A mother knows

We got married in Dec 2009 and soon after my marriage some Pandit told my mother in law,  that since my husband and I have common "nadi" we won’t be able to have any child. But to my surprise I conceived both the times very easily.To this too my mother-in-law believes was because she donated a huge sum to our Guru's "Temple". 

My husband & myself just laugh it off but can't change her thinking. Both my husband and I are doctors, and yet it is very difficult to shake away the superstitions so ingrained in our society.

Being a doctor definitely helped my son's diagnosis. My son is 3 yrs old & my daughter is 2 months old now, and I am grateful to have both of them in my life. 

During my first pregnancy I was working in LTMC at Sion(Mumbai) and thus, my anomaly scan were done by seniors there.Anomaly scan is generally done before the 20 weeks of gestation. It is the time when all the organs of the baby are formed and helps in identifying any physical problems with the baby. If there are life threatening anomalies, this is also the time when the parents are adviced about medical termination of pregnancy before the government decided 21 weeks.

 I had done this scan at both the government as well as at a private clinic in Dadar and yet my son's supracardiac TAPVC (total anomalous pulmonary venous circulation) wasn't picked up.

I was undergoing a normal labour at a Nasik hospital but  during a per-vaginal examination the gynaecologist noticed meconium, and I had to undergo an emergency caesarean section. My baby had meconium aspiration. The pediatrician who attended him at night during the section didn't visit me despite the phone calls, so we got a friend of my husband to have a look.

 For his blood collection, hospital staff took him away from me saying I won't be able to bear him cry. Luckily my husband went inside the collection room. To his horror these fools were planning to go for a femoral for a 3 day old new-born just for a nonsense 50 or 100 Rupees cut from the laboratory!

 We took him to a third paediatrician for his blood collection.

On fifth day after my discharge I took him to another well-known Paediatrician for immunization.To my surprise despite me being a fellow doctor this senior doctor didn't even examine my child, as he was going through another file, & told his assistant to give immunization !

He asked me to get my son admitted for photo therapy despite his bilirubin being 11 (which I was later told by my friends is physiological jaundice and does not mandate phototherapy).

During these initial few days I had developed allergic bronchitis. I noticed that the urine diapers were less. Being a primi I wasn't sure about the feeding cycle. But I had a gut feeling that something was wrong.

 I decided to visit yet another paediatrician, who told me that my son has got cough from me. That was strange since It was impossible that I could infect my son as I had allergic cough! At the age of 10 days he was diagnosed having URTI(upper respiratory tract infection) which is not seen at that age.

Because of my multiple visits to various doctors I was diagnosed with "postpartum psychosis", but that did not stop me from trying to uncover the cause of my sons cough.

Finally on 14th day I visited another doctor. By then he had started vomiting and showing signs of pulmonary hypertension. The doctor suggested that we should do an ECHO which made the diagnosis.

The doctor who did ECHO was our college senior. Though he diagnosed correctly my son’s cardiac condition, he started telling me about treatment packages & how I should go to a specific hospital for my son's surgery! This horrible person knew that my husband was doing his cardiology & being a mother I was just trying to get into the situation.

 I immediately went to Mumbai ( Sion) where my husband was doing his residency. Meanwhile an ICU bed was booked & next day he was operated. I remember asking the operating surgeon if my son would ever be able to have children of his own, a common question asked by patients but which we used to find funny earlier.After the surgery, when the operating surgeon said that the surgery was a success, I touched his feet.

 During my long stay at hospital I noticed that all the operated babies were around 2 Kgs & only my son was the one with birth weight 3.34 kg which helped in an early recovery.

 Also being medico we got him operated before developing pneumonia which is very common in such kids. During my stay I used to feed him every 2 hourly and  breast milk output never stopped which generally happens for mothers when their children are in intensive care.

At 1 month follow up I saw all the kids who were operated during  the same time. I realized the importance of breast milk, as most of others were on top feed.

 Also post- op my son started having seizures which is very difficult to pick up since all his four limbs used to get stiff for few seconds. This was followed by anticonvulsants, EEG's & MRI's. Then despite all the care he got a stitch abscess .After the abscess drainage he was started on Vancomycin i.v. and developed allergy to it! Till then I had only read about red-man syndrome in my pharmacology books but actually saw "red man syndrome"(vanco allergy)in my son.

