WEBVTT 00:00:12.490 --> 00:00:15.570 and welcome back to Style Points. We've decided 00:00:15.570 --> 00:00:18.589 to skip the RSI for this episode. Some of the 00:00:18.589 --> 00:00:21.769 subject matter today is a little heavy. Today 00:00:21.769 --> 00:00:23.730 I'll be talking with my friend Mary Roberts, 00:00:23.910 --> 00:00:26.690 who did her anesthesia residency and OB fellowship 00:00:26.690 --> 00:00:29.910 here at the University of Cincinnati. Let's jump 00:00:29.910 --> 00:00:33.710 right in. I just sent this to you. I feel like 00:00:33.710 --> 00:00:37.909 I should be able to find it. Here we go. You 00:00:37.909 --> 00:00:42.380 go to your set email. I'm just kidding. This 00:00:42.380 --> 00:00:48.000 isn't helpful. You're welcome. Just because you're 00:00:48.000 --> 00:00:51.380 married to one of the podcast hosts doesn't mean 00:00:51.380 --> 00:00:55.719 that you can harass me the whole time. No, I 00:00:55.719 --> 00:00:57.500 thought that was because we're friends. I can 00:00:57.500 --> 00:01:00.640 harass you the whole time. Okay, that's awesome. 00:01:02.460 --> 00:01:05.780 Mary, thank you so much for joining us. Thank 00:01:05.780 --> 00:01:10.739 you for having me. One of the benefits that I 00:01:10.739 --> 00:01:15.209 have, as a podcast producer is that I get to 00:01:15.209 --> 00:01:16.930 ask all of my friends to come join me on the 00:01:16.930 --> 00:01:19.390 podcast. And you are somebody that I've been 00:01:19.390 --> 00:01:21.730 trying to get to come on the podcast for a really 00:01:21.730 --> 00:01:24.290 long time because you are one of my close friends. 00:01:24.590 --> 00:01:30.109 You also happen to be married to my podcast co 00:01:30.109 --> 00:01:35.590 -host, Nate Moore. That is true. So my first 00:01:35.590 --> 00:01:37.969 question for you is what took you so long to 00:01:37.969 --> 00:01:41.840 come on the podcast? Ooh, that's a tough question. 00:01:42.400 --> 00:01:46.120 And I have two separate answers. One is because 00:01:46.120 --> 00:01:49.700 my husband is a co -host on the podcast. It's 00:01:49.700 --> 00:01:53.739 his and your domain. And so, you know, we work 00:01:53.739 --> 00:01:55.900 together a lot, my husband and I. We're both 00:01:55.900 --> 00:02:00.859 anesthesiologists, but we each have our own kind 00:02:00.859 --> 00:02:04.120 of roles as anesthesiologists, and we don't always 00:02:04.120 --> 00:02:06.519 cross over. We do sometimes, and it's a lot of 00:02:06.519 --> 00:02:14.069 fun. This is a newer thing, and that's awesome, 00:02:14.169 --> 00:02:18.729 but not my thing. The other reason is I just 00:02:18.729 --> 00:02:22.229 don't like to hear my voice. It sounds kind of 00:02:22.229 --> 00:02:27.430 weird. I guess what I'm hoping for after this 00:02:27.430 --> 00:02:29.930 is that you're going to be approached by all 00:02:29.930 --> 00:02:32.310 of the people who listen to the podcast, and 00:02:32.310 --> 00:02:34.509 they will tell you that your voice does not in 00:02:34.509 --> 00:02:36.770 fact sound weird because it just sounds like 00:02:36.770 --> 00:02:42.319 your voice to me. Oh, good. Let me start out 00:02:42.319 --> 00:02:44.659 with the who you would go out to dinner with 00:02:44.659 --> 00:02:47.439 question. So if you had the chance to go out 00:02:47.439 --> 00:02:49.699 to dinner with anyone in the world, it could 00:02:49.699 --> 00:02:52.759 be somebody from the past or even from fiction. 00:02:52.840 --> 00:02:54.439 Who would you go out to dinner with and why? 00:02:57.400 --> 00:03:01.879 So my immediate answer is my daughter, Alice. 00:03:02.099 --> 00:03:07.099 But I don't want to skip forward in talking about 00:03:07.099 --> 00:03:11.379 that. That would be my answer is I want to go 00:03:11.379 --> 00:03:17.460 to dinner with my daughter. I think that it's 00:03:17.460 --> 00:03:20.280 fair that we don't want to skip ahead, but I 00:03:20.280 --> 00:03:23.599 think that that is a reasonable preview. Before 00:03:23.599 --> 00:03:27.719 we get into that, and maybe we can talk more 00:03:27.719 --> 00:03:30.680 about why that is a little bit later, let's talk 00:03:30.680 --> 00:03:33.400 about OB anesthesia. That's what you did your 00:03:33.400 --> 00:03:36.469 fellowship in. That's your specialty. What drew 00:03:36.469 --> 00:03:40.150 you originally to OB anesthesia? I think there 00:03:40.150 --> 00:03:43.490 were a couple things that drew me to OB anesthesia. 00:03:44.550 --> 00:03:50.129 As a CA1 resident, I was first introduced to 00:03:50.129 --> 00:03:52.969 OB anesthesia outside of little things I'd done 00:03:52.969 --> 00:03:55.430 as a med student. But my first true exposure 00:03:55.430 --> 00:03:59.949 was a CA1. And I was not expecting to love it 00:03:59.949 --> 00:04:03.189 as much as I do, which is interesting looking 00:04:03.189 --> 00:04:06.219 back on it because I feel like, Now I couldn't 00:04:06.219 --> 00:04:13.680 see not doing it. But when I started doing OB 00:04:13.680 --> 00:04:16.959 anesthesia, I really enjoyed the patient interactions. 00:04:17.300 --> 00:04:20.980 I enjoyed being there for that special moment 00:04:20.980 --> 00:04:23.939 in my patient's lives, whether it was a good 00:04:23.939 --> 00:04:27.199 moment or a bad moment. It was it felt very special 00:04:27.199 --> 00:04:31.439 to be a part of it and to help ease their pain 00:04:31.439 --> 00:04:35.519 or help them through. Because even though it's 00:04:35.519 --> 00:04:37.220 a very special moment, it can be a very stressful 00:04:37.220 --> 00:04:40.220 moment. Again, good or bad outcomes, it can be 00:04:40.220 --> 00:04:43.459 a stressful moment. And so being there and being 00:04:43.459 --> 00:04:46.120 able to help them through that is an amazing 00:04:46.120 --> 00:04:50.920 gift that we are given as OB anesthesiologists. 00:04:51.480 --> 00:04:54.019 And then, of course, I also liked working with 00:04:54.019 --> 00:04:59.759 my hands, being able to help with pain control, 00:04:59.819 --> 00:05:02.680 seeing immediate gratification from. taking away 00:05:02.680 --> 00:05:06.060 their pain with epidurals, spinals, and taking 00:05:06.060 --> 00:05:08.579 care of two patients at once or more than two 00:05:08.579 --> 00:05:12.360 patients at once. It's very uncommon that we're 00:05:12.360 --> 00:05:15.339 in a situation where what we give one patient 00:05:15.339 --> 00:05:19.279 actually affects another human being so directly 00:05:19.279 --> 00:05:21.879 because that human being is still inside mom. 00:05:23.860 --> 00:05:28.660 So I also enjoy OB anesthesia for the same reasons. 00:05:28.920 --> 00:05:32.550 And one of the things that I think about especially 00:05:32.550 --> 00:05:35.709 on OB, is communication and how that communication 00:05:35.709 --> 00:05:39.670 matters in those special moments or those stressful 00:05:39.670 --> 00:05:43.589 moments, right? When you are talking to laboring 00:05:43.589 --> 00:05:46.569 patients for the first time, what are the things 00:05:46.569 --> 00:05:49.509 that you try to communicate with them so that 00:05:49.509 --> 00:05:53.569 they feel safe and comfortable with you? Yeah, 00:05:53.649 --> 00:05:57.810 I think one thing I do, and it's not specifically 00:05:57.810 --> 00:06:01.889 saying anything. It's just asking them about 00:06:01.889 --> 00:06:06.269 themselves or their baby or anything even in 00:06:06.269 --> 00:06:09.129 the room that I have an opportunity to almost 00:06:09.129 --> 00:06:12.189 latch on to, to show them that I care about them 00:06:12.189 --> 00:06:16.110 as a person and not just a patient. Establishing 00:06:16.110 --> 00:06:19.089 that rapport with them can go a really long way 00:06:19.089 --> 00:06:23.129 so that when you're talking to them throughout 00:06:23.129 --> 00:06:25.550 their experience, they know that you're seeing 00:06:25.550 --> 00:06:28.819 them as. them and what they're experiencing and 00:06:28.819 --> 00:06:32.579 not just another patient um and so it's can be 00:06:32.579 --> 00:06:34.699 something simple like oh i really like your nails 00:06:34.699 --> 00:06:38.959 or oh i see you have a you know reds cap on i 00:06:38.959 --> 00:06:41.100 like the reds too too bad they're really bad 00:06:41.100 --> 00:06:45.819 this season um just having those moments or even 00:06:45.819 --> 00:06:49.180 just saying you know tell me about who's with 00:06:49.180 --> 00:06:52.939 you today or um you know tell me about your baby 00:06:52.939 --> 00:06:57.439 or something um to establish that connection 00:06:57.439 --> 00:07:03.600 with them on a more human level. So you supervise 00:07:03.600 --> 00:07:05.899 a lot of trainees. Education is something that 00:07:05.899 --> 00:07:09.540 you do a lot of. Are there phrases that people 00:07:09.540 --> 00:07:13.100 tend to use on OB that you don't think are super 00:07:13.100 --> 00:07:16.819 helpful? I do think that phrasing things is extremely 00:07:16.819 --> 00:07:20.379 important when it comes to talking with patients. 