“When the OB becomes the High Risk Patient” – with Dr. Stephanie Melka

Dr. Fox: Welcome to “High Risk Birth Stories” brought to you by the creators of the “Healthful Woman” podcast. I’m your host, Dr. Nathan Fox. “High Risk Birth Stories” is a podcast designed to give you, the listener, a window into life-changing experiences of pregnancy, fertility, and childbirth. Dr. Stephanie Melka, welcome to “High Risk Birth Stories.” Glad to have you here. 

 

Dr. Melka: Thanks for having me. 

 

Dr. Fox: Wonderful. So, as many of our listeners know, Melka is a regular on the “Healthful Woman Podcast.” But Melka, you got a great birth story. 

 

Dr. Melka: Yes. 

 

Dr. Fox: So, I thought it would be amazing to have you on for that part of your life as well so we could talk about that. 

 

Dr. Melka: Yes. 

 

Dr. Fox: Let’s start from the beginning. So, just set us up. Where were you in life? What was going on, you know, in terms of when you got pregnant? 

 

Dr. Melka: I married my husband, Giles. We were living in White Plains at the time and honestly… 

 

Dr. Fox: Hi, Giles. 

 

Dr. Melka: …working with the practice. 

 

Dr. Fox: Does he listen to these? 

 

Dr. Melka: I don’t think so. He’ll probably listen to this one. 

 

Dr. Fox: All right. Giles, she’s doing great. 

 

Dr. Melka: He’s working from home now. Like, anyone that was listening to podcasts has lost their commuting time… 

 

Dr. Fox: That’s a good point. 

 

Dr. Melka: …which was their podcast time. 

 

Dr. Fox: Okay. Hello, Giles. Hello, Allison. 

 

Dr. Melka: Hi, Giles. I was pregnant July of 2017 and then delivered in March of 2018. 

 

Dr. Fox: Okay. And at the time you got pregnant, so you were obviously working as an OB/GYN in our practice. How long had you been there at that time? I know the answer to that, but our listeners might not. 

 

Dr. Melka: I started with the group in 2012. 

 

Dr. Fox: Okay. So, it’s five years. 

 

Dr. Melka: Yes. 

 

Dr. Fox: All right. And did you have any thoughts or concerns about, you know, the timing of getting pregnant in regard to your career, in terms of your practice? Was that something you thought about a lot or just, sort of, you know, whatever? 

 

Dr. Melka: Not that much. I mean, I graduated residency in 2012 and was single at the time and was never, like, I need to, you know, find someone and start a family. It just, sort of, happened over time. 

 

Dr. Fox: Okay. All right. And I think one of the interesting things about pregnancy for someone who is an OB/GYN is this you’re in the world already. And decisions you make are gonna be very interesting. Like, for example, how do you decide who your own doctor was gonna be? 

 

Dr. Melka: I needed someone that I would listen to, not someone that was, like, my friend, or my colleague, or someone that was junior to me. I mean, obviously, I work with a lot of people that I trust and respect, but, like, I needed to truly be the patient. 

 

Dr. Fox: You mean for your own sake, just know your own personality. 

 

Dr. Melka: And for Giles’ sake. 

 

Dr. Fox: Because he could say, you know, “Listen to your doctor.” 

 

Dr. Melka: Well, early on when he and I were dating, I forget what happened, I think I had a cold or something and it wasn’t going away. And I was like, “I’ll just write myself for a Z-Pak.” And he’s like, “You can’t do that. You have to see a doctor.” I’m like, “Oh, honey, let’s talk.” 

 

Dr. Fox: You’re like, “I am a doctor.” 

 

Dr. Melka: Right. And then we were doing this, he’s like, “Can you not be your own doctor? Can your doctor not be like you or one of your friends?” And I’m like, “Fair enough.” 

