The woman had tried to flush her baby down the toilet in a motel. She deserved my ire.

I immediately dismissed her as less-than for not, at least, leaving the baby in a warm blanket. Why try to kill him– a near-term boy who probably cried as he hit the cold toilet water.  There was just no state of mind that would justify such a heinous act.

I didn’t want to see her, didn’t want to force myself to smile, and didn’t want to be empathic. That’s just not how I felt. And, I would have to walk past the police standing outside her door, which only added to my discomfort.

I sat at the computer in the middle of the nursing station and reviewed her labs and read the notes written on the previous shift. “She’s fine. She’s ready to go to jail now,” I scoffed.

“Please be kind. She has been through a lot.” Bridget’s hand reached toward me as she spoke. She had been a nurse at this hospital for 25 years. Bridget was a white nurse who carried a toughness that belied her small frame and olive complexion. The type of nurse that every doctor wants around in the midst of an emergency. She has a keen clinical eye and calmly executes her duties.

“Are you kidding me?” I thought without responding to Bridget’s plea. The hotel maid heard the baby crying when she came in the clean the room. Who would do such a thing?

As I walked down the hall, a swarm of emotions filled my head. I was embarrassed by the admonishment. It was my role to exhibit professionalism and forgiveness. Confusion and surprise also visited my mind. In 25 years I have never heard a labor and delivery nurse defend an abusive mother. Not once. I have worked in six different hospital systems in the Northeast. Yet, today I was alone in my wrath because my negative emotions were not aligned with that of the clinicians around me.

Walking towards the patient’s room, I tried to cool my disgust: maybe she was raped and felt nothing but hatred for the baby; maybe she was a prostitute and was under duress; maybe she was homeless; maybe mentally ill, etc.

I said good morning to the police officers as I entered the room.

At first I saw a pair of slender feet that managed to escape the cover of the blanket. The room was too warm.  I was thinking about the temperature when the room, slowly, came into focus. The shades were drawn. A glance down at my notepad gave me a few seconds to put on my “doctor face.” I took a deep breath and managed a closed-lipped smile. It took a few minutes more for the scene to register.

The patient was white. She was not a Black mother.

I had to consciously un-wrinkle my face as I took in the blue eyes and light brown hair sitting up in the bed. He faced displayed no emotion whatsoever.

Wow.

I, a black physician, had assumed that she, the patient I deemed horrible, was a black mother. The picture of the crack mom is so inked into my mind. It’s a story printed there by decades of imagery that consistently delivered negative images of black mothers. It never occurred to me that the baby who was found bloodied, screaming, cold, abandoned in the toilet of a hotel room, came from a white woman. And, of this I am almost certain, Bridget would have never had come to her aide had she been a black woman.

Unconscious bias is all around.

it’s like the gleeful swimmer who is unaware that a shark is close by, until the shark bites. Or, like the fisherman who merrily gets his fish having never appreciated the harm done to the beings in the ocean by tactics that are harmful. We’re both guilty—Bridget and I. But I thank her still, for holding up the mirror.

I’m a sorry, Black mother, for my participation in the processes that contribute to your deaths. Alia McCants died after giving birth to her twins: implicit bias was responsible for her death. We can train our doctors and clinicians to do better. 

I was kind to the patient when I spoke, as I recovered from my fugue. Every patient deserves professionalism and respect. Every person deserves a chance to explain, or at least to ask for forgiveness. This should be the expectation of every clinician, no matter his or her creed or color, sex, gender—whatever the type of PRIDE celebrated. Certainly, Covid had made getting care even more difficult for women in general. As we emerge from the pandemic, we need to keep our attention steadfast on the issue of racism in healthcare in America.

~Juliet_MD~

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Juliet_MD chats with psychiatrist and fitness guru, Dr. Ludmilar Mesidor, about how to survive pandemic related depression and isolation. We need to find a way to stay COVID free and stay sane while adhering to social distancing recommendations. See the conversation: BelowTheBellyButton with Juliet MD.

COVID 19 has dispaportionately affected black and brown communities. We are working harder to stay afloat. We are not sleeping. And we are suffering, in silence, from the significant impact of this pandemic on our emotional and physical states.

If you need help coping during this time, The Love Land Foundation provides a fund for therapy for communities of color.

There you have it. Spread the word.

~Juliet_MD~

The post How to Survive Pandemic Related Depression and Isolation appeared first on Below The Belly Button.

Every time there is a shift in our culture, it usually means that women have to manage more tasks to keep the household running. And so it follows, women are working harder during this pandemic.

“More Work For Mother: The Ironies of Household Technology From The Open Hearth To The Microwave,” by Ruth Schwartz Cowan is one of those iconic writings that remains relevant, even in the midst of a pandemic. Women, even those who have partners, but especially those who are heads of households have been left strung out by the dizzying amount of house work that they alone must do.

Food preparation—breakfast, snack, lunch, snack, dinner, snack, and finally dishes—swallows swaths of time. Remote learning means that paid work or needed rest is often interrupted. And let’s not forget about the damn laundry! Social isolation means that caretakers or help from family is not available. And, even when a partner is available, the “homemaker” is still targeted for these additional chores.

