

Open Windows

A story of postpartum anxiety and depression

June L. Young

IF YOU ARE EXPERIENCING A LIFE-THREATENING EMERGENCY, GET IMMEDIATE ASSISTANCE BY CALLING 9-1-1.

This book is not intended as a substitute for the medical advice of a physician. Dear reader, please regularly consult a physician in matters relating to your health and particularly with respect to any symptoms that may require diagnosis or medical attention. Refer to the Resources section at the very end of this book for additional information and referrals for support and medical help.

I have tried to recreate events, locales and conversations from my memories of them. In order to maintain anonymity, in some instances I have changed the names of individuals and places, and I may have changed some identifying characteristics and details such as physical properties, occupations and places of residence.

Copyright © 2016 by June Linh Young

All rights reserved. This book or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the author except for the use of brief quotations in a book review.

Cover image copyright © depositphotos.com/Malgorzata_Kistryn

Contact the author at junelinhyoung@gmail.com

Editing by Deborah Lott

For Mom

Table of Contents

INTRODUCTION

Part 1: PREGNANCY

Part 2: BIRTH

Part 3: POSTPARTUM

Part 4: THE STORM

Part 5: HEALING

Part 6: FAITH, HOPE, LOVE

EPILOGUE

ACKNOWLEDGEMENTS

DEFINITIONS

NOTES

RESOURCES

# INTRODUCTION

I am not a doctor, a psychologist, a spiritual leader, or a high profile anyone. I am a mother. I am a wife. I am a daughter. I am a sister. I am a friend. I am a survivor of perinatal mood disorders. When I was ill, I made a promise in my deepest and darkest moments that once I was able I would write about my experience as a way of reaching out to other women. To cry out, "You're not alone. It's not your fault. And there is hope." My writing project stemmed from an intense desire to help other women in similar circumstances as my own. In the end it became so much more for me, writing became more than an exercise of sheer will, it became a means of healing for me.

As I write this note, it is 2016 and perinatal mood disorders are still not widely known or understood by the general public. Even the medical community is grappling to fully understand them and develop effective treatments. In this story I use Postpartum Support International's definition of the term perinatal which refers to the entire period from pregnancy to the baby's first birthday. Postpartum refers only to the period after childbirth. The term perinatal mood disorders is more inclusive of the wide range of symptoms I experienced during my pregnancy and postpartum, compared to the term postpartum depression with which many people are already familiar. In fact, for many women, the problems start long before the baby is born, and worsen, or fail to resolve, afterward.

Perinatal mood disorders can occur during pregnancy and/or after childbirth and may include depression, anxiety, panic disorders, obsessive compulsive disorder, post-traumatic stress disorders, bipolar mood disorders, and psychosis. I am not a medical expert; a glossary of terms is provided in the back of this book for reference only. I encourage you to find an informed medical professional to thoroughly answer all your medical and treatment questions, and I have included a list of organizations that may be able to help you find an informed medical professional.

During my first pregnancy with my daughter Anabelle, my husband Charlie and I took all the baby preparation classes which included information about the baby blues and postpartum depression. I don't remember ever hearing the term perinatal mood disorders or any discussion of the fact that depression isn't the only problem. Anxiety and panic disorders, like my own, can strike during pregnancy and continue after childbirth.

My story is a reflection of my personal experience, thoughts, and decisions during this period of perinatal distress. It is in the form of a journal I kept as I went through the experience. I've gone back through this journal and fleshed it out so that it tells a more complete story of my experience. I've also relied on my medical records and personal calendar.

My story starts the moment I found out I was pregnant with my second child. People say no pregnancy is the same as another, even for the same woman. My second pregnancy felt different from the beginning, and there were early signs I wasn't doing well. Pre-pregnancy I would describe myself as a sensitive person with generalized anxiety. My condition was never officially diagnosed, nor was I ever treated with any therapy or medication since I learned to be productive with it and accepted it as part of my daily life. Though from the beginning of my second pregnancy, I felt very emotional, ultra-sensitive, and often overwhelmed with anxiety. I interpreted these feelings as typical symptoms of a pregnant woman. In hindsight, I wish I had taken these signs more seriously. Instead I dismissed them as the result of hormonal changes that would pass. I brushed them aside because I had too much to do.

Since completing undergraduate school, I had been focused on work and meeting certain goals I'd set for myself. At some point in my ho-hum life, I chose a road I thought would lead me to success, and the toll was to put my dreams and imagination on hold. This path was drawn out for me as a child by my parents, grandparents, aunties and uncles; it was a path too narrow and straight for any frivolity. So I went to college where one of my greatest achievements was meeting my future husband, then attended law school, studied and passed the bar to obtain my license to practice law so I could make lots of money to buy the house, have children, raise the family, and live the happy American dream. In this pursuit of "happiness" I was like a machine, pushing myself to do it all, and do it exactly right. I set the parameters, worked hard, and then just let my life run on autopilot. On this pragmatic path, I found some happiness, but after a few years I realized the occasional moments of happiness didn't seem to justify the sacrifices in self-fulfillment I'd made along the way. I thought I would be happier if I could make everyone around me happy which proved to be an exhausting task. Instead of contentment my days and nights were riddled with melancholy over a strained personal life and anxiety about my inadequacies at my all-consuming job.

So after the birth of my first child, Anabelle, I made the decision to quit my full-time job as an attorney and be a work- at-home mom. My mom had stayed at home to raise me and my sister, and I wanted to be like her so I thought I needed to be at home too. It wasn't a difficult decision for me because I didn't closely identify with being an attorney. I considered myself good at what I did, not exceptional. I was valuable to my colleagues and employers because I was amiable and a good worker bee.

Being a work-at-home mom meant being Mommy when my little one was awake then attorney when she was napping or sleeping at night. I became a contract attorney so I could choose projects that were not too time consuming or time sensitive. On the rare occasion I had to go to court, my mom helped with childcare. It was a very precarious balance that worked well enough so long as everyone was healthy, cooperative, and patient. Needless to say, I was setting myself up for a hard fall. When I found out I was pregnant with my second child, what little health and patience I had left at the end of the day was spent nurturing the growing baby inside me. Each of the responsibilities I'd taken on and the standards I'd set for myself all proved to be too much. I wish I had known the storm waiting ahead for me. Looking back from where I am now, I probably could not have avoided it, but I wish I had been more prepared. But critiquing the past is always easier than living through it.

After I quit my full time job to have and raise my children, I followed up with a mental breakdown. As bizarre and irrational as it may sound, my mental health crisis, illness, whatever you want to call it, was a good thing for me. I now realize that I needed something to interrupt my journey, to shake me up and remind me of what really mattered to me in life. After I lost my mind I began a long journey in search of it. And like with many lost things, in my search I found other things I wasn't looking for like a deeper and more honest relationship with my mom, a dry soul thirsting for spiritual renewal, a new way of loving my husband and children freely, with fewer demands, less restraint.

I am better now. I am more myself than I could have imagined. When I wasn't well I feared I would lose myself, that the real me would be destroyed by the non-stop craziness in my head. Fortunately, I found help fairly quickly and my perinatal distress didn't touch the inner person, the real me. In truth, it forced me to explore part of me that had long been suppressed and ignored - a part of me full of faith, hope, and love. I learned how to love life again. I also learned that it was okay to have such intense emotions and important for me to express them.

I am not an advocate for any specific medication, therapy, or form of support group. There is no single answer that works for everyone. I relied on my healthcare provider's expertise and her three-pronged approach of: (1) medication and cognitive behavioral therapy; (2) exercise and sleep; and (3) diet. I added my own essential fourth prong of faith and spirituality. My experience has made me a believer in informed decision making, compassionate professional care, and unconditional support for mothers suffering from perinatal mood disorders.

Things may not work out exactly as you planned; it likely will not. When I was struggling most, a survivor of perinatal mood disorders told me, "I promise you, it will be better. I promise you will feel joy again. I promise you will be yourself again." I tried to hold on to that promise, which I now share with you. Perinatal mood disorders are treatable. Please keep finding hope in living every day and hold fast to the truth that you will be well again.

# Part 1:  
PREGNANCY

Family Discussion on Pregnancy

GRANDMA: I'm so happy for you sweetheart. Now remember not to overreach or tip toe.

AUNT: And each morning before you get out of bed use your fist to pat the middle of your back three times and then massage in a circular motion.

MOM: Remember don't eat any crabs or the child will be grabby and all over the place.

GRANDMA: And honey, try to have a boy, if you can.

ME: Ok, I will try my best.

First Trimester

July 2013

In a span of two weeks my one and only sister got happily hitched to the love of her life, my mom underwent a major abdominal surgery, and to help, I moved into my parents' home with my daughter Anabelle while my husband Charlie remained in our home an hour's drive away. Oh, and I found out I was pregnant. It was a busy two weeks.

First to happen was my sister's wedding. It was a beautifully balanced mélange of Vietnamese, Chinese, Buddhist, Egyptian, and Eastern Orthodox cultures and faiths. My sister was stunning in her wedding gown and radiant with joy while my new brother-in-law was beaming with love and intense eagerness for the day's events to be complete. As for me, I was not the maid of honor or bridesmaid, but not because my sister didn't want me to be. In the utmost matter-of-fact fashion, my mom told us she needed my help during the wedding which meant I couldn't just stand around and look pretty for pictures. I was not saddened or surprised at all about my mom's decree; instead I took my gofer duties seriously and with honor just like my sister had in my wedding.

Then three days after the wedding my mom was wheeled into the operating room for major abdominal surgery. She had been very ill for the latter part of 2012 and most of 2013. Her doctor recommended surgery as her best option. Post-operatively, the surgeon described it as a textbook surgery; everything that needed to be removed had been removed, and my mom's abdomen was stapled neatly back into place. She was released from the hospital after about two days to recuperate at home. She had never had surgery before so this was a big deal for her. It was a big deal for all of us.

My husband Charlie and I decided to rearrange our living situation so I could help care for my mom. My parents' home was about one hour away from ours, so Charlie and I decided it would be best for me and Anabelle to move in with my parents for a few weeks instead of my having to drive back and forth. My sister lived nearer to my parents, but since she had just been married, she had immediate honeymoon plans following our mom's surgery. She was going to cancel the travel plans, but we demanded she go and not worry too much. Mom's surgery was considered routine to her surgeon. Besides, she had cared for mom for months before the surgery, and it was my turn to step up. It all worked out neatly enough since my current employer, my daughter Anabelle, wouldn't mind at all if we stayed at grandma's for a spell. So for about three weeks, Anabelle and I lived mostly at my parents' home and slept in my childhood bedroom. As for Charlie, he visited us after work as much as traffic and stamina would allow.

Monday, July 29, 2013

Once my sister returned from her honeymoon, she relieved me of my post by staying with mom for a short while, so Charlie, Anabelle, and I could return to our home for a few days. Mom had pain and discomfort but otherwise nothing alarming or unexpected according to her surgeon. At our own home, Anabelle and I were getting back to our daily morning routine: breakfast at the dining table, clean up the kitchen, walk around the neighborhood, and then back home to figure out what to do with the rest of the morning before lunch. But today I had a plan.

Some time earlier, my husband Charlie and I had made the decision to try and make a forever playmate for our Anabelle. Based upon my calculations, today was a good day to take a home pregnancy test and get an accurate result.

I let Anabelle play in her crib while I gathered my equipment: Dixie cup, gloves, a box of pregnancy test sticks. Retiring to the restroom right across the hallway, I conducted my little science experiment.

In the quiet privacy of my own bathroom I nervously followed the directions on the box and waited. Immediately when I dipped the stick in my urine, the first prominent red line appeared and then ever so slowly I watched as the faint second line emerged, and became more prominent with each passing minute. I was pregnant! I skipped out of the restroom, scooped Anabelle out of her crib into my arms, waltzed our way into the living room, and twirled her around as she giggled with delight. Then I set her down, turned on the radio and we did one of her favorite activities: we danced. After lots of jumping, running in circles, and erratic leg kicks, I called Charlie.

"Charlie, I have some good news," I said breathlessly into the phone.

"Uh. Ok, what's up?" he hesitantly replied.

"I know it's early but I couldn't wait. I took a home test and I'm pregnant!" I nearly shouted.

"Oh my gosh! That's fantastic." He laughed as excitedly as he could while sitting in his cubicle.

My Charlie is a man of few words. I remember the first time I told him I was pregnant with Anabelle. It was 6:00 in the morning and he was half asleep when he smiled, kissed me and said, "Good job, babycakes," then lightly dozed for thirty more minutes. By the time my second pregnancy rolled around, we had been married for about five years. We had been college sweethearts and our road to marriage was filled with twists, turns, and a lot of mixing of cultures and faith. He is Caucasian and Catholic; I am Chinese/Vietnamese and Buddhist by birth with Christian leanings. I knew him well enough to know he was happy about my second pregnancy because we had been talking and dreaming about what it would be like with two little ones. We imagined the chaos and the overwhelming joy of watching them grow up together.

This second pregnancy naturally revived memories of my first during which I experienced a lot of worry about the baby. I remembered sleeping on my side from the very beginning of my pregnancy because I wanted my baby to get the very best circulation. It didn't matter that my baby wasn't even the size of a peanut yet. I restricted eating out but when I did I usually ordered it to go, took it home, and nuked my food in the microwave to destroy all the potentially harmful bacteria. I recalled completely freaking out when without thinking I had eaten a piece of soft cheese at a work cocktail reception. I had nightmares of all the bacteria from the unpasteurized cheese coursing through my system potentially harming my unborn fetus.

On top of all the medical articles and books about pregnancy, my loving mom, grandma, and aunties gave me a mysterious list of activities I shouldn't do during pregnancy: don't wear a scarf, don't stand and linger in any doorway, don't walk and eat at the same time. It wasn't easy for me but I adhered to all of these warnings and superstitions as best I could.

So when I found out I was pregnant again, I was happy and felt as if I'd done it once before and could do it again. The big difference this time around was that I wasn't working full time, so I didn't have the anxiety and distraction of work. Instead I was forever on the clock as mom for my very active two year old.

Friday, August 9, 2013

Since my positive home pregnancy test on July 29th, Anabelle and I had returned to stay with my parents. I kept busy with entertaining Anabelle, watching over mom, light house chores and some cooking. Fortunately, my grandma and aunties lived nearby so they brought over food and came to visit at least every other day. My sister was nearby too so she would stay with mom on the weekends when she wasn't working. I didn't tell anyone, not even my mom, that I was pregnant because I wanted to confirm with my doctor first. This Friday I returned to my home because I had an appointment with the doctor's clinic for a pregnancy test.

For my first pregnancy I had called my doctor's office the same day I got a positive home pregnancy test result. I was given the earliest appointment with a midwife which happened to be within days of the call. Even before my first doctor's visit, I had a teleconference with a nurse about the dos and don'ts of pregnancy. Then on my first appointment, the midwife took an ultrasound that showed us pictures of the amniotic sac, and we received lots of congratulations from the staff. It was a pretty exciting beginning.

This second time around I called my doctor's office about a week after my home pregnancy test, and they scheduled me to come into their lab for testing to confirm my pregnancy. At the lab I was given a pee cup. I filled it up and presented it to the nurse who took the sample into her gloved hands, did her little test and confirmed, "Yep, you're pregnant. Congratulations!" I didn't take a selfie with the tester strip this time, but I did call Charlie to share the good news. Then I did an internal somersault and carried on.

The nurse asked if it was my first and I said no. So, she gave me a choice as to how soon I waited before seeing the OB. I knew if I went in too early they wouldn't be able to see much so I didn't schedule that first appointment until I would be at least five weeks pregnant.

Despite the anticlimactic clinic visit, I was very happy. I loved being a mommy, and now my joy was multiplied. I walked out of the clinic lost in quiet thought about being a mom. Motherhood is the most confounding, exhilarating, and gratifying identity I've ever assumed. Although my experience wasn't rosy and cheery all the time. I had bouts of mild depression from lack of sleep, lack of adult contact, and/or lack of cerebral stimulation. But those depressed moments always came and went; there were more ups than downs. I often marveled at Anabelle in disbelief that I was her mother, that she chose me to be her mother, that she was created in me and now was this living, moving, thinking, and growing human being. I have no idea what perfection looks, feels, smells or sounds like, but I believe the mystery of conception is probably the closest thing to it I can think of.

Watching Anabelle develop ignited this part of my brain that sent bursts of happy hormones into my body. I daydreamed about all those microscopic cells in her body replicating perfectly and communicating so efficiently to create this beautiful baby girl whose silky soft cheeks I greedily squeezed and chubby body I so eagerly snuggled every day.

To this day, I am still baffled and completely bowled over about the miracle of life.

Monday, August 12, 2013

I was giddy with joy after my clinic visit. I remember I was still staying with my mom when I finally told her the news. I was clearing the breakfast table, Anabelle was watching television in the living room, and my mom was standing at the kitchen counter taking her medications.

"Mom, I have some good news. I'm pregnant," I said casually with a slight smile, still clearing the table.

My mom stopped what she was doing. She looked at me and said, "What? Did you say you're pregnant?"

"Yes, I took a test and it's positive."

"Are you sure? How far along are you?" my mom said with knitted eyebrows and a look of concern on her face. She wasn't smiling, she was frowning and looked worried. I didn't expect her to jump for joy, but I wasn't expecting this reaction either.

"I'm sure," I said. "I took a home test and then went to my doctor's office to confirm. I'm really early. Maybe a few weeks." She asked how I was feeling and then we didn't really talk about my pregnancy for the rest of the day. I knew my mom was happy because before her illness she had talked about a sibling for Anabelle. When this news came I figured she was overwhelmed with worry and pain from her surgery, so she was not able to express her joy. Nonetheless, I was a little hurt by her reaction.

It took a few days for the news to set in. When her condition improved so did her excitement about my pregnancy. She started talking about all the things I should and shouldn't be doing now that I was pregnant. For a while I think she was worried about my health, staying with her, the stress of work, and caring for Anabelle and now another little one.

To make matters more interesting, while still living at my mom's house, I got a call from my former employer about a big contract job. I could work mostly from home, and it paid well. It was an offer I couldn't resist, so I accepted. So much was going on, and I had just enough energy to get through one day at a time. In retrospect, I can see that I was more stressed physically and mentally than I realized. I was trying to find a balance between caring for Anabelle, my mom, and work. On top of that, I was missing my Charlie. Fortunately, I didn't stay too long at my parents' home since my mom's condition improved dramatically after the first month. The surgery had been a complete success; she was regaining her strength and gaining weight. With her quick recovery I was back home permanently by August 19th. I was thankful that during the time I'd spent with my mom, the morning sickness hadn't really kicked in yet.

Monday, August 26, 2013

Oh sweet home, sweet bed, sweet couch, sweet sweet husband. When we moved out of my parent's home and back to our own home, I found everything about my home sweet. I was comfortable living in my childhood house but it wasn't home.

Now that my mom was fully recovered, Anabelle and I returned home just in time for my first prenatal visit and sonogram. Charlie was held captive in a work meeting so Anabelle and I got the first glimpse of our new little peanut. He or she had landed in the right spot! Everything looked good so far. I was dealing with what felt like constant fatigue but it was manageable since I was back home with Charlie and Anabelle, so my balancing act was just a little easier to maintain. The doctor ordered the usual blood tests, including first trimester screening tests. All went well, and it seemed to be a routine checkup. The morning sickness had begun to kick in though.

Wednesday, September 11, 2013

For the past few weeks the morning sickness had been making mornings slow to start and rough on the tummy. In addition to nausea, I occasionally experienced heart palpitations (or at least sensations that Google and I diagnosed as heart palpitations.) Sometimes I'd feel my heart racing as well as feeling completely exhausted. This usually happened in the morning. I reported the symptoms to my OB who ran some tests and assured me it was related to my pregnancy and nothing to worry about.

During all my ickiness, my sweet Anabelle and Charlie were troopers. Charlie tried to get out of work as early as possible to come home and give me a break and spend time with Anabelle. He helped with the chores and didn't complain much about my already mediocre housekeeping skills slipping further still. As for Anabelle, I don't know if she understood what I meant when I tried to describe and act out my nausea but she understood when I needed to lie down and rest. She would plop herself near me and entertain herself with toys, books, and television. She could go for about a half hour of independent play until she would bounce around the house like a ball of energy and I would intervene to help diffuse some of her energy before she exploded like a grand fireworks display. As for work, I summoned the strength to sit in front of my computer and work for at least 2-5 hours a day and some on the weekends when Charlie could help care for Anabelle.

Most if not all of my pregnancy grievances were communicated to my doctor at my second prenatal checkup. At this checkup she asked how I was doing, so I felt free to whine about the hard work of caring for a two year old, morning sickness, and work (cue the playing of the world's smallest violin). For the first trimester, every day was washed over with lapping waves of nausea that peaked in the mornings and usually subsided by the evenings. A part of me wanted to stay in the exam room a little longer, to be able to complain a little more and then get some grand life-changing words of wisdom in return. But this was a prenatal checkup, not a therapy session. She did an ultrasound, confirmed that the baby's heartbeat was strong, and I was as healthy as a pregnant woman of my age could be. She did commiserate with me some, more than I expected, and then I was on my way.

I tried not to complain to Charlie but he could tell the nausea was sapping me of energy and the will to get up and be active. I would lie down whenever I got a chance. Unfortunately, there was little he could do during the day except text and call to check up on me because he was at work. This was just a part of pregnancy, and I would get through it. I tried to think positively and counted the days when my first trimester would be over. About one and a half years later, while writing this memoir, I noticed under the Health Problems Reviewed my OB had documented HIGH RISK PREGNANCY, SUPERVISION.

Second Trimester: Warning Signs

Friday, October 4, 2013

I came down with a cold, complete with a sore throat and the dreaded stuffy nose. Maybe it's the fact that I have such small nostrils, but I get really bad congestion when I get sick. This cold was no different; I absolutely could not breathe through my nose. I shined a flashlight up my nostrils, and my nasal cavity was so swollen you could see the nasal passages totally closed off.

This was not my first experience of a cold during pregnancy; I caught a bad cold during the first trimester of my first pregnancy. It was miserable being pregnant, sick, and unable to take any decongestant to ease the discomfort. During pregnancy, I didn't want to take any drugs except acetaminophen which is considered relatively safe. Since I didn't have a fever, I didn't even take that, I just tried my best to keep comfortable and let the cold run its course.

This Friday evening I was tired from a long week. Charlie, Anabelle, and I had dinner and cleaned up, and I put Anabelle down for bed. After all was quiet, we dimmed the lights and hunkered down on the couch in our living room. Our couch is L-shaped so I staked out the most comfortable section for myself, the corner part of the L. I propped my feet up and leaned back on the oversized cushions, closed my eyes, and tried to relax. I was super congested, so I propped myself up with lots of pillows in hopes my nasal passages would reopen soon, so I could breathe and fall asleep.

Then I started feeling anxious. I absolutely hate feeling congested because for as long as I can remember I've had a great fear of suffocation. I don't have any specific memory of an accidental near-suffocation or drowning, but growing up I didn't even like to have water on my face for fear of suffocating. That night, my anxiety about my breathing started to escalate quickly. Charlie was seated next to me playing some game on his phone, probably storming some beach or tending to his farm.

"Charlie, can you turn on something funny I can listen to? Maybe 'Everybody Loves Raymond'," I suggested.

"Sure, I'll put it on the tablet." Charlie set up the tablet next to me, and I leaned back and tried to take my mind off my congestion by listening to the dialogue and imagining the scenes being played out in my head. Whenever I needed help unwinding before bed, I would just listen to comedy shows; I didn't watch them because the light from the television or tablet was too stimulating. It was my habit to close my eyes and let my imagination wander around the dialogue, the sounds, and the voices from the show; as I drifted deeper into a state of relaxation my mind would meander and slide effortlessly into dreamland.

This night my old tricks weren't working. I couldn't get my mind off my congestion and anxiety. I suddenly got this urge to stand up and walk. The room felt stuffy and much too dark. So I got up from the couch and turned on the lights because I felt as if the darkness was interfering with my breathing; it made the room seem smaller.

"Are you okay? What's the matter?" Charlie asked. He still had his phone in his hand, right index finger poised as if in mid game, and he looked up at me with one arched eyebrow. I knew that look; it was the "what's wrong, something is wrong, tell me what's wrong" look.

"I don't know. I can't breathe through my nose, and I just can't seem to relax. It's this darn cold," I said. Though I didn't tell him I was scared and feeling out of control. I didn't want Charlie to know how I really felt because I was embarrassed about going berserk over a common cold. He was satisfied with my answer so he went back to his game for another five or ten minutes before he announced he was going to bed.

"I'm getting tired. I think I'm going to turn in now. You want to go to bed?" he asked.

"Nah, I still can't breathe. I'm going to stay out here so I can at least sit up and maybe sleep a bit. I'll come in when my nose thing clears up."

"Okay then. Don't stay up too late. Try breathing through your mouth," was his parting advice before he kissed me goodnight.

Alone in the living room, I felt free to openly freak out. I started to pace and work myself up into a frenzy. Everything agitated me. I turned off the tablet because all the voices were irritating me which made my breathing even more labored for some reason. I was alone in the living room, working my way up to a panic attack without knowing it.

At the time, I thought my anxiety was all centered around my breathing. If I could just breathe through my nostrils then I'd be fine, I thought. Quickly spiraling into a panic, I stepped out into the cold night air hoping that would help clear my congestion. Nothing. Then I remembered that an old college friend used to eat wasabi to clear his sinuses. I couldn't remember if he had eaten it or just smelled it. No matter because I didn't have wasabi, but I did have some medicated oil, an analgesic remedy made up of herbs like menthol, camphor, and mint. When massaged into the skin it creates a lot of heat to relieve all sorts of muscle pains. Growing up, medicated oil was the cure-all remedy for cuts, bruises, aches and pains. Why not congestion too?

I know now that I was acting a tad bit irrationally – I even knew it then but I felt desperate to breathe normally. I dabbed some of the medicated oil under my nose and on my upper lip. What a horrible mistake. I felt like the top layer of skin on my upper lip was burning off. Totally reacting without thinking, I wiped my upper lip which just spread the pain up and into my nostrils— now my nostril hairs were on fire. This sudden self-inflicted burning sensation was the extra push that took me over the edge of anxiety into panic. My mind was racing out of control. I was angry with myself for being so stupid as to apply medicated oil to such a sensitive part of my face. I might as well have rubbed ghost peppers, which are 180 times spicier than jalapeños, on my upper lip. My vision became blurry. I spun around frantically looking for something to soak or stick my nose in for relief. All the while I was gasping for air. With every breath I could feel the heat of the medicated oil, pouring down my throat making me want to gag.

