The pregnant surgeon

A recent article on Kevin MD (originally from the New York Times) discussed “The Plight of the Pregnant Surgeon” http://well.blogs.nytimes.com/2012/02/23/the-plight-of-the-pregnant-surgeon/?smid=tw-share&_r=0 . While the article makes good points, it doesn’t actually give any insight into what it is like to be pregnant and a surgeon at the same time- the actual day to day mechanics.  I had three different pregnancies while a surgeon at three different hospitals in two different countries, so I thought I would share some insights.  If one pregnant (or thinking about being pregnant) female surgeon reads and identifies with this, and feels slightly less alone because of it, then my work is done.

Over ten years ago, I was sitting with 2 female surgical colleagues.  I was recently married, one colleague engaged, and the other in a serious relationship.  We were discussing the best time to have children as a female surgeon.  Before medical school? As a medical student or resident (registrar)?  Or as a staff surgeon?  We discussed pros and cons of each, mostly focusing on the financial implications (never good) but ended up deciding unanimously that there basically was never a good time to be pregnant during a surgical career. We really had at that point very few senior female surgeons to look up to who had managed to combine having kids and a surgical career. (We recently reunited 10 years later, now having 8 kids between the three of us). Having said that, most women who choose a career in surgery will also choose at some point to have children as well, so this is something that we are all going to have to get used to.  While I realise having children is a choice, being a surgeon and a mother should not be mutually exclusive.

A month or so after that conversation, I found out I was pregnant.  This was a wanted pregnancy, make no doubt about it, we were elated.  There was about a 3-4 day gap between figuring out I was pregnant and the morning sickness hitting.  At the time I was working in a full time surgical position with 1/3 on call.  We knew the stats on miscarriage and we decided to keep the news to ourselves until after the pregnancy had passed 12 weeks.

I am normally a busy, active person but the fatigue associated with my pregnancy was not something I was prepared for.   One Saturday at about 8 -9 weeks pregnant I remember having the day off and my husband leaving at 6 am for golf.  The only things I managed to do in the 6 hours he was gone were go the bathroom and make a piece of toast.  He returned, grabbed his sailing stuff and headed out for another 6 hours.  At 6 pm he came home to find me still in bed, not having left the house all day and still in my pajamas from the night before.  It felt like someone had strapped a 50 kg weight to my back.  My bed was constantly calling to me to come lie down, and like Sirens calling to the sailors, it was irresistible.  I yearned to be lying down 24 hours a day.  This feeling, however, is largely not compatible with surgical life.  While a 40 hour work week is routine for a lot of jobs, a busy on call week for me was 60-80 hours.  And that was working, not just the on call.  I struggled to get up for work in the morning and loved hitting my bed at the end of the day.  I dreaded my pager going off. I don’t particularly recall being less attentive or churlish with patients, but I could have been.  I would also look back fondly on that day I spent in bed, as once you have young children, they don’t care if you have morning sickness, (or any other kind of sickness, bad call night, hangover, etc).

Work did provide a distraction from the constant nausea (which lasted all day). Particularly bad were some of the smells that come with working in a hospital, and some especially bad ones that come with general surgery, where one whiff would set me off, hurrying down the hallway muttering some lame excuse to whoever I was with.  But I soon discovered if I allowed my stomach to become even partially empty, the nausea would build until I started retching up bile.  I then learned to eat almost continuously to keep myself from retching and keep the nausea under control (cue massive weight gain and jokes in the lounge about getting checked for an insulinoma).  This approach worked provided I was not in the operating room.  The times I couldn’t get something into my stomach during a long case, I would dash into the nearest bathroom at the first opportunity once scrubbed out to retch into the sink.  I knew where every toilet was in the hospital and my pockets and purses were filled with sleeves of soda crackers. The idea I might vomit in front of my colleagues, or even worse into a surgical mask,  mortified me enough that while scrubbed I would swallow the bile down and soldier on.  One late evening while waiting to go into the OR for an emergency case, hypersalivation (another charming pregnancy symptom) started, probably because I hadn’t eaten dinner.  I stood dripping over a sink in the women’s bathroom hoping 1. that nobody would come in, and 2.that this would not continue once the case was called for (it didn’t). I liked the nausea in a way though. Morning sickness would become my frenemy in first trimester. While it was there, and the stronger it was, the more I was reassured I was not going to miscarry.

