With every hardship there is relief…

“Where is my baby?” I awoke from a coma, confused and upset. My belly less than 24 hours before bulging through my doctor scrubs had surprisingly flattened.  No one had asked for my permission to deliver my baby. He was delivered emergently, at 32 weeks gestation, “To save both our lives?” They told me.

I was a 3rd year pediatric resident, the senior for the pediatric intensive care unit, on the night of his birth. My overnight call had just started with an admission of a 12 year old with a painful sickle cell crisis.  As I began to place admission orders, I felt a sudden descent in my pregnant belly, and then an intense, halting stab of pain down my spine. I thought maybe, I could pass through this contraction but the spikes of pain were unrelenting –and set in the sirens of a firing alarm. I quickly stood up, somewhat conflicted and bewildered. Should I ignore this pain and continue to manage this patient’s care or seek help for myself? I worked up the courage to tell my attending faculty doctor that I need to go to my OBY doctor.  Without even looking at me, glaring at the computer screen, she dismissed me. The nurse, standing behind her, insisted I take a wheel chair.  

“You don’t look like you can walk, Dr.”, she said.

We, medical residents were supposed to be super-human.  We weren’t expected to ask anything for ourselves, eating, sleeping, or peeing was only meant to happen when we had the luxury of time.  This time, however, I did heed the nurse’s advice.

Hours later, the labor of uterine contractions developed a regular cadence. My blood work also raised alarms with my OBY doctor who had meant to call me that day. I was in a H.E.L.L.P crisis she said. That’s doctor talk for: Hemolysis, Elevated Liver enzymes, Low Platelets. With elevated blood pressure and abnormal labs indicating liver failure, delivery of the baby had to done urgently.

“HELLP” was also the state of my mind at that time as well.

The last few months had been harrowing. I was working over 100 hours per week while being struggling to stay present for my 3 year old girl and an attentive South Asian wife to my husband, desperately trying to finish his Ph.D. 10 days prior, I had just returned from Pakistan where I had left my dying father in conditions I could do nothing about.  Finances were stretched, loans accumulating, loneliness, sleepless and fatigued. Yet, at work, I had to keep my personal issues out of my head and forged in any capacity to keep my pregnancy healthy.

They say in our religion, “Verily, with hardship comes ease.” I had always thought that when you sacrifice the successful resulting harmony and peace comes after. I told myself this while growing up an immigrant with limited access, resources or knowledge. Just keep working hard, harder, and even harder and the strain and pain would be justified with happiness, achievement, and relief.

What I have learned however after so many years, that it is not the end that is better.  The verse says, “WITH hardship comes ease”. Why WITH?

In the neonatal Intensive Care Unit, my prematurely born son, lay on his back, flaccid – tubes passing through all of his orifices. He was breathing fast and hard.  My vision and mind were still leaden from all the medications given to me for seizures the night before. Yet, the first impression I had of my baby was; this baby needs to be intubated!

Two weeks later at my premature son’s bedside, I watched the nurses, and doctors, (my colleagues and attending residents), rounding day in and out. Each day all I wanted was to have had just a few extra weeks of him in my womb. Inside me, he felt closer to my heart and in my control. His feet would rub inside my belly and he would tug at me when he was hungry. Now that he was outside, all I could do was pump my milk with a lingering hope that when he is off TPN, (IV nutrition) he would have enough for his first feed.  I waited.  Through the incubator, I examined his every movement, his breathing, his jerks, his eyes open and close, and his soft creaseless, pink feet. Pain is most intense when we feel powerless.

Yet, it was in this very pain, this despair of lacking control, the ache of regret, and the heaviness of guilt, that I felt a relief.  I held him, for the first time, on his 13th day outside of my womb. All his weight in my hands felt firm like gold. He lay in my arms with his blanket to cover all the tubes and IV’s I knew too well. His darkly colored eyes glared back at me – he knew me, he had heard me, and he had felt the inner sides of me. I drew him close, his heart beating against mine. As he rested upon my chest for the first time, I stroked the bottom of his soft, creaseless, pink feet, delicate like porcelain.  

It was the hardship that I had shared with him that bound us in that very moment.  I knew then that it is in those most difficult, most challenged times, that there resides in us -a deep beautiful pain. It is WITHIN those moments of hardship, that I found my ease.

Written by  Dr Alya Ahmad MD FAAP    August 11, 2018