I chose to stay calm. I was upset, but things needed to be handled at that moment. I called the person directly and gave other options of contacting me other than text. I closed the loop and asked if this person was having a tough day or had issues with me, but, they said they didn’t have an issue with me and that it was a technical error with poor cell phone signal. That seemed reasonable and rational to me. They noted my requests for other contact means. Life moved on. Maybe it won’t always be this easy, but I prefer to make direct contact with the person of interest and make sure I have the full story.
Well, this is quite the title. We knew we wanted to expand our family. Arden has been such a good kid, and we felt like we could handle another kiddo. But little did we know it would/could happen so soon.
The first day of my last period was May 31. I’ve never had a regular period, so I didn’t think my period would be any different post-pregnancy. Arden had a mixed formula/breast milk feed since she was about a week old. Despite breastfeeding/pumping 12x/day, I could never get my milk supply to meet her feeding needs. Even knowing this, I still tried to pump for about a month at work before my supply went completely down to nothing. So, my pumping ended around June 20, 2018.
As it was nearing Arden’s 5 month birthday, my husband and I thought I should take a pregnancy test just for kicks as I hadn’t had my period yet… but that wasn’t out of the ordinary for me to go 30-40 days between periods. But something gave me an inkling that the pregnancy test may be positive. About two weeks before the pregnancy test, I had what felt like a period cramp right in the middle of my abdomen. It lasted for about a day, and I thought I was going to get my period soon. Then, I also had breast tenderness… but that wasn’t uncommon as that’s a common symptom for me prior to my period. But two weeks passed after these symptoms and still no period. So, I took the pregnancy test a day after Arden’s 5 month old birthday. Lo and behold it was positive! I couldn’t believe it! I had to show my husband. He was shocked and happy all at the same time! We get our first ultrasound in two weeks and this time I promised my hubs that we could know the gender before the delivery.
Week 7 – Aug 6, 2018
Today I’m 7 weeks, 6 days. I had my first ultrasound a week ago and by ultrasound the Nugget measured 6 weeks 6 days. The fatigue has been unrelenting. I need naps daily or I hit the sack early like 9p. Last night, Arden kept rolling over onto her tummy and I was getting up every two hours to turn her over. It makes me a little nervous for her to be on her tummy still as she still hasn’t mastered rolling over to her back. The Nugget’s due date is March 19, 2019. That means the two kiddos will be 13 months apart. Whoa! For right now, I still have my Mondays off… but that is going away mid-October. I’m a little worried when it does go away. I haven’t been able to workout for the last 3 weeks bc of fatigue. I just have no energy. But I know I need to do something so I’m trying to still get evening walks in before Arden goes to bed. I ordered a 1 year subscription to SugarySixPack because she has workouts for pregnancy and they’re safe as she’s a certified trainer and she did them herself throughout her pregnancy. Obviously, listen to your body and see how it feels… everyone is different. Another workout plan that I thought was helpful (but I only did during my third trimester) was Expecting and Empowered. Cravings have included pineapple, baked potatoes, sandwiches, ice cream, VG plain donut, Nilla Wafers, potato chips… let’s just say it’s not the healthiest cravings. The morning sickness is getting more intense and certain foods are turning me off (fried foods, onions, sauces, tomatoes).
Week 8 – Aug 14, 2018
This week was a rough long week at work. I worked for 13 days with one day off (Sunday – post OB). Also, this week, Arden got hand, foot, and mouth disease at day care. My post of her illness is here. The worst of it was probably the first 3 days she had the illness. My morning sickness is getting better. I find that I have a little more energy to go for walks around the block and not just be a dud on the couch. Feeling better this week despite the work hours. Thanks to my mom and husband for being here this week to help out with Arden. And the craving of Le Croix is back!
Week 11 – Aug 28 – Sept 3, 2018
Cravings this week: mashed potatoes, pizza, Le Croix, cookies…. everything but healthy. On weekends, I find that my energy level is zapped! My best productive times are from 7a-11a and then 5p-8p. From the hours of 12p-4p… I’m pretty much a zombie or need to nap during that time. It’s a bummer bc I feel like such a bore. My poor husband! Earlier this week, I took the NIPT to test for common genetic issues in our baby. It came back negative for any of the common chromosomal abnormalities. And, we found out we are having a little boy! I am so excited to hear this news! For some reason my husband was thinking we would have another girl… and I was thinking ‘oh man, we’re gonna have to try again for a boy if it’s a girl and I don’t know if I can handle being pregnant a third time.’ Well, luckily, we hit the jackpot and we couldn’t be more thrilled!! So far everything is looking good for our lil Nugget!
Week 12 – Sept 4 – 10, 2018
This week, we’re going to surprise the moms with the announcement of our pregnancy. I found a cute lil shirt on Etsy for Arden that says “Look Whoooo’s going to be a big sister!”. I also ordered gluten-free cupcakes with blue buttercream filling on the inside as a gender reveal for the moms. Lastly, I was able to get a colleague to help cover my #2 day from 5p-8p so I can witness my mom’s happiness when she is here. I’m so glad we’re telling them this week as I’ve been starting to show probably since week 9. That’s way sooner than I showed with Arden.
Week 13 – Sept 11 – 17, 2018
This week was a blur! Trying to get ready for the trip and making sure everything is packed. meeting with the contractor, interior decorator, and architect for our lil building project.
Although I didn’t anticipate this to be a busy week… it was. Bear had multiple deadlines and was really worked this week. I missed seeing Arden 2 days this week. That’s so heartbreaking for me. The days that I don’t see her really makes me stop and think about priorities and changing my work schedule.
M O M G U I L T.
Yes, it’s a real thing. Before Ardenbug, I focused on my education and career. I didn’t have a problem putting in the time, staying up late, covering extra shifts, taking extra call, working on weekends and holidays. Then it all changed when she was born. My priorities changed. I’ve learned to give up my weekend calls and happily take the early day home if need be. It was an adjustment. But I want to be as present and available to my lil girl. There are still days/nights where I won’t see her. This past week, I didn’t see her two of those days because I left before she woke up and got home after she went to sleep. Those days are especially hard for me. Not because of the work hours, but because I didn’t get to see my Ardenbug’s smiling face. I ever thought it would hit me so hard. I was never the baby type. But, this whole process proved me wrong. And that’s ok. I’m human. And I want to be present as much as I can. So, if I don’t say YES to weekend activities or things…please don’t take it personally. I just want to see my kiddo and spend time with her because time stops for no one.
Work hours = 33 (in 3 days)
Week 16 – Oct 2 – 8, 2018
Nothing new this week. Arden started really crawling and getting about the house this week.
Work hours = 44.75 (in 4 days)
Week 17 – Oct 9 – 15, 2018
Arden has been having a productive cough and sometimes the mucus will cause her to gag and vomit. Poor thing has vomited 3x this week. And to top it off, Bear and I both got some food poisoning over the weekend. After multiple episodes of vomiting and diarrhea, I called my OB bc I wanted to check on baby G. One of the midwives said I probably ate something that didn’t agree with me and it wasn’t food poisoning. Nope. My hubs and I were both having diarrhea and vomiting. So, I called Bears’ mom for backup and as soon as she got to our place, Bear and I headed to the ER and got 2L LR, Reglan, Zofran, and some labs. Lil G looked good on ultrasound (I HAD to come and check him out,….couldn’t help it). After a couple of hours, we headed home and laid low and slept for most of the afternoon/evening. Thank goodness for the moms being relatively close by (my mom would’ve helped but she got a stomach bug too). We’re now on the mend!!
Work hours = 36.5 (in 3 days)
Week 18: Oct 16 – 22, 2018
I had this week off, but was able to pick up some work at some surgery centers. It was nice to be able to pick Arden up from school. She’s such a happy kiddo! This week, we’re moving everything out of the downstairs bathroom, bedroom, den, and laundry room in anticipation for our renovation. I really hate moving bc I hate the packing and unpacking. Luckily, my Bear is super supportive and is the muscles behind the move. This week, I’ve been feeling Lil G’s kicks and I have missed that feeling of those lil flutters in my belly. I’ve also been feeling pretty tired this week. Not sure if it’s bc I’m still recovering from our sickness last week, or if I’m just overall more tired. Seems like nap time wants to hit me around 2pm.
Work hours = 23.25h (in 5 days)
Week 19: Oct 23 – 29, 2018
This has been a busy week! We have moved all the stuff from the downstairs bathroom, bedroom/closet, den, and laundry room. We moved the upstairs couch downstairs, and the downstairs couch upstairs. We re-arranged the newly placed downstairs couch. We’re exhausted. Not only that, Chase Travel rewards happened to screw up our flights that we need ASAP. So that was a stressful debacle just now. Just found a super great website for traveling with baby to decrease lugging stuff across the country: Baby’s Away.
Work hours = 22.75 hrs (in 3 days)
Week 20: Oct 30 – Nov 5, 2018
Had an excellent vacay up in Nor Cal!! We stayed in a cabin in the woods and went hiking in the forests/redwoods. Big Basin Redwood State Park and Henry Cowell State Park were my fave. Is it bad that I have an inkling to move up there? Not gonna lie that I browsed Redfin for housing.