I raced into our bedroom to wake up Charlie. I couldn't breathe through my nose because of the congestion, and now I couldn't breathe through my mouth either because of the burning. I could barely catch a breath to speak.

"Charlie. Wake up. I can't breathe," I panted while standing in the doorway.

Bleary eyed, Charlie bolted out of bed and was in front of me within seconds, holding me by the shoulders and staring down into my terrified face. "What's wrong? What happened?" he asked.

"I can't breathe," I gasped.

"What, what should I do? What happened? Is it your congestion?" Charlie was half asleep, but I could tell he was trying very hard to wake up and assess the situation. Since becoming a dad, he was no stranger to emergencies in the middle of the night. Anabelle has had some late night scares, and we'd always worked as a team. But this time I was the sick one.

"I can't breathe. I don't know. I used that tiger balm and now it's worse. Maybe you should call 911," I suggested.

"Okay, are you sure?"

I paused for a few seconds. Did I need the fire truck, paramedics, and all the commotion over my silly cold and embarrassing medicated oil incident? Maybe it would go away. But I really couldn't breathe. Then I started to imagine that my problem was more than just congestion, that maybe there was something seriously wrong with me. And if I wasn't breathing then my baby wasn't getting oxygen.

"Yes. Yes, call 911," I said breathlessly.

While Charlie was on the phone with the emergency dispatcher, I paced back and forth in our living room until Charlie told me to sit down as directed by the dispatcher. I started to feel faint; my heart was racing, my hands and legs were going numb. I didn't know I was hyperventilating and having a panic attack. I thought I was going to suffocate and die.

Within minutes my living room was filled with at least five paramedics and firefighters, all staring at me. They looked calm and ready to respond to any emergency. Looking back, they probably wondered, "what was the emergency?" After all, there was no body on the ground, no blood, no cuts, no broken bones, just a pale middle aged woman sitting quietly at the kitchen table.

My vitals were taken and everything was within normal range. Given my symptoms, the paramedic told me I might have had a panic attack and hyperventilated. He told me to sit down and try to focus on breathing normally. In an abundance of caution, especially since I was pregnant, he gave me two options: (1) an ambulance ride to the hospital to get checked out; or (2) drive my own car to the hospital to get checked out. I was no longer in full panic mode and I didn't want to wake my Anabelle so I chose option 2.

After the paramedics left, Charlie and I sat at the kitchen table for a few minutes to gather our senses and decompress from all the excitement. I was grateful Anabelle was still fast asleep, none the wiser to all the chaos I was creating. At this point I didn't feel the urge to get up and pace anymore, I didn't feel dizzy or numb, just very tired physically and mentally. Even lifting my arms up to drink a glass of water took more effort than usual. I wanted to go to sleep but was afraid to lie down.

"Do you want to try to go to bed?" Charlie asked.

"Yeah, I guess I should try. My nose is kind of clear right now. Maybe some fresh air will help. Can you open the bedroom window all the way?" We both stood up and walked towards our bedroom.

"Sure, let's go." Charlie smiled at me and put his arm around my shoulders and pulled me close to him. I gratefully leaned my heavy head against his chest. "You want to listen to a movie?" Charlie said and gave a firm squeeze around my arms. He was trying his best to cheer me up; he knew listening to funny movies or sitcoms usually calmed my nerves because it took my mind off whatever was agitating me.

"Oh, yeah. That's a good idea, babe. Yeah, why don't you pick something, I don't care," I said with a sigh. I felt ashamed about having to call 911 to find out that I had been hyperventilating and likely had experienced a panic attack. At that time panic to me meant weakness and overreaction. I was frightened and troubled by my inability to control or even manage my anxiety.

For the rest of the night my nasal passages dictated whether I slept on my right or left side. I had to sit up in bed a few times when I felt a sudden urgency rising from the pit of my stomach. I tried to breathe through my mouth and not focus on my congestion or dry throat. I listened to "Men in Black" while Charlie watched it and eventually dozed off to sleep. At some point I fell asleep for about three hours before the sun and cottonmouth woke me up. Time to wake up and take a trip to the closest urgent care.

Saturday, October 5, 2013

Early Saturday morning, after a night filled with fire trucks, paramedics and medicated oil, we had an uneventful breakfast together. Then I decided to drive myself to urgent care. Charlie stayed home with Anabelle. He was worried about me but tried not to show it. I could be a very stubborn person and prided myself in doing as much as I could by myself. I took great care not to be helpless or ever give the appearance of helplessness. So, he knew that I was embarrassed about last night's fiasco. Charlie knew me very well, so he had offered to drive me but also expressed his confidence in my ability to drive myself to the doctor's. I could do this.

If I hadn't been pregnant I probably would have just dismissed the event as an anomaly unlikely to happen again. But I was pregnant and really concerned about our baby. In my head if I wasn't breathing, our baby wasn't getting enough oxygen, so I just wanted to get checked out. I needed to hear our baby's heartbeat. After the usual long wait, I was seen by a doctor to whom I recounted the previous night's events. I focused on how my congestion had led to panic. I mentioned what the paramedics had identified as a panic attack, the numbness in my hands and legs. He didn't seem concerned about it because I didn't have a history of panic disorder or any other mood disorders. He mostly addressed my congestion. He recommended saline nasal spray for my stuffy nose and albuterol for my breathing, and he discussed other possible medications that might be safe during pregnancy.

After my visit, I dropped by the pharmacy and bought some saline spray. I didn't want to use any decongestant or inhaler even if was "considered" safe. I went home feeling much better because the doctor had checked out the baby and found a healthy heartbeat. Nothing wrong with me, just a little freak out... or so I thought.

Friday, October 11, 2013

Exactly one week after my panic attack I started cramping and spotting. I called my doctor's office and spoke to a nurse who recommended I go to the ER. I was thankful to have a good doctor and a decent health insurance that enabled me to do this.

Friday afternoon I drove myself to the ER as soon as Charlie came home to care for Anabelle. The ER doctor and I discussed my medical history, he checked my vitals, and requested a urine sample. All was clear. The attending physician was puzzled about the reason for my spotting and consulted with an OB colleague. The OB recommended I monitor my cramping and bleeding and return to the ER if my condition worsened. Otherwise, I should just follow up with my regular OB on my next prenatal appointment scheduled for October 23rd. I went back home and followed the ER doctor's advice. I monitored my bleeding which stopped after one day, and the cramping subsided soon after.

I was beginning to worry about my health, both physical and mental. Was I overreacting? Or was there something really physically wrong with me that the doctors were missing? I'd heard of these stories in the news and online about doctors missing a diagnosis. I had gone through two false emergencies in a span of two weeks. I didn't tell anyone, not even Charlie, that I thought I was really sick or, alternatively, going plain mad.

Wednesday, October 23, 2013

I went to my scheduled OB visit for a prenatal checkup and follow up. She confirmed there was no longer any bleeding, and my cervix was firm and supporting the baby. Baby and I got another clean bill of health. I was relieved that all was well. Nothing wrong with me, I was just a little overly sensitive and tired.

As a child, my father was the main bread winner for the family, working as a machinist, and my mom supplemented the family income working at home as a seamstress. In times of torrential downpour, scorching sunshine or even sickness, dad would still wake up every day at 4:30 in the morning to go to work in the unheated, non air-conditioned garage of the machine shop. At home Mom would get bags and bags of clothes from various clothing manufacturers. She would sit for hours every day at her industrial-grade sewing machine placed at the end of the bed and sew. I remember playing at her feet, accustomed to the steady hum of the machine and unfazed by the rapid drilling sound made when she stepped on the foot pedal. Financially we were on the lower end of middle class which meant I didn't get to take private music lessons or dance classes and I didn't have many toys. But we had just enough for food, shelter, clothes, small wants and taxes. Dad was proud to pay taxes, he saw it as paying back the country for taking in him and his family.

I was the younger of two girls: quiet and painfully shy. My only non-family socialization was done at school and family gatherings. I didn't attend sleep overs, didn't have play dates, and didn't go to birthday parties. My physical world was confined to home and school. So, I borrowed books from the public library to learn inexpensive hobbies like knitting, crocheting, cooking, and drawing; and I discovered the world of fiction, comics, travel, and romance. Books provided an escape hatch from my sheltered and sometimes stifling home life.

At a young age, I started journaling as an outlet for all my emotions and creative ideas. My first journal was an insignificant spiral college ruled notebook my mom purchased from Kmart. Then during college my journaling became very inconsistent and pretty much stopped once I started law school. After law school I had no desire to write or read for pleasure anymore because I was working full time; at the end of a long work day, I wanted to have dinner, watch television, and go to bed.

It was only after I had Anabelle and quit my full time job that I started journaling again. I journaled for Anabelle and for my own sanity, imagining that she would read my entries once she was old enough to understand them. My intent was also to save my journals so that she would have them after I was gone.

At first my entries were mostly about her. I'd describe everything about her and her development. The first year of Anabelle's life was kind of a blur in that the days just melded together in a continual cycle of feeding, pumping, changing diapers, rocking, pumping, feeding, changing diapers, pumping, feeding, cleaning, changing diapers, pumping, rocking, feeding, cooking, etc.

I needed more new material to write about, so I started writing about my own feelings on motherhood, on quitting my job, and anything else I was thinking about but didn't want to share or didn't have anyone to share with. I was most honest in my journals because I felt free from judgment and from my own shame. In my journals I could be erratic, contemplative, crazy, kind, vindictive, sad, forgiving.

I remember the journal entry on October 24th in which I described my dark thoughts and struggles for the first time after finding out about my second pregnancy:

I love you so much so I must live life and love it because without it there is no you. For months I've been walking this earth on autopilot, doing things because they needed to be done because I felt obligated. Then when my to-do list dwindled to just staying at home and caring for my family I was out of juice. Physically, emotionally, and mentally I was exhausted. My hormones were raging and then I had a panic attack. Then after my panic attack I slowly felt like I was descending into a dark dark dungeon for lost souls... I want to reconnect with the world—I want to find purpose in my life. I want to be the best Mommy and wife to my family...

How foolish I was to ignore my own calls for help. At the time I didn't see the flaw in my own logic, I was just coping the only way I knew how and that was to suppress the bad parts and carry on. At a young age I was taught by example that the world didn't stop for whiners and complainers, you have to work for what you want and you get what you deserve. Over time I had softened the edges of this unforgiving code of conduct but they were still a part of me. And when my anxiety started getting the better of me I started to panic. A professional acquaintance once told me that the world swallowed the weak and spit them out into the bowels of the earth. I'd seen it happen, and I wasn't ready to be swallowed, and I'd be damned if I had to raise my kids in the center of the earth.

Tuesday, December 31, 2013

OB visit. Normal, but gained a lot of weight over Christmas. Ten pounds in four weeks! I only had one cookie a day. The problem was I had only one cookie of each kind that was made, and we made six different types of cookies that Christmas.

November and December were filled with good and bad days. Health-wise, morning sickness was a moving target, and the heart palpitations wore me out. Though with the holidays, I was able to keep upbeat, busying myself with projects, events, and planning. The biggest change in our home life happened in November when Anabelle got the intestinal flu. For about a year, she had been sleeping alone in her own room. Charlie and I had kept Anabelle in the bedroom with us from the moment we brought her home from the hospital until she turned one. That was not Charlie's preference; he wanted Anabelle in her own room at four months. We compromised and agreed that after her first birthday, she would sleep in her own room, and we would sleep alone in our master bedroom with a baby monitor propped up between us.

Then one night in November, I woke up to noises of coughing in her room and got up to check on her. I looked in the crib to find Anabelle on her back choking on her own vomit. I picked her up, cradled her head over my shoulder, and rubbed her back. The idea of what could have happened if we hadn't been awakened by her choking scared the bejeebers out of us so we both agreed she should be back in our bed and bedroom for a while. Anabelle didn't last long in our queen-sized bed because of my growing belly and her dynamic sleep acrobatics. We eventually set up a toddler bed next to our bed and there she would sleep at least until the birth of her little sister or brother.

Third Trimester: HELP!

Saturday, January 18, 2014

I was in the home stretch of my pregnancy and I felt sleep deprived, uncomfortable, and restless. My big contract job had ended, and I had picked up another case that wasn't as time consuming. Theoretically I had more time to rest and focus on Anabelle. But even with more time, I felt like a failure as a mother because I couldn't be as active as my daughter needed me to be. I was always tired. We didn't do as many park days as we used to and I didn't make much of an effort to set up playdates for her. Most days were spent at home, the occasional lunch with my friends, or visiting my parents.

Have I mentioned Anabelle is a very physically active child who is only still when she is sleeping, watching television, or sick? So keeping her cooped up indoors made her ill-tempered. She would tantrum more because she had so much pent-up energy, and my response was disconnected and unacceptable because I didn't have enough energy for patience. I found myself unbelievably irritated at fulfilling innocent requests such as rereading her favorite book for the umpteenth time. I wished many of these days away, hoping they would be forgiven and forgotten, so they would just pass quickly until the day our new little one arrived, and I could be more mobile and good humored again.

The last thing I needed was for Charlie to be mad at me. So of course, as fate would have it, we had a fight. During most of my pregnancy, Charlie was busy with work which included traveling every other month or even more often, to my dismay.

On this day, Charlie had to travel out of town, just about two hours away, for a weekend conference. During breakfast he suggested Anabelle and I go with him.

"Hey, the conference is kind of local. You and Anabelle can come stay with me in the hotel; get out a little bit for the weekend. You can drive up separately and leave when you want to," Charlie offered. I had such bad cabin fever, and I wanted so much for all of us to be together I jumped for joy at his suggestion.

"Yes! That's a great idea! We'd love to go with you. Maybe we can catch dinner one night after your conference. I can take Anabelle around town; find a park, and maybe window shop." I was so excited about our little trip, mostly because Charlie had suggested it. I had been feeling distant from him during this pregnancy because he was working more so he missed a lot of my prenatal visits, including my very first one. It may not have been as big of a deal except that I compared this pregnancy to my first when he had made all of Anabelle's prenatal visits. Also, I was so tired I didn't stay up late to chat and catch up on how he was doing. I felt like my second pregnancy had been kind of a letdown from the very beginning. The whole novelty of the pregnancy experience was nonexistent. So, Charlie's invitation was exactly what I needed.

After breakfast Charlie left for work while Anabelle and I got ready for the trip. Charlie was going to leave after lunch so that morning I happily busied myself with packing as Anabelle shuffled around inspecting and unpacking my work. At that moment I was filled with joy and purpose again.

When Charlie came home for lunch he was quiet. While eating lunch he looked at the packed bags and said, "I was thinking. Are you sure you want to come with me? You know I won't be able to see you very much at all, probably only at night and Anabelle will be asleep. I'll feel bad I can't be with you guys," he said with his gaze locked on his uninteresting sandwich. I suddenly felt my morning sickness come back.

"What do you mean? I know you have to work, I've been with you on work trips before. We won't be in the way," I said.

"Well, I'd love to have you guys there but you're kind of a distraction you know. I'll be stuck at the conference all day, and I'll want to be with you."

Silence. I pursed my lips, willing the tears welling up in my eyes not to fall. I dared not blink and let him see them stream down my face. First, he invites us on a weekend trip with him, and now he's saying it's not a good idea. Why? Were we really a distraction? Did he say that because he loved us? Or was he hiding something? Someone? I was beside myself with anger and distrust.

"Fine. We won't go. You could have told me sooner so I didn't have to get all excited and pack our bags," I said.

"Babycakes, don't be mad. I'm sorry. You know what I mean. It's not that I don't want you guys there. I do but I won't get to spend much time with you, that's all. Please don't cry. Come with me. Forget what I said. I'm sorry."

Too late. I was crying and very upset. At that very moment he could go to hell for all I cared. We weren't going to go with him. The only way to make me go with him would be if he could punch himself in the gut so hard he'd travel back in time and start all over without this whole business of reneging on his invitation. During this whole conversation Anabelle had been seated in her high chair. I couldn't stand to sit at the same table with him, so I picked Anabelle up and put her down for a nap.

Charlie followed me into the bedroom and asked me to come with him again, but I said no. After futzing around the bedroom, trying to figure out how to fix the situation, he gave up and kissed me goodbye. He took his suitcase and left.

After Anabelle fell asleep, I went into the living room and cried my eyes out. I sobbed loudly and gasped for air so I could sob some more. Then I got up to wash my face in the bathroom and when I cast one glance at my swollen body in the mirror, I cried some more.

The most terrible thoughts ran through my mind that day and all weekend. Without any reason or evidence, I suspected Charlie didn't love us anymore and was having an affair. Anabelle and I weren't the distraction; it was some floozy in sales. My mind was full of mean and hateful thoughts.

For months I had barely been keeping things together emotionally, so this was my tipping point. Charlie was my love, my life, and his joy was my joy. We had been a team and now I felt rejected, abandoned, and nervous about our future together.

Sunday, January 19, 2014:

Excerpt from my journal:

I'm feeling down and out. Anabelle, you can't help but make me smile and laugh and want to be happy... but at times I feel kind of numb.

I called my sister and recounted every detail of my conversation with Charlie and then rambled on about my feelings. She consoled me with her kind and understanding words. Even though she agreed that Charlie's un-invitation was a bit strange and hurtful, she reminded me of what a good man Charlie was and how much he cared for me and Anabelle. I listened in agreement, but I was still hurt.

Sunday morning I took Anabelle to the beach for a morning walk. We played in the sand, and I did my best to play good mommy, but I was a frazzled hot mess inside. Then I took her to a nearby Catholic church in hopes I would be enlightened with wisdom and some vision of hope and reconciliation. I ended up pouring all my attention and energy into keeping Anabelle from crawling under the pews and escaping down the aisle and out the doors. There was no enlightenment; I didn't even stay for the whole service.

I'm not a regular churchgoer; I don't belong to any specific church. I'd call myself the Christmastime Christian. I went to church on the major holidays and some in between; I went to Catholic Church, various Protestant denominations and non-denominations. I wanted so much to believe in God but I never made the commitment or took the time to let Him enter my life on a daily basis. I kept waiting for that feeling — that sudden surge of faith. I didn't know what it would feel like, but I expected it to be intensely profound and dramatic. I had a very immature and selfish relationship with God. I prayed when I needed something, when I was in trouble. It was more about what God could do for me rather than what I could do for Him.

After Anabelle went to sleep for the night, I cried again. All the emotions I kept inside during the day gushed out of me. Then I did something I was and am still very much ashamed of. I logged onto Charlie's Facebook and spied on his messages and posts. I was so crazy with jealously and feeling so out of control I committed a total betrayal of trust. But it wasn't easy at first. I didn't remember his Facebook password but I knew his email password. So, I hit the "forgot your password" icon and just like that I was able to reset his Facebook password and enter into his private page. At the time I felt justified, I felt empowered and entitled. When I finished scouring his pages, which didn't take long, I didn't find anything that even suggested an extramarital affair. In fact, after my spying I thought he needed to reconnect with his friends more. I felt deceitful and sick to my stomach. I felt even sicker when I imagined confronting him. Do I tell him first or wait for him to find the email from Facebook about the changed password? In moments like this I usually hear my mom's voice and this time she said, "a snake always exposes his tail eventually." I was a snake.

By the end of the weekend I was a frightful mess from all the late night crying sessions. For the first time ever, I reached out for help. After my Facebook hacking, I emailed my OB doctor and explained to her my overwhelming emotions and struggles keeping it together. I ended my short email with a request for help, some suggestion, information, or resources for counseling.

My doctor's nurse called me the day after my email and referred me to Behavioral Health Services to make an appointment with a therapist. I called and made an appointment for January 30th. I had never been in therapy or counseling before but I've spoken to therapists and scheduled appointments before on behalf of my clients. I wasn't against therapy, in fact I would have happily gone to a therapist, but it was an extra expense I couldn't afford. And even with all the anxiety in my life I had learned to manage it in my own way. Even if sometimes that meant just digging a hole and burying it deep down inside me.

Monday, January 20, 2014

During a quiet morning, before Charlie came home, before Anabelle was awake, I sat at our kitchen table and I journaled. Excerpt from my journal:

Each day I'm drowning more and more in sorrow and sadness. All I feel is hopelessness, exhaustion, dread...I'm drowning in an ocean of my own tears. Bathing my face, hands, whole body in it every day. But I ride it out to meet a new day because I have to. I have a choice but I won't let myself go there even if I'm thinking it. Things aren't that bad yet. Can things ever get that bad?...I know I'm upset and thinking the worse. God, please help me because no one else can...

Charlie returned from his work trip around noon. I gave him a cool welcome home even though I wanted him to snuggle me in his arms, squeeze all the doubts and fears out of me then kiss me into forgiveness. We talked later that night. He found out about my spying on his Facebook as I hung my head down in shame and apologized profusely about mistrusting him. I told him about my jealousy and the reason for my overreaction. I did most of the venting while he listened quietly and didn't have much to say except that he was sorry and didn't mean to hurt me. We made peace with each other and home life was back to normal though I could tell he was just a little more careful with his words and attentive to me.

After our reconciliation I felt more critical and self-conscious about myself as a mother, a wife, a person. I started to question whether quitting my job and being a work-at-home mom for the past two years had taken an irreversible toll on my brain cells and emotional health. I didn't regret my decision, but I considered how I could have transitioned better. Since graduating from college I'd spent little time indulging my passions of reading, writing, and traveling, but I still had "me" time before having children. Then when I became a mother, I gave everything I had into caring for my Anabelle. Love, time, money, patience, sanity, I willingly gave it all to her. I realized I even gave her my identity. I was "Anabelle's mother." Even my own mother did not call me by my name anymore but referred to me as "Anabelle's mother." Then I started reading articles about other women who gave up their careers to be stay-at-home moms. Most didn't regret their decision but some wished they had worked part time. Many described the isolation and depression. These articles spoke directly to me. I realized how I'd isolated myself and Anabelle from the world because it had just seemed easier. I went to a few mommy groups but never connected with anyone and ended up chasing Anabelle around the playground. Plus, I was chained to my breast pump for a whole year, so it was an easy excuse to stay at home.

I did make an effort to meet with my former colleagues once a month or every other month. Socializing with them became increasingly more difficult because I didn't have much news to share except poop stories, suspicious rashes, and park drama. It was like a scene out of a C-grade movie: a table full of attorneys chatting away about who was climbing up the ladder in the prosecution's office, who was gunning for a seat on the bench. And at the farthest corner of the table I sat in the shadows holding my baby, looking like the frumpy, boring mommy who wasn't excelling at work or at home. Seated in the big adult chair, I visibly started shrinking into a little shy girl with a baby doll in her arms until I inevitably faded into the background and became part of the drab old wallpaper.

Even in those awkward moments when my two worlds of work and home life collided, I didn't regret my decision to quit my full time job to be at home for our children. I was blessed to have a choice: to work full time or be at home with our children and work a little on the side. I chose the latter course because that's what Mom did. I wanted to be by their side as much as I could and explore the world with them, to be there during those teachable moments. I prayed they would grow up to be happy strong women, and I wanted to be there to watch as much of it as possible.

At one time I thought quantity over quality. Then I realized if I wasn't emotionally available for them it didn't matter as much if I or some other caregiver was physically present with them. Still, it was exhausting and impossible for me to always be emotionally present; sometimes they just needed me to be physically near. How much time do I need to spend with my children to make them feel loved and safe? I still don't know the magic number because it depends on the child and the day. But what I want is for them to know I love them all the same if I'm with them or not, when I'm mad or happy, when I'm tired or energetic.

I occasionally have my moments of doubt but I still don't regret my decision to stay at home, I just wish I did a better job. I have very accomplished and fun days, but I still make so many mistakes and struggle every day, just like every parent at work, home or other.

Wednesday, January 22, 2014

One rare night, I stayed up late and had a little quiet time to myself. Everyone was fast asleep. I sat cross-legged on the couch in my living room, cupped my hands under my belly, looked up at the ceiling, and I prayed. Since my emotional meltdown over Charlie and his work trip, I had started to pray more. But the format and content of my prayers had evolved ever so slightly. I still wasn't opening up all the chambers of my heart, but I wanted to try something different. I tried not to start by asking for things anymore, instead I started with thanksgivings. I would thank God for all the blessings in my life. Like a child I would start naming all the blessings in my life from the food in my fridge, to my family, neighbors, friends, to the shoes on my feet, and so on. Then I would start talking about my feelings; I talked about my joys, my frustrations, my doubts, my fears. Looking back, my prayers were taking the form of a therapy session, except I didn't hear any voices responding to me or see any images of a being before me. I just talked. And in the end I would ask for forgiveness and then sneak in a few requests. Old habits...

Despite my improved mood, I knew there was definitely something not right with me. I continued to blame it on my raging hormones and the discomfort of the third trimester. On various occasions after my first panic attack in October, I had experienced more episodes of intense anxiety. One evening after dinner, we were in Anabelle's room stacking blocks with her on the floor when the room suddenly felt stuffy, and I couldn't catch my breath. I had to get up abruptly and leave Anabelle with Charlie because the room felt too small, as if the walls were closing in on us. This feeling was familiar; it felt like the precursor to my last panic attack, so I left the room to go outside for some fresh air. I didn't tell Charlie what I was feeling because I was embarrassed and scared to admit that something was wrong with me. I didn't want to make a big deal out of it.

Other times it happened when I was doing seemingly relaxing activities like watching a movie. I remember one evening I put Anabelle to sleep early so Charlie and I could have a movie night. With Anabelle fast asleep, I made popcorn and Charlie chose the movie "Planes, Trains and Automobiles" - a classic comedy I had never seen in its entirety. I was delighted to have some alone time with Charlie. I sat on the couch with my feet propped up, Charlie next to me with a bowl of popcorn on his lap. About thirty minutes into the movie, I suddenly had difficulty breathing, then felt myself moving into short choppy breaths. My heart started racing and the urge to get up and walk was too strong to resist. I made some excuse to get out of my comfy seat and walk. I think I complained about being hot even though it was a chilly winter night. Hormones I said. I put a light throw over my shoulders and went out into my backyard for some fresh air. Charlie was none the wiser to my panic attack. I don't think he even noticed. I walked around back and forth until I was able to catch my breath and return to the movie.