A recent New York Times article described the results of a survey about housework and outlined what we already knew—-men believe that they contribute more that they actually do!

Before this is further cemented as the norm, delegate specific tasks to everybody in the house.

To start, never confuse self-care with selfishness. Second, delegating effectively means giving up on the notion of perfection.

Children, six and above, can expertly navigate the Ipad, Nintendo switch, and Zoom. Also, they can’t wait to get back to soccer practice and swim meets. Which means they can run down the stairs to put clothes in the washer and press a few buttons. There are lots of tools on how to assign chores to children, including verywellfamily.com and parents.com, for example. Make a chart, assign age appropriate tasks, and dedicate a period of time to do the chores together before cutting the umbilical cord.

The same thing follows with the dishes, someone else can load and press buttons, it doesn’t always have to be you. But don’t sit, pout and stew in resentment. Ask for what you need and be specific, “I need you to load the dishwasher, turn on the machine, wipe down the counter, and sweep the floors.”

For this to work, let go of the Superwoman Syndrome. Resolve to let go of bad stress. Send the teenager or partner to the grocery store with a list, and don’t freak out if they buy the wrong brand. It really does not make a difference if they buy Prego instead of Ragu.

In the long run, everybody will appreciate what it takes to keep a house running. They will wonder how you have managed to do it all by yourself. More importantly, you will have acted to preserve your health and peace of mind.

There you have it. Spread the word.

~Juliet_MD~

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We will not weather the pandemic, or this period of social unrest, unless we sleep. Without sleep, we will eat more unhealthy foods, drink too much alcohol, and will be persistently irritable and angry.

1 of 3 Americans do not get enough sleep.

The average person needs 7 hours of sleep. There are many ill effects of not getting enough rest. Without enough rest, heart disease, diabetes, and stroke will lurk in your future. Also, depression and psychosis are two other illnesses that are caused by sleep debt. And if you’re not worried about going crazy, you should worry about gaining weight. We eat more when we are tired. The hunger hormone, ghrelin, is released when we don’t sleep, leading to overeating. That craving for ice-cream may just be a call to get some rest! And, let’s not forget that tired people do not have good sex.

Take action. Take sleep seriously. 

“Sleep is about the preservation of life itself.”

Start with these tips:

Avoid alcohol. Besides the dehydration that is shaken into any good cocktail, alcohol interferes with the ability to sleep deeply.

Turn off the lights. Our culture of always being “on” is a major disruptor of our circadian rhythm, our natural sleep cycle. Our bodies should ideally rest and wake in tandem with sunrise and sunset. When its dark, Melatonin, the “hormone of darkness,” is released. This biochemical signals the body to relax. The bright lights, the television, the computer, and the phones, all interfere with how the body naturally prepares for sleep.

Exercise. Exercise is one of the best ways to release stress from the body, and movement also releases endorphins, “feel good” hormones that will help you to relax.

Why We SLEEP

Practice good sleep hygiene. Go to bed! You’re are better able to problem-solve and concentrate if you have had a good nights’ sleep. If you are totally exhausted, it’s better to get up early to finish that project, than to stay up late in an attempt to force your brain to work.

The American Academy of Sleep Medicine sponsors a great website: Sleep Education. This is a great resource to learn about specific sleep issues like shift work, sleep apnea, snoring, jet lag, etc.

We are living in what is, for many of us, the most tumultuous period of our lives. Sleep right, eat right, and exercise. We will get through this, in one piece, if you take care of yourself.

There you have it. Now spread the word.

~Juliet_MD~

1.“The Science of Sleep”, National Geographic, August 2018

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I cringe at the mere mention of the words Home Birth. As much as I don’t want to offend the exceptional nurse midwives who provide this approach, and do not want to belittle the exercise of self-determination by mothers who choose this route, I worry about the risk. Multiple studies have clearly demonstrated that the baby is at greater risk of injury or death when delivered at home. That fact alone makes home births–scary. 

Home Births Pose Greater Risks

Between 2010 and 2017, almost 14 newborns for every 10,000 live births died following planned home births – that’s more than four times the rate for babies born in hospitals.

Last Friday I had what would have been considered the perfect home birth candidate–young, thin, no medical problems, and had a previous successful vaginal delivery with no problems. For the first 12 hours she labored with no intervention but she did not dilate. Still, we decided to give it more time–we were patient, counting on her pelvis to do what it did with her first baby, give way. But, at 6:30am in the morning, on day 2, when the baby’s heart rate slowed and did not recover, we got her into the operating room and got that baby out in 4 minutes. That’s the difference. When nature takes a turn for the worst, how far away are you from help?

Many people counter, “well women have been having babies for centuries.” Ah, did we forget about all the mothers and babies who died in childbirth? Childbirth can be dangerous, for both mother and child. As an obstetrician, my job is not just to stand there and watch the baby slide out–like poop. Women bleed, women get horrendous lacerations that have to be repaired in the operating room, babies get hurt, and babies die.