Work hours = 10.25 hrs (1 day)
Week 21: Nov 6 – Nov 12, 2018
First full week back to work. Was a bit brutal of a call night and pre-call day. Had this one patient on OB and the husband was trying to make all the decisions for his wife. She was a primip and he insisted on a C/S for his wife when she was just slowly progressing. I placed her epidural and she was comfortable and went from 1.5-3cm dilated in about an hour. However, apparently it wasn’t fast enough for his liking. So, he insisted on his wife having a C/S. Baby looked fine on the monitor, and had been looking great since admission. It’s unfortunate that bc he felt he was a doctor (a plastic surgeon) that he could make these decisions for his wife. The OB and I proceeded to talk to him that it was normal to take some time to progress for the first pregnancy, but he wasn’t having it. Once she finally gave consent (but you could tell unwillingly), I spoke to her about the risks/benefits of anesthesia for C/S. The doctor husband said he’s very familiar with anesthesia. So, I asked if he was an anesthesiologist and he said he was a plastic surgeon. Unless you did an anesthesia residency and are well-versed in the basic knowledge of anesthesiology, please do not confuse your plastic surgery/medical degree with my expertise. He set a great example of how I will never be with another physician or healthcare worker who is providing care to me. (end rant) 🙂
Lil G is moving around and kicking nicely. 🙂
Work hours = 40.75 (in 4 days)
Week 22: Nov 13 – 19, 2018
Arden turned 9 months old this week. Otherwise, feeling good and about 10 weeks ahead in size vs my first pregnancy. The peeing on myself when I sneeze has commenced again.
Work hours = 34 hours (in 3 days)
Week 23: Nov 20 – 26, 2018
This week was busy and rough. Work the day before and after Thanksgiving. Got the Christmas tree up yesterday! Lil G is kicking around. Got my glucola test today (11/26) for my 24 week test. This time I stayed NPO. My diet has NOT been good this pregnancy. Everything sweet has been so appealing to me. Sweets and carbs have been my jam. But, I have no real cravings like I did with the first pregnancy.
This was a hectic week. Got a bunch of things squared away with the renovation. It’s coming along. We’ve passed two inspections so far. Got my eating in gear with no sugar and meal planning in place. Really cut back on the sweets. I actually feel better. I’ve even managed to get in two workouts over the weekend! Lil G is an active kicker! There’s not set time when he gets active… I just feel him kicking around randomly. That is so different from Arden bc she would typically be quiet throughout the day and then kick around 8pm when I sat down on the couch.
Work hours = 53.5 hours (in 5 days)
Week 25: Dec 4 – 10, 2018
I have been clean eating for the last two weeks since I failed my 1st glucola testing. Today, I did an experiment of doing random blood sugars.
7:00a — fasting since 8pm the night before.
BS = 84
8:58a — done one hour after my last bite of breakfast (1/2 cup greek yogurt, strawberries, paleo granola)
BS = 97
9:22am — last bite of homemade beef and bean paleo chili (1 cup). 1 tbsp unsweetened, unsalted organic crunchy peanut butter.
12:33p — last bite of work soup (1/2 chicken and sausage jambalaya, 1/2 lentil and chickpea, salt load thru the roof).
13:43p — BS 93
16:45p — last bite of grilled chicken, brown rice, veggie bowl from FlameBroiler. 1/2 an orange.
17:36p — BS 120
19:15 — granny smith apple; 1 tbsp natural, organic crunchy peanut butter. 1 piece of dark chocolate.
This was a really rough week for me. In fact, this past month has been really tough with the increased work hours, remodel, baby at home. This is the most I’ve been depressed in a long time. I know it will pass. But, there’s no ME time for just the self and there’s no together time with husband. It’s taking it’s toll on me, but I know it’s temporary and that it will all pass. I was really lucky to not have any postpartum depression… but this is how I imagine it would feel. Somedays I’m lucky to see my lil girl for an hour before she goes to bed, but lately it’s been 30 minutes. I’m exhausted. I’m sad. And I’m ready for December and the holidays to be over.
Hubs and I had our first date night out without baby in at least 10.5 months. It was wonderful. Went close by to Amaya… but we were both exhausted. We need to make some changes to when the moms come to help. I think if I’m working late… that would be a good time to help hubs. Or I proposed a weekly date night and I think that will help get back to that closeness we had before baby.
Work hours = 41.75 hours (in 4 days)
Week 28: Dec 25 – Dec 31, 2018
We had Christmas at both families’ homes. With two kids and my work schedule coming up, I’m not sure how long that will be sustainable. I’m more than happy to have everyone come to our home. Simplicity and less stress. We had a terrific Christmas at home. Arden absolutely loved hearing the gift wrapping tear and the sights and sounds of Christmas. She always acknowledged the Christmas tree everytime she woke up in the morning as well as when she woke up from naps. She got so many wonderful gifts and I had so much fun watching her interact with her new toys. we put the fireplace on for the first time and she got to see fire, which intrigued her greatly! On the 26th, we drove up to Big Bear to show our lil one some snow. She totally looked like the bundled up kid from A Christmas Story! She wasn’t too fond of getting all the layers on, but once she got out into the cold, she was ok. She got to see snow falling down as well as snow on the ground for the first time. We also took her sledding, which she seemed to be open to the idea when we would drag her on the sled. But when we got on the sled with her on a little slope, she would cry at the end of the run. It was so completely cute! I’m glad she could have this experience. One of my main goals in being her mom is to give her many different experiences. I don’t want her to be spoiled with stuff…. but I do want her to be spoiled with healthy food, cultural experiences, and travel.
Work hours = 7 hours (in 1 day)
Week 29: Jan 1 – Jan 7, 2019
Back at work… lil G has been kicking up a storm. I’ve started kick counts and he has no problem meeting the 10/hour during the day (whereas Arden would get her kick counts around 8pm when I sat on the couch). The reno was on hold for the holidays. I’m definitely looking forward to it being done by the end of January! Talked to hubs about potential middle names for our #2, and I’m really loving Lukas. 🙂
Work hours = 40 hours (in 4 days)
Week 30: Jan 8 – 14, 2019
I am off this week. What that really means… I have no work responsibilities. But, I’m getting up in the middle of the night to nurture/feed Arden and getting her ready for school in the mornings and taking her to school. She’s such a good kid, but there is definitely more effort involved in getting all these things ready. The last two days, I’ve taken Arden to school in my sweat pants and no makeup. And honestly, I’m ok with that. I really do appreciate my husband bc he normally takes Arden to school on his way to work. We don’t have the moms coming this week as they really were a huge help this past weekend to allow Ross and I a baby-free weekend. The Reno project has restarted from the holidays. Tiling will be started this week! Garrett has been kicking like crazy and meeting his kick counts. The meal prep has been going well.
Felt a bit lightheaded one night this week. Not sure what happened… I hadn’t been working. I’ve been doing very well with my diet, healthy stuff, no sweets. Everytime I would standup (esp after being bent over), I would feel lightheaded. It wouldn’t help with sitting either… I had to go full on horizontal and lay down to feel better.
Took my 3 hour glucola test and passed the first two blood draws (fasting, and 1 hr after 100g drink)… then got the call that my glucose was slightly elevated on the last two draws (2 hours after the drink and 3 hours after the drink). I’m disappointed that now I have to go and meet with a diabetic educator. Pretty much since I found out that I had a positive 1 hour glucola test, I have been on a lower carb, no-sweets diet. That’s been about a month and a half. Ugh. So, I’ll have a separate entry on Gestational Diabetes Mellitus (GDM).
Work hours = OFF!
Week 31: Jan 15 – Jan 21, 2019
I’ve been battling a nasty cold that I got from our Bug, which she got at daycare. It’s an upper respiratory infection, most likely viral in nature. A lot of coughing, sinus pressure, headaches… but I’m going the minimalist route for now — good wholesome foods, fluids, rest, and Tylenol. Lil G has been kicking around as usual. He’s so active compared to Bug. I feel him all throughout the day and night. Makes me worried that he won’t be a good sleeper.
Work hours = 37 hours (in 4 days)
Week 32: Jan 22 – Jan 28, 2019
I’m still battling my cold. It’s been almost 2 weeks. I have an OB appt today, so I’ll kill two birds with one stone and just get a second opinion. The reno is coming along: baseboards are in, W/D is in, tiling has occurred in the laundry and downstairs bathrooms. Plumbing and toilet are in. Waiting on paint, vanity, bath accessories, cabinetry, and countertops to arrive… the end is in sight! The project was supposed to be done by the end of January, but realistically looks more like mid-Febrary. LLC established and getting business accounts setup. It’s been busy, despite my random days off. I’m getting up to pee every 2 hours…so I just feel tired all the time.
Work hours = 50.25 hours
Week 33: January 29 – Feb 4, 2019
This week has been a blur! Everyone at home has been sick. I worked on Super Bowl Sunday. Happy Chinese New Year — it’s the year of the pig!
I’ve started splitting my night calls as I just don’t have the stamina (nor can I get comfortable sleeping in the call room) to do a full night call anymore. I’m definitely feeling more tired this go around. Lifting and chasing Arden, preparing meals, working full-time, it’s tougher. But, I’m still planning on working until I go into labor or have my set maternity leave (whichever comes first!). Not only am I tired, I’m insatiably thirsty…despite drinking 3x 32oz waters throughout the day and 2x 32oz waters at night…. waking every 2 hours to pee…. eating such small meals bc I have early satiety…. constipated despite my best efforts to get in green juice and poop tea. 😉 I think the month leading up to delivery is the hardest. Lil G is active as usual and definitely more active than Arden was in utero. Hopefully he’ll be a good sleeper like his older sister.