These panic episodes were sporadic enough that I could brush them aside. In my mind I had too much to do and worry about to give in to these annoying little anxiety episodes. I convinced myself if I just ignored them, they would have to go away once the baby was born and my hormones stabilized.

Growing up with anxiety, I had learned to internalize it because my parents disapproved of outward exhibitions of emotions. So as a young woman I learned coping skills for my anxiety; I would take deep breaths or take a walk, I'd write in my journal, or force my brain to think about happy thoughts like ice skating, beaches, reading. I created happy places in my mind. The problem was that all these coping techniques that had once worked well enough were no match for my increasing anxiety and panic.

Monday, January 27, 2014

Three days until my first therapy appointment ever. I was having good days so I wasn't looking forward to starting therapy. I was hesitant about the meeting because I didn't know what I would even have to talk about. Always the anxious student, I wanted to be prepared with an outline of everything I needed to discuss.

Therapy felt like an indulgence. Why should I need therapy? I had a pretty good life; I really had nothing to complain about. Charlie was traveling for work again so Anabelle and I went to stay with my parents while he was gone. I felt as if my mood was improving, but I still had my ups and downs. My due date was about two months away, and other than the rare panic attack and general discomfort, I felt all right. The morning sickness and heart palpitations had abated. I was focused on the finish line.

Excerpt from my journal:

Since my meltdown we've been doing better. I've been able to find some peace and joy in prayer...in God and I've been able to share that with you. We've had fun park and mall days. Because I'm more at peace with my issues (doesn't mean my issues have disappeared) I'm able to be more mindful of the present...Anabelle and Baby 2—life is good. It is hard at times and you most likely will have meltdowns of your own—probably more than once in your lifetime but there's always a window of hope, there's always a hand ready to lift you up, arms to carry you through the muck of life. Don't be afraid to look for it and reach for it when you find it...

Overall, it seemed that I was managing my health better. I reached deep inside and sought for faith as my source of peace and strength. I thought I had the inner strength to get through my troubles on my own. I was glad I had reached out to my OB and shared with her my problems, but I still felt a little embarrassed at what I considered my overreacting. So, foolishly I decided to cancel my therapy appointment. This would not be my last cancellation. Later I would regret not being in therapy earlier in my pregnancy.

Friday, February 7, 2014

OB visit. Dr. Murray was very concerned about my emotional health since my emailing her for help and a therapy referral. She inquired about my therapy session, and I told her I was feeling better and had cancelled my appointment. Dr. Murray was admittedly unhappy with my decision though she was very understanding and kind during this conversation. We talked about life, family, and work; she shared with me a little about her family life and the stresses of finding that balance between raising children and work. She ended our meeting by making me promise to reschedule an appointment with the behavioral health center before I left her office. To appease her I did.

A nurse walked me into a private room and sat me down and explained the importance of acknowledging my emotional needs. She recounted a sad story about a former patient who battled with depression and didn't seek help. Now that woman's baby was without a mother. I started to cry thinking about the prospect of my babies being left without me. So, I called and made an appointment for later that month.

In my mind I didn't need therapy; I was feeling better. Looking back, I was so prideful and in denial. Just because I didn't have a physical illness, I discounted the seriousness of the anxiety, the panic attacks, and the emotional outbursts. I'd never been diagnosed with a mental illness, and there were no genetic indicators. I was crazy but not crazy crazy. I thought I could handle it all myself. So, a few days after this OB visit, I cancelled my therapy appointment again...

February and March

From February until the birth of my baby, I was preoccupied by the physical complications of my pregnancy. This second time around my belly bump was hanging down really low due to weak stomach muscles. I started having lots of contractions and what seemed like false labor or possibly early term labor.

Excerpt from email to OB doctor on February 20, 2014:

I've been having a lot of contractions every hour for the past two weeks. Hard contractions vary from 3-6 every hour and my stomach is consistently hard all over when I'm in the upright position--feels like baby is encased in a cement shell when I walk.

The slightest movements such as sitting up, turning in bed, walking, full bladder, etc, set off a contraction. Also, I've been drinking lots of water and lying on my left side when it gets bad and that seems to help. My mom tells me to rest a lot but I wanted your advice as to whether I should be concerned with these contractions and if bed rest will help.

My doctor's office said it was too early for regular contractions and recommended contacting Labor and Delivery at the affiliated hospital to determine if I was actually in labor. If I was in labor, they could admit me. The OB nurse also provided me with information on preterm labor.

So I took another trip to the hospital. There, they hooked me up to monitors and measured my contractions. The nurses gave me a ton of water to drink and the contractions subsided. Dehydration was the diagnosis. So I went home and drank jugs of water and rested when contractions seemed regular.

A family friend who had been a Labor and Delivery nurse for decades suggested I put myself on light bed rest. I was still over a month away from my due date. Already having been filled with anxiety for what now seemed the entire pregnancy, I put myself on moderate bed rest. I did light housework, played with Anabelle as much as I could, and rested when I felt frequent contractions. But I needed help with my active little Anabelle.

I needed my mom. Since her surgery, Mom had fully recovered and returned to work and her active lifestyle. I didn't want to worry her too much, so I had been communicating a milder version of my physical difficulties to her but I couldn't bear the last month of my pregnancy home alone. So, I asked her to stay with me a few days out of the week. It was really a blessing to have her with me, to keep me company and help with Anabelle.

# Part 2:  
BIRTH

NURSE: PUSH! You can do it. PUSH! Push like you're taking a big poop!

ME: I AM! Believe me I'm an expert...

Wednesday, March 12, 2014

3:32 a.m.

I woke up for one of my many nightly potty breaks when I got more than I expected: I sat up in bed with a trickle of water which could have been my water breaking but I just wasn't sure. After my restroom break, I went back to bed and waited to see what would happen.

"Oooh..." I quietly groaned.

"What's the matter?" Charlie rolled over in bed and put his hand on my shoulder.

"Contraction. I think my water broke but I'm not sure," I said trying to hold back my excitement. I was so ready to meet my little one.

"Really? Was it a strong contraction? Should we time it?" he asked.

"Yeah, I'll start timing it."

So I rolled onto my left side with my phone in hand. The contractions came every 15 minutes, and they were strong. After three contractions I had to get up for another potty break. As I sat up in bed I felt another trickle. Now I was certain my water had broke.

That week my mom wasn't staying with us, so I called her and she answered after the second ring. She knew I had been having lots of contractions and I could go into labor any day, so she was ready. I asked her if she and Dad could come down and watch Anabelle so I could go to the hospital. My folks were at my house in an hour.

While I waited for my parents, my contractions brought back fond memories of Anabelle's birth. With Anabelle, my water broke on my due date. Once at the hospital, I labored for about 15 hours. By the time I was ready to push, it was about 2:00 in the morning. I pushed for almost three hours, but she wasn't coming out.

"Push! I can see the head! She has lots of hair!" the midwife cheered me on. No matter how hard I pushed, no matter how much of her head the midwife could see, Anabelle was not coming out.

"Can't you just go in and pull the baby out?" I asked the midwife. I was exhausted and getting discouraged from all the pushing and no baby. The nurse and midwife were getting worried too because Anabelle's heartbeat showed some fluctuation. The surgeon was called in for a consultation. Dr. Gloria came in to check me. She reached in and felt the position of the baby.

"Baby's heart rate is okay for now but you've been pushing for a long time and that puts stress on the baby. Something is pulling the baby back in. I think the umbilical cord is wrapped around its neck and you'll need surgery. I'm not certain. If you can keep pushing I'll let you but as soon as baby shows signs of distress we're going to have to rush you to surgery," Dr. Gloria said. We'd taken the birthing classes, I wanted a natural birth but learned about the necessity of C-sections too. I thought I was prepared for the worst case scenario.

Charlie and I talked it over. We didn't want to take our chances and put Anabelle in distress only to end up rushing into surgery. So, I took Dr. Gloria's recommendation and cried while they prepped me for surgery.

"Oh, honey. Don't cry. You're going to be fine, and you're doing what's best for your baby," the midwife said, consoling me. She hugged me, and I never saw her again.

Surgery went smoothly. I was given a spinal block so I didn't feel a thing from my waist down to my toes except for the tugging and pulling around my abdomen. Charlie was right beside me or above me holding and stroking my head. About twenty minutes after they cut me open, Dr. Gloria pulled out my beautiful screeching Anabelle. I was fully awake so I heard her first cry and got a glimpse of her lovely little red face.

Despite the emergency C-section, I was flooded with happy feelings and excitement. I helped create this perfect human being. I loved staring at her, stroking her cheeks, cuddling her against my chest.

"Ooooh..." I groaned as a hard contraction snapped my glowing reminiscing back to the present situation at hand. I was going to have another baby!

6:00 a.m.

This second time started out well too. I kissed my sleeping Anabelle goodbye, hugged Mom, and got a confident pat on the back from Dad. Then Charlie and I were on the road to the same hospital where Anabelle was born. We were so excited. We chatted about our first experience and how there were so many unknowns. Even though this was our second time, the whole drive, scenery, and experience was just as exhilarating as our first time.

As fate would have it, Dr. Gloria was on call that morning. For just the second time in my entire life, I was poked, probed, shaved, and all lathered up for surgery. I was about two weeks early for my scheduled C-section, but baby was ready to come out, and I was totally okay with her slightly early arrival. As silly as it sounds, I was tired of being on bed rest. I was anxious about surgery only because I wanted to see my new baby and be active again. Dr. Gloria did a top notch job; it was a textbook surgery. I could feel when she and her colleague were pushing and pulling my baby out of my womb. There was a split second of silence. Then a piercing scream.

"It's a... GIRL! Ten fingers and ten toes!" Dr. Gloria announced. In my head I was thinking, "Again? Are you sure? I really thought it was going to be a boy this time." My initial disbelief passed quickly as soon as I saw her. Sure I was hoping for a boy because I wanted Charlie to have a boy, and my whole family wanted me to have a boy, but all those months of now meaningless predictions and hoping melted away as Charlie brought her to me. I marveled over our little Madeline, I was enveloped with amazement and blissful fatigue. She looked healthy: kicking, screaming, and red all over. Madeline was locked in my gaze for just a few seconds before they whisked her away to be examined and cleaned. Charlie kissed me on the forehead and left me to follow Madeline. As part of our birth plan, we agreed Charlie's number one job was to follow Madeline and make sure she didn't accidentally get mixed up with another baby. If for any reason he couldn't follow Madeline, then Charlie was to take out his jumbo Sharpie and mark an X on her belly before she left his sight.

10:00 a.m.

The morning wasn't even over yet and I'd already had major abdominal surgery, had a child yanked out of my womb, and then been stitched and glued back together again. I was feeling pretty accomplished, more than I had in a really long time. Madeline was resting on my bare chest in the recovery room, and I cuddled her against me with delight. I brushed my nose and lips across the top of her head. I was awed by her tiny fingers and toes. I drank up her smells. All the worries, fears and anxieties of the past nine months were extinguished into oblivion, like they'd never happened. At that moment with Madeline in my arms, I was at peace. We were all healthy and together. Charlie stepped out to make phone calls to our parents and siblings with the good news of Madeline's birth.

Around 5:00 in the evening, my parents brought Anabelle to meet her new baby sister Madeline for the first time. I felt bloated, numb, and exhausted from surgery but happy. When Anabelle entered the room with my mom she took one look at me and started to cry. She cried and bawled out, "No Momma! No!!!" Apparently all the wires coming out of my arms and legs scared her. I had a urinary catheter and drainage bag hanging off the side of my bed, leg compression sleeves strapped to my legs making scary pumping noises, and an IV tube coming out of my left wrist connected to a bag of saline hanging on a tall steel IV pole. There I was lying in the hospital bed, immobile and pale. I don't blame her for crying; I looked scary.

After some coaxing she gathered her courage and got down from Grandma's arms and stood on her own. Timidly, Anabelle came up to me, kissed me and said, "Momma, no doctors, no doctors." She stroked my arm that had the IV connected to it and she said, "Momma hurt?" I assured her I was okay and kissed her.

Then the nurse came in to check up on me and pass out my pain meds. Anabelle was back on high alert. She ran toward the nurse, put both hands up, palms facing out and yelled, "No doctors! No doctors! Stop! Stop!" Oh, my little angel of protection. Well, she was my protective angel for all of one minute until the nurse offered her graham crackers and milk which she took and then sprightly skipped over to the couch to eagerly consume. The nurse finished her business with me while Anabelle enjoyed her crackers and milk, completely in her own world. Despite her Kryptonite-like vulnerability to all types of snacks, I thought one minute of her full attention was pretty good for a two year old.

Our Madeline was healthy. Thank God. I was managing the whole birth experience better this time around. This time I knew I was going to have a C-section; my body remembered the fatigue and pain, and we expected the severe sleep deprivation but knew all this would be temporary. Since it was our second child the hospital staff mostly left us to manage on our own. My parents were caring for Anabelle so their visit to the hospital was brief. With Madeline, Charlie and I had more time to ourselves to adjust and bond with our new daughter.

The first night with Madeline was actually tranquil. We took advantage of the restful night and tried to sleep because we knew what was coming. We remembered what the nurses told us when we commented about how well Anabelle slept through most of the first night. "Oh yeah, most babies sleep through the first night because they're so tired from the whole birth experience. Then they wake up the second night and the third. . ." and for many months thereafter.

I snuggled my Madeline as much as I could. She slept on my bare chest, skin to skin as I imagined my body heat radiating and wrapping around her teeny little body. I felt such a joy in the physical contact with her. Maybe it was my happy hormones or her hormones or both, but I felt an intense need to have her physically connected to me which made nursing a little easier. Madeline was a persistent eater, and I was an eager participant this time around. She needed some help latching on to me, but once latched she'd go to town even though no milk was coming out. Whether from age, surgery, or medications, my milk supply didn't come in until three days after her birth. Despite a dry milk tap, during each feeding Madeline would still try to latch on and nurse for half an hour if I let her. I was her human pacifier, and I figured it was good practice for me and her. Besides, she looked so perfectly lovely in my arms.

Thursday, March 13, 2013

The nurses gave me clear instructions to get out of bed and go to the bathroom on my own at least once by the end of the morning. My reward for being able to do numbers one and two on my own would be the removal of the IV catheter from my arm, one step closer to being discharged. I missed my Anabelle and the comforts of home so I scooted, pulled, and pushed myself up to walk and heal quickly so I could go home. 

# Part 3:  
POSTPARTUM

We make a living by what we get,

but we make a life by what we give.

Winston Churchill

The Beginning

We had a full house. My mom had been staying with us off and on during the last month of my pregnancy. As when we had Anabelle, my mom was going to live with us for at least the first month of Madeline's life. So, we assigned sleeping arrangements accordingly.

For me and Madeline, we set up a temporary baby room in the front of the house because that room had a bathroom connected to it. It was a cozy twelve by eleven foot room immediately to the right of the front door. The room was furnished with a couch, bookshelves, a small desk, rocking chair, changing table, and breast pump so I was set. The couch became my bed and next to it we put up the portable crib where Madeline would sleep for the first month. The couch was quite comfortable and had a bamboo frame that provided a means for me to pull myself up to a sitting position.

In the adjoining room, separated only by a shared bathroom, Charlie slept in our master bedroom with Anabelle in her own toddler bed. Since the two rooms were connected, Charlie and I could walk through the shared bathroom to see one another and steal away seconds filled with kisses, hugs and tired looks before the call of the wild made us scurry back to our stations. Even though we were technically in separate rooms, that little bathroom physically joined me to Charlie and Anabelle.

My mom had Anabelle's old room which we converted into a semi-adult bedroom. It was located farthest from the front room where Madeline and I slept. Since my mom is a light sleeper we gave her this room to shield her from Madeline's late night screaming sessions. We gave her our queen sized bed, a dresser for her personal belongings and pushed the crib into a corner. Since the room was so small we were limited with what we could do. My dear mom's only requests were for a firm pillow and an electric blanket. These were modest requests for offering to put her life on pause for an indeterminate length of time and to immerse herself in the nitty gritty and mostly gritty part of growing children. I was asking her to dig deep and pull out the files on child rearing she had long stored away in her memory bank.

In our small room, Madeline and I learned each other's smells and noises. I learned how to nurse her, and she learned how to latch. I adored our Madeline. I was obsessed with caring for her immediate needs which were feeding, changing, and rocking her to sleep. I had that fuzzy feeling with her as I hugged her to my chest to keep her warm and kissed her tiny forehead. She was so tiny I used my sweater to wrap around her entire body; I'd walk around the house with her safely tucked in my arm. Every night, as I did with Anabelle, I prayed she would grow up to be loving and kind, gentle and patient, humble and honest, happy and wise.

With all the joys, we also had our struggles. I was determined to nurse Madeline and not have to pump every 3-4 hours a day. With Anabelle, after the emergency C-section I felt overwhelmed by the recovery and stresses of motherhood so I gave up on nursing and decided to pump for a year. I thought at least if I pumped Anabelle would still be getting breast milk, which I was told was the very best thing for her.

Pumping was a nightmare. With Anabelle, I was chained to that milking machine for a year. In the beginning I would have to pump every 3 hours then store the milk so I or someone else could bottle feed Anabelle. To add to the pile of housework, pumping created a whole lot of extra cleaning with all the parts to the breast pump – the tubing and gaskets, not to mention all the bottles. Feeding Anabelle the first year of her life became a whole production. So, with Madeline I was going to cut out the middle man and was determined to make nursing work.

Overall, we were managing with Madeline. My mom had planned to stay with me for at least a month until I was more mobile and fully recovered and adjusted. I was more prepared for her stay. During Anabelle's first month, my mom and I butted heads about all sorts of things. I wanted to go by the book and pediatrician's advice while my mom went with her instincts. In hindsight, mom was right most of the time. So this time, I decided to let her be mom and I would be her daughter. There was too much conflict having two moms in one household. Second time around seemed far less stressful than the first because we knew more of what to expect and at the same time we accepted the reality that the unexpected would happen.

Saturday, March 16, 2014

I was tired but feeling content. I was busy with all the tasks of a new mom and glad to be slightly lighter and more mobile.

Excerpt from my journal:

Visit to pediatrician office for jaundice monitoring. Madeline lost one whole pound. :( Nurse practitioner recommended we continue supplementing and feedings every two hours...

This was an exhausting task because Madeline was a grazer. Nursing was so soothing to her she would fall asleep while feeding, so I would gently stroke her cheeks or pat the bottom of her feet so she would wake up to eat. By the time she was done feeding and I was able to put her down to sleep, it was almost time to wake her up to nurse again. I didn't trust myself to wake up for all her feedings, so I set an alarm on my phone. To add to my exhaustion, I was having a tough time with breastfeeding. The initial comfort and joy of nursing in the beginning days were fogged over by my painfully engorged breasts and sore, chapped, and bleeding nipples. I described the pain to my husband who is a guitarist as the painful sores he had on his fingertips when he first learned how to play the guitar. I asked him to imagine playing with sore, cracked, and bleeding fingers. Now times that pain by ten and that's how breastfeeding felt for me. Despite the pain and the frequent feedings, I was so exhausted that I was able to fall asleep pretty quickly after nursing and sometimes during nursing.

The two hour feedings lasted about a week. Once Madeline started gaining weight the pediatrician advised us to go back to the feedings every three hours. Yay! A whole extra hour.

Sunday, April 27, 2014

Madeline's one month celebration. Our family and friends gathered at my parents' home for a traditional celebration of her first month of life.

In the Chinese culture a child's first social event is her one month celebration. During this celebration, prayers and blessings for a healthy and fruitful life are bestowed on the newborn. A huge table full of various vibrant and tasty foods are put on display and offered to the gods and ancestors first, then shared with everyone at the party. It is customary for family members to give monetary gifts stuffed in a little red envelope symbolizing good luck for the child. Then, as a parting gift, the parents, or in this case the grandparents give the guests sweet rice, a piece of roasted pork, and a red dyed egg symbolizing the cycle of life, harmony, and happiness. It was a joyful celebration, and I felt good to be out of the house and chatting with family I had not seen for some time. I was a happy mommy showing off my new bundle of joy.

To add to my happiness, I was finally comfortable with breastfeeding and didn't have to pump anymore. Since I was able to nurse I was doing all the feedings by myself, and I had no more pain or bleeding. I could even do it with one hand standing up! I was feeling competent as a mommy and in a good place.

First Signs

Friday, May 2, 2014

It was a hot day, and I was coming down with a cold. I suspected I'd caught the cold at the one month celebration the weekend earlier. I wasn't used to being exposed to so many people. I remember coming out of the shower feeling tired and congested. We'd had a little heat wave that week so the tepid shower felt extra good.

After my shower I nursed Madeline in the rocking chair in the cool dark room. While nursing her I suddenly started to get anxious. I couldn't breathe through my nose again, and the room felt like it was closing in on me. I felt suffocated. I stood up and started pacing. I tried to finish nursing but wasn't feeling well, and I couldn't take any medication because I was nursing. I was having another panic attack. I handed Madeline to Charlie because I needed to walk off my panic. After an hour or so of pacing and futzing around the house, I felt almost normal and back on schedule. I didn't tell Charlie, and he didn't suspect that I had experienced another panic attack. Without questioning me he watched Madeline while I walked around the house busying myself with cleaning the kitchen, doing laundry, and other housework.

Our sleeping arrangements had not changed since the first day we brought Madeline home from the hospital. Charlie slept in the master bedroom with Anabelle. Madeline and I stayed in the front room, I slept on the couch and the baby in her portable crib. Up until now I'd had no problem nursing Madeline and then falling back to sleep. But this Friday night my stuffy nose was keeping me wide awake.

I lay next to Madeline, watching her and waiting for her to wake up for her next feeding. My nose was completely stuffed. If I didn't breathe through my mouth, I was certain I would suffocate. I didn't hyperventilate the way I had the last time I'd had a cold and stuffy nose but I paced. I would lie down and almost immediately feel the urge to get up. I must have lain down and gotten back up over a dozen times that night. When I was prone, I tried to concentrate on breathing through my mouth, praying and trying to convince myself I wasn't going to suffocate just because I couldn't breathe through my nose. I would have a few minutes of relief, no sleep but just calm before I would shoot up off the couch to catch my breath and pace. The pacing was maddening but I couldn't help myself. I would walk circles around the living room at a brisk pace, arms hanging listlessly by my sides, fingers vigorously rubbing against my palms. I tried to clear my head and fill it with happy thoughts: the morning sunshine, breakfast, park days, funny sitcoms. I convinced myself that everything was fine, after all, it was just a little cold. I remember repeating to myself, "If you don't sleep well tonight, you'll sleep tomorrow. Stop freaking out, you're not crazy."

I tried to clear my nasal passages and then I'd lie back down to just rest. I felt exhausted and yet revved up. This sleepless cycle went on for hours before Madeline started to stir. I nursed her then rocked her back to sleep. The panic didn't seem to go away. It felt like hours of constant panic but I didn't hyperventilate and I wasn't feeling numb and faint. Instead, my stomach decided to turn on me. The anxiety must have alerted my body of some emergency and ordered a mass evacuation in my gastrointestinal unit. It was a familiar and embarrassing side effect of my anxiety.

I witnessed every minute of the night go by and was so relieved at sunrise. Charlie, Anabelle and Madeline woke up and I didn't feel alone anymore.

Saturday, May 3, 2014

My mom was living with us but had gone home the day before to spend the weekend with my dad and planned to return Sunday evening. Since I had my hands full with two little ones, she stayed longer with me than she did when I had just Anabelle. Charlie was helping with the girls this morning so I could try to take a nap. But even after having been up nearly the entire night before, I was finding it physically impossible to sleep. Madeline kept crying, Anabelle wanted my attention, and my brain just wouldn't shut down. I would think about all the things I needed to do: feed Anabelle and Madeline, figure out meals for the day and worry about Charlie getting enough rest. I'd fret about Charlie being mad and disappointed at my inability to care for the children. I would obsess about my inability to rest. The more I thought about my sleep problems the more afraid I became of them. My obsessive thoughts created this monster that fed on my fears. When I wasn't thinking about anything in particular I would just stare into space. My eyes would fasten onto an object and my mind would wander but no sleep. Then I'd start obsessing about sleep again and continue feeding the monster in my head.

Charlie was also very tired and overstressed because he had just returned from paternity leave and started back at work. I began to feel guilty for asking him to take care of the girls, nervous and overwhelmed. He was a very involved daddy with Anabelle, but I felt it was my job to be the main caregiver. Since he was working and I was at home, it was my job to do most all the baby chores and leave the fun stuff for him. I wanted him to enjoy the children and not have to fuss over changing their diapers or feeding them. I wanted to show him I was a good mommy to our children and justify my decision to quit my job. Of course adding guilt to the mix did not help my fragile emotional state.

By 11:00 that morning I knew something was very wrong. I could feel the anxiety rise from the pit of my stomach. I felt nauseous, my breathing became short and shallow, then my hands and face started to get cold, tingly, then numb. It was starting again. The hyperventilation, the full-blown panic. My hands started to involuntarily curl up and I felt unstable on my feet. I started to get very agitated and scrambled around the house looking for the discharge paperwork from the hospital. I wanted to look up information about postpartum symptoms, to find out if what I was experiencing was "normal."

I called the nurse hotline. The nurse suggested I check myself into the nearest Emergency Room given my symptoms. After I hung up, I debated whether to go to the ER or not. I didn't want to go alone again which meant I would have to take the girls with me and I didn't want them, especially Madeline, exposed to all those germs. Charlie was worried but I could tell he was also impatient about my indecision. He was sleep deprived and irritable. I decided to call my mom and ask her if she could come back to watch the girls so I could go to the doctor. My folks came to watch the girls while I went with Charlie to the ER.

