and welcome back to Style Points. We've decided
to skip the RSI for this episode. Some of the
subject matter today is a little heavy. Today
I'll be talking with my friend Mary Roberts,
who did her anesthesia residency and OB fellowship
here at the University of Cincinnati. Let's jump
right in. I just sent this to you. I feel like
I should be able to find it. Here we go. You
go to your set email. I'm just kidding. This
isn't helpful. You're welcome. Just because you're
married to one of the podcast hosts doesn't mean
that you can harass me the whole time. No, I
thought that was because we're friends. I can
harass you the whole time. Okay, that's awesome.
Mary, thank you so much for joining us. Thank
you for having me. One of the benefits that I
have, as a podcast producer is that I get to
ask all of my friends to come join me on the
podcast. And you are somebody that I've been
trying to get to come on the podcast for a really
long time because you are one of my close friends.
You also happen to be married to my podcast co
-host, Nate Moore. That is true. So my first
question for you is what took you so long to
come on the podcast? Ooh, that's a tough question.
And I have two separate answers. One is because
my husband is a co -host on the podcast. It's
his and your domain. And so, you know, we work
together a lot, my husband and I. We're both
anesthesiologists, but we each have our own kind
of roles as anesthesiologists, and we don't always
cross over. We do sometimes, and it's a lot of
fun. This is a newer thing, and that's awesome,
but not my thing. The other reason is I just
don't like to hear my voice. It sounds kind of
weird. I guess what I'm hoping for after this
is that you're going to be approached by all
of the people who listen to the podcast, and
they will tell you that your voice does not in
fact sound weird because it just sounds like
your voice to me. Oh, good. Let me start out
with the who you would go out to dinner with
question. So if you had the chance to go out
to dinner with anyone in the world, it could
be somebody from the past or even from fiction.
Who would you go out to dinner with and why?
So my immediate answer is my daughter, Alice.
But I don't want to skip forward in talking about
that. That would be my answer is I want to go
to dinner with my daughter. I think that it's
fair that we don't want to skip ahead, but I
think that that is a reasonable preview. Before
we get into that, and maybe we can talk more
about why that is a little bit later, let's talk
about OB anesthesia. That's what you did your
fellowship in. That's your specialty. What drew
you originally to OB anesthesia? I think there
were a couple things that drew me to OB anesthesia.
As a CA1 resident, I was first introduced to
OB anesthesia outside of little things I'd done
as a med student. But my first true exposure
was a CA1. And I was not expecting to love it
as much as I do, which is interesting looking
back on it because I feel like, Now I couldn't
see not doing it. But when I started doing OB
anesthesia, I really enjoyed the patient interactions.
I enjoyed being there for that special moment
in my patient's lives, whether it was a good
moment or a bad moment. It was it felt very special
to be a part of it and to help ease their pain
or help them through. Because even though it's
a very special moment, it can be a very stressful
moment. Again, good or bad outcomes, it can be
a stressful moment. And so being there and being
able to help them through that is an amazing
gift that we are given as OB anesthesiologists.
And then, of course, I also liked working with
my hands, being able to help with pain control,
seeing immediate gratification from. taking away
their pain with epidurals, spinals, and taking
care of two patients at once or more than two
patients at once. It's very uncommon that we're
in a situation where what we give one patient
actually affects another human being so directly
because that human being is still inside mom.
So I also enjoy OB anesthesia for the same reasons.
And one of the things that I think about especially
on OB, is communication and how that communication
matters in those special moments or those stressful
moments, right? When you are talking to laboring
patients for the first time, what are the things
that you try to communicate with them so that
they feel safe and comfortable with you? Yeah,
I think one thing I do, and it's not specifically
saying anything. It's just asking them about
themselves or their baby or anything even in
the room that I have an opportunity to almost
latch on to, to show them that I care about them
as a person and not just a patient. Establishing
that rapport with them can go a really long way
so that when you're talking to them throughout
their experience, they know that you're seeing
them as. them and what they're experiencing and
not just another patient um and so it's can be
something simple like oh i really like your nails
or oh i see you have a you know reds cap on i
like the reds too too bad they're really bad
this season um just having those moments or even
just saying you know tell me about who's with
you today or um you know tell me about your baby
or something um to establish that connection
with them on a more human level. So you supervise
a lot of trainees. Education is something that
you do a lot of. Are there phrases that people
tend to use on OB that you don't think are super
helpful? I do think that phrasing things is extremely
important when it comes to talking with patients.