00:07:21.319 --> 00:07:25.459 One thing that I find... frustrating from my 00:07:25.459 --> 00:07:27.459 perspective but I know everyone's a little different 00:07:27.459 --> 00:07:32.060 is when you have a patient who's not English 00:07:32.060 --> 00:07:35.060 speaking talking to the interpreter instead of 00:07:35.060 --> 00:07:38.620 talking to the patient can be very frustrating 00:07:38.620 --> 00:07:42.480 from my standpoint because I feel like yes they 00:07:42.480 --> 00:07:45.279 don't understand you but even just saying things 00:07:45.279 --> 00:07:48.319 to the patient and looking at them when you're 00:07:48.319 --> 00:07:52.149 talking can be meaningful even if They don't 00:07:52.149 --> 00:07:55.370 understand the words you're saying. I heard something 00:07:55.370 --> 00:07:58.290 the other day that kind of stuck with me that 00:07:58.290 --> 00:08:00.750 that reminds me of, which is that something like 00:08:00.750 --> 00:08:05.569 80 % of communication is nonverbal. And so that 00:08:05.569 --> 00:08:09.069 certainly matches up with that. And I try to 00:08:09.069 --> 00:08:11.329 be really intentional when I'm using interpreters 00:08:11.329 --> 00:08:13.810 as well to make sure that I'm looking at the 00:08:13.810 --> 00:08:18.949 patient, that I'm doing all of the same facial. 00:08:20.129 --> 00:08:22.910 movements that I would do if the patient understood 00:08:22.910 --> 00:08:25.790 me so that they can get a sense for what I mean 00:08:25.790 --> 00:08:29.949 and how I mean it. Absolutely. And I think that's 00:08:29.949 --> 00:08:32.490 really important when you have that communication 00:08:32.490 --> 00:08:35.370 barrier, that language barrier. It doesn't have 00:08:35.370 --> 00:08:39.289 to be a full communication barrier. You can still 00:08:39.289 --> 00:08:41.429 communicate with the patient in ways that are 00:08:41.429 --> 00:08:47.429 not, you know, direct spoken language. So I think 00:08:47.429 --> 00:08:51.759 that's really, really meaningful. So one of the 00:08:51.759 --> 00:08:54.580 things that makes it tricky to do OB anesthesia 00:08:54.580 --> 00:08:57.799 is we do get to take away pain with spinals and 00:08:57.799 --> 00:09:01.799 epidurals, anorexial anesthesia. But we actually 00:09:01.799 --> 00:09:05.360 have to cause people pain by placing those things 00:09:05.360 --> 00:09:08.000 before we can relieve that pain. And that can 00:09:08.000 --> 00:09:11.220 sometimes be a really anxious moment for people. 00:09:11.679 --> 00:09:16.539 So how do you explain to patients what they're 00:09:16.539 --> 00:09:19.149 about to feel that makes it? maybe a little bit 00:09:19.149 --> 00:09:21.809 less scary for them. Because I know that there 00:09:21.809 --> 00:09:25.250 are a lot of people who are very afraid of an 00:09:25.250 --> 00:09:27.070 epidural. It's a needle that's going into your 00:09:27.070 --> 00:09:30.970 back. Yeah, absolutely. I think the best thing 00:09:30.970 --> 00:09:33.649 to do is to try to normalize things as much as 00:09:33.649 --> 00:09:38.309 possible. So everyone experiences labor delivery 00:09:38.309 --> 00:09:42.350 epidurals differently. And so there's a whole... 00:09:42.700 --> 00:09:45.679 range of what's normal, but kind of walking them 00:09:45.679 --> 00:09:48.679 through what to expect and even relating it to 00:09:48.679 --> 00:09:51.340 experiences they may have had in the past and 00:09:51.340 --> 00:09:54.179 using specific language. Like when you're pressing 00:09:54.179 --> 00:09:56.480 on someone's back, I say I'm going to press on 00:09:56.480 --> 00:09:57.820 your back. I don't say I'm going to touch your 00:09:57.820 --> 00:10:01.299 back. I'm not saying I'm going to push on your 00:10:01.299 --> 00:10:03.539 back because one sounds a little too aggressive 00:10:03.539 --> 00:10:06.299 and one sounds maybe too light. But saying pressing 00:10:06.299 --> 00:10:08.980 on your back, that's what I expect them to feel. 00:10:09.879 --> 00:10:13.090 Or when I'm numbing them. Relating it to say, 00:10:13.210 --> 00:10:16.250 have you ever had a tooth numb during a procedure? 00:10:16.350 --> 00:10:18.450 That's the kind of numbing that you're going 00:10:18.450 --> 00:10:21.129 to feel before we insert the needle to put the 00:10:21.129 --> 00:10:23.309 catheter in. We're going to numb it up first, 00:10:23.389 --> 00:10:25.490 just like we numb up a tooth. So it's something 00:10:25.490 --> 00:10:27.450 that they may have experienced before and they 00:10:27.450 --> 00:10:30.830 can relate to. Or if they haven't had that before, 00:10:30.870 --> 00:10:33.649 saying things more like a pinch and a burn or 00:10:33.649 --> 00:10:37.490 a numbing shot, not. We're going to inject medication 00:10:37.490 --> 00:10:40.610 or do anything aggressive, but just trying to 00:10:40.610 --> 00:10:44.509 not downplay it too much, but also not overplay 00:10:44.509 --> 00:10:47.629 it either. And then also, again, normalizing 00:10:47.629 --> 00:10:50.629 different experiences. So you may feel a shock 00:10:50.629 --> 00:10:52.529 down your leg. It might feel a little bit like 00:10:52.529 --> 00:10:55.850 a funny bone feeling. Again, a normal sensation 00:10:55.850 --> 00:10:59.210 that they probably can relate to. But then I 00:10:59.210 --> 00:11:01.129 also say, but you may not feel that. And that's 00:11:01.129 --> 00:11:03.549 also normal because I don't want them to say 00:11:03.549 --> 00:11:06.230 I didn't feel it or. Oh, yeah, I did feel it. 00:11:06.429 --> 00:11:09.750 Both are normal. And so giving them that expectation, 00:11:09.970 --> 00:11:11.950 but then also saying, but you're not strange 00:11:11.950 --> 00:11:14.190 if you don't feel it or you're not, you know, 00:11:14.230 --> 00:11:15.529 it doesn't mean it's not working just because 00:11:15.529 --> 00:11:19.289 you didn't did or did not feel that. Sometimes 00:11:19.289 --> 00:11:24.049 on OB anesthesia, we get patients that are extremely 00:11:24.049 --> 00:11:27.210 anxious or on the verge of a panic attack when 00:11:27.210 --> 00:11:29.789 they come to us. And that can be for a variety 00:11:29.789 --> 00:11:33.250 of reasons. They could be their social situation. 00:11:34.120 --> 00:11:37.679 they're dealing with. It could be an anxiety 00:11:37.679 --> 00:11:40.500 problem that they're dealing with. When patients 00:11:40.500 --> 00:11:44.059 have that extreme heightened anxiety that we 00:11:44.059 --> 00:11:47.399 see on OB, what are some of the ways that you 00:11:47.399 --> 00:11:53.120 treat them differently such that you're taking 00:11:53.120 --> 00:11:57.610 the best care of them that you can? People have 00:11:57.610 --> 00:12:00.269 all different levels of anxiety coming into a 00:12:00.269 --> 00:12:01.809 delivery. And like you said, it could be for 00:12:01.809 --> 00:12:04.169 a variety of reasons. Maybe the last delivery 00:12:04.169 --> 00:12:08.309 didn't go well or maybe they're just anxious 00:12:08.309 --> 00:12:10.429 about things or maybe there's a social component, 00:12:10.549 --> 00:12:15.029 like you said. But listening to them and to why 00:12:15.029 --> 00:12:16.769 they're anxious, what they're anxious about, 00:12:16.970 --> 00:12:18.409 because it could be the C -section or it could 00:12:18.409 --> 00:12:21.370 be the epidural or it could be both. It could 00:12:21.370 --> 00:12:24.409 be a variety of reasons. So listening to that 00:12:24.409 --> 00:12:27.250 and then again, normalizing it like. very normal 00:12:27.250 --> 00:12:30.230 to feel anxious about these things that's that's 00:12:30.230 --> 00:12:34.490 okay that is honestly expected that you're going 00:12:34.490 --> 00:12:36.789 to be anxious about these things but we're going 00:12:36.789 --> 00:12:39.070 to take good care of you and we're going to do 00:12:39.070 --> 00:12:43.149 the best we can for you um so not trying to be 00:12:43.149 --> 00:12:46.070 you know override their anxiety or say you know 00:12:46.070 --> 00:12:48.529 that's okay it's all good it's all fine that's 00:12:48.529 --> 00:12:50.809 not what we're trying to do you want to recognize 00:12:50.809 --> 00:12:54.690 their their apprehension their feelings but then 00:12:54.690 --> 00:12:58.110 say you know We're going to be here for you. 00:12:58.750 --> 00:13:01.470 And then also reading the patient. It's hard 00:13:01.470 --> 00:13:05.629 to do sometimes, but is this a patient who's 00:13:05.629 --> 00:13:07.809 going to do well with a joke or a distraction? 