I wonder how many mothers with newborns have checked themselves into Emergency Rooms hoping to get admitted just to get a break from the stresses of being a mom and wife. I was too proud to ask for more help or a day off, but if the doctor admitted me then I'd have a legitimate reason to take a break. So, I wished with all my might the doctor would admit me for a few days so I could just get some rest. But all my lab tests came back normal and my EKG was good. I was just another exhausted mommy who needed some sleep. While at the hospital, my hands and face began to feel tingly again and the ER doctor said I was likely hyperventilating so the nurse gave me a paper bag to breathe into. We discussed what I could do if I was hyperventilating, and he sent me home with some Xanax, Sudafed, and a printout of instructions on insomnia, hyperventilation, and viral respiratory illness. He advised me that I would have to stop nursing Madeline if I chose to take any of the prescribed medications and wait 12 hours after my last dose before I could start nursing again.

That afternoon when I had to swallow the water along with my meds, I remember feeling as if I were drowning. With my nose so plugged, every time I swallowed, I couldn't breathe through my mouth at all. While I was drinking a glass of water, I looked down to the bottom of the cup and felt that same drowning sensation. I put the glass down, paused, and collected myself mentally. I seriously thought I was going crazy; I had to talk to myself and convince myself it was just a glass of water, it wasn't going to hurt me. I had to take small sips of water because I had trouble taking large gulps for fear of choking. In my mind I knew something was not right; I was afraid of drowning in a small cup of water?! The mental health I'd previously taken for granted was slowly unraveling. I was entering a new realm of irrationality I'd never experienced and I wasn't ready for it.

Wednesday, May 7, 2014

OB visit. I told my doctor about my ER visit and what had preceded it. I was still having anxiety and difficulty sleeping but had not tried the Xanax yet. She suggested I try to get out of the house to help ease the anxiety but to contact her if things didn't get better. Otherwise, she checked me out and gave me a clean bill of health.

I had been cooped up in the house for about three months. Except for doctor visits, one visit to the farmer's market, and Madeline's one month celebration, home was where I always was. In the last months of my pregnancy, I had been afraid to leave home for fear of going into preterm labor. After birth, I adhered to the Chinese cultural tradition which prohibited me to leave our home for the first month. In Chinese culture, it's believed that the new mother is weak and any evil winds or harsh sun could make her sick. Traditionally, the new mother is not even supposed to shower or walk and God forbid if there were stairs in the home. Even sitting up was discouraged. I couldn't abide by the "no bathing" or "no walking" rules, but I did stay home for the first month except for doctors' visits. It was fortunate I didn't have much of an appetite because my diet was also restricted to very bland uninteresting meals.

Friday, May 9, 2016

About one week after my Emergency Room visit, I went on my first outing on my own. Well, aside from driving myself to my first postpartum doctor's visit, this was my first non-medical outing alone.

I went to the supermarket about fifteen minutes away from where we lived. I had a short list of things to get for the Mother's Day BBQ on Sunday May 11th. I'd been to this supermarket many times and was familiar with the parking, the people, and the layout. I was feeling good, delighted that I was able to get out for a little bit by myself. That Friday wasn't any different from any of my other visits to the market except when it was time to leave.

I got into my car in the parking lot and started to back out. I was feeling proud of myself for braving the great outside world. Things were good again, back to normal, until I heard a thud and I jerked forward towards the steering wheel. Great, just great, I thought. I'd backed my van into the side bumper of a small Lexus sedan.

The other driver was a nice older gentleman. We both looked at each other, puzzled about who caused the accident and reluctant to accept liability. I was shaken up, but I contained my nervousness. I was mad at myself for getting into an accident and unsure of my ability to drive myself back home. Fortunately, there were no injuries and the dents on our vehicles were very minor. The bumper on my van was actually worse off than the small mark on his car. He suggested we just call it bad luck and go about our separate ways without calling the insurance companies. I said that sounded good, but we exchanged insurance and contact information anyway.

After this accident I lost what little confidence I had left in myself. My first effort to exert my independence and regain a small semblance of normality and competence had ended with a crash. What if the children had been in the car with me? What if the accident had been worse? I determined I was in no condition to be driving until I was able to get more sleep. I couldn't be left alone because I no longer trusted my own judgment.

Sunday, May 11, 2014 - Mother's Day

I remember hosting Mother's Day at my house because it was easier to have my family come to me instead of me traveling with a toddler and newborn. So, I cooked a meal of mac n cheese, barbecue chicken, baked beans, bread, coleslaw and other side dishes. I remember sitting at the dinner table and picking at my food. I had little appetite because I was tired and anxious. I had hot flashes sitting at the table and tried hard to find some joy in my family. But I remember I looked at everyone gathered in my home and just wanted to be left alone.

Thursday, May 15, 2014

For weeks, I'd endured very poor sleep. The problem was not just the frequent awakenings necessary to nurse Madeline. In the beginning, I had been so tired that I would sometimes nod off to sleep while Madeline was on my chest nursing but now, after each feeding, I felt wide awake. I was chronically exhausted and yet I couldn't sleep. First it was my cold, and then the heat wave seemed to bring on more episodes of hyperventilation. Then I had another night of zero sleep.

Through the wee hours of the night, my brain never rested. It was on high alert, unable to shut down. The wheels were spinning, stuck in the mud, and just getting deeper and deeper into the ground. As when I'd come down with the cold, I would lie down, then get up and pace. This had become my pattern when I felt anxious, and sometimes that anxiety escalated all the way into a panic attack. I would force myself to lie down again to try to at least rest even if I couldn't sleep, but then the whole miserable cycle would start again. Lie down, get up, pace. Lie down, get up, pace. Lie down, get up, pace. My brain was like a record skipping. It didn't matter where the song ended or started, the pattern kept repeating: hyperventilation, pacing, racing thoughts – full-blown panic. I didn't want to wake anyone else in the house for help because I didn't know if I could even explain what I was going through.

Most of all, I was ashamed and scared. This was not me. I was the calm one, I was the rational one, I was the one people with panic attacks went to for a hug and some comfort. I couldn't wake up Charlie and tell him his wife was going crazy.

So, I let my panic cycle its way through my body and brain. And in my darkest moments I wondered if my brain had gotten permanently stuck in this tormenting loop, running and running in what seemed a race with no finish line. Was this the new me? If it was me then I'd probably just get worse and eventually lose my sanity completely. What if I hurt someone or myself? That's what the doctors always asked on those baby wellness questionnaires, I knew what they were getting at. If I confessed to any thoughts of hurting someone they'd take my children away and I'd be institutionalized. I couldn't bear the possibility of being in a mental ward, all I knew about mental wards were from television; the poking, the probing, the torture. I didn't want my children, my husband or family to see me like that. My God! I cried thinking about the pain, the fear, the shame, the solitude, the unrelenting mental anguish. One of my worst fears was to be physically paralyzed, unable to meaningfully communicate but still be mentally cognizant of my surroundings and trapped in my own deranged mind forever. In such distress I thought it would be a blessing to just let me die.

With each panic episode, my thoughts became darker. The less sleep I got the worse each episode seemed. I had had other bad nights since the one that drove me to the ER, but with most of them, I got at least one to two hours of sleep. But this night, hour after hour, the same pattern of lying down, getting up, pacing, continued until the break of day with not a blink of sleep. I was so ramped up I wasn't even able to rest. I tried to drive the bad thoughts out of my head and ended up obsessing about my need for rest and sleep so I could care for my babies in the morning. I remember watching Madeline through the night as she was sleeping peacefully, just waiting for any signs of her stirring. If I wasn't sleeping I could at least do something useful like nurse my baby. I was afraid I wouldn't have the energy for the day and all its demands, but I looked forward to the morning because then at least I wouldn't be alone. At least I would be distracted from the dreadful thoughts going through my head.

Friday, May 16, 2014

Madeline finally stirred around 5 a.m. so I changed her and nursed her alone. Since Madeline's birth I had been adamant about trying to nurse and care for her on my own without bothering others.

I put the responsibility of all childcare on myself and tried not to depend too much on anyone, even Charlie. He had to worry about work, so I worried about the children. Even though my mom was staying with me I would try to do things on my own because I knew help was only temporary, and I needed to learn to manage on my own. At that time my expectations seemed reasonable, within my abilities. In reflection I was deluding myself. I was asking too much of myself mentally, physically, and emotionally. I didn't know myself well enough to know my own limitations.

That morning I was slowly revealing the cracks in my armor of pride and competence. I asked my mom to help take over so I could try to get some shut eye. She gave me a quizzical look of concern as she took Madeline out of my arms. I told her I hadn't slept well the night before and just needed a little nap. I didn't go to the front room; instead I went into my master bedroom to lie next to Charlie. I dozed in and out of sleep for about an hour before everyone in the house was wide awake, including me.

That afternoon, after my dad picked up my mom to take her home for the weekend, I called my OB and asked for some help with sleep. She prescribed Benadryl and Ambien. She instructed me to try the Benadryl first, and only to take Ambien as a last resort. She emphasized I should use the Ambien sparingly. That night I didn't take anything. I was still nursing and was trying so hard to stick it out without meds. How could my body not eventually wear itself out and be overcome with sleep?

Saturday, May 17, 2014

This Saturday was a blur. My mom went home for the weekend and it was just Charlie and me with the girls. I remember having anxiety all day and panic attacks in between. I was so tired but still couldn't sleep. The only clear memories of this day were donuts in the morning and a park visit in the evening.

Charlie suggested we go to the park for some fresh air. At the park I put Madeline in the stroller, and Charlie played with Anabelle. I watched them laughing with delight, going up and down the slide. I smiled at them. Then I stared blankly at the sun slowly descending below the skyline as the dark dread of another sleepless night seized my heart.

But I had a plan. After the park, I made dinner with some good old country music in the background. Alan Jackson's, "Remember When" came on, and I had to sit down because I started to cry. Why was I having such a hard time? Why wasn't I able to enjoy these precious moments I would never get back? Was I really going to allow myself to miss out on this? I took a moment to pull myself together and have dinner with my family. Since my cold after the one month celebration, I ate very little because I'd had no appetite. As nighttime rolled around, I retired to my own quiet bedroom with no children, no husband.

We had decided I should try sleeping alone. I had my yoga mat and meditated on it with the sound of Tibetan chants and the scent of aromatherapy candles in the background. Then I drank some chamomile tea.

After the house went quiet, I lay down in bed with the window open to the fresh air, no lights and the gentle hum of traffic. Minutes passed then the clock chimed the one hour mark. Not a wink. So I got up, took a Benadryl and lay back down. Hours passed. Nothing.

I got up and meditated some more because my anxiety was growing with each passing sleepless minute. Then I lay back down. Nothing. In my head I heard the nurse's voice "...then take Ambien as a last resort. Use it sparingly..." Desperate, I took out my bottle of Ambien, held it for a while, then put it down. Then picked it up and put it down again. How long this dance went on I don't remember but I finally opened the bottle, and feeling defeated, took one pill. This was my last resort; this would have to bring me sleep.

Nothing. The Ambien didn't work any better than the Benadryl. That was it. I wondered if I would ever sleep again. In a complete panic, I jumped out of bed, exited the bedroom, and began to pace the living room and kitchen. My breathing was short and shallow; I was starting to feel as if I were suffocating again. I paced and paced for I don't know how long before I started to sob uncontrollably. I cried so hard I couldn't breathe. I started talking to myself, "Don't cry. Crying makes it harder to breathe. You're not crazy. You're not crazy. Just breathe through your mouth, get yourself together. Get back to calm. You're not crazy. Please God don't make me crazy." And when I couldn't stand to hear my own voice I cried some more. The bad thoughts were creeping into my cycle again: the mental ward, people taking Anabelle and Madeline from me, pain, solitude, death. I didn't want to wake up Charlie because I knew he would need his energy to care for the children in the morning because I couldn't. I didn't want to bother my sister or friends. So, I called a suicide hotline because I needed to talk to someone, anyone. Thank God I had this number, the only professional number that I knew would be answered at 2:00 in the morning.

I cried to the counselor on the phone. I'm sorry I didn't write down her name so I could give her credit here. She talked me through my fears; we talked about family, birth, postpartum, sleep. At some point during my 15 minute conversation, Charlie had woken up to my sobbing and saw me on the phone.

"Who are you talking to? It's 2:00 in the morning..." he whispered.

"Don't worry, I called a therapist, it's okay," I assured him and told him to go back to bed. He still looked worried. He stood in the doorway for a while frowning but shook his head and went back to sleep.

I was quietly weeping throughout the phone conversation. I clearly remember the therapist asking me, "What would you tell a mother going through the same thing you are right now?" I mumbled to her through my sobbing: "I'd tell her it's not your fault and you're going to be okay." She repeated my own words to me and they were a brief salve to my frantic brain and hurting soul. When I finally was able to breathe, I pleaded for help. She said she would schedule me with the earliest emergency therapy session. That would be on Monday morning, two whole days away.

After my call, I went to wash my face and walk around the living room and stand in my backyard, waiting for the sunrise.

Sunday, May 18, 2014

I truly have no idea what happened on Sunday. I didn't take any notes that day except for writing down the medications I took at night. At this point, I had started a medicine notebook. I jotted down the time and date of every medication I took since I couldn't rely on my memory. My brain felt sapped from panicking, pacing, not sleeping, and crying.

Excerpt from my medication notebook:

10:30 AMBIEN

Either the Ambien or the exhaustion gave me a few hours of sleep that night. Since I decided to take medication to cure my sleep problems I stopped nursing but pumped and dumped what I made. During this period, I felt worse than a cow when I pumped; at least a cow's milk would go to nourish another animal even if not its own offspring. But I was pumping to then just pour it down the sink. Looking back I should have at least watered my plants with it.

Monday, May 19, 2014

My mom was back to help with the girls, so Charlie was able to come with me to my first emergency therapy session. As I sat in the waiting room, filling out paperwork, it took all I had to not get up and pace. I couldn't catch my breath and felt intense anxiety. I looked around the room and wondered if any of the other patients were going through what I was. I didn't want to watch television, didn't want to read magazines. I just waited there with Charlie next to me, hoping for help.

I was anxious meeting the therapist. I sat on my hands waiting for my name to be called. It wasn't long before Dr. Madge came to the waiting room to greet me and walk me to her office. I was relieved her office was down a long hallway because that allowed me to move. The physical activity eased my anxiety. I entered her office, a 12 by 12 foot room, dimly lit, and furnished with a pleather couch adorned with fluffy pillows. I could see that it was an objectively comfortable room, but not to me. No, to me it was a small box trapping and suffocating me. My anxiety quickly turned into panic, and a few minutes into the session I asked her if I could go into the hallway and walk a bit because I was having a panic attack. She got up and walked with me. I don't remember what she said but I felt better just being out of her office. We were in the hallway for about a minute when she excused herself and went to check on something at the front desk. While she was gone I walked up and down the hallway, looking at the ceiling, the lighting, and the paintings on the walls. I tried to distract myself from this embarrassing situation on my first therapy session.

When she returned I was ready to go back into her office, but I could barely talk because I felt so out of breath. The therapist asked me about my medical and family history. I didn't know where to start, so I started from the beginning with my parents.

My parents' lives had been filled with stress. They grew up in Vietnam - a war-torn country - so theirs were not childhoods filled with carefree dreaming and careless play. They escaped Vietnam in the late 70's on a civilian fishing boat. My mom is the oldest of eight children, so she had to function as the second mom to her siblings. It's no surprise she has a type A personality and lives and sleeps with anxiety, though she's never been officially diagnosed. My father is a stern and proud man who rarely complains about his hard lot in life. He never complained about giving up his dreams of becoming an engineer in his home country to arrive in America to sweat and labor at blue collar jobs to support his family. I don't know if my father experienced anxiety because he never talked about it, but I can't imagine he wouldn't have after all he went through and sacrificed.

Growing up, my sister and I learned not to complain too much because it was frowned upon. We didn't talk about emotions; we talked about actions, plans, doing. We had simple marching orders to do well in school so we could get good paying jobs and not have to struggle in life like our parents. As adults, we rarely complained about school or work to our parents because we understood our parents' sacrifices and had witnessed them every day. We had no right to complain.

With the therapist, I talked about life before kids, life during kids, and finally work. I told her I wanted to be a stay-at-home mom because that's what my mom did and I believed that's what I needed to do to be a good mom. But I also had decided to take on contract legal work because we needed the money and I was blessed with an education and wanted to keep my brain sharp. The therapist said I had supermom syndrome. She was surprised when I told her that before children I had held a full time position as an attorney. We talked about my definition of raising kids which to me meant being with my children 24/7, about my work ethics, and about my goals and desires and hopes. She suggested that after I got better I think about going back to work again, that being back in the workplace might stimulate my brain in a healthier way.

She scheduled me for an appointment with a psychiatrist the next day but until then she suggested I try taking the Xanax that the ER physician had prescribed. She stressed the importance of getting sleep. My discharge paperwork had the following diagnosis:

Health Problems Reviewed:

ADJUSTMENT DISORDER WITH MIXED ANXIETY AND DEPRESSED MOOD

There was one thing I appreciated the most about this session; she hugged me. She hugged me and said, "You're going to be fine." As I recounted my therapy session to Charlie on the ride home, I couldn't remember large chunks of our conversation. She had explained parasympathetic, sympathetic, and fight or flight but I couldn't get it straight. I couldn't remember what she had said about it. Then I couldn't remember if my next appointment was the next day or two days later. I felt foolish and lost. I know now it was anxiety and sleep deprivation taking a toll on my short term memory.

Since my call to the suicide hotline, I'd returned to sleep in the master bedroom with Anabelle while Charlie slept in the front room with Madeline. He helped with the night feedings while I pumped and dumped almost every three or four hours. That night I didn't fight taking medication. I knew I needed something besides meditation and prayer to get me to sleep. My medication notebook has the following notes:

10:30 PM Xanax

This was the first time I actually took the Xanax I'd been prescribed way back on May 3rd. I felt my heart rate drop fast and hard. I wasn't prepared for this feeling and I didn't like it. It relaxed me enough that I fell asleep for an hour only to be awakened by a nightmare followed by a panic attack and a long night of anxiety. While asleep, I dreamt that someone was outside my bedroom window. It was a figure clothed in darkness; it was a man, and he wasn't supposed to be outside. I remember him talking to me. He said something like, "Thanks for letting me in." I literally shot up in bed, it felt so real. I threw my legs over the side of the bed and looked out my open window. I got up and hurriedly closed all the windows in the house, peeped in on Charlie and Madeline then sat back down on my bed and watched my Anabelle sleeping. I took an Ambien and got a few more hours of sleep that night.

Tuesday, May 20, 2014

My medication notebook has the following notes:

12:00 AM AMBIEN

8:30 PM XANAX

Wednesday, May 21, 2014

I was prepared for my visit with the psychiatrist. After my therapy session of the day before, I'd gone home and written down all my thoughts and questions. I had a list of my symptoms which included the anxiety, panic attacks, hyperventilation, and then the pacing. I wrote about my fears of sickness and the overwhelming responsibilities of home life. Then I jotted down some notes from my online research about medications and vitamins that might help. In the midst of all my thoughts and questions the million dollar question for me was "Is this postpartum depression?" I wanted, needed to know what I had. Somehow the label mattered very much to me. If I had a name for my illness then (1) I wasn't the only sufferer; and (2) there was treatment, hope. Even though the therapist and my OB nurse told me that my condition was likely postpartum related, I didn't quite believe them because I didn't seem to fit what I thought were the criteria for postpartum depression. My impression of postpartum depression was a mother who had the baby blues shortly after giving birth and those blues persisted for more than a few weeks or months. I pictured a mother unable to get out of bed, unable to function and always crying and sad. In my mind, I had the image of a mother looking solemnly out the window. In my case, though there were some warning signs and precursors, the most severe symptoms sprung up six weeks postpartum. I didn't have trouble getting out of bed, it was staying in bed that was difficult. I was breastfeeding, no traumatic birth, no drama in my home life, instead I had help from my mom and most importantly, I hadn't experienced anything like this with my first baby. After a long week of little to no sleep and what seemed like constant waves of panic attacks, I was willing to do anything to feel better.

I was anxious but looking forward to my appointment because I still had so much hope that I had not reached my last resort. I still had hope there was help out there for me.

Dr. Smith was very kind. At first I was so anxious that I had to stand while she asked me some survey questions about my condition to better make a diagnosis. I can't remember how many questions she asked but it related to my family medical history, my own physical history, physical symptoms, mental perspectives, my moods, etc. It took most of an hour to answer all of them. After she had input all my answers into the computer, she turned towards me and started to discuss the results of the survey.

She was extremely informative, and I'd brought my little medication notebook with all my notes and questions for her. During the appointment I jotted down as many notes as I could because I knew I would forget as soon as I walked out the door.

When I look back and decipher my notes, I can reconstruct the takeaways. Based just on my answers from the survey, she gave me an assessment of my condition. Dr. Smith used the metaphor of a tank, telling me that my serotonin's tank had a hole in it, and I needed help refilling it until the hole closed up, which would take time. A selective serotonin reuptake inhibitor (SSRI), like Prozac, would keep the serotonin from being reabsorbed so would increase my brain levels of this neurotransmitter. She also gave me natural remedies for sleep such as melatonin. She let me choose among three different SSRIs: Lexapro, Prozac and a third one I cannot remember. I chose Prozac because it was the oldest and most tested medication of the three. At the time I was overwhelmed and surprised she was asking me, the crazy sleep-deprived, anxiety-ridden mother, which drug I wanted to take. I thought to myself, "I am not in any right mind to be picking out drugs. Can you pick one for me, doctor?" She also gave me BuSpar (sounded like boost bar) which was supposed to help with my anxiety. I was to take that as needed. We discussed breastfeeding and anti-depressants. She gave me a copy of a medical article on the possible side effects of breastfeeding while on SSRIs. Overall, the studies considered antidepressants safe enough for a breastfeeding mother to continue nursing. I made the decision to continue to pump and dump until I could be off medication. I didn't want to take any chances that the Prozac would hurt Madeline in any way. Dr. Smith's diagnosis on paper:

Health Problems Reviewed:

DEPRESSION, UNSPECIFIED

PANIC DISORDER WO AGORAPHOBIA

At the time I didn't or couldn't really reflect on how surprisingly arcane the whole examination appeared to be. There were no diagnostic tests performed or orders for blood tests or a CT scan of my brain. I do not even recall her or a nurse taking my vitals. In our age of technology filled with MRIs, genetic mapping and manipulation, artificial intelligence and so much more, my first experience with psychiatry seemed to be untouched by these high-tech advancements. After answering questions to a detailed survey, I was given a probable diagnosis and offered a variety of mind-altering medications that were only likely to help. Looking back, I suppose no blood test or MRI could have revealed how anxious I got over taking a shower, reading a book to my daughter, or the intense sadness I felt in not being able to sleep next to Madeline. My best chance of receiving an effective course of treatment hinged on how accurately and detailed I could communicate my pain and problems.

It was a very instructive session, not touchy feely, just the facts and research. Dr. Smith ended our conversation with a clear and direct plan of action. I needed to change my bad cycles into good cycles again. For the coming months she wanted me to focus on her three-pronged approach of (1) meds and cognitive behavioral therapy; (2) exercise & sleep; and (3) diet. It would be three months until I saw her again. At least that's what she ordered. She made an appointment for me with a therapist within the Behavioral Health Services, the same department she was associated with.

I left Dr. Smith's office and drove directly to the pharmacy down the street to fill my prescription. After a short wait, I walked out of the pharmacy with my bag of pills and instructions in hand. I liked the physical feel of the bottle of pills because it was real, concrete, something I could hold, touch, and control. Mostly, I felt adequately equipped to battle my mood disorder and insomnia.

That evening I was not well. I came home feeling exhausted, overheated, and riddled with panic attacks. That evening I took the following meds:

8:00 pm melatonin

9:00 pm BuSpar

10:20 pm BuSpar

A bad afternoon led to a bad night. I didn't want to take the medication, but as the hours passed with no sleep and increased anxiety, I took all the meds in my arsenal. I started off with the natural remedy (melatonin) first then moved on to the BuSpar. The directions for BuSpar were "take 1 to 2 tablets orally two times a day as needed for anxiety." I tried one BuSpar first and then when I wasn't feeling better I took another one, thinking I just needed a higher dosage.

I was pacing and walking outside in my backyard in the middle of the night. Then I remember lying on the living room couch trying to read an Agatha Christie mystery in hopes I would get drowsy and fall asleep. In college reading in bed always put me to sleep. No such luck. By 12:00 a.m. I was in full panic mode again. The storm was brewing.

# Part 4:  
THE STORM

Life isn't just about waiting

for the storm to pass.

It's about learning

to dance in the rain.

Thursday, May 22, 2014

12:00 a.m. After the failed attempt to sleep despite taking melatonin and two BuSpars, I started to pace which usually meant panic was just around the corner. I frantically looked for phone numbers for anyone I could call for advice in the middle of the night. The doctors were not available, and I didn't want to take the last medication in my bag, Prozac, without some professional advice. I was panicking and desperate.

I called the 24-hour pharmacist. I thought maybe I could take the Prozac at night because the psychiatrist said some people take it in the morning and some take it at night because it helps them sleep. She did recommend taking it in the morning, since I didn't know how it would affect me. But I wasn't sleeping, and I believed there had to be some drug out there that would put me to sleep and make it all go away.

The pharmacist was of little help. He was ambivalent about when I should take the drug. Though my memory was fuzzy during this period, there are memories that stand out clearly. This is one of them. The pharmacist told me to "just relax and try to go to sleep." On any other normal day I would have been furious at this dismissive response, but in my condition I kept talking until he gave me a definitive answer because I felt incapable of making any decisions on my own. In the end he said to go ahead and try the Prozac. Maybe he was just trying to get rid of me. So I did. It was a mistake. The Prozac made me even more amped up. At least before I took the Prozac I could lay down and read. Now I couldn't even sit still, all I could do was fight for every breath and pace. I went outside into the dark backyard and looked up into the sky, praying for light to come soon. The vicious cycle was starting again, the hyperventilation, the pacing, the anxiety, then panic. Every noise bothered me and would get me all flustered. I was hot and sweating and felt like it was 100 degrees outside even though the weather was quite mild. I felt hopeless. I had seen a therapist and a psychiatrist, I'd taken all the medications prescribed to me, and I wasn't anywhere closer to feeling normal. Maybe this was more than just postpartum depression?

At 7:00 a.m., after not sleeping all night, I felt that I had to go for a walk. Only a walk could burn off some of my anxiety. Charlie was awake by now so he joined me. After we had circled the block a few times he needed to go home and get ready for work, but I was reluctant to go back. Home and the bedroom was not a happy place for me these days. Since I rarely left the house, home was where most of my panic attacks occurred. Home was where sleep wasn't.

