day, but I do miss work.  It seems crazy, but I guess I do enjoy being a doctor.  I miss my patients.  I miss my coresidents.  I miss learning about medicine.  I know it will be hard to go back, but I’m definitely not stay-at-home material.  The mommy-guilt gets to me sometimes, but I know I’m doing what I’m meant to do with my life.  I hope Anika and Ayla will understand.  For now, I’m going to continue to enjoy my little break from medicine.  We are heading back to Nebraska for Ayla’s baptism and to introduce her to our families.  Flying standby with two kids should be an adventure, so wish us luck!

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Breaking Bad News

A few months ago I participated in a small group session about breaking bad news.  It was a requirement during my Ambulatory Rotation in December.  During the session people took turns role playing a physician breaking bad news to a patient.  In each activity the patient would react differently, perhaps getting angry or expressing denial, and the doctor would have to respond appropriately.  I attended a similar session last year as an intern.  However, I had no idea that only a month later I would find myself in just such a situation.  Unfortunately, this time I would find myself in the role as the patient.

I suppose that this is as good a time as any to announce that I am pregnant.  My husband and I learned at the beginning of November that we were expecting our second child.  In fact I found out after my second long-call shift in the ICU.  My month of working 28-hour shifts every three days was especially tiring in early pregnancy.  I had lots of nausea, but no vomiting.  And unfortunately, it meant I had to limit my caffeine intake, so some nights felt especially long without some caffeine to sustain me.

In December I crammed for and took Step 3 of the boards, my second board experience while being pregnant.  I felt complete unprepared and left feeling like I had surely failed, but learned later that I passed with flying colors, one more test to put behind me.  I had planned my first OB visit the day before my exam, but mixed up my dates and ended up rescheduling my appointment.

Two days after Christmas I went to see my OB for my first visit at 11 weeks.  Things went well until we couldn’t heart a heartbeat with the Doppler.  No big deal, this happens sometimes this early in pregnancy, so she sent me across the hall for an ultrasound to make sure there was a heartbeat.

As soon as I saw my baby on the ultrasound, I felt such a relief.  I could see one (yes, only ONE!) tiny little baby, wiggling and wriggling around.  And I could see a tiny little beating heart.  Now I could relax, knowing I wasn’t having twins and that the baby had a heartbeat.  But I could also tell something was wrong.  I had multiple ultrasounds when I had Anika.  And this time I noticed the technician was unusually quiet.  Maybe it was nothing.  Not everyone is talkative.  But something felt off.

My suspicions were confirmed a few minutes later when the technician left to go get someone.  I knew who she was getting.  She left the machine on, she didn’t wipe off the gel.  She saw something.  And she was going to get the doctor.  And I knew.  He was going to be breaking bad news.

In walked to the doctor – the maternal fetal medicine specialist.  He introduced himself and sat down.  And I knew exactly what he was doing.  I recognized every step, every technique.  He fired a warning shot.  My ultrasound was abnormal.  He spoke slowly and clearly, trying to let his words sink in.  There was fluid.  Fluid where it shouldn’t be.  Fluid around the brain.  Fluid around the spinal cord.  My baby had Hydrops.  He showed me on the ultrasound.  He asked if I understood what he was saying.

My mind flashed back to medical school.  I remember learning about it.  I couldn’t remember all the details.  But I knew it wasn’t good.  I also knew that, based off my training, I was probably going to forget most of what was said for the remainder of the visit.  I tried to focus.  I held back the tears.  I asked him what exactly that meant for my baby.  Probably a chromosome abnormality, such as Trisomy 13 or 18, possibly down syndrome.  Or it could be a cardiac defect.  Again, I remembered learning about trisomies in medical school.  I had vivid images of deformed babies with cleft lips or one eye.  I asked what the next step was.  A blood test, he said.  This would tell me my risks of chromosome problems.

