A physician’s postpartum depression [PODCAST]

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“I may be practicing the art of repression and washing myself of any speck of contamination that would take me back to the state from which I have come very far. My suffering of the past, today, is a mere jumble of words devoid of any color or feeling. It is now a part of life that happened, changed me for good, and disappeared in the deep waters of the sea, hopefully never resurfacing.”

Fareeha Khan is an internal medicine physician.

She shares her story and discusses her KevinMD article, “My postpartum depression was a stumble, but am I really past the trauma?”

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Transcript

Kevin Pho: Hi, and welcome to the show. Rate and review at kevinmd.com/rate. Subscribe at kevinmd.com/podcast. Today on the show we have Fareeha Khan. She’s an internal medicine physician. Her KevinMD article is titled “My postpartum depression was a stumble, but am I really past the trauma?” Fareeha, welcome to the show.

Fareeha Khan: Thank you very much for having me. How are you?

Kevin Pho: Good. Thank you so much for joining me. We’ll get into your article in a little bit. First off, briefly share your story and journey to where you are today.

Fareeha Khan: Sure. I’m actually originally from Pakistan. That’s where I did my medical school. Then I came here to the U.S. back in 2016 for my residency, and I completed my residency in the notorious year of 2020. For the past two and a half years, I’ve been working as an academic with Loyola University, and I’ve been teaching residents and students alike. That’s been an interesting journey. And as a part of my residency journey, I had my experience with postpartum depression when my daughter was born.

Kevin Pho: So tell us your story. This is what this article is about, so tell me a little bit about that story.

Fareeha Khan: Sure. It’s interesting, because I went into medicine, and I was like, “OK, I’m very career-oriented. I’m probably not going to have any kids until maybe the last year of my residency.” You always make those plans. Lo and behold, I found myself pregnant toward the end of my intern year. And it wasn’t a really nice ride at all, because I had an IUD in place, and I was like, “This is impossible.” So anyway, there was some resentment, because I was not expecting something like that to happen.

Anyhow, toward the end of, basically, I guess, the middle or early part of my second year, I was diagnosed with preeclampsia, and my daughter, my unborn daughter at that time, had intrauterine growth restriction. So of course I had my different appointments made with the doctors. You’re a resident, so of course you’re trying to find the days that you’re able to get off early or somehow make the appointments happen, all those CTG studies and all those biophysical profiles. So that was all happening, and of course I was doing my ICU rotation. Then, at one of my regular checkups, I was told, “Hey, listen, now we find protein in your urine, so you’ve got to get admitted, because people who look as good as you actually end up in a very bad state. So just get admitted.” So I was admitted for a whole week, and at the end of it, of course, I ended up having a C-section, an emergency C-section, for my elevated blood pressure.

And then my daughter was delivered. She was delivered at 30 weeks. We had the NICU attendings come by, and of course my MFM physicians and everybody else, and they were all very positive about it. But one thing that I remember is that one of the social workers was talking to me about it: “Hey, listen, you’re going through so much in your position. You’re at risk of postpartum depression.” And at that point, and it’s odd enough that I’m saying this right now, I just kind of brushed it aside.

Kevin Pho: It’s such a whirlwind. You’re going into your second year, you had all these appointments like you said, and then an emergency C-section. So just tell us, at that point, everything that was going through your mind. Tell us everything that was circling around you during that point.

Fareeha Khan: Sure. It’s very interesting, as I sit and think about it right now, that I think of it as an episode that happened in the past. At that moment, I think I was confused about what my goal was and what I was trying to do. I was trying to be an excellent resident, an excellent intern, and at the same time, I was trying to make sure about the baby that I was carrying, which was my first-ever experience. I didn’t have any siblings who had gone through such an experience, so I didn’t know exactly what my priority was. So I would be prioritizing my work.

I remember when I was working my ICU shift, and I wasn’t gaining enough weight. I had these Ensure bottles that my husband had gotten me, and just about when it was time to go home, I would remember, “Oh my gosh, I forgot to drink my Ensure bottle.” My husband would check my bag to see how much I’d eaten. So I would just gulp all of them down so I could come home and tell him, “Hey, listen, I had everything.” So, looking at it now in retrospect, I figure my priorities were not the most appropriate. I was really trying to excel in my career while my own personal life, and probably my mental health, which I did not know at the time, was taking a backseat for sure.

Kevin Pho: Wasn’t this during 2020, during the beginning of COVID as well?

Fareeha Khan: No, that wasn’t then. It was in 2017, 2018, around that time. Yes, exactly. So the world was different for sure, but it wasn’t really pre-COVID at that time. But my daughter was born in 2018, and by 2019, my family, my husband, everybody was saying, “You’re not looking like yourself. You’re not looking like the confident person who’s able to make decisions.” I was even scared of taking my daughter alone into the bathroom to change her diaper, or of taking her out. I would always wait for either my mom, my dad, or my husband to be there, and I wouldn’t be doing things or making decisions. I was like, “I have to run it by somebody.”