 He was diagnosed with intra-op hypoxic seizures. Later with anticonvulsive Rx he never had them. 6 months later it was stopped. Meanwhile he was achieving his milestones & by 8 mnts of age everything was stopped. Then I went ahead for my interview of Asst Professor in ophthalmology.

This is an anonymous post 

editors note: Thankyou doctor for sharing your story. It is a powerful narrative with many lessons. First off, it is a mirror at the medical profession where a doctor herself speaks about , inability of the radiologists to pick up the diagnosis intrauterine, the maternity unit trying to make extra money by pricking a small baby, senior consultants not paying attention and passing on to their assistants, the pressures of private practitioners to 'sell' the various 'hospital packages'. 

But more than anything I think the story highlights that 'a mothers instinct ' is a strange and powerful thing. Here is a mother whose own husband is a training cardiologist, but even the father was unable to pickup that something was wrong with the son. Even after being diagnosed as 'post partum psychosis' and everyone naturally telling her that 'it is all in her mind', she persisted! The mother's instinct knew something was wrong; even though she was a first time mother. That's just AMAZING! 

2 Gynaecs and a baby!

I wish I could write this one with the baby's viewpoint instead of mine but thankfully my little one was spared the verbal onslaught the first six months! ( fetus can recognize and register the mother's voice and sounds only in the third trimester) So here is a gynaec "to- be- mom's" and Gynaec "to-be-grandmom" and their little baby's story with all their ups and downs.

 It all started with a positive UPT. I mean duh..like all other pregnancies u know..but that's where the similarity ends. Our first argument was over when I should get my first scan with mom insisting I hurry and me wanting to wait so I could be absolutely sure as I was only 5 days overdue. Given that we were in different cities obviously helped my side and I got my first scan at around 7 weeks. 

Unfortunately I had a small bleed inside the sac and for the very first time experienced the anxiety that any mother and a patient feels when she s broken those news. The first person I called was my mom and believe me I now consider myself lucky to have a gynaecologist as mom. Her sturdy experience with probably over a thousand cases like mine overcame my anxiety over all the losses I had seen with first trimester bleeds and she helped me calm down although i argued(again) about going home for the prescribed rest.

 And then she did the next best thing..she took charge and the next day our car was waiting to ferry me home for some much needed bed rest. In the ensuing week i was home i got at least 3 ultrasounds courtesy a hyper mom and an indulging grandmom! Rest assured my album for my babys first months inside me was already full!

Even after being diagnosed with Graves hyperthyroidism and having conceived while I relapsed her reassurance on the cases she had handled though few but all with good outcomes was an immense help along with my rockstar of an endocrinologist who since day one had literally been holding my hand through it all. 

Yes I underwent some investigations which for her seemed overdone and not at all routine like a fetal echo repeated twice, TDap vaccine etc.. It took some patient discussion, Google and her discussing my case with my attending gynaecologist in Mumbai for her to be convinced..not that she ever failed to remind me how they never had all that in their day and look how fine i turned out! And I obviously vehemently defended science and all its tests and their advantages (mostly to little avail!)

 The best part about my pregnancy today is no matter what week I am in its the easiest thing to call her up to the day of the week crib about my symptoms and silently hope she ll say its normal. 

Because no matter how many patients I counsel or deliver there is no greater teacher than going through the whole experience by self where everyday especially in the last trimester brings a new symptom most of them worrying because the due date is so close.

 Having my mom as my gynaec is the next best thing to delivering at your moms place..as most of us do! Although she is doing the prudent thing by not actually delivering her grandchild, my pregnancy with all its hiccups could not have been this smooth a ride without her being a rock by my side!

Dr Asavari is a practicing Gynaecologist and obstetrician. She is expecting her first child mid January 2016 and is blogging her experiences at http://ravingsofapregnantgynaec.blogspot.in/, where she chronicles all the ups and downs of a 'pregnant gynaec'.

editors note: Thank you for the post Dr Asavari. As a doctor parent we are already analysing our own pregnancies, and later our parenting choices. Just like in the medical profession there are "two schools of thought" or a difference of opinion in managing a disease, parenting has it's very own 'camps' the 'attacment parenting' camp, the 'baby sleeps with me in our bed' camp to the 'baby sleeps in her own crib, in her own nursery' camp, to 'bottle feeding' / 'breast feeding' and tiger moms/ lazy parenting! There seems to be a lot of opinions out there on how to bring up your children, which I realised after having my baby and during my copious readings, as you will soon realise. I hope you will write again for doctor parents with your new insights as a new mom and how they might have changed. 

