My
experience of the 4th year of medical school has been a whirlwind of clinical
work, late-night writing sessions laboring over applications and letters of
interest, dreams of the next stage of my life as a doctor as I traveled and
completed interviews, and now plans for a move across country to begin my
residency in my chosen field of OB/GYN. Like many, if not most of my
classmates, the intensity of the year left little time to process the personal
lessons learned during this long marathon of hopes, dreams, and hard work. Unlike most of my classmates, this year had
an additional feature in my life: the birth of my first child, my daughter
Margalit Reva. Her birth allowed for a unique perspective; so many of my
experiences were seen simultaneously through the lens of the medical practitioner
and at the same time, the patient. Next year will have its own set of
challenges; so, before I forget, before this year’s lessons lose their potency,
here are some of the lessons I learned:
Lesson Number 1: Giving birth is
painful
While on
one of my interviews, one of the OB/GYN attendings said, “labor is called labor
for a reason”. How very true. But
while an epidural can mitigate the pain during actual labor, no one talks about
the pain afterwards—regardless of if you had a C-section or a vaginal
delivery. As a third year clerk on my
OB/GYN rotation we divided postpartum rounds into two groups: the vaginal
deliveries and the C-sections. And we
were taught, rightly so, to pay careful attention to the C-section recovery:
they had undergone major abdominal surgery and needed to monitored more closely
and for longer than their vaginal delivery counterparts. And because of this, I worked under the
assumption that vaginal deliveries were no big deal. That you just “bounced back” immediately
following delivery. When my OB came to
discuss my postpartum instructions the morning after I delivered my daughter,
he instructed me to hold off on exercise for 4 weeks. I remember thinking, why? I had had a vaginal
delivery, I was young and strong, I had exercised regularly up until the day I delivered. I should be up and running in a day or
two. There is no way I'm going to be
able to wait 4 weeks. But recovery was long and slow. And when 4 weeks
rolled around, I was still in a significant amount of pain. It hurt to
sit, I was afraid to cross my legs for fear of re-tearing, my legs were still
swollen. I could barely walk down the block. I found myself wishing
my doctor had told me to hold off for longer. And, talking to my friends
who had babies already, every single one of them said there was no way they
were going for a run after 4 weeks. 8 weeks maybe...but that was a big
maybe.
Lesson Number 2: Doctors know a lot,
but much wisdom can be gained from a network of female friends
The swaddle and white
noise machine
A few days
after I came home from the hospital a friend of mine, a recent mother herself
sent me a package. In it was a set of
baby swaddles and a white noise machine, accompanied by a note with the
instructions, “put these on and go to sleep.”
It was the soundest advice I have ever received.
The donut
On day 4 post partum, as I was
lowering myself onto a chair with a wince, my mother said "there is this
thing called a donut, a little inflatable inner tube you can sit on, so that
there isn't any pressure on your bottom. You can buy them at any drug
store that sells medical equipment." My husband went out and got me
one that moment. It was bliss. I carried it with me for a good 6
weeks. Why, I thought, did I not know about this on my OB/GYN
rotation? Why do we not discharge women with such a donut? And my
mother was the only one privy to this secret. When my friend, who had a
baby 8 months before I came to visit, she saw me sitting on the donut and said
"oh yeah! I forgot about that thing. I had two of them!"
"Who told you about it?" I asked. "I guess my
mom," she said.
A day or
so after that, I went to borrow sugar from my new next door neighbor. She
had just had a baby herself, a day or so before me, and it was her 4th.
She was a pro. Fully dressed and caring for her large and active family,
I would have never known she had just had a baby. I stood next to her in
amazement, with my sweatshirt hanging around my pajama clad shoulders, hair and
teeth unbrushed, spit up in my hair. As she handed me the sugar, she
hesitated, leaned in and whispered "And I sat on this round
thing...like a donut." As I left, I wondered, what is this secret
world that I have just entered into? This world outside of what I see on
the hospital wards. This world that physicians don't seem to know
anything about? This secret world of motherhood?
