Women in Neurosurgery

EXPERIENCE OF A NEUROSURGEON AS A MOTHER

‘The pipe is sweet’, ‘The lute is sweet’ by them’t will be averred, Who music of their infants’ lisping lips have never heard

We Tamils, pride ourselves on an ancient book ‘Thirukkural’. This quote is Kural 6 from Chapter 7 of this book. It means: ‘The pipe is sweet, the lute is sweet’ say those who have not heard the prattle of their own children.

Since Women entered into the modern working force, having to find a balance between career and family is a constant struggle. I have seen many female surgeons, especially those who have done super-specialty, not preferring to get married and avoiding having a child since they want to excel in the profession they have chosen. But I had dreams of building my own family while also pursuing my own passion for neurosurgery. I got married at the verge of completion of my neurosurgical residency and I am a mother of two children now. When Prof. Yoko Kato asked me to write up about my experience on pregnancy, child birth and child rearing and how I managed both the professional and personal dimensions of life, I was initially reluctant since it was not all that pleasant as we see in televisions, advertisements, social media etc. The first childbirth came with its own distinctive blessedness and it was remarkably easier when compared to the second one, due to a multitude of reasons. I wondered many a times whether I made a mistake of having another child. However the smiles and innocence of my 4 months old bring out my motherhood and makes me forget all the pain I went through. I have no doubt now that it was worth it, to go through the transient pain to have two kids. Here, I ended up writing the pleasant and unpleasant experiences of the birth of the second child.

I am Dhivya Palanisamy, a neurosurgeon from Tamil Nadu and a mother of two children- the first one is currently 7 years old and the second one, 4 months old. When I delivered my first daughter in the year 2014, I was not a certified neurosurgeon and I was preparing for my final examination. Recalling that time, I remember I had severe pregnancy-induced giddiness and hypothyroidism, which made me choose not to practice neurosurgery during my pregnancy. Also, it had always been my wish to spend at least one dedicated year with my child after his/her birth, so I then, chose to stay with her for about 8 cherished months. We named her ‘Ponni’, after the name of a famous river Kaveri in Tamil Nadu. I restarted my career as a neurosurgical registrar at Chennai, when she was 8 months old, after which I did not have enough time to spend for Ponni. This was because she would be asleep when I leave in the morning to hospital and also by the time I return home in the night. During that period, I had 7 duties per month. That is, for almost 14 days I will be working in the hospital almost all the time. When I became a consultant, I was able to find some quality time for her. My husband, my parents and my in-laws were extremely supportive in caring for Ponni, which enabled me to concentrate on developing my surgical skills. She grew up with them mostly. Till the age of 6, she could never stay with us for even 2-3 months wholly. There were times I questioned myself whether I was doing justice to my daughter as a mother. Hence, I was always in a dilemma whether to choose having another child.

It turns out that raising a single child is not that easy and they want siblings to play with. Yes, my daughter started to feel lonely and started asking for another child seeing other parents having two kids. However it was not easy for us to decide on having another kid. I already had a big gap in my career during my first childbirth for almost 18 to 20 months and having another child will make me absent from neurosurgical work for another one year. I will be behind my male colleagues (even my juniors) in neurosurgical experience by 3-4 years. Despite all this, I chose not to compare my life with others because each one’s life experiences are unique. The other issue I had to counter was how to take care of the next child since my parents and my in-laws were getting older and this time it will be difficult for them to look after the second child. In India, the responsibility of caring for children falls mostly on the mother and without good support from family, working women cannot continue their work. Industrialisation and urbanisation have made sure that the joint family system is a thing of the past. There is no good supportive system available for working women other than our own families. I might end up extending my absence from neurosurgical work to look after the second child. We had financial issues to manage too, since hospital management told me that I might not be able to avail the maternity leave benefits.

