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- Chapter 14: A House on Fire
A House on Fire
Everyone said it was normal. My friends, my family, my doctor. This was normal? So my life would just be crying all the time? Over and over again I asked, “Why didn’t anyone tell me? Why do people do this? How do people do this?”
Shortly after Olive arrived into the world the fires began. Fires that began in various parts of the house, creating a never ending loop of panicked plans to save the baby. Short spurts of newborn sleep cut even shorter by this vicious cycle of planning for hypothetical fires I was certain would come. I had no tools for this. No way to prevent the fire from spreading night after night.
Fueling the flames was the added stress of breastfeeding. Determined to succeed I took the advice. Pump every two hours, through the night, but of course, get some sleep. Take the supplements, take care of yourself. Eat well, drink lots of water. Take care of yourself. Sleep. Were these people living on the same planet as me? I was drowning in tears of failure, rage and fear. Putting out hypothetical fires at night in between feeding the baby and pumping.
I’d daydream about driving far away, anywhere but where I was. The impulsivity of it felt simultaneously ludicrous and rational. Convinced they would be better off without me, I saw it as an act of mercy for all three of us. Father and daughter living harmoniously without the rageful monster that cried and cried.
Months later the fires continued and the drive off into the sunset no longer sufficed. The basement steps became my new act of mercy. I pictured standing at the top of the steep, rickety old stairs, focused on the concrete floor below, what I could only hope would be the end. This felt doable. It wasn’t until this vision played over and over in my mind that I recognized that something was wrong. This wasn’t normal.
My training and experience as a Physician Assistant only alerted me to a problem when death, not death, suicide crept into my thoughts. I had a plan. The transition from driving off and away to ending my life occurred effortlessly, like turning a page. My perception of “normal” up until this point included intrusive thoughts, rage, excessive crying and lack of self worth.
My daughter was 10 months old by then. Ten months of severe anxiety and depression that my brain could no longer handle. It planned an exit strategy.
I smiled. I laughed. I worked. There were times I felt complete adoration for this baby. But there were more moments I panicked at thoughts of being alone with her. Lived in fear for the weekends my husband worked. Regularly muting his concerns and gentle nudges to get help. Terrified the world would discover how much of a monster I’d become. Surely, they would take her away from me. They’d hospitalize me, I’d lose my job.
A break in the cycle
In the midst of a job change I gifted myself a week off before the new position started. The day before I was scheduled to begin, my new employer called to let me know there was no longer room in the budget for the position. For healthcare providers, the consequence of this was enormous. It takes months to be credentialed for a position, let alone the interview process. No job, more time with the baby, more time in a house on fire, more time at the top of the stairs. I was terrified.
The rickety stairs beckoned to me. The fire spread faster and faster. I now had time. What I did with it saved my life. I called my primary care provider and scheduled an appointment to tell her about the fires and the stairs. At the appointment I was guarded. Fearful that if I disclosed the truth, she would deem me a harm to myself and potentially others. Instead I chose my words carefully, lingering sadness, intrusive thoughts, none of which included self harm. A prescription for an antidepressant was given. Recommendation for therapy.
Days went by as I struggled with the idea of taking the drug. Why wasn’t I strong enough? Maybe it will get better, I can do this on my own. I don’t need help. But, I was tired and sad and afraid. It had taken such a toll, I needed help. I took the prescription and used my neighborhood facebook group to search for a postpartum therapist. I went to my first visit and felt safe enough to tell her everything. The fires. The rage. The stairs.
She validated all of it and informed me that what started as postpartum anxiety, left untreated after several months had escalated to postpartum depression. It was not, in fact, normal, but it will get better. We kept meeting. The bursts of flames in various rooms of my home no longer erupted. Therapy and the SSRI (anti-depressant) were doing all the things I was clinically trained to know they would do. They worked.
When I read the statistics it is clear that I was honing in on the darkest days. The time that my brain and body could no longer manage “normal” any longer, “Perinatal women most frequently completed suicide at 9 to 12 months postpartum” (Grigoriadis S. et al, Perinatal suicide in Ontario, Canada: a 15 year population-based study, 2017).
I began to find pleasure in spending my days with Olive. I continued therapy and diligently took my prescription. It was a huge relief for all three of us. I’ve mourned the time I lost living in a house on fire. Pangs of shame, guilt and sadness creep in, but thankfully, I’m equipped with tools that allow me to navigate through them instead of dwell. Mostly, I’m grateful that the intervening event of joblessness sponsored my healing. I don’t know where I’d be had I continued down that dark road, I try not to think about it. I’m here. Right where I’m supposed to be.
I smiled, I laughed, I worked
If you are struggling, please call or text 988 or text TALK to 741741
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Epilogue with Karen Smith
Below, Karen and I engage in a dialogue about maternal mental health, mental health in healthcare professionals, and more including an invitation to complete a 5 minute survey regarding your postpartum experience and an invitation to a small group experience with others who are navigating this journey.
Karen, thank you so much for your vulnerability in sharing your story navigating postpartum anxiety and depression. I can imagine it’s difficult to sit down and write, but freeing at the same time. I’m an advocate for allowing us to be seen so that others can be seen through us, too. I am confident that many people will see themselves in what you shared.