Honest goodbyes

Looking at my two year old son cautiously stroking my new born daughter’s hair, a feeling richer than any contentment ever known filled my heart. Time has its own orchestrated rhythm; wherein happy and sad notes go in tandem. Neither a sad time is devoid of memories of the good ones, nor does a happy occasion fail to tune in to the tough past. Such was the time which I had lived through the loss of my first pregnancy.

 I revived inadvertently the moments of that roller coaster ride, as I peacefully swayed through the present bliss…..

With a home pregnancy test in my purse and a spark of excitement in my eyes, I opened the lock of my apartment. We hadn't been planning for too long, with only two years of marriage behind us. But those years had given us the precious moments of sharing, of working together to get ahead in career, me as a pediatrician and my husband, a studying urologist.

I cannot depict the feeling, the overwhelming sensation I felt when the result came positive. Maybe I didn’t actually acknowledge it to be true till I told my husband, whose happiness was way beyond words. And then and there, we made a bond with our unborn child. A bond so strong that it didn't need the actual physical presence or form or shape of this new life, just the affirmation of its beginning this journey of life was enough.

Moments in life that are labeled” chaotic”, ironically do not affect much of our routine, the very flow of events that we have to live each day. But they do seem to colour the canvas of our subconscious, the parallel thoughts that fill our mind as we live through the daily grind.

As I floated through the bright colours of euphoria through my initial few weeks, I was totally unprepared for the dark shades due to come...

 Drops of blood (called spotting) was all it was; but it painted my whole canvas red. I was put to complete bed rest at the end of my very second month of pregnancy. What followed was a tug of war between hope and fear, which stretched every moment of every day to eternity.

My first scan showed no cardiac activity, which was a red flag. I was advised to give a trial of injectable hormones as a last resort. I was told by all the gynaecologists I consulted, that being a medico and consequently having a late pregnancy and with all the job stress, I should have had pregnancy support sooner. I wished I knew sooner.

Fate hadn't ended this torture here; for those few injectables got the heart beating. Hope eluded me a second time, when I went for a check scan a week later, only to find our baby surrounded by red. 

I hadn't bled out, I had bled inside and the damage was fatal. I had to get the surgical clearance of the baby, the D and C procedure.

I remember my husband trying to be all brave faced and my mother telling me 'all that happens is for good', only I found it hard to believe. This brief journey and its dismaying culmination left me feeling empty and incomplete. Though wheeled out of the operation theater was the same me that had been all these years, but something more was missing than the left out remains of our dream.

This episode left me contemplating, if it was almost our fault to have been negligent, not being overcautious, having been in the profession which expects the same. But whenever I recall those days, it’s only me, as a mom to be, that comes to my mind, excited and a little scared like any other woman. And it still leaves me with an ache, that maybe it could have ended differently. I am content now and hold no contrition. It was, to speak medically, after all some “lost products of conception” in an abortion. But to the life that never could be; I do convey all my honest goodbyes….

Editors note: In medicine we often ask our patients difficult questions , like "how many miscarriages, at what month of gestation?". We then go on to draw family trees depicting these angel children; as either triangles with a cross though it, or a darkenened black circle with a cross through it, or a square/circle with a cross through it, depending on if it was a miscarriage,still born or death of a new born. 
This gut wrenching, deeply emotional moment is put in perspective in our medical words. As a doctor parent I now wish we could offer some words of solace or kindness, empathy even, to our patients. 
But, in drawing these little symbols in the family tree , we acknowledge that these these unborn children still belong part of your family, they are right there and will forever be part of your lineage tree. 

Thankyou Dr Karnika for sharing your toughest moment as a parent with us. 

for more stories by doctor parents click here and  here http://doctorparents.blogspot.in/2015/12/a-mother-knows.html