Work hours = 33.5 in 3 days
Week 35: Feb 12 – Feb 18, 2019
I am off this week. The reno should be near complete this week!!! It’s been going on since the beginning of November 2018! I’m ready to have the garage back as well as a porta-potty out of the driveway and access to our movie room and downstairs bathroom and hallway again! There was a lot going on with this and coordinating things. Plus, I watched the Bug on Friday and it is A LOT to take on…. especially while pregnant. I have a huge respect for stay at home moms who tackle this daily! I was exhausted after the day. But, we went out to the Aquarium Friday afternoon and she had a wonderful time looking at the fish and seeing the movement of the water. It was great to get her out of the house and I know she enjoyed the external stimulation. Sunday, she ended up developing a fever of 102-104F and that scared the crap out of me. I gave her Tylenol immediately. She was lethargic after her second nap (she typically has two naps for 30 minutes at a time, but this time she had 2 two hour naps!). Plus, instead of wanting to play after her nap, she just wanted to be held… she’s typically not this cuddly. After calling urgent care to let them know we were on our way, the answering service transferred me to the nurse and they both kept telling me that they close in 5 minutes…despite us living 5 minutes away and with our daughter having such a high temp. I was furious. I hung up and opted to go straight to our Children’s hospital ER. They were fabulous. After Bug went through a series of vitals checks and physical exam (which she was not stoked on), she got some motrin and we were in and out of the ER in an hour! That’s a huge feat by any medical facility!! By the time we got home, her fever had subsided to 99F and she was wanting to eat, drink, and be merry. We watched her like a hawk all night and the rest of the holiday weekend.
Hours worked = 0
36 weeks: Feb 19 – Feb 25, 2019
Bug went back to school today. Her highest temp after the ER visit was 99. We still gave her some tylenol this morning before school just to help her through the day. She also has molars coming in…. so that can help with the pain. Lil G has been meeting all his kick counts. I’m still peeing every 2-3 hours at night…and drinking about 100oz daily. I have this insatiable thirst esp during the 3rd trimester…and that has been with both babies. He’s looking large in the belly. We had our 36 week growth scan and everything looked good. He’s looking like he’ll be 7.5 lb at birth. NST/AFI was great. No issues. Had my last OB shift on Friday and it was busy! But luckily, got to go home around 9:30p and didn’t get called back. Saturday, my mom and aunt came and watched Arden while hubs and I organized the media room, Arden’s new room, and Garrett’s room. Lil G’s bassinet is setup in our room and ready to go. We cleaned, dusted, mopped, vacuumed and were exhausted. I’m super thankful that my aunt cooked up some great meals that got us through the day!! Sunday, Ross’ mom came to help watch Arden while Ross did some heavy cleaning of the garage (where I could park the car again!! woohoo!). The construction has come to a close… they moved the port a potty on Friday, Feb 22. The construction guys have been using the house toilet, despite me paying for a port a potty, so I was pissed. Now, we just have a final walkthrough and some flooring to tackle and painting. It’s so great to have this done. Arden has been having some little colds/runny nose, but has been playing and her happy self. She’s started becoming more vocal about what she wants and what she doesn’t want. She had a lil temp (100F) and we gave her some Tylenol.
Hours worked = 48.5
37 weeks: Feb 26 – Mar 4, 2019
This week was brutal. We are on the home stretch with our renovation. The grandmas now come on the weekends to help with Arden while we organize, clean, and recover from the reno. It’s crazy to live in the space during the reno…I’m not sure I’d do that again. There were 3 days this week that I didn’t get to see Arden bc I was at work late those days. That absolutely killed me. As much as I love my job, I love my kiddo more and I feel like I’m missing out on her activities, milestones, etc. This week, I also caught Arden’s cough — it’s productive, but I’ve felt ok (no sinus pressure, headache or fever). My sleep has gotten noticeably worse this week — I’m insatiably more thirsty; drinking about 60 oz at night. I pee every 1-2 hours and can’t catch up with my thirst. My blood sugar checks for GDM have been stellar. Fasting blood sugars have been less than 90. Lil G is kicking away and moving. All is good on the home front… just looking forward to meeting this lil dude! Had a realization with Ross… how the heck are we going to do this without losing our sanity? 2 kids under 14 months? Arden will be 13 months old in a week. We just re-enrolled her for the next school year, and our future son is on the waitlist and they couldn’t tell us when we could start. That’s super stressful for us bc we both work full time jobs. Our moms are out of town. I’m just annoyed and stressed that he may not be able to go to school at 4-5 months. But, we just have to wait and see. 4-5 months down the road….Arden will be 17-18 months and eligible to move up to the toddler class. So hopefully this will all work out and I won’t have to be worried about that. There’s been a ton on my mind and my memory is not keeping pace. Perhaps it’s the sleep deprivation for the last 2 months (getting up to pee)… or just trying to remember everything going on in life. Does it get easier?
Hours worked = 48.5
Week 38: March 5-11, 2018
Final walk through with inspection completed this week. Final painting, flooring, and touch ups. It finally feels like this project is coming to an end and I am grateful!! Last night, Arden was super tired and fussy to go down to sleep. We were working on transitioning her from her bottle to a cup, but there’s something soothing for her about the nipple that the cup simply won’t comfort. I’m getting up every hour to pee. My U/S looked great. AFI was 14. NST was terrific. Cervix is still high and just waiting for lil G to come on down. He’s still super active and kicking. It’s nice to be able to be home and laze and eat and pee when I want/need to. I weighed 161 lb,…the exact same since Nov 2018. The only thing I did was change to a modified Whole30/paleo diet cutting out processed sugars bc of the GDM. Don’t worry, lil G is growing… him pushing on my stomach and decreasing my food intake and more intake of healthier meals is probably causing my weight to just plateau. We have weekly U/S and NSTs moving forward. Dr. W and I discussed possible induction on March 18 bc I really don’t want to go beyond 40 weeks with this pregnancy. I’m just not comfortable in this state.
You have devoted the last decade of your life to medical school, residency, and fellowship. It’s time to get out into the real world for a REAL job. Where do you want to live? What type of practice would you like?
Timing is everything. Start early!
I started my fellowship in August. During my elective pediatric hearts rotation, I met a team of physicians who were very encouraging and asked if I had a job yet (this was October). I told them I didn’t have a job yet, but I wanted to stay in California. Maybe it was my lucky day, but one of the lady docs I worked with sat on the application committee for my current job. She encouraged me to apply to their anesthesia group. After going through the proper channels, I got a phone call from the anesthesia group saying they would like to interview me for a position. I had my interview in November and heard back in December that I had a job. Everything happened in such quick succession. When I left residency, I knew I wanted to be in southern California. Thank goodness I matched into a fellowship spot in Southern California! It makes it easier if you know what area/region/state you want to practice in. Keep in mind that some states are more friendly to physicians than others.
What type of practice works for you? Do you want a large academic center with a physician-led team approach to healthcare? Do you want to practice in a private practice setting in a team or solo? There are so many practice models out there — I wish residencies explored/explained more of these options. Fortunately, I knew a solo-practice physician-only model would work best for me.
Keep in mind the number of hours you want to work. What are the opportunities for working more or less? How many vacation weeks will you get? Is there paid-time-off? Will you have a salary or productivity-based income? How many calls/month will you take? Is there a discrepancy between new hires vs. senior partners in access to vacation/salary/calls/etc.? Is there fairness in scheduling? How long will it take to make partner? What’s the buy-in amount? Is there a buy-out when you leave/retire? I didn’t know to ask these questions when I was going through the process of looking for my job. Don’t forget to ask about retirement options and health insurance coverage. Also, ask if it’s possible to work at another hospital or surgery center in the area or if there is a non-compete clause in the contract.
Bring your best self to the interview. The people who are interviewing you want to know more about you. Tell them about your hobbies, lifestyle, goals for the group, plans for the future. Engage your interviewer and ask them how long they’ve been with the group. How do they enjoy their time? Keep in mind that they’re interviewing you because you look great on paper. They want a chance to get to know you better. Show them your best self, especially all your hobbies and interests outside of medicine. Keep the conversation casual and inviting.
Read over the contract carefully. My group has a one year contract that is revisited yearly and is the same for every member of our 250+ physician group. Before I started, some people recommended a contract attorney specializing in medical contracts to read it over. I didn’t find it necessary in my case as my contract was the same for every physician in my group and the language was very clear to understand. Use your own judgement. If you don’t understand the contract, get some help.
What recommendations did you find helpful in your job search and interview?
Breastfeeding is hard. The first week after Arden was born was a really rough one — lack of sleep, whole new routine/schedule, physical pain, soreness, learning new parenting skills, etc. It took a while for my milk to come in… almost a week for me. Once it did, it wasn’t much. So my pediatrician recommended that we start supplementing with formula as Arden had lost 10% of her birth weight. This made me so sad as I was committed and ready to exclusively breast feed. But, my body was not ready. So, I continued breastfeeding her every 3 hours (we set alarms to make sure I was on time) while also supplementing her with 2 oz. of Enfamil Premium Newborn. I started going to a breastfeeding support group which is so wonderful because it connects mothers with other mothers and helps us all troubleshoot our breastfeeding challenges. It’s interesting to hear other moms speak of their troubles because everyone seems to have different questions at various points in their baby’s life. After doing a week of formula supplementation, I went back to the pediatrician and Arden not only met her birth weight but also gained some as well. This made me feel better as a mom because she was getting the nutrition she needed despite my best efforts at breastfeeding. But, I wasn’t giving up on the boob. The more I searched the internet and asked at our breastfeeding support group, the more I learned and started brainstorming to see if I could get my body to produce more breastmilk.
