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Being There with Mary Roberts · Style Points

0:12
and welcome back to Style Points. We've decided
0:15
to skip the RSI for this episode. Some of the
0:18
subject matter today is a little heavy. Today
0:21
I'll be talking with my friend Mary Roberts,
0:23
who did her anesthesia residency and OB fellowship
0:26
here at the University of Cincinnati. Let's jump
0:29
right in. I just sent this to you. I feel like
0:33
I should be able to find it. Here we go. You
0:37
go to your set email. I'm just kidding. This
0:42
isn't helpful. You're welcome. Just because you're
0:48
married to one of the podcast hosts doesn't mean
0:51
that you can harass me the whole time. No, I
0:55
thought that was because we're friends. I can
0:57
harass you the whole time. Okay, that's awesome.
1:02
Mary, thank you so much for joining us. Thank
1:05
you for having me. One of the benefits that I
1:10
have, as a podcast producer is that I get to
1:15
ask all of my friends to come join me on the
1:16
podcast. And you are somebody that I've been
1:19
trying to get to come on the podcast for a really
1:21
long time because you are one of my close friends.
1:24
You also happen to be married to my podcast co
1:30
-host, Nate Moore. That is true. So my first
1:35
question for you is what took you so long to
1:37
come on the podcast? Ooh, that's a tough question.
1:42
And I have two separate answers. One is because
1:46
my husband is a co -host on the podcast. It's
1:49
his and your domain. And so, you know, we work
1:53
together a lot, my husband and I. We're both
1:55
anesthesiologists, but we each have our own kind
2:00
of roles as anesthesiologists, and we don't always
2:04
cross over. We do sometimes, and it's a lot of
2:06
fun. This is a newer thing, and that's awesome,
2:14
but not my thing. The other reason is I just
2:18
don't like to hear my voice. It sounds kind of
2:22
weird. I guess what I'm hoping for after this
2:27
is that you're going to be approached by all
2:29
of the people who listen to the podcast, and
2:32
they will tell you that your voice does not in
2:34
fact sound weird because it just sounds like
2:36
your voice to me. Oh, good. Let me start out
2:42
with the who you would go out to dinner with
2:44
question. So if you had the chance to go out
2:47
to dinner with anyone in the world, it could
2:49
be somebody from the past or even from fiction.
2:52
Who would you go out to dinner with and why?
2:57
So my immediate answer is my daughter, Alice.
3:02
But I don't want to skip forward in talking about
3:07
that. That would be my answer is I want to go
3:11
to dinner with my daughter. I think that it's
3:17
fair that we don't want to skip ahead, but I
3:20
think that that is a reasonable preview. Before
3:23
we get into that, and maybe we can talk more
3:27
about why that is a little bit later, let's talk
3:30
about OB anesthesia. That's what you did your
3:33
fellowship in. That's your specialty. What drew
3:36
you originally to OB anesthesia? I think there
3:40
were a couple things that drew me to OB anesthesia.
3:44
As a CA1 resident, I was first introduced to
3:50
OB anesthesia outside of little things I'd done
3:52
as a med student. But my first true exposure
3:55
was a CA1. And I was not expecting to love it
3:59
as much as I do, which is interesting looking
4:03
back on it because I feel like, Now I couldn't
4:06
see not doing it. But when I started doing OB
4:13
anesthesia, I really enjoyed the patient interactions.
4:17
I enjoyed being there for that special moment
4:20
in my patient's lives, whether it was a good
4:23
moment or a bad moment. It was it felt very special
4:27
to be a part of it and to help ease their pain
4:31
or help them through. Because even though it's
4:35
a very special moment, it can be a very stressful
4:37
moment. Again, good or bad outcomes, it can be
4:40
a stressful moment. And so being there and being
4:43
able to help them through that is an amazing
4:46
gift that we are given as OB anesthesiologists.
4:51
And then, of course, I also liked working with
4:54
my hands, being able to help with pain control,
4:59
seeing immediate gratification from. taking away
5:02
their pain with epidurals, spinals, and taking
5:06
care of two patients at once or more than two
5:08
patients at once. It's very uncommon that we're
5:12
in a situation where what we give one patient
5:15
actually affects another human being so directly
5:19
because that human being is still inside mom.
5:23
So I also enjoy OB anesthesia for the same reasons.
5:28
And one of the things that I think about especially
5:32
on OB, is communication and how that communication
5:35
matters in those special moments or those stressful
5:39
moments, right? When you are talking to laboring
5:43
patients for the first time, what are the things
5:46
that you try to communicate with them so that
5:49
they feel safe and comfortable with you? Yeah,
5:53
I think one thing I do, and it's not specifically
5:57
saying anything. It's just asking them about
6:01
themselves or their baby or anything even in
6:06
the room that I have an opportunity to almost
6:09
latch on to, to show them that I care about them
6:12
as a person and not just a patient. Establishing
6:16
that rapport with them can go a really long way
6:19
so that when you're talking to them throughout
6:23
their experience, they know that you're seeing
6:25
them as. them and what they're experiencing and
6:28
not just another patient um and so it's can be
6:32
something simple like oh i really like your nails
6:34
or oh i see you have a you know reds cap on i
6:38
like the reds too too bad they're really bad
6:41
this season um just having those moments or even
6:45
just saying you know tell me about who's with
6:49
you today or um you know tell me about your baby
6:52
or something um to establish that connection
6:57
with them on a more human level. So you supervise
7:03
a lot of trainees. Education is something that
7:05
you do a lot of. Are there phrases that people
7:09
tend to use on OB that you don't think are super
7:13
helpful? I do think that phrasing things is extremely
7:16
important when it comes to talking with patients.
