Relinquishing Control; embracing the unknown and living in the present moment
One of the most challenging things that I have had to deal with is the unknown. As someone who likes to have control over a schedule and who is regimented, unchartered territory has always been difficult for me. When I was a child, teenager, and a young adult in college, in medical school and newly married, I tried to create order from chaos. As a tennis player, I felt like I had some control over the outcome of a match as I felt responsible playing against my opponent. I felt like if I practiced enough and was playing well, than I would be able to win the match and if the person was really that much better than me, than it wasn’t in my control if I won the match. If I played someone that was ranked higher than me and I didn’t expect myself to win, than it was merely a bonus for me to win (not great thinking according to many sports psychologists!) In terms of grades in high school, college, medical school, and even graduate school, I believed that academic success was in my control as well. If I worked hard, if I studied, spent time outlining and writing papers, spent time learning the various subjects in medical school and studying text books, than I would somehow control the outcome of my test or grade on a paper (within reason).
When I went to Williams, I had a single room for all four years. This fed right into my system where I had control over how clean my room was, where everything was in the room, what time I could shut the lights off to go to bed (not many other college students went to be at 9:30-10pm!) I loved college because even moreso than being at home, I felt in control of my surroundings and great self-awareness as to what I felt was comfortable and soothing for myself. I knew I liked to go to bed early; I knew that I needed quiet when I studied and didn’t do well procrascinating. I also knew that starting my morning off with endorphins from exercise set me up for a much better day than if I was not able to exercises in the morning and that afternoon or evening exercise was definitely not my thing. I was very good at thriving in a life that I set up for myself, surrounding myself by good friends, creature comforts, and holding to my comfortable regiment and schedule.
When I got married, control started to give away, a little (my husband was very adaptive!) I could control my schedule and what I did, but I could not control my husband’s. Still as two young individuals, Ben in law school at the time, and myself in medical school, with no children we were able to maintain a schedule that was adaptive to our creature comforts. When I entered my third year of medical school, the year when rotations began, I lost more control over my schedule, my creature comforts, and my bedtime! Overnights on surgical rotations would throw me through a loop. Since I was little, I always had difficulty sleeping away from home. I had anxiety over not being able to fall asleep and worrying that I would be tired the next day. For those of you who have also suffered at one time or another from insomnia, you know the more that you lay in bed and think of how you cannot fall asleep, the less likely you are to fall asleep. I remember getting my schedule for when I would be overnight and feeling this deep-rooted panic in my stomach; how would I do this? How would I stay overnight on call in the hospital? How would I be able to only sleep a couple of hours and have no time to unwind with my husband in the evening? How would I get my endorphin fix in the morning to start my day when I was supposed to go home and go to bed during daylight? There were so many questions and so much panic at the thought of losing my routine. In retrospect, what is clear to me is that beginning in the third year of medical school, which I always look at as the beginning of the loss of control over events that have unfolded in my life and the beginning of the journey through uncertainty, is that I was way more adaptive than I realized.
I had a lot less faith in myself than I should have and I ended up being a lot more resilient than I could have ever imagined. For years after I had been traumatized as a child, controlling my environment and setting myself up for success through this control was the only way I knew how to shelter myself from any further trauma. Although I had close friends and was married at just 23, having met my husband at 21, I stil had a barrier between my true self (the self that had been traumatized for a year ages 8-9 and was stuck as a little girl, afraid to talk to anyone and afraid to trust that anyone could help, as well as never really finding a voice to speak of the unthinkable) and this outward person that was “put together,” academically successful, a doctor, athletic, and seemingly very on top of things. I never spoke of fourth grade with my husband, family, or even therapist until I became a resident in psychiatry and was so triggered during a night shift at the VA hospital in the Bronx, I broke down. Even then I did not speak of my past. Hypervigilant, anxious, unable to sleep, obsessed with the endorphin release exercise provided, I was diagnosed as having Bipolar Disorder and had started taking mood stabilizers, none of which really helped, because I really suffered from complicated Post-Traumatic Stress Disorder. I still had difficulty speaking of my trauma, and kept it to myself despite the inaccuracy of doctors’ psychiatric assessment and diagnosis. I found it virtually impossible to speak of my past when doctors consistently framed questions in such a way that I was assumed to have no history of trauma; “you never had any sexual or physical abuse when you were a child or have been assaulted, have you?” Yes, this is clearly a very open way to ask a question; clearly someone who has trouble speaking of the unthinkable would be able to confide in an individual who has already made the assumption that you can’t possibly have had any of “that stuff” in your past. As a result, I went to different therapists and other physicians over the course of my life without ever finding the voice to speak. I was unable to imagine staying in my residency; I did not want to be a psychiatrist. I realized that I could not control being triggered by patients and their histories; this realization was painful and shameful. I had to come to terms with the fact that my past was not just my past, but had affected me in the present and who I would become in the future. Still, I refused to discuss my history. Moving forward with my life, I tried to take control once again, enrolling in a masters program in elementary education, passionately believing that I could help young students find a voice for themselves and become strong and independent adolescents and young adults.