And then I asked what I dared not ask.  With this ultrasound, what were the chances my baby would be born without any problems?  He said, “Well, that would be very rare.”  He asked if he could call anyone for me, as I had come to the visit alone.  My husband was somewhere in-flight to Cancun for his 30th birthday.  I had no one to call.  I was alone.  He was very kind.  He said I could call tomorrow if I forgot anything he said or thought of anymore questions.  And I knew at that moment that he did a very good job of breaking bad news.  He had done this before.  But it didn’t make it any easier.

I sat sobbing in the waiting room to get my labs drawn.  I looked around and hoped that no one would recognize me.  This was my hospital after all.  They called patient after patient while I saw with tears streaming down my face.  Couldn’t they see which lab they were drawing?  Wouldn’t my lab take precedence over everyone else’s CBCs and BMPs?  I just wanted to go home and cry.

I cancelled my afternoon clinic.  I felt guilty knowing my patients would need to be rescheduled, but I knew I couldn’t go.  I tried to call my husband, but I couldn’t reach him.  I texted my family and close friends.  I asked for prayers.  And I knew I shouldn’t, but I started to research Hydrops.  The prognosis was poor – 50-90% chance of fetal demise, and only around 40% of babies who were born survived to 1 year.  I researched every possible etiology of Hydrops – Edward syndrome, Patau Syndrome, Downs Syndrome, Noonan Syndrome…you name it.  I didn’t even know what to hope for.  What was the best case scenario in this situation?  A heart problem?  Miscarriage?  I felt so confused.  I couldn’t imagine burying my baby.  But I couldn’t imagine a baby with special needs either.  No matter which scenario I imagined, I knew that I couldn’t handle it.

I was finally able to reach Nick later that night.  I felt horrible breaking the bad news over the phone on his birthday.  And he felt horrible that he was so far away, and I was alone with such news.  He was able to fly home several days later.  We cried together while we waited for my test results.  It took a week.  The longest week of my life.  But we had good news, the labs showed that we had low risk of chromosome abnormality.  And it also showed that we were expecting a girl.

We met with the MFM specialist a week later.  He scheduled another ultrasound.  In the meantime I asked for prayers from everyone I could think of.  We had hundreds of people – friends, family, complete strangers – praying for our baby girl.  We needed a miracle.  And if God wouldn’t grant us a miracle, I just asked for strength for whatever lay in store.

Nick was able to go with me to my next ultrasound.  I held my breath as the technician looked at our baby.  Her little heart was still beating.  She was kicking and sucking her thumb.  It was a relief just to know she was still alive.  I felt a sense of hope.  This time the technician was very talkative.  That’s a good sign, I thought.  But again, she left to go talk to the doctor.  Again, I became worried.  That was never good.  She returned a few minutes later, without the doctor.  She sat down and said she had discussed the ultrasound with the doctor.  They had compared it to our previous ultrasound, and he said that the baby looked completely normal.  Whatever had been seen on the first ultrasound, was completely gone.  She said that the doctor couldn’t believe it and told her, “They must be saying a lot of prayers.”  In all her years as an ultrasound technician, she said, she had seen a number of miracles, and she was glad that they were still happening.

As I sit typing this I can feel some tiny baby kicks.  Something I thought I may never get to experience.  I feel so blessed, so lucky.  So many people out there don’t get the miracle that we did.  I know that anything can happen, and I still have five months to go before I can hold my baby girl, but so far things are looking promising.  I have more ultrasounds and a fetal echo ahead, just to be sure.  I am grateful for the physician who had to break the bad news to me.  Having been in his shoes, I know it’s not an easy job, but someone must do it.  Now that I know how it feels to be on the other side, I hope that it will help me be more understanding and more empathetic the next time I’m called upon to break bad news.

Baby girl Howard - Due July 16

 

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Senior Resident

I believe I’ve set a new record for the longest time between blog posts.

