Work update!

I have a new job!

I still have my old job too.

Since I returned to work I’ve been seeing patients in the office 4 days a week, the fifth day is a day of appointments- therapist, chiropractor, acupuncture and general mental well being. I took a significant pay cut to work this schedule, one that kept me out of the hospital, and I am thankful that my practice was able and willing to accommodate me. But the “(when) will I go back to births” question always hung over my head. When I first asked to be an office-only midwife, I left the door open to return to birth, but with no time line. I still like having that option, but my practice needed something a little more definite. I honestly thought I’d be back by the holidays (Thanksgiving and Christmas) so I could repay my co-midwives for unexpected holiday time they put in for me last year. But I soon realized that goal was unrealistic. It caused me a lot of stress to even hear my co-midwives even talk about holidays and schedule, knowing they had more to do because of my absence from the hospital. When the topic came up at our winter midwife meeting, I conveniently had to use the bathroom at that moment. In addition, my practice wanted to know whether they should hire another midwife to replace me or if I’d be back soon. Well I finally was able to give them an answer.

As of April first I took on a part time position as Program Director for Hope After Loss, my local non profit helping those who have experienced pregnancy and infant loss. The organization runs peer-led pregnancy and infant loss support groups in four towns, does outreach and education to hospitals, medical providers and anyone who asks, and provides burial or cremation financial assistance to those who cannot afford it for their babies.

Taking on this new position means I plan to remain in the same capacity at my other midwife job- no call. I gave them the go-ahead. Hire another midwife! Takes a huge burden of guilt off my shoulders. I know my colleagues are sad to hear I’m not doing birth in the near future and I’m sad too- there are some things I miss about it, certainly the hospital staff I almost never see anymore! But I know I’m not ready. Some may call it avoidance, but I call it self-preservation. I need to still work on enjoying midwifery in the office and finding fulfillment there before I can return to joyful birth in a place that holds so many memories for me.

This wonderful new part time position has kept me a busy bee these past few weeks, hence my absence from the blogosphere.  But my dear friends, I have missed you!  And I”m trying to be back.  I have much to tell.

Hi from the silence

Hi, I say meekly.

I’ve fallen off the map.  Everyday I want to write, I want to connect with the community that has held my hand through the past year and a half, I want to tell you all what’s in my head.

I’m ok.  I just wanted you to know that.

I”m just swamped!  I’ve taken on a second job, which I”ll write more about as soon as I can rightfully.  I feel like I have so little time- most of it I try to stay on top of reading other’s blogs so I feel more connected.  But the longer I stay away from writing, the harder it seems to restart.

So for now, I’ll write just a snippet.

Today I was at the dog park and there was a woman there with a teenage girl with Down Syndrome.  She had dark hair and glasses, very high functioning with good conversation skills from what i could overhear.  I so so badly wanted to tell both her and her mother about Mabel.  I wanted to talk to the girl- get to know her.  We exchanged a few words- about our dogs and about a lady who was holding her tiny dog in the pouch pocket of her sweatshirt.  I hung out close to them, trying to figure out how to start more conversation, but then it was time for them to go.  That sweet little interaction made my day.

Validation at work

“You’re really good at this!” she exclaimed as we finished up her visit. I had just put in a Nexplanon in her arm (a small subdermal form of birth control that lasts 3 years). It’s popularity is growing, mostly in my younger patients, who love the idea of something easy and long acting.

I smiled somewhat sheepishly. “Thanks!”

“No really, I mean it,” she went on, with her teenaged enthusiasm. “You’re so thorough and just really friendly. I’m so glad it was you who did this. You’re really good at your job, you know. It’s so cool, finding something you’re good at.”

Her words were well timed. I often have so many doubts about my place at work. Some days I feel like an empty shell. I smile and say all the encouraging words that I’m supposed to, but then go how and stew over things people say, especially around pregnancy. It doesn’t feel good to be “faking it” all the time. But on a visit like this, it was really easy. I love my teenaged and early 20s patients. I’ve made it known in my practice that I have a special interest in the adolescents, so my staff and fellow colleagues often book patients in that age range with me.   I need these patients right now- they remind me (even without them saying so) that I enjoy parts of my job, that it can be fulfilling and that I can find meaning in it.

“Thanks,” I told her more earnestly. “I sometimes need to hear that. I do love my job sometimes.”

She jumped off the table, her arm neatly bound by the pressure dressing, and I knew she’d be back next year to see me.

