Perils of a postpartum pediatrician

During my first pregnancy, I frequently dreamt of my baby. I couldn’t remember the details of facial features or hair color, but I always knew that I was going to have a girl.

Three years passed after Claire was born, two more heartbeats were identified and then lost somewhere deep within my abdomen. On two occasions, I watched blood seep from my body and stain my clothing, realizing that I didn’t know if it was my blood or my baby’s. I watched our blood ripple into concentric circles as it dripped into the toilet.

I clung to the fact that I had a healthy beautiful toddler. I rocked her to sleep each night and sang to her long past the time when her body grew slack in my arms, and her breathing became slow and regular. “So sleep tight baby, unfurrow your brow and know I love you. We’re alright for now, we’re alright for now.”

Months went by with their clockwork crimson verification that I was still not pregnant. Bloodwork obtained after the second miscarriage revealed a clotting disorder of questionable significance. I was straddling the fertility precipice of my 35th birthday. I second-guessed my decision to pursue a career in medicine, delaying marriage until age 29. I cursed the slow wheels of evolution, irritated that our bodies are still prime to reproduce in our teens and 20s even though emotionally and financially we are better off in our 30s and 40s.

After nearly a year, I discovered that I was pregnant in the Target bathroom. I saw a high-risk OB/Gyn and was labeled an elderly multigravida. I injected anticoagulants into the soft flesh of my belly twice a day, just to be safe. I delivered a perfect baby boy at 38 weeks.

Charlie was perfect until the evening when I noticed that he had the mildest of retractions, causing his chest to suck in right below his ribcage with every breath. I snuck a stethoscope out of my bag and listened to Charlie’s heartbeat. It was way too fast for a sleeping infant. I repeatedly calculated the horrifying sum of 200 beats per minute.

I packed a bag to take to the ED, certain that we would be admitted to the PICU with a life-threatening congenital heart defect. I was already envisioning Charlie’s inevitable first open-heart surgery.

But when we got to the ED, the triage nurse looked at my seemingly healthy baby and seemed perplexed. I had to sheepishly explain that I had broken a cardinal rule of physician parenthood — listening to one’s own child’s heart. But my embarrassment was no match for my terrified conviction. She counted his pulse for 10, maybe 20 measly seconds. “It’s normal,” she chirped.

Once in the exam room, I was dismayed to see one of the newest ED attendings making his way toward us. He glibly stated/inquired, “I know that part of my job is to reassure you, so what can I do to make you feel better?”

“Well, can you at least put him on a monitor?” I asked, incredulous that this had not yet been done. Charlie was attached to the cardiorespiratory monitor that confirmed that his heart rate was trucking along at 215. Dangerously close to being textbook SVT. While we sat there, my eyes glued to the monitor, Charlie fussed a little and I started to nurse him. ED Physician was quick to point out that eating was exercise for babies, so of course his heart rate would be high!

After he left again, I watched as the number on the monitor gradually went down to the 170s over the next 30 minutes. When he returned, I curtly stated, “I’m reassured that he does not have anything immediately life-threatening,” so we were given our discharge papers. Over the next couple of days, Charlie’s heart rhythm, structure, and function were carefully evaluated and pronounced normal.

Within days, though, I felt Charlie’s foot twitch rhythmically while I held his ankles during a diaper change. I quickly tried to reproduce the twitching by bending his foot back at the ankle, a maneuver to check for clonus. Sure enough, I could get his tiny feet to twitch five, ten —, sometimes even 15 — times in a row. Clonus is a pathologic neurologic finding in older humans, but I was desperate for reassurance that it could be normal in infants.

So I broke another fundamental rule, fully aware of the Pandora’s box I was opening, by performing a Google search. Not even a medically sophisticated one. I found an article that correlated the number of clonus beats with abnormal neurologic outcomes. I was devastated by this article and its implication that my son had a high likelihood of pathology. I spent weeks of my maternity leave obsessively checking him for clonus hundreds of times per day.

I slept on the living room couch next to his bassinet. Every time he stirred, the noise from the plastic mattress cover woke me up. I was analyzing Charlie’s every move, certain that his jerky baby movements portended an ultimate diagnosis that would break my heart. I poured out my observations to my husband who tried to reassure me that we would love Charlie no matter what. I called my mom and begged her to pray for Charlie and me. I stood sobbing on the front porch, repeating my pleas over and over because she couldn’t understand my anguished, distorted words.

I held Charlie for hours that winter as we watched the Oscar contenders. Toward the end of my maternity leave, I mustered enough insight to call my obstetrician, to meet with a counselor and to start a lactation-friendly SSRI. I know I love Charlie, and we’re alright for now. But I wish I could have fully immersed myself in those heady hours and days of his fleeting infancy. I worry about how my worry may have impacted him, that tiny vulnerable creature who bore the brunt of my scrutiny.

Lisa Sieczkowski is a pediatrician. 

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