Breastfeeding 10 minutes on each breast every 3 hours (starting from the initial feed, not at the end of the feed). Nipples were extremely sore. Arden had a great latch and would suckle vigorously. I even considered a nipple shield for pain. I used breastmilk and lanolin around the nipple after each feed. This was the most painful week.
I started experimenting with pumping as there was one day where my nipples were too sore to allow Arden to breastfeed. I still went every 3 hours on the breast pump (Medela In-Style Advanced). After 1 day of pumping, I revisited trying to breastfeed her and my nipples felt better. I read somewhere that I should try and pump at the halfway point of my breastfeeding times. So, I would pump 1.5 hours after I started breastfeeding. This helped increase my milk supply. I went from doing 0.5 oz per breast to 1oz per breast. I think this more closely mimics a cluster feed and helps the body adapt to feed a hungry baby. Halfway through week 2, Arden started doing 15 minutes at each breast. I would often see milk in and around her mouth, so I know she was getting some breast milk. The biggest trouble was getting her to stay awake at the breast. Burping her and changing her diaper helped wake her up for the 2nd breast. Towards the end of the week, Arden started only taking one breast at each feed. She would pass out at the breast and even when we tried burping her and changing her diaper, she was satisfied enough that she did not want the second breast. This was a new behavior and I’m not sure what to do. So, I would pump the second breast…and then start her on that pumped breast at the next feed.
One of the days, Arden fed 12 times in a day. My nipples were incredibly sore from the constant feeding. I called three different local board certified lactation consultants to help — currently scheduling when that will be.
1) Undress Arden down to diaper to feed and feed every 3 hours or sooner if she cues.
2) Use Breastfriend pillow to get her to nipple height. Turn her tummy to tummy. Firm up nipple. Touch top lip, wait for wide open mouth and bring her to you quickly. (RAM = rapid arm movement).
3) Stimulate breast (5 o’clock position) for squirt to wake her at breast. Feed effectively for goal 15 minutes (ok 10-15 min) on one breast.
4) Burp her in front position. Change her diaper. Then offer second breast for 10-15 minutes (goal 15 minutes).
5) Handoff to help when available —> Supplement with previously pumped breast milk first, then formula to meet goal of 2.75oz (full feed goal).
6) Pump while help in supplementing her. Do 15 minutes of pumping both breasts simultaneously directly after breastfeeding (or after supplementing if no help available). Every 5 minutes: increase the suction as tolerated and hand massage both breasts simultaneously and lean over for another letdown. Don’t need to hit the letdown button on Medela pump if just came off breastfeeding bc Arden already stimulated the letdown.
7) Save what is pumped from breasts for supplemental feed the next time at feeding.
8) Journal all feeds, supplement, wet diapers, stools, spit ups, behavior, etc.
Things are going better with the combo breastfeeding, pumping, and supplementing. Arden seemed like she had a growth spurt a couple of days ago that left her almost inconsolable and crying and fussy for most of the 2 days. Her intake has gone up (and that’s self-guided by her). The pump output has increased (but I’m still popping the galactogogue pills and cookies/drinks). The tatas are sore, but not like week 1 or 2 sore. I’m slowly becoming okay with the reality that she may be a formula baby. But, I want to give her the best I can. The other change that happened this week is that I rented a hospital grade breast pump for a month –> Medela Symphony. I like it…. it is definitely bigger than my small portable Medela In Style Advanced and I think the Symphony has better suction capability. Perhaps that is really helping to increase my supply and the other pills/cookies/drinks are just placebos!
For the first time, my letdown has ejected milk from the other boob while Arden is feeding on the opposite boob. I got the NatureBond Manual breast pump to place on the “free” boob while Arden is nursing and it collected 0.8 oz of liquid gold! This is a new thing for me and I’m so stoked to be able to collect every single drop!
Looking back at what I have taken consistently to get to an increase in milk supply:
I’m decreasing the pumping after breastfeeding to just 2-3x/day. On days where I pump only and don’t breastfeed, I’m getting roughly 3oz total. How do women create freezer stashes? I don’t get it. I’m poppin’ pills like a druggie, putting Arden to my breast at least 8x/day, pumping after feeds at least 2-3x/day (now I’ve spaced them out instead of pumping directly after a feed…I now pump about an hour after a feed — to resemble a cluster feed). I could do a better job of hydrating. I’m watching my nutrition. I’ve started to workout. Then when I look at the real facts… I had a prolactinoma… that was resected… and it may have affected my milk production from a hormone standpoint. Even if all the working parts are there in my breasts, I have come to the realization that it’s ok if I’m not fully able to give my baby 100% of what she needs from nursing. I’m happy if I’m still able to transfer at least some of my milk and antibodies and goodness to her…. as well as help her develop and gain weight with the addition of formula supplement.
Things are going well. I’ve come to terms that I just don’t have enough milk. My letdown is fine. There’s fullness in the breasts if I go more than 5 hours for a feed. SO, I scheduled an appointment with an endocrinologist to follow up on my prolactinoma to see if that’s it. Either way, I’m enjoying breastfeeding with what I can supply and then having my husband or family pitch in to bottle feed. She just went through a growth spurt and was eating and fussing a ton.
Through all of my breastfeeding challenges, here are my thoughts/reviews on what has and hasn’t worked for me:
Medela Personal In-Style Advanced (PISA) — This is a great pump for me and it was covered by my insurance. When I got out of the hospital after delivery, this is what I used to help boost my milk supply. Granted, I was super sore the first two weeks, but I think that was because I was breastfeeding and then pumping right after. Plus, I don’t think it’s that uncommon to have sore nipples when first learning to breast feed and/or pump.Medela Pump in Style Advanced Breast Pump with On the Go Tote
Medela Symphony — I would highly recommend using this pump first for the first month bc it has such a gentle cycle of letdown/expression. Rent one from the hospital if they have availability. I think it’s a tad gentler and smoother than the Medela PISA.
Maymom flanges — same reason I got these flanges. Both manufacturers work nicely and you can’t go wrong. What I don’t like as much about the Medela fitting flanges is the little suction piece with that fragile plastic flap. It’s a pain in the ass to clean and find.
Willow Pump — I had such high hopes for this pump. I wanted it to work to not be tethered to a pump with cords and such. However, when I tried this pump, it hurt. It was heavy in my bra and I felt like it pulled my breasts down. The suction is HIGH even at the lowest setting — even my more seasoned/withered nipples couldn’t weather the pull of the Willow. I’m going to give it another go as I used the 24mm flange that comes with it… and I ordered the 27mm ones and haven’t tried those yet. For reference, I started with the 24mm flanges on Medela…. then moved to a 27mm which I think is more comfortable.
Medela breast milk freezer pack bottles– these are great to pump into. Plus, since I don’t have enough of a stash to freeze, it’s great to put these bottles directly into the fridge. I use the standard Dr. Brown nipples or generic nipples on these for a feed.Breast Milk Freezer Pack, 2.7 oz (80ml) Bottles (Pack of 12)
NatureBond Silicone Manual Breast pump — this is a great asset to catch the milk letdown from the opposite breast that you’re nursing. You’ll be amazed at how much collects in this device.
If I were to do it all over again I’d get:
Medela Symphony rental for the first month or two after leaving the hospital.
I like both my Medela PISA as well as my Lansinoh. Both are highly portable and perfect for returning to work. KEEP IN MIND that the Freemie collection cups work with the PISA and not the Lansinoh (as of this writing on April 10, 2018). For a second go, I would get the Spectra S1 just to try it bc I hear the suction is so gentle.
Freemie Collection Cups — I’d get two sets.
Medela breast milk freezer pack bottles
NatureBond Silicone Manual Breast pump
I’ve been back at work for a month. Breastfeeding/pumping has been a challenge. My job is a bit difficult in terms of getting a set schedule to breastpump at work. See my schedule below for what I’ve been trying to do:
6:00a breast pump
Try and get a 1-2 pump sessions at work when possible
6:00p breast feed
9:00p breast pump
I can definitely see my supply going down, but I’m trying my best with what I can. Arden has been thriving on what I’ve been able to give her supplemented with formula (see 4 month update here).
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Work-life balance and taking care of yourself #anes17 #meded #stress #medicine #burnout #administrators
The ASA 2017 had an interesting self-study module called Physician Wellness Beyond the Usual Suspects. It was a great learning tool to focus on the importance of the anesthesiologist to consider their own stress levels and seeing how to best mitigate the issues that could be problematic.
Check out these great articles from that self-study module:
The first day of my last period was April 25, 2017. According to my Glow app, my average period length is 6 days and it looks like there’s roughly 37 days between periods. That’s about 10 days longer than the average Jane. That last period occurred on our honey moon! We came back home on May 9. Then, I had a weeks worth of diarrhea from May 20-27 and ended up taking ciprofloxacin at that time. As June approached, I was just fatigued for a bit and so was Bear. We thought we had caught a bug or had some kind of weird travel lag from the trip. I was still surfing regularly with Ross — maybe a couple times a week. Around the summer solstice June 20, I had some light cramping. Breasts had been tender for a while, but that wasn’t anything out of the ordinary as my period approaches. In early June, we went to the Toast the Coast Wine Festival at the Del Mar Fair (June 10) and then the evening of June 20, we had burgers and beers at Encinitas Alehouse. I had a funny feeling to pee on a pregnancy stick that evening, so I did. Lo and behold it was POSITIVE! I quickly called out to Bear to make sure he got an eye on the reading to make sure I was reading it correctly. The next day, we went to the drug store and got one of those digital ones so there couldn’t be any reading errors. It said PREGNANT.
