Reflections from Night Float

Last night was the last night shift of my medical school years. I welcome the end to sleeping in this secluded, deserted at most times, yet noisy call room.  

Creepy is the best word I have for these rooms. 

I will not miss the lack of blankets and pillows, nor will I miss scavenging questionably clean pillows and sheets.  I will not miss the exhaustion or the emotions that come with combining sleep deprivation and missing my little family. Missing bath time and bed time. Missing snuggling with my husband in a real bed.  Instead, to sleep on a cast-off hospital bed circa 1960. To be woken up by street noises, a mysterious person coughing, my own discomfort, a confused sleep cycle, or the nightmarish sound of a beeper going off. 


A myriad of memories are swirling through my head. My husband and sister-in-law bringing my son to hang out with me on trauma call until I got the first page of the night. Eating dinner at this table with them a little less than a year ago. 

Breast feeding Liam and him dozing off in my arms that night. The joy I experienced as I felt his little warm body against mine and listened in awe to his deep breathing, marveling at this perfect creature that was my very own son. 

Pumping later during the night because my milk production was off from being up at night. Walking a quarter of a mile through a very deserted hospital to get to the appointed refrigerator to chill my milk. 

Stumbling about the same distance to get to the ER, after the beeper jarred me awake, sleep blurring my eyes as I willed my body to wake up. 

And finally, last night is now a memory too. My wonderful husband brought my son and Chick-fil-A to celebrate this, my very last night at the hospital.  I remember my feeling of triumph.  Much like that feeling of crossing the finish line in a long race that you weren't so sure you would make it through. I can't imagine how amazing it will feel to be completely done in three weeks! It's so strange how time flies when you look back but drags on in the moment. At any rate, my night shifts are over and Spring Break is upon us! 

                                     

The Mommy Side of "Routine" Surgery

My son got ear tubes today--bilateral myringotomy with tympanostomy tubes in medical jargon.

I watched dozens of these surgeries when I was a third year medical student rotating through Pediatric ENT, which was actually a surgical subspecialty I enjoyed.  I'm really not a surgeon type, in case you couldn't tell. Wearing hot scrub gowns and masks while holding retractors all day is not my image of paradise.  But ear tubes and tonsillectomies were pretty cool.  First off, you didn't have to gown up so no sweating and having to avoid scratching your face the entire day.  Second, the kids were pretty healthy and super cute before you put them to sleep.  And, last, the procedures lasted 30-45 minutes tops (and this was rare).  Ear tubes were the most minimal of the surgeries.  They take about 15 minutes.  They are very quick and purely routine.  In other words, not a big deal.

Until you're the mom.

From my understanding and experience, ear tubes were usually placed after struggling with many, many ear infections.  Liam had had one that we knew of.  But he had fluid in his ears that may have been there since the fall and he had since started developing a speech delay that was becoming concerning by his 15 month check up.  His pediatrician sent us to an ENT who recommended ear tubes.  To explain why, the ENT told us to stick both fingers into our ears.  That is how my baby was hearing.  His tympanogram backed this up, showing that the ear drum on one side was not moving at all and barely so on the other.  But the ENT also reassured me that I had time to think and decide.  A few weeks would not change anything.

I agonized over the decision of whether or not to have my son undergo this surgery.  No surgery is without risk.  The dangers of anesthesia (though it's really more like sedation in this case and is about as low risk as it gets) are not a joke.  I know about those rare cases where a patient can start breaking down their own muscle in reaction to the anesthesia, get acidotic, overheat, and die.  Of course that's the extreme but some studies are blaming general anesthesia for lost IQ points, increased ADHD and other behavior problems.  And there's the more common and well-known risks of breathing disturbances, aspiration, nausea, vomiting, and headaches.  Then there's the possible complications of the surgery itself: needing more ear tubes, scarring of the ear drum, a permanent hole in the ear drum, hearing loss... the possibilities go on and on.   I knew too much and couldn't help worrying about it.

Different doctors advised us to do different things.  The fluid could clear.  It was almost spring; fluid clears in the spring.  Or he could get retractions and scarring.  But that's rare and the surgery could cause it too...  It was confusing to say the least, but the overwhelming message seemed to be "get the tubes...they will help him hear and feel better.  You won't regret it."

I did some research and found a great article from the AAP that I thought I would share with others who are in the processing phase after being told by a physician that their child needs ear tubes.  Here's the link: AAP Practice Guidelines: Otitis Media with Effusion The article restated what I already knew: that tubes are overused and that the surgery is not without risk.  But there are instances when it is the best choice.  It shared some criteria that have been identified in children to predict better outcomes when tubes are placed.  Liam fit the criteria because he has a speech delay.