After Charlie left me to return home, I was still walking, still panicking, so I used my cell phone to call the suicide hotline again. I needed to talk to someone who knew what was going on with me. During my walk I felt like my neighbors were gawking at me as they climbed into their cars to go to work. Some I knew better than others. Most knew I had been very pregnant a while ago, so they must have figured that I had a little one at home. I was on my cell phone, so I didn't have to strike up a conversation with anyone I saw.

The therapist talked with me for a while then suggested I go back home. Reluctantly, I walked back home to my crying baby, attention-craved two-year old, and worried mother. Charlie had to go to work but he was, of course, distressed about my worsening condition.

Later that morning I called my OB's office for advice. I asked the nurse what I should do. I figured that she'd dealt with postpartum women on a daily basis and might have some insight. She said I was getting all the right treatment by going to the psychiatrist and therapist. I remember she was very kind and understanding and emailed me information about postpartum depression from the National Institutes of Health. Its description included some of the symptoms that I was experiencing like intense anxiety, but not panics attacks or hyperventilation:

The symptoms of postpartum depression are the same as the symptoms of depression that occurs at other times in life. Along with a sad or depressed mood, you may have some of the following symptoms:

Agitation or irritability

Changes in appetite

Feelings worthless or guilty

Feeling withdrawn or unconnected

Lack of pleasure or interest in most or all activities

Loss of concentration

Loss of energy

Problems doing tasks at home or work

Significant anxiety

Thoughts of death or suicide

Trouble sleeping

A mother with postpartum depression may also:

Be unable to care for herself or her baby

Be afraid to be alone with her baby

Have negative feelings toward the baby or even think about harming the baby (Although these feelings are scary, they are almost never acted on. Still you should tell your doctor about them right away.)

Worry intensely about the baby, or have little interest in the baby

This list made me think I was worse off than the average mother with the postpartum depression syndrome because my anxiety often turned into panic attacks. It also suggested that these problems only came up after delivery and didn't encompass all the perinatal problems that I - and many other women I've since learned - experience.

The nurse also included the phone number for Postpartum Support International (1-800-944-4773). That day I didn't just call my OB's office. I called my psychiatrist's office and told them about my late night pill popping and my continued sleep problems. The nurse got back to me and said Dr. Smith's instructions were to take the Prozac in the mornings, and that the BuSpar could take 2-4 weeks to take effect. Then she prescribed Restoril for sleep, to help take the edge off the first month on my new medications. I was to take one Restoril before bedtime and if I still couldn't sleep after a couple of hours, then I could take another one.

By the afternoon I had been awake for about 30 hours straight. Surprisingly, I was very alert and aware of my condition. I thoroughly documented each of my conversations with the pharmacist, nurses, etc.

Physically, I felt like I was suffocating and overheating. I would lie down to only get up a few minutes later and pace around the house. My mom kept telling me to try to rest, but I told her I needed to walk. The anxiety and panic attacks were driving me mad, but so was the anticipatory anxiety about my mind and body eventually crashing. I imagined collapsing onto the ground from exhaustion, malnutrition, and worse, I thought I might go into cardiac arrest from all the panic attacks. She was very worried, but there was little she could do since she had her hands full with my Anabelle and Madeline. She knew I wasn't well, but I don't think she knew the full extent of my postpartum crisis.

I don't know the exact time but around 2:00 p.m. I was at my wit's end. Now in a full-blown panic attack, I walked out of the house with my cell phone and called Charlie. I was crying over the phone and told him I wasn't doing well and he needed to come home.

Until then, I had done my best to keep it together in front of my family. I'd have panic attacks at the dinner table but force myself to sit, shoveling food down my throat and then quickly excusing myself, or I'd find excuses to get up out of my chair and walk. I could no longer hide it. Charlie had seen me cry, of course, but not like this. This was the first time I admitted to him that I really wasn't well and was afraid for my life. He said he would come home right away. I couldn't go back into the house. I just paced back and forth in front of our house until Charlie came home. When he finally pulled up in the driveway, he jumped out of the car and hugged me, a strong crushing hug.

When I finally came up for air he said, "We have to wait out here. The police are going to be here." I had no idea what he meant. Had he called the police because he was concerned I might hurt myself? He explained that he had been pulled over by the police for speeding. He told the police officer he knew he was speeding and to just make out the ticket as soon as possible because he needed to get home to me. He explained the situation and the officer let him go home without a ticket but instructed him to "stop driving like a jerk." The officer was going to send someone to our home for a wellness check. At some point I started sobbing uncontrollably. I was a mess and the police were on their way. Again, I tried to pull myself together. We waited outside the house for the police to arrive.

It seemed as if we had been waiting forever but my perception of time was very skewed during this period. In reality, they probably arrived about ten or fifteen minutes after Charlie. Fortunately, there was a female crisis prevention therapist named Pam who arrived with the two male officers. I was so grateful Pam was there because I didn't know if I would have been able to explain what was going on to a man. I felt that a woman might be better equipped to empathize.

I explained to her my situation and she comforted me with the ease of a professional and the compassion of one who has experienced a lot in her lifetime.

"I don't know what's wrong with me. This isn't me. I, I just feel overwhelmed with anxiety, and I just can't sleep. I just need to sleep. I'm exhausted, but my brain won't shut down," I rambled on to Pam.

"You're going to be fine. You're a new mom, and there's a lot going on. You have two little ones? Where are they now?" she asked as we stood on the driveway in front of my house.

"They're in the house with my mom. Thank God she's been with me to help with the girls. I have two beautiful little girls, and I can't even..." I stopped myself because I could feel the tears forming in my eyes.

"Oh good. That's awesome that mom is with you, so you're not alone during the day. Come here. Let's talk more about what's going on."

Pam put her arm around my shoulders and gently guided me away from the other officers, then we chatted more about my birth experience and did a quick review of my symptoms and the medical care I had received up until that moment. All the while the male officers stood by and comforted Charlie which I am very grateful for. One officer shared his personal history with raising his own four children. I was feeling embarrassed and ashamed standing in front of my house with uniformed officers on my driveway and me sobbing in my sweats. I could feel the eyes of my neighbors searing through the back of my head. I didn't dare look around or face my neighbors' homes for fear of making eye contact with their alarmed eyes peeping out a window. I was a mess. My outward appearance reflected the inward turmoil in my brain and body. Before this I could at least keep an outer appearance of sanity, but now I felt like I had let the crazy out. My face was flushed and streaked with tears, my hair was oily and disheveled; I was wearing pregnancy sweatpants, an old tank top, and a flannel shirt too small for my still pregnant looking body.

I felt sad for myself but more for my mom who was at the doorway holding Anabelle's hand looking bewildered and concerned at the spectacle that was her daughter. Sensing her angst, Charlie went up to my mom to update her on my well-being and picked Anabelle up. He brought her to the officers to show her off. Safely perched on her daddy's arm, she smiled and shyly said hello to everyone. I wiped my face and told Pam, "that's my oldest, Anabelle."

"She's beautiful," Pam said, and I smiled in agreement. I looked at Charlie and was awed at how much Anabelle looked like her daddy, and at that moment I hoped she would be more like her daddy and not me.

When I finally took a moment to compose myself, Pam called the County Behavioral Health Center and put me on the phone with a counselor who took down my information for a referral to the Postpartum Wellness Program in my county. This program was a blessing. It had everything I needed: support groups, therapy, child care, and hope. Through this program I was later connected with my therapist Grace who became an integral part of my recovery. I don't know why my OB hadn't mentioned this program to me earlier; I can only guess that she was working within the set parameters of my HMO and their protocol was to refer moms like me to their general behavioral health department.

Before the officers left my home, they made me promise I would go to the Emergency Room to get checked out. I went into the house and explained to my mom what had transpired with the police, and she was supportive. I kissed my girls and mom good bye then went to the Emergency Room, again with Charlie.

At the hospital, the admitting nurse looked at me with furrowed eyebrows. She asked if I had suicidal thoughts. I was having a panic attack and breathing into a paper bag at the time. I told her though I'd thought of killing myself, I really wasn't seriously considering taking my own life. I told her "I don't want to die but I don't want to live like this anymore." She wrote something down, and I was put in a screening room.

I was so frazzled and anxious I couldn't lie or even sit down on the bed. I paced the hallways which worried my kind nurse. He said he had called the psychiatric nurse who would be with me shortly. In the meantime I spoke to the emergency room doctor.

It was like another therapy session. I retold him the same thing I had told the therapist, the psychiatrist, the police officers, the nice lady on the suicide hotline. At one point I asked him if he could "zap" my brain back to where it had been two weeks earlier. I was convinced something had short circuited my brain, and I just needed a quick electrical shock to whip me back into shape. I showed him my medication notebook. He reviewed my notes, and then he furrowed his eyebrows, rested his chin on his fisted hand and said, "Wow, that's a lot of medication. Maybe a detox would help?" He went on to comfort me with his kind words about my decision to be a stay-at-home mother and how it was the hardest and most gratifying job in the world. Then he asked if I heard any voices in my head.

"Umm, well, I do hear voices but it's my own voice. I mean, I can hear myself thinking, and it's rational. I mean, it's not telling me to do anything crazy like hurt myself or anyone. Do you know what I mean? So, yes I do hear voices but only my own voice," I blabbered inarticulately to the ER doctor. He looked at me with pursed lips and an arched eyebrow, though my answer was satisfactory enough that he didn't order me to be strapped to the gurney or have a guard stand outside my room. Other than that he wasn't able to speak much to my condition until the nurse who specialized in psychiatry arrived.

While I waited, I tried to sleep. Charlie left the room to go search for some food since it was getting late and I wanted him to eat something. The room was cold enough that I didn't feel as if I were on fire anymore. I covered my eyes with Charlie's sweater and just tried to rest. I was so tired yet still so very alert. Hyperalert. I just kept waiting for my body to give out and totally crash.

By the time the psychiatric nurse came into my room I may have been dozing a little but not sleeping. I recounted the same details about my condition to the nurse who then left to consult with the on-call psychiatrist. After a half hour or so he returned and said I wasn't at the point where he would involuntarily commit me, but he recommended I voluntarily admit myself into a mental health institution for the weekend so I could at least rest.

I was floored. My worst fears were coming true. I thought at most I would be admitted into the general hospital for a day or two to be sedated and monitored. Little did I know that if I were admitted, it would be to the psychiatric hospital? The nurse described the layout and structure of this hospitalization. I would have my own bed and share a room with 5 to 7 other patients with a variety of different mental health problems. There was one hospital with a wing dedicated to postpartum patients but there was no guarantee a bed would be available there. In general, I would be allowed visitors only in the evening hours and visitations could last no more than two hours. In essence, I would be without family contact almost all day and night. Listening to him describe the mental health hospital quickly threw me into another panic. He gave me and Charlie some time to think about it.

Where do I start? Charlie was being his usual diplomatic and supportive self, and I was completely freaking out.

"What should we do? I don't want to be away from you and the girls overnight? My poor mom. I need to sleep but I'm freaking out just thinking about being alone without you for so long," I blurted out.

"I don't know but you really need to get some sleep and he's right, you haven't been able to get any at home. Maybe staying at the hospital for a few days would help. But I don't want you to be alone either. I don't know. It's your decision, babycakes. You know I'll support you either way."

Charlie was my rock, he was my forever partner in life. We were a team. I didn't want even to imagine breaking up the team.

"I know they'll just drug me up at the hospital. I mean, nothing so far has been able to get me to sleep. But when I wake up I'll be alone with a bunch of strangers. At least at home when I panic you guys are there, and I'm able to walk around and leave the house if I want to. I want to be able to see the girls. I can't do this. I can't make a decision," I said. I felt overwhelmed by this sudden turn of events. Mental ward? What if I got worse while in the ward? My voluntary commitment could turn into involuntary.

Finally, I spoke to the ER attending nurse. He came into my room. He did a quick visual scan of me from head to toe then looked me straight in the eyes and said, "You don't look like you need to go to the mental ward. I've worked at a mental ward, and you don't want to go there unless you really think you need it. Do you think you need to?" We discussed my new sleep medication Restoril and how I had not tried it yet. The nurse suggested I go home and try it before voluntarily admitting myself. But he made it clear it was my decision.

In the end, Charlie and I told the psychiatric nurse I wanted to go home and try my new sleep medication before voluntarily admitting myself. If I didn't get sleep over the weekend I could return to the ER. The potential consequences of voluntarily admitting myself at that moment were too much for me. I couldn't handle the thought of being locked up alone. Right or wrong, I made a decision. The psychiatric nurse tried to convince me to admit myself for the sake of getting some sleep, especially since it was a long holiday weekend. He mentioned the crying children and the fact that I had not been able to sleep at home for the past few weeks. But I told him it would take hours to make arrangements to admit me to another hospital anyway and with the morning doctor's rounds I would still get no sleep. I had a better chance of sleep if I just went home and sedated myself. He couldn't argue with that logic even if it was coming from a frantic, sleep-deprived mother.

So at 11:00 pm I was discharged with Restoril and more Xanax. After this ER visit, I wasn't any closer to an explanation for my sleep disorder. No one really knew how to address my perinatal mood disorder; they all focused on getting me to sleep. Even the psychiatric nurse didn't give me any more information about postpartum depression or anxiety. The doctors and nurses just referred to my psychiatrist's notes when addressing my medical condition. The ER nurse's parting reminder was to check in with my psychiatrist Tuesday morning and tell her about my ER visit.

At home I was greeted by my mother and dear sister. My mom had called my sister because she needed help with the girls in case I wasn't coming home. My sister had taken the following day off from her teaching position to be with me. They were glad to see me and relieved I had decided to come home instead of checking into the hospital. I got into bed and started with Xanax as instructed. Then when I still couldn't sleep I ended up taking Restoril. I took Restoril at approximately 12:45 a.m. and I didn't wake up until 6:00 that morning. I had finally slept after weeks of little to no sleep, after going 43 hours straight of being awake and nearly always panicked. This would mark the beginning of my difficult journey of healing.

# Part 5:  
HEALING

Then He arose and rebuked the wind, and said to the sea, "Peace, be still!" And the wind ceased and there was a great calm.

Mark 4:39

Friday, May 23, 2014

I woke up, looked at the clock, put both arms up, and shouted with joy, "I slept!" I had survived the night without waking up. I didn't feel rested, but I knew I had slept because I had no memory of the night after taking my Xanax and Restoril pills; everything had just gone dark after my last dose. Feeling reassured about my decision to be at home, I went for a walk with Charlie.

My sister was there to help my mom with the kids, and Charlie stayed home with me all day. He had called in to work and spoke to his boss about taking more family leave. His boss was encouraging and sympathetic because he knew I wasn't doing well the past few weeks. I thank God for my family, friends, and the kindness of strangers. After much discussion back and forth, we decided I needed to be away from the kids for a few days. Since it was a long holiday weekend, it would be a good time for me to get adjusted to my new medication.

This was a difficult decision because I was very attached to my children. At that time, my own expectations of raising children and being a good mother meant physically being with them 24/7. When they woke up in the morning, I wanted to be there to greet them, and at night I wanted to be the one to rock them to sleep. I wanted to be everything they needed me to be. But I was exhausted. I felt like the tree at the end of Shel Silverstein's The Giving Tree:

I wish that I could give you something...but I have nothing left. I am just an old stump. I am sorry...

Anabelle had never slept without me nearby except one night at the end of my second pregnancy and when Madeline was born. I felt like a terrible mother. In my mind I couldn't keep it together, so I had to send my children away. I was overcome with guilt, but I knew it was the best thing I could do for my girls. I was blessed to have the support and help of those who were willing and able to care for my children. I needed to get better so I could be with them and be the mother who could care for and love them. My mom took Madeline and my sister took Anabelle for the weekend. They had to go to different homes. When my parents and sister left, I cried but I was also relieved. I learned an important lesson that day. For me, part of being a good mother meant loving my children enough to do what was best for them despite the expectations I'd unrealistically held for myself.

That night I tried to fall asleep without medication. I was still fighting so hard to do things naturally. I didn't want to get addicted, especially to the sleeping pills. So I tried to sleep but finally gave in around midnight.

My medication notebook:

12:45 AM Restoril x1

I couldn't even write it down myself; couldn't even bring myself to open the bottle and get a pill. Charlie had to give me the pill and then write down the date, time, and dosage. Somehow in my head, if Charlie was giving it to me that meant I wasn't completely giving in yet. The drugs were being administered to me, I had to take them. I was so indecisive and in such denial. I had been praying God would heal me without any more medications; I wanted faith alone to heal. But I wasn't well; it wasn't going away as quickly as it had come. In fact, it was getting worse. That night I prayed God would give me the help I needed to heal. So, I took the pill.

Saturday, May 24, 2014

Around this period, I began to notice the worsening extent of my short term memory loss caused from the sleep deprivation, drugs, and unstable hormones. I had difficulty finding things because I would forget where I set things down; I'd forget the content of conversations just seconds after having them. One time Charlie asked me to get him a napkin so I got up, went into the kitchen, and just stood there because I forgot why I was in there. I just hoped these memory lapses would go away once I was well again.

I can remember some of this Saturday spent at home with Charlie. I thought of the children often and missed them. I especially missed Anabelle because I knew she was old enough to be confused and sad. I felt guilty about Madeline because she was so young, but I knew my mom was giving her all the attention and care I had not been able to give her these past few weeks.

I was also worried about my bonding with Madeline. The original soft fuzzy feeling I'd had for her had faded away as a sad side effect of my illness and medications. I made every effort to care for her when I wasn't anxious or panicking but after my release from the ER on May 22nd, we decided my mom should sleep with Madeline because I couldn't. Sleeping next to Madeline made me anxious, and I didn't trust myself when I took Restoril at night. The potential side effects were too dangerous for me to be caring for her at night.

I didn't want Madeline to feel my anxiety, and I didn't want to make the association between her and my anxiety. I wanted to feel calm when I cared for her. One connection I clung to with Madeline was breastfeeding. Since taking my medications, I had been pumping and dumping in hopes I would be well soon so I could nurse her again. I wasn't producing as much milk as I had been when I was nursing, but I was trying to keep it going for Madeline. I was convinced once it was safe for her to nurse again I could get my supply back up.

In regards to my insomnia, I was relieved that I was able to "sleep" at night. It was a drug-induced sleep so it didn't feel completely restful to me, but at least I wasn't up all night having panic attacks and pacing the room anymore. Restoril forced my brain to shut down; it wasn't peaceful or natural but I needed it. My brain was in hyperdrive; it needed something to force it to turn off. I knew Restoril wasn't the cure, but it would buy me some time while my body figured things out.

This Saturday Charlie and I went out for lunch after a walk at the farmer's market. I sat in the restaurant's patio area, feeling absent, and waiting for Charlie to order our food. I watched families enjoying the water fountain, children running around laughing, parents doting over their children. I just sat there staring blankly at them, wanting to feel what they were all feeling: joy.

When Charlie came back with our burritos I didn't have much of an appetite and had to force myself to take a bite. The salsa was a bit spicy. Whether the spicy salsa took me over the edge or I was going to go over anyway, I don't know. But after one bite of the burrito I could feel the anxiety rising from the pit of my stomach. I could barely sit down, I had to get up and walk. The spiciness was burning my mouth, and again I felt as if I couldn't breathe. I felt as if I had to flee, to just get up and walk out. I forced myself to remain seated and distracted myself by playing with the tabletop menu holders; I tapped my feet, and drummed my fingers on the table. I tried to shut out the growing anxiety and go to my happy place, my safe sacred place free from pain and worry. Charlie could tell something was wrong. He asked if we needed to leave but I said no. So, he scarfed down his burrito then we headed home.

At home Charlie took the opportunity to take a nap while I tried to distract myself and prevent another panic attack. Talking seemed to help, so I started to call people. I called Charlie's parents first because they were my second parents. They'd always made me feel like their own daughter and not just a daughter by marriage. I knew they would listen and give me strength and encouragement.

I remember my mother-in-law picked up the phone and was probably a bit surprised by my call because I didn't call her regularly. She asked how I was doing and I remember saying "I'm not doing well," as my voice broke and the tears welled up in my eyes. I bared my heart to her about my recent health problems but tried to remain optimistic as she was going through her own health problems as well. I didn't want to burden and worry her too much because she already felt frustrated at being far away and unable to physically help. She shared with me her own feelings of the baby blues after having her own children. She told me how she probably had some undiagnosed postpartum depression symptoms after having Charlie because she would constantly fret over him and take him to the doctors about any little potential sign that he was not developing normally. She felt obsessed with his health and development. Then my father-in-law got on the phone, expressed his concern, and asked what they could do to help.

"What can we do to help, hon? Anything? We're really worried about you."

I said the first thing that came to my mind. "You can pray for me, Dad. Pray for us please. Knowing you are saying a special prayer for us makes me feel better already."

"Honey, we already pray for you guys every day. Every morning and night we pray for each and every one of you kids. You bet we'll pray for you, but I wish there was something more we could do."

I also wished there was something more they could do, and I would not have hesitated to tell them if I could've thought of anything. But for the moment their faith was what I wanted. I really felt their prayers were more genuine than any of my own prayers had ever been. It may seem silly but my hope was that since they were such devout Catholics their prayers would get priority somehow. And I needed all the help and prayers I could get.

Before I hung up, my mother-in-law encouraged me to call my cousin-in-law who had some similar postpartum difficulties because she would better understand and maybe have some guidance. I thanked them for their suggestions and prayers.

Then I called my cousin Rose and chatted with her for over an hour about my anxiety, her anxiety, and exclaimed how funny it was that we never talked more to each other about such issues. During our many get-togethers we would often talk about various other physical ailments, usually related to our digestive systems, but somehow the anxiety that plagued almost every aspect of our lives eluded our conversations. It was a relief to know I wasn't alone. She wasn't as bad off as me, but she was able to relate and was kind and compassionate.

After all my phone calls that afternoon I felt better. I didn't know it at the time, but these phone conversations were a form of talk therapy for me.

My medication notebook:

9:05 am Prozac

2:00 pm vitamin & prenatal

9:15 pm Restoril x1

11:00 pm Restoril x1

I survived another day.

Sunday, May 25, 2015

I missed my Anabelle, and she missed us. My sister told me she asked for us at night and had a hard time falling asleep. When I spoke to Anabelle over the phone Saturday night, she was timid and spoke in a small mousy voice. She asked us where we were. As numb as I felt emotionally, I had not lost myself yet. I knew I felt sad and guilty. I knew I missed her. Charlie and I decided to pick her up earlier than planned, Sunday morning. She'd been away from us for two days.

We arrived at my sister and brother-in-law's home in the morning. Anabelle came slowly to the door; she didn't come running up to me as I'd hoped. She had her head down and looked shyly at me. She was all dressed up in a bohemian shirt with a sparkly headband and colorful bracelets. They were playing dress up. My heart was heavy when I saw her reaction. I knew she was happy to see us but still sensed that something was wrong, and sad that we had left her overnight at my sister's. She finally came up to hug me and Charlie.

In the car, Anabelle quickly warmed up and started chattering away about her day at Auntie and Uncle's house. She was fine and happy to be going home. Thank God for a child's ability to forget and forgive.

My medication booklet:

7:40 AM Prozac

2:00 PM vitamin + prenatal

9:30 Pm Restoril x1

12:36 AM Restoril x1

I survived another day.

Monday, May 26, 2014

Memorial Day. Charlie suggested we go to the beach and get some fresh air and sun. We got an early start. Anabelle was so excited to be back home and now going to the beach with us. I remember this trip clearly.

When we first arrived at the beach parking lot, I started getting anxious. It wasn't very crowded yet because it was early. Still it was Memorial Day weekend, and I knew the beach would soon be mobbed with vacationers and locals. Part of me wanted to just stay in the car. It crossed my mind that if I really got into trouble the ambulance would have to come to take me away in front of all these beachgoers. At least at home the walls shielded me from a multitude of strangers glancing and judging me during my agonizing panic attacks. Since Madeline's birth, this was the first outing with just the three of us: Charlie, Anabelle, and me. I didn't want to ruin this moment, so I made the decision to get out of the car.

There was a long flight of stairs leading down to the beach. Charlie walked with Anabelle, and I followed. We made our way down and found a nice little location in between the rocks and water. Anabelle and Charlie played in the sand while I sat watching. The ocean air was hard to breathe. The sun was too bright, the sound of the crashing waves deafening. Everything about the beach irritated my senses. I felt too keyed up, too tuned into my surroundings, as if I needed to turn down the volume on my own nervous system. I started to get more and more anxious and bothered. I was upset with myself for feeling this way because I'd always loved the beach. Here was my chance to have a wonderful day with my daughter and my husband and I wasn't enjoying it. I got up and ran on the sand. I had learned that exercise helped with my anxiety, so I ran back and forth.

After I finished my run I sat down under our umbrella and watched Anabelle splashing in the water with Charlie. I was glad that she was having fun; she was laughing and really enjoying herself. All was forgiven. I knew I should have felt the surge of happiness at the sight of my healthy little girl so full of life. I knew I did somewhere deep down in my heart but I didn't feel it. I couldn't stop thinking about getting through the trip without calling 911. Since my illness, I had become an observer of life around me. I no longer felt like I had a part to play. I couldn't care for my children alone. I couldn't give comfort to my weary husband. I could barely care for myself.

We didn't stay long. After about three hours we packed up and headed home for lunch. On our way out Charlie carried Anabelle on his back, and I followed behind. I had run off some of my energy so I was not panicky, only a bit anxious. At the bottom of the stairs, I paused and looked up to the top. As I was staring blankly, an elderly woman was coming down the stairs. She looked at me and said, "It's a long hard trip up to the top." Then she put her hand on my shoulders and said, "but you'll make it." She couldn't have really known what I was feeling but what comfort those words gave me. How her words imprinted themselves in my mind and resonated in my soul then and many times later during my dark moments of sorrow and pain. I didn't ask her name. I don't even remember what she looked like, but I am certain she exists. Nevertheless, in my mind's eye I envisioned wings and a shiny halo.