One thing that I find... frustrating from my
perspective but I know everyone's a little different
is when you have a patient who's not English
speaking talking to the interpreter instead of
talking to the patient can be very frustrating
from my standpoint because I feel like yes they
don't understand you but even just saying things
to the patient and looking at them when you're
talking can be meaningful even if They don't
understand the words you're saying. I heard something
the other day that kind of stuck with me that
that reminds me of, which is that something like
80 % of communication is nonverbal. And so that
certainly matches up with that. And I try to
be really intentional when I'm using interpreters
as well to make sure that I'm looking at the
patient, that I'm doing all of the same facial.
movements that I would do if the patient understood
me so that they can get a sense for what I mean
and how I mean it. Absolutely. And I think that's
really important when you have that communication
barrier, that language barrier. It doesn't have
to be a full communication barrier. You can still
communicate with the patient in ways that are
not, you know, direct spoken language. So I think
that's really, really meaningful. So one of the
things that makes it tricky to do OB anesthesia
is we do get to take away pain with spinals and
epidurals, anorexial anesthesia. But we actually
have to cause people pain by placing those things
before we can relieve that pain. And that can
sometimes be a really anxious moment for people.
So how do you explain to patients what they're
about to feel that makes it? maybe a little bit
less scary for them. Because I know that there
are a lot of people who are very afraid of an
epidural. It's a needle that's going into your
back. Yeah, absolutely. I think the best thing
to do is to try to normalize things as much as
possible. So everyone experiences labor delivery
epidurals differently. And so there's a whole...
range of what's normal, but kind of walking them
through what to expect and even relating it to
experiences they may have had in the past and
using specific language. Like when you're pressing
on someone's back, I say I'm going to press on
your back. I don't say I'm going to touch your
back. I'm not saying I'm going to push on your
back because one sounds a little too aggressive
and one sounds maybe too light. But saying pressing
on your back, that's what I expect them to feel.
Or when I'm numbing them. Relating it to say,
have you ever had a tooth numb during a procedure?
That's the kind of numbing that you're going
to feel before we insert the needle to put the
catheter in. We're going to numb it up first,
just like we numb up a tooth. So it's something
that they may have experienced before and they
can relate to. Or if they haven't had that before,
saying things more like a pinch and a burn or
a numbing shot, not. We're going to inject medication
or do anything aggressive, but just trying to
not downplay it too much, but also not overplay
it either. And then also, again, normalizing
different experiences. So you may feel a shock
down your leg. It might feel a little bit like
a funny bone feeling. Again, a normal sensation
that they probably can relate to. But then I
also say, but you may not feel that. And that's
also normal because I don't want them to say
I didn't feel it or. Oh, yeah, I did feel it.
Both are normal. And so giving them that expectation,
but then also saying, but you're not strange
if you don't feel it or you're not, you know,
it doesn't mean it's not working just because
you didn't did or did not feel that. Sometimes
on OB anesthesia, we get patients that are extremely
anxious or on the verge of a panic attack when
they come to us. And that can be for a variety
of reasons. They could be their social situation.
they're dealing with. It could be an anxiety
problem that they're dealing with. When patients
have that extreme heightened anxiety that we
see on OB, what are some of the ways that you
treat them differently such that you're taking
the best care of them that you can? People have
all different levels of anxiety coming into a
delivery. And like you said, it could be for
a variety of reasons. Maybe the last delivery
didn't go well or maybe they're just anxious
about things or maybe there's a social component,
like you said. But listening to them and to why
they're anxious, what they're anxious about,
because it could be the C -section or it could
be the epidural or it could be both. It could
be a variety of reasons. So listening to that
and then again, normalizing it like. very normal
to feel anxious about these things that's that's
okay that is honestly expected that you're going
to be anxious about these things but we're going
to take good care of you and we're going to do
the best we can for you um so not trying to be
you know override their anxiety or say you know
that's okay it's all good it's all fine that's
not what we're trying to do you want to recognize
their their apprehension their feelings but then
say you know We're going to be here for you.