The raw truth: it’s hard for healthcare professionals to ask for help especially around areas like mental health. We often feel like we have to tiptoe around it, scared that our colleagues will find out and cast judgment, or that we’ll lose professional credibility and credentials. But no one is immune to health challenges including those that work in healthcare.
You mentioned: “At the appointment I was guarded. Fearful that if I disclosed the truth, she would deem me a harm to myself and potentially others. Instead I chose my words carefully, lingering sadness, intrusive thoughts, none of which included self harm.”
How did being a healthcare professional affect your postpartum experience?
Despite navigating uncharted territory physically and mentally as a new mom, I thought my knowledge and experience would compensate for what was happening, like an override button. Once I recognized that I needed help there was another fear that interrupted my ability to pursue it, the fear that my license would be at risk. I can’t say for sure if I would’ve sought help sooner than I did if I was not a medical professional. I do know that my professional title served as a barrier for me on how my condition would be perceived and treated, which delayed my pursuit of help and health.
What suggestions can you tell other healthcare professionals or patients navigating this process?
My experience was wrought with societal expectations of what a mom and a healthcare provider should be. These expectations had a crippling effect as I struggled to be both while also wanting so badly to appear unflawed, resilient and altogether non-human. Seeking help while wearing a new title I was excited and proud about felt a lot like what we assign as “failure”. Because I was now a mom and a healthcare professional I should have it together. I should handle it. A huge relief came in sharing even the smallest bit of what I was going through and having one person say, “me too”. Sharing is healing in whatever we are going through so I encourage that as a start.
It is well known that perinatal support is lacking in the US and there are significant disparities in maternal mortality. According to the CDC, death rates for black mothers in 2021 occurred 2.6 times the rate of white mothers.
Standard of care for the postpartum period for women is a PHQ-9 depression screen at the pediatrician's office (who realistically can’t do much with the results other than pass it on to your medical provider) WHILE your newborn is being evaluated and then a 6-8 week check up at your OB’s office, mainly to assess physical healing.
But — as we see through your story, there are so many emotional, physical, and not to mention, exhausting changes happening at the same time. As you mentioned, “Perinatal women most frequently completed suicide at 9 to 12 months postpartum” (Grigoriadis S. et al, Perinatal suicide in Ontario, Canada: a 15 year population-based study, 2017).
From your perspective, what are the challenges and opportunities for how the healthcare system can better support mothers and the family during the perinatal/postpartum period?
I see an enormous missed opportunity by finalizing our treatment with a 6 week follow up. Minor injuries and surgeries require more follow up than that and they often do not involve major hormonal changes as well as physical changes. My take on the checklist in regards to mental status during the pediatric visits is that it is irresponsible. The pediatrician is not the mother’s provider and having gone through these visits, your focus as a parent is entirely on your baby not yourself. This speaks volumes to the transition of what becoming a parent is. Putting yourself on the back burner to attend to your child. With the evolution of telehealth, we can do better for parents and we should.
You are a Physician Assistant by training and have turned much of your focus to health advocacy, bridging gaps of communication between patients and their care teams, helping patients to navigate the challenges of both their diagnosis and the healthcare system, and building relationships within the healthcare community. Tell us a bit about that and why you are passionate about it.
I’ve been disappointed by the limitations to provide the care my patients need. Specifically, time restrictions have created a barrier that hinder the success of clinical outcomes. Despite the masses screaming for more time spent face to face with patients we are inundated with more boxes to check and processes that supposedly streamline our charting, but nothing specifically that carves out dedicated face to face time with patients. The space in healthcare advocacy allows more time for explanations that are understandable with clear instructions for next steps and expectations without the interruptions and administrative burden
And, alongside your advocacy work, you’re specifically looking to put some data around the postpartum experience for healthcare professionals. What are you hoping to accomplish?
I want to better understand if more support is needed and if we collectively need to reduce the stigma and create a community of empowerment and understanding that improves personal and professional well-being for healthcare professional parents.
📣 Are you a healthcare professional who has been through a postpartum experience? Please take this 5 minute survey to help Karen better understand how she can help.
📣 Would you like to join a small group of healthcare professionals navigating this experience? Let us know here
This newsletter is rooted in helping us remember our shared humanity through the stories and experiences of others. As we close this chapter, what dose of humanity do you want to leave readers with today?
DOSE OF HUMANITY 💜
Shared experience is the root of connection. With connection as a highlighted, circled and exclamation pointed theme of the times I encourage all of us to share more and unite in what binds us.
Thank you, Karen, for your vulnerability in sharing your story and using it to make experiences better for healthcare professionals, patients, and caregivers.
Karen is healthcare professional with a comprehensive background in clinical practice, sales, and program development with proven ability to deliver exceptional patient care, build strong relationships with clients, and drive revenue growth through strategic initiatives.
🤝 To connect with Karen, please find her on LinkedIn and subscribe to her newsletter, Sound Health, focused on wellbeing and preventative health
🔗 links referenced in this chapter:
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