00:13:08.950 --> 00:13:10.830 If you guys just start talking about baby, or 00:13:10.830 --> 00:13:13.269 maybe that's not the right thing to talk about. 00:13:13.529 --> 00:13:15.590 Everyone's different, but recognizing something 00:13:15.590 --> 00:13:21.120 that can help them feel more comfortable. take 00:13:21.120 --> 00:13:23.639 their mind off it or maybe they don't want their 00:13:23.639 --> 00:13:25.580 mind taken off it and they just want you to walk 00:13:25.580 --> 00:13:30.279 them through everything that's okay too um but 00:13:30.279 --> 00:13:31.960 just trying to gauge what that patient needs 00:13:31.960 --> 00:13:35.100 in that moment one of my favorite lines that 00:13:35.100 --> 00:13:38.039 i use on patients that i have deemed appropriate 00:13:38.039 --> 00:13:42.299 that are feeling very anxious is i will say something 00:13:42.299 --> 00:13:45.799 like well we've never dealt with any anxious 00:13:45.799 --> 00:13:48.039 patients before so this will be my first time 00:13:48.039 --> 00:13:52.009 but we're gonna try to get through it A lot of 00:13:52.009 --> 00:13:55.509 patients have to think about it for about a second, 00:13:55.549 --> 00:14:01.450 but then it helps them relax knowing that I'm 00:14:01.450 --> 00:14:04.429 obviously joking. And then they also get to think, 00:14:04.549 --> 00:14:08.350 you know, this guy deals with patients who are 00:14:08.350 --> 00:14:11.230 anxious all the time. And that's why he's telling 00:14:11.230 --> 00:14:14.190 this joke. I think sometimes that can be helpful. 00:14:14.370 --> 00:14:18.090 Yeah, sometimes that can ease the tension. A 00:14:18.090 --> 00:14:20.820 joke I like to... to do sometimes is is people 00:14:20.820 --> 00:14:23.740 say oh i'm scared of needles and i say i love 00:14:23.740 --> 00:14:25.960 needles just not when they're pointed at me oh 00:14:25.960 --> 00:14:27.919 sure you know so then you're saying you know 00:14:27.919 --> 00:14:30.120 i could be scared of needles too i'm just they're 00:14:30.120 --> 00:14:32.440 not pointing at me so i i don't you know i don't 00:14:32.440 --> 00:14:35.639 care but but it's just kind of levity to the 00:14:35.639 --> 00:14:41.059 situation which is helpful so another situation 00:14:41.059 --> 00:14:44.659 that we deal with a lot in ob anesthesia is walking 00:14:44.659 --> 00:14:46.360 people through what they're going to be feeling 00:14:46.360 --> 00:14:52.039 in a c -section How do you set expectations for 00:14:52.039 --> 00:14:54.860 those patients to try to help them get through 00:14:54.860 --> 00:14:58.340 that scenario? Again, I think everyone feels 00:14:58.340 --> 00:15:02.419 pressure pain differently. Pain is an interpretation. 00:15:03.220 --> 00:15:07.279 It's not a yes or no thing. There are different 00:15:07.279 --> 00:15:09.700 levels of pain. There are different experiences 00:15:09.700 --> 00:15:12.120 that are interpreted as pain. Just because you've 00:15:12.120 --> 00:15:15.080 numbed someone doesn't mean they're not feeling 00:15:15.080 --> 00:15:17.500 pain. If you've ever had a tooth numbed and pulled, 00:15:18.299 --> 00:15:21.700 pulling the tooth still hurts. It's just that 00:15:21.700 --> 00:15:24.820 it's not a sharp pain. You're not feeling the 00:15:24.820 --> 00:15:27.840 pain receptors anymore. But pressure can still 00:15:27.840 --> 00:15:30.899 be very intense and very uncomfortable. And so 00:15:30.899 --> 00:15:33.240 talking to patients and telling them ahead of 00:15:33.240 --> 00:15:37.100 time before they're feeling this pain. what to 00:15:37.100 --> 00:15:38.940 expect. Like, okay, you're numb. You shouldn't 00:15:38.940 --> 00:15:40.740 feel any pain. However, you might still feel 00:15:40.740 --> 00:15:42.700 pressure and actually the pressure can get really 00:15:42.700 --> 00:15:44.940 intense, but then turn it around. The pressure 00:15:44.940 --> 00:15:47.139 can be really intense right before baby's delivered, 00:15:47.279 --> 00:15:48.960 but that's a really good sign because that means 00:15:48.960 --> 00:15:51.179 baby's almost here, which is really exciting. 00:15:52.399 --> 00:15:54.840 Or maybe it's not exciting for them, but just 00:15:54.840 --> 00:15:58.080 say, which means it's almost over. Something. 00:15:58.860 --> 00:16:02.919 to to help ease them to so they're still expecting 00:16:02.919 --> 00:16:07.559 it it's not a surprise in any way but still not 00:16:07.559 --> 00:16:11.860 overplaying it either so one thing that we will 00:16:11.860 --> 00:16:14.320 often do after spinals and epidurals is something 00:16:14.320 --> 00:16:17.179 called checking a level can you briefly explain 00:16:17.179 --> 00:16:21.179 what that is for people and then how you like 00:16:21.179 --> 00:16:23.879 to do it to get the best information that you 00:16:23.879 --> 00:16:29.600 can yeah so checking a level basically is a test 00:16:29.600 --> 00:16:32.919 that we do to determine how high the numbness 00:16:32.919 --> 00:16:36.700 has gotten on an individual after they've gotten 00:16:36.700 --> 00:16:40.340 their epidural or spinal. And for a C -section, 00:16:40.419 --> 00:16:42.860 for example, we want it to be about mid -nipple 00:16:42.860 --> 00:16:45.799 line, so about what we say T4 dermatoma level. 00:16:46.100 --> 00:16:49.480 And so we'll check different levels of the skin 00:16:49.480 --> 00:16:51.759 height starting on the leg and working our way 00:16:51.759 --> 00:16:56.330 up and determine where our numbness is. Now I 00:16:56.330 --> 00:16:59.649 gave a specific level for numbness, but numbness 00:16:59.649 --> 00:17:04.829 is actually a gradient because pain level will 00:17:04.829 --> 00:17:07.329 be higher than touch. Like I said, I still expect 00:17:07.329 --> 00:17:09.609 them to feel touch and pressure, which is a different 00:17:09.609 --> 00:17:12.490 level from motor. Everything has a different 00:17:12.490 --> 00:17:14.930 level, but what I want to see is where our pain 00:17:14.930 --> 00:17:18.650 level is. And so what we often do is we use a 00:17:18.650 --> 00:17:23.529 sharp, but not too sharp implement to check. 00:17:24.109 --> 00:17:26.950 um to see if if they're feeling like a poking 00:17:26.950 --> 00:17:29.789 sensation kind of like the end of a paper clip 00:17:29.789 --> 00:17:34.950 yes um it if it feels more like the tip of your 00:17:34.950 --> 00:17:37.809 finger that would be a more dull sensation but 00:17:37.809 --> 00:17:40.289 if it feels like a pokiness like the end of a 00:17:40.289 --> 00:17:44.049 paper clip that would be the sharper sensation 00:17:44.049 --> 00:17:48.809 that we're looking for um this can be really 00:17:48.809 --> 00:17:51.769 tough because again people might feel it but 00:17:51.769 --> 00:17:55.519 can't tell us If it's sharp or not. So oftentimes 00:17:55.519 --> 00:17:58.339 we'll start on the arm, which we expect not to 00:17:58.339 --> 00:18:02.900 be numb and to feel quote unquote sharp. And 00:18:02.900 --> 00:18:06.640 then say, does it feel the same as we work our 00:18:06.640 --> 00:18:09.200 way up from leg all the way up to again arm? 00:18:10.859 --> 00:18:14.240 Another thing we can do is to check temperature 00:18:14.240 --> 00:18:17.079 because your temperature sensation goes away 00:18:17.079 --> 00:18:19.900 with your pain. So you can check to see if something 00:18:19.900 --> 00:18:24.250 feels cold. It might not feel cold until you 00:18:24.250 --> 00:18:28.630 again get to where your would feel sharp pain. 00:18:29.450 --> 00:18:32.109 And so you can check and see, does this feel 00:18:32.109 --> 00:18:34.069 cold? And it's an ice cube. And of course it's 00:18:34.069 --> 00:18:37.329 going to feel cold except if they're numb. So 00:18:37.329 --> 00:18:41.329 one is not necessarily better than the other, 00:18:41.369 --> 00:18:44.230 but both work well on different patients and 00:18:44.230 --> 00:18:49.009 how they respond to your questions. That makes 00:18:49.009 --> 00:18:53.200 a lot of sense. Let's talk about when patients 00:18:53.200 --> 00:18:57.559 might start feeling a big sensation during a 00:18:57.559 --> 00:19:01.400 C -section. Obviously, it's very important to 00:19:01.400 --> 00:19:03.079 us to make sure that our patients are getting 00:19:03.079 --> 00:19:06.180 through things safely and comfortably. But a 00:19:06.180 --> 00:19:09.599 lot of times, things can be misinterpreted as 00:19:09.599 --> 00:19:12.339 pain when it's actually pressure, or it could 00:19:12.339 --> 00:19:14.579 be real pain that we don't want to ignore. How 00:19:14.579 --> 00:19:18.299 do you approach those situations to tell what's 00:19:18.299 --> 00:19:22.339 what? And how do you treat those patients? Yeah. 00:19:22.400 --> 00:19:26.940 So when a patient says that they're feeling pressure 00:19:26.940 --> 00:19:30.039 or they're feeling pain or they're feeling uncomfortable, 00:19:30.299 --> 00:19:33.720 any of those words, even if they just grimace 00:19:33.720 --> 00:19:35.680 and they are not voicing it to you, but they're 00:19:35.680 --> 00:19:37.019 showing you signs that they're uncomfortable 00:19:37.019 --> 00:19:39.880 during their C -section, it's important to delve 00:19:39.880 --> 00:19:43.119 further into what they're truly feeling. Now, 00:19:43.140 --> 00:19:45.990 some of them will say, I don't know. Which basically 00:19:45.990 --> 00:19:48.289 just means that the pressure or discomfort is 00:19:48.289 --> 00:19:50.650 so intense that they really can't parse it out, 00:19:50.829 --> 00:19:54.849 which to me may not be pain. But for them, it's 00:19:54.849 --> 00:19:57.549 intense enough to feel like pain and probably 00:19:57.549 --> 00:19:59.930 should be treated in one way or another because 00:19:59.930 --> 00:20:03.730 they're at that level of discomfort. But a lot 00:20:03.730 --> 00:20:05.490 of times they can tell you, oh, yeah, it's just 00:20:05.490 --> 00:20:07.029 pressure. It just feels a little uncomfortable. 00:20:09.190 --> 00:20:11.470 Or they'll say, oh, no, I'm feeling pain. It 00:20:11.470 --> 00:20:14.589 feels sharp. It feels like a knife. And then 00:20:14.589 --> 00:20:17.789 that's a sign that the numbness is not where 00:20:17.789 --> 00:20:19.890 you think it's going to be or where you think 00:20:19.890 --> 00:20:24.130 it is. And that maybe your epidural or spinal 00:20:24.130 --> 00:20:29.930 is not working adequately. Now, even an epidural 00:20:29.930 --> 00:20:32.910 that is, quote, unquote, working normally, if 00:20:32.910 --> 00:20:34.849 they're still feeling pressure that's that intense, 00:20:35.170 --> 00:20:37.369 maybe they do need supplementation. And it doesn't 00:20:37.369 --> 00:20:40.430 mean that the epidural, you know, doesn't have 00:20:40.430 --> 00:20:43.339 a good level. But in some sense, it is a bit 00:20:43.339 --> 00:20:45.619 of a failure of the epidural because it's not 00:20:45.619 --> 00:20:47.359 keeping them completely comfortable and they 00:20:47.359 --> 00:20:50.140 do need supplementation or even conversion to 00:20:50.140 --> 00:20:52.380 general anesthesia. So that needs to be a constant 00:20:52.380 --> 00:20:54.480 communication with the patient, telling them 00:20:54.480 --> 00:20:57.039 that you hear them, asking them how they're feeling 00:20:57.039 --> 00:21:00.500 and seeing what you can do to help them through 00:21:00.500 --> 00:21:04.380 that moment or the rest of the surgery. Yeah, 00:21:04.440 --> 00:21:07.640 I think it's a very individualized thing too. 00:21:07.779 --> 00:21:10.960 And I think you have to connect empathetically. 00:21:11.500 --> 00:21:15.200 with the patient, look at their face and try 00:21:15.200 --> 00:21:20.920 to ask yourself, do you think that this patient 00:21:20.920 --> 00:21:24.380 is going to be able to get through this with 00:21:24.380 --> 00:21:28.279 enough comfort for it to be acceptable or appropriate? 00:21:28.400 --> 00:21:31.220 Or do we think that we need to do something about 00:21:31.220 --> 00:21:33.920 it? But it's also tricky because whatever we 00:21:33.920 --> 00:21:37.160 give to mom also goes to baby for the most part. 00:21:37.500 --> 00:21:41.420 So whenever we give mom a pain medicine, It can 00:21:41.420 --> 00:21:44.500 affect how the baby is breathing when it comes 00:21:44.500 --> 00:21:47.400 out from the C -section too. So it can be really 00:21:47.400 --> 00:21:50.339 tricky. Absolutely. It's definitely a balance 00:21:50.339 --> 00:21:53.160 of making sure that mom is comfortable, but then 00:21:53.160 --> 00:21:56.700 also making sure that baby is safe because that 00:21:56.700 --> 00:22:00.539 will impact mommy and baby's experience as well. 00:22:02.039 --> 00:22:05.299 So shifting gears a little bit, back when you 00:22:05.299 --> 00:22:08.319 were in your OB fellowship, that is when you 00:22:08.319 --> 00:22:10.480 became pregnant for the first time. Is that right? 00:22:10.970 --> 00:22:16.109 Yes. Can you walk me through what that time was 00:22:16.109 --> 00:22:23.089 like for you? It was mostly anxiety provoking 00:22:23.089 --> 00:22:27.349 because I could see all the complications that 00:22:27.349 --> 00:22:30.609 we deal with on OB. And that was very scary. 00:22:31.049 --> 00:22:34.289 It was also very exciting. And it was neat to 00:22:34.289 --> 00:22:37.390 be able to relate to patients on a new level, 00:22:37.529 --> 00:22:41.799 like not just. hey, I kind of, in theory, understand 00:22:41.799 --> 00:22:44.779 what you're going through to, oh, no, I'm actually 00:22:44.779 --> 00:22:48.440 there and I'm experiencing things as well, being 00:22:48.440 --> 00:22:52.339 able to relate on that new level with patients. 00:22:54.640 --> 00:22:57.460 I think in medicine, we often see the complications, 00:22:57.700 --> 00:23:00.579 which is why, again, it can be anxiety provoking. 00:23:00.619 --> 00:23:02.460 But as time progressed through that pregnancy, 00:23:02.700 --> 00:23:05.500 it became easier and easier. Like, OK, nothing, 00:23:05.640 --> 00:23:09.000 you know, nothing's really. gone wrong. And, 00:23:09.059 --> 00:23:12.720 and I'm, I understand a lot of what's going on. 00:23:12.839 --> 00:23:15.180 And so it was, there were certain moments that 00:23:15.180 --> 00:23:18.319 were reassuring to me, given my physician background 00:23:18.319 --> 00:23:23.460 to help with the pregnancy. And then, like I 00:23:23.460 --> 00:23:26.220 said, it was kind of exciting to be pregnant 00:23:26.220 --> 00:23:28.779 and relating to my patients in that way as well. 00:23:29.299 --> 00:23:31.619 Yeah, that makes a lot of sense. And I remember 00:23:31.619 --> 00:23:36.819 talking to you a lot about how you were feeling. 00:23:37.279 --> 00:23:39.700 during that pregnancy, and it was something that 00:23:39.700 --> 00:23:43.440 was exciting because we're friends and we enjoy 00:23:43.440 --> 00:23:46.700 spending time with each other and we play board 00:23:46.700 --> 00:23:53.400 games at each other's houses a lot. But let's 00:23:53.400 --> 00:24:00.279 talk about sort of what happened. In whatever 00:24:00.279 --> 00:24:03.420 way that you feel comfortable sharing, I wonder 00:24:03.420 --> 00:24:06.400 if you could talk about... What happened about 00:24:06.400 --> 00:24:12.200 halfway through pregnancy? Yeah. So at 23 weeks 00:24:12.200 --> 00:24:19.180 pregnant, I did get sick for about 24 hours and 00:24:19.180 --> 00:24:23.180 thought nothing of it. And nothing really happened. 00:24:23.220 --> 00:24:27.779 And it was fine until a few days later when I 00:24:27.779 --> 00:24:30.980 was at home and I stood up and my water broke. 00:24:33.840 --> 00:24:36.680 As a physician, I was very nervous, and I was 00:24:36.680 --> 00:24:38.900 also a little bit in denial. I was like, no, 00:24:38.940 --> 00:24:41.220 that can't have been my water. That can't have 00:24:41.220 --> 00:24:46.980 just happened. But I went in to the OB office, 00:24:47.059 --> 00:24:51.319 and they confirmed that my water had broke. And 00:24:51.319 --> 00:24:56.079 I recommended that I go to the hospital. At the 00:24:56.079 --> 00:24:59.700 time, I was in the care of a different hospital 00:24:59.700 --> 00:25:04.220 system, different health system. But I chose 00:25:04.220 --> 00:25:10.140 to come to our hospital because I knew the high 00:25:10.140 --> 00:25:13.759 -risk OB group here. And I knew that at 20 weeks 00:25:13.759 --> 00:25:17.220 and five days, I was now in a high -risk group 00:25:17.220 --> 00:25:21.000 of individuals who had had my water prematurely 00:25:21.000 --> 00:25:25.460 broken. So I came in and was admitted to the 00:25:25.460 --> 00:25:31.079 hospital. For a few days, I was in the hospital 00:25:31.079 --> 00:25:36.940 and being monitored. And then day three or four 00:25:36.940 --> 00:25:42.339 of being admitted, I started to feel abdominal 00:25:42.339 --> 00:25:44.880 pain. And again, I was a little bit in denial. 