And then also reading the patient. It's hard
to do sometimes, but is this a patient who's
going to do well with a joke or a distraction?
If you guys just start talking about baby, or
maybe that's not the right thing to talk about.
Everyone's different, but recognizing something
that can help them feel more comfortable. take
their mind off it or maybe they don't want their
mind taken off it and they just want you to walk
them through everything that's okay too um but
just trying to gauge what that patient needs
in that moment one of my favorite lines that
i use on patients that i have deemed appropriate
that are feeling very anxious is i will say something
like well we've never dealt with any anxious
patients before so this will be my first time
but we're gonna try to get through it A lot of
patients have to think about it for about a second,
but then it helps them relax knowing that I'm
obviously joking. And then they also get to think,
you know, this guy deals with patients who are
anxious all the time. And that's why he's telling
this joke. I think sometimes that can be helpful.
Yeah, sometimes that can ease the tension. A
joke I like to... to do sometimes is is people
say oh i'm scared of needles and i say i love
needles just not when they're pointed at me oh
sure you know so then you're saying you know
i could be scared of needles too i'm just they're
not pointing at me so i i don't you know i don't
care but but it's just kind of levity to the
situation which is helpful so another situation
that we deal with a lot in ob anesthesia is walking
people through what they're going to be feeling
in a c -section How do you set expectations for
those patients to try to help them get through
that scenario? Again, I think everyone feels
pressure pain differently. Pain is an interpretation.
It's not a yes or no thing. There are different
levels of pain. There are different experiences
that are interpreted as pain. Just because you've
numbed someone doesn't mean they're not feeling
pain. If you've ever had a tooth numbed and pulled,
pulling the tooth still hurts. It's just that
it's not a sharp pain. You're not feeling the
pain receptors anymore. But pressure can still
be very intense and very uncomfortable. And so
talking to patients and telling them ahead of
time before they're feeling this pain. what to
expect. Like, okay, you're numb. You shouldn't
feel any pain. However, you might still feel
pressure and actually the pressure can get really
intense, but then turn it around. The pressure
can be really intense right before baby's delivered,
but that's a really good sign because that means
baby's almost here, which is really exciting.
Or maybe it's not exciting for them, but just
say, which means it's almost over. Something.
to to help ease them to so they're still expecting
it it's not a surprise in any way but still not
overplaying it either so one thing that we will
often do after spinals and epidurals is something
called checking a level can you briefly explain
what that is for people and then how you like
to do it to get the best information that you
can yeah so checking a level basically is a test
that we do to determine how high the numbness
has gotten on an individual after they've gotten
their epidural or spinal. And for a C -section,
for example, we want it to be about mid -nipple
line, so about what we say T4 dermatoma level.
And so we'll check different levels of the skin
height starting on the leg and working our way
up and determine where our numbness is. Now I
gave a specific level for numbness, but numbness
is actually a gradient because pain level will
be higher than touch. Like I said, I still expect
them to feel touch and pressure, which is a different
level from motor. Everything has a different
level, but what I want to see is where our pain
level is. And so what we often do is we use a
sharp, but not too sharp implement to check.
um to see if if they're feeling like a poking
sensation kind of like the end of a paper clip
yes um it if it feels more like the tip of your
finger that would be a more dull sensation but
if it feels like a pokiness like the end of a
paper clip that would be the sharper sensation
that we're looking for um this can be really
tough because again people might feel it but
can't tell us If it's sharp or not. So oftentimes
we'll start on the arm, which we expect not to
be numb and to feel quote unquote sharp. And
then say, does it feel the same as we work our
way up from leg all the way up to again arm?
Another thing we can do is to check temperature
because your temperature sensation goes away
with your pain. So you can check to see if something
feels cold. It might not feel cold until you
again get to where your would feel sharp pain.
