A 'ma' speaks about 'Asthma'

Today I am known all around for my skills with children suffering with asthma...

The story had a personal beginning.

Ekalavya, my son, now 30, would come down with recurrent episodes of cold and cough taking long to settle as an infant. I was then in my mid-twenties, a young captain in the Army Medical Corps. I would often wonder that why does he suffer as his sibling a year older did not get afflicted. It was probably not an infective etiology then. Since the episodes were not very severe and settled down easily, I stopped worrying.

Around the time he was 18 months old I was posted to Base Hospital Barrackpore, in the outskirts of Kolkata. I was a single parent, my husband was pursuing higher studies overseas. There were floods in Bengal and an officer had to be sent on special duties to help the locals and the troops. As I spoke Bengali, I was given the orders to go. Not one to shirk duties, I accepted the orders but made a request to be allowed to take my children and their nanny with me. I was given the permission to do so.

The duty was gratifying but the surroundings damp and mouldy. One night I heard loud wheezing in the room at night .There were my two children and me in the room. I knew the sound came from one of them .Little Ekalavya was breathing heavily and distressed. With a torchlight, I skipped over puddles of water to bring him some medicines. I knew none of this would work in a hurry .Those days asthma care was primitive. I had to give him a shot of adrenaline. He settled.In a few days time we returned back to the base as my duties were over. I knew then that Ekalavya had asthma, he had strong genetic propensity from both sides of families.

In a few month’s time I completed my commission with the Indian Army. We joined my husband at UK. I chose to work as an observer in the Respiratory Unit of a tertiary care Paediatric Hospital. I got home what was the best available treatment for Ekalavya and he did very well.

On return to India we discontinued treatment. But one Diwali when the house was buzzing with friends who had dropped by to wish us, I saw Ekalavya was not in the room. He had been coughing the past few days. I found him lying in bed breathless, answering me in monosyllables. My husband ,not from the same profession did not understand the gravity of situation. But one of my childhood friends was there. We got onto his scooter, me clutching onto a breathless child, who was beginning to grunt. We raced to the hospital Emergency Room, it helped that I was the senior Paediatric resident. Ekalavya settled. But many don't...

Thus started my crusade for the asthmatic child.

I make their lungs the heart of my practice.

editors note: Thank you Dr Barnali Bhattacharya for your heart felt message. it is said that to be a good doctor we must empathise. but beyond Empathy is 'kinship'. where empathy says ; i know how you feel...kinship says; i have felt what you are feeling. 

This kinship with your patients parents , makes you a better doctor, and thus a renowned name in Asthma counselling and treatment.

to eat or not to eat

As an obstetrician , I have been asked this question thousands of times – what do I eat in pregnancy? Can  I eat papaya? Can I eat pineapple? Should I avoid meat? Is eating egg harmful? And the alltime favorite – should I eat ‘garam’foods or ‘thanda’food? Not hot or cold in terms of temperature but in terms of whether it increases body heat or not. Don’t ask me , I don’t know how?! As a practitioner of Allopathy , I am clueless about these concepts , which are probably derived from Ayurveda.

 As students in medical college , we were not taught to answer such questions, so ,when faced with such queries , I advice them on calorie & protein intake and the need to avoid unhealthy junk food.

The tables turned though when I was expecting. 

No one asked me anything , everyone turned advisor instead." Do not eat methi", said my cousin. "Do not eat nachni , it is garam " - my neighbor said. My rational scientific mind rebelled against this – to no avail. Everyone assumed they knew better- I was only a gynaec whereas they were already mothers!

 It only got worse post delivery. Most communities in India have their own brand of post partum foods. In Maharashtra , the new mother is fed laddoos of methi (yuck!) , and also raisin- all made with lots of ghee (which I don’t like) . In Tamilian Brahmins , there is something called ‘pathiya samayal’. This excludes all pulses except moong , all tubers, vegetables like brinjal and okra and even green and red chillies.

 Unfortunately , having a Tam-bram mom and a Marathi mum -in-law , I was ‘forced’ to follow both traditions!