Once we found the info out, I immediately called to setup an appointment with my chosen OB/GYN. I feel lucky to have a job in anesthesia because I get to directly see the work of our surgeons and care providers so it gives me an idea of who to seek for my own care if needed. I setup an appointment with Kim Washkowiak for July 5 (1st ultrasound) and then an initial consultation on July 11. I also started researching best books to read during this time and finally chose the Mayo Clinic Guide to a Healthy Pregnancy.
But according to our OB and U/S reports, we’re due February 20, 2018.
July 5, 2017
I’ve had about 2 weeks of low grade nausea. I keep wanting to eat small meals to stave off the “morning sickness” that rears its ugly head throughout the day. I’ve got some ginger candies to help. I’m also eating more plant-based meals (Veestro and Splendid Spoon) and craving grapefruit and fruits! I haven’t worked out much bc of the nausea. I’m trying to get 3x 16oz waters down in a day. Initially, I was having to pee a lot…. not just during the day but it would also wake me up in the night.
Week 18 – Sept 19-25, 2017
Recap: The nausea was the worst for me from weeks 7-13. It slowly got better. Things I did to calm the nausea: ginger chews, ginger hot water/tea, bananas, toast, crackers, pasta, hydration, rest. I found it worst during the day. During that time, I also shunned Veestro and Splendid Spoon. In fact, I could hardly tolerate any of my paleo foods that I typically eat. Crackers and carbs were my savior.
I’m still feeling pretty energetic and able to maintain my pilates workouts. Typically, I aim for 3-4 one hour sessions/week. The ladies at Club Pilates in Del Mar are fantastic and are always offering me alternatives for new moves as I advance in my pregnancy. I’m hoping to keep this up until delivery and beyond! We’e completed two prenatal classes so far. Scripps offers a lot of classes and resources and we’re taking advantage of the learning opportunities! So far, we’ve done Getting Ready for Baby part 1 and 2. It was a great overview for absolute essentials we may need for our newborn as well as how to change a diaper, swaddle, when/how to bathe, etc. It also included an excellent session given by a pediatrician on normal/abnormal poops, diaper changes, breastfeeding, circumcision, vaccines/shots, etc.
I’ve been in a rabbit hole of baby registry items/reviews and we’re slowly building our list. I’m pretty meticulous about researching anything prior to pulling a trigger on anything big (house, car, insurance, stocks, appliances, electronics, etc.). I consider a newborn to be a really BIG thing!
This week, it was recommended that I only stick to the pilates 1.0 or 1.5 classes. 😦 Pilates has been great, but they’re totally right. My cardiovascular capacity needs to really stay in check. The mini is the size of a papaya this week.
Week 23: Oct 24 – 30
We just got back from our last flight to Boston. Overall, I felt like I traveled fine… but I could see it being tougher as the pregnancy progresses. Lately, I’ve been booking infant care tours for our little one when they turn 3 months. I have two girlfriends with 2 kids who are terrific moms…each offer the advice of getting a nanny (instead of daycare). I think a nanny or our moms would be great, but my biggest push for the daycare is to engage early development and socialization. I think the nanny and our moms are great to help on certain days, but Bear and I work and that would be a 5 day a week commitment. That’s a lot to ask for from our moms who live out of town. Plus, I do not want a complete stranger (i.e. the nanny) around our baby just yet. Consider it the mamma bear in me. But, I want accreditation, vetting, background checks, early childhood education, experience…. and from what I am finding in my searches… it’s really hit or miss with the nanny. I really am taking to the Montessori method for independent learning and self-soothing and the way it encourages infants/toddlers to participate in their environments. Plus, one of the Montessori schools we’re looking at does language immersion. Many educators have said that the most absorbent stage of learning is from 0-6 years. Great link that compares infant care and nanny care.
Plus, I don’t really believe in decorating a nursery and such — we’re in the midst of creating/designing/constructing a companion unit and will then at a later date do a large remodel of the house. So, simplicity and minimalism are my jam. I read this article on the Montessori way of setting up your home for infant and I love it and would like to replicate it!
Comparing Montessori and Reggio learning styles (2 infant care philosophies we are looking at):
I’m ecstatic to learn about MontiKids ($30 off with referral code: REFW6UGPGEGO5) – a toy delivery service that bases it’s philosophies on Montessori. Every 3 months, the company will send you age/development appropriate toys to you. I am so thankful for minimizing screen time and maximizing play/learn time with my future kiddo.
We had our first breastfeeding class last night. It was actually really really informative. We’re always the smallest “bump” in the class as I think most of the moms in there are due November…. and we’re not due until February. But, I love having the info ahead of time so I can plan….and I only know my schedule one month in advance 2 weeks prior to the new month. We’re definitely on board for 6 months of exclusive breast feeding and then starting organic, non-GMO, hormone-free foods around that time with supplemental breastfeeding. I’d love to breastfeed for at least 1 year if it’s possible. We’ll see! I know it’s not an easy task.
We had our 24 week growth scan ultrasound on Oct 30. Everything looked great!
Week 24: Oct 31 – Nov 7
This week, the mini is the size of a large zucchini. At this stage, we have a viable fetus. Things are still going well. I’m feeling little kicks. Mini’s insertion of the umbilical cord is just slightly off center on the placenta. The last growth scan showed no vasa previa and the baby was already positioned head down. Funny thing, at every ultrasound… the Mini is super chill. The ultrasound tech will push the probe into my belly to shake/wiggle the baby to move and change positions…. but to no avail. Hopefully, they’ll be this chill when they’re born!
I’m looking at various cord blood companies to see whether it’s worthwhile to bank stem cells from the umbilical cord when the baby is born. Basically, it’s kind of like having a backup source of undifferentiated cells that could turn into anything (bone marrow, red cells, white cells, tissue, etc.) if we ever need to use them down the line. My biggest question is: what’s the viability/longevity of these cells to be effective if we need them? It’s a pretty large upfront cost. And nothing is guaranteed. So… I asked my OB what she did with her kids and she said the first one it was free, and then she paid for the 2nd and the 3rd. I’m going to continue my polling today to figure out if it’s worth it or not. What I’d really like to know is if anyone has had to use these stem cells….. was it worth it? Did it change the course of disease or alter treatments?
So after reading through every one of these links…. I’m leaning more towards NOT banking. If something isn’t going to be useful 10-20 years down the road…. why bother? Plus, in 10-20 years, research and medicine will have advanced that there may be better treatment options available – i.e. creating stem cells that are a match to a recipient. There are public stem cell and tissue registries. I suppose the key thing is would we have a match for our multi-racial family from a public bank/registry? We both have ZERO genetic history of diseases or cancers. It’s a big upfront cost — and I’m not sure the technology is quite there for advanced treatments. But, if I were to choose a private cord bank company right now, I’d probably choose CBR.
Update Jan 15, 2018, 34 weeks, 6 days: We ultimately re-discussed the cord blood/tissue banking and decided on CBR. After chatting with several moms who did it…. a lot of them have regrets for not doing it…. and the ones who did it have peace of mind. Bear and I further researched the topic and decided we would do it and chose CBR.
Had my 24-26wk Glucola testing on Nov 6. This was after an unseemingly busy call day and night. In fact, I got called back to the hospital at 2am and was starving — so had half a bagel at 2am (and therefore breaking the 12 hour fast rules). I went in for the Glucola test at 7:30am. The Glucola drink is 50g of sugar that tastes like a really flat Sunkist soda. I thought for sure my test would be positive given my cortisol surge with the busy and stressful call day…… and fueled by my half bagel at 2am. But, low and behold, my result was 126 (range less than 139) and negative for gestational diabetes. Woohoo!! Here’s some interesting reading material on gestational diabetes and diagnosing it: part 1, part 2.
Week 25: Nov 7-13
Definitely seeing and feeling changes during this week. There’s no mistaking that I’m pregnant. Before I just felt “fat” and heavy in the belly — so funny that some of my colleagues asked if I put on weight. That stuff doesn’t bother me, but it cracks me up how guys can be so frank. I’m still trying to do at least 3 classes a week of pilates. I’m really enjoying Club Pilates that’s a studio all around the country. Currently I’ve dropped down to just the 1.0 and the 1.5 classes — but they’re still kicking my booty! I was consistently doing the 1.5 and 2.0 classes up until 23 weeks. My fam has an ongoing bet whether the Mini is a boy or a girl. I love it! I even want to get in on it — but I can’t be the biased house. So far…..here’s the tally…
Stud Hubs = girl
Mimi = girl
Aunt Chawn = boy
Uncle Larry = girl
Mom’s friends (Raymond and Nashat) = girl
My thoughts = I have no idea! How do people predict this stuff? Girl names keep popping in my head though.
At work (Lisa, Rick, Suzette, Thuy, Katy) = boy
At work (Juliette, Christina, Annetta) = girl
Baby shower majority = boy
Massagers at ThaiSport = girl
I can’t wait to see the bets roll in!
Week 26: Nov 14 – 20
Even at 26 weeks, I’m up daily at 6:22am… perks of the job. There’s usually one or two pee awakenings in the middle of the night usually anywhere from 1-4am. I think this sleep deprivation thing will be just like a call night. I’ve been doing those for years (yes, at least a decade). Night call on OB is roughly an every 2 hour wakeup call for an epidural or a bolus or a C/S… or it’s a trauma rolling in through the OR. I think I’ll handle the transition well — but maybe that’s wishful thinking. I want to do it all — have an amazing career, raise the Mini and be an awesome mom, and be everything my husband has ever dreamed. Is it possible? Will I be tired? Time will tell. In the meantime, I’ve had a fabulous time jammin’ out on my uke. In fact, I got an early Christmas present for myself — a new uke!
