Friday, October 31, 2014

Medical leave, Bed rest, and Induction

Things have progressed quickly, in all the wrong ways. On Monday, my diastolic blood pressure was over 100 and my doctor decided to place me on anti-hypertensive medications. The protein in my urine had increased significantly by my appointment on Tuesday, at which point he said I needed to begin my medical leave and spend the majority my day in bed, laying on my left side. I was given orders for a 24-hour urine collection and he began talking about inducing me early. I had still not dilated at all, was having only minor irregular contractions, and she had not yet dropped.

On bed rest, my blood pressure stabilized for a day or so, but has been creeping back up. My 24-hour urine test came back significantly elevated. Another non-stress test on Thursday was generally normal, but took a while because she was sluggish. At this point, despite being a little early and showing no clear signs of labor, he decided it was best we cut our losses and scheduled me for an induction. I am scheduled to arrive at the hospital tonight at midnight.

I can't help but draw the parallels between how this pregnancy began and how it will likely end. Scheduled. Not-spontaneous. With my body not cooperating.

My doctor warned us to brace for a long labor since we are starting from square one. He discussed the slightly increased complications of poor lung development given that we haven't made it completely to term and the higher complication of possible cesarean delivery if my body continues to be non-cooperative. Aside from these risks, I am hopeful that we will be welcoming a healthy baby girl into this world in the next 24-36 hours. There is a sense of calmness and separateness as we each make final preparations before heading to the hospital. Here we go...

Wednesday, October 29, 2014

Work Life Balance

A couple of weeks ago, shortly before my health hit the proverbial fan, I was called into my boss' office. He commended me on how strong of an employee I have been and then informed me that he has submitted my name for highest consideration in a very high leadership position within the hospital. The details were relatively vague in regards to timing, but he told me that I should consider this recommendation to be solid, to begin preparing to take on this role in the future and that, essentially, he would begin grooming me for this more formally upon my return from maternity leave.

This is huge. This is the kind of thing that doesn't get offered to 30-year-olds. I spent the rest of day in disbelief and shock. This was mixed with a huge sense of honor, pride, and recognition.

I am still in shock when I really think about it. The outcome of the meeting was that I should continue doing what I've been doing in my current position, but with mental preparation and eventual logistic preparation to take on a dramatically different leadership role at some point in the future.

This poses some obvious challenges. First of all, many of the big projects I am currently working on will likely need to be handed over, but when or to whom is unknown, and I am not to let that influence my current work on them. Secondly, I had begun fantasizing about taking my foot off the gas pedal a little once having a baby, and had even considered trying to negotiate working a four-day workweek. I'm not sure if I ever would have actually felt comfortable putting those fantasies into reality, as I am generally so career-driven and value this aspect of my identity so much, but it definitely felt like the rug was ripped from underneath me in one short, vague conversation. Any previous notion I was feeling to take a step back, lighten my load, or stop trying to be so damn impressive all the time was immediately squashed. It has been replaced now with a greater drive to commit to the career and the hospital and prove that I really am worthy of such a recommendation and position.

Writing this out on a forum that has been almost entirely dedicated to my greatest goal over the past few years of having a child makes me feel uneasy. Is this what working mother guilt feels like? I haven't even had her yet and I am already giving up on the idea of putting family obligations higher on my priority list to commit more fully to my career. Yet, I am not wavering in the decision to pursue this opportunity. Maybe I'm still naive, still able to buy into the notion that it is possible to have both successful career and fulfilling family life. I have the feeling this will definitely be tested in the year(s) to come.

Monday, October 27, 2014

Microblog Monday: Ghost of Infertility Past

This morning my biophysical profile was scheduled at the same location at my RE. The waiting room for the actual RE appointments was separate, but they utilize a shared waiting area for the ultra-sound appointments.

I sat in the waiting area surrounded by women without obvious bellies, feeling remarkably uncomfortable and like a traitor. The old emotions of hopefulness mixed with fear came rushing back to me and my level of empathy for these women soared. The one woman, sitting next to her husband, with her hand held tightly in his, kept looking me and my belly. I wanted so badly to let them know that I knew, I understood, I got it, but I couldn't figure out how to say these things.