There are also a whole lot of myths associated with pregnancy and delivery – my mallish wali bai scolded me for not stuffing my ears with cotton lest the ‘hawa/air’ leads to abdominal bloating , my maid asked me not to eat rice so that my scar heals well, ‘well wishers’ adviced that tying a tight cloth around my waist will make me all slim and trim again!

  The whole experience made me  realize that pregnancy and delivery is a social event in our country , with everyone and their aunt chipping in with well intentioned and conflicting advice. 

The new mother is generally left confused, not knowing whose advice to follow – the obstetrician does not even figure in her scheme of things!

I think my whole pregnancy experience changed the way I practice gynecology and obstetrics. Earlier , I believed educating patients was the key to good nutrition and healthy pregnancy. Now , I counsel mothers and mothers- in –law  instead as they have the final say!

Editor's note: Thank you Dr Lakshmi on the true tale of unsolicited advice in Indian scenerio. I do wish our medical textbooks had armed us better with the cultural and social aspects of pregnancy and motherhood. Food fads especially are an intrinsic part of pregnancy, and what I noticed is that what was bad for you in pregnancy becomes good for you in early motherhood. I guess it depends on their 'claimed effects on uterine contractility'. I am sure they have a kernel of truth in them especially in the time of yore, but they have been blown right out of proportion. unsolicited advice is common in every society, but most parenting guides will tell you to "go right ahead and follow your maternal instinct." in Indian joint family scenerio, the new moms instincts are not given much importance when there are other 'veteran moms' such as grand moms and great grandmoms, and aunts and dais. I think you might have a point there on educating the family tree.

A mother helps her child see

 I am DR. Samyukta, practicing anesthiologist from Chennai. Though I had read of nystagmus and its types in 3rd year of MBBS, I had nott seen a case of nystagmus  during the course.when I noticed it at 9 months of age in my daughter, I was thinking that it will settle down with age as congenital squint.

Even at that time I did not know that "shaking of black ball is “nystagmus".This shows the  importance of practical knowledge /clinicals in our profession.

  After 6 months , ie when she was  about 1.5yrs I took her to opthamalogist for squint, even at that time the shaking was not observed by doctor, after 2 weeks I myself presented with the complaint of shaking  and it was the first time I came to know it as "NYSTAGMUS". I was shocked, felt bad about it. The doctor had referred to a paediatric ophthalmologist who is experienced in squint and nystagmus surgeries.

                                       

Without reading   much of it, we went to for consultation where he said observee for null point direction and we would operate and it should be within 4 yrs for best results, it was the first time when she had eye drops. being in medical field , that too anesthiology I know the risks, complications,  psychological trauma , mishaps  that can take place during surgery. Thinking we can get operated in UK we continues with our plans for travel.Though scared by the surgery, till then we had a positive hope things will settle down and her eyes will be normal after it.

            

  But things have changed after the consultation in UK. We did ERG  and MRI, we came to know she is having cone dysfunction with nystagmus being defect in afferent system nothing can be done.

He explained the most important points, how nystagmus eyes see the world.

As all are aware, consultation in UK is a process of 5- 6 months, before we understood how her eyes see the world, we troubled her a lot. I  used force her to sit away from TV, to look straight and talk , poor girl she even tried to see straight, whenever  that flashes in my mind I hate myself.I searched   what might be the causes of cone dysfunction, and I found in one of researches that  when foetus gets exposed to bright light , it damages its retina. I hated myself more because I was working in operation theatres until 9 months and even I did CPR at 8 months of pregnancy. Even today I feel my profession is a curse for my little one.

What really helped me was not medical books but internet  and blogs.

When we hear the word  ‘cone’ one first thing which comes to our mind is colour blindness.Intial she use to even get confused with green and red. Everyday I used show apple to tell her it is red color and leaf for green color, slowly she started to identify them correctly.Now her identification, colouring everything is perfect.All these things are shared by other parents

I have joined the nystagmus network UK, which taught me how parents should support the kids. I am most thankful to it.With idea to help other parents of nystagmus kids in india I have started Nystagmus Group India.