I’ve been doing more research and reading and listening to Audible books every spare chance I get. This is of course at the same time when November and December are the busiest times at work (a lot of people try to fit their doctor visits in before their deductibles run out at the end of the year)…. and we’re starting a small (phase 1) remodel. But, there’s never a good time to get stuff done despite being busy, so we just go for it!
Here are the books that I’m currently listening to or reading or are on my future reading list:
Nov 23: Took the Amtrak train up to Camarillo to hang with Ross’ fam for Thanksgiving. The train is the way to go! Lots of space, bathrooms (important when a prego gal is going to the bathroom every 2 hours!), wifi, charging outlets, cafe cart, etc. Ever since living in Boston, I have been a huge fan of public transportation! It’s the way to go! Thanksgiving was great. Lots of great food, company, conversation, and mingling!
Nov 24: I’m on call today and just got called into work — that’s the life of a doc — we signed up for this so don’t feel sorry for us. We know being on call and away is part of the gig. No sympathy needed. Saturday, we’ll go to my mom’s house and have another yummy feast! For some reason, this year…I’m really loving and craving leftovers! I know my mom will hook it up as I told her to prep a lot so I could eat it for at least a week. Been playing the uke a lot lately (especially since getting my new tenor uke!). Starting to form calluses on the fingers (used to have these when playing the violin)… such a good thing! This lil kiddo is def gonna love music and the uke! Now, to play more classical music and read to them!
Nov 25: Thanksgiving at my mom’s was great. Lots of great food and leftovers and of course football — that’s our Thanksgiving tradition!
Nov 27: Everything looked great at my 28 week appointment. Got my dTaP vaccine. Baby’s HR in 140s and baby is growing nicely. My BP was good 119/64. 155lb on the scale (whoa!). That’s about 20lb over my norm! It’s definitely an adjustment to seeing the changes in my body…what it can and can’t do. I’m getting more short of breath these days and that’s with hardly ANY activity. Taking a flight of stairs – yeah… short of breath.
Things I miss most: hiking, wine, rock climbing, feeling in shape, being at peace (vs thinking about a million things constantly), date nights (usually too tired by the end of the week)
Things I won’t miss: being thirsty and drinking water all the time, peeing a couple of times in the middle of the night, not being able to sleep through the night while also being tired in the day (currently thinking about a lot of things right now), the low pressure/cramping, being short of breath, reflux, asking myself whether something is too hard or too heavy to lift or push, the hormonal push to growl at everyone
Today, the Mini is the size of a large eggplant. Kick counts have started. I have to get 10 kicks in an hour from now until the due date. So far, the Mini has been meeting the 60 minutes on the 10 kicks. Today was a long day at work — 11.5 hours all while being czar as well. I feel like the month of December has been full of 10-12 hour days. So, I decided to keep a log of my hours from now until my due date. This Mini is gonna be resilient and adaptable.
I started having sacroiliac pain will doing bridge in pilates last Wednesdays. It was a new feeling for me. It felt kinda like something pulling my hip bones apart. The pain was sharp and constant (but nothing I couldn’t handle) and stayed right in that sacroiliac joint. It has resolved since then after a couple of other pilates classes.
The Mini is doing well and making all their kick counts (10 in an hour). Yesterday, we saw Todd and Lauren’s baby Skyler and she was absolutely adorable! Almost 2 months old and such a gem to hold. Todd and Lauren will be great parents! One of the other girls there, Jenny who has had 4 kids, was such a wonderful wealth of information! I felt like we talked most of the night! Great food and company and baby welcoming!
My stress meter has been high this week. The lack of sleep, the million things I’m reading and thinking about for a work-related issue/project, and the planning/decision-making for our phase 1 renovation of our home. The great thing is that Bear is a great shoulder to lean on and I think he can tell that I’m feeling stressed (rarely do I show it). I think it’s adorable how he looks after me and makes sure I’m ok. D-Day was Dec 4.
Week 28 work hours: 51.5 hours
Week 29: Dec 5 – 11
Our mini is the size of a cauliflower this week! There’s no mistaking that I’m preggo now — the belly can’t be sucked in. It’s been interesting going through the changes with my body. It’s such a surreal experience: the bump, the reflux, the constant peeing, the oops pee, the constipation/gas/bloating, the smaller stomach size (I get full on half my meals!), the sleeping positions to get comfy,… and it’s only going to get more interesting as the weeks go on.
Week 29 work hours: 44.5 hours
Week 30: Dec 12 – 18
The OB shift was a gnarly one on Tuesday. Worked solid from 7a to midnight. There were a lot of colds on the OB floor. It’s only a matter of time before I come down with something. As luck would have it, I got assigned two TAVRs on Wednesday and worked from 8a-3:30p…. and that’s post-OB at #21. Well, I did come down with a cold. Mainly sore throat and slight sinus congestion. Bear was sweet and brought some tom yum soup home for me as well as picked up a whole pharmacy of goodness. I hit the Chloraseptic, lozenges, and Emergen-C. Called the OB to find out if these meds were safe to take. Theraflu is NOT safe for pregnant gals to take. Tylenol and Robitussin are safe (neither of which I’ve needed). Fortuitously had Thursday off bc I was unassigned that day (oftentimes we get work at a surgery center or something). Spent the day on the couch in my jammies. Bear brought home some pho for lunch and just took really good care of me. He’s a solid support system! Back at work today (Friday) for a full day and working both days this weekend. The Mini is making their kick counts and growing!
We had another OB appointment today and growth ultrasound. Everything is looking great!! My BP is 110/60. Fetal heart rate was in the 140s. I weighed in at a whopping 156 lb. For our ultrasound, the Mini measured at 3lb 15oz and is 60% on the growth curve! They’re in the middle range for amniotic fluid, which is just right. So far, everything is just going great for our lil Mini — who isn’t so mini anymore! I’m feeling more of the symptoms of heartburn, stomach fullness, bloating/constipation/gas/etc…. and the bladder is taking a beating! Nowadays I’m getting up 3-4 times a night (roughly every 2 hours). The gals at work eagerly remind me that this is just prepping me for motherhood — funny but too realistic of a joke!
Week 30 work hours: 48.25
Week 31: December 19 – 25
This week was a rather joyful week as we were in the Christmas spirit! The work week was a busy one as people try to fit in their surgeries before their insurance deductibles reset at the beginning of the 2018 year. This year, my fam came down from Temecula and I whipped up a cabernet beef short rib, mascarpone polenta, and banana bread pudding. My mom and aunt brought fermented cabbage, salad, and brownies. We picked up some sides like beet salad and broccoli salad. Overall, this was the first time I was making the recipes, but I was ecstatic that it came out as yummy as it did! I did make some tweaks to the original recipes as I added some things more to my taste.
On Christmas Eve, Ross and I headed up to LA to spend time with Ross’ fam. His brother made reservations at Fogo de Chao, a brazilian meat restaurant. The meat cuts were tasty and the buffet bar was loaded with veggies and yummy fruit (I went back for thirds on the winter citrus fruit!). For dessert, we had a delicious fruit ice cream. After a big lunch (I didn’t even eat dinner that night bc I was still so full!), we headed back to Ross’ fam’s place and played Bingo, LCR, and pictionary. Everyone was having a great time!
Christmas day, Ross and I had a nice peaceful morning opening presents and listening to Christmas music with the fireplace going. It’s bittersweet to think that this will be our last Christmas alone together before the Mini comes! It’s exciting to think how the Mini will change our lives in incredible ways! Today, we pulled the trigger on MontiKids bc it’s such an amazing company that creates toys that are age appropriate with a focus on development and the Montessori way. Here’s one gal’s review on MontiKids.
Hours worked: 35 hours
Week 32: Dec 26 – Jan 1
My last full night call was Dec 26. It ended up being a really nice, decent call night…. but I couldn’t get comfy sleeping in the call room. I find that I absolutely NEED my Snoogle pillow. So, not much sleep Tues night. Came home and crashed Wed from 8a-11a. Did a pilates class and felt good.
Thurs, Dec 28th: I don’t think I drank much water that day and ended up feeling pretty dehydrated. Went to pilates and as I was doing bridge pose started feeling light headed like I was going to pass out. I stopped and rolled onto my left side and put my legs up on the reformer foot bar (venous return is key!). I stayed in this position until I felt back to myself (roughly 10 minutes) and then I finished off the class. BUT,… when I went home that evening, the Mini did NOT make their kick counts. They would maybe do 1 kick in an hour (instead of the 10 they’re supposed to get). I fell asleep before I remembered to call the OB office.
So, Friday, I went to work and did a double heart day and then walked up to Labor and Delivery to get on the monitor to check out fetal heart tones. Everything seemed to be ok — and that was a huge relief for me!
Saturday, Dec 30: Ross got a new car! We needed to seriously upgrade his ride to something more child friendly and safe for our lil Mini! The new year will be welcomed in 2018 with a lot of new changes!
Pilates this week has been a real kick in the pants. I felt faint twice and realized that the wedge padding I use is not high enough for me bc I still feel light headed and get reduced venous return with any increase in heart rate. Bridge pose is out for me as are most exercises on my back. I’m super bummed about that. For January, I dropped from the unlimited pilates plan (go as much as I want) to just the 4 class pass.