7:21
One thing that I find... frustrating from my
7:25
perspective but I know everyone's a little different
7:27
is when you have a patient who's not English
7:32
speaking talking to the interpreter instead of
7:35
talking to the patient can be very frustrating
7:38
from my standpoint because I feel like yes they
7:42
don't understand you but even just saying things
7:45
to the patient and looking at them when you're
7:48
talking can be meaningful even if They don't
7:52
understand the words you're saying. I heard something
7:55
the other day that kind of stuck with me that
7:58
that reminds me of, which is that something like
8:00
80 % of communication is nonverbal. And so that
8:05
certainly matches up with that. And I try to
8:09
be really intentional when I'm using interpreters
8:11
as well to make sure that I'm looking at the
8:13
patient, that I'm doing all of the same facial.
8:20
movements that I would do if the patient understood
8:22
me so that they can get a sense for what I mean
8:25
and how I mean it. Absolutely. And I think that's
8:29
really important when you have that communication
8:32
barrier, that language barrier. It doesn't have
8:35
to be a full communication barrier. You can still
8:39
communicate with the patient in ways that are
8:41
not, you know, direct spoken language. So I think
8:47
that's really, really meaningful. So one of the
8:51
things that makes it tricky to do OB anesthesia
8:54
is we do get to take away pain with spinals and
8:57
epidurals, anorexial anesthesia. But we actually
9:01
have to cause people pain by placing those things
9:05
before we can relieve that pain. And that can
9:08
sometimes be a really anxious moment for people.
9:11
So how do you explain to patients what they're
9:16
about to feel that makes it? maybe a little bit
9:19
less scary for them. Because I know that there
9:21
are a lot of people who are very afraid of an
9:25
epidural. It's a needle that's going into your
9:27
back. Yeah, absolutely. I think the best thing
9:30
to do is to try to normalize things as much as
9:33
possible. So everyone experiences labor delivery
9:38
epidurals differently. And so there's a whole...
9:42
range of what's normal, but kind of walking them
9:45
through what to expect and even relating it to
9:48
experiences they may have had in the past and
9:51
using specific language. Like when you're pressing
9:54
on someone's back, I say I'm going to press on
9:56
your back. I don't say I'm going to touch your
9:57
back. I'm not saying I'm going to push on your
10:01
back because one sounds a little too aggressive
10:03
and one sounds maybe too light. But saying pressing
10:06
on your back, that's what I expect them to feel.
10:09
Or when I'm numbing them. Relating it to say,
10:13
have you ever had a tooth numb during a procedure?
10:16
That's the kind of numbing that you're going
10:18
to feel before we insert the needle to put the
10:21
catheter in. We're going to numb it up first,
10:23
just like we numb up a tooth. So it's something
10:25
that they may have experienced before and they
10:27
can relate to. Or if they haven't had that before,
10:30
saying things more like a pinch and a burn or
10:33
a numbing shot, not. We're going to inject medication
10:37
or do anything aggressive, but just trying to
10:40
not downplay it too much, but also not overplay
10:44
it either. And then also, again, normalizing
10:47
different experiences. So you may feel a shock
10:50
down your leg. It might feel a little bit like
10:52
a funny bone feeling. Again, a normal sensation
10:55
that they probably can relate to. But then I
10:59
also say, but you may not feel that. And that's
11:01
also normal because I don't want them to say
11:03
I didn't feel it or. Oh, yeah, I did feel it.
11:06
Both are normal. And so giving them that expectation,
11:09
but then also saying, but you're not strange
11:11
if you don't feel it or you're not, you know,
11:14
it doesn't mean it's not working just because
11:15
you didn't did or did not feel that. Sometimes
11:19
on OB anesthesia, we get patients that are extremely
11:24
anxious or on the verge of a panic attack when
11:27
they come to us. And that can be for a variety
11:29
of reasons. They could be their social situation.
11:34
they're dealing with. It could be an anxiety
11:37
problem that they're dealing with. When patients
11:40
have that extreme heightened anxiety that we
11:44
see on OB, what are some of the ways that you
11:47
treat them differently such that you're taking
11:53
the best care of them that you can? People have
11:57
all different levels of anxiety coming into a
12:00
delivery. And like you said, it could be for
12:01
a variety of reasons. Maybe the last delivery
12:04
didn't go well or maybe they're just anxious
12:08
about things or maybe there's a social component,
12:10
like you said. But listening to them and to why
12:15
they're anxious, what they're anxious about,
12:16
because it could be the C -section or it could
12:18
be the epidural or it could be both. It could
12:21
be a variety of reasons. So listening to that
12:24
and then again, normalizing it like. very normal
12:27
to feel anxious about these things that's that's
12:30
okay that is honestly expected that you're going
12:34
to be anxious about these things but we're going
12:36
to take good care of you and we're going to do
12:39
the best we can for you um so not trying to be
12:43
you know override their anxiety or say you know
12:46
that's okay it's all good it's all fine that's
12:48
not what we're trying to do you want to recognize
12:50
their their apprehension their feelings but then
12:54
say you know We're going to be here for you.
