One year ago today, I spent my 29th birthday in a psychiatrist’s office, getting diagnosed with what I already knew I had: postpartum depression.  Henry was 3 ½ months old, and I had spent the majority of those 3 ½ months feeling exactly how you would expect a mother of a toddler, mother of a newborn, pediatric resident, wife of a resident, with family 2,000 miles away, to feel: exhausted and overwhelmed.

So I had spent that 3 ½ months telling myself that the way I felt was normal.  I knew it wasn’t normal, but I at least felt it was “to be expected.”  The last three weeks leading up to “my breaking point”, this was my typical day: I woke at 4 am to get ready for work, feed the baby, pack all my pumping supplies, and be at the hospital by 6 am.  Work was a rat race from 6 am to 6:30 pm, caring for pediatric hematology and oncology patients, many of whom were gravely ill.  I paused every three hours on the dot to make milk for my baby.  The “break” was only long enough to hook up to the pump, however, because I was still sitting in front of the computer, getting my work done as quickly as possible. I tried to drink enough, I tried to eat healthily enough, and I tried to not despair when each pumping session produced less and less milk. 

I got home around 7 pm and fed Henry.  Around 8 pm every night, he started crying.  Until 1 am.  Unfortunately, my husband was working nights at the time, so I was on my own.  Some nights I tried for hours to console him.  Other nights I put him in his crib, closed all the doors between us, got as far away as possible, and tried to ignore the screaming.  Usually we both fell asleep around 1 am.  I fed him around 2:30 am, and at 4 am, we started all over again.  And every minute of it, I wished he were never born.

Henry was a wanted, planned, loved baby.  My husband and I had been married for 4 years, had already “succeeded” at parenting an infant once, are professionally trained to take care of children even in their sickest and most fragile states, have financial stability, good insurance, safe transportation, ample baby supplies, and friends and family that love us.  But when you have postpartum depression, none of that is enough.

To be honest, it all probably started even before he was born.  When I was six months pregnant, I got a very “ordinary” infection (cytomegalovirus, or CMV) from a patient who accidentally spit in my eye while I was examining her throat. 

Trouble is, while the mother is generally asymptomatic, CMV can wreak havoc on an unborn baby: growth restriction, abnormal brain development, lesions in the intestines, liver problems, deafness, severe mental retardation, and even death.  I am so fortunate that A. we knew I was infected, B. treatments are available, C. I had excellent insurance, and D. we had both obstetric and pediatric specialists who were incredibly knowledgeable about congenital CMV.  I was treated with one dose of a $50,000 drug, and with a giant pill five times a day for the rest of my pregnancy.  We had ultrasounds every three weeks to track Henry’s growth, to look at his brain, and to reassure ourselves that all was as it should be.

Despite all that, my husband and I were terrified.  It’s hard to describe the dual senses of responsibility and helplessness in protecting your unborn child.  Before Henry was even born, I felt that I had failed him.  The place where he should be safest, I had allowed him to be exposed to something that could literally kill him.  I knew, intellectually, that it wasn’t my fault, and that with all the treatments we had completed, it was very unlikely that he would be profoundly affected by this virus.  But the fear of the unknown was a tremendous burden.  My husband and I prayed diligently that the blood tests after he was born would prove that the virus had never even crossed the placenta in the first place, that my immune system had fought it off before it could infect my baby.

Henry was born after nine hours of natural labor, two days before his due date.  He was 8 pounds 5 ounces and beautiful.  Those first moments with him were filled with joy, relief, thankfulness, and still in the back of my mind, were poisoned by reservation and fear. 

He was a few hours old when we sent off the blood tests, and it was less than 48 hours before we learned that he did indeed have the virus floating in his blood stream.  I was so bitter.

Henry was healthy enough to go home with us, but would have to take an oral medicine twice a day.  I always found a way to have my husband be the one to give it.  He asked me to give the dose a few times, unaware of my phobia.  But after about two weeks, I broke down and explained that I simply could not do it.  Every time I looked at my son, I saw visions of miniature robot-like viral demons swimming through his veins.  The medicine, as insignificant as it seemed to Henry (who was a champ), debilitated me.  My husband graciously understood, and from then on, gave the dose quietly and away from my presence.

The medicine was not a benign one in terms of side-effects, and within a month Henry had a critically low white blood cell count.  This put him at high risk for serious infections with an immune system that had no “ammunition”.  We decided to stop treating the virus (which, even after it is cleared from your blood stream, lies dormant in your body and can be reactivated in the future), because the risk of an immune-compromised state was the more imminent danger.  The good news was that all of his organs (and brain!) had developed appropriately, so the primary risk at this point was hearing loss, and we were willing to accept that.

Developmentally, Henry is beyond perfect.  My husband and I still marvel at what he is capable of.  Several months ago, my husband put into words what I had long been thinking: “I think God is allowing Henry to beat every developmental milestone to put our hearts and minds at ease, to let us know that the CMV did not hurt him.”  We are blessed.

The story does have a happy ending, and today I could not be more thrilled with my 20 pound, boisterous, cheerful, sweet, snuggly, adventurous, fearless, giggly 15 month old.  But literally, the joy he brings me now is a near constant reminder of the misery I felt just one year ago.

I want to describe postpartum depression, because I think it is often misunderstood.  And because it is misunderstood, it is often missed.  It is all at once so crippling and so invisible.  So I hope this sheds light, because women suffering from PPD are in a way blinded by it, and are in desperate need for their loved ones around them to recognize it, to reach out, and to seek help on the mother’s behalf.