A few patients later, I sat in front of one of my prenatal patients. She comes weekly for an injections that helps prevent preterm labor in those who have already had a preterm birth, so I’ve see her frequently. Last time I saw her, she had been struggling terribly with heartburn that made her vomit and caused bad headaches after. She had exhausted all the over-the-counter and lifestyle changes to try to combat her discomfort without any relief. Las time I tried a non-traditional medicine- one for nausea that helps with headaches, though not usually used for heartburn. I told her I was unsure it would work, but worth a try because the safety was well established and her symptoms were non traditional.

Now, two weeks later, I asked how she was doing. She told me the new meds still didn’t help. She had waited to talk to me about it, avoiding the topic at her last visit with a different provider.

“I think it’s time we try a prescription heartburn medication,” I said. I explained how the medication is “category C”- a category given to medications to rate their safety in pregnancy. We usually try to stick to category A and B medications and take category C medications on a case by case basis. In her case, I think its worth the risk (not that there is established risk, simply many of the category C medications there is just not enough information).

“See, this is why she’s my favorite,” she turned her head and was speaking to her husband and brother in law who tagged along to the visit. “She explains everything and really tries to help.” She looked back at me and continued, “let’s give it a shot. If this doesn’t work, then really, I’m just going to have to deal. I don’t have that much longer anyways.”

I smiled for several reasons. Her compliment, like my other patients, was well needed, especially coming from a pregnant woman. I also appreciated her attitude- she felt like she didn’t have that far to go, she could put up with discomfort if she had to. She was 24 weeks and had plenty of time to go. I know so many patients who feel like the last 3-4months are an eternity with their discomforts, and here was this woman who understood the transience of pregnancy and recognized that sometimes we just have to put up with discomfort to simply be pregnant. It was a relief for someone to understand that. I put up with many discomforts during Mabel’s pregnancy- and though I might have mentioned some of them to my providers and friends, I always tried to make the point that I wasn’t complaining, just stating- because really I was just so grateful to be pregnant. Every day I had still pregnant was a gift, considering how high my risk for loss was. Even without that risk, I do truly believe everyday being pregnant is a gift. I just wish some of my patients realized that.

What gets you through the days? Where do you get your validation?

“Healed”

Healing. It’s a word we use frequently when talking about grief and I don’t particularly like it. My therapist pointed it out when she used the word and I stiffened. My issue with the word is that it connotes an end. We use it in medicine to talk about how someone gets better, and in a way this is applicable. As we move through our grief, we function better in society, we come to terms with the unchangeable fact that our babies are dead and we begin to find enjoyment and fulfillment in the world around us. But… and it’s a big but…in my medical world we declared someone healed- their uterus is back down to normal size, their stitches have dissolved and their milk has dried up- they are healed. In grief, there is no end. There aren’t even any concrete steps. Going back to work, holding babies, getting to the one year mark- these are things we do, but it’s not clean cut. When I went back to work, I shook, I cried, I took Ativan just to get through the door. Now I move fluidly through my day, rarely crying for my own situation. But there was no discrete time point when I went from being barely able to function to now. It was gradual and I still wouldn’t say I am in a great place. I recently came across this post and loved how he used the word adjusting to loss. A more apt term.

As Mabel’s one-year mark approaches, I think people have certain expectations. One year, I should be healed. I worry that expectations at work will change, that people will think somehow getting through the anniversary of my daughter’s birth and death somehow means something huge. That somehow the difference between February 15 and 16 will be significant, when really it’s just another day in the process. I remember reading early in my grieving this post (I can’t seem to link it directly.  click on http://glowinthewoods.com/  –> at the kitchen table –> scroll down to the post entitled “Tick Tock”) and taking away the message that it can take up to two years to integrate babyloss into your life. (I like how they used the word integrate and not “healed”). Two years! I thought. How am I going to survive two years!?! I thought I wanted to be healed right away, but now I can see I really just simply wanted to stop feeling the pain so acutely. Those early days were rough, weren’t they?

I still stiffen at the word “heal.” I think when those within the babyloss community use it, there is subtext. We know we are never healed from our children’s deaths, but it signifies we are functioning in the new world, the one without our babies. When those outside of our community use it, I can’t help but feel a little resentment, believing they think there is a true endpoint in our grief.

Where are you in your loss timeline? What do you think- are you healed? How do you feel about that word?