 

Dr. Fox: Right. And that’s, sort of, like a general concept in medicine, this idea, number one, you’re not supposed to really, like, “treat your family members.” And some of that’s just because there’s not a conflict of interest, but it’s hard to think sometimes rationally and it’s hard to think, sort of…you wanna be detached from the situation in a sense. For OB/GYN people, you know, frequently ask me, like, “Did you deliver your own kids?” I’m like, “No, I did not.” And first of all, just, I didn’t want to. My wife certainly didn’t want me to. But also, it’s like, what if you’re there delivery and things are going wrong? It’s too emotional. It’s not just a kid. It’s my kid. Right? It’s not just a woman. It’s my wife. And so it’s very hard to, sort of, be in that situation. And so, okay. Treating yourself is…I think people just think you’re just gonna make bad decisions. You’re not gonna do the right test, like, “I don’t wanna do that. It seems hard or this.” 

 

Dr. Melka: I would either not do anything or do way too much. 

 

Dr. Fox: Yeah. And then for picking an obstetrician, so, you said, okay, you want someone who you’re gonna respect, you’re gonna trust, who’s maybe more senior to you. But how about deciding whether to be someone that you knew? I knew this person already versus going somewhere totally different, like, to a different hospital and just like throwing yourself into that practice. 

 

Dr. Melka: I knew that I wanted to stay at Sinai because I think being with…Since I trained there and I’ve only worked there, I feel like I trust people there on a different level than somewhere else. If you’re going to a new place entirely, you do get, sort of, the anonymity where you’re just, kind of, walking in and you’re any old person as opposed to now when it’s someone you know, you’re like, “Oh, so and so is here.” But I kind of wanted that familiarity. And it kind of helps if you have to call in a favor or two from time to time to, like, know somebody. 

 

Dr. Fox: Right. Like, “Hey, can you give me a better room?” Did you have any concerns about privacy, for example, that so many people who you know are not gonna know your business? I mean, you know, if there is business. 

 

Dr. Melka: I didn’t because having taken care of people in the Sinai system, you know, nurses, residents, other OBs, like, we don’t talk about that stuff with each other. If I had someone in labor, nobody’s like sitting there opening their chart, reading all their history. We’re still professional about it. 

 

Dr. Fox: I agree. It tends to be a greater fear of a problem than an actual problem. I think that, really…I mean, we know the people we work with, but everyone knows, like, what’s appropriate, what’s inappropriate, and where the lines are drawn. And so on the one hand, if I see someone who I know who’s there in labor or their partner is there in labor, whatever it is, it’s nice that I know them, I can say hello to them, but I’m not gonna know their business. I’m not gonna know what’s actually going on unless they want me to know because I’m taking care of them. And as you said, there is something nice about having a familiar group of people taking care of you. It takes away some of the fear sometimes that can come about. Okay. So, you’ve picked your obstetrician and you’re going along in pregnancy. And how was that for you just in general? 

 

Dr. Melka: It was weird. 

 

Dr. Fox: In what way? 

 

Dr. Melka: Because it’s all the things that I would talk about with patients but never experienced and now I was experiencing it. And now I was like, “Oh, now I get it.” 

 

Dr. Fox: So, anything in particular that really hit you in terms of inexperience? 

 

Dr. Melka: Really bad fatigue early on in terms of like… 

 

Dr. Fox: Yeah. We thought you were just lazy. 

 

Dr. Melka: Yeah. You know what? True story. I am lazy. I just lie and pretend it was fatigue. 

 

Dr. Fox: Actually, I apologize. My wife tells me that we’re not supposed to use the term lazy. She doesn’t use it about children. Unmotivated is the right word. So, we just thought you were… 

 

Dr. Melka: No, I was lazy. 

 

Dr. Fox: Yeah. We thought you were unmotivated. Yeah. That’s rough. And listen, many, many people have difficult jobs in various fields of whatever. Being an OB/GYN is a hard job, physically. You’re talking staying up nights, you miss meals, you’re working long hours. It’s hard. It’s hard to do when you’re pregnant. It’s hard to do first trimester. Did you have a lot of nausea and vomiting? 

