Getting Away

Last week we were away on our, previously scheduled, annual family camping trip. It probably couldn't have come at a better time and was a very necessary retreat. My family has been going to the same park, staying in the same group of cabins, for over 50 years. I have never missed a year since I was 3 months old. Every year, the view is relatively the same, although sometimes the river is higher or lower based on the rain patterns. Some years it is hotter and we spend more time in the river, or colder and then we spend more time hiking. Some years it is rainier and then we spend more time on the cabin porches playing card games. We go with my mother's family, her cousins and my second cousins, and then a smattering family friends. Some years as many fifteen different families are represented.

This is my singularly ideal retreat. When people say, "imagine your happy place", this is mine. I think of the running water gliding over the rocks and the moist air in the mountains. This is my serenity.

There is just the right amount of creature comforts for me. A mattress, flushing toilet, and shower. An oven and refrigerator and an indoor fireplace for chilly evenings. We bring up a coffee pot, but one year when we attempted to bring up a toaster the lights dimmed and the toast took over an hour to brown so we gave up on this luxury. There is no TV, no internet, and no cell phone reception. If you want to leave us a message, you'd call the camp office and they literally write out the message on a piece of paper and thumb tack it to your cabin door. Being "off radar" is now my favorite aspect of the trip. When I was young, my favorite aspect was being able to walk to the different cabins and see my cousins instantly. I cannot wait to share this with our daughter.

For two days, between when he was injured and when he passed, we were planning to bring the recovering Marv with us on the trip. I began imagining him with us in the cabin and taking short walks on the trails, not to tire him out as he continued on his recovery. For two days, I had adjusted my expectations for this year's vacation, and then needed to adjust them again. Instead, we traveled alone and used the retreat as just that, a retreat from the daily memories of Marv and of discussions of how to handle the neighbors and legal issues. It was a nice retreat.

We left a few days early to travel to Minneapolis for wedding. I had spent a year in this city for my internship and this was the city that C traveled to and proposed to me. It was lovely and nostalgic. I saw many of my old friends that I hadn't seen since my own wedding. We walked around the city and visited my favorite places and then discovered some new places. A big part of me longed to move back, remembering how much I had enjoyed this year and forgetting how much I missed my family when I was living there. This long weekend was also lovely.

I had moments of sadness this past week, but was not overwhelmed with it until on the plane ride back home. Back to reality. Back to our empty house, still littered with dog toys and treats and food bowls. Back to tracking down the deputy, dog warden, and deciding on whether or not to get a lawyer involved.

It is usual for me to feel a minor post-vacation depression, knowing that I will be returning to a hectic job and mundane life. Vacationing while pregnant is extra exhausting and traveling in an airplane with nausea is no picnic. However, returning to the home where Marv took his last breathe just over a week earlier has made this especially difficult. I am so grateful that the vacation came when it did, but am not quite ready to return to reality just yet.

Cremation and Ultrasound

The juxtaposition of last Thursday cannot be understated. Less then 8 hours after seeing our beloved dog pass away we were scheduled for an ultrasound of our baby.

After C woke me me to tell me the news, I didn't return to sleep at all that night and spent the time laying awake in bed. This was now my third night with very minimal sleep, one to two hours at the most.

We got up early and took Marv to the vet to say our final goodbyes and have him cremated. And then we drove straight to the ultrasound appointment.

I wasn't hungry, but C made me eat a little something before the appointment. We then waited to be called back and tried not to look like we were utterly depressed in the Maternal Fetal Medicine waiting room.

The ultra-sound technician has just graduated from school a month earlier and was only working there for three weeks. She was very nice, but with a squirmy baby, she was not the most expedient person. The room we were in also had a broken monitor so I spent the entire time trying to strain my neck to see her screen and because of her lack of experience, she didn't angle the screen well for us both being able to look at it. After she was finally finished, her supervisor came in to repeat certain parts that she didn't get a great picture of. Then the doctor came in to get her own look at certain parts. Needless to say, it was a somewhat long and painful experience. C sat in the chair next to me in the dark room and nearly fell asleep several times and I couldn't blame him at all.