00:25:45.660 --> 00:25:49.700 Did not realize I was in labor until a few hours 00:25:49.700 --> 00:25:54.240 into the labor when the OBs came and checked 00:25:54.240 --> 00:25:57.200 on me and said, oh, your cervix is dilating. 00:25:57.799 --> 00:26:00.900 The umbilical cord has come through the cervix. 00:26:01.599 --> 00:26:04.980 What do you want to do next? And it was a snap 00:26:04.980 --> 00:26:08.119 decision. I had to have emergency C -section 00:26:08.119 --> 00:26:14.359 to try to rescue my baby. And so she was born 00:26:14.359 --> 00:26:19.259 via an emergency C -section. She lived for a 00:26:19.259 --> 00:26:21.779 few hours in the NICU, during which she coded 00:26:21.779 --> 00:26:26.480 a few times. And then after or around her third 00:26:26.480 --> 00:26:33.190 code, we decided not to continue with. and to 00:26:33.190 --> 00:26:38.349 transition to comfort care. So then she passed 00:26:38.349 --> 00:26:44.869 away. And it was, of course, very hard at the 00:26:44.869 --> 00:26:56.430 time. And it still is very hard. But there's 00:26:56.430 --> 00:27:00.700 no but to it, really. It's still very hard. to 00:27:00.700 --> 00:27:02.880 lose your child. And it doesn't matter that it 00:27:02.880 --> 00:27:08.500 was only 24 weeks and two days. It's still, she 00:27:08.500 --> 00:27:16.880 still is very much my daughter. And, but now 00:27:16.880 --> 00:27:21.720 I do feel like I have a different grasp on obstetrics 00:27:21.720 --> 00:27:24.359 because I have not been that patient who had 00:27:24.359 --> 00:27:29.470 a complication. And so I can, in some ways, relate 00:27:29.470 --> 00:27:34.970 to my patients even better because those times 00:27:34.970 --> 00:27:37.309 when things are scary and things aren't the way 00:27:37.309 --> 00:27:43.109 we planned, I've been there. One of the reasons 00:27:43.109 --> 00:27:49.869 why we talked about having this conversation 00:27:49.869 --> 00:27:58.390 was not to... share your story with the podcast 00:27:58.390 --> 00:28:02.970 audience for no reason, but so that people who 00:28:02.970 --> 00:28:08.329 are listening could understand a little bit better 00:28:08.329 --> 00:28:13.829 how to help deal with patients who are going 00:28:13.829 --> 00:28:16.009 through something like what you went through. 00:28:16.509 --> 00:28:20.930 And that's a really difficult thing. I remember 00:28:20.930 --> 00:28:27.710 at the time being your friend. And it was obviously 00:28:27.710 --> 00:28:32.109 impossibly hard for you. But in a different way, 00:28:32.150 --> 00:28:34.069 it was hard for me as your friend seeing you 00:28:34.069 --> 00:28:38.089 go through it and not knowing exactly what the 00:28:38.089 --> 00:28:43.730 best way was to support you. Now, I remember 00:28:43.730 --> 00:28:49.609 as sort of people started to find out what had 00:28:49.609 --> 00:28:56.259 happened, our whole department, rapidly got behind 00:28:56.259 --> 00:28:59.819 you and mobilized and got you guys things like 00:28:59.819 --> 00:29:02.140 food and tried to support you as best we could. 00:29:02.920 --> 00:29:07.079 Um, yeah, I am eternally grateful for all the 00:29:07.079 --> 00:29:10.160 support that our department has given me and 00:29:10.160 --> 00:29:15.400 my husband, um, during not only that after that 00:29:15.400 --> 00:29:19.460 pregnancy, but then with our, uh, pregnancy for 00:29:19.460 --> 00:29:21.359 our next child, because I was very stressful. 00:29:21.779 --> 00:29:25.789 Um, everyone has been Over the top supportive 00:29:25.789 --> 00:29:28.569 of us every step of the way and very understanding. 00:29:29.849 --> 00:29:32.329 And I think that's one of the biggest things 00:29:32.329 --> 00:29:37.049 is just showing that you care. Being supportive. 00:29:39.769 --> 00:29:45.390 Acknowledging that what your friend or what your 00:29:45.390 --> 00:29:49.670 patient has gone through is is real and it does 00:29:49.670 --> 00:29:53.519 hurt. I think some of the. Hardest things that 00:29:53.519 --> 00:30:01.339 people said is all related to, you know, oh, 00:30:01.380 --> 00:30:03.839 you know, you'll have another kid or oh, well, 00:30:03.940 --> 00:30:07.140 kind of brushing it under the rug was really 00:30:07.140 --> 00:30:09.180 hard to go through because I just wanted to be 00:30:09.180 --> 00:30:15.140 validated that, yes, what I went through was 00:30:15.140 --> 00:30:19.359 real. is awful and it's not just oh I'll have 00:30:19.359 --> 00:30:22.619 another kid it's that was my kid and I lost it 00:30:22.619 --> 00:30:24.599 sure I'll have another kid but that's not what 00:30:24.599 --> 00:30:28.420 I'm worried about right now is the loss of my 00:30:28.420 --> 00:30:34.279 current kid um so having that validation of what 00:30:34.279 --> 00:30:37.319 you're going through is tough and maybe you don't 00:30:37.319 --> 00:30:39.500 understand how to relate to it and you can't 00:30:39.500 --> 00:30:42.779 really say oh yeah I you know um even people 00:30:42.779 --> 00:30:46.420 um people would say oh you know I had this terrible 00:30:46.420 --> 00:30:49.240 experience during my pregnancy nothing like what 00:30:49.240 --> 00:30:52.779 you went through and telling me that saying having 00:30:52.779 --> 00:30:55.720 that extra thing of like you know I understand 00:30:55.720 --> 00:30:58.240 that like what I went through was hard but it 00:30:58.240 --> 00:31:01.599 wasn't losing my child and so having that validation 00:31:01.599 --> 00:31:05.980 was very comforting and then when people didn't 00:31:05.980 --> 00:31:08.700 validate or they did because it's uncomfortable 00:31:08.700 --> 00:31:11.220 try to kind of sweep it under the rug or forget 00:31:11.220 --> 00:31:15.039 about it or That was actually what hurt the most. 00:31:15.140 --> 00:31:16.920 And I think it's hard because we don't want to 00:31:16.920 --> 00:31:21.880 talk about things. One of the reasons I wanted 00:31:21.880 --> 00:31:24.200 to talk about this is I did have a resident come 00:31:24.200 --> 00:31:26.960 to me and they were in a C -section with a baby 00:31:26.960 --> 00:31:29.240 who was not expected to survive. They said, I 00:31:29.240 --> 00:31:34.380 had no idea what to say. And I said, well, just 00:31:34.380 --> 00:31:39.759 being there for them is important. Not saying, 00:31:39.920 --> 00:31:43.880 you know, not ignoring it. It's hard to talk 00:31:43.880 --> 00:31:46.539 about it, and maybe the mom doesn't want to talk 00:31:46.539 --> 00:31:49.359 about it, but it also shouldn't be something 00:31:49.359 --> 00:31:51.880 where you completely ignore what they're going 00:31:51.880 --> 00:31:56.400 through at that moment. Acknowledging them still 00:31:56.400 --> 00:31:58.940 as a mom, because I very much identified as a 00:31:58.940 --> 00:32:04.140 mom. Those are all really important things that 00:32:04.140 --> 00:32:07.980 you can do if you know someone or, again, know 00:32:07.980 --> 00:32:11.509 a patient. who has gone through that loss is 00:32:11.509 --> 00:32:16.250 recognizing that loss. I had a friend who also 00:32:16.250 --> 00:32:24.869 lost her child at 35 weeks, and we talked about 00:32:24.869 --> 00:32:28.029 this, and she also agreed with me. She said the 00:32:28.029 --> 00:32:30.710 biggest thing was just recognizing the elephant 00:32:30.710 --> 00:32:32.549 in the room. One of the nurses turned to her 00:32:32.549 --> 00:32:35.490 and said, wow, this really sucks. And she said, 00:32:35.609 --> 00:32:39.160 yeah. Yeah, that was really helpful to have someone 00:32:39.160 --> 00:32:42.279 say, I see what you're going through and it's 00:32:42.279 --> 00:32:46.579 awful. And it's a silly little thing, really. 