At the same time, my husband and I tried to get pregnant. We had very little luck. Once again, I was not able to control when I would conceive or if I would be able to conceive. This was an uncertainty. After one round of infertility treatments and intrauterine insemination, I found out in the reproductive endocrinologist’s office that I was pregnant with not just one baby or twins as had been seen on the 5-week ultrasound, but five! Looking at this alien uterus on the screen with 5 heartbeats, all control that I had retained over my body and the direction of my future seemed to fly away. Was this really me on the screen I was looking at? Was that my body that had 5 heartbeats inside of it? That summer of 2012, just one year after coming to terms with how my past had affected me and starting to try to come to terms with my childhood trauma and starting to find a voice, I spent in and out of high risk maternal fetal medicine offices, obstetrician offices, getting three chorionic-villi-sampling tests, then reducing the five fetuses to two fetuses. I was incredibly sick, uncomfortable, and dependent on others physically and emotionally since I was so compromised. I had no control over my body. Every appointment was like an out of body experience; whose uterus was this really?
Just when my husband and I thought, “wow, we actually might pull through and have two healthy little girls,” at our 20 week ultrasound, my body started doing weird things. As naïve as I was, I thought that these weird contractions or movements of my belly were movements of the baby, only to find out that they were actually preterm contractions. At just 20 weeks, suddenly I went from beginning to have faith and think that I had control over the outcome of the pregnancy to being on the labor and delivery floor 3 cm dilated and given strict hospital bedrest. For 3 weeks, I lay in bed, used the bedpan, had sponge baths from nurses, and had very little that I found soothing. Once dependent on working out or taking long walks to zone out and practice mindfulness, I was stuck in a hospital bed listening to heartbeats of other healthy babies and terrified of losing my twin girls. I had no control over what happened; I lived in sheer terror of losing Twin a and Twin b. Night after night, the resident would come onto the labor and delivery floor or antepartum unit and check the babies; they were so healthy and perfect. I didn’t even want to look, but I did (as I think any pregnant person would laying like a corpse day after day in bed), as I was already so attached to these two little beings. Laying there night after night trying to fall asleep to the noise on the heart monitors of healthy heartbeats of other womens’ babies; women who were 35-36 weeks pregnant with viable fetuses, I lived in terror. My babies were not hooked up to a monitor, because in the words of my obstetrician, who eventually just turned my case over to the high risk doctors who delivered the twins and who had a horrible bedside manner, “the babies were not viable until 24 weeks, so no need to have them on a heartrate monitor.” Yes, this crass doctor did say this right in front of me when I first came onto the labor and delivery floor for an assessment just after she turned my head nearly upside down in order to have “gravity work against the babies being delivered.” This same doctor who ran to my husband and yelled that “her therapist needs to be contacted; she’s going to lose these babies!” as if something my therapist could or would say had the power to make me feel better? As if any amount of medication or sedation would take the pain of losing the twins away?