Tuesday, May 27, 2014

The day after the beach visit, we three went to pick up Madeline and my mom from my parents' house. We all drove back to our house to settle into our new routine. My mom and Charlie didn't treat me like an invalid, but I felt like it. I didn't trust myself to do the things I used to do like give the girls a bath by myself, drive, cook, and be alone. Also, it was like musical chairs with our sleeping arrangements. I no longer slept in the front room with Madeline. My mom moved into our master bedroom to sleep with Madeline and Charlie and I slept with Anabelle in her bedroom. I chose to move into Anabelle's room because I needed new scenery; my master bedroom was no longer a peaceful place for me.

In the days after the beach visit, I tried to create a routine. My goals were to take my medication as prescribed, to eat healthy or at least eat something, and make night time a happy time again, to make my bed a safe and relaxing place. I believed that if I could just sleep normally again, the anxiety and panic attacks would stop. I kept busy with exercise, caring for the girls when I could, writing, and even cooking. And I was on the phone a lot.

Talking calmed me down, it diverted my mind from what my body was going through when I was panicking. When I felt a panic coming on, I would call someone if it happened at a reasonable hour of the day. I had a written list of people I could call: my sister, mother-in-law, my cousins, my friends, random moms from the local MOM Club, eventually my therapist. When no one was available or it was at an hour when everyone else should be asleep I would call the NAMI warm line or the suicide hotline if I was desperate.

During these conversations I'd ask the person on the other line to just talk to me, tell me about what they were doing, describe to me their problems and joys. The talking seemed to trigger a part of my brain that helped counterbalance the anxiety and panic in my system. If only the doctors knew exactly where that mystery spot was then they could send an electrical shock to it and perk it up. Dr. Feng Zhang, a renowned bioengineer at M.I.T, said when describing the reason for his interest in neuroscience and psychiatry "...many people suffer from problems we cannot begin to address. The brain is still the place in the universe with the most unanswered questions." But maybe it wasn't just one spot in my brain making me crazy or happy, maybe it wasn't even a part of my brain. Maybe it was something deep down in my being, the part that makes me who I am. Soul? Spirit? Joy? The part in us all I don't even have a proper word for and that no scientist, doctor, or any human being has ever physically been able to ascertain to study its form or function. But wherever this mystery spot is, I'm certain it's what kept me alive and still does today.

Every day was a challenge, but every new day survived was a win. I kept a calendar and marked off each passing day with a big X. It was a visual affirmation of my achievement. Every day lived was an accomplishment. At the suggestion of a dear friend I marked off a future date on my calendar and designated it as my "look back" date. When I reached that specific date, I would take time to look back and see how I had progressed. I'd read over my journal entries, my notes, my medication booklet. Then, if I hadn't already, I would pick another date in the future. Each date would serve as a milestone. It was a blessing I didn't have any legal contract work to push aside; my calendar was clear for me to focus all my energy on getting better.

At the very least, projecting myself forward into the future gave me something seemingly simple to work towards. If I didn't do anything productive one day, even if I didn't get out of bed, at least I was alive and that brought me that much closer to the next date on my calendar. I am so very thankful for my friend's suggestion because during moments when I just wanted to give up, sometimes staring at that "look back" date gave me hope, just enough to get through another day.

Sunday, June 1, 2014

Excerpt from my journal:

It's a new month and I'm hoping for the best. I'm sitting on the couch watching over my Madeline while Charlie and Anabelle are in the backyard. Sounds like a perfect Sunday doesn't it? Almost, but not quite. My nerves are okay right now—no anxiety at the moment and I pray I don't have any today. New month—new me?

I want to be myself again and even better ... I'm thankful I'm able to get the help I need—meds and therapy. But most of all thankful to God for giving me the support I need so I can get help... I think of all the people who have helped me through these past few weeks and I'm amazed and feel very very blessed. I'm actually feeling excited—that I have a purpose—a goal. I'm going to write about this for other moms to know they are not alone...

I was feeling well enough for a short visit to the mall. We all piled into the van for our adventure into the outside world. At the mall I had Madeline strapped to me in a carrier and Charlie watched over Anabelle. While I was standing in front of a toy store, browsing the window display, I recognized a young woman standing nearby. She was a former client's sister with whom I had worked intimately with for over a year. I had visited her home, spoken with her whole immediate family, and shared meals with her; she was almost like family to me. I had spoken to her countless times but for the life of me I couldn't remember her name. She recognized me too.

"How are you?! I haven't seen you in so long. Last time I heard you were on maternity leave," she exclaimed with genuine surprise.

"Oh my goodness, that was a long time ago. I'm not working full time anymore; I have two little ones now so you know..." as I pointed to Madeline strapped to my chest and cocked my head to the side with my best look of exhaustion on my face, which wasn't hard. I changed the subject. "How is your brother?" I inquired, but was feeling agitated that I couldn't remember her name.

"He's doing well, thank you. I'll have to tell him I ran into you. You look good and your baby's adorable. Congratulations." Her cell phone started to ring which I was thankful for because I felt awkward and very disturbed by my memory loss.

After this encounter at the mall, I wracked my brain trying to think of her name. If I couldn't remember her name, then I felt that I must be losing my mind. I started trying to prove to myself that I was still all right, and to exercise my brain by forcibly recalling memories from my college years, our wedding day, Anabelle's milestones, Madeline's birth, etc. I was terrified about how much I couldn't remember. I feared the illness and drugs would erase certain memories forever.

Wednesday, June 4, 2014

In the middle of the night, I sat across from Charlie while he bottle fed Madeline and I pumped. After 15 minutes I turned off the pump and stared blankly at the measly two ounces of milk I had produced. My supply was dwindling away to nothing.

"Are you okay, babycakes?" Charlie asked.

"Yeah, I guess. Why am I doing this? I can't do this anymore. I'm not getting better fast enough am I? The doctor said I'd have to be on Prozac for 6 months." I sighed and got up to dump what I had produced. I clung onto the hope that I would be cured of my illness sooner than the doctor's estimate so I could resume breastfeeding. I had prayed for a miraculous turnaround. I was taking all the medications as instructed, exercising, forcing myself to eat, meditating, praying, and going to therapy. I was doing everything they told me to do, but I wasn't much better. I still had intense anxiety, I still couldn't fall asleep without Restoril, and the panic attacks came and went every day.

"It's gonna take time. Be patient with yourself. I thought you wanted to try to nurse Madeline and you were doing so well. I know you'd want to nurse again when you're well." Charlie looked at me with his soft brown eyes as he cradled little Madeline in his strikingly large arms. At that moment I loved my husband more than I ever had before in our ten plus years together. I wanted to keep nursing not just for Madeline but for Charlie. I didn't want to let him down too.

Charlie was right but the hope that I would be able to nurse Madeline again was fading away like all my other hopes and dreams of motherhood the second time around. Where were the quiet nights rocking our baby in my arms, nourishing her with my body and love, whispering sweet lullabies into her tiny ears? What happened to the sunny strolls in the park, the happy tummy times on her play mat?

I couldn't even cry when I finally made the decision to stop pumping that night. I was so tired and emotionally numb I just gave it up.

Sunday, June 8, 2014

In a panic and feeling desperate to talk to someone who knew what I was going through, I decided to call my cousin-in-law Melody. This was probably the first time I'd ever called her, so on top of my panic I felt awkward about how to start the conversation. Fortunately, panic bypassed my feeling of self-consciousness, so I just started talking to her.

"Hi, Melody. I'm sorry to bug you on a Sunday but Mom told me I should call you. I'm having a tough time right now."

In her soft girlish voice, she asked how Madeline and Anabelle were doing. I told her the girls were doing fine but I was a mess. "What's the matter? Tell me what's going on?" I could hear the worry in her voice.

I told her about my postpartum journey. I described to her the difficulty sleeping, the feeling of suffocation, the pacing, and inability to sit still. It took just seconds into my description of my symptoms before she interrupted me and said, "Oh, honey! You're having panic attacks. Sweetheart, everything you're describing I know what that feels like. I had those same symptoms after I had Benjamin."

Finally, someone who knew what I was going through! And she was living, breathing, and thriving. I would have never known she had gone through what I was going through. She always appeared put together, and I never imagined her with any mood disorders or postpartum problems. Then again I knew little about mood disorders, and we never had a close enough relationship to talk openly about our personal sufferings and challenges.

Then we started to talk about the misery of panic attacks and sleepless nights. We compared notes on the medications prescribed by our respective doctors and discussed the side effects. Melody had one bit of advice about medication: "Continue to take your medication, it will take a while before you feel the effects. I know you don't want to take them, I didn't want to either, but you've started taking them. You have to follow your doctor's orders, and do not stop taking your medications cold turkey, even if you're feeling better. The side effects of quitting cold turkey could be so much worse." I promised her I wouldn't go cold turkey, but I wasn't convinced the medication would help because I wasn't feeling any better after a few weeks on all my medications: the Prozac, BuSpar, Restoril, melatonin. Instead, the side effects were worse: more anxiety, more panic attacks, more hot flashes, more explosive diarrhea, and still no restful sleep.

We had many more conversations during my journey of perinatal mood disorders. She insisted I call her if I needed someone to talk to no matter what time of the day it was. Melody gave me a kind of hope that up until then no one else had. She had suffered my pain and lived to share her story with me. Amidst all the questions, doctors, theories, invariable encouragements, and ambiguous diagnoses and prognoses, Melody was living proof that this condition, this perinatal mood disorder, was treatable. She was a survivor of the metaphysical chaos in my body. Melody was the real thing.

I remember her parting words during one of our conversations, "I promise you it will be better. I promise you will feel joy again. I promise you will be yourself again." She gave me exactly what I needed, not just a positive outlook or a confident affirmation. She gave me a promise, secured and grounded in the very existence of her own life and joy. This was the beginning of a unique and unshakeable bond between me and Melody, forged through an entwined thread of motherhood and the human condition of mood disorders.

I had a lot of time to talk these days. Talking and walking were my top two activities. Since my mom was living with me, we had the opportunity to talk like we never had before. I cherish these conversations with my mom.

I didn't grow up having many conversations with my parents or elders in general. I was to be seen and heard only when necessary. During my illness my parents were very protective of me and were careful not to tell anyone about my condition. When people asked why my mom was still staying with me they would say I needed help adjusting because I now had two little ones. It was a half-truth. I knew they loved me and worried about my health, but I knew they also felt some shame about my condition. I didn't care though. My mood disorder overwhelmed my reticence to push my mom into uncomfortable territory, and it made me bold enough to speak my mind.

One late afternoon while passing the time in the living room until dinner, I looked over at my mom seated cross-legged in our big comfy but ugly brown couch in front of the window facing the backyard. She looked so petite with her legs crossed and pulled up close to her body. The sun was slowly inching down the horizon as the summer sunlight streamed through the window and outlined the top of my mom's shoulders and head; it was a perfect sitting for a silhouette portrait. I decided to engage my mom in some lengthy conversation to take my mind off the rising anxiety in my gut.

In my mediocre Vietnamese I asked her, "Mom, did you ever go through anything like this when you had my sister or me?"

She thought for a moment and gazed up at the ceiling. "No, but remember when I was sick and had to have surgery? I couldn't sleep either. I would go days without sleeping. I'd lie in bed all night watching the sky until it lit up. But I'd pray and I kept thinking that eventually I'd have to fall asleep."

"Did you feel like you couldn't breathe? Did you have hot flashes? Diarrhea?"

She crossed her arms and sat back, trying to think about her symptoms. "It was hard to breathe and my heart was beating fast but I didn't have hot flashes. I did have some diarrhea but not too often because I wasn't eating much. I didn't have an appetite and couldn't keep food down. I was usually cold and nauseous. The doctor didn't tell me it was related to my hormones; he didn't give me any medication for sleep. He told me to go see a head doctor, he thought I was crazy. They didn't tell me the things your doctors are telling you. I wish someone had. But it's in the past, I had the surgery, and I'm better. I can fall asleep anytime, anywhere now."

"Oh, I remember. The GI doctor told you he couldn't figure out why you weren't able to keep any food down and told you to go to a psychologist?"

She shook her head and pursed her lips to show her disdain for her GI doctor. "Yeah, he told me it was all in my head. I wasn't crazy, he was the crazy one; he was so curt and inpatient when he told me all this. If you ask me he should retire because he obviously doesn't seem to like or care to talk to patients anymore. Eh, it doesn't matter anymore, he was wrong. I had my surgery, and I did get better despite what he said." She gave him her disapproving and sharp hmph sound. Wherever that GI doctor was, I would not be surprised if he felt a sudden phantom pain on the side of his head from my mom's telepathic slap.

"Did grandma or aunties have similar symptoms?" I inquired, mentally jotting down my family medical history, trying to find some genetic connection.

"No. I didn't ask them."

"Why not?" I asked but I knew the answer. These were things our family just didn't talk about. Anxiety? Panic attacks? Depression? These were considered not just weaknesses but mental illnesses. These weren't topics discussed openly because they were embarrassing, shameful. Mental illness was shrouded in a code of silence in the community my mom grew up in. People with mental disabilities were quietly contained and shielded from the public.

I decided to delve deeper into the issue and ask her if she had ever heard of postpartum problems such as mine. I brought up the Vietnamese/Chinese cultural rules and restrictions for a new mom the first month after birth. Maybe the elders knew something about postpartum but just didn't have a name for it.

She explained the reasons for all the restrictions. "After a mother gives birth, all her energy and strength is drained. She is like a crab that has just shed its skin. She is vulnerable to all sorts of illnesses and injuries. The pores on her body are open and exposed, her ligaments and bones are soft. Her organs are stretched and weak. That's why we carefully guard the new mother the first month. In Vietnam, after I gave birth to your sister I wasn't even allowed to leave my room the first month. I would sit up only to go the bathroom, eat, and feed the baby. And I wasn't allowed to speak much. People were very cautious to not upset a new mother. They don't talk about anything negative, sad, or upsetting around her."

This last comment sent my detective antennas into a flurry. Maybe they knew about postpartum depression? There must have been stories about it, if not a medical term.

"So, you're not supposed to talk about anything bad around the mother because she's in a sensitive state?"

Then she shared a story about a woman in Vietnam who died shortly after giving birth. She didn't have many details about the woman's background or medical history. It was just a story so old it became a cautionary tale. All she could remember was that during the first month after giving birth, the woman became so upset over her philandering husband that she died from anger.

"She died from anger? Did she kill herself?" I was amazed to hear this tale that I had never heard before.

"I don't know. Some say she was so upset she died from a burst blood vessel or something. It's just a story around the village; I don't even know if it's true or not."

I felt an exhilaration as if a cold case had been reopened right there in my living room. I felt as if I had the new scientific information to solve the case of the young mother's tragic death. I believed this was a true story that may have been altered over time, but it survived because it was based on real-life events. In my mind I imagined that poor woman had a postpartum mood disorder that led to her death. Likely suicide? Poison? Drowning? Where was her body found? What happened to her baby? Were police involved? Was there an autopsy? If it was suicide, her relatives would likely have kept that a secret from the public.

My mom didn't have a definitive answer. "I don't know. Suicide is such a heartbreaking tragedy; people don't want to talk about such things."

In the Vietnamese culture suicide is taboo. Suicide is a topic spoken about in whispers behind closed doors as if the spirits would personally haunt you for speaking the truth out loud. I proceeded to share with my mother all I knew about perinatal mood disorders and all the information my psychiatrist and therapist shared with me. We sat for I don't know how long talking about anxiety, panic attacks, and depression. All I am certain about is that the sun had set by the time Madeline woke from her afternoon slumber, and it was now dark.

At the end of our conversation she gently suggested I not tell everyone about my condition, especially my colleagues. She didn't have to say it, I knew she didn't want my mental illness to interfere with my professional image and ability to earn a living, not to mention the social stigma. She was coming from a place of love and protection, of self-preservation. In one of the rare moments in my life, I openly defied my mother's request.

"Mom, I know you want to protect me. But I'm not going to keep my condition a secret. What about all the other women like you who felt alone in their suffering? Wouldn't you have felt better if you knew grandma or auntie had similar symptoms? I feel so much hope after you told me what you went through with your anxiety and sleepless nights. I know people will judge, let them, they already do. I shouldn't keep quiet about it."

She was seated on the couch with her arms still hugging her chest, her legs crossed, and her right foot peddling up and down as if she were working a sewing machine. It was her knee jerk reaction to disapprove of my decision, my disobedience. But in her mother's heart, in her spirit of womanhood, in her overriding humanity, she knew it was the right thing to do. I took her silence as an unspoken blessing.

June was a hard month. There were some ups but also more downs. It seemed like the majority of my waking hours were filled with general anxiety and panic attacks. I felt consistently on edge, standing at the tip of the anxiety cliff, and any little disturbance could push me over into a panic. Most times I could feel the panic physically rising from my core and radiating outward. I had panic attacks every day, and they would occur out of the blue: during a shower; while I was feeding Madeline; while reading to Anabelle; when I was hungry; when it was a warm day; if the sun was in my eyes; listening to news, etc. These harmless daily activities became my triggers. Triggers were things or moments that my brain associated with anxiety and categorized as causes of my panic attacks. If I'd experienced panic once in association with a particular activity, then merely facing that activity again could loop me back to panic. Once, I had a panic attack while in the shower. Every time after that incident, I would get anxious even thinking of taking a shower. My therapist called this "anticipatory anxiety" which is the fear of confronting something or an activity that we've come to associate with anxiety. The fear of panic itself could lead to more panic.

The feeling of panic is terrible. It feels more than just terrible to me; it feels like I'm going to die. It sounds dramatic even to me as I type the words, but it truly describes how I feel when I'm in the throes of a panic attack. I pace as if pacing will keep me from dying, my heart beats fast, and I feel feverish no matter the temperature around me. The breathing is the worst part. I feel as if someone is standing on my lungs and I am suffocating. It usually starts with shallow breaths which usually lead to hyperventilation, complete with tingling fingers, face, and legs. This tingling is the result of excessive or over breathing that creates low levels of carbon dioxide in your blood. I still remember an ER nurse's sage advice, "Breathe, don't faint." After every panic attack, I felt exhausted but couldn't really rest. To add insult to injury, sometimes during or after my panic attacks, I was forced to stop pacing and confront the war waged against my gastrointestinal system. That meant disheartening and anxiety-ridden sessions seated in the bathroom which was torture in so many ways, especially when I just wanted to get up and pace.

I tried everything to prevent my anxiety from turning into panic. At times it was discouraging because my list of triggers just kept growing longer and longer as the months progressed. But with lots of prayer and therapy, I thought about and kept a list of reasons why life was worth living. When I reviewed this list I found there was always a reason to keep on fighting, to keep on marking those days off the calendar.

Though I had more anxiety and panic attacks than depression, I would have days when I woke up, opened the door, and depression would just walk in and become my uninvited guest for the day. More often than not, I would just climb back into bed instead of facing the day.

My psychiatrist said that depression and anxiety are like twins, they usually travel together. Though depression felt very different than anxiety to me. I'm not certain but I believe my depression may have been a side effect of my antidepressant or sleep aid because I didn't seem to experience it with such intensity before going on medication. Like anxiety, depression made me feel tired, robbing me of sleep and appetite. But the main difference was with depression I had no desire to function, I was numb to myself, my surroundings, my world. My biggest challenge with depression was to keep alive my will to live. With anxiety I wanted to live; I still wanted to be functional but was physically and mentally over exerted.

Depression relentlessly attacked my spirit, my soul, my heart. I felt numb even though in my mind I knew I should be feeling certain emotions. My brain still remembered what joy, love, and desire felt like; I just couldn't feel those emotions anymore. Knowing I used to feel and experience such pleasures made my depression far worse because it made me acutely aware of my loss.

One depressed day, I didn't get out of bed at all. I wanted the day to just be over so I could mark it off the calendar. I didn't have the energy or will to get out of bed. Thank God, my mom was staying with me that day, and she would walk back and forth past my door and peep in to check on me. She would sometimes be holding the baby, and I would close my eyes and pretend to be sleeping because I felt guilty not caring for Madeline when I was clearly awake. I just wished my Mom would let me be, but she was worried.

Finally, by mid-day she put her foot down gently and said, "You need to get out of bed. You need to at least get up to eat. You can't just lie in bed all day. Don't let this thing get the better of you. You need to fight it. You need to be strong. Don't let it win." I felt ashamed, but I mustered all the courage I had and got up to brush my teeth, go to the bathroom, and eat a little. I even held my Madeline for a little bit and then went back to bed.

Oh that dreaded sleeping pill. I hated taking it. It was such a frightful ritual every night. I would read and look at the clock, waiting for the right time to take the pill, hoping that I would get drowsy on my own, hoping I would just fall asleep reading like I used to. But I never did during that rough patch, though I continued reading in bed because it allowed my mind to temporarily wander away from my miserable situation. I have fond memories of the books and magazines that brought me short respites from anxiety. I loved reading Sunset, Westways, and Better Homes and Gardens. Reading about all the different foods and vacation destinations temporarily transported me to a better world, a happier world filled with peace, love, and purpose. Then there were the children's books: Harriet the Spy and Charlie and the Chocolate Factory. Harriet was my best friend for a while; I was right there with her in that dumbwaiter listening to old Mrs. Plumber gossiping on the telephone. Then there was Charlie Bucket and his golden ticket. I went with Charlie into the factory until right before they entered the Chocolate Room; Mr. Wonka made me anxious so I couldn't read any more. The book is still dog-eared at the very page I stopped reading.

These children's books brought me back to happy memories of my childhood when I would steal away to my corner of the house. This living room corner was safely cushioned in between the edge of the couch, the altar table, and the sliding glass door which provided the best natural light in the entire house. I spent hundreds of hours seated on the floor in that corner, reading everything I could get my hands on, and writing in my notebook. In that corner I had no restrictions; I could do and learn anything I wanted to through my books. Now, in my moments of madness, reading was a distraction even though it did nothing for my sleep problems.

Sleep was elusive. The more I sought it and the more I thought about it, the less I got of it. My dear Charlie would go through the whole production with me every night. He knew what I was doing, what I was wanting, and he knew it would end the same way; with my reluctantly taking the pill. I would usually wait until 11 or 12 at night before relenting. On some nights I just took the pill early because I wanted the day to be over. Sometimes he had to give me the pill because I just didn't want to even open the bottle. But most every night I would pray, thanking the Lord for all the blessings in my life. I prayed for everyone and everything in my life. I prayed fervently because I knew the Restoril would kick in any moment and then everything would just shut down and go black.

But even the Restoril didn't always give me a full night's sleep. More often than not, I would wake up three hours after taking it. I tried not to look at the clock, but I was obsessed with the amount of sleep I was getting, so I would eventually look at the clock. When I realized that I had only been out for a few hours I would become depressed. I would try to read and put myself back to sleep, but usually I would get anxious, get out of bed, and start pacing. Many nights I paced the hallways like a ghost haunting my own home. I wasn't haunting anyone but myself because everyone else was fast asleep. It was a little taste of purgatory; I was like a tortured spirit stuck between life and death.

I tried everything and anything natural that I thought would get me to sleep. I counted sheep. I listened to guided visualizations. I did yoga. I drank all sorts of calming bedtime teas. Whether the lack of sleep was causing the anxiety attacks or vice versa, I didn't know, but I knew I needed to sleep, and the more I wanted it the more frantic I became about my lack of it.

Every night for three months I needed to take that blasted pill to sleep. The pill made everything suddenly go black and I would be out. When I woke up in the morning, I would slowly emerge as if from a thick, foggy haze. I usually felt groggy and not well rested. As soon as I was awake I looked for my cell phone to find out the time. If I had made it to the morning, I would pull myself out of bed and will myself to go to the bathroom and face the day.

Some days I would look in the mirror and just feel this disconnect from the person I saw. I didn't know the person in the mirror; I didn't like her, I didn't love her, I just didn't feel connected to her at all. It would have been better if I just hated her but I didn't, I felt nothing. Maybe it was the drugs, the hormones, the loss of hope, but she was a stranger, and I wanted her to go away. It was as if I had become a spirit who had taken over a stranger's body, and it just wasn't working out. Even worse, in the mirror I saw a set of crazy eyes looking out. The wide bloodshot blank eyes riveted to nothing in particular. Eyes. Windows to the soul they say? Well, then my old battered soul had flown the coop.

I cried a lot. I've always been prone to tears, but this was different. I cried a lot more about a lot more things. I would cry about my condition, about my family, about my poor children who had a debilitated mother, about Maya Angelou's death, about the poor people who had died in the Malaysia Airlines plane crash, and on and on. Mixed with the tears were worries about everyone I loved; about their health, their happiness, their safety. I would cry over reality, and I would cry over things and events that hadn't happened but that I feared might.

During my lowest moments, I would be sobbing for God to make the pain go away. I asked Him to just take my life quickly and painlessly. I felt like I was no good to anyone and a burden to everyone. At that time, I told God it would be a great act of mercy if he helped me die and spare my children the pain and stigma of a mentally ill mother. What if my condition worsened? In my instability I could accidentally hurt them. I was already hurting them by not being able to properly care for them. In the darkness, I imagined how I would want to die. Some nights I told God if I wasn't going to get better then He should not let me wake up from my sleep.

But I didn't WANT to die. I wanted to live but not like that. For the most part, I still had the will to live, I just couldn't control the conditions of my health. What I could still control were some of my decisions of how to deal with what I couldn't control.

As dreadful as the topic of "thoughts of death" is, I believe there can be a saving grace in the act of thinking about death. When I thought of death, I would naturally think of life too. Maybe not at first, but eventually I thought of my role in this world as a mother, a wife, a daughter, a sister, a friend. I started to think of all the things I would miss doing like kissing and cuddling my girls, lying in bed holding hands at night with Charlie, sharing our intimate thoughts with each other and no one else, caring for my parents, chatting with my sisters, lunching with friends. And I cried for the sense of loss and anger my girls would feel without a living mother, how I would miss them. My life when stripped down to the most essential desires and joys didn't revolve around money, professional accolades, or material consumption. It could have been the drugs, the sleep deprivation, the influence of too many romantic movies and books, or God himself, but I saw the meaning of my life in the people I'd met, people I hadn't met yet, and the passion sparked when our lives collided.