My chief resident at the time explained it to me in the simplest of terms: We all have trials, and challenges, and stressors, and fatigue.  But we all have coping mechanisms, and support, and reserves that we can rely on to get us through those times.  Depression robs you of your ability to cope.

That last statement is what finally opened my ears.  I knew that I was tired.  I knew that I was sad.  I knew that I spent hours each day crying.  I knew that I looked at my baby, and in place of love, I felt regret, worry, guilt, and bitterness.  I knew that he was losing weight, that he cried constantly when he was around me.  I thought that he was just a miserable, sad, whiny baby, until a good friend came over to offer me some respite.  She rang the doorbell.  I picked Henry up, held him at arms’ length (I rarely cradled him, as that was too intimate), walked briskly to the front door, opened it, and thrust my three-month-old in her arms.  I didn’t make eye contact, I didn’t say a word.  I turned and walked back to my room and sobbed.  Two minutes later, she was cooing at him on the floor, and he was cooing back.  She called out from the living room, “Hannah!  He is just the sweetest, happiest, most beautiful baby!”

A stab to my heart.  I had no idea.  I knew there were two possibilities: either he was innately a happy baby, and was only miserable around me because of my own misery, or he was innately a happy baby and I was blind to it.  Either one was too painful to bear.  The very next day, I emailed my boss, crying out for help.

Residency is a marathon at a sprint pace.  The pressure and fatigue are due in equal parts to the hours, the pace, the volume of information that must be learned/remembered, and the necessity that there is little (no?) room for error.  Not when children’s lives and wellbeing are at stake.

My husband and I chose to come to the University of Florida for two reasons: A. on-site child care would allow me to run down the stairs and see my children literally within 60 seconds, and B. the leaders of the program seemed to value us equally as doctors, parents, spouses, and humans.  I knew that if I were to survive the marathon-sprint, I would need both of these things.

I will forever be grateful for the immediate and overwhelming support I received from my residency program.  The program director, my advisor, and both chief residents were there to listen, to encourage, and most importantly, to force me to get the help I needed.  Without robbing me of my autonomy, my program director guided me to accept what I had known for months to be true: I had postpartum depression, and it was debilitating.  I could not work safely, but more importantly to her, I could not love my son.  And he and I--and even my husband and 2-year-old son--were suffering immensely for it.  She connected me with a psychiatrist who specializes in postpartum depression, and I don’t think she even realized it was a birthday present.  She encouraged me (relentlessly) to take a month off of work, effective immediately, until I finally agreed that was the right thing to do.

I flew home to the other side of the country to rest and heal.  My husband stayed behind and worked the next four weeks for me.  He had been scheduled for “an easy month”, but instead worked my grueling 13+ hour shifts, over the holidays and all alone, so that I didn’t have to.

I wish I could say that freedom from work and a few weeks of good sleep (whatever that means when you are nursing every three hours) made me feel tremendously better.  I was partly disappointed, but mostly not surprised at all, that I still felt numb, hollow, tired, ashamed, and inadequate.

And that is what depression does to you.  It robs you of your ability to cope.  It robs you of your joy.  It robs you of a healthy perspective on the many beautiful gifts you have been given: a strong and tender husband, two precious children, a mind for science, a passion for medicine, a gift with others’ children, an able body, an army of generous and loving family members.

When I look back at pictures from that “era”, I see the emptiness in my eyes.  I imagine most others saw my smile, not knowing it was forced, saw my wonderful family, saw my “successes”, and had no idea.  This is why I say postpartum depression can be so invisible.

If nothing else, I am grateful for my experience so that, as a pediatrician, I might be more able to see the signs in others.  My screening for PPD at well-child visits has completely changed.  Babies and mothers are intricately intertwined, and when one suffers, so does the other.

This is not to minimize the role of fathers; I learned firsthand how dramatically PPD can affect men as well.  For several months too many, my husband lost his wife, his partner, his best friend.  His household tasks and his parenting responsibilities multiplied.  And the emotional burden of loving me, nurturing me through my fragility and weakness was perhaps an even greater task.  Several months later, back at work, energetic, feeling capable, with Henry thriving, I professed to him that I “felt like my normal self again”.  He meekly stated that he was still scared that he couldn’t count on me as an equal in our household, fearful that “too much pressure” would cause me to crumble.  It had been so painful for him to witness, and really, to experience, that he would do anything to keep it from happening again.  I knew then that I was not the only one that needed to heal.

Today I am 30.  Much has changed in one year.  Henry is healthy.  I am healthy. The marathon-sprint continues.  We have 6 ½ months left until the finish line.  Our third son is due in two months.  I would be lying if I denied the fear that PPD will strike again.  But this time I am equipped with knowledge, both learned from textbooks and gained from experience.  Our families are still 2,000 miles away, but are more than eager to hop on a plane and support us in whatever way necessary, for however long it takes.  I have my husband, my boss, my close friends who loved me through the journey last time, and who will love me through the joys and challenges that we are sure to encounter this time.

I often jest that nothing in my life goes according to plan.  An outside observer, acquaintance, or even a friend would probably never know, but truly, my life is one giant string of “Plan B’s” (or Cs, Ds, Es, Js, or Ps) after another.  It’s never quite what I expect it to be, but somehow, it always turns out well.  I would never have picked to have postpartum depression, but I am so grateful for what I learned about myself, for the way it deepened my respect for my husband and strengthened our marriage, and for the perspective I now have when I look into Henry’s joyful eyes (that happen to look exactly like mine).  We went through a lot together, and I am a better woman, mother, and pediatrician for it.