12:58
And then also reading the patient. It's hard
13:01
to do sometimes, but is this a patient who's
13:05
going to do well with a joke or a distraction?
13:08
If you guys just start talking about baby, or
13:10
maybe that's not the right thing to talk about.
13:13
Everyone's different, but recognizing something
13:15
that can help them feel more comfortable. take
13:21
their mind off it or maybe they don't want their
13:23
mind taken off it and they just want you to walk
13:25
them through everything that's okay too um but
13:30
just trying to gauge what that patient needs
13:31
in that moment one of my favorite lines that
13:35
i use on patients that i have deemed appropriate
13:38
that are feeling very anxious is i will say something
13:42
like well we've never dealt with any anxious
13:45
patients before so this will be my first time
13:48
but we're gonna try to get through it A lot of
13:52
patients have to think about it for about a second,
13:55
but then it helps them relax knowing that I'm
14:01
obviously joking. And then they also get to think,
14:04
you know, this guy deals with patients who are
14:08
anxious all the time. And that's why he's telling
14:11
this joke. I think sometimes that can be helpful.
14:14
Yeah, sometimes that can ease the tension. A
14:18
joke I like to... to do sometimes is is people
14:20
say oh i'm scared of needles and i say i love
14:23
needles just not when they're pointed at me oh
14:25
sure you know so then you're saying you know
14:27
i could be scared of needles too i'm just they're
14:30
not pointing at me so i i don't you know i don't
14:32
care but but it's just kind of levity to the
14:35
situation which is helpful so another situation
14:41
that we deal with a lot in ob anesthesia is walking
14:44
people through what they're going to be feeling
14:46
in a c -section How do you set expectations for
14:52
those patients to try to help them get through
14:54
that scenario? Again, I think everyone feels
14:58
pressure pain differently. Pain is an interpretation.
15:03
It's not a yes or no thing. There are different
15:07
levels of pain. There are different experiences
15:09
that are interpreted as pain. Just because you've
15:12
numbed someone doesn't mean they're not feeling
15:15
pain. If you've ever had a tooth numbed and pulled,
15:18
pulling the tooth still hurts. It's just that
15:21
it's not a sharp pain. You're not feeling the
15:24
pain receptors anymore. But pressure can still
15:27
be very intense and very uncomfortable. And so
15:30
talking to patients and telling them ahead of
15:33
time before they're feeling this pain. what to
15:37
expect. Like, okay, you're numb. You shouldn't
15:38
feel any pain. However, you might still feel
15:40
pressure and actually the pressure can get really
15:42
intense, but then turn it around. The pressure
15:44
can be really intense right before baby's delivered,
15:47
but that's a really good sign because that means
15:48
baby's almost here, which is really exciting.
15:52
Or maybe it's not exciting for them, but just
15:54
say, which means it's almost over. Something.
15:58
to to help ease them to so they're still expecting
16:02
it it's not a surprise in any way but still not
16:07
overplaying it either so one thing that we will
16:11
often do after spinals and epidurals is something
16:14
called checking a level can you briefly explain
16:17
what that is for people and then how you like
16:21
to do it to get the best information that you
16:23
can yeah so checking a level basically is a test
16:29
that we do to determine how high the numbness
16:32
has gotten on an individual after they've gotten
16:36
their epidural or spinal. And for a C -section,
16:40
for example, we want it to be about mid -nipple
16:42
line, so about what we say T4 dermatoma level.
16:46
And so we'll check different levels of the skin
16:49
height starting on the leg and working our way
16:51
up and determine where our numbness is. Now I
16:56
gave a specific level for numbness, but numbness
16:59
is actually a gradient because pain level will
17:04
be higher than touch. Like I said, I still expect
17:07
them to feel touch and pressure, which is a different
17:09
level from motor. Everything has a different
17:12
level, but what I want to see is where our pain
17:14
level is. And so what we often do is we use a
17:18
sharp, but not too sharp implement to check.
17:24
um to see if if they're feeling like a poking
17:26
sensation kind of like the end of a paper clip
17:29
yes um it if it feels more like the tip of your
17:34
finger that would be a more dull sensation but
17:37
if it feels like a pokiness like the end of a
17:40
paper clip that would be the sharper sensation
17:44
that we're looking for um this can be really
17:48
tough because again people might feel it but
17:51
can't tell us If it's sharp or not. So oftentimes
17:55
we'll start on the arm, which we expect not to
17:58
be numb and to feel quote unquote sharp. And
18:02
then say, does it feel the same as we work our
18:06
way up from leg all the way up to again arm?
18:10
Another thing we can do is to check temperature
18:14
because your temperature sensation goes away
18:17
with your pain. So you can check to see if something
18:19
feels cold. It might not feel cold until you
18:24
again get to where your would feel sharp pain.
