A young mother's view: Residency, reproduction and refrigerators
When I started residency, I agonized over which refrigerator to buy for my new townhouse: Stainless steel or black? Should I go side-by-side model, or for the French doors with the oversized freezer drawer? I was single. I made simple meals and didn't have much use for fancy appliances. I had moved from New York to the middle of a cornfield in Illinois. I planned on working my butt off for the next six years – marriage and kids didn't fit into that equation.
Of course, plans change. I met my future husband during our intern surgical orientation, and by the second year of training, we were engaged. We had a dream wedding our third year of residency and decided to start our family. Many women on faculty at Southern Illinois University (SIU) were mothers and surgeons, and I was part of a residency that was predominantly female throughout all six years of my training. Every single female resident who had graduated before me during my training had a child during residency. This was going to be easy.
Or so we thought. After a year of trying to get pregnant, we met with the reproductive endocrinologist at SIU. A series of tests confirmed what we'd already figured: I was unable to conceive naturally and would need reproductive assistance to have a child. So I began the long journey of fertility treatments.
Fertility is both physically and emotionally exhausting. I needed labs drawn every few days, and with monitored cycles, I had ultrasounds every 48 hours to track my progress. Most residents complain about finding time to go to the dentist – here I was trying to coordinate visits three times a week to monitor my follicular size, all while taking high-dosage hormones that did not help my mood and anxiety. I felt guilty asking for the time away for these appointments, and sensed some resentment for my absences from my peers.
I was fortunate. Once we found the right combination of medications and procedures, we were finally pregnant and could not contain our joy at the news. As my belly grew, my husband and I would use the clinic ultrasound machine to check on our little one.
Everything changed at our 20-week anatomy scan. This is when most couples finally find out if they're having a boy or a girl. The ultrasound tech was spending an awfully long time scanning our baby's brain, and suddenly she began to cry.
"I'm not supposed to tell you this, but I don't think that your baby's brain has formed properly," she said. "I'm going to have to call the doctor to take a look."
My heart sank. I couldn't hear. I couldn't think. I remember someone bringing tissues. I remember having to call my mother to tell her what was happening.
With the help of our supportive faculty, we saw a slew of specialists over the next few days. It was a whirlwind of emotions and more news. We were having a baby boy – and not only did they see differences in his brain development, he had severe cardiac anomalies that would require open-heart surgery after birth to save his life. We were left heartbroken, and with more questions than answers.
But as two busy residents, life moved on. I buried myself in my work and tried to focus on my growing baby. Pregnancy is hard enough with persistent nausea, vomiting and fatigue. Now I tried to mask the constant anxiety about what this baby faced and if he would survive all that lay before him.
My husband finished residency and matched in a urologic oncology fellowship at the National Cancer Institute in Bethesda, Md. As I entered my third trimester, I saw my support system melt away as my husband moved halfway across the country to complete his training.
After a long first week alone where I threw myself into my job, I started to notice contractions that weren't normal. With my husband across the country, one of the doting secretaries took me immediately to the hospital to be evaluated. I was in preterm labor. They hooked me up to monitors and gave me medication to stop labor and mature the baby's lungs. The cardiac surgeons warned me that due to the baby's size, he would be unable to be put on cardiopulmonary bypass at such an early gestational age. He would not be able to have his life-saving surgery if he came this early. I called my husband, who flew back to Illinois the next morning. The medications had worked and stopped my contractions. But I had to stop working – there was no way I could continue at the time.
SIU was amazing. The program did whatever it could to support me. I took a leave from residency and my husband drove me home to New York to be on bed rest closer to family. With much needed rest and surrounded by family, I was able to care for myself and carry my pregnancy until full term.
Our son entered this world a fighter. He was born via scheduled C-section with the NICU team present for his arrival. I was able to see his beautiful face and his black hair before he was whisked away for a thorough evaluation. Our fears were confirmed. He would have his cardiac surgery one week later.
I don't know how we made it through those first few days. When I was finally able to hold my baby, all I could think about was losing him. Handing our brand new child over to the surgeon knowing they would cut open his tiny chest was one of the hardest things I ever had to do. My husband and I held hands and waited in silence. Those six hours felt like a lifetime.
Eventually we got the call. He was off bypass, and his heart was pumping normally.
Realities set in
One week after my son was discharged from the pediatric cardiac intensive care unit, the three of us drove back to Illinois and I returned to my residency. My mother and sister also moved to Illinois to help take care of my son while I returned to life as a chief resident.
The first few months were hard, and my son was very weak. I worked diligently to pump enough milk at work to help him grow and recover. As the holidays approached, we received more bad news. He needed emergency neurosurgery to place a shunt and relieve the pressure on his brain. So the family drove back to the Golisano Children's Hospital in Rochester, N.Y. The surgery took place five days before his first Christmas. He was just four months old. He persevered. I was back to residency by New Year's Eve to take call.
The road in front of us always seemed steep, but with the support of my family and my residency, I could exhale. My son began to grow and thrive. He is extraordinary, and despite his scars, you would never know all he has overcome in his short life. He is smart beyond our wildest dreams, and has a spirit that is so gentle and kind.
As graduation neared, the realities of my time away set in. Although my program director and chair fought for an exception to be made and attested to my competence and training, there ultimately was nothing they could do. The board mandated that I make up the time I had missed to care for my sick child. My board examination eligibility was delayed an entire academic year.
During that extra summer in Illinois, we began fertility treatments again. My son was healthy and we wanted one more child. At graduation, I was three months pregnant with a healthy baby girl.
In hindsight, I'm so glad I bought that big refrigerator when I first moved to Illinois. The oversized capacity fed my husband and myself, as well as all the friends and colleagues who supported us through such a trying time. It stored the frozen meals that neighbors brought for comfort. It stored various meals for my mother and sister as they helped care for my new son. The large freezer provided ample space for the breast milk that sustained our child and helped our little fighter grow and thrive.
Residency is hard, but life is sometimes harder. It's clear that more consideration needs to be made to the needs of new and expectant families. The obligations for change are shared amongst all of us; men and women, teachers, mentors, program directors and members of the board. We are entering a new age of training, where work/life balance is not only valued, it's celebrated. We need to deliver upon that message – and to support the next generation of plastic surgeons and their commitment to wellness.