But that was my personal life. It was weird enough that my professional life was working perfectly fine. I was selected as the chief of my program, and I was doing great in my field. So it was such an odd thing that I was struggling in my personal life, but my professional life was going well. I wasn’t able to reconcile the situation at all.

Kevin Pho: Now, you mentioned that other people were telling you that you weren’t yourself, but how did you feel?

Fareeha Khan: That’s a very important point. Honestly, looking at it now, when you’re actually going through a mental illness, you do not have the insight at all. When people would tell me that, I would just shut them out completely, and I would not believe them. I remember very distinctly, my husband is my support system and everything, but I would be like, “Hey, listen, you don’t know what I’m going through. You haven’t been through this experience, so you don’t get to say what I’m behaving like. This is all normal, and this is not something that’s pathological or physiologically deranged at all, whatever you’re saying.” And my mom kept saying that, too, and I was very annoyed. I was like, “Listen, stop doing this comparison of the previous me and the new me. I’ve been through a lot. You’ve got to give me some grace.”

So they were looking at a certain part of me that was not myself, and I was angry at them for comparing me to the previous me, who was different and hadn’t been through all that I had been through. So it was hard for me to look through their eyes while I was still going through all of those things that I was subjected to.

Kevin Pho: So at what point did your mindset change?

Fareeha Khan: It was interesting. I would get these episodes of panic attacks, or things like that. I would be like, “OK, I’m getting these palpitations, and I feel like I’m dying.” And then I was like, “OK, this is probably just a panic attack.” Because you’re a physician, you put it to one side.

I remember our residency program was having a noon conference. Sometimes, in one of those noon conferences, we would have a book review with our social workers and everyone. They had Dr. Awdish’s book, “In Shock,” and they were reviewing the book. I had not read the book at that time, because of course there were so many things that would be happening around me. They started going through the story, one part after the other, and I just could not sit through it. I could feel that my heart was beating fast, and I would get these physical symptoms of numbness. This was something that I would often get, but not at work. So I was like, “Why am I going through all these episodes? What is happening to me?”

So I just couldn’t sit, and I just had to walk out. That was an odd decision for me, because as a resident, and as a second-year resident, you’re expected to sit through your noon conferences, and unless you’re going to the bathroom, it’s hard for you to just walk away. So I had to make that difficult decision. I was like, “I hope people don’t think that I’m going because I have a phone call to attend, or I have to go lactate, or something like that. I just was not feeling well.” So I made a decision, and I walked out. And then I was like, “This is not normal, you know? You’re going through something that is not appropriate.”

Then I came home, and I talked with my family, my husband, and he was the one who said, “Hey, listen, go ahead and make an appointment with a therapist.” The therapist was very forthcoming about all those things that I had been through, and he actually laid it out right in front of me. It took me a little time to even understand what he was trying to tell me, because I would be telling him my experiences, and then he would stop me and ask me a question. I was just wondering, scratching my head, “What does that mean?”

Kevin Pho: So what did he tell you?

Fareeha Khan: He would often ask me, “Are you an anxious person?” I know I’m an anxious person to begin with. That’s how type A personalities in medicine are. But then he would be like, “Are you really trying to control your emotions, or are you trying to control what’s going on with you?” And I would tell him, “Hey, listen, I get these episodes, and I feel like I’m about to die, and this is what’s happening.” And then he said, “Listen, sit right in front of yourself, and tell yourself, ‘Hey, listen, I am going through this particular episode, and it is not going to kill me.’ It is not going to lead you to your death. You cannot predict it for yourself. Sit through it. Experience it, let it pass, and then you will come out of it just as an observer. You’re going through it; just observe your feelings.”

And I think that was a very eye-opening experience, because once you’re just sitting and viewing your anxious personality, or your anxiety, walk past you, and not letting it affect you, that is an empowering and a different kind of experience. You’re not letting yourself flow into that little river and get taken by the wave of it. So that was really something. And then I got into meditation. He was very helpful about it. And I think meditation was another thing that helped me come out of this deep, deep rabbit hole.

Kevin Pho: Sure. So that appointment with the therapist, when he laid it all in front of you, was that the first time that you realized, “Hey, this was postpartum depression”?

Fareeha Khan: Yes. I think it took me a few appointments. The first time, he actually just opened up about my anxiety and whatever was going on. And then I was like, “Can I have my husband come in and sit with me?” This is so odd, and I know how medicine is, so I thought he would wonder why I was bringing a different person. And sometimes people are not very open about things with their partners. So he was like, “OK, go ahead. Bring your husband if that makes you comfortable. Just have him.” I wanted my husband to actually tell him and basically enunciate things in a better way than I would, because I thought that I wasn’t even able to tell my symptoms well.

It was a really odd situation. And then, after the first two times, I was like, “OK, I think I can do this by myself.”

It was an interesting experience at that time, because now I’m thinking back, and I’m looking at why I had to have another person come with me to talk with my therapist. Despite the fact that my husband knows everything, everything that was going on with me, and he was the one pushing me to do things, it is still my lived experience. So why was I actually having somebody come and sit with me?