 

Dr. Melka: Yes. Which, if you know me, I’m motivated by food. And it was very weird. Again, in pregnancy, you normally talk about, like, morning sickness, first-trimester nausea. And for me, it was always evening and nighttime to the point where, like, Giles almost got worried that I would get home from work and not eat anything. And I had to, like, connect to him, I think, with… 

 

Dr. Fox: Right. He knew you were pregnant, right? 

 

Dr. Melka: He did. Yes. I did connect him with Jamie Miller to be, like, “Dude, she’s eating like a breakfast sandwich every day and a full lunch. She’s getting in enough food. Just she’s not eating a dinner. Let it go.” 

 

Dr. Fox: And then you also…I remember, you had a ton of heartburn. 

 

Dr. Melka: Oh, my God, it was miserable. 

 

Dr. Fox: Yeah. That’s not good for someone who likes to eat. 

 

Dr. Melka: Poor Giles is really on Friday night, like, getting home and making pizza and I had to stop it. Or he could and I just couldn’t eat it and it wasn’t the same anymore. 

 

Dr. Fox: So, I’m curious, what do you do in terms of just those, sort of, not run of the mill but common symptoms that women get in pregnancy and you’re having them, did you even talk to your OB about it? You’re just like, “All right. I know this and I’m gonna deal with this myself.” I’m so curious about these things. 

 

Dr. Melka: I did. And with the nausea, I was like, “I need to start Diclegis. Okay. Now I’m maxed out on Diclegis.” I think I called Meredith Stern and I was like, “I need to take something else.” And she’s like, “So, let me tell you about…” I’m like, “I know. Just give me Reglan, please.” 

 

Dr. Fox: Right. Right. I should have had her on at the same time because it’s also hard as an OB to take care of an OB because, on the one hand, you wanna be like, “I wanna treat this person like I treat everybody else. I don’t wanna, like, give, you know, less than standard prenatal care. I want to tell her everything I know.” But on the other hand, you’re like, “But she knows this. What am I doing here?” When we were having our kids, it was similar, but I wasn’t done with my training, meaning, I had my kids really young. So, our twins were born when I was in medical school, so I didn’t know anything, obviously, a medical student. I knew nothing from nothing. 

 

And then our third was born when I was a resident, so you knew a lot, but, you know, you’re still not done. And then our fourth was when I was a fellow, so I definitely knew what was going on, but it wasn’t the same thing because I wasn’t really taking care of patients in the same way. So, I never really had…First, I wasn’t pregnant myself, obviously, but I never had the same, sort of, experience that you did about being like in practice taking care of patients at the same time that you are a patient yourself. Did your patients know that you were pregnant or at what point did they know? Obviously, at some point, they figured it out. 

 

Dr. Melka: I didn’t tell a lot of people early on. I think there were a few early on that came in with, like, a due date a month after me that were like, “Oh, you can deliver my baby again.” Then I had to quietly be like, “Well, I might not be able to.” 

 

Dr. Fox: You can deliver mine. 

 

Dr. Melka: And then I think on Halloween, I wore one of the maternity shirts with, like, the picture on the baby bump, and if you ever watched “Ninja Turtles,” it had a picture of [inaudible 00:09:58] on it with a little pacifier in his mouth. And that’s when people were like, “Oh, okay.” 

 

Dr. Fox: That’s why you’re so unmotivated. 

 

Dr. Melka: Yes. 

 

Dr. Fox: I get it. All right. And did you find that once it was, you know, out in the open that it was a bonding thing with patients that you would talk about it, or was it just something you kept separate? How did that work? 

 

Dr. Melka: I never brought it up. Some patients did ask. Some had almost, like, no filter, like, patients I’ve known for years. There’s no boundaries. They’re like, “Oh, my God, what is it like for you? Who are you seeing? Are they delivering you here or where are you going? Do you have bad heartburn? Do you have this? Do you have that?” And then others just didn’t ask or say anything. 

 

Dr. Fox: Even though they obviously knew what was going on. 

 

Dr. Melka: Yeah. 

 

Dr. Fox: And then I’m also curious, you know, as an OB, obviously, there’s a lot of really, like, fun, cool things if, you know, you’re the same gestational age as somebody else, or this, that. But we see a lot of bad things happen. 