And so you can check and see, does this feel
cold? And it's an ice cube. And of course it's
going to feel cold except if they're numb. So
one is not necessarily better than the other,
but both work well on different patients and
how they respond to your questions. That makes
a lot of sense. Let's talk about when patients
might start feeling a big sensation during a
C -section. Obviously, it's very important to
us to make sure that our patients are getting
through things safely and comfortably. But a
lot of times, things can be misinterpreted as
pain when it's actually pressure, or it could
be real pain that we don't want to ignore. How
do you approach those situations to tell what's
what? And how do you treat those patients? Yeah.
So when a patient says that they're feeling pressure
or they're feeling pain or they're feeling uncomfortable,
any of those words, even if they just grimace
and they are not voicing it to you, but they're
showing you signs that they're uncomfortable
during their C -section, it's important to delve
further into what they're truly feeling. Now,
some of them will say, I don't know. Which basically
just means that the pressure or discomfort is
so intense that they really can't parse it out,
which to me may not be pain. But for them, it's
intense enough to feel like pain and probably
should be treated in one way or another because
they're at that level of discomfort. But a lot
of times they can tell you, oh, yeah, it's just
pressure. It just feels a little uncomfortable.
Or they'll say, oh, no, I'm feeling pain. It
feels sharp. It feels like a knife. And then
that's a sign that the numbness is not where
you think it's going to be or where you think
it is. And that maybe your epidural or spinal
is not working adequately. Now, even an epidural
that is, quote, unquote, working normally, if
they're still feeling pressure that's that intense,
maybe they do need supplementation. And it doesn't
mean that the epidural, you know, doesn't have
a good level. But in some sense, it is a bit
of a failure of the epidural because it's not
keeping them completely comfortable and they
do need supplementation or even conversion to
general anesthesia. So that needs to be a constant
communication with the patient, telling them
that you hear them, asking them how they're feeling
and seeing what you can do to help them through
that moment or the rest of the surgery. Yeah,
I think it's a very individualized thing too.
And I think you have to connect empathetically.
with the patient, look at their face and try
to ask yourself, do you think that this patient
is going to be able to get through this with
enough comfort for it to be acceptable or appropriate?
Or do we think that we need to do something about
it? But it's also tricky because whatever we
give to mom also goes to baby for the most part.
So whenever we give mom a pain medicine, It can
affect how the baby is breathing when it comes
out from the C -section too. So it can be really
tricky. Absolutely. It's definitely a balance
of making sure that mom is comfortable, but then
also making sure that baby is safe because that
will impact mommy and baby's experience as well.
So shifting gears a little bit, back when you
were in your OB fellowship, that is when you
became pregnant for the first time. Is that right?
Yes. Can you walk me through what that time was
like for you? It was mostly anxiety provoking
because I could see all the complications that
we deal with on OB. And that was very scary.
It was also very exciting. And it was neat to
be able to relate to patients on a new level,
like not just. hey, I kind of, in theory, understand
what you're going through to, oh, no, I'm actually
there and I'm experiencing things as well, being
able to relate on that new level with patients.
I think in medicine, we often see the complications,
which is why, again, it can be anxiety provoking.
But as time progressed through that pregnancy,
it became easier and easier. Like, OK, nothing,
you know, nothing's really. gone wrong. And,
and I'm, I understand a lot of what's going on.
And so it was, there were certain moments that
were reassuring to me, given my physician background
to help with the pregnancy. And then, like I
said, it was kind of exciting to be pregnant
and relating to my patients in that way as well.
Yeah, that makes a lot of sense. And I remember
talking to you a lot about how you were feeling.
during that pregnancy, and it was something that
was exciting because we're friends and we enjoy
spending time with each other and we play board
games at each other's houses a lot. But let's
talk about sort of what happened. In whatever
way that you feel comfortable sharing, I wonder
if you could talk about... What happened about
halfway through pregnancy? Yeah. So at 23 weeks
pregnant, I did get sick for about 24 hours and
thought nothing of it. And nothing really happened.
And it was fine until a few days later when I
was at home and I stood up and my water broke.
