Had a blast from the past when I was walking through one of my orthopaedic wards earlier: bumped into a medical assistant whom I knew from my days as a house-officer in HUKM’s emergency department.
I loved being in emergency department – the rawness of the contact with the human condition, the instant intimacy you share with your patients, their relatives, and with your colleagues, that takes place in life or death situations, and also in the less dramatic ones.
This meeting, especially coming in the wake of a recent dinner, where people were captivated by the ED stories – and who wouldn’t be, by the variety & depth of encounters possible in ED – and by my recent screw-up of 3 orthopaedic operations in the space of 2 weeks, is making me wonder if I will ever love orthopaedics the way I love emergency medicine, or if I will ever have the talent for operating.
And yet, I realise that the wondering is moot – I’ll still stay in orthopaedics – barring getting kicked out of the department – regardless of how I feel, because when it comes to ED shift system vs. time with family and friends, my love for the latter trumps my love for emergency medicine. And because I believe talent is attainable with hard work.
And because love is a decision, not a feeling. #trueacrosstheboard
I’m a great believer in luck, and I find the harder I work, the luckier I get.
– Thomas Jefferson
Granted, I did have an epidural when I was in labour.
But it doesn’t mean that the pain of engorgement wasn’t the worst pain I have experienced in my life. Or that breastfeeding isn’t the hardest thing I have done in my life.
(Great, all my double negatives are confusing me now. I blame it on the fact that I have not slept longer than a 4-hour stretch since giving birth to #joanmarie 2 weeks ago. And that double negatives are just generally confusing.)
By which I mean to say the pain of engorgement was the worst pain I have ever experienced – and hope to ever experience – and that breastfeeding is, to date, the hardest thing I have done in my life, and that includes medical school & working as a doctor in Malaysia.
I think breastfeeding advocates, in their militant passion to push forward the breastfeeding agenda, tend to paint an overly rosy picture of breastfeeding. See example. And gloss over problems such as “sore nipples,” “blocked ducts,” “engorgement.” Admittedly, the latter was my fault as well. When one sees fractures, polytrauma, limb amputations on a fairly regular basis, one tends to treat anything less than a major infection is trivial. Which is why the only potential breastfeeding problem I took seriously was the possibility of mastitis or breast abscess.
How wrong I was.
I started out textbook. Immediately after delivery (which was also textbook – #joanmarie arrived exactly on her estimated date of delivery), my obstetrician employed delayed cord clamping. I also had skin-to-skin contact whilst waiting for the placenta to be expelled
– #joanmarie came into the world yelling, with her huge eyes wide open, looking around the suite, which totally captured me, since in my experience, most newborns hardly ever opened their eyes immediately post-delivery and tended to wail with their eyes shut –
– then again, even if her eyes were closed, I’m sure I would’ve been captured, anyway; she IS my own baby –
and was able to start trying to breastfeed her on the same day itself.
However, on day 3, my milk came in, and by the jugful. So my jugs were full of milk (heh, heh), but since little #joanmarie’s demand didn’t quite match my supply, I ended up with all this milk piling up in my breasts with no place to go, which made my breasts become steadily engorged, until they were rock-hard, tense, with my veins standing out prominently on my chest, and of course, painful.
Obviously, I wasn’t prepared for this
– again, not covered in massive detail in medical school –
So I thought, you know, painful, rock-hard breasts were normal, and did not seek help until I became worried that #joanmarie was jaundiced and for some reason, wasn’t drinking enough
– like I said, totally did not occur to me that it was because my breasts were so hard her mouth couldn’t get a proper grip (ie. latch) –
and finally went to Sime Darby Medical Centre (SDMC) to get her checked out. After which they checked me out.
And that’s when the torture began.
‘cos you see, with labour, one has a myriad options, from nitrous oxide gas, to intravenous sedation & analgesia, to epidurals.
– GOD BLESS ALL THE NOBLE MEN & WOMEN WHO INCORPORATED EPIDURALS INTO LABOUR –
but with engorged breasts, there’s naught for it but to get the milk out to relieve the pressure, and short of having a spinal block at the cervico-thoracic level, there was no way to numb the pain of not 1, not 2, not 3, but 4 nurses alternately hand-expressing & pumping both breasts to squeeze the milk out past all the blocked milk ducts.