I don't want to complain too much, because everyone treated us well and getting to see our little one squirm is never something to balk at. While I couldn't see everything very well, all of the measurements were great and there are no concerns at this point. The baby is measuring in at 10 ounces, which puts it at the 30th percentile. I was very happy about this because it's still in the normal range but on the smaller end, although the doctor later told me that measurements this early on aren't very predictive of actual birth weight. When the ultrasound technician asked if we wanted to know the gender, we of course said yes!

"Three lines," she said. It's a GIRL! Then I immediately began crying. Not loud, but tears were definitely falling. It was just too much emotion at that moment, that day, that week. "It" is a "she" and she is a healthy baby.

There is no doubt in my mind that C and I would have loved both Marv and our little girl and we would have been a very happy family. But there is still this feeling that one chapter of our life is coming to an end and another is just beginning and this is very bittersweet. I sometimes think about how in movies, often when a character dies, they talk about the timing of this coming after this character has served their purpose and has left the other characters changed and in a good place. There was no reason for Marv to die, but he did change us. He did help us so much in our time of sadness. And he did leave us when we are in a better place.

Marv

A little after midnight on Wednesday night, technically Thursday morning, Marv passed away. I had recently fallen asleep after not sleeping much at all the past two nights and C woke me up in tears.

I believe the injuries were more extensive then the vet initially thought. C is still beating himself up for not taking him back to the vet when he wasn't improving by Wednesday. I honestly don't think there was anything else to be done at that point. He spent his last two days in complete misery and it was so hard to watch his suffering.

Marv was our first dog. We got him as our first Christmas gift together. Marv taught us how to work together as a couple and how to love jointly. He was our first child as we struggled to conceive.

The sheriff and the dog warden have been involved, but neither seem very invested at this point because it was unclear whose property the attack actually occurred on. We are stuck in this limbo place of needing a resolution, needing to feel safe on our land again, but not having a clear path to get there. The entire family is distraught.

I woke up this morning and the bed was empty because C left early for work. Usually, Marv would have taken over C's spot, with his head on the pillow. My first gut reaction was to go in his room next door and open the crate for him. These habits and the emptiness will take a while to overcome.

Anger is Secondary

Sometimes it is easier to feel anger then other emotions. When I am not completely absorbed with the anger, I feel horrified and guilty and so very sad. There is a theory about anger acting a secondary emotion, or something that we feel to cover up or protect ourselves from more vulnerable emotions. I've learned about this theory in graduate school. I've used it with patients on occasion. But I have never truly understood it until yesterday. 

Source

Two years ago, my parent's dog wondered into their neighbor's yard one evening when there were fireworks going off at a home down the street. She was 15 years old and mostly blind. A twenty point shih-tzu/poodle mix. My parents have nearly three acres and none of the neighbors ever had any fences because it wasn't needed. But on this night, she wandered into their yard and their three Great Danes attacked her, brutally ripping her apart with their teeth. By the time my father tore them off her, she was in pieces. He was devastated. C came over that evening and buried her for them. The whole family was distraught that such a violent thing could happen. 

With time we moved on. We remained more cautious and less trusting. When we moved into my parent's home last year, with our twenty-pound Cavalier King Charles Spaniel, we kept him on a lead. As he and we became more comfortable, we would allow to run around the backyard without the lead, but only when we were watching. Only when we were also outside. He always came back when he was called, never wandered too far, and was such a good dog. We started to let our guard down. 

Last evening I went outside with him while my mom was finishing dinner. It was a lovely evening, cool outside but too hot to stay indoors. He was in pure heaven running around in the backyard, always returning to me in-between his laps. C came out and began to talk to me about the dinner being almost complete. Then we heard the back door open at the neighbors, and Marv took off sprinting to see what was happening. We called after and started walking towards him. A second later I heard a high-pitched yelp. 