Lying in the hospital, day after day and night after night unsure as to what my body had in store, I would make pleads with some “higher power” (not that I’m religious), begging to do anything if the twins could make it to 24 weeks, 25 weeks, 26 weeks, please just let them make it and I will do anything. I spent hours and hours (what else did I have to do?) doing research on the fetus if it were born at each of these weeks. What would the NICU course look like and what were the chances of survival and a quality life? Google became a friend and an enemy of mine. Through the interne; I wasted a lot of time, but I also created a great deal of anxiety as I read womens’ stories; the miracles of a 23 weeker and the tragedies of even 30 week old fetuses. It should be noted that I actually feel that google is a pregnant woman’s worst enemy and that we should just all go without internet for nine months! This false sense that I had control kept me going. In such chaos, tragedy, and uncertainty, I needed to think that I had some role and some control over the outcome, when in reality I did not. At 22 weeks and 6 days, my body went into active labor. “Push,” in the words of the high risk delivering ob. Thinking to myself, “why would I want to push when pushing will simultaneously bring life and death to these beautiful children?” Born within 20 minutes of each other, the twins lay on my chest for nearly 2 hours; I had no control over their fate. At this moment in my life, I realized just what I had control of and what I didn’t. I realized that things don’t necessarily “happen for a reason,” and despite my long practice of yoga and study of Buddhism, I did not believe in karma, which would mean that I was being punished for something I had done in some past life or in this life. What I had control over was the kind of mother that I was for those few hours to my children. I had control over whether I let the doctors take me right to surgery as I was hemorrhaging and somewhat unstable; I refused to go until I had spent all the time I could being a mother. Kissing them, talking to them, and telling them that it was okay, they could pass away and not suffer anymore, that I loved them, that these few moments with them were worth the heartache and difficulties of the quintuplet pregnancy, I was a mother. Within those hours, I controlled what kind of a mother I was and what I would again become with my son and daughter several years later. Motherhood was taken from me in just a couple of hours. Having moved all of our belongings to our home in Williamstown, we decided to stay in the city in my mother-in-law’s apartment in order to continue to try to have the family we dreamed of and had almost had. I reenrolled in my masters program and tried to once again take control over my life.
Just 5 months after having the twins, I became pregnant with my son using single embryo in vitro fertilization. Believing that this pregnancy would be so different (or just really hoping it to be), I again felt that I was “through the woods.” At just 25 weeks and too coincidentally on the one-year anniversary of losing the twins, I had preterm contractions with my son and was put on modified bedrest. The control was vanquished once again as I became physically and emotionally dependent on others and uncertain as to the fate of my baby and my body. At just shy of 36 weeks, I had a healthy baby boy.
One year later, I decided to try once more. Single embryo IVF and exactly one year later, I became pregnant with my daughter. Once again, even though I was definitely more uncertain and cautiously optimistic about this pregnancy, I had started to regain control over my life. I was almost done with my masters program having had to take a semester off when I was on bedrest with my son. We would have this last miracle baby and move on to Williamstown, where we had tried to settle just three years before. I want to preface that Ruby was born at 36 weeks and was a healthy baby girl who also did not need a NICU stay, but that her pregnancy and the journey that my husband and I undertook to have this healthy baby girl was anything but in our control. Feeling like I knew just about everything that could go wrong in pregnancy, I was not aware of bleeding, low-lying placenta, velamentous cord insertion, slightly elevated AFP levels, and other complications that just “arose” in this pregnancy. Beginning at 21 weeks, I started modified bedrest, and at 23 weeks it became even stricter for the next 11 weeks, before becoming slightly more modified 34-36 weeks. Living in fear that I would lose another baby girl, I was in terror for nearly 4 months. Being afraid that anxiety would negatively impact my pregnancy, I was afraid of being anxious (helpful, huh?) I was afraid to get too worked up, but at the same time had no psychiatric medications that were safe in pregnancy or that I was willing to take in case it would harm the baby that would be calming and I could not rely on my endorphin release from exercise while being on bedrest. Staring at a brick wall for 4 months in my hot NYC apartment with my mother and my 18-month old beautiful toddler who had no idea what was going on, feeling hepless as a mother, I tried to hold myself together. I tried to have control over my composure in order to influence the outcome of the pregnancy. I realized that the only thing I had control over was following doctor’s restrictions about moving and bedrest, which I did to a tee despite my hyper and anxious demeanor.
