Impatience

The cognition was fading, more rapidly than anticipated.  An intervention that would likely prevent it was not what the patient wanted after watching a loved one die of the same.  The primary team called an emergency family meeting to get a decision made.  The patient refused to let anyone make decisions except them and yet, they could not follow the conversation.  The family was afraid to make decisions because of past history of animosity and anger if things didn't go the way the patient wanted.  The onus was put on us to get a decision made.

It's amazing how easy it is to feed into that sense of impatience.  I felt like I didn't get to do things the way I prefer to - get to know the patient, figure out what's important to them, determine what treatments they for sure knew they did or did not want before being thrust into forcing the patient's hand on a decision.  Instead, the rapidly fading mental capacity of the patient led to a hard push to try to get a decision made, and it ended in the patient's family getting the silent treatment.  That, I felt, was my fault for not doing things the way I typically do them.

Today, we got nothing from the patient.  The chemicals in the blood already having their affect on the clarity of consciousness.  The edge that was present yesterday, was gone today.  The patient is rapidly becoming a shell of themself.  The family is still paralyzed by the patient's previous indecision.  The team was impatient, angry that we hadn't "made the patient hospice" so they could get rid of them.  It was heartbreaking.

How do you balance doing what feels right for you when it comes to setting up the conversations at hand with the expectations of the primary team and the abilities of the patient?  Knowing that this patient wanted to make all of their own decisions without family intervention makes it harder now because that's not possible.  We have no information on what the patient wants us to do beyond the things they don't want.  How do we proceed.  We know the patient does not necessarily need to be in the hospital, and yet the family is saying they wouldn't want multiple other options that would be supportive of the family.  Where do we go from here?  How do we support the family into inertia to make a decision?  How do we block them from the pressure of the impatience of the primary team?  How do I keep myself from also giving into the pressure of external impatience in the future?

My Birth Story Part 2

The actual birth of my son was as unexpected as I'm sure most births typically are.  My blood pressure decided to go up around 38 weeks.  In retrospect, what I should have done was wait it out as it was a particularly stressful day at work.  However, as a new mom, I did what my OB recommended which was come in for an induction.  Now, for starters, most inductions are scheduled to start in the morning.  Mine, with being done at a new birth center, was scheduled to start at 5 PM on Tuesday, January 28.  I thought nothing of this until the OB on-call slept through his alarm to come break my water at 1 AM and instead showed up at 3 AM.  I had been on increasing doses of pitocin since 7:30 PM, and learned at 3 AM that it hadn't done anything.  Once my water was broken, everything seemed to speed up and slow down at the same time.

I have now also learned that I need an epidural before my water breaks.  I am a wimp when it comes to that level of pain and waiting 2 hours for anesthesia to finally come in was brutal.  I am shocked my husband doesn't have PTSD from not being able to do anything for my pain during the wait.  Once that epidural was in, it was fantastic except for the hip flexor pain that I think was probably triggered by the fact that my son came into the world facing the wrong direction.  In other words, when babies are born, for them to more successfully pass through the birth canal, they should be facing toward the ground if mom is lying on her back.  This makes it easier to pass under the pubic bone.  On the other hand, my sweet little boy came in looking up (and hasn't stopped since then, wanting to see everything) which meant his sweet little top of his head was bruised and raw from smacking into my pubic bone instead of passing underneath it.

I think if I had waited it out, my blood pressure would have dropped, and my baby boy could have had a little more time to get into optimal positioning.  And yet here we are, happy and health.  He finally arrived at 2:04 PM on January 29 at 7lb 10oz.  He is precious and sweet and I don't think I knew how much I could love another human until he arrived and that was after 3 hours of pushing...

My Birth Story, Part 1

It has been almost a year since I last published.  At the time of my last post, there was so much going on.  For starters, in January of 2019, I was told that if I wanted to have children, I needed to start sooner rather than later because my ovaries "weren't getting any younger".  See, at the time, I had gone over a year without a period.  I now know this is because of PCOS, and at the time was also fairly certain of that.  However, there's nothing like your GYN making the above comment to get your biologic clock ticking.  With little support from said doc, I turned to my internist to get the necessary labwork to show I had PCOS (with the help of a friend in endocrinology to tell us what to order).  I will say, the average time to diagnosis for most women with PCOS is several years with visits to several different specialists.  I was beyond lucky to have a wonderful primary care doctor who was willing to do what needed to be done.  I also was fortunate to have bloodwork that shows that my ovaries are doing just fine for their age.

With the diagnosis in hand, we turned to a local reproductive endocrinologist to help figure out just what needed to happen to trigger ovulation for me.  Fast forward to April, and we were talking about using pulse dosing of Femara (typically used to help keep breast cancer in remission when taken daily).  The idea is to mimic what typically happens for egg maturation.  Estrogen levels drop with the Femara which triggers an increase in follicle-stimulating hormone which causes an egg to mature.  It took two tries to finally get egg maturation kick-started and then the use of a trigger shot to cause ovulation.  The next few weeks of waiting to be able to take a pregnancy test were really tough.  And when I could finally take one, I took 6 just to make sure I was, in fact, pregnant.

I had pretty bad nausea during the first trimester, and developed several food aversions that stuck around for the entire pregnancy (I can thankfully say that they are over and done with and I pretty much eat anything in sight at this point).  Pregnancy (like motherhood) is a mix of joy and anxiety on a regular basis.  I felt paranoid at times because I felt like any wrong move would be the end of my little nugget.  I worried about everything I ate, how much I slept, the exposures at work while at the same time being so incredibly thankful for the ability to carry and grow and protect my little one.  It's an incredible experience knowing that I was and still am a safe haven for my sweet little boy.

Speaking of which, little man is needing my attention. Until next time.