Twenty years ago, when I started medical school, I had no idea that this would be my path. Coming from a research background in cancer biology and biophysics, I did not have much exposure or interest in integrative medicine. My path to practicing integrative and functional medicine and incorporating new modalities to my foundation as a general internist, was not linear, and not expected.
I was pregnant twice during my three-year internal medicine residency training. I was crazy enough to listen to my obstetrician, who said, it is just like the Nike slogan, “Just Do It!”. So, I did it, I had my babies. I figured the risk is lower when I am younger, and I will figure out the rest. During both of my pregnancies, I was regularly doing thirty-plus-hour shifts every three to four nights on inpatient rotations and working six days per week. I was taking care of sick patients, often in life-or-death situations if I was doing ICU care. I loved my residency training and knew this was my calling. At the same time, as I was learning how to be a physician, I felt the competing demands of my residency and my pregnancy. I had to be hydrated, rested and fed, to keep my growing baby healthy, but this is not compatible with residency training. If you had to pick the fastest road to burnout, this would be one of them.
During my long shifts, I often did not have time to get water, go to the bathroom, and I was not allowed to carry food on the hospital floors, which could mean not eating for twelve or more hours, especially when I was on call. What did I do? I snuck a bottle of water, banana or apple and almonds in my white coat pocket and ate in a nurse’s room or bathroom. This kept me hydrated and nourished but it did not keep me from being exhausted, burned out and questioning whether this abuse to my body was going to lead to complications to my child. On top of this, my first baby was measuring big (in fact, both were over nine and ten pounds at birth), and my obstetrician brought up the idea of induction of labor and C-section given the size.
This was my critical point. I woke up in the middle of the night, burned out, tired and desperate. I felt the physical and emotional overwhelm to my baby and me. As a science nerd, I was up at 2 a.m. researching the effects of these long hours and night shifts on the likelihood of pregnancy complications, including pregnancy loss and premature birth (yup, there was plenty of evidence). Long work hours and night shifts during pregnancy are associated with a higher risk of miscarriage and early pregnancy loss according to the American College of Obstetricians and Gynecologists. This association is stronger for night shifts and the risk ratio is 1.51 for those working night compared to day shifts. Rotating shift work, fixed night shifts and working more than forty hours per week during pregnancy increase the odds of preterm delivery, miscarriage, gestational hypertension, preeclampsia, gestational diabetes and infants born small for gestational age or with low birthweight.
I decided: Something had to change. As I was sitting there, staring at my computer screen with all these research articles, I made a commitment to myself and my not-yet-born daughter Olivia: I was going to be proactive rather than reactive about our health. I found a prenatal yoga instructor and a doula and started working with them to better manage stress and nurture a connection to my baby. I started seeing an acupuncturist and a friend recommended a chiropractor to prepare my body for the birth of this large baby. What was fundamentally different in these practitioners, compared to what had mostly been my experience as a patient in the modern medical system, is that I felt like they were on my side. They were in it to empower me and show me what I am capable of. They believed in me.
As I was noticing a mental and physical shift in my body, my outlook on medicine and the ability of our body to heal started to transform. There is nothing more powerful than priming our body to heal and optimally perform. With the natural birth of my daughter with no pain medication, and later my son; I even laughed through one of my last contractions as my husband told a joke, I learned that we can reframe any situation, that our bodies have the incredible capacity to do what seems impossible, and if we listen and respond responsibly, our bodies will listen back.
This is the commitment that I make to every patient, and the foundation of my teaching. In addition to offering the best evidence and tools we have, we must not forget that our job is to empower, to offer support, to truly care for the individual we are working with and be an active partner in the science and art of their healing.
Bojana Jankovic Weatherly is an internal medicine and integrative medicine physician.
