ALS, Breastpumps and Jam

It’s 7am and the babysitter has arrived. I’ve spent the past week reading up the ALS (Advanced Life Support Manual) in 5 minute breaks; in the garden, in the kitchen or while breastfeeding. I’ve not left my baby for this long, I’ve got a 1 hour drive to the course and the last exam finishes around 6.30pm. I’m worried. Baby needs to nurse else the day will have unknown consequences. But she’s having none of it and 20 minutes late I leave the house with my breasts full of milk. As I’m driving up and get stuck in traffic I’m now 40 minutes late. The last time I did a simulation course was after 9 months of maternity leave and I was terrible. I realise again, that I’ve not been on the ward in 6 months and I have baby brain. Husband has been on nights and I’ve been up 3 times breastfeeding baby. ‘This is sheer lunacy’ I think to myself. ‘Why am I doing this?’

Arriving late and last, the instructor announces ‘there’s a space at the front’. I walk to the front in front of everyone and sweating take my seat. I’m the only FY1 on the course and there are ICU consultants, anaesthetic registrars, other senior doctors and a few FY2s. Intimated. I am doomed to fail.

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The morning passes. We do our simulations of cardiac arrest scenarios. It’s about 27 degrees Celsius, hot and sweaty. I’ve let them know ahead of time I’m still breastfeeding and will need to pump at some points during the day. The timetable looks a bit tight. They’ve kindly found me an office and while everyone else pops off to lunch, I go in there and begin pumping. The fact there are 5 people in the office next to me and my pump is noisily whirring and sucking, unsurprisingly I have no let down of milk. Hard staring at pics of my little baby I eventually manage a measly 1oz of milk. ARRRGGHH!! Panic sets in as I know that I have 7 hours to go until I get home.

I return to the course with milk a plenty, sore jumbo boobs which spurt milk with every cycle of CPR. It’s quite distracting. Still, we’ve a nice bunch, supportive instructors and we continue our day. By the time it comes to my exam, I’m thinking it’s a tall order whether or not I will pass. My first scenario exam goes horribly wrong. I do that classic stressful situation thing of saying the opposite of what I mean. I can’t fix it. Midway through my exam I realise what I have done, explain and carry on. I know I’ve failed. My boobs are set to burst with all the stress!

I’m taken to another room where I do another exam. Nothing to lose this time. I think I’ve really extended myself now and will really be quite happy if I fail. Miraculously I pass. Praise be. In celebration, my boobs join in and spurt yet more milk. I now wait for the written paper. It’s 1 hour long. I have no time to express milk. I sit it and wait. Eventually after a long day, it’s announced that I have passed. I am too exhausted to be delighted and manage a relieved, wry smile. I need to get to the car and get home as I’ve not seen my kids in 12 hours.

My breasts direct me to the car and drive me home at top speed. I run in the door. ‘Where is she?’. Poor child reunited with mum is overwhelmed by the abundance of glorious milk. Husband shouts ‘did you pass?’. ‘Yes’, I yell as the joyful softness returns to my painful boobs. Now, I’ve got 2 kgs of strawberries in the fridge lovingly picked by my aunt and if I don’t make jam with them tonight they will go off. So I now begin the prep for jam making. Shattered!

Now, you will have to forgive my honesty. I talk frankly. Breastfeeding mums will empathise with what I am saying. Part of my frankness is to say. WHAT ON EARTH am I doing this for? The past few months have been pretty hellish. I’ve even Googled ‘alternative careers for doctors’ as this life is too much. There aren’t enough hours in the day to fit this in. On maternity leave, I’ve done two teaching courses, started two audits and quality improvement projects (and ALS). Why? Because I need to boost my CV for specialty applications later this year. Oh, and by the way, after three long years I can finally say I’ve been signed off for FY1 and will start FY2. This small piece of news is actually quite major! I’m delighted.

The main reason for the hell I’m afraid has largely been to my husband’s Emergency Medicine job. The hours and the rota are brutal for families. With no disrespect to single parents (my mum was one) I feel like a single parent most of the time. I do ALL the household chores, which with 4 kids is rather extensive and add in all the other ‘man’s jobs’. I’m not one for calling this man’s jobs but there are some I’m afraid. I haul the bins out, fill the car with power steering fluid, mow the lawns and basically seem to do everything in the house. He works long stretches at a time. Average 70-80 hours per week, most of them antisocial and weekends. He seems to have nights virtually every week. My son has no idea where or when he will see daddy. The few days off he gets between these 7-8 day stretches just don’t make up for his absence. By the time we get to a week’s break we are both so exhausted in takes 3 days to feel slightly normal again. When he works antisocial hours, it means I do every evening and the routine, I get up in the morning, there is no rest time. In the early days, I actually had days stretches where I got about 2 hours broken sleep. I would get to bed at 11pm, feed regularly throughout the night and when my son decides to get up at 4.30am, I’d be up for the day (until 10pm). This kind of lifestyle is unsustainable. I will say that my lovely husband does what he can when he is home, and does a lot. But I recognise that the nature of his job means he needs to stand and run around all day. I will ‘allow’ him the lie-in instead of me, when the chance arises. We are used to napping at odd occasions and he will tell me to nap when he can. This means we rarely have time together. Some days we may have only 15 minutes to discuss important things, re-mortgages, catching up with the kids and so on. It’s relentless. This kind of lifestyle impact is why emergency medicine is in ‘crisis’. This week the GMC reported that fact. My husband loves emergency medicine, but the toll on family life is too great. Around 50% of junior emergency medicine trainees leave the job at ST3. I am counting down the days until this job is over. In the past 2 and half years he’s done 16 months of emergency medicine in total, largely coinciding with the first few months of our youngest ones lives. I’m over it already.