I haven’t forgotten that I have a blog.  I actually think about writing quite a lot these days.  But it seems every time I sit down and try to write about my life, the words just don’t seem to flow.  Where to start?  What to say?  What not to say?  And after a few minutes of staring at the screen, I give up.

But today is the day.  Today, I write.  But again, where to start?

I’m a senior resident now.  Actually, I’m almost halfway done with my second year of residency!  It’s amazing how time flies.  I can still remember my first day as a new intern in the ICU.  I remember asking one of the nurses to stop referring to me as “Dr. Howard” because it was giving me palpitations.  And yet, just last month I found myself back in the ICU, as a senior resident, taking care of unstable patients, running codes, placing blind central lines, and basically kicking ass.  It’s amazing how far I’ve come.

Being a senior resident was terrifying at first.  I started off the year as night float senior, covering both brand new night interns as well as running the cardiology service overnight.  I was scared.  I felt so unprepared.  And yet, I wasn’t.  I was ready.  I knew what I was doing.  Somehow, after only a year of training, I had learned how to be a doctor.  I knew how to manage patients.  Most of the time, anyway.

And as I sit here typing this, I realize I am halfway through my residency, and I have so much yet to learn.  So many things I have yet to know, before I graduate, and I’m on my own.  With no one to check my mistakes.  With no one to guide me in the right direction.  And I’m again, terrified.

But the days are long, and there is no time to sit and worry about the future.  I barely know what my plans are for tomorrow.  Every day is a constant battle to keep my head above water.  To eat three meals a day.  To make sure that no one runs out of clean underwear.  And to make sure that there is still milk in the fridge.

Anika is 3 1/2 years old now.  She is the boss.  She runs the show.  She is cuter than ever, and she knows it.  She brings so much life and joy into my world, and yet she drains me of my energy and my patience with her strong-willed persistence.  I hope she never loses it.  But I also hope it isn’t the death of me.

Nick got a job as an airline pilot working for SkyWest.  He spent 2 months this summer in Utah for training.  And now he is based out of Detroit, on call for 3-4 days at a time, living at a crash pad, and coming home sometimes just for 24 hours a time.  I rarely know what city he is in, let alone what time zone.  I miss having him by my side, to help with the chaos.  We hope it is only temporary, and that eventually things will settle down.  We hope he can be based in the same city in which we live.  And we hope that we don’t end up strangers.

I have to take Step 3 of the boards in one week.  Yet another board exam.  That I haven’t studied for.  No matter which hurdle I jump over, there seems to always be another right behind it.  But today I finished a blog post!  And I call that a win.

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Numb

I’m sure you’re wondering what I’m up to.  Wondering if I’ve forgotten about my blog.  Wondering if maybe life as intern just got so busy and hectic that I could no longer find time to write.  I haven’t forgotten. And I’m not too busy.  Lately I just haven’t been able to find the right words.

Life as an intern is almost over.  It’s been a long year.  And I want nothing more than for it to end.  I started the year as a bright-eyed new doctor, looking forward to seeing patients and learning the ins and outs of patient care.  But slowly through the year, I’ve grown tired.  Physically.  Emotionally.  Just, tired.  And this month especially, as I am working in the ICU (Intensive Care Unit), I find myself feeling a little burnt out.  Numb.

Being an intern, being a doctor, is so much more than I ever imagined.  More difficult.  More tiring.  More consuming.  More challenging.  More of everything.  One minute can be thrilling and exciting.  The next can be emotional and terrifying.  And I just don’t feel like I was prepared to feel this way.  Medical school taught me a lot about medicine.  But it didn’t prepare me to deal with the emotions that come along with a life in medicine.

Nobody prepared me to pronounce the time of death on a patient.  Nobody prepared me to put in orders for “comfort care only.”  Nobody prepared me to call someone’s family and tell them their loved one is dying.  Nobody told me how to deal with the fact that I was the last person someone ever spoke to.  And nobody ever told me how to deal with the haunting feeling that maybe if I had done something differently, maybe if I had been a better doctor, my patient might still be alive.