As a physician, I was very nervous, and I was
also a little bit in denial. I was like, no,
that can't have been my water. That can't have
just happened. But I went in to the OB office,
and they confirmed that my water had broke. And
I recommended that I go to the hospital. At the
time, I was in the care of a different hospital
system, different health system. But I chose
to come to our hospital because I knew the high
-risk OB group here. And I knew that at 20 weeks
and five days, I was now in a high -risk group
of individuals who had had my water prematurely
broken. So I came in and was admitted to the
hospital. For a few days, I was in the hospital
and being monitored. And then day three or four
of being admitted, I started to feel abdominal
pain. And again, I was a little bit in denial.
Did not realize I was in labor until a few hours
into the labor when the OBs came and checked
on me and said, oh, your cervix is dilating.
The umbilical cord has come through the cervix.
What do you want to do next? And it was a snap
decision. I had to have emergency C -section
to try to rescue my baby. And so she was born
via an emergency C -section. She lived for a
few hours in the NICU, during which she coded
a few times. And then after or around her third
code, we decided not to continue with. and to
transition to comfort care. So then she passed
away. And it was, of course, very hard at the
time. And it still is very hard. But there's
no but to it, really. It's still very hard. to
lose your child. And it doesn't matter that it
was only 24 weeks and two days. It's still, she
still is very much my daughter. And, but now
I do feel like I have a different grasp on obstetrics
because I have not been that patient who had
a complication. And so I can, in some ways, relate
to my patients even better because those times
when things are scary and things aren't the way
we planned, I've been there. One of the reasons
why we talked about having this conversation
was not to... share your story with the podcast
audience for no reason, but so that people who
are listening could understand a little bit better
how to help deal with patients who are going
through something like what you went through.
And that's a really difficult thing. I remember
at the time being your friend. And it was obviously
impossibly hard for you. But in a different way,
it was hard for me as your friend seeing you
go through it and not knowing exactly what the
best way was to support you. Now, I remember
as sort of people started to find out what had
happened, our whole department, rapidly got behind
you and mobilized and got you guys things like
food and tried to support you as best we could.
Um, yeah, I am eternally grateful for all the
support that our department has given me and
my husband, um, during not only that after that
pregnancy, but then with our, uh, pregnancy for
our next child, because I was very stressful.
Um, everyone has been Over the top supportive
of us every step of the way and very understanding.
And I think that's one of the biggest things
is just showing that you care. Being supportive.
Acknowledging that what your friend or what your
patient has gone through is is real and it does
hurt. I think some of the. Hardest things that
people said is all related to, you know, oh,
you know, you'll have another kid or oh, well,
kind of brushing it under the rug was really
hard to go through because I just wanted to be
validated that, yes, what I went through was
real. is awful and it's not just oh I'll have
another kid it's that was my kid and I lost it
sure I'll have another kid but that's not what
I'm worried about right now is the loss of my
current kid um so having that validation of what
you're going through is tough and maybe you don't
understand how to relate to it and you can't
really say oh yeah I you know um even people
um people would say oh you know I had this terrible
experience during my pregnancy nothing like what
you went through and telling me that saying having
that extra thing of like you know I understand
that like what I went through was hard but it
wasn't losing my child and so having that validation
was very comforting and then when people didn't
validate or they did because it's uncomfortable
try to kind of sweep it under the rug or forget
about it or That was actually what hurt the most.
And I think it's hard because we don't want to
talk about things. One of the reasons I wanted
to talk about this is I did have a resident come
to me and they were in a C -section with a baby
who was not expected to survive. They said, I
had no idea what to say. And I said, well, just
being there for them is important. Not saying,
you know, not ignoring it. It's hard to talk
about it, and maybe the mom doesn't want to talk
about it, but it also shouldn't be something
where you completely ignore what they're going
through at that moment. Acknowledging them still
as a mom, because I very much identified as a
mom. Those are all really important things that
you can do if you know someone or, again, know
a patient. who has gone through that loss is
recognizing that loss. I had a friend who also
lost her child at 35 weeks, and we talked about
this, and she also agreed with me. She said the
biggest thing was just recognizing the elephant
in the room. One of the nurses turned to her
and said, wow, this really sucks. And she said,
yeah. Yeah, that was really helpful to have someone
say, I see what you're going through and it's
awful. And it's a silly little thing, really.