Alumnae Magazine

Back in July I received an email from my class rep from my alumni magazine. At the end of each magazine, there are class notes, where people write in and tell a tidbit about themselves. It’s organized by year and every month it’s the first section I turn to, to see if I recognize any names. I’ve never written in myself. I weird felt- like I had one chance to do so, because otherwise who wants to be reading the same names over and over. The paragraphs are filled with my overachieving classmates and their marriages, their children, their lawyer or doctor jobs, their start ups, their amazing trips around the world. In the midsts of all the humble brags I love finding morsels about people doing less typical things. I am mostly annoyed by what I read, yet still am drawn to it.

This summer an email appeared in my inbox aimed at those of us who lived in our freshman dorm. It was a smart tactic- I certainly gave it more thought since I was asked rather than just volunteering info.

What are you up to these days?  Whatever you want to share is welcome. Although family and work news is always great, I (and your fellow ’02ers) would also enjoy hearing about hobbies, travel, get-togethers with other ’02ers, and commentary on 30-something life. It doesn’t have to be written in third-person or otherwise edited/print-ready either; that will be done by me and a series of copy editors following me, so feel free to hit reply and send me a quick note!

When I first read it, I thought “Hah! Family and work is what 30-something life is often about!” It is for me, at least. The request came at just the right time. I spoke to Chris and he was supportive so I replied:

I am currently living in Connecticut and working in the New Haven area as a nurse-midwife.  This year my husband and I welcomed our first child, Mabel. We knew she would be born sick, but we remained hopeful.  She lived for six precious hours after birth.  Lately I spend my free time blogging about my grief in hopes of advocating for others who have also experienced baby loss and hoping to increase awareness for bereaved parents.  

My class rep responded so appropriately with the right kind of “I’m so sorry” and asking if my blog was public so she could read it.   She said they don’t usually publish websites, but she’ll see if the editors would in this case.

So this month I opened up my magazine and found my name in bold among the wedding and baby announcements of my doctor and lawyer classmates. I was four months younger in my grief when I wrote it, just starting to feel the desire to speak up- really speak up- about my grief. I was nervous, thinking I’d be perceived as a Debbie downer or attention seeker. At the same time, I was angry at the injustice of the social pressure I felt to not share about the birth of my daughter which was followed quickly by her death. I had the same right to share baby with my classmates too! So now, with many months of speaking up under my belt, I’m so glad I to took the risk.

Have you taken any risks that paid off? Any that didn’t?

IMG_5591

The Office Cleaning Lady

“You, baby?” she asked me in her broken English.

At first I wasn’t sure exactly what she was asking. I’m embarrassed that I don’t know her name. She and her family have cleaned our office for several years now. I think it’s a family- a husband and wife with two teenaged kids. One of the kids sits in the waiting room and plays on her ipod; the other helps take out the trash. They are always friendly, greeting me with broad smiles and asking politely if they can empty my trash can.

I only run into them if I’m at the office late enough. My last patient is usually scheduled at 4pm and they come after 6pm. I commonly spend a fair amount of time after I’m done seeing patients catching up on my notes from the day, calling patients back and reviewing results. Leaving the office at 5pm is a rare treat.

Today I found myself the last person in the office, everyone eagerly taking off to attend a work party. I heard the familiar sounds of our cleaning crew walking the hall and knew how late it was without checking the clock. The woman, the one I have designated the mother, leaned into my office and said as she reached for the trash can,

“You, baby?”

I let the question settle, marinating in my mind with all possible meanings. But I knew what she was asking.

“Did I have the baby?” I confirmed her question.

She nodded her head vigorously, sweetly, still smiling her excited smile. In the past few years, this woman has noticed me as much as I noticed her. She watched as my belly ballooned- clearly big enough to silently announce my expectant status, but not too big because I’m tall and I had no fluid. And then I disappeared from her evening cleaning rounds for several months. Now that I am back, she recognized me without my protruding belly. She asked such an innocent question in those two words, expecting a happy answer. It’s a question I have gotten numerous times now, and I almost hate answering it. Not because of the pain it causes me. It causes me no more pain to talk about my baby. Saying the words “my baby died” doesn’t make her more dead or make me suddenly remember that she died, as if that were something I could ever forget. I hate answering the question because I know I’m about to disappoint someone.  Her polite interest and good memory will be rewarded with a sad story and the awkwardness that follows.

“Yes.” I responded when she nodded her head.

“Boy or girl?” she continued.

“A girl,” I said with a smile. Maybe it will be one of those conversations that just end there.

“Ooo!” She cooed excitedly, “How old?”

“She would have been six months.”