Imagine the kind of heavy-duty squeezing & kneading to push a large kidney stone out through the tiny ureters & urethra. Multiplied by the number of milk ducts in a breast. Multipled by 2, since I’ve got a pair of breasts.
And the pain. Like the pain of a thousand nipples being twisted at the same time.
I felt like I endured that which I should have had in childbirth in those 4 hours, with nothing more than a couple paracetamol. I was so out of my mind with the pain I probably would’ve signed a consent form for a mastectomy under general anaesthesia. (In hindsight, glad none was proffered.) The pain nearly brought me to my knees; as it was, I was crying out from the pain & pleading with them to stop. But the worst was when after 2 hours, when it had taken 2 senior nurses to finally semi-relieve the pressure in my left breast, who had then worked for about 10-15 minutes on the right breast, suddenly one of them looks back at the left breast and says, “I think it’s getting engorged again.”
I broke down & just wept then. I cannot describe my disappointment & frustration – after having endured 2 hours of literally, the worst pain of my life, to find it all for nothing 10 minutes later.
Cut a long story short, those nurses worked way past their going-home time & missed out on spending time with their families to make sure I was finally comfortable enough to go home. AND in the coming mornings, they kept working with me (and/or my breasts, rather) to make sure the engorgement didn’t get as bad as it had originally been. And for this, I owe my heartfelt thanks to the post-natal nurses & the lactation consultant at SDMC. Absolute godsends.
Cabbage leaves also did a lot to help soften my breasts. Never liked cabbages before – they are my new favourite vegetable now. Wore them inside my bra until they wilted. That, plus plenty of hand-expression (not the sign-language kind) both in & out of the shower, helped to keep my breasts a consistency which #joanmarie was able to cope with. Though, I still have the times where I’m desperately kneading my breasts to soften them while Joan cries in the background for milk now, now, NOW.
And, even if Joan isn’t hungry, I still have to get up to express my breasts every 3-4 hours, or risk engorgement. Hence, why I have yet to sleep longer than a 4-hour stretch. It’s better this week than that first week, though. That time, I had to express every 2 hours. So I guess things are improving, apart from my on-going problems with over-active letdown & leaky breasts..
Stay tuned for the next installment in the riveting saga, Breastfeeding Woes.
The setting: The Ministry of Health (MoH) finally decides to act on the overuse of antibiotics in Malaysia. MoH orders all pharmacies in the respective government clinics to furnish data on antibiotic-prescribing.
Enter the heroine, the clever, considerate doctor-in-charge, who sees her assistant pharmacist labouring in her clinic’s pharmacy after office-hours.
Heroine, hereinafter referred to as Me: What are you doing so late in the clinic, good sir*?
PPF: Why, my kind & gentle lady,** (looks sorrowfully at the heroine) I have been given a nigh impossible task: to compile a list of all the antibiotics that have been prescribed in this clinic from 2011-2012 by the end of this week.
Me: Oh, dear. ’tis a Herculean task indeed. However, do not sorrow, for I might have a solution to your plight.
PPF: Do tell, my lady, for I am at my wits’ end.
Me: Could you not take the total number of each type of antibiotic we received at the beginning of last year, and then deduct from it the number of antibiotics currently in stock? Surely, I reckon, by such simple reckoning, we ought to be able to arrive at the total number of antibiotics that have been dispensed, ie. prescribed by our clinic over said period of time.
PPF: (sigh) An inspired idea, madam, but alas, one that does me no good. For I am to list exactly which doctor prescribed exactly what antibiotic for exactly how long.
Me: Such a taskmaster as you have! How are you going about your task, then?
PPF: (feebly gestures at the mountain of prescription books in the background) I have no choice but to leaf through every single prescription book used over the past 2 years & decipher everyone’s handwriting in order to find out who prescribed what & when.
Me: Surely, you cannot mean.. You have to read every single prescription written by every single doctor in this clinic from January 2011 until today??
For that is a cruel & unusual punishment!
PPF: Yes, that is my lot. But do not fret yourself, my lady, for your handwriting is still legible.
I liked this story while I was still the heroine😦