Friday May 08, 2020
For FP Moms, This Mother's Day Is About Impact on Community
Editor's note: With Mother's Day approaching, we asked two of our new physician bloggers who are moms to reflect on balancing motherhood and medicine during a pandemic. Here is what they shared.
Caring for Other Mothers' Children
Mother's Day will look significantly different to most of us this year. There may not be the usual multigenerational brunches, and most of our favorite restaurants are closed or limited to carry-out service. Many typical gifts -- like spa days -- aren't options.
MaryAnn Dakkak, M.D., M.S.P.H., with her children Isabelle and Elias at the Grand Canyon.
Like any Mother's Day, however, there's also a wide spectrum of emotions people feel. Some may be grieving the loss of their mother (whether from COVID-19 or otherwise). Some may have loved ones who are sick, and many will not be able to see their mothers because of social distancing or the fact that nursing homes aren't allowing visitors. Others will be mothers for the first time.
Early in this pandemic, before we saw the surge here in Boston, when everyone was already comparing it to the 1918 flu epidemic, I told a doctor-mom friend of mine, "There is one key difference. There weren't doctor moms during the 1918 pandemic."
Indeed, at that time, less than 6% of doctors were women. Now women make up the majority of medical students and 48% of AAFP members are women. A full 90% of nurses working in hospitals are female. As The New York Times reported, women make up most of the essential workforce in the United States.(www.nytimes.com)
What does that mean for Mother's Day? Many mothers are essential workers, and as they work, they will be carrying the worries of exposing their families to the virus. Many essential jobs are undervalued, and the mothers who have those jobs can rarely afford to stay home. Many mothers have gotten sick with COVID-19. (According to the CDC,(www.cdc.gov) up to 73% of infected health care workers are women.)
But essential working mothers aren't the only ones who carry these worries. Some mothers have lost their jobs. Mothers who are able to work from home have the near impossible task of trying to get work done with children present. Regardless of their work status, mothers are raising their kids in a vacuum that used to be filled with school, childcare, friends, family and organized activities.(morehumanthandoctor.home.blog) Motherhood has always come with multitasking, but never to this extent.
In the most fundamental ways, becoming a mother has changed. I have seen pregnant patients intubated. One had a cesarean section during her ICU course and woke up not knowing she had delivered. Another pregnant woman recovered after a week of intubation and was discharged home, only to be readmitted for tracheal swelling from her intubation. We have a robust system of monitoring our outpatient prenatal and postnatal patients who are SARS-CoV-2-positive via telemedicine. We even have a system for delivering food and supplies to moms in need.
In labor and delivery, we have instituted many COVID-specific policies. All pregnant patients are screened on admission (and we are seeing the asymptomatic positives that data suggests).(www.nejm.org) All laboring or delivering patients are allowed to have one healthy labor support person. That person must stay in the hospital with the patient. We have had some patients who have no support person available because their entire families are sick.
If a mother with COVID-19 delivers, we have a conversation about what happens with the baby. Do they separate or room together? If they separate, for how long? We discuss the risks and benefits of each scenario. Along with the AAFP's guidance on breastfeeding and COVID-19, and patient-centered birth,(174 KB PDF) we discuss recommendations from the CDC(www.cdc.gov) and the American Academy of Pediatrics.(downloads.aap.org)
I work at a safety-net hospital where 57% of our patients are underserved and 32% do not speak English as their primary language. Many of our patients do not ask questions about specific risks or policies, but instead just ask, scared, what is best for their baby. I worry about our vulnerable patients, many of whom come in already scared, with histories that include racism, immigration, trauma and poverty. Although I cannot change the history that informs their decisions or their assent to us making decisions for them, I try my best to empower them to understand the known versus theoretical risks, and to reassure them that they do have power in the process of what is happening with their newborns.
I cannot blame other mothers for assenting to separation if there is the slightest risk of their infants becoming ill. In a parallel way, I have sent my children to live with my parents. I have thrown myself quite literally into my work. When I'm not at work, I'm in meetings where I talk with friends, patients and loved ones about COVID-19. Instead of living a life immersed in the pandemic, my kids are living a lovely, sun-kissed life in warm California. I miss them dearly and they miss me, too, but this is temporary, they are safe and well, and I am safe and well. I am putting my love into my work.