Sunday, October 26, 2014


In approximately two and a half weeks, give or take, I will be transformed from pregnant to a first time mom. It feels very soon and very surreal.

Physically, I am ready for pregnancy to be over. I ache everywhere. I can't find a comfortable position. I had a chiropractic appointment last week, which was amazing, but the relief only lasted about 12 hours. The same is true for any foot massage I can squeeze out of C. It takes forever to get dressed in the morning, to walk anywhere, to get in and out of the car. I feel out of breath all the time. I am chronically congested to the point of C sneaking out of the bedroom most nights because of my very lady-like snoring. I am very ready to get my body back.

Logistically, the nursery is 99% complete. Moving in with my parents has created a constant need for space and storage, so there are still some things that don't have a home, but that may just be the way they stay for now. The hospital bag is nearly packed, aside from the items we are still using. Clothes are folded and diapers are bought. We received our lovely glider rocker and I have already enjoyed sitting in.

However, the threat of Beuhla coming early has definitely resulted in added stress and pressure. C is finishing up a costly review course for his nursing licensing exam and is trying to figure out if he should rush to take the exam before she may arrive or instead attempt to take it when there is an infant in the home affecting our sleep and concentration. I have several projects at work that I am trying to finish, most of which are due on November third. After that, I have made a list of additional/optional projects that I would like to accomplish but am trying to accept that these projects may or may not get done. The unknown timing makes it very difficult to plan, and I am a planner.

Aside from these less important distractions, I am still trying to wrap my head around the fact that very soon there will be a baby in our home. A baby that relies on us for her every living need. A baby that will forever change our lives. It feels incredibly overwhelming, so it's been easy for me to focus on work tasks instead. In a matter of a few hours, my life will completely shift in focus from pursuing my career and taking care of patients, to physically recovering from birth and taking care of a needy infant.

Physiologically, the difference between anxiety and excitement is non-existent. When we anticipate something in our future, be it exciting or scary, our body shifts into a fight-or-flight response. It's all about perspective as to whether we interpret those physiological signs as those of fear or of thrill and elation. Right now, I am definitely wavering on my perspective between these two interpretations.

Saturday, October 25, 2014

Day by Day

My health has continued to be slightly problematic, seemingly just enough to keep me on my toes and add on a whole bunch of extra appointments and tests.

On Tuesday, I had an ultra-sound to assess Beuhla's growth. I was actually sort of happy about this because it seemed like everyone and their mother had something to say about "how I'm looking." In the same day, people would tell me how big I looked (when did that become socially acceptable?!?!?), ask if I were carrying twins, told me that I still looked small and that I had a long ways to go, and told me that it looked like I was dropping and it would be any day now. It seems like everyone is a gynecologist now, and it's frickin' annoying! So I was happy to get some objective data and be able to shut people up.

The actual ultrasound was a little disappointing because she is so big that the images weren't very clear and she insisted on covering up her face the whole time with her arm, although I was amused by her chubby little arm and hand. Mostly, I'm beyond caring about ultrasound images at this point and am just ready to meet her in real life. The good news is that she is measuring right on track, maybe a day or two ahead. I'm focusing on the "right on track" part of the message, because there is so much variance with those things. They predicted that she is 7 pounds, 5 ounces - plus or minus a pound. A pound! That's huge variability! Like I said, I'm focusing on the normal part of the results and not trying to guess birth weights at this point.

On Thursday, I had my 37-week appointment. My blood pressure had risen again, my ankles were already swollen at 9am, and there was protein in my urine. This bought me a ticket for some blood work, an order for a non-stress-test, and a conversation about the possibility of being induced early if my health continues to decline. Luckily, her heart rate continues to be pretty stable around the 130-140s and she is still in a good position with her head down. He was slightly disappointed in the internal exam to learn that I am not yet dilated at all.

On Friday, I had the non-stress test. The name is ironic to me because any extra testing that may indicate fetal distress is clearly causing me some stress, even if it's meant to be non-invasive and not stressful for her. Basically, I had to lay down for about thirty minutes while there was continuous monitoring of Beuhla's heart rate and any movements or contractions. The worst part was the discomfort of laying still for that long and some boredom. Actually, the worst part was probably the stress leading up to it and trying to figure out how to re-schedule my entire Friday afternoon of patients to fit in this last-minute appointment.