18:29
And so you can check and see, does this feel
18:32
cold? And it's an ice cube. And of course it's
18:34
going to feel cold except if they're numb. So
18:37
one is not necessarily better than the other,
18:41
but both work well on different patients and
18:44
how they respond to your questions. That makes
18:49
a lot of sense. Let's talk about when patients
18:53
might start feeling a big sensation during a
18:57
C -section. Obviously, it's very important to
19:01
us to make sure that our patients are getting
19:03
through things safely and comfortably. But a
19:06
lot of times, things can be misinterpreted as
19:09
pain when it's actually pressure, or it could
19:12
be real pain that we don't want to ignore. How
19:14
do you approach those situations to tell what's
19:18
what? And how do you treat those patients? Yeah.
19:22
So when a patient says that they're feeling pressure
19:26
or they're feeling pain or they're feeling uncomfortable,
19:30
any of those words, even if they just grimace
19:33
and they are not voicing it to you, but they're
19:35
showing you signs that they're uncomfortable
19:37
during their C -section, it's important to delve
19:39
further into what they're truly feeling. Now,
19:43
some of them will say, I don't know. Which basically
19:45
just means that the pressure or discomfort is
19:48
so intense that they really can't parse it out,
19:50
which to me may not be pain. But for them, it's
19:54
intense enough to feel like pain and probably
19:57
should be treated in one way or another because
19:59
they're at that level of discomfort. But a lot
20:03
of times they can tell you, oh, yeah, it's just
20:05
pressure. It just feels a little uncomfortable.
20:09
Or they'll say, oh, no, I'm feeling pain. It
20:11
feels sharp. It feels like a knife. And then
20:14
that's a sign that the numbness is not where
20:17
you think it's going to be or where you think
20:19
it is. And that maybe your epidural or spinal
20:24
is not working adequately. Now, even an epidural
20:29
that is, quote, unquote, working normally, if
20:32
they're still feeling pressure that's that intense,
20:35
maybe they do need supplementation. And it doesn't
20:37
mean that the epidural, you know, doesn't have
20:40
a good level. But in some sense, it is a bit
20:43
of a failure of the epidural because it's not
20:45
keeping them completely comfortable and they
20:47
do need supplementation or even conversion to
20:50
general anesthesia. So that needs to be a constant
20:52
communication with the patient, telling them
20:54
that you hear them, asking them how they're feeling
20:57
and seeing what you can do to help them through
21:00
that moment or the rest of the surgery. Yeah,
21:04
I think it's a very individualized thing too.
21:07
And I think you have to connect empathetically.
21:11
with the patient, look at their face and try
21:15
to ask yourself, do you think that this patient
21:20
is going to be able to get through this with
21:24
enough comfort for it to be acceptable or appropriate?
21:28
Or do we think that we need to do something about
21:31
it? But it's also tricky because whatever we
21:33
give to mom also goes to baby for the most part.
21:37
So whenever we give mom a pain medicine, It can
21:41
affect how the baby is breathing when it comes
21:44
out from the C -section too. So it can be really
21:47
tricky. Absolutely. It's definitely a balance
21:50
of making sure that mom is comfortable, but then
21:53
also making sure that baby is safe because that
21:56
will impact mommy and baby's experience as well.
22:02
So shifting gears a little bit, back when you
22:05
were in your OB fellowship, that is when you
22:08
became pregnant for the first time. Is that right?
22:10
Yes. Can you walk me through what that time was
22:16
like for you? It was mostly anxiety provoking
22:23
because I could see all the complications that
22:27
we deal with on OB. And that was very scary.
22:31
It was also very exciting. And it was neat to
22:34
be able to relate to patients on a new level,
22:37
like not just. hey, I kind of, in theory, understand
22:41
what you're going through to, oh, no, I'm actually
22:44
there and I'm experiencing things as well, being
22:48
able to relate on that new level with patients.
22:54
I think in medicine, we often see the complications,
22:57
which is why, again, it can be anxiety provoking.
23:00
But as time progressed through that pregnancy,
23:02
it became easier and easier. Like, OK, nothing,
23:05
you know, nothing's really. gone wrong. And,
23:09
and I'm, I understand a lot of what's going on.
23:12
And so it was, there were certain moments that
23:15
were reassuring to me, given my physician background
23:18
to help with the pregnancy. And then, like I
23:23
said, it was kind of exciting to be pregnant
23:26
and relating to my patients in that way as well.
23:29
Yeah, that makes a lot of sense. And I remember
23:31
talking to you a lot about how you were feeling.
23:37
during that pregnancy, and it was something that
23:39
was exciting because we're friends and we enjoy
23:43
spending time with each other and we play board
23:46
games at each other's houses a lot. But let's
23:53
talk about sort of what happened. In whatever
24:00
way that you feel comfortable sharing, I wonder
24:03
if you could talk about... What happened about
24:06
halfway through pregnancy? Yeah. So at 23 weeks
24:12
pregnant, I did get sick for about 24 hours and
24:19
thought nothing of it. And nothing really happened.
24:23
And it was fine until a few days later when I
24:27
was at home and I stood up and my water broke.