00:32:46.660 --> 00:32:50.640 But being that person and saying that, you know, 00:32:50.660 --> 00:32:52.619 like what you're going through, that's that's 00:32:52.619 --> 00:32:58.160 really awful. It's extremely interesting how 00:32:58.160 --> 00:33:05.599 validating that feels and how. that can actually 00:33:05.599 --> 00:33:07.440 be helpful because no one wants to say that no 00:33:07.440 --> 00:33:11.200 one wants to say wow this you know I'm so sorry 00:33:11.200 --> 00:33:14.839 that your your baby's dying or that that absolutely 00:33:14.839 --> 00:33:17.400 sucks your baby's about to die or you know you 00:33:17.400 --> 00:33:21.359 don't want to say those things but just actually 00:33:21.359 --> 00:33:24.519 acknowledging that the mom is going through something 00:33:24.519 --> 00:33:28.660 and I took that and I used it going forward once 00:33:28.660 --> 00:33:32.160 I had come back to work you know seeing a pregnant 00:33:32.160 --> 00:33:41.740 patient who had to have basically had a miscarriage 00:33:41.740 --> 00:33:47.019 and talking to them and being like, you know, 00:33:47.039 --> 00:33:49.480 this is really awful. And I'm so sorry that you've 00:33:49.480 --> 00:33:51.619 had to go through this. I know this is a really 00:33:51.619 --> 00:33:54.240 tough situation for you. And not even saying 00:33:54.240 --> 00:33:56.400 like, oh, I went through something similar, but 00:33:56.400 --> 00:33:59.619 just saying this is really, really sucky. And 00:33:59.619 --> 00:34:01.319 I'm really sorry that you've been put in this 00:34:01.319 --> 00:34:07.539 situation. And also acknowledging that it's nothing 00:34:07.539 --> 00:34:10.119 that they did. They've been put in this situation. 00:34:10.820 --> 00:34:13.960 It's not like, oh, well, if you had done this 00:34:13.960 --> 00:34:17.500 or, oh, you know, well, maybe next time. You 00:34:17.500 --> 00:34:20.199 know, nothing like that, but just saying this 00:34:20.199 --> 00:34:26.760 happened to you. And I'm sorry it did. I think 00:34:26.760 --> 00:34:30.900 that it can be very difficult for patients going 00:34:30.900 --> 00:34:36.010 through this when they activate. the backwards 00:34:36.010 --> 00:34:38.829 looking part of their brain thinking to themselves 00:34:38.829 --> 00:34:45.309 if anything could be different or if things had 00:34:45.309 --> 00:34:49.070 been different. And I remember having some of 00:34:49.070 --> 00:34:52.489 those conversations with you and they were really 00:34:52.489 --> 00:34:56.610 hard conversations where we were looking backwards. 00:34:57.170 --> 00:35:03.309 And the thing that I remember is that at that 00:35:03.309 --> 00:35:06.750 time, it seemed like you had a lot of guilt. 00:35:07.670 --> 00:35:14.349 And to my eye, that seemed wild to me that you 00:35:14.349 --> 00:35:18.650 would feel that way. I wonder if you could tell 00:35:18.650 --> 00:35:23.309 me a little bit more about how you felt and if 00:35:23.309 --> 00:35:28.610 that's changed now with time and what you think 00:35:28.610 --> 00:35:34.489 about it. Yeah, I think it's very... easy to 00:35:34.489 --> 00:35:38.650 feel guilty when a bad outcome happens especially 00:35:38.650 --> 00:35:42.530 when you're the parent of a child that passes 00:35:42.530 --> 00:35:46.550 away it's easy to say oh I could have done something 00:35:46.550 --> 00:35:49.530 and I think as a physician especially we have 00:35:49.530 --> 00:35:52.329 we feel like we have a lot of control and understanding 00:35:52.329 --> 00:35:57.849 over things but ultimately we can't change the 00:35:57.849 --> 00:36:01.369 past For sure. We can look back and they always 00:36:01.369 --> 00:36:04.150 say hindsight's 2020. But even now, I don't think 00:36:04.150 --> 00:36:09.389 hindsight's 2020 on this. But you can look back 00:36:09.389 --> 00:36:11.190 and say, well, I should have done this or I could 00:36:11.190 --> 00:36:13.230 have done that. And again, the people I know 00:36:13.230 --> 00:36:18.269 who have lost children will say that, too. Like, 00:36:18.349 --> 00:36:20.269 oh, you know, I felt like I could have done this 00:36:20.269 --> 00:36:23.639 or maybe I should have. gone in sooner I should 00:36:23.639 --> 00:36:25.880 have done this and there's a lot of could have 00:36:25.880 --> 00:36:29.280 should have but ultimately it's not anything 00:36:29.280 --> 00:36:36.760 you did um that brought this about things happen 00:36:36.760 --> 00:36:45.179 and and it's not anyone's fault to this day I 00:36:45.179 --> 00:36:48.480 do I still sometimes feel like Could I have done 00:36:48.480 --> 00:36:50.880 something differently? I don't think that feeling 00:36:50.880 --> 00:36:53.840 will ever really go away. I can logic that no, 00:36:54.039 --> 00:36:55.579 like there's nothing I could do differently. 00:36:56.460 --> 00:37:00.860 But there's that lingering feeling of could have, 00:37:00.880 --> 00:37:07.119 would have, should have that doesn't really change. 00:37:07.239 --> 00:37:11.500 And the best thing you can do is just accept 00:37:11.500 --> 00:37:15.679 that that things happen and that sometimes there 00:37:15.679 --> 00:37:18.429 isn't a reason or maybe. Next time there's something 00:37:18.429 --> 00:37:20.389 you would do differently. And it's irrational. 00:37:21.130 --> 00:37:24.610 My second pregnancy, I didn't fly. I don't think 00:37:24.610 --> 00:37:26.590 it had anything to do with flying, but I had 00:37:26.590 --> 00:37:28.889 been on a flight less than a week before my water 00:37:28.889 --> 00:37:31.070 broke. So in my mind, I was like, I'm just not 00:37:31.070 --> 00:37:33.590 going to fly. It wasn't really harmful to not 00:37:33.590 --> 00:37:38.030 fly. So why not just do it? And so I think everyone 00:37:38.030 --> 00:37:41.210 kind of carries those little things with them 00:37:41.210 --> 00:37:47.110 that. You can't let it impede your life, but 00:37:47.110 --> 00:37:50.369 at the same time, you know, if there are little 00:37:50.369 --> 00:37:54.309 things you do that give you comfort, then that's 00:37:54.309 --> 00:37:57.670 okay too. The second time I went to the OB emergency 00:37:57.670 --> 00:38:01.070 department one or two times, not because anything 00:38:01.070 --> 00:38:04.369 was wrong, but because I felt odd. And I said, 00:38:04.449 --> 00:38:07.570 ah, I don't want to feel odd. What if something's 00:38:07.570 --> 00:38:11.449 happening? And it probably cost me a couple hundred 00:38:11.449 --> 00:38:15.159 bucks, but. It did give me the peace of mind 00:38:15.159 --> 00:38:17.980 of knowing that everything was still going okay. 00:38:19.380 --> 00:38:23.659 And so there are little things that I changed 00:38:23.659 --> 00:38:26.039 or did differently. And that probably stemmed 00:38:26.039 --> 00:38:27.980 from guilt or the thought that maybe I could 00:38:27.980 --> 00:38:31.320 control or change anything. But ultimately, it 00:38:31.320 --> 00:38:36.059 really isn't in our control. And trying to accept 00:38:36.059 --> 00:38:40.559 that can be really hard, but helpful. I remember 00:38:40.559 --> 00:38:46.679 talking to you. once or twice when you were having 00:38:46.679 --> 00:38:49.000 some acute anxiety during your second pregnancy 00:38:49.000 --> 00:38:54.079 with Christopher. And you were trying to ask 00:38:54.079 --> 00:38:56.920 my opinion about whether or not you should go 00:38:56.920 --> 00:39:00.639 and talk to the OBs and kind of curbside them 00:39:00.639 --> 00:39:04.780 to maybe get a quick ultrasound done to see what 00:39:04.780 --> 00:39:06.579 was going on because you maybe felt slightly 00:39:06.579 --> 00:39:11.820 differently and things like that. And I remember... 00:39:12.409 --> 00:39:14.829 You're going on maybe a couple different occasions 00:39:14.829 --> 00:39:19.030 just to curbside the OBs. Yeah, helpful bonus 00:39:19.030 --> 00:39:21.469 to being an OB anesthesiologist is I know the 00:39:21.469 --> 00:39:27.989 OBs and they know me. And so it was very easy, 00:39:28.090 --> 00:39:30.269 fortunately, for me to just pop over and say, 00:39:30.369 --> 00:39:32.909 hey, what do you think of this? Am I being crazy? 00:39:33.489 --> 00:39:36.230 And sometimes they'd be like, let's just check 00:39:36.230 --> 00:39:38.909 you out. Make sure everything looks okay. Okay, 00:39:39.090 --> 00:39:43.090 everything looks great. No big deal. And just 00:39:43.090 --> 00:39:48.010 having that little curbside was so helpful because 00:39:48.010 --> 00:39:51.789 I could, you know, rest assured a little bit 00:39:51.789 --> 00:39:56.250 that things were going okay. Do you feel like 00:39:56.250 --> 00:39:59.909 it made it easier or harder having all of your 00:39:59.909 --> 00:40:03.090 obstetric knowledge going through pregnancies? 