But being that person and saying that, you know,
like what you're going through, that's that's
really awful. It's extremely interesting how
validating that feels and how. that can actually
be helpful because no one wants to say that no
one wants to say wow this you know I'm so sorry
that your your baby's dying or that that absolutely
sucks your baby's about to die or you know you
don't want to say those things but just actually
acknowledging that the mom is going through something
and I took that and I used it going forward once
I had come back to work you know seeing a pregnant
patient who had to have basically had a miscarriage
and talking to them and being like, you know,
this is really awful. And I'm so sorry that you've
had to go through this. I know this is a really
tough situation for you. And not even saying
like, oh, I went through something similar, but
just saying this is really, really sucky. And
I'm really sorry that you've been put in this
situation. And also acknowledging that it's nothing
that they did. They've been put in this situation.
It's not like, oh, well, if you had done this
or, oh, you know, well, maybe next time. You
know, nothing like that, but just saying this
happened to you. And I'm sorry it did. I think
that it can be very difficult for patients going
through this when they activate. the backwards
looking part of their brain thinking to themselves
if anything could be different or if things had
been different. And I remember having some of
those conversations with you and they were really
hard conversations where we were looking backwards.
And the thing that I remember is that at that
time, it seemed like you had a lot of guilt.
And to my eye, that seemed wild to me that you
would feel that way. I wonder if you could tell
me a little bit more about how you felt and if
that's changed now with time and what you think
about it. Yeah, I think it's very... easy to
feel guilty when a bad outcome happens especially
when you're the parent of a child that passes
away it's easy to say oh I could have done something
and I think as a physician especially we have
we feel like we have a lot of control and understanding
over things but ultimately we can't change the
past For sure. We can look back and they always
say hindsight's 2020. But even now, I don't think
hindsight's 2020 on this. But you can look back
and say, well, I should have done this or I could
have done that. And again, the people I know
who have lost children will say that, too. Like,
oh, you know, I felt like I could have done this
or maybe I should have. gone in sooner I should
have done this and there's a lot of could have
should have but ultimately it's not anything
you did um that brought this about things happen
and and it's not anyone's fault to this day I
do I still sometimes feel like Could I have done
something differently? I don't think that feeling
will ever really go away. I can logic that no,
like there's nothing I could do differently.
But there's that lingering feeling of could have,
would have, should have that doesn't really change.
And the best thing you can do is just accept
that that things happen and that sometimes there
isn't a reason or maybe. Next time there's something
you would do differently. And it's irrational.
My second pregnancy, I didn't fly. I don't think
it had anything to do with flying, but I had
been on a flight less than a week before my water
broke. So in my mind, I was like, I'm just not
going to fly. It wasn't really harmful to not
fly. So why not just do it? And so I think everyone
kind of carries those little things with them
that. You can't let it impede your life, but
at the same time, you know, if there are little
things you do that give you comfort, then that's
okay too. The second time I went to the OB emergency
department one or two times, not because anything
was wrong, but because I felt odd. And I said,
ah, I don't want to feel odd. What if something's
happening? And it probably cost me a couple hundred
bucks, but. It did give me the peace of mind
of knowing that everything was still going okay.
And so there are little things that I changed
or did differently. And that probably stemmed
from guilt or the thought that maybe I could
control or change anything. But ultimately, it
really isn't in our control. And trying to accept
that can be really hard, but helpful. I remember
talking to you. once or twice when you were having
some acute anxiety during your second pregnancy
with Christopher. And you were trying to ask
my opinion about whether or not you should go
and talk to the OBs and kind of curbside them
to maybe get a quick ultrasound done to see what
was going on because you maybe felt slightly
differently and things like that. And I remember...
You're going on maybe a couple different occasions
just to curbside the OBs. Yeah, helpful bonus
to being an OB anesthesiologist is I know the
OBs and they know me. And so it was very easy,
fortunately, for me to just pop over and say,
hey, what do you think of this? Am I being crazy?