I began sprinting towards the edge of our yard. C was right behind, yelling at them to get off him. I got to the pack first and two of the dogs backed away as I came barreling towards them, but the one dog was on top of Marv and didn't leave. I grabbed his collar and forcefully pulled him back. He snarled at me, but I didn't let go. I turned my attention to Marv, who lay limp on the grass. 

Thank God C was right behind me. He scooped up Marv's lifeless body and as he did, the Great Dane I was still holding lunged at him. I held on tight. It wasn't until C and Marv were walking away that I finally let go of his collar. At the end of this altercation, the neighbor came out of her house to her back deck. "Where were they?" is what she demanded to know, knowing that she would not be legally liable if they were in her own yard rather than ours. She never asked how he was. 

Marv was still alive and awake. We figured out the nearest emergency vet 30 minutes away and I sped there while C held Marv in a towel. Flesh, blood, and sweat have a very distinctive smell. He panted all the way and then we handed him off to the vet. 

He was very lucky, the vet told us on two separate occasions. He had numerous puncture wounds, was skinned across much of his back, and one gash that went through to his muscle. But his abdomen wasn't punctured. His lungs were okay. He will require surgery and an overnight stay for monitoring, but is stable. In no more then thirty seconds of turning our back, this was the damage. My dad was in the house when the same dogs killed theirs, likely only a few seconds from where we were standing with Marv. 

I shudder when I think about taking another thirty seconds to get to him. I close my eyes and the sight of his lifeless body immediately appears in my mind. I can't even imagine the thought of my unborn child one day accidentally kicking a soccer ball into their yard and running in after it. So instead, I think about revenge. How I will be printing off fliers alerting the entire rest of the neighborhood how vicious and horrible these animals and people are. How we will be building an ugly 6 foot fence along her property line, decorating the one side with names and messages of hate while putting flowers along our end. Sometimes, I even imagine more gruesome options of luring her dogs onto our property with some raw meat so we can beat the life out of them with a baseball bat. Because anger and hate is easier than the guilt and horror. 

Some Thoughts on Gender

My anatomy scan is coming up at the end of this week, at exactly the beginning of week 19 because we will be on vacation the following week. I am really excited to stop referring to the baby as "it".

The gender is the number one question that I get asked when people congratulate me on my ever-expanding belly. C and I are definitely interested in knowing ourselves, primarily because of the "it" issue and that I am horribly impatient, but I'm not yet certain if I want the world to know quite yet. There is something so incredibly un-private about being pregnant. It suddenly becomes okay for people to comment on my changing body shape, touch you, and ask personal questions. On the other hand, I am a horrible  liar so I'm really not sure how to approach the answer to the number one question these days, "do you know the gender yet?"

Another interesting phenomena that has occurred is that most people like to offer unsolicited guesses as to what the gender will be. This part is probably not all that interesting. The interesting part is that every single person has guessed that the baby will be a boy. EVERY SINGLE PERSON. It started getting really creepy actually. Anyone who gave a reasoning, tended to use different wives tales to justify, only making it creepier. The heartbeat is on the slower end, but the extensive research I've done says that this really is nothing more than an old wives tale with no evidence to back it up. I still look pretty and apparently if he/she is a girl then my "she would steal your beauty"; however, my aunt claimed this on a day that I was dressed for a wedding and spent at least five times the usual amount of usual effort in getting ready to look nice. I am carrying more in the front, or higher up, or something. I can't tell how I'm carrying compared with anyone else, so this one really makes no sense to me.

I really don't have a strong preference one way or the other. However, boys scare me. I never had any brothers. I'm obviously not male. I'm not sure what to do with a boy. I really don't know how different they are from girls or if this is really a silly to thing to worry about. Also, the oppositional side of me now really wants to prove everyone-and-thier-mother wrong as further evidence for justifying people to keep their nose out of other people's business. So I suppose there is a very slight preference for a girl, but in reality all of these reasons are very silly and I really am just excited to find out so I can more easily continue bonding.