Lesson 3: Keeping another person
alive
That’s a
heavy task and a weighty responsibility.
I remember thinking the weight of this responsibility must be akin to
the responsibility physicians bear.
Lesson 4: How to balance shared
decision making with clinical expertise
Margalit had reflux. It wasn’t terrible reflux—she wasn’t losing
weight or dehydrated, but it kept her up at night and she looked miserable. Desperate, I took her to our pediatrician’s
walk in hours. The doctor on call
listened to my story, did a thorough exam, and reiterated the literature on
reflux that I had learned in my 3rd year: if she is gaining weight
and adequately hydrated, there is no indication to treat the reflux. I nodded my understanding and left. When
we went for her two month visit a few weeks later, my pediatrician asked about
the reflux. Not much had changed; she
still spit up after every meal and she still woke up about every hour or so due
to the reflux. He listened, and offered
the option to start medication. “What do
you want to do?” he asked. I
hesitated. Intellectually I knew the
other pediatrician’s plan was an appropriate recommendation. But I was also so tired, and my baby seemed
uncomfortable. I had no idea what to do,
and I felt guilty that I didn’t-- I was in medical school after all, and this
was just a simple case of reflux. My
pediatrician saw my hesitation. “Do you
want to know what I think?” he asked
very gently. I nodded in relief and appreciation. And then he outlined what he thought the best
plan would be based on his clinical experience. I think about the way he asked
me that question often—it is a tone and manner I hope to emulate next year.
Lesson 4: Everything is Personal
We are
always taught never to take anything personally. But that is never possible—at least not for
me. When Margalit went on a nursing
strike, I took it as a personal affront.
When she stopped crying after I handed her to her Dad, I worried she had
forgotten who I was. When I pumped a
little less one morning, I took it as a reflection on myself and my capabilities. Every time I knew I was being irrational, but
I couldn’t help it. I think it is hard
to not take things personally; everything about becoming a parent is personal,
but sometimes it’s nice to have an outside party tell you to not be so hard on
yourself, or at least that you are not crazy for feeling this way.
Lesson 5: Giving birth uniquely
touches the boundaries where life and death merge
Margalit is
named for a grandmother I never knew. And
I think Margalit’s name was a way for me to connect to a woman I had heard
stories about but never met-- and a way to pay respect to or show appreciation
for that woman, and the daughter she raised, who grew up to raise me.
In
Judaism, a baby girl is named within the context of a prayer for the mother and
child’s health: “May He who blessed our fathers… bless the woman who has given
birth (mother’s name) together with the daughter who was born to her in an
auspicious time, her name shall be called in Israel: (child’s name)…” After which the mother recites a second
prayer, a prayer one says after surviving a near death experience, a prayer a
mother is instructed to say after a safe delivery: “Blessed are You, oh Lord…who
bestows goodness upon the accountable, who has bestowed every goodness upon me.” These two prayers, simultaneously acknowledge
all the risk and the possibility of labor-- on one side is joy, life, and birth
but on the other side is death and sadness.
When I recited these prayers aloud as a new mother, I was struck by the
juxtaposition of life and death, and intimately aware of the intense love a mother
feels towards her newborn. She embodied
“every goodness” I had ever known and future joy I could imagine.
Acknowledgment of both extremes has
been shared through time and space by different cultures across the world, most
recently through the global health committee’s decision to make one of their
millennial objectives the improvement of maternal health. But women’s health
takes many shapes and forms. Rotating
through various sites for my Women’s Health block, I saw a myriad of ways women
seek medical care, and I was reminded of a line from Yate’s poem Adam’s Curse:
And thereupon
That
beautiful mild woman for whose sake
There’s
many a one shall find out all heartache
On
finding that her voice is sweet and low
Replied,
‘To be born woman is to know—
Although
they do not talk of it at school—
That
we must labour to be beautiful.’
I
said, ‘It’s certain there is no fine thing
Since
Adam’s fall but needs much labouring…’
Aliza
Machefsky
DUCOM 2016