 

Dr. Melka: Yeah. 

 

Dr. Fox: And I’m curious, number one, how did that feel yourself in terms…Did it trigger anything yourself, like, “Oh, my God, now I’m worried that this could happen to me?” That’s the first aspect. And the second aspect, did you have the sense, like, “Oh, I’m gonna come in pregnant and it’s gonna trigger her because here I am with a healthy pregnancy and she’s not?” How did you deal with those? 

 

Dr. Melka: I can think of two patients in particular right around when I was like 22 weeks where it was obvious that they had not good outcomes in the second trimester. And they felt bad for me. I remember being in the operating room, like, holding their hand and they were like, “I’m sorry you have to deal with this while you’re pregnant.” And I’m like, “That’s so kind of you.” 

 

Dr. Fox: That’s amazing, actually. 

 

Dr. Melka: It really was. 

 

Dr. Fox: That someone could have that thought process while undergoing such a horrible situation to talk about you. That’s impressive. 

 

Dr. Melka: They’ve both gone on to have children. I delivered one of them. And it, sort of, like, became a bonding thing in, like, kind of, a different way. 

 

Dr. Fox: That’s really nice. Yeah. I don’t wanna say I’m floored because I know how amazing, you know, our patients are and how amazing people are. 

 

Dr. Melka: Yeah. It was the opposite of what I was expecting. I was expecting them to have that, not anger, but that, like, “Well, ugh, you’re pregnant and I can’t believe I have to, like, see you being pregnant taking care of me.” And it was the opposite. 

 

Dr. Fox: I remember we had a similar situation, not the exact same situation, where we had a patient who really horrible outcome happened to the mother. And the husband came and visited us and he actually, he said, “I really feel bad for all of you. How are you guys doing?” 

 

Dr. Melka: I remember that. Yeah. 

 

Dr. Fox: And it’s amazing that people think that way and feel that way. And it’s more common than people think. And I think it’s also this relationship that patients and doctors build with each other, particularly over the recourse of a pregnancy, because it’s not a one-time thing. You’re seeing someone for a year straight and they’re coming in every month, every week, and there’s a real back and forth bond that develops it. We have empathy for them, they have empathy for us, and it’s a real relationship. And I think that’s really interesting. Wow. Okay. And so your pregnancy is going along. Oh, one more thing. You went backpacking, like, in the middle of nowhere, right? 

 

Dr. Melka: So, for my first visit, Giles came. He was, like, doing the dad thing, “Okay, I’ll come along.” And then we sit down in the office with Meredith Stern and going over stuff. And I think Giles is like, “She’s eating a lot of junk food.” 

 

Dr. Fox: She Meredith or she you? 

 

Dr. Melka: Me. And I’m like… 

 

Dr. Fox: “Why is Meredith eating so much junk food?” 

 

Dr. Melka: “Yeah, I’m eating normal food.” I’m like, “I have chips from time to time.” And Meredith is like, “Okay. Well-balanced diet. You can have chips. Giles, leave her alone.” And then I was like, “So, I like to run and I signed up for the Marine Corps Marathon in October when I’ll be 20 weeks.” And she’s like, “What the F is wrong with you?” 

 

Dr. Fox: Smoke coming out of her ears.” 

 

Dr. Melka: “You are not…” I’m like, “But I have friends that have done it.” And she’s like, “And what’s your level of exercise been like the last couple of weeks?” I’m like, “Nothing.” And she’s like, “Just stop. I know it’s bragging rights. I know you wanna do it, but no.” And I was like, “Okay, fine.” And then Giles was like, “I like this doctor.” And then he never came to a visit again. He came to sonograms, but he’s like, “I know you’re gonna listen to your doctor.” 

 

Dr. Fox: I know Giles was thinking, “This is the first person I’ve ever met who she listens to.” 

 

Dr. Melka: Yes. Not even him. 

 

Dr. Fox: Yeah. He’s like, “Wow. This is an amazing person to have in my life.” 

