Dear patients, here are the things I never said

One early summer morning in the quiet hour of dawn, I opened the door to let in some fresh air and was delighted to be greeted by a feathered guest. In the curvature of my hanging wreath, a beautiful round bird nest of twigs and dried moss was tucked away perfectly between two silk flowers. Inside the nest, a mother sparrow sat very still on her eggs. She looked at me curiously and cautiously from the side of her head, tilting slightly without making a sound. For the next couple of weeks, I was in awe watching her sit patiently on top of what appeared to be four whitish eggs day and night, her eyes alert for any predators, and her petite body warming up her unborn baby chicks.

Seeing the mother bird hard at work reminded me of my first pregnancy and all the mixed emotions during my incubation period, which occurred during the pandemic. The world did not seem welcoming, as an unknown virus had paralyzed almost every corner of the earth. I felt jubilation at the confirmation of a life growing inside of me. Blended in with the joy was a shade of worry as I wanted to protect the new life from foreign invasion and keep it in the safe nest of my warm cocoon for as long as possible. To make the time of anxious waiting pass, I welcomed work as a nice distraction to keep me from feeling helpless. I was a young doctor who recently finished residency training in psychiatry and moved to a new city to start a family. Armed with theories and knowledge, I jumped in to help when anxiety and depression were rampant during this challenging time for everyone. I kept busy seeing patients online, and I felt lucky to work from the safety and comfort of my home while some of my medical colleagues did not have that luxury. Outside of work, social life was limited as everyone was isolated, and I longed to have someone guide me about pregnancy and feel a sense of camaraderie. My girlfriends lived in different states, and the weight of not knowing what to expect, pregnancy or otherwise, was heavy. Unexpectedly, my wish came true in a twist of role reversal—from my patient.

Georgina (name and details are modified to protect patient privacy), who came to see me for evaluation of adult ADHD, was in her late twenties and worked in marketing. When she switched from the office to working from home, it was difficult for her to concentrate at home long enough to complete her work. As her tasks piled up, she became increasingly stressed. She told me that she had set up a workstation in her bedroom, but she would have her TV on in the living room with the news blasting, her Instagram open on her phone, while trying to work on her meeting notes on the computer simultaneously. The fear of missing out was eating up her limited attention capacity. We first worked on setting up a proper new routine at home and had her go on a news and screen diet. That calmed her, but she would find herself procrastinating when completing her tasks. We then tried to have her do the Pomodoro method of concentrated work at 25-minute intervals punctuated by short breaks. It helped her complete certain smaller tasks, but a five-minute break would soon turn into an hour, and her days were lost managing the timer instead of managing her work. The detail-oriented tasks were still left untouched on the shelf. Meanwhile, her boss pressured her and gave feedback that her performance was slipping. Finally, after exhausting other non-medication methods, we settled on a very low-dose trial of medication, which was an overnight success. She was very grateful to finally produce work she was proud of and not lose her job. 

One day, I logged onto our session to follow up on how she was doing, and she jumped to share the good news of becoming pregnant. She had a bright eye look about her that, even through the screen, I felt her exuberance. We discussed the pros and cons of continuing the medication, as well as her concerns and questions. She decided to pause the medication just to be safe for the baby but to continue seeing me for supportive therapy during this transition time. 

I was happy she shared the news with me and looked forward to seeing her every other week. Soon after, I had my good news, but to keep my professional boundaries, I did not tell her that I was pregnant, too. And since we were meeting online, you could not tell from our floating heads that our bodies were undergoing massive changes. Over the next few months, we discussed how to manage her productivity, her reactions to the pregnancy, and her worries and fears. Hearing someone voice them out loud gave me a sense of companionship, and as I cheered her on, I was cheering myself on as well. Since her pregnancy was a bit ahead of mine, she was giving me a preview of what was to come as my symptoms were almost in lock steps behind hers. Initially, she was so nauseous that she couldn’t keep much food down; then, a few weeks later, I, too, had the smell triggers that would send me hunched over the toilet. After the first trimester passed, both of our nausea subsided, but other symptoms started. She was irritable and cranky one day and happy and worry-free the next, and my mood swings were wild, with highs and lows, too. She was alarmed about how much weight she was gaining, and I, too, saw my weight on the scale with numbers I had never seen before. She would tell me how she slept poorly because of the aches and pains, and some nights, I couldn’t get comfortable and would toss and turn all night. These visits were making me feel less alone. All the while I offered her a safe space to reflect, she also provided me with a sense of comfort.