The main reason for starting this group to prove to my kid that she is not the only person with this problem, there are many persons like her and how they cope up in Indian scenario.the feeling that someone is there with similar problem like me, itself  boosts their self confidence.

IF we really know what is the problem , we can come up the solutions, but for it we should understand the problem thoroughly.This is the most difficult part in nystagmus.Even myself being in medical field took nearly 2 years to understand it, what would  be the postion of non medical person??? Commom man???At present I am working on this aspect,this should stop with face book, it should reach all kids and hope I can reach this in couple of years.

                EDITORS NOTE: Thank you Dr Samyukta for your words. You are so right, knowledge is power. And in todAys age knowledge is at our finger tips. But as a paediatric ophthalmologist I have realised that with knowledge, patients and parents need empathy,need support; and that is where support groups come into play. I have learnt a lot about handling nystagmus patients from the facebook support groups, especially from our own Indian group. you have taught me from your own examples, how you make your daughter brush her teeth, help in her homework, spread the message in her class rooms, these were issues which I earlier did not address as a paediatric ophthalmologist. today one of my questions to my patients is "do you have facebook? or internet access" so that they can get in touch with other parents/patients with nystagmus.

other than that this story deals with a universal topic- of a mothers guilt. There is no escaping that, as mothers we are wired to blame ourselves. child crying at night, child not eating well, child having a temper tantrum, and in India they go a step further and blame mothers for having a female child. As a paeditric ophthalmologist I assure you, you did not cause this to your baby, and as a mother I applaud your quest to provide the best to your child, as well as understand her physical handicaps so as to better help her adjust. 

another important lesson here is acceptance. As Dr Samyukta says, until you accept your child has a problem, you will not be able to help her, or find solutions. like in Nystagmus, trying to make your child look straight (when she CAN'T, or making her soit further from the TV or board (WHEN SHE CAN;T SEE) arte classical examples where parent refuse to accept that their child has a problem. Acceptance is the first step to solutions, not cure in many cases, but solutions nevertheless.

to join the nystagmus group click here

to read more stories by doctor parents :click  here

The balancing act

A recent headlines in the Times of India caught my eye , it read “More women study medicine ,but few practise.” The article essentially spoke of how women are unable to balance work and home and many choose to forfeit their medical degree for their marital duties.

The article speaks of how 50.6% of admissions into a medical college are women, but only 17% of allopathic doctors were women. to read the whole article press here.

As a new mom and currently on a sabattical from work, I can in a way identify with the herculean task of balancing work and family.

Early into my pregnancy, or rather even before I conceived, I was well aware that I stood at a disadvantage to my non-doctor friends. First, as a doctor in a private hospital, I did not get paid maternity leave. Unlike government positions, a doctor working in a private hospital is not always paid for the 3 to 6 months that she takes to raise her new born. Doctors, especially those who have their own practices, or are freelancing in multiple hospitals, are essentially ‘daily wage earners’; they earn as much as they work, and for as many days.

This early realisation that I was more akin to my local bhajiwali, who got paid depending on the wares she sold, and whom I wouldn’t dream of paying if she decided to go on a maternity leave, made me feel more kindly towards her. I stopped bargaining for the extra 5 rupees, I even paid my cleaning woman her bonus, knowing fully well that these ‘working women’ were trying to balance a home and work, without the benefits of a government plan to safe guard our interests as we brought up the next generation of Indians.

The slogan says “beti bachao, beti padhao’ no where does it say, ‘beti ko job dilao’!

My friends working with multinationals and corporates spoke of their ‘maternity leave packages’ and ‘work from home’ plans, and ‘in house crèches and daycares’ within their companies. True, these were non-government jobs, and many of them financed by foreign investments, and yet, they seemed to care about the ‘working Indian woman’ more than many ‘indian companies’ did.

I did finally come to terms with my not getting any ‘paid maternity leave’, and then contemplated about my medical insurance.