24:33
As a physician, I was very nervous, and I was
24:36
also a little bit in denial. I was like, no,
24:38
that can't have been my water. That can't have
24:41
just happened. But I went in to the OB office,
24:47
and they confirmed that my water had broke. And
24:51
I recommended that I go to the hospital. At the
24:56
time, I was in the care of a different hospital
24:59
system, different health system. But I chose
25:04
to come to our hospital because I knew the high
25:10
-risk OB group here. And I knew that at 20 weeks
25:13
and five days, I was now in a high -risk group
25:17
of individuals who had had my water prematurely
25:21
broken. So I came in and was admitted to the
25:25
hospital. For a few days, I was in the hospital
25:31
and being monitored. And then day three or four
25:36
of being admitted, I started to feel abdominal
25:42
pain. And again, I was a little bit in denial.
25:45
Did not realize I was in labor until a few hours
25:49
into the labor when the OBs came and checked
25:54
on me and said, oh, your cervix is dilating.
25:57
The umbilical cord has come through the cervix.
26:01
What do you want to do next? And it was a snap
26:04
decision. I had to have emergency C -section
26:08
to try to rescue my baby. And so she was born
26:14
via an emergency C -section. She lived for a
26:19
few hours in the NICU, during which she coded
26:21
a few times. And then after or around her third
26:26
code, we decided not to continue with. and to
26:33
transition to comfort care. So then she passed
26:38
away. And it was, of course, very hard at the
26:44
time. And it still is very hard. But there's
26:56
no but to it, really. It's still very hard. to
27:00
lose your child. And it doesn't matter that it
27:02
was only 24 weeks and two days. It's still, she
27:08
still is very much my daughter. And, but now
27:16
I do feel like I have a different grasp on obstetrics
27:21
because I have not been that patient who had
27:24
a complication. And so I can, in some ways, relate
27:29
to my patients even better because those times
27:34
when things are scary and things aren't the way
27:37
we planned, I've been there. One of the reasons
27:43
why we talked about having this conversation
27:49
was not to... share your story with the podcast
27:58
audience for no reason, but so that people who
28:02
are listening could understand a little bit better
28:08
how to help deal with patients who are going
28:13
through something like what you went through.
28:16
And that's a really difficult thing. I remember
28:20
at the time being your friend. And it was obviously
28:27
impossibly hard for you. But in a different way,
28:32
it was hard for me as your friend seeing you
28:34
go through it and not knowing exactly what the
28:38
best way was to support you. Now, I remember
28:43
as sort of people started to find out what had
28:49
happened, our whole department, rapidly got behind
28:56
you and mobilized and got you guys things like
28:59
food and tried to support you as best we could.
29:02
Um, yeah, I am eternally grateful for all the
29:07
support that our department has given me and
29:10
my husband, um, during not only that after that
29:15
pregnancy, but then with our, uh, pregnancy for
29:19
our next child, because I was very stressful.
29:21
Um, everyone has been Over the top supportive
29:25
of us every step of the way and very understanding.
29:29
And I think that's one of the biggest things
29:32
is just showing that you care. Being supportive.
29:39
Acknowledging that what your friend or what your
29:45
patient has gone through is is real and it does
29:49
hurt. I think some of the. Hardest things that
29:53
people said is all related to, you know, oh,
30:01
you know, you'll have another kid or oh, well,
30:03
kind of brushing it under the rug was really
30:07
hard to go through because I just wanted to be
30:09
validated that, yes, what I went through was
30:15
real. is awful and it's not just oh I'll have
30:19
another kid it's that was my kid and I lost it
30:22
sure I'll have another kid but that's not what
30:24
I'm worried about right now is the loss of my
30:28
current kid um so having that validation of what
30:34
you're going through is tough and maybe you don't
30:37
understand how to relate to it and you can't
30:39
really say oh yeah I you know um even people
30:42
um people would say oh you know I had this terrible
30:46
experience during my pregnancy nothing like what
30:49
you went through and telling me that saying having
30:52
that extra thing of like you know I understand
30:55
that like what I went through was hard but it
30:58
wasn't losing my child and so having that validation
31:01
was very comforting and then when people didn't
31:05
validate or they did because it's uncomfortable
31:08
try to kind of sweep it under the rug or forget
31:11
about it or That was actually what hurt the most.
31:15
And I think it's hard because we don't want to
31:16
talk about things. One of the reasons I wanted
31:21
to talk about this is I did have a resident come
31:24
to me and they were in a C -section with a baby
31:26
who was not expected to survive. They said, I
31:29
had no idea what to say. And I said, well, just
31:34
being there for them is important. Not saying,
31:39
you know, not ignoring it. It's hard to talk
31:43
about it, and maybe the mom doesn't want to talk
31:46
about it, but it also shouldn't be something
31:49
where you completely ignore what they're going
31:51
through at that moment. Acknowledging them still
31:56
as a mom, because I very much identified as a
31:58
mom. Those are all really important things that
32:04
you can do if you know someone or, again, know
32:07
a patient. who has gone through that loss is
32:11
recognizing that loss. I had a friend who also
32:16
lost her child at 35 weeks, and we talked about
32:24
this, and she also agreed with me. She said the
32:28
biggest thing was just recognizing the elephant
32:30
in the room. One of the nurses turned to her
32:32
and said, wow, this really sucks. And she said,
32:35
yeah. Yeah, that was really helpful to have someone
32:39
say, I see what you're going through and it's
32:42
awful. And it's a silly little thing, really.