I had Ruby at Mount Sinai and was taken care of by the same high-risk team and labor and delivery nurses that had seen me through the quintuplets, through Jack’s pregnancy, and now into Ruby’s pregnancy. Just 3 years after losing the twins, I had a healthy boy and healthy girl. Luckily, I had managed to finish my masters program just before being relegated to bedrest. I had endured 3.5 years of losing control over my surroundings, my body, my ability to do things that were once so crucial to my schedule and wellbeing. I had endured dozens of ultrasounds and scary exams over the course of my pregnancies, painful procedures, heartbreak, and ups and downs of complicated pregnancies. I had endured the uncertainty and the unknown and fought and succeeded in having two healthy children.
After I had Ruby, things changed. We finally moved to Williamstown and I became very aware of reminding myself to live in and enjoy the present and to try to heal from the past several years and my childhood. Still plagued by events from my past and traumatized from my obstetrical history and complications, I dove further into my yoga practice, cultivating a sense of awareness of my mind and body within this spiritual and movement oriented practice. I began to appreciate twisting and turning, loosening my body, challenging myself with inversions and arm balances. I began to encourage my children to practice yoga and others in the community and opened Smalltown Yoga Studio as a place for adults and children of the community to learn and practice yoga. More than yoga, I want students to learn how to feel like they are in their body and in the moment while relinquishing belief that they have control over the future. Facing each moment with uncertainty, it is important that we are confident in our ability to handle whatever may come. In order to do this, it is necessary to build strength and courage in the present. In yoga, we are completely aware of our breath and take time to bring awareness to how parts of our body feel in various poses, but we are not necessarily in control over whether we have the right balance, flexibility, or strength on any given day to get into the same inversions and backbends, challenging arm balances, twists, and binds as we were yesterday or as we might be tomorrow. Without mirrors in the studio and without being critical of my students as to their alignment and form in each pose (unless they are at danger of being injured), I like my students to flow and dance mindlessly through a vinyasa paying attention to their breath and their body in the moment. After years of worrying about the future (during pregnancies) or trying to compartmentalize and rid myself of the past (sexual assault traumas in childhood, adolescence, and adulthood), or trying to move into a profession that did not fit my interests but was an admirable profession, I believe that the only way to live life is to embrace all aspects of the present moment. I realize that who I am today is a result of past experiences without dwelling on these experiences, without feeling the shame or denying these experiences, and that how I act in the present and who I am is what impacts my uncertain future.
Not even two weeks after opening Smalltown Yoga, I was hiking a trail that I have hike hundreds of times since being a student at Williams College and I broke my patella in two places. The timing could not have been worse and I was extremely disappointed and upset at starting my new business as a yoga instructor physically compromised and in pain. However, I realized very quickly, that I could not blame myself for tripping and falling, nor could I wallow in self-pity and give up teaching yoga because of my broken knee impediment. Determined to live in the moment and strengthen myself physically and emotionally, I would go on long walks in my straight-legged brace; I learned to kick up to inversions with my other leg, get into arm balances with a straight leg, and how to teach with a broken knee with the same energy, excitement, and vigor as I always had. Teaching children and adults, I lived each day getting stronger and feeling better, also uncertain as to how long it would take for me to heal and if I would have longterm effects in my knee. It’s been a little over three months and I can say that I’m back to running, hiking, kicking up with both legs, and stronger than I was before I broke my leg both mentally and physically (trust me I’m not saying that it was a good thing that I broke my leg or that things happen for a reason!) Yes, I do have knee aches by the end of the day and worry that my muscles are not fully restrengthened, but I look at how just far I’ve come and I cannot be disappointed in myself; I can only have pride in myself for my resiliency and determination.
Again I find myself embarking on the path of uncertainty; I currently feel the anxiety of that which is not known and realize that all I can do is live in the moment, embrace everyday with my kids and not try to regain control of the future, because I cannot and could never have imagined any of these experiences in the past 5 years. In my yoga classes, I tend to end every class in savasana and tell students to try to focus only on their breathing and to try to find compassion for the parts in their body that are not fully released or are still tense and give permission to rest in the present moment. I speak of intentions that we can set for our self and for those around us, to be safe, to cultivate happiness and peace, and to find compassion towards our self and others in the past, in the present moment, and in the uncertain future. We cannot set goals or think of what we should do, but merely reflect on what we intend to do and act in such a way so as to follow our intentions while knowing we cannot control what life throws us and we must be prepared and embrace life’s waves.