Birth Centers

Midwives have a different approach to birth and it is really beautiful. This is often not a question of who did the delivery. Ask the question: is the mid-wife certified? And, did that person undergo training to manage complications?It is always a question of where the delivery takes place. How far and how long will it take you to get help if you need it?  I have been on the receiving end of the drive-by-the-emergency-room-and-dump-the-patient-and-leave. It’s always sad, and usually lends to a devastating outcome.

Birthing centers offer the setting that allows women to feel “at home.” And, most of them (always check) have a tested system whereby they a) have a relationship with the doctors at the hospital, and b) have a tested, and efficient, way of getting mothers to the hospital, if it looks like there is going to be a problem. Check with the American Association of Birth Centers (AABC) for certified centers near you. 

Don’t hand over control of your birth experience to someone else, other than Mother Nature. (You should read “What you can do to avoid a c-section.”) Do be completely informed about the risks and benefits of a home birth by asking the critical questions.

There you have it. Spread the word

~Juliet_MD~

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When we met it never occurred to me that she was going to die. But I can still hear the sound of her ribs crack with each chest compression. Sometimes I get a flash image of her unattended arm sliding off the bed alongside a swath of brown hair. Mary was dead. It was clear to everyone, though it took sometime before we could summon the courage to admit it. This pregnant woman, mother of a two-year girl with blonde hair, died from the flu.

Only Fifty three percent of pregnant women are vaccinated against the flu.

It’s really hard to convince pregnant women to take medicine, especially if it’s in the form of a vaccine. It’s medicine for an illness they don’t have. Even the tiniest, most theoretical, risk is thought too much. The unvaccinated, however, represent a lost opportunity for mothers to protect themselves and their babies, who cannot get vaccinated for the first six months of life.

This is one of the worst Influenza flu seasons on record. Thus far in the 2019-2020 flu season, 55000 people have gotten the flu and 2900 have died. Pregnant women are at greater risk of getting the flu because pregnancy itself hampers the immune’s system ability to ward off the infection. Pregnant women are more likely to get pneumonia when they have the flu. When pregnant women do become ill with the flu, they are more likely to need hospitalization, and more likely to need intubation and care in the Intensive Care Unit.

And, because the flu is an infection that causes a high fever, there is also an increased risk of going into labor prematurely.

On the morning Mary died she woke up and felt dizzy, and had an annoying cough.

Her husband brought her to the hospital because she had fainted. A half an hour after she arrived to the emergency room her heart began to beat irregularly. She was rushed to the cardiac catheterization laboratory, and while they were evaluating her irregular rhythm, her heart stopped beating. A code was called. The cardiologists and the critical care doctors began chest compressions. Obstetricians (me included) went about starting an emergency caesarean section to deliver her thirty-two week old fetus—while her body was bouncing up and down on the table.  Mary started to bleed profusely because of a reaction called DIC (disseminated intravascular coagulation). More doctors filled the little procedure room. More blood filled the abdomen. 

We extended her incision from the pubic hairline to the breastbone in order to better see and control the bleeding. Her bowels fell out of her body and rested on the white sheets; they changed color from pink to a dusky brown. More blood. The cardiac doctors were compressing her chest, still trying to revive her heart. Ribs cracked. Her head lobbed to the side, and her brown hair cascaded off the bed in slow resignation. 

That’s when I could feel it; she was gone. In our fear and anguish we feverishly tried to pound and stich life back into Mary. No one could accept the sudden loss of this young mother–from the flu. I was so relieved when the code leader said it: stop. This woman was alive two hours before, and now this family, these two girls, will have to forge ahead without her. She declined her influenza vaccine and the virus infected her heart—a rare and ridiculous reason to die. I’m still angry.

Get vaccinated.

And if you have symptoms, get treated. The Center for Disease Control and the American College of Obstetricians and Gynecologist state that pregnant women can be safely treated for flu symptoms with Tamiflu (Oseltamivir) or Relenza (Zanamir).

~Juliet_MD~

The post Pregnant With The Flu:One Story appeared first on Below The Belly Button.

The key to a successful year is to stop making New Year resolutions. Yes. Counterintuitive. But making, and breaking, New Year Resolutions is so…Bridget Jones. It’s just old. Bring in the new. Start with self-acceptance. When I watched Lizzo in her red Santa suite wagging her butt and doing her hair toss at the end of her Madison Square Garden performance, I thought, ummm, she’s at risk for heart disease and diabetes. (I can’t help it; I’m a doctor.) But, damn if I didn’t wish that I had a smidge of her love-me-don’t-judge-me bravado, and take-me-as-I-am-world confidence. I want some of that!! 

Second, add a little self-actualization. Who are you? When you take away the kids, the job, the partner, the friends…who are you? Take thirty days, more if you have to, just to figure that out. Once you are able to clearly define yourself, commit to doing ONE THING, everyday, that aligns with your true self. When all of those “one things” add up, you will find your joy, and quench that unyielding yearning for something “more to life than this”. Today, not New Year’s Day, today is the first day of the rest of your life.

There you have it; spread the word.

~JulietMD~

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