32:46
But being that person and saying that, you know,
32:50
like what you're going through, that's that's
32:52
really awful. It's extremely interesting how
32:58
validating that feels and how. that can actually
33:05
be helpful because no one wants to say that no
33:07
one wants to say wow this you know I'm so sorry
33:11
that your your baby's dying or that that absolutely
33:14
sucks your baby's about to die or you know you
33:17
don't want to say those things but just actually
33:21
acknowledging that the mom is going through something
33:24
and I took that and I used it going forward once
33:28
I had come back to work you know seeing a pregnant
33:32
patient who had to have basically had a miscarriage
33:41
and talking to them and being like, you know,
33:47
this is really awful. And I'm so sorry that you've
33:49
had to go through this. I know this is a really
33:51
tough situation for you. And not even saying
33:54
like, oh, I went through something similar, but
33:56
just saying this is really, really sucky. And
33:59
I'm really sorry that you've been put in this
34:01
situation. And also acknowledging that it's nothing
34:07
that they did. They've been put in this situation.
34:10
It's not like, oh, well, if you had done this
34:13
or, oh, you know, well, maybe next time. You
34:17
know, nothing like that, but just saying this
34:20
happened to you. And I'm sorry it did. I think
34:26
that it can be very difficult for patients going
34:30
through this when they activate. the backwards
34:36
looking part of their brain thinking to themselves
34:38
if anything could be different or if things had
34:45
been different. And I remember having some of
34:49
those conversations with you and they were really
34:52
hard conversations where we were looking backwards.
34:57
And the thing that I remember is that at that
35:03
time, it seemed like you had a lot of guilt.
35:07
And to my eye, that seemed wild to me that you
35:14
would feel that way. I wonder if you could tell
35:18
me a little bit more about how you felt and if
35:23
that's changed now with time and what you think
35:28
about it. Yeah, I think it's very... easy to
35:34
feel guilty when a bad outcome happens especially
35:38
when you're the parent of a child that passes
35:42
away it's easy to say oh I could have done something
35:46
and I think as a physician especially we have
35:49
we feel like we have a lot of control and understanding
35:52
over things but ultimately we can't change the
35:57
past For sure. We can look back and they always
36:01
say hindsight's 2020. But even now, I don't think
36:04
hindsight's 2020 on this. But you can look back
36:09
and say, well, I should have done this or I could
36:11
have done that. And again, the people I know
36:13
who have lost children will say that, too. Like,
36:18
oh, you know, I felt like I could have done this
36:20
or maybe I should have. gone in sooner I should
36:23
have done this and there's a lot of could have
36:25
should have but ultimately it's not anything
36:29
you did um that brought this about things happen
36:36
and and it's not anyone's fault to this day I
36:45
do I still sometimes feel like Could I have done
36:48
something differently? I don't think that feeling
36:50
will ever really go away. I can logic that no,
36:54
like there's nothing I could do differently.
36:56
But there's that lingering feeling of could have,
37:00
would have, should have that doesn't really change.
37:07
And the best thing you can do is just accept
37:11
that that things happen and that sometimes there
37:15
isn't a reason or maybe. Next time there's something
37:18
you would do differently. And it's irrational.
37:21
My second pregnancy, I didn't fly. I don't think
37:24
it had anything to do with flying, but I had
37:26
been on a flight less than a week before my water
37:28
broke. So in my mind, I was like, I'm just not
37:31
going to fly. It wasn't really harmful to not
37:33
fly. So why not just do it? And so I think everyone
37:38
kind of carries those little things with them
37:41
that. You can't let it impede your life, but
37:47
at the same time, you know, if there are little
37:50
things you do that give you comfort, then that's
37:54
okay too. The second time I went to the OB emergency
37:57
department one or two times, not because anything
38:01
was wrong, but because I felt odd. And I said,
38:04
ah, I don't want to feel odd. What if something's
38:07
happening? And it probably cost me a couple hundred
38:11
bucks, but. It did give me the peace of mind
38:15
of knowing that everything was still going okay.
38:19
And so there are little things that I changed
38:23
or did differently. And that probably stemmed
38:26
from guilt or the thought that maybe I could
38:27
control or change anything. But ultimately, it
38:31
really isn't in our control. And trying to accept
38:36
that can be really hard, but helpful. I remember
38:40
talking to you. once or twice when you were having
38:46
some acute anxiety during your second pregnancy
38:49
with Christopher. And you were trying to ask
38:54
my opinion about whether or not you should go
38:56
and talk to the OBs and kind of curbside them
39:00
to maybe get a quick ultrasound done to see what
39:04
was going on because you maybe felt slightly
39:06
differently and things like that. And I remember...
39:12
You're going on maybe a couple different occasions
39:14
just to curbside the OBs. Yeah, helpful bonus
39:19
to being an OB anesthesiologist is I know the
39:21
OBs and they know me. And so it was very easy,
39:28
fortunately, for me to just pop over and say,
39:30
hey, what do you think of this? Am I being crazy?