I thought about telling her that I too was going through pregnancy, but I bit my tongue many times. I wanted her to feel that these sessions were about her, and I was afraid that disclosing my pregnancy would change that somehow. My professional training taught me to be a blank canvas for patients to project their thoughts as much as possible and only disclose something personal if it was to the patient’s benefit. In this case, I felt that my urge to share my news was more about me relating to her as a friend instead of me relating to her as her doctor. I wanted to tell her, but I also didn’t want to tell her. What if she started to ask me more about my life? Was I obligated to say more since I opened this door? As a young psychiatrist, I was not yet adept at navigating this blurring boundary line. Never mind; it's best to keep things as they are, I thought to myself. Still, a part of me wondered if our sessions together were helping her to feel connected as well.

Pretty soon, it was December, and the empty streets were eerily quiet during the holiday season. We were more than nine months into pandemic isolation already and the virus showed no sign of abating. Georgina and I were both in our last trimesters. The hospital systems were still overwhelmed by the daily death toll and overflow of ICU patients. Medical resources were limited. All other departments in the hospital, including the labor and delivery unit, had to absorb the tsunami of patients coming from the emergency room. All elective or non-urgent procedures were canceled. Instead of the usual practice of having more privacy, six women would share a room after going through mandatory daily COVID testings, and no visitors were allowed due to the contagious risks. Georgina was going to have to deliver her baby alone. I couldn’t imagine giving birth to my baby without my family by my side, but somehow, knowing that she would do it made me feel a bit braver. 

I debated again whether to tell her as a way of showing solidarity. Maybe it would help her to know she was not alone, but would she wonder why I had never said anything in our sessions thus far? Would that break her trust in me? Then I gave myself a pass that if she asked me, I would tell her. But she never asked. The part of me feeling guilty about not telling her pulled me to decide to be available for her in case she needed me postpartum, despite my maternity leave. I could not imagine not being there for her if she needed me after all this time we shared, but all that came out was, “I will be thinking of you,” I said.

Soon, I got an email from Georgina titled “Welcome to the World, Adam.” Attached was her baby boy's picture with eyes closed, an adorable grin, and a note saying that all went well. Before long, I delivered my baby too. I thought of Georgina when I was in the delivery room and wondered what the pain was like for her. On the ward, holding my baby in my arms, I was amongst other mothers separated by thin curtains. I could hear them reassuring their families outside, babies crying, and the tender whispers. Our bodies were recovering from having just birthed the next generation of humans, while our spirits were high from the resilience within. The common struggles were initiations for us to join the tribe of motherhood, and I felt our collective strength. I imagined Georgina holding her baby behind the curtain beside me, even though I had never met her in person. I wondered if other new mothers were as lucky as me to have had a Georgina in their lives during this vulnerable time.

Some time had passed before we resumed our sessions. Georgina continued to share her journey with me. I continued to offer her the space to listen and for her to make sense of all the changes and her feelings. Pretty soon, the topic progressed from the challenge of breastfeeding to how difficult it is to take care of a newborn, to her resentment of her husband not helping enough and her exhaustion. Then there was the returning to work anxiety, and we resumed her ADHD medication. As time passed, Georgina didn’t need me as much as she did. Her schedule got busier, and we spaced out our visits. I never got to tell her how I felt during our pregnancies together. I wish I could have said to her that the supportive therapy she asked for was giving me the support I needed as well. I wish I could have thanked her for her guidance. 

Looking back on my younger professional years, I would have advised myself to follow my instincts and not hesitate as much. Over time, I have become less rigid about disclosing personal information. I learned that as much as there is value in being a blank canvas, there is also something to be said about being human to patients. As mothers, our shared identity allows us to lean on each other, grow together, and lift each other up. We may play other roles in life, but in the humbling experience of motherhood, we are equals. 

Outside, the loud chirping tells me that the baby chics have finally hatched. The mama bird has prevailed. I thought to myself, the next time I see Georgina, I will tell her I am a mother too.