The conclusion of the test was that "she looks happy." I'm sure there are better medical conclusions, but it helps me to focus on the overall simple message - healthy baby. Then, he took my blood pressure again... and it was high, again. So the moral of the story, so far at least, is that my daughter appears perfectly healthy and content, but my own body and health are not nearly as promising.

I am returning for additional testing, a biophysical profile ultra-sound, on Monday and then another OB visit on Tuesday. C and my mother are monitoring my blood pressure from home three times per day. Basically, at this point, we're just taking it day by day. I am reassured that she continues to be healthy and nearly full term, so if the worse case scenario now is early induction I am working on accepting this as a possibility. C hasn't taken his nursing licensing exam yet, is in the middle of a review course that we paid substantial money for, and I am feverishly trying to wrap up several big things at work; but, aside from this, we are ready and there are far worse possibilities and outcomes.

Day by day is my new motto.

Thursday, October 16, 2014

Health Threats

Ebola has come to Cleveland. Well, not technically, but it might as well have. A nurse from Texas spent a few days in northeast Ohio and then flew back out of the Cleveland airport with a mild fever that progressed into a higher fever by the following day and then she tested positive when back in Texas.

The entire city is in complete panic mode. Schools have shut down on account of a teacher who may have flown in the same plane, although not the same flight. Stores, banks, and churches have all closed their doors. The media can talk of nothing else.

The hospitals are on high alert, with CDC meetings and email alerts and protocols and distribution of PPE (personal protective equipment). Despite this, hospital business continued as usual. I entered the hospital and met with my scheduled patients, children with a reputation for being carrying germs. I did my job.

Internally, my mind was on my own health. I had just come from my 36-week appointment and again the concern was raised with my swollen ankles, moderately high blood pressure, and now small amounts of protein in my urine. This all adds up to returning concerns of preeclampsia, although no symptom was high enough for drastic measures and instead we're back to increased monitoring.

Ironically, the panic of the city over a significant threat that I have minimal control over has helped me to remain calm of my more realistic personal threat. They are both largely out of my control. I am doing everything in my power to minimize my risks, but short of putting myself in isolation and/or bed-rest, I need to carry on. I follow the recommendations of the experts and then I continue to live my life. Panicking never did anyone any good.

Friday, October 10, 2014

Ebola Panic is Over-rated... Panic About This Instead

Every year, often beginning in the fall, all of hospital staff get email alerts about the medical practice guidelines for managing symptoms, diagnosis, and current statistics on cases for many contagious diseases. H1N1 and the flu are usually the most popular, but this year it's begun early with Enterovirus D-68. So it was not shocking when we started getting alerts about Ebola. The hospital alerts are not panicky, more procedural than anything else. The panic messages seem to be coming from the media.

So then, in retaliation, many of my health-care worker friends and family have taken to posting alternative news articles on reasons why we should not be panicked by Ebola. I generally agree with these messages and support people getting the word out on this.

That was, until I read this article: Six Diseases You Should Worry About Over Ebola

Now, I continue to not be overly concerned with an Ebola outbreak in the US, as I was not previously. However, my anxiety about all the other more realistic threats to our unborn daughter's health has quadrupled. Seriously, I simultaneously want people to read this article for educational value and also avoid the article to avoid distress. Have I mentioned that I've noticed an increase in anxiety in this pregnancy

My initial delight in our due date being shortly before Thanksgiving and the rest of the winter holidays have now been replaced almost entirely with fear of exposing her anything and anyone that could potentially be carrying germs. I contemplate how it would be possible to keep her entirely encapsulated in a bubble for her first six months, or at least until spring...

Thursday, October 9, 2014

Clam Bake Baby Shower

The shower was a success, despite some initial confusion from the invite over if it was actually a shower or just a clam bake. With my very large family and it being co-ed, we were prepared for a large gathering and it turned out to be just that. Approximately 60 people came, from most areas of my life.

We served the traditional clam bake meal - a dozen clams, chicken, fresh corn on the cob, and sweet potatoes. There was also salad and cornbread muffins with honey butter.

