Despite my protruding second-trimester bump, I had never exited a patient's room so quickly.
As a second-year EM resident working in the pediatric ED, I had assigned myself to a 4-year-old with a chief complaint of dysuria, as he had a history of a vesicorectal fistula leading to frequent urinary tract infections in his short life. Walking into the room, I found an uncomfortable-appearing child in a brown Winnie the Pooh T-shirt, with a concerned mother at bedside. We chatted about his presentation (2 days of fever and general discomfort), and then I tugged off his shirt to reveal vesicles in various stages spreading across his chest.
My heart quickened as I peered over him and noticed the rash popping up on his hands, arms, legs. I quickly excused myself from the room, giving thanks under my breath that I was still wearing an N95 despite the institutional expiration of the mask mandate. After relaying this story and my concern to my co-resident, they agreed without hesitation to take over the care of this likely varicella case, and I spent my post-shift hours that day reading up on vertical transmission.
It is a tricky thing to balance an unborn child’s wellness with the needs of the patients walking into the ED. Throughout those 9 months, the fear of nosocomial infection and uncertainty in navigating choices surrounding maternity leave, counterbalanced with the warmth and kindness of colleagues, attendings and patients made my first pregnancy a profoundly confusing and heartwarming journey.
I remember sitting in the ergonomic spinning chair at my program director’s office for my maternity leave planning meeting, wondering if I was asking too much. While most PDs make informal adjustments as needed, most EM programs do not have formalized scheduling policies for their pregnant residents.1 I was 8 weeks into this journey – exhilarated, terrified, nauseous. Out of the 20 annual templated schedules, there was exactly 1 that would allow for the flexibility of 2 months that did not require coverage during the dates of my predicted due date, ensuring - to the extent that I could control it - that none of my co-residents would have to step in to cover my absence. My program director responded, to my immense relief, “Choose whatever schedule you want, and we’ll make it happen.”
Several months later, another memorable interaction - chief complaint: testicular pain. He was in his mid-50s, with a neat plaid shirt and a backwards-facing trucker hat. As I entered the room, he beamed. “You’re having a boy! I can tell, just by the way you’re carrying.” Turns out he had 10 children of his own, with 5 grandchildren and counting. He was here for STI screening after an episode of unprotected sex. The trick: to balance charitable feelings toward this man and listen humbly to his parenting advice while performing a genital exam, without tipping the scales toward condescension. With gusto, pantsless, he narrated the early stories of his children: the thrill of a swelling belly, the sacred act of cutting the umbilical cord, the early, milky, sleepless nights. Bashfully yet steadily, my excitement for parenthood continued to grow with each memory he recounted.
Fast-forward to my 35th week of pregnancy, as I waited to board a flight back home after a medical conference. Before leaving on the trip, I made sure to check with my OB/Gyn - an intern whom I worked with as a senior in the ED - in order to obtain the required letter confirming my ability to fly until week 36. The prior night, I could not sleep after a full day of business meetings, subsequent socials, and 6 miles of walking through the city. A deep, persistent pain in my lower abdomen spurred my first visit to emergency OB triage, halfway across the country from my husband and family. As I boarded an Uber at 0300 from the conference hotel to a nearby hospital, the gentleman driving gave his standard introduction but quickly became silent. After a long 5 minutes, he blurted out, “Ma’am, I don’t mean to be rude, but are you about to have a baby?!” I chuckled softly, “I really hope not.” For the next few hours, I laid in OB triage hooked up to a tocometer and Doppler, trying and miserably failing to get comfortable. The contractions mercifully petered off after some fluids and rest. The nurses were incredibly kind, and cautioned me about the risks of dehydration and overexertion. I bid them goodbye and caught a ride back to the hotel to finish out the conference in the morning, taking with me a lesson in the physiologic changes of pregnancy learned the hard way.
It is no small wonder that studies show pregnant residents working long hours and nights may be at higher risk for depression,2 hypertension,3 spontaneous abortion,4 and preterm birth.5 After years of pushing the limits, accustomed to our ability to cram in more than we believe is possible, the very real physical constraints of pregnancy are shocking. How do we hold these two realities in tandem – the jealous demands of a residency schedule, with the flourishing of new life and a new role as a mother? Hospital versus home? Patients versus family?
All told, I had a relatively easy pregnancy journey. My co-resident husband and I benefited from a short commute, financial stability, and grandparents nearby to ease our childcare burden. Thanks to the work of our resident union, I also had the option to take a full 2 months of maternity leave prior to returning to work, delaying graduation by just 2 weeks in favor of more time with the little one in early postpartum days. These privileges challenge my preconception of the mutual exclusivity of the roles of resident and mother, pushing role balances toward equilibrium, allowing space for patients and family, hospital and home.
I pondered all these things as a summer rain was falling lightly outside O’Hare; it looked like a christening of the tarmac and of this beautiful city. I breathe in, I breathe out. I am grateful for my calling to medicine. I am grateful for my husband, family and friends. I am grateful for frequent fetal kicks. And, more than ever before, I am grateful to be headed home.
References
- MacVane CZ, Puissant M, Fix M, et al. Scheduling practices for pregnant emergency medicine residents. AEM Educ Train. 2022;6(6):e10813.
- Lee A, Myung SK, Cho JJ, Jung YJ, Yoon JL, Kim MY. Night shift work and risk of depression: meta-analysis of observational studies. J Korean Med Sci. 2017;32(7): 1091-1096.
- Patterson PD, Mountz KA, Budd CT, et al. Impact of shift work on blood pressure among emergency medical services clinicians and related shift workers: a systematic review and meta-analysis. Sleep Health. 2020; 6(3):387-398.
- Whelan EA, Lawson CC, Grajewski B, Hibert EN, Spiegelman D, Rich-Edwards JW. Work schedule during pregnancy and spontaneous abortion. Epidemiology. 2007;18(3):350-355.
- Lawson CC, Whelan EA, Hibert EN, Grajewski B, Spiegelman D, Rich-Edwards JW. Occupational factors and risk of preterm birth in nurses. Am J Obstet Gynecol. 2009; 200(1):51.e1-51.e8.