 During the period of time (a few weeks) that we were thinking about whether to go ahead with the surgery or not, we started noticing more and more that he didn't seem to hear very well.  My mom tried the blink test by snapping near his ears--no response.  One of my friends tried to get his attention by clapping loudly--not even a flinch.  His speech delay seemed to worsen instead of improve.  He stopped saying "Bubbo" (for our cat Bubbles) and even went through a period where he stopped saying "Mama."

So, we decided. We needed to give him the best chance for building his vocabulary as soon as possible.  I went to his ENT the next day and scheduled the surgery feeling that we were making the right decision.

From my rotation through Peds ENT, the thing I remember the most is actually the part that I dreaded the most.  The part where the kids are wheeled away from their parents, sometimes screaming at the top of their lungs.  Back then, my son was about 5 months old.  With my new-found maternal love, I felt the heartbreak of the parents each time, and I teared up frequently. (The hormones were still flowing strongly...but perhaps they never stop for us moms because I never was a crier but I still am today).  I was thinking how terrible it would be if that were me...

Fast forward a year to today and it was me.

 Liam is a typical toddler and did not wait quietly in the pre-op room.  We roamed the hallway with him.  He was hardly anxious. But I teared up as I saw other kids being wheeled away. I was surprisingly dry eyed when it was our turn.  We had refused the Versed they wanted to use to ease the separation anxiety because I felt it unnecessary to add to the many medications he was already going to receive (much to the disappointment of the anesthesiologist who I could not assure that he would go back to the OR without shedding tears).  But I tucked him in on the gurney with his security blanket and paci.  The nurse pretended the bed was a choo choo train and I advised them not to force him to lay down so they let him ride sitting up.  I clapped for him as they wheeled him off and thankfully he didn't shed a single tear while I could still see and hear him.


Those 15-20 minutes we waited felt like an eternity.  I was just beginning to worry when they called our names.  My husband says I ran to my baby.  He couldn't even keep up (that's saying a lot if you know my runner).

Liam was a champ.  He was the happiest of all the babies that were in recovery (the nurse told us that the distraught baby next to us had received Versed and in his opinion with short procedures like this, it irritates them much more upon awakening due to leaving them with a drunken feeling that they can't shake as the anesthesia wears off).  My baby was pretty happy as he snoozed once I was holding him and he had his paci firmly back in place.  Then, in about 15 minutes, the anesthesia mostly wore off and he woke up. We dressed him and we were off.  He even downed a Mango squeezy snack and some crackers in the car on the way home.

Now, 12 hours later, I feel even more confident in our decision (thank goodness!).  Besides sorely needing a nap when we got home and being a little dizzy and somewhat grumpy intermittently, he has acted pretty happy today.  (Though he despises those ear drops we have to give twice a day!)  He loves his prize from the OR, a pretend sword and shield.

But the biggest thing that we are overjoyed about: our baby boy can hear so much better!  We can already tell.  He's started making new vocalizations (of course no new words yet since it hasn't even been a day).  But there is change.  Even the way he says "uh-oh" is different. My husband described it sounding as if Liam can finally hear himself and can self correct the sounds.  He's also more sensitive to noises. He jumped and covered his ears when I dropped one of his books onto the carpeted floor in our living room (never has he done this!).  He also announced proudly "Uh-ooohhhh!" when the Keurig hissed out my hot chocolate after lunch.  I'm excited just thinking of all the new sounds he can hear now!  I can't wait to hear his precious voice talking to us soon!

How Motherhood Changed Me

Having a baby...it opens something inside of you.  It's almost like the world splits in two, you're so open.  All different sorts of things can rush inside of you, can fill you up.  Some women fill with sadness...it's hard to explain. Loving something so much--you're not prepared.  It's so big, so ancient and animal.  It's terrifying...It can make you feel crazy.
                                                                           ~The God of Animals by Aryn Kyle

Before I had a baby, I was a type-A student.  In high school, I actually read textbooks and studied.  I was that annoying kid that would ruin the curve.  I didn't feel satisfied with getting all A's.  I wanted all A+'s.  (I swear I wasn't a pompous jerk...I was never in your face.  My parents are first generation immigrants so the pressure to achieve was very strong.) And, I was blessed with a brain that had the capacity to learn and a thirst for knowledge so A+'s was what I got.  In high school and college.  Medical school wasn't much different.  There were no A+'s but despite all the terrifying introductory speeches about all of us formerly being the upper crust and how that would no longer be possible, I did it again.  Top student in a few subjects and top quartile overall.  This was what I had been raised to view as success.  I was on track.  My parents were proud, my teachers were happy, and I felt accomplishment and pride in my hard work.

Then, my world shifted.  I was pregnant.