So most days I’m left to myself.  Left with my thoughts.  Left with my feelings.  Left with my worries.  And the worst part about being a doctor is, that you feel isolated.  You feel like you can’t talk to anyone, because how could they ever understand.  When I come home after a 14 hour shift where I spent half of those hours managing a dying patient, how am I supposed to tell my husband about my day?  How can I explain to him that I don’t want to talk about it?  That I can’t talk about it.  That I just want to forget.  That I just want for it to never have happened.

Believe me.  I’ve thought about writing.  I’ve thought about how to explain everything I’m feeling.  But there are no words.  There is nothing to say how this feels.  There is nothing that can make it better.  It is what it is.  This is what being a doctor is like.  And some days, I just wish I wasn’t a doctor.  I wish that I didn’t have to know what this feels like.

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Limitless

There is a limit to what people can take.  In my short time as a doctor I’ve seen a lot of people who have reached their limit.  Their body, their mind, their spirit has had all it can take.  I’ve met people whose body hasn’t reached its’ limit, but their spirit has.  And I’ve seen people whose body has reached its limit, but their spirit is still going strong.

This month has probably been my most difficult month as an intern.  This month I have been rotating at a different hospital.  I started off the month by getting sick with a bad cold.  Of course I didn’t want to call in sick my first day at a new hospital, so I toughened up and pushed through.  The commute to this hospital is more than double what I’m used to, so the hours have been long.  I’ve been getting up about 4:30 every morning and trying to be in bed before 8:30 every night to get a decent nights sleep, especially trying to recover from being sick.  And I’m really outside my comfort zone.  It’s a different hospital with a different computer system and different policies and different practices, and it’s been a steep learning curve.  Meanwhile I’ve had some really, really sick patients who I’m responsible for taking care of, while struggling to take care of myself.

But this month I’ve met some amazing individuals.  Some amazing physicians.  Some amazing patients.  And some amazing physician patients who have reminded me that every day is a gift.  They remind me that even doctors get sick, and that good health isn’t guaranteed to anyone.

One evening I was leaving the hospital quite late, and I stopped to see one of my patients before I headed home for the evening.  Being a physician himself, he felt compelled to have me pull up a chair so he could give me a lecture on physician burnout.  I appreciated the advice, but couldn’t help but see the irony in spending 30 minutes at the end of a long day talking about physician burnout.  But his advice was this: find something in life that makes you happy and find time to do it.  And if you need help, never be afraid to ask someone.

Some days I feel as if my mind, my body, and my spirit are at their limit.  Some mornings I can’t imagine getting through the day.  It takes so much energy and effort to get out of bed and spend the entire day taking care of others.  But then I see my patients.  Those whose bodies can take no more, but their spirit drags them onward.  They refuse to give up, no matter how terrible the odds.  They inspire me.  And I know I haven’t reached my limit.  Not yet.  They’re the reason I can get through the day.

Being a doctor is such a strange profession.  Every day is new and exciting.  Every day I meet new patients who teach me something.  No day is predictable, and no two patients are alike.  Some days I wonder what I’ve gotten myself into.  And some days I can’t imagine life any other way.

I feel so extraordinarily blessed to do what I do, and there is no limit to what life has in store.

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What I Love About Being an Intern

As promised in my prior blog post, I’ve been trying to focus on the good in my life.  This month of ambulatory rotation has been a much-needed breath of fresh air.  I’ve caught up on my sleep.  I’ve been cooking and baking.  I’ve cleaned my house.  My Christmas letters will go out in the mail tomorrow.  And I’ve had time to regroup.  I feel a little more like my normal self and a little less like an “intern.”  In short – working forty hours a week agrees with me.

So as I near the half way point of my Intern year, I wanted to share a few of my favorite things about being an intern.

