Note: In true “new mom” fashion, I drafted this post in August. It has taken until now for me to complete it!
Sometime last year, Noah and I were chatting about parenthood, our work, birth stories and death stories…you know—the usual light-hearted conversation topics! He wondered how it was for me to be a mom while simultaneously working in pediatric palliative care. I have long since wanted to blog about this topic, but struggled with what exactly I wanted to say. What follows are some thoughts that came to me during a long stroll with my infant daughter.
I have two young daughters (3 years old and six months old), and thus have had the experience of being pregnant in my work environment twice. During my first pregnancy, I remember working very closely with a mom and her infant son during the active dying process. I couldn’t hide the fact that I was pregnant and she seemed to want to talk a lot about it while we sat together with her baby. It seemed as though this discussion gave her “permission” to talk about her own pregnancy and mothering experiences. Her son died that night after I had left for the day. The next day, his pediatrician and I removed him from our portable morgue and dressed him in preparation for the arrival of his family. The paradox of what was happening occurred to me. For a moment I was holding the body of a baby whose life had ended against my body, which housed a baby whose life had yet to begin.
The idea that birth and death are two closely related concepts is by no means a new idea. Many end-of-life care workers, me included, know the honor of accompanying a person’s last breath parallels the same honor as witnessing their first. The obvious difference is what each symbolizes. Most of us would rather celebrate the beginning of a life than the end any day of the week. People flock to new life while often shying away from death. When I was pregnant, there was often a disbelief of my continued ability to work or the often “sorry you have to see this” sentiment. Seemingly both couldn’t exist in the same space. Someone who has the capacity to hold life no longer has the capacity to hold death, specifically the death of a child.
But it is the death of a child—the thing we fear most. The idea that no one wants to think about, let alone talk about. The rift in the natural order of life. The idea that something could possibly happen is so terrifying that we can’t even mention it. So, what do you do when the realities are unavoidable?
During my pregnancies, I found myself struggling with three things: 1) My baby will be healthy, but some babies are not. 2) My pregnancy will be safe, although some pregnancies are not. 3) It is ok to celebrate both of those things. By celebrating them, I am not taking away from those whose babies are not healthy or whose pregnancies are not safe. Those three things were hard for me to learn. Perhaps I did a better job the second time around. Perhaps I was just as scared. These struggles were very real. Thinking back to the vignette that I shared at the beginning of this post and others that swim around in my head, I can begin to admit to myself that there were definite feelings of guilt that emerged for me. It’s actually pretty hard to say (type) that out loud. At the time, it seemed somewhat necessary to create an illusion of feeling ok so that colleagues would continue to be able to rely on me to be “business as usual”.
Through the process of critical self-reflection, clinical supervision and conversations with colleagues, I began to develop ways to compartmentalize the things that needed to be separate from each other in order for me to maintain my emotional health. For example, I found it difficult to transition from my own doctor’s appointments to work, so I scheduled appointments for my days off. I also felt myself pulling back from working with the parents of my clients. Perhaps I could handle the unspoken thoughts and emotions of the children, but not the visible grief of their parents. I’m not sure that I did this consciously, but looking back on it, I definitely did make this shift. I think it is ok to protect ourselves. We all do it, consciously or unconsciously. It is necessary to function as a therapist and a human being. However, I also think we need to delve into these issues in the context of clinical supervision to bring our self-preservation to our conscious mind. In any circumstance, we are viewing clinical judgment and decision making through our own lens. What is that lens? Can you see clearly through it? Does it color or cloud your vision in any way? Truly it is not the content of the countertransference that is the problem, but rather our lack of awareness of its existence.
We each bring a unique perspective to our work. For me, it is the perspective of being a mom. Sometimes the vulnerability that role brings is overwhelming. Sometimes being a witness to other moms in the most terrible situations is too much. Most times, I can compartmentalize what I am seeing. Admitting to the fear was always the hardest part and thus I don’t often do so. Like most end-of-life care workers, there is some element of self preservation that is necessary to continue to do this work. So, as much as the work has altered my perception of motherhood, I think that it is the ability to mother these two little girls that has contributed to my longevity as a therapist. Being able to come home each day to my two healthy girls continues to put things in perspective.
I accept that the hardest questions in this world will never be answered. I know that after helping a family say goodbye to their child I will come home and say hello to my own. My persistent struggle with this reaffirms my core belief that we cannot separate ourselves from our clients as fellow humans. Yet, in continuing to celebrate all that is good in our personal lives we are not minimizing the suffering of others. Rather, it is by partaking in that celebration that we reaffirm our own commitments to caring for ourselves, thereby deepening our ability to care for our clients. I think it is ok to admit that I have many things to celebrate.