I needed help. I needed professional help. After my emergency therapy appointment on May 19th, I had to find a therapist who could care for me on a more long term basis. So, I relied on my healthcare provider to set up an appointment. My first therapist was very new to her profession and did not have any experience working with postpartum mothers. She was very professional and kind, but I couldn't connect with her, in part, because of the way she structured our relationship. She purposely kept the sessions just about me and did not share anything about herself except for her professional experience and education. When I asked if she had children she politely smiled and said, "I don't like to share any personal information about myself." I appreciated all the possible reasons why she preferred to keep her personal life private, but it did inhibit me from creating the connection with her that I needed. I needed someone who knew my suffering, who had studied it, or had gone through it. She did provide some very useful techniques for coping with my anxiety like creating a happy place in my mind where I could retreat to whenever I was experiencing intense anxiety. She instructed me to focus on the details of my happy place: the sounds, the smells, the feel of the physical surroundings. This happy place was my private sanctuary, a safe place just for me. I didn't have to share this place with anyone which made it all the more sacred. I was grateful for her willingness to help me and I did meet with her a few times, but I just didn't feel that essential bond and was bothered by her inexperience with my illness. She referred me to another clinician in her department she believed had more experience with new mothers.

In my first meeting with this second therapist, I described my anxiety, panic attacks, and how the psychiatrist had diagnosed me with postpartum anxiety and panic disorder. The therapist looked at me with a raised eyebrow and said, "I think it's more than just postpartum, I think you have a panic disorder." I remember this statement pushing me into a panic attack. I had a disorder that wasn't just related to postpartum? I would go on to have panic forever?

I had been a very shy girl and woman which I believed to be the source of a lot of my anxiety. But a panic disorder? Before my pregnancy I couldn't remember having moments of such intense anxiety that I couldn't breathe or function normally or at the very least sit and be still. This therapist didn't seem to have had much experience with postpartum mothers either. I looked at the books on her bookshelf, and they were mostly about anxiety, nothing about perinatal or postpartum. I was devastated. Maybe the therapist was right, but the way she told me wasn't helpful, and I didn't feel any connection with her.

I was so desperate for help I let her persuade me to attend her anxiety seminar in the evening. She dismissively said, "Can't someone else at home pass out food to the kids so you can take this class? I really think it will help you." If I were in my right mind I might have had a sarcastic and awkward retort for her like "well, after my mom passes out the food who will help her shovel the food down their gullets?" But I was having intense anxiety at the moment, so I just sat there with my hands in my lap staring at her. So, I mindlessly took her advice and went back home to quickly cook dinner and asked my mom if she could "pass out food" for Anabelle and Madeline while I went to this anxiety management class.

This class was being held in a windowless box of a room with tables lined up in rows conference room style. I arrived late so I started off already feeling anxious. I pulled up a seat in the back and sat against the wall. As soon as the doors were closed I started to hyperventilate. I was really nervous. I looked around the room full of people with anxiety problems and wondered if they were as anxious as me.

The therapist informed us that this was the second class in the series so there was going to be a 20 minute guided meditation at the beginning of the class. After a short introduction the therapist dimmed the lights all the way down and played a CD from her laptop. Suddenly, a female voice told me to relax my arms and legs. It told me to take deep breaths and then slowly tense up certain portions of my body from my head, neck, shoulders, and all the way down to my toes.

This was torture. I started sweating and couldn't breathe. I was ready to get up and pace. I was having a panic attack. It didn't help that the girl next to me was having her own panic attack. She was seated cross-legged on the floor and during the meditation she was loudly fidgeting. I heard her silver bracelets jingling and jangling and when I peeked a look, I saw her violently bouncing her knees up and down and rubbing her hands together. She didn't do this for too long because unlike me she had the wherewithal to get up and leave the room while I sat through the whole excruciating session. Since I was extremely troubled by my prior therapy session with this therapist, her anxiety management class made it easy to never go back to see her again.

The situation wasn't hopeless. After Ms. Doom and Gloom and her anxiety class, I met Grace. Grace was a godsend. I felt comfortable with her; she was extremely experienced with mothers dealing with perinatal mood disorders because almost all her patients were like me. She worked with the Postpartum Wellness Program that the officers had referred me to on May 22nd.

The first time I met Grace was at my home in the early part of June. The fact that she was willing and able to meet me at my home spoke volumes about her and the Program. I imagined some mothers didn't have any help at home or had no car or were just unfit to drive. I remember looking out the front screen door, waiting for her; of course, I was anxious. When I saw a car slowly drive up and park in front of my house the butterflies went crazy in my stomach.

Grace was kind, friendly, and confident from the very beginning. She entered my home, quickly and casually scanned the room, then warmly greeted me and my mom with hearty handshakes. Charlie was in the backyard with Anabelle and Madeline was asleep in her rocker. Grace and I went into the front room to talk. She introduced herself, provided me with pamphlets about the Program, and about postpartum. After we went through all the administrative checklists we talked.

"So, tell me about yourself. How are you feeling this morning?" she asked.

I went into a rambling soliloquy about my postpartum plight and Grace just sat and patiently listened to me. She occasionally interjected with questions to fill in the gaps in my story which showed she was attentive. She looked me in the eyes, she nodded occasionally, she smiled at the appropriate times in my story, she never furrowed her eyebrows or looked shocked at anything I said and never during my story did she look at her phone. I felt like she was there for me. I finally felt like someone could really help me get better.

"You're going to be fine. I have so many new moms with anxiety and panic attacks like you. You're seeing a psychiatrist, taking the right medications, you're open to therapy and most importantly, you want to get better. It's going to be a long road to recovery, but you're going to be okay." When she said "long road" it reminded me of the kind older woman at the beach. She had given me hope at the bottom of the long winding staircase; I thought maybe Grace would help me all the way to the top. Grace was so confident when she said these words to me I cried because I believed her.

Grace taught me techniques to deal with my anxiety: breathing exercises, yoga, talking, walking, praying. She encouraged me to write down my experience and make note of all the techniques and what worked and what didn't. The moment she walked into my life she filled a void in my healing I was so anxious to fill. Grace was professional, knowledgeable, but most of all she was compassionate. Every word from her mouth was filled with confidence, empathy, and kindness. The month I first met her I had this quotation written on my calendar:

Life isn't just about waiting for the storm to pass. It's about learning to dance in the rain.

Grace was exactly what I needed for my recovery, she was my rain dance teacher.

Wednesday, June 25, 2014

I was awake and out of my pajamas, so it was a good start to the day. I was seated at the dining table with my mom having breakfast.

"Is the conversation doctor coming today?" she asked.

"Yes, Grace is coming today. She'll be here around 8:30 or so. It won't be too long, just like last time."

"It's okay. Take your time, I'm here to watch the girls so no reason to rush. Has she been helping you? What do you talk about?" My mom had never been in therapy, and I figured her only concept of therapy was probably from the Korean or Chinese soap operas on television.

"She's very compassionate and knowledgeable. I feel like she knows what I'm going through, and she teaches me ways to calm down to get past the anxiety. She says a lot of women go through this, more than I ever knew. I wish you could talk to her, she's really honest and caring."

"Yes. I wish I'd had a Dr. Conversation when I wasn't well. No one knew what I was going through, they just gave me medication. They should have more of these doctors for women. Men don't understand, well, most don't understand." It made me smile that my traditional, conservative Asian mom was actually open to therapy, to telling a perfect stranger all the intimate details of her life. I liked that she called Grace, Dr. Conversation; it was such a simple and endearing title.

8:30 rolled around and Grace was at the door. We exchanged our now familiar greetings then disappeared into the front room/therapy office. We sat on office chairs across from each other, positioned at a ninety degree angle.

"So, you look good this morning. Tell me how your week has been? Are you still having panic attacks?"

"Yes, I still get them every day. They come and go. Some days I'm okay with the panic attacks like I've accepted them as part of my life for now. Then there are days I'm completely depressed about having them. Every day seems like forever."

"What do you do when you feel the panic coming on?"

"I walk. I pray. I talk to my mom or call someone."

"And does that seem to help?"

"Yes, talking and walking mostly. I have a list of people I call but I'm afraid of wearing them out because every day that I'm not better I want to talk about my illness more and more."

"Why do you talk about your illness? What are you wanting them to tell you?"

"I want them to tell me it's going to be okay. Hearing them say it gives me hope, their affirmation gives me hope because I can't trust my own judgment anymore. I tell myself I'll be better but I'm not sure sometimes. I want someone who is not sick to tell me."

"Okay, when you get a moment, write down what you're feeling when you're anxious or panicky. Write down what you did to make you feel that way and what you did to ease the anxiety. I really think keeping a journal of this journey will help in your recovery."

Then we proceeded to talk about my sleep and my bonding with Madeline and my interactions with Anabelle. She'd share stories about her personal struggles with anxiety and depression. She shared just enough to make me feel reassured with her expertise and experience. At the end of this session, she gave me a handout from a chapter out of a postpartum anxiety workbook. This chapter was titled "Modify Anxious Thoughts." My homework was to read through the chapter, fill out the exercises so we could discuss them at our next therapy session.

I was thankful for the handouts and homework because it gave me something to work on every week. Somehow I thought Grace was sizing me up as a genetic product of type A with a desire to be type B and a healthy dollop of type C. Ever the keen and intuitive therapist, she recognized my need to be active in my recovery so she always ended our therapy sessions with some homework for me. In truth, we didn't formally go through the handouts. Every week we just talked about whatever came to my mind and she would weave the various handouts into our conversation. We just talked like old friends.

I was glad to be over with June and my sporadic journal entries reflected it. Some days I wrote just a few sentences:

"Had a bad night—woke up at 1ish—tossed and turned until 5:00 a.m.—took 2 BuSpars and slept in until 7ish—got up around 8."

And other days I would fill the pages with my positive feelings, hopes, dreams...

...Everything good takes patience. I'm having to relearn everything from sleeping, to waking up, to eating, driving, washing the dishes, showering, caring for my babies, everything because when I had my bad weeks—everything would set me off. As Grace told me, I have to work to turn this bad negative cycle into a benign cycle ...In this moment I am me. I am loving this moment and ever so thankful for it...

A good day for me had windows of normalcy, open windows when I was panic- and anxiety-free, even if for a short period. I cherished those moments because it reminded me of how life once was, how it could, and would be, again. It proved to me that the craziness caused by my hormones, chemical imbalance, or whatever it was, had not yet altered my inner being. Somehow, some way, the real me was still preserved. And when the panic and anxiety took a time out, the real me would come out to give me hope, to remind me to keep fighting and reassure me that the real me was still alive. How much longer could the stronghold protecting myself endure before crumbling under the pressure of the illness? Only God knows and I'm glad I have not found out.

In those good moments when my window was wide open, I tried to do as many things on my to-do list as possible. Things like write thank you letters, call a friend, cook meals for my family, journal, pray or just sit and soak in the moment.

# Part 6:  
FAITH, HOPE, LOVE

For now we see in a mirror, dimly, but then face to face. Now I know in part, but then I shall know just as I also am known. And now abide faith, hope, love, these three; but the greatest of these is love.

1 Corinthians 12:12-13

There are few decorations in my home. At the time of my illness the only artwork hanging in my living room was a gift from Charlie's parents. It's a framed painting of three Chinese characters that translate roughly to "faith, hope, love."

Grace, my therapist, suggested a relaxation technique that involved repeating a personal mantra. Charlie suggested "Serenity Now!" from Seinfeld which I politely declined with a half-hearted smile. While searching for a mantra, one day I looked at the only painting on our living room walls. And as I repeated those three simple words - Faith, Hope, Love - I cried.

It was a good cry, a catharsis. That beautiful painting reflected the three greatest blessings in my life. In my suffering I found Hope which gave me Faith to continue living for the sake of Love. Every day I looked lovingly at my girls. Even if I didn't feel the love, I knew I did in fact love them and would be able to feel again soon. I loved Charlie, my parents, my sisters and brothers, my friends, my family, the doctors that helped me, the policemen and woman who came to my home on May 22nd, the kind woman at the beach who gave me words of hope, the cashier who gave me a warm smile, Grace, my therapist, etc. Earlier I mentioned my trigger list, all the activities that I associated with my panics. Now my list of reasons "why life was worth living?" grew and grew every day and soon outnumbered that list.

July was better than June. I still had panic attacks and anxiety but I was beginning to let more of the real me out. I wasn't afraid of the panic attacks anymore; I didn't welcome them, but I chose to face them. On good days I even thought of weaning off my medication because I was concerned about becoming addicted to my sleeping pills. I learned to appreciate the drug for the sleep it gave me, but I wanted to be able to sleep again on my own.

I had made the decision to take medication as part of my treatment, so I needed to follow through with my decision. This meant taking the medication as directed by my psychiatrist despite my desire to wean off it as soon as I had a few good days. And when I was ready, it was important to consult my psychiatrist about weaning off my meds. NO COLD TURKEY.

Tuesday, July 1, 2014

Hot summer nights. Hot summer days. Hot summer mornings. I was always feeling hot. This afternoon I was lying prostrate on the floor directly under the ceiling fan in the front room. I was burning up, and the breeze from the fan was small relief from the still warm air. My mom walked in with Madeline in her arms and sat in the rocking chair in the corner.

Tired of thinking about my own misery, I prompted my mom into talking about her own. "Mom, were you ever depressed when we were young?" I used the Vietnamese word for sad which I thought was the same as depressed.

She looked at Madeline sleeping in her arms. "At times I had my moments. It was difficult living with your dad's mom because she was very controlling. I was the daughter-in-law and I didn't have much say in how the household was run. I had to do the cooking, cleaning, sewing, and still watch over you girls. She loved us but she was very demanding."

I have fond memories of my father's mom. She was a stout woman with a ready smile, quick wit, and jovial spirit. She loved me and my sister to the moon and back. She would tuck us in at night and despite complaining about it, she'd re-tuck us in the middle of night after we kicked and shoved our blankets aside. Whenever we were in trouble and in for a well-deserved spanking, we would run to my grandma who would use her large sturdy body to shield us from our parent's hot temper and whooping stick. She would shout at our assailant "What do you think you're doing? Are you crazy? Stop that nonsense and put that stick away." I remember her living with us until she died peacefully in her sleep in her own bed at home. I adored my grandma, so it was hard to believe she could be the cause of so much domestic disagreement for my mother.

"It's not that she wanted to cause arguments in the home, but it was just her way of doing things that made me upset. It was the way she went about things, always suspicious of me and my intentions. She wanted us to be financially secure, and she was always a very strong willed person. In Vietnam she was a savvy business woman; she knew what was in demand. If people needed lumber for building homes, she'd go into the lumber business. If they needed cement, she'd figure out that business. It was largely because of her we were able to escape Vietnam. She didn't change all that much when we came to the States. She was the head of the household, the matriarch. Your dad's salary, everything I made from sewing, it all went to your grandma and she managed it."

"So you guys argued about money a lot?"

"No, it wasn't just the money. It was her control over our way of life. I was under a lot of stress when you guys were young. I was alone here with your dad and his family and I worried about my three younger brothers who came on the same boat but couldn't live with us. And I worried about my parents in Vietnam, I'd try to send money home as often as I could but it was hard. I worked at home sewing for various clothing manufacturers but it wasn't much. Never enough."

At that moment, I really looked at my mom for the first time. I studied her face and my gaze was drawn to the dark purplish circles under her eyes which were more prominent than I remembered. Her hands were wrinkled and decorated with bulging veins, all physical signatures from many years of hard work. Then I mentally traced the lines weaving back and forth across her forehead. But it wasn't just her physical features that caught my attention; I knew my mom was old but for the first time she felt old to me. She was radiating a heavy aura that only time and wisdom can create. Mom had a far off look in her eyes as people do when traveling back in time to memories long suppressed. Her eyes reflected the wear of age and experience.

This solemn look on her face reminded me of one clear memory from when I was no more than five years old. My sister and I were playing with our toy little ponies in the backyard and went inside looking for Mom for some reason. It was the middle of the day but we didn't find her in her usual locations, in the kitchen cooking, or at the sewing machine. Instead, we found her lying down in the bedroom and she wasn't asleep, just lying in bed looking right through the ceiling to some far off memory or dream. She seemed more tired than sad, at least that's what I thought at the time. But what did I know then? I was only five years old and she wasn't crying so I figured she was just tired.

Then I remembered how my mom was sick often during my elementary school days. It seemed like she went to the doctor or herbalist every other week. I didn't like the western doctor's office visits because the waiting rooms were boring and sterile. To the contrary, I rather enjoyed the visit to the herbalist. My sister and I would accompany my parents to the herbalist who, to our great luck, happened to work in the back of a liquor store. We'd buy some snacks, meander around the store, and entertain ourselves outside in the parking lot. But no matter how many packages of herbs my mom stewed and consumed, or how many different colored pills she swallowed, she didn't get better. She would get through a day so she could just lie down and rest, staring up at the ceiling to some world far, far away.

Wednesday, July 9, 2014

Excerpt from my journal:

Bad night. Anabelle had a fever — so no sleep for anyone except Madeline. You're rolling onto your right side. You're just about to turn.

Anabelle — my baby — you're still running a fever...

My mom was no longer staying with us as often because I was having better days and able to care for the children more on my own. But when Anabelle got sick I was a complete mess. The previous night I clearly remember hugging her before bed and feeling her burning forehead against my cheek. Her temper spiked up to 103, and I was ready to take her to the hospital. But Charlie calmly reminded me this was not her first fever. We gave her Tylenol and kept her cool throughout the night. Charlie offered to take over the night shift with Anabelle and told me to sleep in the front room, but I just couldn't.

I threw myself into a panic cycle over Anabelle's illness. I took all the anxiety meds that I had in my arsenal: melatonin, Restoril, BuSpar and still no sleep. Excerpt from my medication notebook:

6:02 am Prozac (20mg)

9:06 AM BuSpar (1)

9:48 AM BuSpar (1)

4:00 PM BuSpar (1)

4:44 PM BuSpar (1)

9:00 PM Melatonin

11:00 PM Restoril (2)

That day I took the maximum dosage of almost all my prescribed medications. I called my sister early that morning to ask for her help with Madeline because we were trying to keep the girls separated so Madeline didn't catch what Anabelle had. And me? I was a puddle of anxiety. I was useless and more of a distraction. I wasn't confident I could care for Madeline alone. Despite having days alone with the girls, I couldn't deal with Anabelle's sickness. It threw me for a loop. I started to catastrophize the whole situation. All day I had hot flashes and panic attacks again.

I dove headfirst into a cycle of panic and anxiety, and I didn't know what to do. I'd taken all my prescribed medications with no relief. In my mind I imagined the storm brewing all over again. Back to square one. I remember walking out of the house around 10:00 that morning and calling Grace because I felt completely out of control.

"Where are you right now?" Grace asked calmly.

"I'm walking outside. I'm talking to you on my cell phone."

"Are you by yourself right now?"

"Yes. Charlie and my sister are with the girls. I needed to leave the house. I couldn't stay, Grace, I need to walk. Anabelle is sick, she has a bad fever, and I didn't sleep again last night. I think it's starting all over again."

"Okay. Have you taken your medication this morning?"

"Yes."

"How about your BuSpar? Didn't your doctor tell you to take that as needed?"

"Yes, I already took two this morning."

"That's good. Well, it sounds like you didn't sleep well last night which is making everything seem much worse. You're getting better, this is just a little relapse because you didn't sleep well last night. I want you to walk back to your house. I want you to walk close to home. Do your yoga, your breathing techniques, and do whatever it takes to get some sleep."

"But if I sleep during the day I won't sleep again at night. I can't take another night without sleep." At this point I was obsessed with keeping busy and awake during the day so I could be worn out and assured some sleep at night time.

"Right now you need to sleep if you can. Don't worry about the night time; you can take your sleep aid at night. If you can sleep now then sleep." Grace's voice was calm, gentle but stern. Her instructions were simple and clear. Go home and sleep if possible.

As instructed by Grace, I walked back home and hunkered down on the couch next to Anabelle and tried to rest. My sister was in the kitchen making soup and Charlie was napping with Madeline. Any outsider looking in on us might think everything was under control and it was, except for the roiling panic in my body and mind.

Within three days of Anabelle's sickness, she was eating and playing again. It was just a virus. Why had I freaked out? My meltdown reminded me of what Grace had told me during one of our very first sessions, "When you're well again, and you will be well again, you may still have moments of anxiety and maybe even the occasional panic attack. Maybe not this year, or next or years from now. But life happens. They will not be as frequent or as bad. You'll be more prepared and in tune with your body to better manage your anxiety."

As well as I felt, I was still recovering and learning to cope with the daily business of life which included illnesses. I reminded myself that even when I was fully recovered, I needed to be patient with myself. To have a little faith.

Monday, July 21, 2014

After my relapse, it took a few days to get back on the road to recovery. By late July, my sleep and anxiety had seemed to stabilize so my psychiatrist Dr. Smith advised me I could start tapering off my Restoril. I had been taking the sleeping pills for about two and a half months so I needed to slowly reduce my dosage because otherwise the side effects could be harsh. She told me to cut my dosage in half, so from two pills to one, for about one week. Then if I felt okay and things weren't getting worse I could cut my dosage in half again, which meant cutting my pill in half and taking that half pill for a week or so. Then if all was well I could just stop taking the sleeping pill altogether.

I was ready and excited to get rid of the sleeping pills, but it was hard. Weaning was tough. I had some bad nights with little sleep and my anxiety intensified again, but I used all my breathing and calming techniques to get me through the rough nights and days. And when all else failed, I always had prayer.

Thursday, July 24, 2014

Dear Lord. Not again?! I was having a terrible morning filled with anxiety, hot flashes, pacing, and hyperventilation. It was my fourth day weaning off two Restorils to only one pill, and I was having a heck of a time with the side effects. My mom wanted to go shopping, and I needed to get out of the house, so we went to the nearest shopping center and walked around. My mom could tell I was having a hard time because I had a blank look on my face and was silent. She tried to distract me with clothes and good deals, but all I could muster up was a mannequin smile and "that looks nice" about every item she showed me.

The night time was worse than the day. I fell asleep around 11:00 and an hour later I sat up in bed, wide awake, anxious, and sweaty. Charlie was fast asleep next to me and my mom and kids were likewise slumbering. Feeling the anxiety growing in my gut, I got up and walked out to the living room. I turned on the tablet and watched "Honey I Shrunk the Kids" until the scorpion started chasing the kids, then I switched to the PBS nature documentary "The Private Life of Deer." My mom came out for a glass of water around 4:00 in the morning and saw me on the couch. She knew I was having a hard time weaning off my sleep aid.

She came over, cupped my head in her hands, and kissed my forehead. "It's okay honey. It'll be hard a few nights because your body will make you want to take the sleeping pill. It's like an addiction. Your body will tell you to take it, but don't give into it, don't let it break you. You may not sleep tonight or tomorrow, but you'll eventually have to sleep. Trust me." I did trust her. Then she drank a glass of water and went back to bed.

I fell asleep on the couch at some point after my mom's sobering words of encouragement. Then 6:00 rolled around, and I was up with everyone else.

Monday, July 28, 2014

It was a warm afternoon, and I was in the parlor holding Madeline in my arms, walking her around the room in hopes she would drift off to sleep. I felt at peace. In that quiet moment, I had a chat with God. I gave thanks for my windows of normalcy that allowed me to feel the love I knew I had for my children and family. And for the first time in my prayers I was honest. I bore my soul to God. I didn't say what I thought He wanted me to say, I didn't choose my words carefully. I broke the dam holding my real thoughts and feelings and let Him have it. I questioned Him about why He didn't just take away my pain. He could work miracles like in the Bible or were they just stories like the ones I told Anabelle at night? I knew He could heal me then and there. Why didn't He? I was angry, I was confused, I was weary from days and weeks of suffering.

At the end of this heated conversation, I still asked God to make me better but I wasn't going to push it. It was like I just had a fight with my sister and we ended it with, "I'm still a little upset with you, but I love you anyway." In the end, I accepted my condition. I accepted my situation. I had no idea why I had to experience this mental illness and will never know so I didn't obsess about it anymore. Essentially, I surrendered my pain to my faith in God. In the end of our conversation I said I could and would endure with His help.

I believe He answered my prayer. I didn't see any images, or hear any voices, but I felt His answer in my heart and in the good days to follow. From that day forward, I didn't have any more panic attacks. I had some anxiety but no more panic attacks. I started to have good days after good days after good days.

Maybe the drugs had finally kicked in? Maybe the hormones in my body figured out a balance? I choose to give meaning to this moment, this moment of prayer with God. Is it the right meaning? I don't know for sure but I stopped worrying about that because in my heart I want to believe in this little miracle. I need to believe. This moment taught me to pause, to be mindful, and most importantly, to trust someone other than myself. I'm learning to trust in people, in God. Through my weaknesses He taught me my great strength which is in the network of people around me: my family, my friends, my doctors, the therapist on the suicide hotline, the nice elderly lady at the beach, Grace, the police officers at my home on May 22nd, even Ms. Doom and Gloom. Ego and pride took up too much of my limited energy, so I put them aside and let my mom help with the girls. I began to ask for a break when I wasn't feeling well or just tired. I was willing to admit that working and taking care of the children full time was too much for me. I learned it's okay to feel alone, but I know I am never alone.

Wednesday, July 30, 2014

Excerpt from my journal:

...Had a good day. No panic attack, no anxiety. We went to Target in the morning. Afternoon jog for me and naps for girls and Grandma. Thank you God for a good day. Thank you for giving me joy and allowing me to feel and experience joy and happiness again.

Anabelle, in the morning you said to me, "Mommy back?" and it caught me by surprise. I felt good and happy—even more than I was before my panic attacks. And you noticed? God speaks through children, and so many other ways. I just have to take a moment and listen.

She noticed? My little girl noticed when her active Mommy stopped taking her to the park, stopped reading as often to her at night. She noticed my irritability; how I snapped at her more than I played with her. Yes, she did. And just a day after my prayer was answered, she noticed I was in better spirits. Mommy was back and determined to stay.

That same day, after Anabelle said "Mommy back?" I went outside and sat by myself on the little step in my backyard to catch a break from the heat trapped inside the house. The evening air was warm and still. I was thinking "a breeze would sure be nice right now." I continued to sit and quietly pray. Suddenly, a cool breeze came my way. Feeling rejuvenated, I wrote in my journal:

A cool breeze pranced across my damp skin and settled on me for a brief moment of rest and peace.

I remember writing this down and thinking with joy that I was physically and mentally calm enough that a breeze chose me to rest upon. I was being sappy and sentimental again—I was being more of my old self again.