It’s an honest declaration that doctors are extremely poor with understanding investments and finances. Maybe it is our inherent dislike for numbers, or the fact that we start earning much later than our counterparts in any other profession.  And medical insurance is something we doctors take extremely lightly, especially so early in life. All the minor ailments are easily solved by a quick call to another doctor friend, most doctors (atleast the ones that I have met) don’t charge other doctors any consultation fees as part of the unspoken ethical code we follow.

If being ‘jobless’ was scary enough for me, the fact that no health insurance covered pregnancy/delivery/newborn care was another new revelation.

We were going from a double income family of two, to a single earning member of a family of three! With the loss of around six months of pay as well as the added costs of hospitals, as well as a full time baby care if I ever wanted to join back work, the financial dilemma was obvious.

For doctors there is also the question of ‘losing our practice’. Our patients would need to see other doctors in our absence, and what are the chances that they would return once I resumed work?

I don’t know about the 50.6% of female doctors who decided to take up the medical studies, but I always planned on practicing my knowledge and not  just because I wanted to gain degrees.

Yes, it’s true some parents hope that a degree will help their daughters marry a better prospective husband, and they never intended to use their medical degree for any other reason, but if a degree is all that one is after,I can think of less gruelling courses to apply for.

Is it not sad then, that after excelling in competitive exams, burning the midnight oil, many female medical graduates have the coveted Dr. in front of their name, but are essentially homemakers?

Don’t get me wrong, being a home maker is bloody hard work!

If the last couple of months have taught me anything, then it is that staying up feeding, burping and rocking to sleep a baby, is as tough as any night duties I did as a doctor (maybe even tougher on some nights). The physical tolls of motherhood, the continuous undivided attention that a baby demands is more than the most demanding bosses in any profession.

It’s like an alarm without the snooze button, which can ring at any given time day or night. You are never on a coffee break, and you can never call in sick, neither are there any furloughs as a mother. I have done it only for 5 months and I can only imagine, how many women volunteer to do it all their life. Being a stay at home mom is a demanding job, more demanding than maybe even being a doctor, and yet I want to be able to practice my profession.

Why is it so difficult for doctors? First, there is no concept of ‘working from home’ doctors. Maybe in years to come we will have online consultations and doctors working in atleast a few fields will be able to work from home, but all in all medicine is a field where we need to palpate, percuss, auscultate and do various hands on tests on a patient. Secondly, many medical fields have emergencies and do not have flexible timings, say an anaesthetist who is dependent on the surgeons hours, or a gynaecologist who can hardly decide when her patients go into labour.

 Nuclear families have made the need for caretakers a necessity, and unlike multinationals which have in-house crèches, very few hospitals have such facilities for their doctors. As one hospital administrator once told me ‘Hospitals don’t owe doctors anything’. In an age where we are well into second generation working moms, and where even grandmothers are working women , we can hardly hope for ‘grandmaternity leave’ where we expect working grandmothers to leave their jobs and look after the grandchildren. (to read my article on caretakers and nannies read ..  here)

India is going through ‘growing pains’ where we want our women to work, but we want them to look after home and hearth as well. Doctor- moms, who always kept their patients first, find their priorities changing once they have children and they become mom-doctors where they are moms first.

As I inch towards the arbitrary 6 months period , after which it is generally considered that women who hope to have a professional life start to resume the role of a ‘working mother’ rather than just a ‘mother’, I will soon be lifting the balancing scales. Sometimes they will tip in favour of being a mom, and I will be judged as not being professional enough, and sometimes they will tip towards my work and again I will be criticised for neglecting my child. I realise that the balance will continue to swing up and down and I may very well never have the perfect balance. But, I hope that I am part of the 17 % women doctors who are practicing doctors, for then I will know that I have beaten the odds. And even if I meet a doctor mother who chose to not practice, I will not judge her by saying that she let her weighing scale fall or that she lost her balance, it’s just that she decided to weigh her life on a different scale.  

other posts by doctor parents

http://doctorparents.blogspot.in/2015/12/honest-goodbyes.html

http://doctorparents.blogspot.com/2015/12/2-gynaecs-and-baby.html

http://doctorparents.blogspot.com/2015/12/a-mother-knows.html

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