“Six months!” The glimmer of excitement that comes with talking of a new baby was still in her eye. I could tell she only understood the time frame and the subtlety of the past tense was lost on her. I could have left it at that, but I pictured future encounters where she would ask again about the baby.

“She died,” I said gently. It took her a moment to understand. It was a rare treat to observe the transition from lighthearted excitement to surprise and sadness on someone’s face as she absorbed the news. The language barrier gave me a few extra beats to watch as understanding dawned on her.

“oh…sad,” she said and her broad smile turned into a genuine frown. It was almost cartoonish in how pronounced it was, but it was still natural on her truly expressive face. She smiled big and she frowned bigger.

There were few words between us, but there was understanding.

This interaction was neither good nor bad for me; it just was. I told this to Chris when he picked me up from work. I just needed to share it.

How’s work?

How’s work?  They all ask.  I don’t know how to answer just yet.  Work is.  It’s uncomfortable, to say the least.  I spend most of my time so far doing computer work, but I have spent time seeing a few patients and shadowing one of my docs as I get in the swing of things.

********

The sign I posted at the check in window:

“There has been a loss in the Greater New Haven OBGYN Community

One of our midwives, Meghan, gave birth to her daughter, Mabel, on February 15, 2014.  Meghan knew her daughter would be sick, but she was wanted and welcomed with love.  She enjoyed her pregnancy, despite a poor prognosis and hoped she would bring her baby home.  Sadly Mabel lived for only six precious hours.  Our sympathies are with her and she wished for us to share the news with the community here.  She enjoys talking about her daughter and welcomes questions and comments.  Thank you for your kindness and empathy during this difficult time for her. “  [insert photo of Mabel]

*****

Once her visit was over and the focus was not on her anymore, she turned to me in the hallway and said “Congratulations!”  I thanked her with a smile.  “How’s the baby?” she asked.

She had not seen the sign I had posted at the check in window.  I stopped walking and paused.  There was so much in that pause.  Such a simple question, the pause itself said it all.  I had been preparing for this question for the past four months.  It was showtime.  I was now a few steps behind her and didn’t want to have to raise my voice for my practiced answer.  I resumed walking and when I got closer I said after my long pause.

“My baby died.  But thank you so much for asking.”

I gave her a quick, awkward smile, in an attempt to make her feel more comfortable after such disconcerting news.  I don’t know if she said anything.  I didn’t even see the look on her face.   I turned around and retreated to my office.

*******

“How are you?”

When I entered the room I said I knew that she had been scheduled to see the doctor, but since I happened to be back, was it ok if I saw her, because I knew her.  She was happy to acquiesce.  She asked, “how are you?” in the casual, chit chatty kind of way.  Oh, what a hard question to answer.  By the way she asked, I knew she hadn’t seen the sign.  “Fine,” I said, as happy as possible.  Fake it till you make, my therapist had instructed me.  We continued the visit making small talk about her and the events in her life.  Thus begins the lies.  They are not lies exactly; they are just not truths.  People talk about white lies, but I would consider this a professional lie.  When a patient asks me “how are you?” as part of the introductory small talk, I can’t say- “Well, I’ve just had the worst few months of my life, living through one of life’s greatest tragedies.  And now I’m back work in a place where I’m constantly reminded of what I have lost.  So I’m feeling pretty crappy right now, but thanks for asking!”  So I will say “Fine.  Ok.  Good.” Minus the sad intonation I have used with others outside of work, to remind them that I am not fine, ok or good.  I will answer with a polite cheeriness that is not the truth.  It is not the truth, but it is the right thing to do.

*******

In the middle of the visit she turned to me and said, “Congratulations! Did you have a boy or a girl?”

“A girl. Thank you.”  I gave her a genuine smile.  I love when people ask about my baby.  I was also on edge, waiting for the next question.  But there was no next question.  She smiled and we went back to the visit.

******

As I walked her daughter out to the waiting room, she saw me and I could see that look of unease- worry about what to say, how to handle the awkwardness of acknowledging that my baby died but being sensitive at the same time.  She said “hi,” but the word was split into two syllables, “hi-i” with the second syllable dropping down in tone, like a sigh.  She had read the sign.  “So I heard what happened…”  Her eyes portrayed sincere sadness, but I was left somewhat speechless.  How do I respond to that?  My go-to “Thank you” would have been inappropriate; she didn’t offer condolences.  So I just said “Yup.” in that same two-toned voice she used earlier with me.  Awkward silence ensued and I quickly broke it, directing the conversation back to her daughter.