Heartbeat

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PORTRAIT OF A PSYCHIATRIST

SERIES EDITOR,H. Steven Moffic, MD

Medical school was rough. From a young age I always knew I would enjoy working more than I would enjoy school, and that has turned out to be true. The confines of exams and deadlines were stifling. After an anxious, anticipated beginning in residency training, I got used to the scheduling demands. Eventually, I would finish residency and fellowship and start employment as a child psychiatrist.

For many people in medicine, the academic and professional journey advances in a cookie-cutter fashion-you know what is next and what comes after that. I thought life would unfold for me in a similar fashion. You may struggle, deal with rejection, but eventually the fairytale ensues. I did not realize how tumultuous the journey would be for me.

I wanted to get married to the man of my dreams before my dad passed away. That didn't happen. The former US Surgeon General Dr Vivek Murthy said that loneliness is America’s biggest health problem. For all intents and purposes, I had made it professionally, but it was the loneliness that made living in a big city daunting, despite being surrounded by millions of people. I made friends, but a partnership seemed elusive.

Recently, I got married-15 years later than I had envisioned. Being fiercely independent for so many years, I no longer feel lonely. That juxtaposition of loneliness with independence as a single person sometimes can feel both confusing and crushing.

Many professionals envision some version of personal goals that include financial stability, work-life balance, and family. As I started writing this, I entered my tenth week of pregnancy. At my first prenatal appointment, we found out the fetus was 2 weeks behind in size and the heart rate was low. My husband and I were told to wait things out to see if the fetus would develop, but the doctor explained she was not confident about this pregnancy. After she left the room, we both cried.

As a child psychiatrist I have borne witness to the ramifications of abuse, neglect, and genetic/environmental influences on children. I was under no illusion of the inherent fallacies of bringing a child into this world. Most of us in this field would state emphatically that some people are not capable of parenting. Whether it is addiction, mental health issues, or an emotional disconnection from their offspring, it is a simple fact that not all children are brought into this world wanted and loved.

As an older mother, I would like my child to have plenty of autonomy (with appropriate supervision). External pressures and expectations can kill a child’s curiosity. I have always felt that a child must develop a strong will. Still, you can do everything right as a parent, but your child may still deal with suicidal thoughts or develop a substance abuse problem. Your child may lose motivation to do something purposeful. I see all of this in my career. So, I decided to approach this pregnancy with objectivity.

At 41, I knew the rates of miscarriage were higher, so although I was disappointed, I was not surprised when the obstetrician expressed concern about whether this would be a viable pregnancy. However, objectivity went out the window when I saw the heartbeat. I felt a deep and innate desire to protect this little life that was struggling to grow. Until then I had been telling myself if this baby has a will to live, it has to do so of its own accord. I have experienced grief before, and I have shed tears over losses. Losses are an inevitable part of life and having a partner does soften the blow.

What is the answer in our car culture isolated environment? Meetup groups, rock climbing clubs, or poker tournaments? Reading, writing, meditating, and self-care? Networking events can be exhausting and seldom result in more than small talk. Maybe balance comes with trying to connect, even when your heart is not in it. We may look for that connection our whole life, whether with a family member, a partner, or a friend, only to have it taken away at the end. There is simple beauty in appreciating what is given to us.

I am grateful for this pregnancy and the glimpse of a life beginning inside of me.

For centuries, women before me have endured slavery, oppression, and abuses while going through pregnancies and miscarriages. Brave women have fought for the survival and evolution of the human race. When I think about other minority women and the hardships they have faced, it makes my personal struggle seem more manageable.

We know that other mammals such as elephants grieve in an expressive fashion when they lose their young. Is there anything that can be learned from this? It is okay to be interdependent as a species. I used to fault myself for not being stronger emotionally when I was alone and for not being more positive and present in the moment. For not being able to fix things. For a psychiatrist, that lesson poses a tremendous conflict of interest.

On December 27, I learned that this pregnancy will not come to fruition with a baby for me. The healing process begins for me as it has for countless women before me.

Disclosures:

Dr Narasimhan is in private practice in Los Angeles, CA.