NYE was a busy day! I worked from 7a-5:30p and then went out to a nice 7p dinner with my Bear at our first date spot Cucina Enoteca. We got home around 9ish and tried to stay up, but we passed out on the couch from then until midnight! Thank goodness for DVR bc we could rewind the NY ball drop and watch it and celebrate! We opted for a new year tradition: planting one tree/plant (indoor or outdoor) each year! This year we planted three indoor palms (chamaedorea costaricana, howea forsteriana, chambeyronia macro) and one outdoor palm (from our wedding: the blue green palm — butia capitata blue).
Hours worked: 37.5 hours
Week 33; Jan 2 – Jan 8, 2018
Our Mini is the size of a pineapple! Nowadays, sleep is escaping me (from the multiple wakeups to pee to just not being able to sleep despite being exhausted) — my most comfortable position is propped up with pillows and oftentimes I find my best sleep upright on the couch. Bear is starting to nest — it’s so cute to see. I easily go through a liter of La Croix in a day, but I found out that the BPA in the aluminum cans clearly aren’t good. So Bear went to Jimbo’s and bought three different soda water beverages in glass containers. He is soooooooo thoughtful! At work, I’m heading to the bathroom every 2 hours.
Hours worked: 26 hours
Week 34: January 9 – 15, 2018
Even though this week was a bit lighter for me (I had originally taken this week off as a staycation, but opted to just take Friday off), I couldn’t get comfy sleeping. I took an OB call on Wednesday and was essentially done around midnight (I have a midnight rule at work: if I’m still at work at midnight, I just sleep in the call room). While sleeping in the call room, I was only sleeping 1.5 hours at a time. The insatiable thirst and constant and consistent potty breaks are starting to become unbearable. I’m tired all the time and it’s from getting up every 1.5 hours all through the night. It’s not even something I feel like I could fix unless I had a urinary foley catheter in place. The belly feels like it’s getting bigger: getting up and out of bed is becoming more difficult (I have to roll to one side and then get up vs just getting straight up from a bend at the waist); the SI joint pain has returned with more frequency but it’s not unbearable; the Braxton-Hicks contractions are more common and coming higher up on my belly — before I would have maybe 1 every couple of days — this week I’m having several a day. The Mini is still making their kick counts. The gals on OB think I’m having a boy — they base this on: my “glow”, lack of acne on my face, the way I’m carrying the baby, my lack of all over weight gain…. although I’m not sure any of these old wives tales are accurate in any way. I’d be ecstatic with a healthy baby, regardless of sex.
Unconditional Parenting: Moving from Rewards and Punishments to Love and Reason – started this on Audible (3rd trimester). This book was a nice eye opener that not all praise and punishment is the right kind. I learned a lot about fostering positivity with effort and not just for anything that is done. I agree that punishment is not a good system for motivation, but this book really uncovers that reward is NOT the best system for motivation either. I plan to implement these techniques for our Mini. This was my 3rd favorite book in the bunch I’ve been reading.
Montessori from the Start: The Child at Home, from Birth to Age Three – listened to this on Audible (3rd trimester). Also gifted to both moms. This was a close second to Brain Rules for Baby (for me). It tackles the principles of Montessori and the whys and hows to implement this method of development. It promotes independence of the child, but also places importance on how to promote brain development with the simple things (simple toys: no bright lights or sounds, no screens, the power of imaginative play, etc.). I highly recommend this book as a 2nd read after Brain rules for Baby.
Our baby shower went off without a hitch! It was great catching up with people and seeing the outpouring of love for our lil one on the way! We could’ve easily fed 50 people — it’s always hard to know how much food to factor in. We had Cardiff crack (tri-tip), burgers, pulled chicken sliders, coleslaw, veggies, dips and chips, cakes, cookies, potato salad. It was an incredible feast!! I only wish I could eat more! I was only able to get a bite of beef tri-tip, one burger slider, and one chicken slider down before I was super stuffed! Dessert came later around 7p for me.
The Braxton-Hicks contractions are more frequent now — having at least one daily — but anywhere up to 5 in a day. Still waking up every 1.5-2hours nightly for a pee. Drinking adequate amounts of water (I probably go through 4x 32oz of water daily and also 1x 32 oz water nightly.
We ultimately re-discussed the cord blood/tissue banking and decided on CBR. After chatting with several moms who did it…. a lot of them have regrets for not doing it…. and the ones who did it have peace of mind. Bear and I further researched the topic and decided we would do it and chose CBR.
Hours worked: 19.5
Week 35: January 16 – 22, 2018
This week has been insanely busy. Not sure if that’s how the schedule just worked out this week or people are back to signing up for surgeries. Additionally, this week Bear and I felt that the Mini was significantly bigger. I feel more fatigued, larger, more difficulty moving around, more thirst and urinating, etc. Lately, my craving has been winter citrus — oranges and mandarins. Really, I’m craving anything with liquid… I can’t get enough. Another great treat we’ve enjoyed is root beer — what is going on with these cravings? Bear has been nesting hard! He’s organized the house, setup the bassinet, installed the car seat, packed his hospital bag and the baby’s bag. It’s so cute to see him so excited and nesting! He’s been such a great husband, supporter, massager, and I know he’s gonna be an amazing father! I can’t believe how fast the days are moving now! We got our Cord Blood Registry kit and filled out everything for it so it will be ready to go with our hospital bags.
We had our 36 week AFI and NST. I’ll be doing these twice a week now as I’m deemed “high risk” because I’m AMA (advanced maternal age: > 35 years old). My BP was great at 108/76. Fundal height was right on track at 36. AFI was normal at 9 (but the range I was told was 5-25). I want that number to be higher. Dr. W asked if I could drink more water. I’d happily do that — currently I’m drinking 6 x 32oz of water in a 24 hour period. My urine was free of protein and glucose. All good things. I’m 160lb. Whoa! Mini is head down right now. So far, everything is good! Had the 2nd AFI and NST after a 14 hour workday. AFI was 9.5 and NST was perfect – nice and reactive. Dr. W said I could stop working at anytime, but I really want to save up all that time for when the baby comes. Good to know that I can pull that card when I just can’t take it! I was really dragging after working 37.5 hours in 3 days. My legs are swelling, despite my best efforts of wearing calf compression socks and trying to put my legs up. There’s a dull ache by the end of the work day. Luckily, my Bear is always down to give my legs and feet a good rub down at the end of the day.
And I had to look at the odds of going into labor…
Our 1 year wedding anniversary on Feb 4!! I can’t believe how quickly the year flew by and everything that has come our way! It’s been an incredible year! Nevermind that it’s SuperBowl Sunday (go Eagles!)… we spent a wonderful relaxing spa day at Rancho Valencia. The Duet 90 minute massage was incredible (we had Sara and Noelle — both were fantastic!). A chill day lounging by the pool — I couldn’t have asked for a better way to celebrate our 1st year wedding anniversary! In fact, Bear and I decided we will have a full spa day every wedding anniversary.
Feb 5 was our weekly appointment for NST/AFI/Dr. W for week 38 (which is tomorrow!). I’ve lost a couple of pounds and was 158.8lb for today’s visit. Who knows what that is from as I haven’t changed anything in my diet or activity level (although this past week was pretty taxing). 117/73, hr 70. FHR 140s. Good NST read with adequate accelerations and contractions. I’m contracting several times throughout the day, but not regularly. AFI was 10.5 today! On the cervical exam, Dr. W said I was at best finger tip (which is more than what it was last week – softened closed cervix). There’s some spotting after the exam this go around.
I’m already thinking of getting out and about with the newborn. We have a retirement party coming up for some of our colleagues and I want to go…but I also want to bring the Mini. I think my strategy is a carrier and keeping it a short visit.
Had a bit of light spotting on Wednesday (38 weeks, 2 days). Still contracting away. The tiredness is evident – the lack of sleep for the last month has been tough. Maybe next week I’ll get the doctor’s note. NST was reassuring and the AFI was 10.1 on Thursday. Everything is still going great!
February 10, 2018 — There’s been a change in my contractions. Instead of just being abdominal contractions, they’ve turned into more back and abdominal contractions. Right now, they’re about 8-10 minutes apart, lasting 40sec – 1 min. Looks like we’re getting close. With the contractions is the urge to poo. I’ve started spotting again. I’ve been up since 4:30 bc of the new back contractions — they’re pretty uncomfortable. The abdominal contractions just feel like a strong menstrual cramp. I’m on call this weekend (I traded down to #3 today bc I was #1 in the main OR). Let’s see how this day plays out!
For the Chinese zodiac…
If baby is born before the Chinese New Year (before Friday, Feb 16, 2018), they are the year of the ROOSTER
I woke up this morning around 4:30a feeling a lot of low back pressure and new buttock/tailbone pressure. It woke me up from sleep. It lasted for about an hour and then subsided. Luckily, the day before, I traded with Milbern down to #3 for my #1 weekend call. The new back pressure was off and on throughout the day — timing the contractions were about 11-13 minutes apart. They definitely felt different from my other contractions which were mainly front and abdominal. By the time the evening rolled around, my contractions were 5 minutes apart and still painful! We went in to Labor & Delivery to get checked out since they said come to the hospital if you’re 5-1-1 (5 minutes apart on the contractions, 1 minute in length, and for 1 hour total). Once we got to the hospital around 6pm, I got checked out and was only 1 cm dilated. We found that the baby’s position was OP/OT. One of the midwives suggested some positions to try at home to see if we could turn the baby — trust me, I was all ears to help get this baby into a more deliverable position! We left the hospital to try these techniques. There was a website she recommended called SpinningBabies.com that was super helpful for a bunch of these techniques. We tried me being on all 4s with a bit of inversion. We tried a hot bath with ice packs on my back. I tried a couple of the techniques from the Spinning Babies website. We tried these different techniques all the way until Sunday, Feb 11 at 2am.