00:40:04.289 --> 00:40:08.010 I think in some ways it made it easier because 00:40:08.010 --> 00:40:14.239 there were things that I understood. that were 00:40:14.239 --> 00:40:21.340 helpful to me going through my pregnancies. Things 00:40:21.340 --> 00:40:27.840 I understood about odds and after I did have 00:40:27.840 --> 00:40:31.820 my water break, what that might look like, having 00:40:31.820 --> 00:40:38.480 seen patients go through that as well. Having 00:40:38.480 --> 00:40:40.980 an idea as to what I was, when I chose to have 00:40:40.980 --> 00:40:43.900 an emergency C -section to try to save my daughter, 00:40:44.079 --> 00:40:47.000 I knew very well what I was going into. I was 00:40:47.000 --> 00:40:49.400 about to have a major abdominal surgery. And 00:40:49.400 --> 00:40:51.480 because I was so early on, I was going to have 00:40:51.480 --> 00:40:54.019 no choice but to have C -sections for all future 00:40:54.019 --> 00:40:57.039 pregnancies. And some people don't know what 00:40:57.039 --> 00:41:00.519 that means, but I've been through OB enough that 00:41:00.519 --> 00:41:04.699 I knew exactly what I was accepting as a risk. 00:41:05.239 --> 00:41:08.219 in order to try to get my daughter out so she 00:41:08.219 --> 00:41:12.340 could live. And maybe if I didn't have that knowledge, 00:41:12.380 --> 00:41:14.360 I would have still made that decision. But I 00:41:14.360 --> 00:41:16.800 at least went in with my eyes open as to what 00:41:16.800 --> 00:41:21.079 exactly the risks I was accepting with that. 00:41:22.800 --> 00:41:25.760 So in some ways, it was helpful. And in other 00:41:25.760 --> 00:41:28.699 ways, it was more terrifying. Like when they 00:41:28.699 --> 00:41:31.880 told me in the OB office, yeah, your water broke, 00:41:32.039 --> 00:41:34.059 I started crying immediately. And they were like, 00:41:34.510 --> 00:41:36.789 We haven't even really told you what that means. 00:41:36.889 --> 00:41:41.730 Why are you freaking out? But I had seen enough 00:41:41.730 --> 00:41:45.309 patients that I knew exactly what it meant. And 00:41:45.309 --> 00:41:47.670 I knew what the road ahead of me looked like. 00:41:47.849 --> 00:41:53.449 And so helpful, but also not because my anxiety 00:41:53.449 --> 00:41:55.849 level was probably higher than the average person 00:41:55.849 --> 00:42:02.460 who was told their water broke. I think also 00:42:02.460 --> 00:42:05.300 it gave me a false sense of control. So I was 00:42:05.300 --> 00:42:09.099 in the hospital and I would, you know, something 00:42:09.099 --> 00:42:11.699 would happen. I was starting to feel pain. I'm 00:42:11.699 --> 00:42:14.480 like, this can't be labor. I know what labor 00:42:14.480 --> 00:42:18.639 looks like. It was labor. But I thought I knew. 00:42:19.019 --> 00:42:21.679 I didn't. I'd never been through it before. I 00:42:21.679 --> 00:42:24.699 don't know why I thought that. Having seen it, 00:42:24.760 --> 00:42:30.059 I would then know what it felt like. So I think. 00:42:30.519 --> 00:42:35.920 It kind of goes both ways. I remember a very 00:42:35.920 --> 00:42:39.539 distinct point in your second pregnancy with 00:42:39.539 --> 00:42:45.960 Christopher where you got to the same length 00:42:45.960 --> 00:42:49.840 of time in your pregnancy that you did when you 00:42:49.840 --> 00:42:55.579 had Alice. Was that reassuring to get past that 00:42:55.579 --> 00:42:57.860 point? Can you describe what your feelings were 00:42:57.860 --> 00:43:02.570 around that time? So 24 weeks was very hard on 00:43:02.570 --> 00:43:05.329 me when I was pregnant with my second because 00:43:05.329 --> 00:43:09.570 I had lost Alice at 24 weeks and two days. I 00:43:09.570 --> 00:43:13.130 had ruptured at 23 and five days. So those four 00:43:13.130 --> 00:43:17.250 days were very anxiety provoking for me because 00:43:17.250 --> 00:43:20.329 could it happen again? Logically, it wouldn't 00:43:20.329 --> 00:43:22.489 happen at the same exact time. That would be 00:43:22.489 --> 00:43:26.989 really, really odd. But there is something inside. 00:43:27.610 --> 00:43:29.949 You that says, oh, my gosh, this could happen 00:43:29.949 --> 00:43:32.030 again. And this is the moment that it did happen 00:43:32.030 --> 00:43:36.829 before. Could I could it happen again? Once I 00:43:36.829 --> 00:43:40.010 got to 25 weeks, it was reassuring because I 00:43:40.010 --> 00:43:42.230 had never made it that far in pregnancy before. 00:43:42.750 --> 00:43:46.329 And so there was a sigh of relief of, OK, I have 00:43:46.329 --> 00:43:49.630 made it to 25 weeks. And again, being an OB anesthesia 00:43:49.630 --> 00:43:54.190 and having worked a little bit in the NICU. I 00:43:54.190 --> 00:43:55.969 kind of I knew what the difference between a 00:43:55.969 --> 00:43:59.050 24 week baby and a 25 week baby was. And so it 00:43:59.050 --> 00:44:02.050 was reassuring from that standpoint, too, that 00:44:02.050 --> 00:44:05.269 if he was born now, he at least had a better 00:44:05.269 --> 00:44:09.030 chance of survival than my baby at 24 and two. 00:44:09.449 --> 00:44:13.110 So even if it did happen again, we had made it 00:44:13.110 --> 00:44:16.110 further and there was a better chance that he 00:44:16.110 --> 00:44:25.699 was going to have. a more positive outcome. I 00:44:25.699 --> 00:44:37.119 remember when you came back, you had a tough 00:44:37.119 --> 00:44:39.960 time coming back to work on OB, which I think 00:44:39.960 --> 00:44:44.500 made a lot of sense. I think that there was likely 00:44:44.500 --> 00:44:48.280 some component of PTSD associated with that. 00:44:49.179 --> 00:44:53.579 But over time, You sort of eased yourself back 00:44:53.579 --> 00:44:56.539 into working in OB, and that's what you did your 00:44:56.539 --> 00:44:59.739 fellowship in, and you're quite good at it. I 00:44:59.739 --> 00:45:03.699 wonder if you could talk about how you overcame 00:45:03.699 --> 00:45:09.300 that to a degree and how you feel working in 00:45:09.300 --> 00:45:14.079 OB now. I did take a little bit of time coming 00:45:14.079 --> 00:45:21.420 back to OB. I think, as you mentioned, Having 00:45:21.420 --> 00:45:25.280 been through everything, PTSD would be normal, 00:45:25.460 --> 00:45:28.500 and we don't always normalize it, but it would 00:45:28.500 --> 00:45:31.519 be a normal response to what I went through. 00:45:31.739 --> 00:45:34.340 I think the major reason I didn't go back to 00:45:34.340 --> 00:45:36.659 OB right away is I did not want my experiences 00:45:36.659 --> 00:45:40.139 to impact my patients' experiences. I did not 00:45:40.139 --> 00:45:42.360 want to be in a delivery and start crying, and 00:45:42.360 --> 00:45:44.320 they're like, but my baby's fine. What are you 00:45:44.320 --> 00:45:50.289 doing? Because... of how recent my experiences 00:45:50.289 --> 00:45:55.670 have been but over time that became easier to 00:45:55.670 --> 00:45:58.690 do and it's something I really do have a passion 00:45:58.690 --> 00:46:01.530 for and love so it's not something I would ever 00:46:01.530 --> 00:46:05.469 really plan on leaving behind or letting the 00:46:05.469 --> 00:46:11.369 fear or emotions associated with my experiences 00:46:11.369 --> 00:46:19.380 impact my career. as an OB anesthesiologist. 