39:33
And sometimes they'd be like, let's just check
39:36
you out. Make sure everything looks okay. Okay,
39:39
everything looks great. No big deal. And just
39:43
having that little curbside was so helpful because
39:48
I could, you know, rest assured a little bit
39:51
that things were going okay. Do you feel like
39:56
it made it easier or harder having all of your
39:59
obstetric knowledge going through pregnancies?
40:04
I think in some ways it made it easier because
40:08
there were things that I understood. that were
40:14
helpful to me going through my pregnancies. Things
40:21
I understood about odds and after I did have
40:27
my water break, what that might look like, having
40:31
seen patients go through that as well. Having
40:38
an idea as to what I was, when I chose to have
40:40
an emergency C -section to try to save my daughter,
40:44
I knew very well what I was going into. I was
40:47
about to have a major abdominal surgery. And
40:49
because I was so early on, I was going to have
40:51
no choice but to have C -sections for all future
40:54
pregnancies. And some people don't know what
40:57
that means, but I've been through OB enough that
41:00
I knew exactly what I was accepting as a risk.
41:05
in order to try to get my daughter out so she
41:08
could live. And maybe if I didn't have that knowledge,
41:12
I would have still made that decision. But I
41:14
at least went in with my eyes open as to what
41:16
exactly the risks I was accepting with that.
41:22
So in some ways, it was helpful. And in other
41:25
ways, it was more terrifying. Like when they
41:28
told me in the OB office, yeah, your water broke,
41:32
I started crying immediately. And they were like,
41:34
We haven't even really told you what that means.
41:36
Why are you freaking out? But I had seen enough
41:41
patients that I knew exactly what it meant. And
41:45
I knew what the road ahead of me looked like.
41:47
And so helpful, but also not because my anxiety
41:53
level was probably higher than the average person
41:55
who was told their water broke. I think also
42:02
it gave me a false sense of control. So I was
42:05
in the hospital and I would, you know, something
42:09
would happen. I was starting to feel pain. I'm
42:11
like, this can't be labor. I know what labor
42:14
looks like. It was labor. But I thought I knew.
42:19
I didn't. I'd never been through it before. I
42:21
don't know why I thought that. Having seen it,
42:24
I would then know what it felt like. So I think.
42:30
It kind of goes both ways. I remember a very
42:35
distinct point in your second pregnancy with
42:39
Christopher where you got to the same length
42:45
of time in your pregnancy that you did when you
42:49
had Alice. Was that reassuring to get past that
42:55
point? Can you describe what your feelings were
42:57
around that time? So 24 weeks was very hard on
43:02
me when I was pregnant with my second because
43:05
I had lost Alice at 24 weeks and two days. I
43:09
had ruptured at 23 and five days. So those four
43:13
days were very anxiety provoking for me because
43:17
could it happen again? Logically, it wouldn't
43:20
happen at the same exact time. That would be
43:22
really, really odd. But there is something inside.
43:27
You that says, oh, my gosh, this could happen
43:29
again. And this is the moment that it did happen
43:32
before. Could I could it happen again? Once I
43:36
got to 25 weeks, it was reassuring because I
43:40
had never made it that far in pregnancy before.
43:42
And so there was a sigh of relief of, OK, I have
43:46
made it to 25 weeks. And again, being an OB anesthesia
43:49
and having worked a little bit in the NICU. I
43:54
kind of I knew what the difference between a
43:55
24 week baby and a 25 week baby was. And so it
43:59
was reassuring from that standpoint, too, that
44:02
if he was born now, he at least had a better
44:05
chance of survival than my baby at 24 and two.
44:09
So even if it did happen again, we had made it
44:13
further and there was a better chance that he
44:16
was going to have. a more positive outcome. I
44:25
remember when you came back, you had a tough
44:37
time coming back to work on OB, which I think
44:39
made a lot of sense. I think that there was likely
44:44
some component of PTSD associated with that.
44:49
But over time, You sort of eased yourself back
44:53
into working in OB, and that's what you did your
44:56
fellowship in, and you're quite good at it. I
44:59
wonder if you could talk about how you overcame
45:03
that to a degree and how you feel working in
45:09
OB now. I did take a little bit of time coming
45:14
back to OB. I think, as you mentioned, Having
45:21
been through everything, PTSD would be normal,
45:25
and we don't always normalize it, but it would
45:28
be a normal response to what I went through.
45:31
I think the major reason I didn't go back to
45:34
OB right away is I did not want my experiences
45:36
to impact my patients' experiences. I did not
45:40
want to be in a delivery and start crying, and
45:42
they're like, but my baby's fine. What are you
45:44
doing? Because... of how recent my experiences
45:50
have been but over time that became easier to
45:55
do and it's something I really do have a passion
45:58
for and love so it's not something I would ever
46:01
really plan on leaving behind or letting the
46:05
fear or emotions associated with my experiences
46:11
impact my career. as an OB anesthesiologist.