Sunday, Feb 11, 2018
2am we came back into the hospital bc our contractions were now about 3.5 minutes apart. The pain was still pretty intense despite our best efforts to get the baby to turn. When we came back in, they opted to either give me some Tylenol and Ambien or Nubain and Phenergan. I opted for the Nubain/phenergan combo as the pain was intense and the midwife stated I needed to relax to allow my cervix to dilate. I was able to sleep for 3 hours and then after waking up, they decided to admit me as I was 3 cm dilated and 80% effaced AND could get an epidural. That’s exactly what I did next. Shiyin did an awesome job with the placement. After that, I was able to get comfortable and get some rest. I was started on Pitocin a couple of hours after the epidural. By around 3pm, I had progressed to 6-7cm dilated. Then I had SROM’d and enjoyed a celebratory pickle. By around 7pm, I was 7.5-8cm dilated, but baby was still OP. There was a forebag of amniotic fluid that was ruptured by the midwife. We again tried a bunch of the different positions to help move the baby out of OP, but to no avail. Around 8:30p, I was 10cm dilated and started pushing. I was doing 10 seconds of pushing x3 per every contraction. My OB (Kim Washkowiak) who wasn’t even on call came to deliver her. This went on for an hour until our little girl was born at 22:09pm. She looked perfect! We were able to get skin-to-skin immediately and our cord blood and tissue was sent. She got checked out by the baby nurse and everything looked great! She was 7lb 3oz, 21 inches long. She came out with a cute conehead! An hour after delivery, she was latching and had a strong suck and we were able to breastfeed immediately. This has been such an adventure and we’re so excited to see what each day brings!
I’ve taken this week off as a staycation to catch up with life. We’re nearing the end of our wedding planning and everything is falling into place. I think when times get a bit overwhelming, it’s helpful for me to take a step back and take a breather. Whether that’s taking time for myself or diving into a project or doing some inner soul searching… I like to take some time to prioritize my mind and body to get it back on track.
The most important thing is a mental reset. Try and learn from each situation. If you’re too overwhelmed to learn, then try and make small changes by shifting your negative thoughts to positive ones. Maybe then, you’ll be able to discover the lesson and truly discover the goodness and positivity in life.
I grew up in a small west Texas town called Abilene, TX. My mom was a standard tiger mom in that she encouraged me to pursue multiple activities while nudging me to do my best. After drama lessons, tennis lessons, basketball, volleyball, piano, violin, band, taekwondo, pageants, and just life, I left Abilene and pursued a biomedical science degree at Texas A&M University. My earliest memory of wanting to be a doctor started when I was in the third grade. I hadn’t been feeling well and was diagnosed with pneumonia — I had been reading a book called This is the Child. My family practice physician Dr. Lawson was about to prescribe me prednisone, and I immediately got worried because that was the same medication used to help with the child’s leukemia. Dr. Lawson picked up on my early curiosity and invited me to hang out with him in his medical office observing patients. After college, med school proved to be a great experience at University of Texas Medical Branch in Galveston and it felt like learning on steroids (as compared to college). My clinical rotations led me to the path of choosing anesthesiology as a career. Anesthesia is the perfect combination of anatomy, physiology, pharmacology, psychology, and sociology. I matched into a terrific internship in Austin, TX and continued my anesthesia training at the prestigious Massachussetts General Hospital. Following 4 grueling years of training, late nights, memorable cases, and lifelong friendships, I chose to pursue a cardiac anesthesia fellowship at University of California San Diego — a world renowned institution for the treatment of right heart failure following pulmonary thrombosis. 14 years after graduating high school, I have the job of my dreams. Here’s a sample of my day…
Today I’m #2 in our call lineup, which means it will be a pretty busy day. Typically, we have 15 call spots in our main operating room (OR) numbered #1 to #15. #1 position gets the first pick of cases. #2 gets the next pick and so on.
5:45a Early heart day wake up. Today, I will be providing anesthesia to a 70-something year old lady who needs a new heart valve. On heart days, I wake up at 5:45a to be at work by 6:30. And on regular main OR days, I wake up at 6:15a to be at work by 7:00. Ahhhh… To have more beauty sleep!
6:17a Breakfast in the car – it’s either green juice, Shakeology, or banana on the go!
6:31a I meet the patient and her family in the pre-operative area. We go over a detailed plan for her anesthesia as well as answer any questions. One of the best parts of my job is meeting all different types of people. It’s an amazing feeling to meet people at one of their most vulnerable moments in their lives and win over their trust and respect. It is my job to safely manage their physiologic processes. Oftentimes, patients tell me it is the anesthesiologist who is the most important part of a surgery — they understand how easy it is to bring them close to the brink of death and then revive them back to a wakeful state. It’s incredible the amount of trust patients place in your hands in such a short time after meeting them.
7:15am The patient is under anesthesia and all invasive monitoring lines (arterial, central venous pressure, cordis, pulmonary artery lines) have been placed. The transesophageal echocardiogram is performed and results are relayed to the cardiac surgeon.
7:45am Cardiac surgeon makes incision. The patient is monitored throughout the case. Multiple screens show all the physiologic monitoring results.
10:00a Bathroom break! Partners/colleagues break each other out so there is always an anesthesiologist monitoring the patient. It’s also a good time to grab a snack!
11:32a Drop first patient off in Cardiac Care Unit and grab some lunch. The doctor’s lounge keeps us fed with soup and salad. Today, I’m feeling the vegetable soup. Grab a quick bathroom break and then to interview the next patient.
11:45a Electrophysiology study for atrial fibrillation ablation. The view from this OR is such a delight!
The view from my little nook.
14:00 I get a call from our anesthesia czar, one of my partners who runs the schedule. He was wondering if I would make my 15:00 hip replacement. After a quick conversation, we decide that I would call him in 30 minutes for an update.
14:33 We are finishing up with the current case and I call the czar back to find out about my next case. I learned that there is an emergent heart that will be started by another colleague and that I will continue the lineup in EP (so my day went from a 16:30 finish on paper to roughly a 19:00 finish). Anytime I am in the top 5 call positions, I know not to make defined plans because you never know if there will be add-ons or changes to the schedule. This makes my social life a bit frustrating as my non-medical friends have a tough time understanding and adapting to this “you don’t get out of work at 5p?” concept.
15:20p Drop patient off in the Post Anesthesia Care Unit (PACU). Grab a quick snack and head back to EP for the next patient.
15:25p Speak to the next patient who has arrived for an a-fib ablation as well. Induce and get started with the case.
19:22 Drop last patient off in the PACU. As #2 on the call list, I look at my watch and realize that I am #2 at night. This means I will be the 2nd person they call tonight if extra rooms in the OR get booked (traumas, heart call, etc.). As much as I’d love to head home and grab a glass of wine and unwind, I meet up a friend for dinner to catch up and relax.
21:42 Head home. Shower. Brush my teeth and get into bed. There’s always a risk of being called into work. Tomorrow will be a shorter day. After the hectic day, I am still thankful for my wonderful job and colleagues. Looking back at my journey to get here, I smile because I couldn’t be happier.
These parents were so sweet. Sloane was their fourth baby, and they barely made it to the hospital. They left their camera at home and their cell phone just went to 0% charge. I asked if it was ok to use my cell phone and then send them pics so they could capture this special day. (In a hospital setting, permission and patient consent is everything). I love deliveries because the little babies are so precious… Innocence captured in such a happy moment.
Little notes from patients like this truly make my job incredible!
Anesthesia is a pretty social field in medicine. Even though you can be stuck in a room with no windows for hours on end, one can typically have good conversation with the people in the room (nurses, scrub techs, surgeons, assists, reps, etc.). Typically, it’s a jovial atmosphere. Well, while checking-in with our schedule runner (the czar) a call came through that someone needed to be intubated upstairs.
Luckily, I was in between cases and decided to run upstairs to assess the situation. I see a rather obese gentleman appearing a bit mottled in color. The vitals monitor said SpO2 90%. The patient was on a bipap machine. His belly was heaving up and down with each breath…making it appear that he was using a lot of effort for each breath. I called for the intubation supplies. Sadly, this gentleman had suffered from a cerebellar stroke a week ago and they had attempted an extubation a couple of hours prior to my arrival. Needless to say, his respiratory effort was wearing me out…and I had already huffed and puffed my way up several floors of stairs (my preferred method of solo transport). Once the supplies were ready, it was go time. Labs checked out ok. He seemed to be moving all extremities appropriately, despite his stroke. All systems go. After the drugs were pushed through his central line, I took a look and quickly suctioned his posterior oropharynx — there was mucus covering his glottic opening. Once it was cleared, I skillfully maneuvered the endotracheal tube through the vocal cords and secured his airway. The end tidal CO2 detector changed color appropriately and bilateral breath sounds were established. For those crucial few minutes, everything around me seemed to halt. I consciously let out a sigh of relief and thanked the RT and nurses who were present in the room for their help. The beauty of my job is that it’s ever changing. One must be flexible enough to adapt to different types of cases as well as challenging anatomy and situations. Plus, I get to meet all types of people from all walks of life. Therein lies the reason why I love my job.