Published on October 7th, 2020 | by Melody Glenn0
Spilt Milk in the ER
Four hours into my shift, my breasts had moved passed the sensation of fullness and into the realm of engorgement, a sense of urgency building. I glanced up at the clock; the trauma patient was supposed to arrive in ten minutes. Was there enough time to start pumping? Or should I wait until after? It could be a fast exam and then off to the CT scanner, or it could be an hour of procedures and critical care.
Mommy blogs caution against waiting more than four hours to pump, otherwise your body will interpret the delay as meaning your baby isn’t hungry, and in the absence of need, you will start to produce less milk. It’s a system. Before you know it, your breastfeeding relationship will be toast, dooming your child to a lifetime of psychological trauma.
But, I barely had time to pee on a busy shift, much less the twenty minutes required to use a traditional pump. So, I bought a fancy pump, $500 fancy, that promised to let me have it all: I could pump and see patients at the same time. Just slip it on and go, no breaks needed!
Whereas standard breast pumps, plugged into the wall and sprouting tubes and flanges, are cumbersome and made me feel like a dairy cow, my pump was a sleek machine designed to maximize efficiency. I liked the narrative it was selling: motherhood would not hold me back. The device, composed of two half-spheres, slipped into your bra. It ran on batteries, and the milk was sucked directly into a plastic bag that rests within the device. Nobody the wiser. Except that it pushed your bra forward in a way that made you look like Dolly Parton. Once, when I was pumping while signing out patients to the oncoming doctor, I noticed that his eyes kept leaving mine, going to my chest, and then back up to my eyes. I wondered if he was a creep or genuinely confused about what was going on in there.
The next time, I considered looking for a more discrete place to pump. The Fair Labor Standards Act requires that employers provide private spaces for women to pump. But in our county ER, a space that was already too small for our large patient volume, that just wasn’t an option. One of the residents shared her personal favorite pumping area, the Sexual Assault Response Team room. “It even has a fridge and a sink!” she added with a wink. True, it was a private room with amenities, and the only one designed primarily for women, but it didn’t exactly evoke a warm, fuzzy feeling. It was a space designed to collect “evidence” for sexual assault cases, and the fridge was used to store samples, i.e. semen swabbed from vaginas. No thanks.
So I decided ten minutes would have to be enough. I slipped into a closet, aligning my nipples until I felt the suction, and then quickly returned into the chaos of the department. Relieved that the trauma has not yet arrived, I leaned against the double glass doors between the central pod of the Emergency Room and the trauma bay and closed my eyes. Because my four-month-old baby still couldn’t sleep more than a few hours at a time, neither could I. But after a couple of seconds of “resting my eyes,” I felt something wet against my stomach. Drops of milk had escaped from under my shirt, pooling in a small white puddle at my feet.
In this job where I struggled to be recognized with the same authority so easily handed to my male colleagues, I often tried to cover up my feminine characteristics. No makeup, no jewelry, no form-fitting clothes. But even in boxy scrubs, I couldn’t hide anymore. Now I was a mother with large, leaking breasts. Panicked, I run to the bathroom, cutting off a tech who was just steps away from the door.
As doctors, we are trained to believe that we are, or should be, invincible—in contrast to our patients’ bodies, bodies with needs and demands that must be fixed. Weaknesses. I once bragged about the time I worked an entire shift while febrile with strep throat, as we didn’t have a way to call in sick, or my ability to slam down a cliff bar while peeing, a trait I had learned out of necessity. ER doctors didn’t take lunch breaks, for God’s sake. But pregnancy, and then breastfeeding, had started to erode such illusions of control.
Then, I dropped the pump on the bathroom floor. This wasn’t any bathroom floor—it was the bathroom floor in the county ER. My shoe stuck to the linoleum as I backed up, and I noticed that the tacky film extended under the pump. Trying to avoid as much contact as possible, I gingerly picked up the pump with two fingers, ripped off a paper towel, and held it under the soap dispenser. I heard the automatic click, but nothing came out. Empty. I put my baby in daycare, a place she hates so much that they once called me to pick her up because she had been crying for five hours straight, for this?