Sometimes I think about the original purpose of the anatomy scan, which is to determine if the baby is growing appropriately and proportionately and to identify any early signs of issues. That is the real deal. However, thoughts of everything that could be wrong, everything that they are really checking for, is worrisome. Wondering about the gender is a much more hopeful and enjoyable way to anticipate this upcoming ultrasound. So, like many other mothers before me, I choose to focus on the least significant but most anticipated result and continue fantasizing about whether we will narrowing down the name list to girls or boys.

18 Weeks

I am officially at the point where I can no longer pretend I'm not pregnant. Patients are calling it from the waiting room. Colleagues are asking about it in the elevator. It's completely out in the open. I am 90% in maternity clothes and am already sick of my options. This is going to be a loooooong summer.

My weight is up 8-10 pounds depending on the day, which is a little bit more then I was hoping for. I am focusing on the fact that it seems primarily staying put in the belly region. I am trying hard to pick healthy choices for foods, but have definitely indulged in the occasional ice cream treat or macaroni and cheese.

Over the past two weeks, I have developed this insatiable hunger which is then followed by feeling overly stuffed and bloated. There is no happy medium, or at least I haven't figured it out yet.

Cravings? This is complicated. There are things that I used to like that I now love - hamburgers, cheese, macaroni and cheese, bagels with cream cheese (noticing a theme?), ice cream, berries - but I never get in a have-to-have-it mood. I did make a rule that I shouldn't be grocery shopping by myself because I pick out some weird crap that is not so well-rounded. Plus, I'll decide something sounds like a great idea in the store and then forget to eat it when we bring it home and completely lose interest.

Heartburn is still my prominent symptom. My OB told me to take Prilosec daily, but I get nervous about taking medicine so I tend to skip days when I'm feeling better and they I pay for it later. Congestion is also the bane of my existence and I keep going back and forth on whether it is due to allergies or a cold. I'm usually not an allergy prone person, but I know this is an especially bad year for people and, well, I've discovered nothing is off the table when you're pregnant. I still get random pains and twinges in my back and my abdomen. This is tolerable and they never last long enough to worry me.

Feeling anything? I have no clue! I can definitely feel a weight on my pelvis at times. Lately, I've been getting specific pains on my right side or lower abdominal region that could possibly be interpreted as being kicked or stabbed. But the key word here is pain. No fluttering. It's not particularly pleasant. Not what I'm imaging a sweet-potato-sized-human is capable of at this point. So I am interpreting this a my uterus continuing to expand and push other vital organs out of place. I am thinking about the actual baby feeling as an orgasm - when it happens, I'll know.

We got the results back of the second part of the sequential screening, which was just a blood test. The baby was given odds of 1/10,000 odds for Down syndrome or Trisomy 18 and 1/620 for open neural tube defects, which are both considered negative. I totally understand why they do the odds-ratio thing, but I don't like it. Yes, one in six hundred and twenty is pretty minimal, but I'd be happier if they just said said it's never going to happen.

Work is chugging along and I think the two-week-long maternity plan debate is finally behind me. Ultimately they went along with my original plan, but made me feel very under-appreciated in implying that I am at risk for "low productivity" (a dirty accusations these days...) when I work my ass off and am one of the very top performers in my department. Part of me wants to put it behind me, but then the emotional pregnant woman inside wants to make them abundantly clear how their  actions affect workplace satisfaction and undermine women. I've noticed that this emotional pregnant woman can be pretty feisty!

Speaking of emotions... I am not generally an emotional person. This past week I've found myself becoming incredibly irritable over the smallest things (My mom asked what I had planned after work in an annoying voice. How dare she!) or just very sad and upset. C will come in the room and I look like I'm about to start bawling. He'll ask what is wrong and then I tell him I have absolutely no idea, I just feel sad. Luckily he believes me and doesn't make it into anything bigger than it is. He hugs me and we try to laugh about it, but sometimes I still just want to cry. When I'm not emotionally volatile, I am very content and incredibly in love and appreciative of everything around me. Yeah, it's really a lovely roller-coaster ride over here...