46:20
Over time, it became easier to shift my experiences
46:25
into positive outcomes for other patients, not
46:29
positive outcomes in terms of like, you know,
46:31
I was going to help their babies do better or
46:33
anything like that, but have their experiences
46:36
be impacted positively by my experiences. And
46:42
so that was important to me too, that I could
46:44
use my experiences to help others as they went
46:50
through similar experiences. What do you think
46:56
are some of your best pieces of advice for how
47:00
to approach friends and colleagues that might
47:02
be going through a situation like what you went
47:05
through? Absolutely. I think anyone who has been
47:11
in the situation would hopefully agree that Time
47:17
doesn't heal all wounds. I wish I could tell
47:21
you that at some point you just it is what it
47:24
is. It's the past. Maybe you're more willing
47:26
to talk about it. Maybe you can turn the situation
47:29
into more positive things like helping others
47:32
with what you've been through. And that's amazing
47:35
and important. But to this day, I still think
47:40
of my daughter. That never goes away. And it
47:45
can sneak up on you in different moments. And
47:48
that's okay and that's normal. Everyone grieves
47:55
differently. Everyone has different experiences
48:00
when it comes to losing someone they love. And
48:04
just because you are different from your spouse,
48:08
are different from your mother, are different
48:12
from... Siblings, everyone experiences the loss,
48:16
but everyone experiences it differently. And
48:19
it doesn't mean you're different or grieving
48:23
wrong. Everyone grieves differently. And understanding
48:30
that is important and trying to understand where
48:34
other people are coming from and their grief,
48:36
because you're not the only one grieving when
48:38
you've gone through a loss. The people around
48:41
you are grieving with you. And they might show
48:43
their grief in different ways. And that's important
48:47
too. That you all recognize your grief. And then
48:55
recognize other people's grief as well. I think
49:00
those are the biggest things that I would want
49:02
someone to take away. That people grieve differently.
49:06
Different timelines. You never stop truly grieving.
49:09
But it just looks differently. And sometimes
49:11
you can. Turn it into helping others. What should
49:15
friends do if they want to help but they are
49:18
afraid of saying the wrong thing? I think that's
49:23
a fear that a lot of people have when they have
49:25
someone, a friend, family member, going through
49:28
a loss. And again, I think it's hard to say things
49:34
like, so sorry for your loss or to bring it up.
49:38
You don't want them to, if they're not talking
49:40
about it. You don't want to bring it on them
49:43
so that they are thinking about it. I can tell
49:46
you they're thinking about it, whether they're
49:47
talking about it or not. And so just as I mentioned
49:53
earlier about reading each patient, reading your
49:58
friends and seeing what they need most. And sometimes
50:02
it's a hug and some silence. And sometimes it's
50:05
saying, that really, really sucked. Or sometimes
50:08
it's letting an ear and being like. Tell me about
50:11
it because I don't know what you're going through
50:14
or don't know what you went through. Sometimes
50:17
it's just very simply addressing it, saying,
50:23
I'm so sorry that that happened. But I think
50:28
as a society, we're very commonly, we just kind
50:31
of ignore it or we push it under the rug or we
50:35
want to talk about other things. And I think
50:36
there's a lot of things. that you can say and
50:44
maybe some people will take it the right way
50:45
and some people will take it the wrong way but
50:48
I think just saying something or being there
50:53
is is one of the biggest things and not ignoring
50:57
it or um brushing another rug or um saying oh
51:07
well but At least this is true or, you know,
51:11
trying to look on the bright side because maybe
51:12
they don't want to look at the bright side right
51:14
now. And that's okay. If they want to look on
51:17
the bright side and they say at least that, you
51:18
can agree with them. But I think that's important
51:25
as a friend just to be there for them in whatever
51:31
way that looks like. Bring them a book to read
51:35
or a meal you made or, again, just sitting there
51:40
or listening. You don't have to say anything
51:45
but just being there. Lastly, I want to wrap
51:51
up with a question about what your style points
51:56
are or what your points of personal preference
51:58
are. help you on OB anesthesia or just generally
52:03
in life. What do you want to leave us with today?
52:09
I think one of the great privileges of our job
52:13
is to be there for patients, whether it be on
52:16
OB or in the main operating room or whatever
52:20
environment you're in as an anesthesiologist,
52:24
being there for patients during a time of need.
52:30
And recognizing that, recognizing the situation
52:35
they're in, helping them through it, telling
52:39
them that you'll be there, being a confident
52:44
supporter of them, letting them know that you
52:48
see them as a person. These are all amazing things
52:51
we can do to help our patients through the day.
52:54
And I think that also extends into life when
52:57
you... you know, see your friends or your colleagues
53:00
going through something, listening, being there
53:05
for them. Even little things can make a huge
53:09
difference in someone's day, be it a patient,
53:12
you compliment them on their nails, or your friends,
53:15
you just listen to them talk about how terrible
53:18
their weekend was, or what have you. Being there
53:23
for each other is a wonderful privilege that
53:28
we have as anesthesiologists but then also that
53:32
we carry over into life Mary thank you for sharing
53:39
your beautiful voice with us thank you for having
53:42
me that's it for this episode of style points
53:51
I talked to Mary for a while about this episode
53:55
She told me that if anyone is listening who wants
53:58
to reach out and talk to her about what we discussed
54:00
in the episode, she's happy to talk to you. If
54:04
you'd like to help other people find the podcast,
54:06
please feel free to leave us a rating or a written
54:09
review. That's the number one thing that will
54:11
help other people find the show. You can also
54:14
contact me at stylepointspodcasts at gmail .com.
54:19
Take a deep breath. Open your eyes. We're all
54:23
done.