1. Being Dr. Howard

Now I’m not saying this in a snooty, please-call-me-doctor way, but being Dr. Howard instead of “justthemedicalstudent” is definitely a step in a positive direction.  At least it means the nurses take you seriously.  Well, maybe not seriously, but they sure seem like they listen.

2. Increased medical knowledge

I have learned so much in the past 6 months.  And in such a different way than I did during medical school.  Every day I learn more and more, and it’s exciting to go to work and never feel bored.

3. Friendships

I love my fellow interns and residents.  My favorite part of the day is hanging out with them.  Getting along with the people I work with makes work so much more enjoyable.  I can’t imagine spending 80 hours a week with people I hate.

4. Level of Responsibility

So this might seem counterintuitive, but I enjoy being low on the totem pole.  It’s nice to know that I have a senior resident and an attending above me to make sure I don’t mess up.  From this point on my level of responsibility is only going to increase to a point where I am solely responsible for my patients and my patients’ lives.  For now I’m going to enjoy the fact that I have help.

5. Support

One of my favorite things about being an intern is how much support I have.  Not just from my family and friends, but from all of the people I work with.  I’m so blessed to work at a place where people encourage me and inspire me every day to work hard and be better.

Being an intern is hard.  But I’m half way done.  And in 6 months I will be a senior resident.  Which, honestly, sounds even harder.  I hope I’m ready.  For now I’m going to count my blessings that I’m an intern.  Because it isn’t all bad.

Just a sample of some of my baking this month

Just a sample of some of my baking this month

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Doctor and Pilot: A Love Story

I recently celebrated my 6th anniversary with my husband, Nicholas.  I can’t believe we’ve been married for six years!  We got married when we were both 22 years old, which to most people, seems very young.  We dated for 10 months before we got engaged, and we got married exactly one year later, which to most people, seems very fast.  But marrying Nicholas was undoubtedly the best decision I’ve ever made.

We started dating in college.  The first time we discussed marriage, I told Nick that I wanted to wait until I was finished with medical school before getting married.  That quickly changed as I realized that Nick was the one for me.  We weren’t even finished with college by the time we got married!  But Nick knew from Day 1 that I wanted to be a doctor.  He never questioned it.  He never asked me to reconsider.  When I got my first rejection letter, he was the one who encouraged me to try again.  He was there for me during interviews and when I finally got accepted.  He moved to the middle of nowhere Missouri with me for the first two years of medical school, and then he drove halfway across the country in a moving truck with me for my last two years.  And now that I’m in the most difficult year of my training yet, he watches our daughter when I work nights or weekends.  He cancels flights and rearranges schedules to pick her up from daycare when I have to work late.  And the only thing he has ever complained about is that he just wishes he could spend more time with me.

The life of a doctor is not a simple one.  It’s not an easy one.  And it’s not one that many people understand.  Being a doctor is one thing, but being married to a doctor is a different thing entirely.  I’m not sure if Nick knew what he was getting himself into when he married me.  Sometimes I question whether or not he did.  How could he know our life would be this crazy and chaotic?  Would he still marry me if he did?

I’m so proud of my accomplishments in life.  I worked very hard for years and years to become a doctor, and every day is a struggle.  But being a doctor is nothing compared to being a wife.  Being a wife is probably the toughest role I have.  It takes the most work and the most effort.  And it usually falls lowest on my list of priorities.  I have patients to take care of at work.  I have a daughter to take care of when I get home.  I have a house to clean and bills that need to be paid.  And at some point I just need some “me” time.  It’s so easy to forget to make my husband a priority.

I don’t know how I got so lucky to find such a supportive man to marry me.  Our marriage has endured more than most in these past six years.  It seems impossible that a pilot and a doctor could ever make it work, but I wouldn’t trade my husband for anyone else in the world.  I think someday when we are old and grey we will look back on our marriage together and wonder how we ever did it.

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