This is enough baby-vomit. Hopefully some day soon I will be able to put together a coherent post about one topic.

Well Wishes for a Friend

My best friend from graduate school is having her retrieval today. She won't have the transfer until the end of this month because she is getting genetic testing, but please keep her in you thoughts for lots of fertilization and growth. Her name is Emily and she's been diagnosed with "unexplained infertility" which seems so much worse then PCOS as times. My heart goes out to her.

Thanks!

A Letter to My Fake-Boss

My Monday ended with a series of emails between my real boss and my fake-wanna-be boss and myself about my maternity leave. Just as predicted, the shit hit the fan and people are NOT HAPPY.

Just to be very clear, my real boss is fantastic and is completely supportive, although sometimes afraid to stand up to the MDs. The fake-wanna-be-boss is an MD and has no idea how psychology works and micro-manages all of her staff to the point of two of them leaving for competing hospitals within the past two months. She runs the department to which I am the primary [read: only] psychologist consultant.

The background: I sent an email of my maternity leave plan to fake-boss and cc'd real-boss and my administrator (I know, too many people in charge...) last week, but didn't realize that fake-boss was out of town until today. Essentially, the plan is that I will stop accepting new patients beginning in September, which allows me exactly me just about two months to "cure" my entire caseload or otherwise figure who to transfer them to, seeing as that everyone else already has a full case-load and psychology patients generally aren't keen on the idea of transferring care once they've established a relationship with someone (completely understandable). I provided a full page of different referral options for upcoming new patients, based on their insurance and presenting problem and location, etc. This took me some time to compile and I was pretty impressed with the final product. My real boss and my administrator both responded that it was a wonderful plan and very timely.

Fake-boss responded today, not to me directly, but just to my real-boss. This was irritating, because it was as though she wanted the two of them to decide my fate together and then jointly inform me of what my plan would be. Well, he (real-boss) would have none of that and finally included me in on the conversation and asked me to respond to her ridiculous demands/arguments directly.

Here is a summary of her arguments sent directly to my boss:

• My plan gives an inadequate "lead in time"
• My maternity leave will negatively affect my productivity and the productivity of my department
• I should be able to accept new patients until October
• I need to make sure I am opening up more time for follow-up patient slots if I am not accepting new patients

I've composed a short and professional response, but this is what I really want to say:

Dear fake-boss,

I have sent you a full maternity plan with detailed referral options when I was 15 weeks pregnant, just entering my second trimester. I truly apologize if this is not enough "lead time" for you and in the future I will make sure that you are aware of the exact date of my IVF procedure so that you know at the moment of conception. Never-mind that miscarriage risks are much higher for IVF patients in the first trimester, I'll make sure you're the first to know. 

Regarding my productivity - yes, I am fully aware that having a child and taking off several weeks to recover from this, bond, and nature this new life will result in a decrease in the number of patients that I am seeing. In fact, I can guarantee that there will be several weeks that I will be 100% unproductive in terms of "billable hours". I'm sure I'll manage to stay productive in other aspects of my life. 

In the grand scheme of things, productivity is the least of my concerns. Currently, I am one of the top achieving psychologists in the department and my productivity rankings are higher than 85% of the national average. I'm fairly certain that I could drop dead today and still meet my productivity quota for the year. 

I know that the implication is this productivity argument is your preference for me to be working my usual 50 hours per week up until the delivery date. Under other circumstances, I would be very agreeable to this. These circumstances being that a) the delivery date is actually predictable, b) that I am miraculously able to "cure" each and every one of my patients the week prior to this date, but not before, and c) that this delivery date is not preceded by bi-weekly and then weekly physician appointments that I am required to attend. In reality, I am really hoping that my case-load slowly dwindles up until the leave date, meaning that I will have less patients to cancel when I am inevitably driving to the hospital while on the phone with my secretary. 