Next week I return to work. I’m already encountering problems with the old breasts again. Despite being an NHS hospital there is nowhere that I can express my milk. This was the same situation 2 years ago, but I managed by visiting my son in nursery at lunch. I can’t do that this time and my baby is only 5 months old. With her CF she needs my breast milk for as long as possible and I want to give it to her. Bizarre that the NHS advises mums to breastfeed for as long as possible but have nowhere for their own staff to do so. I’m working on this with ‘health and safety’, but it’s one added stress I can do without before returning back. All I need is a quiet place where I can discreetly go off for about 15 minutes and pump, once or twice a day. I’ll give up my lunch break to do so, so as not to affect the team! Its been suggested that I tell my team members that I’m breastfeeding and ask my consultant if he knows of an office I can use. I will do this, but I find it rather personal info to share. I may as well announce to the team ‘I’m off for a poo now’. It’s my private bodily function and I’d rather not share it with my professional colleagues. Oops, just shared it with you though. Ha ha!

Must finish up now. But this week I also did a fundraiser for Cystic Fibrosis Trust and have raised around £1000! Absolutely delighted. Been moved and humbled by people’s generosity and caring. It was hard work (a cake bake and coffee morning) but so worth it. Again, I thank you all. We’re not quite at £1000, so if you fancy adding a few pennies to the pot I’d be most grateful. In return you can enjoy a slice of virtual cake and feel pleased that you are helping a good cause.

Here is our Just Giving page called the Marvellous M!

P.S. Everything I write represents my own views. I am very aware that colleagues, GMC, employers, husband’s colleagues and so on may read it. My blog is about the fact that doctors are human too. Our personal and professional lives are one! Hopefully our dedication to our profession, patients and our own families comes across.

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Checklists and Breastpads – That Doctor Business…

The deciding factor on becoming a doctor was about 15 minutes after an epidural during the birth of my first daughter. I was in awe of the anaesthetist, I could not believe that I went from the worst pain of my life to no pain at all. This man with his tray of marvels and skilled hands was a magician in my eyes. That was it. I MUST do that job. Though then it was the job of a physician not necessarily that of an anaesthetist.

Fast forward 14 years and I’ve been privileged to do two anaesthetic and intensive care FY1 jobs. Love it; love being in the anaesthetic room, love talking to patients before an anaesthetic, spending time with patients and loved ones in ICU. It’s a perfect blend of patient care, pharmacology, physiology, practical skills and technology.

The world of medicine and motherhood collided most embarrassingly one day when helping an anaesthetist in theatre. The surgery was over and the final checklist of sutures, swabs and so on was being applied. I do love a good checklist – so important in patient safety and improving the delivery of care. The theatre was in full swing. I glanced to the floor near the surgeon and noticed a small white circular pad on the floor. I was about to call out – you’ve missed that swab on the floor when I noticed to my horror that it was MY BREASTPAD. It had made it’s way quite happily out of my bra, over the top of my surgical scrubs and onto the floor. I cannot imagine how I would of explained my answer when someone picked it up and said “What’s this? This hasn’t been accounted for.” The anaesthetist must have observed this and felt unable to say anything as we chatted about propofol and ASA grades. Mortified I swept in and stuffed it into my pocket. Needless to say, if you happen to notice me take a quick peek down my front or gently pat my breasts discreetly (not in front of patients, of course) you know that I am checking for errant breast pads.

I'm sure this doesn't appear on a surgical checklist

I’m sure this doesn’t appear on a surgical checklist

Oddly, the journey has come full circle and I am now hoping for a career in anaesthetics. Unfortunately for me, it’s competitive, very competitive in this area. Add into that the need to stay local I have to drag myself to the top of a very large heap of applicants. We shall see. I’ve yet to apply. I shall apply this year, if all goes well. I say if all goes well as my daughter’s diagnosis with cystic fibrosis adds some serious perspective to life. She and my other children will always come first. Her consultant told me not to hold anyone’s dreams hers or my own. “You just carry on,” he said. “Life must be as normal as possible”.

Not that a life in medicine is normal. It’s unpredictable, challenging, hard work and ultimately rewarding. There are ups and downs, good times and bad times. Balancing motherhood and medicine has been an on-going battle – not sure I like that word but can’t think of another at this time. My status as older mum of four quite often baffles my senior colleagues. I can’t pretend it’s not awkward as an FY1 on-call with the consultant with whom my daughter is best friends with. Not often awkward for me, but sometimes for others. One consultant openly told me he was freaked that my kids were older than his. Another remarked when I said I wasn’t keen on paediatrics, “don’t you have a maternal bone in your body? Don’t like kids then”. “Yes”, I replied “I’ve got two (at that time) of my own”. Awkward silence ensued. Even the other day I was asked what I wanted to be ‘when I grow up’ by another colleague. I’m 43 in less than two weeks but I agree with you, I’m yet to grow up!

Now, back to what I need to do for my intended career. My checklist includes, audits, presentations, projects, publications, commitment to specialty and much more. Even on maternity leave I’m at courses, completing audit cycles and sorting the next detail to demonstrate my suitability for this career. Now, I’m not stupid, I know I’ve got a challenge ahead of me. I have my back-up plans. So let’s see. I’ve already been told by a retired anaesthetist that I haven’t a hope in hell, I should give up before I’ve even started, my CV will be in no way competitive compared to my younger colleagues. Do you know you’ll be 50 odd before you are a consultant? All in the space of 5 minutes of meeting me and knowing nothing about me. But we mature medics have heard this all before. We wouldn’t be standing in front of you if we’d not thought about this. But as I keep saying I am enjoying my journey rather than focussing on the destination.

Now back to those lists – shopping, ARCP, to-do. I do love a good list.