00:46:20.900 --> 00:46:25.320 Over time, it became easier to shift my experiences 00:46:25.320 --> 00:46:29.099 into positive outcomes for other patients, not 00:46:29.099 --> 00:46:31.599 positive outcomes in terms of like, you know, 00:46:31.619 --> 00:46:33.860 I was going to help their babies do better or 00:46:33.860 --> 00:46:36.739 anything like that, but have their experiences 00:46:36.739 --> 00:46:42.480 be impacted positively by my experiences. And 00:46:42.480 --> 00:46:44.659 so that was important to me too, that I could 00:46:44.659 --> 00:46:50.000 use my experiences to help others as they went 00:46:50.000 --> 00:46:56.179 through similar experiences. What do you think 00:46:56.179 --> 00:47:00.780 are some of your best pieces of advice for how 00:47:00.780 --> 00:47:02.920 to approach friends and colleagues that might 00:47:02.920 --> 00:47:05.980 be going through a situation like what you went 00:47:05.980 --> 00:47:11.820 through? Absolutely. I think anyone who has been 00:47:11.820 --> 00:47:17.340 in the situation would hopefully agree that Time 00:47:17.340 --> 00:47:21.239 doesn't heal all wounds. I wish I could tell 00:47:21.239 --> 00:47:24.159 you that at some point you just it is what it 00:47:24.159 --> 00:47:26.159 is. It's the past. Maybe you're more willing 00:47:26.159 --> 00:47:29.280 to talk about it. Maybe you can turn the situation 00:47:29.280 --> 00:47:32.000 into more positive things like helping others 00:47:32.000 --> 00:47:35.139 with what you've been through. And that's amazing 00:47:35.139 --> 00:47:40.980 and important. But to this day, I still think 00:47:40.980 --> 00:47:45.400 of my daughter. That never goes away. And it 00:47:45.400 --> 00:47:48.219 can sneak up on you in different moments. And 00:47:48.219 --> 00:47:55.840 that's okay and that's normal. Everyone grieves 00:47:55.840 --> 00:48:00.960 differently. Everyone has different experiences 00:48:00.960 --> 00:48:04.280 when it comes to losing someone they love. And 00:48:04.280 --> 00:48:08.039 just because you are different from your spouse, 00:48:08.380 --> 00:48:12.099 are different from your mother, are different 00:48:12.099 --> 00:48:16.539 from... Siblings, everyone experiences the loss, 00:48:16.780 --> 00:48:19.780 but everyone experiences it differently. And 00:48:19.780 --> 00:48:23.000 it doesn't mean you're different or grieving 00:48:23.000 --> 00:48:30.519 wrong. Everyone grieves differently. And understanding 00:48:30.519 --> 00:48:34.840 that is important and trying to understand where 00:48:34.840 --> 00:48:36.500 other people are coming from and their grief, 00:48:36.639 --> 00:48:38.860 because you're not the only one grieving when 00:48:38.860 --> 00:48:41.119 you've gone through a loss. The people around 00:48:41.119 --> 00:48:43.619 you are grieving with you. And they might show 00:48:43.619 --> 00:48:47.500 their grief in different ways. And that's important 00:48:47.500 --> 00:48:55.360 too. That you all recognize your grief. And then 00:48:55.360 --> 00:49:00.079 recognize other people's grief as well. I think 00:49:00.079 --> 00:49:02.159 those are the biggest things that I would want 00:49:02.159 --> 00:49:05.800 someone to take away. That people grieve differently. 00:49:06.059 --> 00:49:09.119 Different timelines. You never stop truly grieving. 00:49:09.460 --> 00:49:11.420 But it just looks differently. And sometimes 00:49:11.420 --> 00:49:15.760 you can. Turn it into helping others. What should 00:49:15.760 --> 00:49:18.579 friends do if they want to help but they are 00:49:18.579 --> 00:49:23.340 afraid of saying the wrong thing? I think that's 00:49:23.340 --> 00:49:25.659 a fear that a lot of people have when they have 00:49:25.659 --> 00:49:28.940 someone, a friend, family member, going through 00:49:28.940 --> 00:49:34.800 a loss. And again, I think it's hard to say things 00:49:34.800 --> 00:49:37.800 like, so sorry for your loss or to bring it up. 00:49:38.139 --> 00:49:40.639 You don't want them to, if they're not talking 00:49:40.639 --> 00:49:43.800 about it. You don't want to bring it on them 00:49:43.800 --> 00:49:46.219 so that they are thinking about it. I can tell 00:49:46.219 --> 00:49:47.739 you they're thinking about it, whether they're 00:49:47.739 --> 00:49:53.659 talking about it or not. And so just as I mentioned 00:49:53.659 --> 00:49:58.579 earlier about reading each patient, reading your 00:49:58.579 --> 00:50:02.099 friends and seeing what they need most. And sometimes 00:50:02.099 --> 00:50:05.059 it's a hug and some silence. And sometimes it's 00:50:05.059 --> 00:50:08.639 saying, that really, really sucked. Or sometimes 00:50:08.639 --> 00:50:11.320 it's letting an ear and being like. Tell me about 00:50:11.320 --> 00:50:14.460 it because I don't know what you're going through 00:50:14.460 --> 00:50:17.920 or don't know what you went through. Sometimes 00:50:17.920 --> 00:50:23.300 it's just very simply addressing it, saying, 00:50:23.440 --> 00:50:28.159 I'm so sorry that that happened. But I think 00:50:28.159 --> 00:50:31.619 as a society, we're very commonly, we just kind 00:50:31.619 --> 00:50:35.019 of ignore it or we push it under the rug or we 00:50:35.019 --> 00:50:36.900 want to talk about other things. And I think 00:50:36.900 --> 00:50:44.199 there's a lot of things. that you can say and 00:50:44.199 --> 00:50:45.880 maybe some people will take it the right way 00:50:45.880 --> 00:50:48.079 and some people will take it the wrong way but 00:50:48.079 --> 00:50:53.400 I think just saying something or being there 00:50:53.400 --> 00:50:57.300 is is one of the biggest things and not ignoring 00:50:57.300 --> 00:51:07.579 it or um brushing another rug or um saying oh 00:51:07.579 --> 00:51:11.400 well but At least this is true or, you know, 00:51:11.400 --> 00:51:12.780 trying to look on the bright side because maybe 00:51:12.780 --> 00:51:14.639 they don't want to look at the bright side right 00:51:14.639 --> 00:51:17.460 now. And that's okay. If they want to look on 00:51:17.460 --> 00:51:18.900 the bright side and they say at least that, you 00:51:18.900 --> 00:51:25.599 can agree with them. But I think that's important 00:51:25.599 --> 00:51:31.340 as a friend just to be there for them in whatever 00:51:31.340 --> 00:51:35.360 way that looks like. Bring them a book to read 00:51:35.360 --> 00:51:40.800 or a meal you made or, again, just sitting there 00:51:40.800 --> 00:51:45.039 or listening. You don't have to say anything 00:51:45.039 --> 00:51:51.880 but just being there. Lastly, I want to wrap 00:51:51.880 --> 00:51:56.019 up with a question about what your style points 00:51:56.019 --> 00:51:58.480 are or what your points of personal preference 00:51:58.480 --> 00:52:03.619 are. help you on OB anesthesia or just generally 00:52:03.619 --> 00:52:07.619 in life. What do you want to leave us with today? 00:52:09.619 --> 00:52:13.599 I think one of the great privileges of our job 00:52:13.599 --> 00:52:16.420 is to be there for patients, whether it be on 00:52:16.420 --> 00:52:20.079 OB or in the main operating room or whatever 00:52:20.079 --> 00:52:23.980 environment you're in as an anesthesiologist, 00:52:24.099 --> 00:52:28.420 being there for patients during a time of need. 00:52:30.260 --> 00:52:35.480 And recognizing that, recognizing the situation 00:52:35.480 --> 00:52:39.559 they're in, helping them through it, telling 00:52:39.559 --> 00:52:44.199 them that you'll be there, being a confident 00:52:44.199 --> 00:52:48.039 supporter of them, letting them know that you 00:52:48.039 --> 00:52:51.280 see them as a person. These are all amazing things 00:52:51.280 --> 00:52:54.260 we can do to help our patients through the day. 00:52:54.699 --> 00:52:57.960 And I think that also extends into life when 00:52:57.960 --> 00:53:00.840 you... you know, see your friends or your colleagues 00:53:00.840 --> 00:53:05.059 going through something, listening, being there 00:53:05.059 --> 00:53:09.219 for them. Even little things can make a huge 00:53:09.219 --> 00:53:12.239 difference in someone's day, be it a patient, 00:53:12.380 --> 00:53:15.780 you compliment them on their nails, or your friends, 00:53:15.800 --> 00:53:18.440 you just listen to them talk about how terrible 00:53:18.440 --> 00:53:23.400 their weekend was, or what have you. Being there 00:53:23.400 --> 00:53:28.539 for each other is a wonderful privilege that 00:53:28.539 --> 00:53:32.519 we have as anesthesiologists but then also that 00:53:32.519 --> 00:53:39.139 we carry over into life Mary thank you for sharing 00:53:39.139 --> 00:53:42.980 your beautiful voice with us thank you for having 00:53:42.980 --> 00:53:51.440 me that's it for this episode of style points 00:53:51.440 --> 00:53:54.940 I talked to Mary for a while about this episode 00:53:55.769 --> 00:53:58.269 She told me that if anyone is listening who wants 00:53:58.269 --> 00:54:00.650 to reach out and talk to her about what we discussed 00:54:00.650 --> 00:54:04.570 in the episode, she's happy to talk to you. If 00:54:04.570 --> 00:54:06.349 you'd like to help other people find the podcast, 00:54:06.590 --> 00:54:09.269 please feel free to leave us a rating or a written 00:54:09.269 --> 00:54:11.530 review. That's the number one thing that will 00:54:11.530 --> 00:54:14.030 help other people find the show. You can also 00:54:14.030 --> 00:54:17.769 contact me at stylepointspodcasts at gmail .com. 00:54:19.010 --> 00:54:23.289 Take a deep breath. Open your eyes. We're all 00:54:23.289 --> 00:54:23.550 done.