And sometimes they'd be like, let's just check
you out. Make sure everything looks okay. Okay,
everything looks great. No big deal. And just
having that little curbside was so helpful because
I could, you know, rest assured a little bit
that things were going okay. Do you feel like
it made it easier or harder having all of your
obstetric knowledge going through pregnancies?
I think in some ways it made it easier because
there were things that I understood. that were
helpful to me going through my pregnancies. Things
I understood about odds and after I did have
my water break, what that might look like, having
seen patients go through that as well. Having
an idea as to what I was, when I chose to have
an emergency C -section to try to save my daughter,
I knew very well what I was going into. I was
about to have a major abdominal surgery. And
because I was so early on, I was going to have
no choice but to have C -sections for all future
pregnancies. And some people don't know what
that means, but I've been through OB enough that
I knew exactly what I was accepting as a risk.
in order to try to get my daughter out so she
could live. And maybe if I didn't have that knowledge,
I would have still made that decision. But I
at least went in with my eyes open as to what
exactly the risks I was accepting with that.
So in some ways, it was helpful. And in other
ways, it was more terrifying. Like when they
told me in the OB office, yeah, your water broke,
I started crying immediately. And they were like,
We haven't even really told you what that means.
Why are you freaking out? But I had seen enough
patients that I knew exactly what it meant. And
I knew what the road ahead of me looked like.
And so helpful, but also not because my anxiety
level was probably higher than the average person
who was told their water broke. I think also
it gave me a false sense of control. So I was
in the hospital and I would, you know, something
would happen. I was starting to feel pain. I'm
like, this can't be labor. I know what labor
looks like. It was labor. But I thought I knew.
I didn't. I'd never been through it before. I
don't know why I thought that. Having seen it,
I would then know what it felt like. So I think.
It kind of goes both ways. I remember a very
distinct point in your second pregnancy with
Christopher where you got to the same length
of time in your pregnancy that you did when you
had Alice. Was that reassuring to get past that
point? Can you describe what your feelings were
around that time? So 24 weeks was very hard on
me when I was pregnant with my second because
I had lost Alice at 24 weeks and two days. I
had ruptured at 23 and five days. So those four
days were very anxiety provoking for me because
could it happen again? Logically, it wouldn't
happen at the same exact time. That would be
really, really odd. But there is something inside.
You that says, oh, my gosh, this could happen
again. And this is the moment that it did happen
before. Could I could it happen again? Once I
got to 25 weeks, it was reassuring because I
had never made it that far in pregnancy before.
And so there was a sigh of relief of, OK, I have
made it to 25 weeks. And again, being an OB anesthesia
and having worked a little bit in the NICU. I
kind of I knew what the difference between a
24 week baby and a 25 week baby was. And so it
was reassuring from that standpoint, too, that
if he was born now, he at least had a better
chance of survival than my baby at 24 and two.
So even if it did happen again, we had made it
further and there was a better chance that he
was going to have. a more positive outcome. I
remember when you came back, you had a tough
time coming back to work on OB, which I think
made a lot of sense. I think that there was likely
some component of PTSD associated with that.
But over time, You sort of eased yourself back
into working in OB, and that's what you did your
fellowship in, and you're quite good at it. I
wonder if you could talk about how you overcame
that to a degree and how you feel working in
OB now. I did take a little bit of time coming
back to OB. I think, as you mentioned, Having
been through everything, PTSD would be normal,
and we don't always normalize it, but it would
be a normal response to what I went through.
I think the major reason I didn't go back to
OB right away is I did not want my experiences
to impact my patients' experiences. I did not
want to be in a delivery and start crying, and
they're like, but my baby's fine. What are you
doing? Because... of how recent my experiences
have been but over time that became easier to
do and it's something I really do have a passion
for and love so it's not something I would ever
really plan on leaving behind or letting the
fear or emotions associated with my experiences
impact my career. as an OB anesthesiologist.