I fumbled to stop the pump and remove the broken bag, losing an ounce of milk in the process. The tears started. Although an ounce sounds inconsequential, at that moment, it felt like everything. It was more than the literal loss of milk, although that, too, is something; our lactation consultants practically equated formula with the devil, and my body produced the exact amount of milk that my baby ate.
Milk was love. It was health. It was connection when we are physically apart. It was a way to erase the guilt that I felt for leaving her in daycare, for wanting to continue to focus on my career. I was doing everything I could to be both a good mom and a successful physician, yet it never felt like enough. Maybe it never would. When I later asked my partner if he too felt weighed down by the impossibility of meeting such conflicting demands, he looked surprised. The dilemma—fatherhood vs. career—had never crossed his mind.
I eventually got things somewhat cleaned up, and dashed to the trauma bay in time to meet the new patient, a young woman who had been assaulted. Before, I would just have seen her as the patient in room five, nameless and without a story of her own. Compartmentalization kept me protected, I reasoned, and helped me focus on the tasks at hand. Never mind that it also left me feeling dull and flat, even when not at work, and studies showed that patients had better health outcomes when their providers related to them. But now, I saw this woman as a daughter and a mother. I imagined holding my baby, trying to shield her from the violence of the world. Motherhood had teleported me to a new state of vulnerability, one that made me squirm with discomfort.
With the patient stabilized and in the CT scanner, I retreated back to the relative calm of the doc box. One of the residents, a woman with rowdy curls and a surfer vibe, asked, “When are you coming back to working full-time?”
“With the baby, you must be working part-time, right?” She asked, still smiling. The realization hit me: it’s not only the older men who I have to convince that I am still capable of being a doctor, the ones who kept asking what direction my career would take once I became a mother—it’s also other women. I was blindsided. Although she didn’t mean any harm, her words reminded me how easy it was for them—young women without children—to don the cloak of male privilege. How hard it was for people, in general, to empathize with the tribulations of others. I knew, because I had done the same, back when I could.
I was also confused by how unsupported I felt at work, a place supposedly dedicated to wellness and healing. Even though the American Academy of Pediatrics recommended one year of breastfeeding, my hospital didn’t seem to care. Yet, I also knew that this problem was bigger than just my workplace. It was built into the structure of capitalism itself. Thus, the solution would also have to be of a larger scope; it couldn’t just end at the construction of a better pump or a lactation room, although that would certainly be a welcome start. We needed structural reform and systematic change. Although the details of such policies are beyond the scope of this essay, my goal is to create an aperture through which the light of imagination can enter. Instead of patting me on the back for being a strong mother or physician, begin to imagine a better system, to demand it. That is the only way things will ever change.
A year later, it’s spring in Sonoran Desert, and I traipse around the garden as the baby-turned-toddler drags a metal bucket through the sand. She’s still nursing but no longer dependent upon my milk, so I am no longer pumping, and we both sleep through the night.
As I trim the globe mallow, my mind wanders to my shift earlier today. My coworker had just returned from three months of parental leave. She worried that her clinical skills had lapsed during her absence (they hadn’t). She mentioned how she hadn’t slept a full night since before the baby, and she was tired. She left to pump, but was back only a couple of minutes later. “I’m getting some error message with the pump,” she told me, holding the same high-tech model that I had. “I’ll just deal with it later.” But as she placed the pump back in her bag, a circle of milk started to leak through her light scrub top, very much visible. “Man, I really looove lactating,” she joked. And as we laughed together, I became giddy — I had made it through! The horror had been only temporary! If only I had known! I wanted to pass on my relief, to reassure her: you’ve got this, and you’re not alone.
The toddler follows me over to the scrubby creosote bush, the one whose resin fills the desert air with perfume during every monsoon rain. Several yellow flowers are starting to explode from its waxy green buds. “How exciting!” I call out to her, “our creosote is starting to bloom!” She pauses to look up at me, a smile extending across her face. Joy spreads across mine. “Do you think plants are like people? Feeling pangs of discomfort every time they blossom?” With a smile, she reaches for the bright petals, and the world continues to unfurl with such brilliance that it is almost blinding.
All other photos courtesy of the author