Those couple of meetings with my therapist actually laid it out very well, that this is something that my body is going through physiologically, that my mind is going through physiologically. It is physiological, but it does seem to get a little bit overboard on and off, and I need to figure things out. And then he gave me the tools that I could help myself with.

Kevin Pho: Now, you mentioned counseling, and you mentioned meditation. How long did it take you before the symptoms resolved?

Fareeha Khan: It’s interesting, because people say that postpartum depression can start at any time postpartum, and then they give you an arbitrary timeline of six months. I was well beyond that time. It was around the one-year mark when I decided, “OK, I need the help.” So I was probably in some sort of lingering depression or anxiety or whatnot, whatever I may want to call it. I used to call it adjustment disorder for myself. But you could call it whatever.

So it was lingering up until that point. Then I did start expressing my thoughts, journaling, writing about the things that I was experiencing to see what was actually happening, and then of course meditation, letting things pass by themselves, and having counseling. I’m talking about 2019, and it wasn’t until 2020, the COVID times, when things were shutting down and of course people were opening up about their mental health problems, that I actually started realizing, “OK, I’ve literally walked out of a very cloudy situation, and now I am basically stepping into the more real world.” It’s weird. When the world was basically going into depression, I was actually coming out of it and trying to figure myself out at that point.

Literally everything had been like a haze. I felt like I didn’t know where I was. Now I’m a completely new person. I’m ready to live my life. I’m ready to embrace everything outside of medicine or work or whatnot. It took me a good year and a half, I would say, to come out of this entire situation that I had been through since 2018. So the whole period lasted, I would say, two, two and a half years or so, and by around 2020, I really opened myself up to the world.

Kevin Pho: We’re talking to Fareeha Khan. She’s an internal medicine physician. Her KevinMD article is titled “My postpartum depression was a stumble, but am I really past the trauma?” Now, we have a lot of people who do have children during residency or early training. Any pieces of advice that you could share with them from your own experience?

Fareeha Khan: During training, this is very interesting, and I wish I had known this before. A lot of hospitals, a lot of places where you do your training, a lot of training programs, and the bigger ones, I guess you could say the ACGME and everyone, have facilities and places and things available for you. It’s just that they’re not highlighted the way that they’re supposed to be. There are places that you can go and get help when you know that you’re going through something, or, if you don’t know, there are people who can actually highlight that for you. But we don’t really bring it out in front of everybody. It is there because it’s supposed to be there, but it’s not considered to be something very important to be actually laid out in front of you.

So I feel like if I had known that before, if I had been educated about this, then I would probably have gotten the help just through my work experience and my workplace. And I’m sure that every other place has this, and a lot of people are going through the same thing. Some of them just don’t have the insight yet, and some of them, despite having insight, don’t know how to get the right help, because they don’t know, or they’re not educated about, what facilities they have available where they’re working.

Kevin Pho: Now, what kind of symptoms or questions should they ask themselves to look out for in order to seek help?

Fareeha Khan: It depends on the person. For me, my symptoms were more physical. I was getting these psychosomatic symptoms of numbness and tingling. And especially when you’re postpartum, you’re also thinking, “Am I going through a stroke or not?” So that was something I was really concerned about, that I was getting a stroke. So I would just say that you have to be very open and mindful of the things that you are now experiencing that are different from your prepartum self, and you have to make sure that this isn’t something that has come up just because of some pathology that you’ve acquired. Or is it really coming from your psychology?

I think one other thing that I would like to point out, and that I may have missed, is how attached you feel to your own kid. For me, it took a good six, seven months to feel attached to my own kid. I would be getting up, and I would do everything for her that was needed. It’s just that I did not feel the love and connection that a lot of moms are able to feel while they have the baby in their belly. It was hard for me to even do that afterward. So that connection, if you’re lacking it, sometimes it can be that your body is just taking some time, your mind is taking time, but I think that is something to look out for: not developing the connection that you’re supposed to as a mom.

And if you have people who are your well-wishers telling you, be open about that, because they are noticing something in you that you haven’t noticed yet, or that you don’t have the insight into. And then, of course, some physical symptoms. And if you are prone to anxiety and depression, you know what kind of symptoms you have. So be mindful of that, and get the help that you need at the right time.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Fareeha Khan: Absolutely. I think the biggest thing is that as women in medicine, or in any other field of work, we just try to go an extra mile, as though we have something to prove to the world, just so that we can be equal to our male counterparts. I think it is OK to know the limitations that we are going through sometimes, and it’s OK to know that there are certain physiological processes that we are going through, and it’s OK to say no to things. The biggest issue for me was, “I have a career in front of me, and I am a mom, but I want to make sure that my motherhood is not coming in the path of my career. So I have to work extra hard and show the world, ‘Hey, I’m still the same myself.'”

And it’s OK to not do that. I think that’s a very important message, especially for women who are very ambitious and career-oriented, the way that I still am. I still struggle with it, but that is something that I have learned to embrace.

Kevin Pho: Well, thank you so much for sharing your story, time, and insight, and thanks again for being on the show.

Fareeha Khan: Thank you very much. You have a good one.

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