My husband and I wanted kids (a big family at that!)  but the timing was not perfect.  I was in my second year of medical school.  And if you know anything about medical school, you know that the most demanding year as far as hours spent away from home is 3rd year.  I boarded the roller coaster we call pregnancy hormones at this point.  I was up, elated about the thought of a life created by me and the love of my life growing inside of me.  Then I was down, questioning my very ability to be a mother, fearing pregnancy and labor then sleepless nights and active toddler years.... all in the face of the hard months I knew would come before and after my baby's birth.  I also feared losing all of my hard work, of failing, of quitting, of falling off track.

But then time flew (although when I was nearing the end of my pregnancy I would have said time crawled at a snail's pace).  As I began to feel my precious child move inside of me, I bonded in a way that I will never be able to do justice with words.  That baby became my focus.  I spent nights and study breaks organizing, dreaming, decorating, and picking out outfits for the hospital.  I still worked hard during the days (night shifts too) but my heart and focus were already shifting.

Then on a beautiful day in October, my world shifted even further.  The most beautiful (and very loud) baby boy was placed in my arms.  I was a mommy.

This tiny person became the center of my world.

The next days were a blur.  Someday I'll write about all the craziness that went on the week after he was born, but to fast-forward a bit, I spent two months at home, each day fearing how quickly the days were passing.  I dreaded January and starting back to my rotations like nothing I had ever dreaded before (I was one of those kids that actually looked forward to going back to school after long summer breaks.  Not that I didn't love summer but there's always excitement in a change of pace and seeing friends,etc.).

I knew leaving my baby would be hard.  But I didn't know how hard.  I don't remember silly details of that first morning but I will never forget how I felt.  I felt like my world was caving in.  Like I was trapped in some horror movie.  My mom stayed with us the first week and a half so it wasn't that I feared my baby wasn't being taken care of...it was that he wasn't with me.  That base, animal instinct the author refers to in the quote above.  She describes it in horses separated from their foals later in the book:

    After we separated the foals from their mothers, we all stood around, watching their grief.  They screamed and rammed their chests into the fence, running circles in the little pen, colliding with one another in clouds of dust.  Their heads lifted, crying thin, anguished whinnies, slicing the air with their pain...there was nothing {we} could do to make it easier.

I needed to have my baby with me.  The separation felt like torture.   Nothing seemed important in comparison.

I have never been a big crier.  Until I became a working mommy.  I cried on my way to the hospital  every morning for over a month.  And most mornings for months after that.  I lashed out at everyone around me.  Like a wounded animal.  Especially at my husband.  For his love, I am eternally grateful.  His patience seemed boundless at times.  The hugs, the back rubs, the encouraging words...all despite my lashing.  I cried, I screamed.  I claimed that I was being tortured.  I can't imagine what he thought but I honestly was too wounded to care.

I hurt. But who was torturing me? My attendings?  No, they were only pushing me to excellence in a field that deserves nothing less.  My husband?  No, he was my greatest ally.  He was encouraging me so that I could go on not because he was forcing me to continue.  My parents?  While they would have been disappointed if I quit and the pressure to continue was undoubtedly great, I could not blame them.  Then who?  God? No! Even worse, it was a torment of my own devices.

My husband was right (of course).  I had signed on for medicine.  I had wanted a baby during school (granted we were a year early but it really wouldn't be much different intern year). Me.  I wanted all of this.

 That's when I had the greatest realization of all.

I had changed.  Me.  I was different. As a mother, my rosy image of finishing school and working part time once I finished residency had a big flaw.  I had to sacrifice about 5 years of my children's lives.  I would miss out.  And it wasn't until I became a mother that I understood what a great sacrifice that truly would be.  I wouldn't be there to see all the firsts.  These would be reported to me by someone else.  I wouldn't be the primary care giver.  I wouldn't know what soothed my child best, what he ate for lunch (unless I asked), what times he napped, or even what kind of day he had.  All I had was crappy second-hand reports.  I missed the smiles and the coos and the cuddles.  I wanted those.  I wanted them more than what I was spending my days doing.

But I felt stuck.  Expectations (of me, my colleagues, my school, my family) surrounded me.  To quit would waste the time I'd already sacrificed and that was unthinkable.  It was not something I could live with.  So what to do?

After a half a year of torment, I took the boldest step I've taken my entire life.  I stepped off the path.  I decided not to enter residency immediately after I graduate next year.  I am taking a year off.  And for once in my life, that's all I know.  I don't know what lies beyond that...residency?  working from home?  just being a mommy?  I don't know.

But I do know that I get at least a year as a stay-at-home mom.  And I need that.  I need to find myself.  My new self.  My mommy self.  I know she has been in torment these last 12 months.  She deserves a chance to speak.  I need the time to listen.  I don't know what my path will be but I do know that I deserve to find it.