The appetizers were plentiful, clam chowder was served early, and the dessert table was massive. I had requested a german chocolate cake, which was ordered from an ethnic bakery and was to die for. It was still moist and delicious the next day and may have been all I ate for that entire weekend.

My sister had made a diaper cake and as an optional game, we had people guess the number of diapers used to create the cake. It was entertaining to see how both the males and females got so into guessing and trying to analyze the cake.

So many of our family and friends brought us such wonderful gifts. It was overwhelming to see the large pile. When it came time to open up the gifts, we reassured everyone that it was completely optional and then the party pretty quickly separated into the women following us inside for the gift-opening and the men staying outside with the booze and appetizers. I heard afterwards that they had their own share of fun while we were engaged inside.

To break up the gift-opening, we played a game in which we divided the room into two teams (pink and yellow). In between every 1-2 gifts, my sister would read a little story about either C or I as babies or toddlers and the teams would take turns trying to guess who the story about was about. It was actually really funny to hear them discussing their reasoning and everyone seemed very entertained by our stories (turns out, C was quite the trouble-maker as a child and I got into my fair share of mischief as well...).

Overall, the day was very long but very much a success. Many people stayed well into the evening and it seemed like everyone had a good time. I was happy that it seemed like just the right amount of baby shower, but definitely tended more towards Clam Bake and Party. Plus, now that it is over, we are much farther along in being prepared for our little to arrive.

Thursday, October 2, 2014

34 Weeks

34 weeks today. Six weeks to go. Time is a funny thing. Six weeks simultaneously feels both so short and also so long. Our joint calendar looks a little silly. September and October are full, little dots on almost every day with different appointments and engagements and to-dos. Then in November, there are no dots designating plans. The calendar is empty. Our life as we know it ends. We don't know exactly what to expect, but we're both prepared that it will be life-altering.

The fatigue has continued to be my biggest symptom, sometimes feeling nearly unbearable. Pair this with the many nights of pure insomnia, the kind where you lie awake pondering the meaning of life because you're brain has no intention of turning off, and I am often irritable and frustrated. On these days, my whole body feels sore and achey and my eyelids feel extra heavy. My feet continue to swell by the end of many days, but I have officially given up on professional work shoes and have found that wearing tennis shoes to work has been very helpful for this symptom. Heartburn, indigestion, and an occasional racing heart are also still present.

My little girl is relatively active, but not usually in a distracting way. I tell people that she moves around just enough to let me know that she's doing well, but it is not obtrusive. She tends to prefer to hang out my right side, which annoys me a little because I'd prefer symmetry. Today, her heart rate was approximately 150 bpm and all of my vitals were good. There are often times in the day where she positions herself in such a way that I feel all of my internal organs being smushed, breathing becomes painful, and I seriously question how she can possibly get any bigger. Then, I look in the mirror or down at my belly and remind myself that I still don't look that big. People have started making comments about how it looks like I could have her any day now and I get annoyed by this. I don't feel that I look this way yet and am most definitely not yet waddling (most of the time).

My weight is up approximately 30-32 pounds, depending on the day. This is more than I would have originally liked and more than is technically recommended considering I started off in the "overweight" category, but my doctor is fine with it and, surprisingly, I am too. Mostly, I've just accepted that it is what it is and I'll worry about it later. I do often still fantasize about developing a healthy eating and exercise plan once the baby is born. Fantasize is the key word here because in my current state of exhaustion and discomfort I can't possibly imagine starting anything like this now. I think this is also why acceptance of my weight gain is also so easy. I can't imagine doing anything different anyways. I only sometimes get upset when my face looks fat at certain angles and I did nearly cry on the day of our baby shower when I attempted to put on my wedding ring after months of avoiding this and it didn't even fit over my knuckle. Otherwise, my body image is alright. I have developed numerous stretch marks across my abdomen, a few small ones on my hips, and even a couple on my breasts; surprisingly, these don't upset me in the least.

Baby preparations have made huge strides in the past two weeks, thanks largely to two separate baby showers that I will talk about more specifically later on. We have our lamaze class this weekend. I still want to sign up for the "baby basics" and "breast-feeding basics" classes, but otherwise the logistical and physical preparation is nearing completion. The mental preparation is another story and probably nearly impossible. How can you possible mentally prepare for your world to change in such a dramatic and life-altering way?