Over time, it became easier to shift my experiences
into positive outcomes for other patients, not
positive outcomes in terms of like, you know,
I was going to help their babies do better or
anything like that, but have their experiences
be impacted positively by my experiences. And
so that was important to me too, that I could
use my experiences to help others as they went
through similar experiences. What do you think
are some of your best pieces of advice for how
to approach friends and colleagues that might
be going through a situation like what you went
through? Absolutely. I think anyone who has been
in the situation would hopefully agree that Time
doesn't heal all wounds. I wish I could tell
you that at some point you just it is what it
is. It's the past. Maybe you're more willing
to talk about it. Maybe you can turn the situation
into more positive things like helping others
with what you've been through. And that's amazing
and important. But to this day, I still think
of my daughter. That never goes away. And it
can sneak up on you in different moments. And
that's okay and that's normal. Everyone grieves
differently. Everyone has different experiences
when it comes to losing someone they love. And
just because you are different from your spouse,
are different from your mother, are different
from... Siblings, everyone experiences the loss,
but everyone experiences it differently. And
it doesn't mean you're different or grieving
wrong. Everyone grieves differently. And understanding
that is important and trying to understand where
other people are coming from and their grief,
because you're not the only one grieving when
you've gone through a loss. The people around
you are grieving with you. And they might show
their grief in different ways. And that's important
too. That you all recognize your grief. And then
recognize other people's grief as well. I think
those are the biggest things that I would want
someone to take away. That people grieve differently.
Different timelines. You never stop truly grieving.
But it just looks differently. And sometimes
you can. Turn it into helping others. What should
friends do if they want to help but they are
afraid of saying the wrong thing? I think that's
a fear that a lot of people have when they have
someone, a friend, family member, going through
a loss. And again, I think it's hard to say things
like, so sorry for your loss or to bring it up.
You don't want them to, if they're not talking
about it. You don't want to bring it on them
so that they are thinking about it. I can tell
you they're thinking about it, whether they're
talking about it or not. And so just as I mentioned
earlier about reading each patient, reading your
friends and seeing what they need most. And sometimes
it's a hug and some silence. And sometimes it's
saying, that really, really sucked. Or sometimes
it's letting an ear and being like. Tell me about
it because I don't know what you're going through
or don't know what you went through. Sometimes
it's just very simply addressing it, saying,
I'm so sorry that that happened. But I think
as a society, we're very commonly, we just kind
of ignore it or we push it under the rug or we
want to talk about other things. And I think
there's a lot of things. that you can say and
maybe some people will take it the right way
and some people will take it the wrong way but
I think just saying something or being there
is is one of the biggest things and not ignoring
it or um brushing another rug or um saying oh
well but At least this is true or, you know,
trying to look on the bright side because maybe
they don't want to look at the bright side right
now. And that's okay. If they want to look on
the bright side and they say at least that, you
can agree with them. But I think that's important
as a friend just to be there for them in whatever
way that looks like. Bring them a book to read
or a meal you made or, again, just sitting there
or listening. You don't have to say anything
but just being there. Lastly, I want to wrap
up with a question about what your style points
are or what your points of personal preference
are. help you on OB anesthesia or just generally
in life. What do you want to leave us with today?
I think one of the great privileges of our job
is to be there for patients, whether it be on
OB or in the main operating room or whatever
environment you're in as an anesthesiologist,
being there for patients during a time of need.
And recognizing that, recognizing the situation
they're in, helping them through it, telling
them that you'll be there, being a confident
supporter of them, letting them know that you
see them as a person. These are all amazing things
we can do to help our patients through the day.
And I think that also extends into life when
you... you know, see your friends or your colleagues
going through something, listening, being there
for them. Even little things can make a huge
difference in someone's day, be it a patient,
you compliment them on their nails, or your friends,
you just listen to them talk about how terrible
their weekend was, or what have you. Being there
for each other is a wonderful privilege that
we have as anesthesiologists but then also that
we carry over into life Mary thank you for sharing
your beautiful voice with us thank you for having
me that's it for this episode of style points
I talked to Mary for a while about this episode
She told me that if anyone is listening who wants
to reach out and talk to her about what we discussed
in the episode, she's happy to talk to you. If
you'd like to help other people find the podcast,
please feel free to leave us a rating or a written
review. That's the number one thing that will
help other people find the show. You can also
contact me at stylepointspodcasts at gmail .com.
Take a deep breath. Open your eyes. We're all
done.