Updated: Nov 22, 2021
By Melissa Yuan-Innes
This article was originally published in the Medical Post as a response to Dr. Michelle Cohen's piece. The editor changed the title from "Code Breast" (a play on Code Blue) to "Code Lactating Doctor!" I like the exclamation point, and I want the Medical Post to survive as a Canadian source of independent medical journalism. However, I hope CWIM is less likely to censor female anatomy. My husband pointed out that "Code Boob" was even closer to Code Blue.
My breasts were full. I had to run off and pump milk for my baby.
One side of the emergency department's physician mail room opened into the call room, which was a dimly-lit room with a bed, a chair, and a TV. On the other end of the call room was the bathroom. The mail room and bathrooms had locks, but the call room didn't. I needed to unlock the mail room door, rush into the call room with my pump equipment, jam the chair against the call room door, and pray that no one would try to use the bathroom for the few minutes that I pumped. It was a small ER with zero to two other physicians working at the same time. Less than a handful of times, I'd have to yell, "Just a minute!" But it added to the pressure. As if running an ER wasn't enough pressure. Luckily, I was a milk machine. I wasn't talented at getting pregnant, but I could usually lactate like a champ. I just needed to see one more patient. And another. And another, an endless chain of people who needed my care.
And then a code came in.
I was at the head of the bed, intubating and yelling out orders to shock and do CPR and give epi. We got the patient to ICU. Afterward, I realized that my breasts felt okay—because they'd let down during the code. Oh, well. I was wearing a black shirt, which hid the moisture pretty well. I carried on with my shift. Only at the end of the day did I realize that black is good at hiding wetness, but milk dries into white powder. Meaning that I wore two very prominent circles over my breasts for that entire shift, for every patient I saw.
My designated nurse, a likeable and hardworking guy, never said a word. This was back when our acute side emergency physician had a designated nurse whose job was to carry out every order. So the two of us worked in tandem for hours. Oh, well. The RN had several kids. He probably knew what was normal. He wasn't acting embarrassed, so I wouldn't, either. But I never wore a black shirt with no scrub top over it to the ER again while lactating, if I could help it.
So I feel for the women physicians who are trying to breastfeed their babies. Supposedly, we're here for health. We chose medicine because we're altruists who want to Help People. But I've noticed a distinct lack of support for women physicians who (gasp!) get pregnant or (what?) have a baby and (horror!) take maternity leave.
When I was a medical student on obstetrics, for example, the senior resident clearly seemed meticulous to me, but the junior resident knew surgeons who questioned the senior's surgical skills because she'd had a baby in her first year of residency. She'd given birth four years prior, but they remembered. I felt disillusioned that ob/gyn specialized in women's health, but implicitly or explicitly discouraged reproduction in their own trainees. The only specialty that seemed pleased by pregnancies was pediatrics, because they genuinely loved children. That said, I will add that I've seen peds work their residents harder than many others, because you're supposed to sacrifice everything for The Children. I'm sure I missed instances of overworked pregnant or lactating residents. I am not surprised to hear through Dr. Michelle Cohen's column that even in 2019, a peds resident had trouble breastfeeding.
Breastfeeding helps the mothers bond with their babies, lose weight, boost oxytocin, contract their uteruses (uteri?), and reduce their risk of breast and ovarian cancer. It protects the babies by supplementing their immune systems and reducing their rate of everything from ear infections to diabetes and leukemia and lymphoma. It's the most gentle on the environment and the cheapest and best way to feed your infant.
And we still can't give women 20 minutes, a room, and a fridge? What's wrong with medical culture?
What's wrong with workaholics like me, that we keep working until our breasts explode?
I don't have any easy answers.
However, I can offer one piece of a happier ending. That hospital has been renovated. The ER now has two tiny call rooms with doors that lock and a mini bathroom, so you have the option for privacy. The one breastfeeding physician I've seen post-me has chosen to use the doctor's lounge instead, which has a large couch, a window, a fridge, a TV, and a coffee maker, and a lock on the door.
Now all we need are a few minutes to pump.
Melissa Yuan-Innes is an emergency physician and award-winning writer who will teach the humour workshop, Make 'Em Laugh, at CWIM 2020. Her Dr. Hope Sze medical thrillers, written as Melissa Yi, have been recommended nationally by The Globe and Mail, CBC Books, and The Next Chapter, and have been optioned for audio by Kobo Originals. More relevant to this workshop: a nurse began reading the series and declared, “I laughed so hard that I scared my cat.” Melissa’s often-humorous columns for the Medical Post were nominated for a national business media award. Her Fringe show, “I Am the Most Unfeeling Doctor in the World (And Other True Tales From the Emergency Room)” literally made audiences giggle and weep before it won Ottawa’s Best of Fest award. Melissa lives with one husband, two children, and one loud Rottweiler in Eastern Ontario. Sometimes, she sleeps. Find her on Facebook, Twitter @dr_sassy, and her website, http://www.melissayuaninnes.com/