Around 14 weeks the nausea and fatigue faded to a bearable level and we started telling people about the pregnancy. The administrators, nurses, and colleagues I worked with were extremely supportive (for all of my pregnancies actually). In fact one of the first things I did after 12 weeks was apologise for my odd first trimester behaviour to my work colleagues, who assured me they had no clue I was pregnant (I think more likely that they were just being kind).  A new problem then emerged over the next few months.  Fainting- mostly in the operating room.  If I was the primary surgeon doing the case, my adrenaline would largely get me through.  If I was assisting or supervising somebody else though, and not the primary surgeon, within a few minutes of scrubbing in, my blood pressure would drop, the nausea and drooling would come, and I would have to scrub out or sit down.  The hat, gown, gloves, and mask worn in the OR, combined with the heat from the lights, the surgical wound, and the Bair hugger (essentially a large blow dryer used to keep patients warm on the operating table) was just too much.  I never actually fainted and hit the ground, but I came very close dozens of times.   I tried eating and drinking before cases but that just made the nausea worse when it did come on, as well as making my bladder feel more uncomfortably full than it did already. I tried  wearing tight special compression stockings to get the blood supply out of my swollen legs, but they just made me warmer. Moving my legs around during cases just caused me to jostle around and annoy whoever I was working with.  Nothing worked.  Like an athlete upset they have to leave the field after being injured, I would have to scrub out swearing at myself under my breath, feeling I had let everyone down.  Eventually the OR nurses started complaining about the number of new sets of gloves and gowns they had to open as I tried repeatedly to scrub back in for cases.  The further along the pregnancy got, the shorter the time between when I would scrub in and have to scrub out to avoid collapsing.  I ended up finishing work by mutual agreement with the hospital administration at about 31 weeks, as the only thing I was able to do was see patients in emergency and look after ward patients.  I was given paid leave for about 6 weeks, even though I had only worked at the hospital for 10 months, which I remember thinking was quite generous.  The second pregnancy I worked full time until 36 weeks, including call and then did admin only until 38 weeks.  I worked full time up to 38 weeks with the third as well.

The second pregnancy I developed excruciating left leg pain.  It would come on like a lightening bolt unexpectedly, and I would have to hold onto something to avoid falling down (the grab bars on the side of the hospital hallways were very useful).  It felt like someone was using my nerve as a guitar string. It would disappear within seconds, only to come back again a few minutes later.  Luckily these episodes were usually with walking around and not in the operating room. I later figured out this was probably the beginning of a hernia which later needed to be repaired.

Now some women have way rougher pregnancies than mine- hyperemesis, pre eclampsia, pre-term labour with bedrest etc.  I had a lot of the things pregnant women put up with, including constant guessing about the baby’s sex based on my belly shape and continuous comments on my weight and appearance. These aren’t particular to surgery.  But surgery is tougher physically than a lot of jobs.  It involves a lot of long days and even longer nights with responsibility not only to make decisions, but also to be there to physically DO something.  You just can’t phone it in.  The entire surgical system (and in some ways medicine in general) is NOT set up in layers where backup can be called in when surgeons are sick.  Even now I live in dread of getting sick from my kids and having to cancel operating or endoscopy lists, or asking a colleague to have to cover my call.  Although again, when this has happened, my colleagues have been very supportive, and mostly patients as well.  Surgery is hard and so is being pregnant, to varying degrees for different women.  There is lots of room for improvement in how we handle both illness and pregnancy leaves in surgery, including options for part time work, and surgical “supplies”  like the education system has for teachers. But even asking for help is tough and trying to push through the surgical culture to ask for help is ridiculously hard.  Harder than it should be.

So now to answer some common questions.  Yes, I could still reach the operating table (even operating at close to nine months). I would just turn to my belly to the side. No I did not have a C section for any of my pregnancies, even though I am a surgeon.  Would I want to be looked after by a pregnant surgeon?  Absolutely (although I never have been). And yes, I would do it all again in a heartbeat for my three beautiful kids.

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