Just last week, Nelson, my young black patient whose intubation I wrote about last month, came off oxygen and is now stable on room air. His mom is getting her son back home. Nelson and I spent a morning crying tears of happiness when he came off the oxygen. I can only imagine how his mother must feel. Those are the kind of mother's days that are driving me forward. I will be spending my Mother's Day on the COVID-19 inpatient service. As for next year, I'm aiming for a new national park adventure.
MaryAnn Dakkak, M.D., M.S.P.H., Boston
Working at Home (With Family)
I started medical school with a 3-month-old, so I've only known how to be a doctor and mom at the same time. Fortunately, I have a supportive husband who has always been the parent responsible for getting our son to daycare, school and cross-country practice. I've often struggled with feeling inadequate as a mom. I missed so much of my son's toddler and preschool years during third- and fourth-year medical school clinical rotations and, obviously, the 80-hour work weeks in residency.
Kimberly Becher, M.D., with son Ewan on vacation at St. Pete Beach, Fla.
I once had to show ID at my son's day care because the staff had never met me -- even though he had been going there for months. When he was 4 years old, my son asked me, "Mommy, why did you want to be a doctor when it means you never get to see your family?" I'm not sure anything could have made me second-guess my career choice more than that. However, you have to keep your child's priorities in perspective because it was around this same age that he asked if we could "get cats when Daddy dies?" (because his daddy is allergic to cats).
Now that I'm more in control of my schedule six years out of residency, I've tried to make sure I carve out time just for my son, so he knows he is a priority. We take trips during his spring break, and I reschedule patients to make sure I can get to every track and cross-country meet and, most recently, a quiz bowl match.
West Virginia closed schools early, before the state had its first COVID-19 case. I was grateful for the early closure because I knew it would help prevent rapid spread, but I worried about how moms would balance work and child care. I was worried not only about the moms who had to find child care so they could go to work, but also for the moms who would have to try to actually get work done at home with their kids -- and even more so for those who would lose their jobs with no money coming in to pay the utility bills that have increased due to everyone being home.
For the past month, I've gradually been working more from home doing telemedicine. This month I'm only in the office one day a week to help preserve personal protective equipment and limit staff exposures. The rest of the time I'm in the surreal world of my house with my son doing Google Classroom French, me doing Zoom telemedicine visits, and my husband on constant conference calls, all in one house. Sometimes we take turns claiming the quiet back porch.
I was sad when we had to cancel our spring break trip to Los Angeles and disappointed that when my son turned 13, the only gift I had for him was a cake I commissioned a patient to make.
But the time we have been able to spend together has made up for the things we are missing. I've been able to eavesdrop on him participating in online English class as well as help him with projects. Last week we worked together on a geography video, and I don't think there is any better feeling than hearing your 13-year-old say he had a lot of fun, maybe the most fun he'd had, since remote learning started. I love hearing him complain about how many hours of schoolwork he had each day. But as I get to appreciate this time with my son and be grateful that he has access to online learning and teachers at his private school, I worry about the moms and kids in the community I serve as a doctor.
As my son's school has ramped up online testing and lectures, the county I work in continues to make food delivery a priority via school bus routes. The area already struggled with food access prior to the pandemic. Before my office got telehealth off the ground, I had a week with very little patient contact, a week that I used to find funding for food. I secured a grant from The Greater Kanawha Valley Foundation for food vouchers at a new store in town. The Small Town Market opened the last week of March, earlier than planned,(www.wvgazettemail.com) due to the lack of food access and need for a more local, lower risk, shopping option. And although my grant won't reach every family, it will make a few moms slightly less stressed, at least about feeding their kids.
Mother's Day originated in West Virginia(wvtourism.com) to honor a mother who dedicated her life to eradicating and treating childhood diseases like tuberculosis. I find that a perfect reminder to those of us who are physician moms that it isn't just about how many diapers we change, it's also about the impact we have on our communities via our motivation as moms to help one another. And I hope every mom, whether home or away from their kids this year, remembers all the Mother's Days we've celebrated in the past, as well as those we have to look forward to, just like our vacations that will eventually be rescheduled.
Kimberly Becher, M.D., Clay, W.V.
Posted at 03:21PM May 08, 2020 by MaryAnn Dakkak, M.D., M.S.P.H.