Accepting new patients up until October is an interesting compromise, but has the similar flaw with working 50 hours weekly stated above. This assumes that a) I will actually deliver on or after my due date, and b) I am really a miraculous psychologist and can "cure" everyone in less then three appointments. I'm truly honored that you think so highly of me, but even I am not this good. In all seriousness, this is a the primary difference between psychology and traditional medicine: there is no magic pill that cures grief or behavior problems. 

The above arguments are based entirely on my desire to provide the absolute best care to my patients under the current circumstances. Given this, and my recent actions of seeing patients through my lunch hour and after the rest of staff has long since gone home, I am actually offended by the implication that I would not be retaining enough time in my schedule to follow-up with my already established patients. Trust me when I say that if there are not enough follow-up appointment slots, I will make them. 

Now that you have had a chance to share you opinions, I would like to inform you that this whole maternity thing - it's happening whether you like it or not. You can approve or not approve of this plan, but either way I will be gone. So please, take the referral list, inform the rest of your staff, and get your head out of the sand. 

Sincerely,

Your already-pregnant-consultant-who-you-don't-actually-have-any-control-over

Remaining Calm

Ever since my 9-week freak out, I have down a good job of reining in the crazy. At my last ultra-sound, I was much more excited to see the growth then nervous. I am increasingly confident that this pregnancy will actually result in a baby. And then my pregnant co-worker started telling me about her anxieties and the person she knows who went into labor at 16 weeks and then someone else who went into labor at 18 weeks and a story she just read about a baby being born at 22 weeks and still fighting to live. Damn her.

I had somehow convinced myself that if I could make it to 10 weeks and then the first trimester that I would be in the clear. Now she's put these little seeds of doubt in my mind.

When I read that others around my same gestational age are feeling sensations of their little one, despite the fact that most books say it's completely normal not to feel anything yet, I begin to feel nervous. When I gain weight I get upset that I'm gaining too quickly, but if I don't gain weight then I start to wonder if its because the baby is no longer growing.

Anxiety is a funny thing. It has this way of starting out as a small seed and then taking root and growing quickly out of control.

On a daily basis, I hear about the anxieties of children and teens. I have heard fears and worries that many people would have difficulty comprehending. An astroid is going to hit the earth and kill us all. What if I am buried alive? My stomach aches are actually cancer. If I don't wear this one pair of underwear every day, something bad will happen. Santa and Mickey and Chuck.E.Cheese are all evil and will hurt me. If I don't pick out just the right outfit, no one at school will talk to me and I will not have any friends. If my mom leaves on a work trip, she will never return. 

I don't have these worries, but I do understand them. I get it. Take something with a small grain of truth or a minuscule possibility of occurring and then give it some validity. With a little exaggeration and a little ignoring of base-rates and probabilities, these semi-truths and possibilities become facts and certainties. And our creative brains are fantastic at exaggeration and ignoring statistical odds, creating the perfect cesspool for growing and nurturing anxiety.

One of the reasons I think I'm good at what I do because I can relate. Because often kids and teens have the realistic part of their brain telling them that these anxieties are absurd and that they are crazy, and having an adult understand and empathize can be powerful. Then, after we understand how  these seemingly ridicules fears come to be in a very honest way, we can work together to change them. Call out the exaggeration. Return to facts.

The fact is that a very large majority of pregnancies that survive into the second trimester go on to become healthy infants. The fact is the not feeling a baby at 16.5 weeks is perfectly normal, and it may be another month or so until I feel anything, especially since I began this journey in the "overweight" category. The fact is that my weight fluctuates up to 2 pounds in a day or two, so gaining or losing a pound is not a significant revelation. Reliable sources say that gaining or losing 5 pounds in a week or two is something to take notice of, but this has never occurred.