I am certain I will have great anxiety and panic attacks at some point in my life again though I would love to be proven wrong. But life happens. I don't believe God took away all the pain and suffering in my life. I do believe He helped me survive and find meaning in my suffering.

...everything can be taken from a man but one thing: the last of the human freedoms—to choose one's attitude in any given set of circumstances, to choose one's own way.

Viktor E. Frankl

Saturday, August 2, 2014

After about a week of gradually reducing my dosage of Restoril from two pills to one, then to half a pill, and dealing with a relapse of intense anxiety, panic attacks, GI issues, and little to no sleep, the side effects of weaning were finally fading away. This was my first night without taking a sleeping pill. I was nervous about having another relapse, but that night I didn't sleep any better or any worse than I did while taking Restoril which was more than I could have hoped for. "It will take some time for your sleep to smooth out," my psychiatrist had advised me. I wasn't going to be sleeping through the night any time soon. Just like Madeline, I was learning to self soothe and put myself back to sleep when I woke up in the middle of the night.

Friday, October 10, 2014

Excerpt from my journal:

I had a moment with you Madeline. Today I had a moment with you sleeping peacefully on my chest. It was like you were just born into my arms. I felt a joy, a bond, a love and thanksgiving that I haven't felt for you before. I knew I loved you but today I felt it.

It doesn't matter when the bonding feeling comes. What matters is that it will. For me, it finally happened again, but this time it was different. You know the kind of love you feel for someone after you thought you had lost them forever? When I had that bonding moment with Madeline this second time, it was so beautiful it hurt a little. It hurt because I knew it was a long time coming for us, and I knew there were moments I had given up hope of ever having this moment. It was so sublimely painful because in my darkest moments I had wished away her days. With my arms around Madeline I asked for forgiveness; for a moment, her angelic face lifted my spirit into the marshmallowy clouds above while I grounded my feet in the earthly pleasures of my little world.

People tell me children are the embodiment of all the beauty, virtue, and goodwill this world has left. Little children tore off the cloudy film over my eyes so I could see my life honestly. I had some sores, but I learned to heal. When I healed, I learned to value life. When I valued life, life gave me meaning.

Wednesday, October 29, 2014

It has been about five months since I started taking Prozac for my postpartum depression/anxiety/panic disorder. By this time I had weaned off the sleeping pills entirely and had stopped taking BuSpar since my panic attacks had virtually vanished and my anxiety was at a manageable level.

Today I got the thumbs up from Dr. Smith to start weaning off the Prozac as well. It was the last monkey on my back. As with the Restoril, Dr. Smith instructed me to reduce my Prozac dose by one half for about two weeks then just stop taking it.

Dr. Smith said everybody reacts differently when weaning off antidepressants so she prepared me for the worst and hoped for the best. For me weaning off the Prozac was not as difficult as weaning off the Restoril. My sleep pattern had normalized which meant I was able to sleep 5-6 hours a night.

By this time, my mom had returned home, and I resumed my responsibilities as Mommy. My dearest Anabelle didn't skip a beat, we continued right on with our daily routines, and park dates. And I was reunited with our sweet Madeline. Once I was off the Restoril, I started to sleep with Madeline again and by the time I was off my Prozac she was sleeping every night with me. It was perfect timing for me because she was sleeping through the night by the time I took over night duties. A mere coincidence, I assured my husband.

Wednesday, November 12, 2014

Today was the first day I spent entirely drug free. Under the close supervision of my psychiatrist I had slowly weaned off my sleeping meds, then anxiety meds, and finally the Prozac.

I felt such a joy and relief I was doing well without the medication. I was cautiously optimistic as my doctor had warned me that there was a possibility the symptoms might return in which case she would recommend going back on the medication. For now, my psychiatrist said I did not need any more appointments, and she seemed genuinely happy for me. I had stayed on Prozac longer than I wanted to, but it was a good decision to take it for at least six months as my doctor ordered.

As much as I didn't like taking the medication, if I needed it, I would have stayed on it for as long as I needed it. If being medicated meant being able to sleep and wake up to hug and kiss my children and to get rid of the obsessive dark thoughts in my head, I would not have hesitated in refilling my prescriptions. My faith in God included having faith in the doctors and prescription drugs that were given to me to treat my condition.

I recounted my experience with her and thanked her profusely through my happy tears. How different I had been six months earlier. She left me with a parting gift of a little card with an affirmation of the day written on it:

Believe that life is worth living and your belief will help create the fact.

William James

Believe. At the end of my medication notebook I had seven whole blank pages to spare.

Good nights usually led to good days filled with healthy activities with the children. It felt good to take a leap of faith and ditch the final drug. Aside from being a bit nervous, I didn't document or recall any significant side effects of reducing my Prozac dosage and then eliminating it completely from my system. Well, there was one fairly dramatic side effect.

A side effect of weaning off Prozac was the natural high I felt afterwards. Let me explain. After months of feeling dreadful, I was released from mood disorder jail, I had returned to the living. And everything I saw, smelled, tasted, touched, experienced was awesome! Every day was a Mary Poppins day filled with song, joy, and random dance sequences. My girls loved new mommy, and I loved them. I loved the world. Now, medical professionals can hypothesize away at all the medical possibilities for this dramatic change in personality. The hole in my serotonin tank was patched up, oversupply of happy hormones pushed me into a manic phase, Prozac was still working its way out of my system. I don't discount the medical explanations, but here's where the beauty of being able to choose our own meaning comes in. I choose to believe the Boss upstairs had a hand in my transformation. I was having a spiritual high. I was blessing everything and everyone in my path. I'd be driving and I'd bless the man cutting me off and it wasn't a "Goddamnit!" Instead it was a mini prayer of "Dear God, I hope he gets to wherever he's going to safely."

This high didn't last though. At least at such an elevated level of intensity. After a few months I started to see some of my old ways creeping back up and causing me anxiety and some depression. I'd have messy days filled with a bag of angry, frustrated feelings, but I'd eventually pause to breathe, assess, and regroup. I still have those highs, but they aren't a constant, just more frequent than the lows which is all I am hoping for now. I love life, and I pray every day it loves me back.

One of my favorite poets, Maya Angelou, once wrote, "Love recognizes no barriers. It jumps hurdles, leaps fences, penetrates walls to arrive at its destination full of hope." When I had no energy for faith and couldn't muster any hope, Love carried me. Love was my Anabelle hugging and kissing me, Love was in my Madeline's smiles, Love was my mom talking to me and encouraging me to get up and eat, Love was Charlie patiently listening to me rant about my frustrations and never leaving my side, Love was my father living alone for months so my mom could care for me and my girls, Love was my sisters talking to me for endless hours and driving at the crack of dawn to be with me, Love was friends who consistently checked in on me and spoke words of hope, Love was in the kind words of strangers. Even when Love wasn't in me, it was given to me.

How do I end this story? Charlie said end it however you want to. It feels good to have the ability to make choices again, to have some control of myself back, and to have moments of joy even while knowing in the back of my mind that joy may be fleeting. Still, I am learning to enjoy the moment for all it's worth. Back to the subject of ending this story, my mom always told me to leave people with a "sweet fragrance." Mom, I will abide.

To end, after pages filled with descriptions of my anxiety, pacing, and tears, I want to share with you my secret happy place. I created this place in my mind and it was just for me. When I was in the throes of my disorder I guarded my happy place, I didn't share it with anyone, not even Charlie. Now that I am well, I share it freely, openly, with hopes you have your very own happy place(s).

My happy place is set up on top of a grassy hill where an old oak tree flourishes and presides in all its majesty. Under this grand oak is a large bed covered in clean crisp white linen. The sky is soaked in a lively orangey yellow hue. The energizing smell of morning dew lifts and clings to every fiber of my being, swirling around happy memories of carefree school days. In the background, invisible loudspeakers set at the perfect volume play the song "Heavenly Day" by Patti Griffin. And I am lying down in the middle of this bed, my legs stretched out and comfortably crossed, my hands tucked under my head, and my gaze softly fixed on the gently fluttering leaves above. The leaves turn into faces of my children smiling and giggling with delight. Not far away from them is Charlie. Close by are my parents, sisters, brothers, friends, neighbors... Images of life play on the leaves. Then just at the right moment and not sooner, Anabelle, Madeline, and Charlie float down to join me on the bed. We cuddle, we snuggle, we laugh and then lie quietly looking up at the great oak tree set against the now star speckled sky. But we don't feel the urgency of time. Then they drift off to sleep in my arms, like only children know how to sleep. And Charlie holds my hand as we dream away about our day together, about the children, about our hopes and fears for tomorrow and the days after. For in this moment I am happy. I am alive. I am me.

# EPILOGUE

Since weaning off my drugs, I have not had to go back on any medication. I have no future appointments with my psychiatrist or therapist since I no longer fit the criteria for their programs. I miss my therapy sessions with Grace, but I realized in the last months of our meetings, I spoke less and less about my perinatal mood disorder and more about life in general, and that meant I was living life again and dealing with the aftermath of the storm.

As with most storms, the cleanup was messy, emotional, and disheartening at times. After a lot of discussions, calculations, and prayers, Charlie and I made decisions we had long wanted to make but never had the courage to do. I decided to work less and use some of that time to focus more on my children and my own personal care. I'm going to try my hand at writing creatively which always brought me joy since I was very young. Charlie decided to quit his full time job and is now a consultant focused on healthcare, which allows him to spend more time with us. Our decisions were not the most financially sound ones, but we needed to do something. We couldn't go back to our old ways after our crazy summer. I'd like to say everything worked out beautifully, but I can't. We struggle every day, but we do it as a family and that does make all the difference.

After this traumatic perinatal whirlwind, I'm left with more questions than answers. Why did it happen to me? In general why does it happen to some mothers and not others? Is there an ascertainable common link between all sufferers of perinatal mood disorders? Can it be prevented? What is the best course of treatment? I'm learning questions are a good thing because ultimately it's the questions that will lead to the right answers.

In the fields of medicine and psychology, there is much more awareness of postpartum depression than there is of perinatal mood disorders as a whole. Some of that is beginning to change as professionals recognize the full gamut of psychological problems that can happen during and after pregnancy, often to women with no prior psychiatric history. Research is ongoing, and I see medical professionals and patient advocates making admirable efforts to identify, treat, and better understand this condition.

Today I am me again and much more. My children have their mother back, Charlie has a wife to whom he can talk again, my mom can go back to the joys of being grandma, my dad has his wife back, and my sister now has her own little one. My story is kind of like playing an old country song backwards: you get your wife back, you get your house back, you get your truck back... Charlie seems happier than I have ever known him to be. About my change postpartum, he says I talk a lot more now, or in his words, "You complain a lot more," which is a good thing since I used to keep most things bottled up inside me. I think my perinatal experience opened up an overstuffed box flush with emotions and thoughts that had been silenced for most of my life. Now that it's open I'm not quite sure how to manage it all but I'm learning.

When I was overwhelmed with anxiety and panic attacks I felt as if I were constantly trying to catch my breath. I attributed it to the panic attacks and hyperventilation and made a conscious effort to practice my breathing and relaxation techniques. Now that I am better, I still find myself catching my breath every now and then. I haven't had a panic attack since my one-on-one with God. I have had my share of emotional outbursts, crying fits, and feelings of overwhelming rage and anxiety. But I acknowledge my feelings, and I make time to take care of myself.

I can only speak from my own experience, and I believe I had a perinatal panic disorder that was directly linked to biological shifts that occurred during the perinatal period. I am not certain what caused it exactly and neither are my doctors. Do I have a panic disorder? I do have an anxiety disorder by my own definition but whether I fit neatly into the DSM manual's definition of anxiety or panic disorder I don't know. I realize that I have an underlying vulnerability to panic. That panic path has been carved out in my brain and there is no guarantee I won't fall back on that road at some point in my life. So, I try to be more aware of my physical, mental, and emotional health. Each time I have to catch my breath, it reminds me to pause and take note of my body, my current state of being. I do a "systems check" and scan my body, being mindful of how I feel, what may be causing my unrest. Sometimes, it reminds me of when I was curled up in bed in a fetal position, praying for the pain to go away, of the sleepless nights. It reminds me of God's presence in my life.

I can't leave you without talking about sleep again. I cannot stress how important sleep is. Please do whatever possible to get sleep, preferably at least 5 hours straight, but as a new parent it may not be possible at first. Find a way as soon as you can. I am very protective of my sleep now. I am almost always in bed by 10:00 every night. Sometimes I can't control my bedtime; for instance, when the girls are sick I want to be up to care for them, to soothe them, to be there for them. I worry on those late nights if the lack of sleep will trigger something in my brain to cause the panic attacks again. In those moments I take deep breaths and go down the list of coping techniques that worked for me during my perinatal distress, then I pray.

Also, my memory did come back. In the midst of my most desperate moments I thought the anxiety, panic, and depression would forever rob me of my precious memories and ability to retain or recall anything ever again. Somehow my brain stored the details of my experience in a safe place, and they reemerged slowly when I was well again.

What worked for me was a combination of medication, cognitive behavioral therapy, diet, family, friends, the passage of time, and faith. I was willing to try anything to feel better; some things worked and others didn't. For example, I learned that even if I wasn't hungry, I needed to eat regular meals because low blood sugar created symptoms that seemed to mimic my panic attacks. You will find the combination that works for you. I recommend keeping a list of what works and what doesn't.

Believe. Believe in faith, hope, and love. Believe in yourself. Believe there is a treatment that will work for you. Believe you will be well again.

# ACKNOWLEDGEMENTS

In a sea of words, there are none that can truly express my gratitude to my family and friends. I won't let that stop me from trying. To my husband, my hero, my rock, I love you and thank you. To my parents, sisters, brothers, and friends who witnessed the rapid unraveling of my mental health and not only remained by my side but held me even closer to their hearts. Thank you. To my editor Deborah Lott who read version after version of my story and gave me much needed editing and encouragement. Thank you. To the medical professionals, police officers, therapists, and strangers along the way who played a part in my recovery. Thank you. And to my children, for without them life has less meaning, Mommy will love you forever and ever. Thank you.

# DEFINITIONS

**Ambien (generic: Zolpidem)** \- is a sedative-hypnotic (sleep) medicine. Ambien is used in adults for treatment of a sleep problem called insomnia. Symptoms of insomnia include: trouble falling asleep, waking up often during the night.

(www.fda.gov)

**Benadryl** \- is an over-the-counter antihistamine. Since a side effect is drowsiness, it is sometimes used as a sleep aid.

(www.fda.gov)

**BuSpar** \- medicine indicated for the management of anxiety disorders or the short-term relief of the symptoms of anxiety. Anxiety-reducing drugs are called anxiolytics. Anxiety or tension associated with the stress of everyday life usually does not require treatment with an anxiolytic.

(www.fda.gov)

**Lexapro** \- an antidepressant SSRI, a selective serotonin reuptake inhibitor. It works to increase the levels of the neurotransmitter serotonin in the brain. It is important to talk with your healthcare provider about the risks of treating depression and also the risks of not treating it. You should discuss all treatment choices with your healthcare provider. Lexapro is also used to treat:

Major Depressive Disorder (MDD)

Generalized Anxiety Disorder (GAD)

(www.fda.gov)

**Melatonin** \- is a hormone produced in the brain by the pineal gland from the amino acid tryptophan. The production and release of melatonin are stimulated by darkness and decreased by light, suggesting that melatonin is involved in circadian rhythm (the internal body clock) and regulation of diverse body functions. Levels of melatonin in the blood are highest prior to bedtime.

The most common use of melatonin is to aid in sleep. The strongest evidence supporting the use of melatonin is for delayed sleep phase syndrome, insomnia in children and the elderly, jet lag, and sleep problems in people with behavioral, developmental, or mental disorders. The weakest evidence in support of melatonin is for work shift sleep disorder. Good evidence in support of melatonin for other uses is lacking.

(www.mayoclinic.org)

**Postpartum Obsessive-Compulsive Disorder (OCD)** \- Postpartum Obsessive-Compulsive Disorder (OCD) is the most misunderstood and misdiagnosed of the perinatal disorders. It is estimated that as many as 3-5 percent of new mothers will experience these symptoms.

Symptoms of perinatal OCD can include:

Obsessions, also called intrusive thoughts, which are persistent, repetitive thoughts or mental images related to the baby. These thoughts are very upsetting and not something the woman has ever experienced before.

Compulsions, where the mom may do certain things over and over again to reduce her fears and obsessions. This may include things like needing to clean constantly, check things many times, count or reorder things.

A sense of horror about the obsessions

Fear of being left alone with the infant

Hypervigilance in protecting the infant

Moms with postpartum OCD know that their thoughts are bizarre and are very unlikely to ever act on them.

(www.postpartum.net)

**Perinatal** \- period "all around" birth. Used to mean the period of time throughout pregnancy as well as the baby's first year.

(www.postpartum.net)

**Postpartum** \- referring to the time period following childbirth.

**Postpartum Anxiety** \- Approximately 6% of pregnant women and 10% of postpartum women develop anxiety. Sometimes they experience anxiety alone, and sometimes they experience it in addition to depression. The symptoms of anxiety during pregnancy or postpartum might include:

Constant worry

Feeling that something bad is going to happen

Racing thoughts

Disturbances of sleep and appetite

Inability to sit still

Physical symptoms like dizziness, hot flashes, and nausea

Risk factors for perinatal anxiety and panic include a personal or family history of anxiety, previous perinatal depression or anxiety, or thyroid imbalance.

In addition to generalized anxiety, there are some specific forms of anxiety that you should know about. One is Postpartum Panic Disorder.

(www.postpartum.net)

**Postpartum Depression** \- Postpartum depression is a mood disorder that can affect women after childbirth. Mothers with postpartum depression experience feelings of extreme sadness, anxiety, and exhaustion that may make it difficult for them to complete daily care activities for themselves or for others. Some of the more common symptoms a woman may experience include:

Feeling sad, hopeless, empty, or overwhelmed

Crying more often than usual or for no apparent reason

Worrying or feeling overly anxious

Feeling moody, irritable, or restless

Oversleeping, or being unable to sleep even when her baby is asleep

Having trouble concentrating, remembering details, and making decisions

Experiencing anger or rage

Losing interest in activities that are usually enjoyable

Suffering from physical aches and pains, including frequent headaches, stomach problems, and muscle pain

Eating too little or too much

Withdrawing from or avoiding friends and family

Having trouble bonding or forming an emotional attachment with her baby

Persistently doubting her ability to care for her baby

Thinking about harming herself or her baby.

(National Institute of Mental Health: www.nimh.nih.gov)

**Postpartum Mood Disorders** \- A postpartum mood disorder is a mental health disorder striking within the first year of giving birth. All women of childbearing age should be aware that a PPMD can strike any woman after delivery regardless of whether you are a first time mother or have had previous pregnancies.

(www.ppmdsupport.com)

**Postpartum Panic Disorder** \- This is a form of anxiety with which the sufferer feels very nervous and has recurring panic attacks. During a panic attack, she may experience shortness of breath, chest pain, claustrophobia, dizziness, heart palpitations, and numbness and tingling in the extremities. Panic attacks seem to go in waves, but it is important to know that they will pass and will not hurt you.

(www.postpartum.net)

**Post-Traumatic Stress Disorder** \- When in danger, it's natural to feel afraid. This fear triggers many split-second changes in the body to prepare to defend against the danger or to avoid it. This "fight-or-flight" response is a healthy reaction meant to protect a person from harm. But in post-traumatic stress disorder (PTSD), this reaction is changed or damaged. People who have PTSD may feel stressed or frightened even when they're no longer in danger.

PTSD develops after a terrifying ordeal that involved physical harm or the threat of physical harm. The person who develops PTSD may have been the one who was harmed, the harm may have happened to a loved one, or the person may have witnessed a harmful event that happened to loved ones or strangers.

(National Institute of Mental Health: www.nimh.nih.gov)

**Prozac** \- is a prescription medicine used to treat depression. It is important to talk with your healthcare provider about the risks of treating depression and also the risks of not treating it. You should discuss all treatment choices with your healthcare provider. Prozac is used to treat: major depressive disorder, obsessive compulsive disorder, bulimia nervosa, panic disorder, depressive episodes associated with bipolar disorder, treatment resistant depression.

(www.fda.gov)

**Restoril (Temazepam)** \- is a sedative hypnotic (sleep) medicine. Temazepam is used in adults for the short term (usually 7 to 10 days) treatment of a sleep problem called insomnia.

(www.fda.gov)

**Selective Serotonin Reuptake Inhibitors (SSRIs)** \- this class of drugs is used to treat depression, anxiety, and other mood disorders. Marketed under various brand and generic drug names:

Generic name / Found in Brand name(s):

Citalopram / Celexa

Escitalopram / Lexapro

Fluoxetine / Prozac, Sarafem, Symbyax

Fluvoxamine / Luvox, Luvox CR

Paroxetine / Paxil, Paxil CR, Pexeva

Sertraline / Zoloft

Vilazodone / Viibryd

(www.fda.gov)

**Serotonin** \- is a type of neurotransmitter that is found mainly in the central nervous system (CNS)and the gastrointestinal (GI) tract. Much of the serotonin is located in the GI tract where it is used to regulate digestion. In the CNS, serotonin helps regulate mood, sleep, appetite, learning and memory.

(www.psychology.about.com)

**Trigger** \- something that sets off a memory tape or flashback transporting the person back to the event of his/her original trauma. Triggers are very personal; different things trigger different people. The survivor may begin to avoid situations and stimuli that she/he thinks triggered the flashback. She/he will react to this flashback, trigger with an emotional intensity similar to that at the time of the trauma. A person's triggers are activated through one or more of the five senses: sight, sound, touch, smell and taste.

(www.psychcentral.com)

**Xanax** \- medication indicated for the management of anxiety disorder (a condition corresponding most closely to the APA Diagnostic and Statistical Manual [DSMIII-R] diagnosis of generalized anxiety disorder) or the short-term relief of symptoms of anxiety. Anxiety or tension associated with the stress of everyday life usually does not require treatment with an anxiolytic.

(www.fda.gov)

NOTES

1 A **panic attack** is a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause. Panic attacks can be very frightening. When panic attacks occur, you might think you're losing control, having a heart attack or even dying. (www.mayoclinic.org)

2 **Hyperventilation** is rapid or deep breathing that can occur with anxiety or panic. It is also called overbreathing, and it may leave you feeling breathless.

3 **Xanax** is indicated for the management of anxiety disorder (a condition corresponding most closely to the APA Diagnostic and Statistical Manual [DSMIII-R] diagnosis of generalized anxiety disorder) or the short-term relief of symptoms of anxiety. Anxiety or tension associated with the stress of everyday life usually does not require treatment with an anxiolytic. (www.fda.gov)

4 **Serotonin** is a type of neurotransmitter that is found mainly in the central nervous system and the gastrointestinal (GI) tract. Much of the serotonin is located in the GI tract where it is used to regulate digestion. In the central nervous system, serotonin helps regulate mood, sleep, appetite, learning and memory.

5 **Lexapro** is a prescription medicine used to treat depression. It is important to talk with your healthcare provider about the risks of treating depression and also the risks of not treating it. You should discuss all treatment choices with your healthcare provider. Lexapro is also used to treat:

Major Depressive Disorder (MDD)

Generalized Anxiety Disorder (GAD)

(www.fda.gov)

6 **Prozac** is a prescription medicine used to treat: major depressive disorder, obsessive compulsive disorder, bulimia nervosa, panic disorder, depressive episodes associated with bipolar disorder, treatment resistant depression. (www.fda.gov)

7 **BuSpar** is a medication indicated for the management of anxiety disorders or the short-term relief of the symptoms of anxiety.

8 **Restoril** (temazepam) is a sedative hypnotic (sleep) medicine. It is used in adults for the short term (usually 7 to 10 days) treatment of a sleep problem called insomnia. (www.fda.gov)

9 **NAMI warm line** is a free and confidential telephone service providing emotional support.

10 **National Suicide Prevention Hotline** 1 (800) 273-8255

11 **The New Yorker** , November 16, 2015 issue

12 A **trigger** is something that sets off a memory tape or flashback transporting the person back to the event of his/her original trauma. Triggers are very personal; different things trigger different people. A person's triggers are activated through one or more of the five senses: sight, sound, touch, smell, and taste.

13 **Type A** personalities tend to be very competitive and self-critical. They strive toward goals without feeling a sense of joy in their efforts or accomplishments.

14 **Type B** personalities tend to be more tolerant of others, are more relaxed than Type A individuals, more reflective, experience lower levels of anxiety, and display higher level of imagination and creativity.

15 **Type C** personalities have difficulty expressing emotion and tend to suppress emotions, particularly negative ones such as anger. This means such individuals also display 'pathological niceness', conflict avoidance, high social desirability, over compliance and over patience.

16 **Mantra** is a repeated word, formula, or phrase, often a truism.

# RESOURCES

National Suicide Prevention Lifeline

1-800-273-TALK (8255)

Available 24 hours a day, 7 days a week. All calls are confidential.

National Alliance on Mental Illness (NAMI)

1-800-950-NAMI (6264)

Available Monday through Friday, 10am – 6pm, ET.

www.nami.org

Call and find out if there is a local support group or services in your area.

Substance Abuse and Mental Health Services Administration

National Helpline

1-800-662-HsaELP (4357)

www.samhsa.gov

SAMHSA's National Helpline is free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental health and/or substance use disorders.

National Mental Health Information Center

1-877-SAMHSA-7 (1-877-726-4727)

1-800-487-4889 (TDD)

www.mentalhealth.gov

Get general information on mental health and locate treatment services in your area. Speak to a live person, Monday through Friday from 8:30 a.m. to 5 p.m. EST.

Postpartum Progress

www.postpartumprogress.org

Postpartum Support International

Support Helpline: 1-800-944-4PPD (4773)

www.postpartum.net

PPD Moms Hotline

1-800-PPD-MOMS (1-800-773-6667)

Email at info@hopeline.com

Available 24 hours, 7 days a week

Postpartum Dads

Information for fathers whose partners are struggling with postpartum mood disorders.

www.postpartumdads.org

The Pregnancy and Postpartum Anxiety Workbook: Practical Skills to Help You Overcome Anxiety, Worry, Panic Attacks, Obsessions, and Compulsions

By: Pamela S. Wiegartz (Author), Kevin L. Gyoerkoe (Author) and Laura Miller M.D. (Foreword)