Ponni promised to help me in taking care of the next child and with her promise we decided to give her a companion. The second pregnancy started during the peak of COVID 19 infection in our place, which made this pregnancy even more stressful. This time I developed severe aversion for food other than rice, curd and bread and also suffered from morning sickness till the 5th month. I was unable to look at monitors, watch television and use mobiles. I was unable to read the books too. I took leave for 2 and a half months from my practice. Thanks to my colleague and senior from my residency Dr. Misra, I joined back as a non-operative neurosurgeon and did not take night calls. He was very cooperative and managed all the other issues at the hospital. I stopped all the WINS activities and not participated in any neurosurgical conference. When I resumed eating in seventh month I was diagnosed with gestational diabetes, which was controlled with proper diet.

Finally the day came and my second baby girl, Aathini, was born on March 3rd 2021 amidst the second wave of COVID 19. By the time, I was recovering from anesthesia of the second LSCS, on the first POD, I developed nipple crack bilaterally which worsened in next few days. Pain was severe while feeding and this led to a chain of events such as breast engorgement, mastitis, fungal infection of the nipple, UTI etc. and I was put on lots of intravenous antibiotics and antifungal medication. I was in continuous pain so that I was unable to lift my baby girl for a month. I was unable to sleep continuously for even 30 minutes, as I would develop breast engorgement. By the time I recovered from all this, the milk production reduced and Aathini had lost weight. I started her on supplementary feed after which she gradually recovered. Meanwhile, Ponni started missing my attention, which made the situation worse. All these led to postpartum depression. My Obstetrician and my friend from MBBS class told that postpartum depression is so common among working women and that I should take all the efforts to come out of it. And with the support from family, I was able to overcome the depression gradually without medication, though not completely. My mistake was not to consult a lactation consultant at the earliest. I started to resume my routine nowadays and I indulge myself in some other activities during the 30 minutes to one hour that I hardly get for myself.

Now, Aathini is 4 months old. Online classes have commenced for Ponni. I have received the first dose of Covishield vaccine. COVID situation is improving. My daughter’s sleeping time is getting longer and mine too. Unlike the first 2 months, I am getting better at knowing the routines and the needs of my baby girl with improved bonding between us. She is smiling a lot and catching up with her milestones. Ponni is able to help me in taking care of her baby sister to an extent. I have the confidence that I can bring her up well. Once she reaches 3 years and starts going to school I will get enough time to practice neurosurgery. I will make sure that both of them grow with us hereafter, at the same time I am aware that my absence from work is going to increase to look after them. It is strange to feel embarrassed to ask for leave of absence or leave early from work when my daughter fell sick. I have to come to terms with it. I understand and accept that for any female surgeon it is unavoidable to have a gap from their surgical practice during childbirth. For some it may be less and for some it may be more. For me it was more since I had pregnancy and postpartum related health issues. I don’t regret much since I don’t compare my life with my male counterparts because only a female can give birth on earth and I am satisfied that I played my role. In next few months I will rejoin the surgical race to start chasing my dream and I will not be that bothered about my daughters, as they will be in a position to manage things on their own.

Women may wonder why I am writing my experience on pregnancy and childbirth because it is a common phenomenon to go through for a woman and there is nothing special about it. But what women go through stops as a discussion among women and men hardly get the opportunity to know except from their own family. The husband’s role is very important to surpass the difficulties a woman go through these times and he should also have a good understanding about childbirth and its complications. It was not that easy to manage pregnancy and childbirth and I used to pass every hour with difficulty. In addition to physical stress, mental stress about my career, loosing my OPD patients on follow up, the gap in surgical experience were worrying. Sometimes I wonder whether I would be able to operate on a patient again though I know that operating is like swimming, which one cannot forget, once learnt in her/his life. I worry what will my colleague feel if I ask for leave once I join back to work after 6 months of leave in case my daughter falls sick. During these difficult times I used to console myself saying that ‘this will also pass soon and no pain lasts forever’.

The present time may be difficult but the future looks promising, so I am going on accepting and facing the challenges life has for me. My advice to other female surgeons is to prepare them during pregnancy itself about what to do after childbirth and be in touch with a lactation consultant who is available online. There are lots of websites, Facebook support groups and YouTube channels, which guides on how to prepare one-self. Believe me, once you cross the shorter difficult times, longer happier times are waiting for you to cherish. Be strong and be proud to be a mother!