 

Dr. Melka: And then I was like, “So, we have this trip planned in August to go backpacking in Canada.” And I think she might have thought I was talking about camping. I’ve still never really asked her and I don’t wanna upset her anymore. But yeah, we had booked this trip with a friend of ours to go backpacking in Canada. We did two 3-day trips in Yoho and Jasper. And we had booked it not knowing what was gonna happen. And then we’re like, “Oh, it’s 10 weeks. Okay.” And I’m like, “Well, I feel okay enough.” They were short trips, so I wasn’t carrying that much stuff. Yeah. We went backpacking at 10 weeks. 

 

Dr. Fox: But weren’t you only reachable by, like, satellite phone or something? 

 

Dr. Melka: Correct. It wasn’t like our Alaska trip where we were, like, really in the wilderness. You could get out of the woods in a couple of miles if you had to. And I was like,”I’m 10 weeks, so I’m probably fine.” But it’ll be fun. Wake up in the morning, like, filter water, take my Reglan and Bonjesta and prenatal vitamin and baby aspirin for the day. 

 

Dr. Fox: It’s so funny that you mentioned that because when Mikhal [SP] was pregnant with the twins, we had a trip planned to Alaska and we went. So, we went to Alaska and we went into Denali. And again, this was pre-any phone. We were seven hours from the closest, like, payphone. And we went and we came back. And at the time we went she was like, I don’t remember exactly, somewhere 20 to 24 weeks, right there. And we get back and the next prenatal visit, you know, we’re there and, you know, she’s with Charlie Bacall and we’re telling him we went to Alaska, he’s like, “What?” And we’re like, “Yeah.” He said, “What? Where’d you go?” We’re like, “Alaska.” He’s like, “What the hell is wrong with you guys?” He’s like, “There’s no way you should have done that. Don’t you know any better?” I said, “I’m a medical student. I don’t know anything.” I was like, “I know nothing.” I was like, “Was that a problem?” He’s like, “A huge problem. What if something happened?” I was like, “Oh, yeah. What if something happened?” He’s like, “Where would you have gone? What would you have done?” I was like, “I have no idea. It’s a good point.” 

 

Dr. Melka: Good question. 

 

Dr. Fox: Yeah, good point. All right. Lesson one. So, it was…Oh, he was so mad. That’s one of those things better to ask for forgiveness than ask for permission. 

 

Dr. Melka: Permission. Yes. 

 

Dr. Fox: But it wasn’t like we said, “Oh, we can’t ask him.” We had no idea. We didn’t think it was a problem. We’re just fine. It’s all good. Pregnancy is going, sort of, you know, moving along. And then you exploded. 

 

Dr. Melka: Yes. 

 

Dr. Fox: So, let’s talk about that. So, what happened that really made it a lot of fun? 

 

Dr. Melka: So, it was 33 weeks, I was on call because, of course, I’m crazy and insisted on continuing to take call and work. 

 

Dr. Fox: Yeah, thank God for you doing that. 

 

Dr. Melka: Right. Look, it’s a real thing. You don’t wanna be, “Oh, I’m pregnant, I can’t work,” because then other people have to work more. And I wasn’t doing anything unsafe. And it’s just not as fun. So, for a couple of days, I was, like, kind of, feeling off, but it was the usual stuff, like, not great appetite, like, eating a little bit less, then it would pick up. And that day, I didn’t eat breakfast, I had a big lunch. You and I had a section in the morning, then I delivered someone, then I had a [inaudible 00:17:49] that was [inaudible 00:17:49] and I pushed with her for an hour. And I remember, like, “Oh, let me sit down while I’m pushing. It’s just more comfortable.” And I pull in a little stool, and deliver, and everything goes fine. And then I start getting, like, right lower quadrant pain as I’m, like, doing her paperwork. And in my mind, I’m like, “I gotta finish this delivery summary. I gotta finish the birth certificate.” 

 

Dr. Fox: Right. “I can’t leave this for Fox. He’ll be so pissed off.” 

 

Dr. Melka: And then I leave, TMI, go to the bathroom, like, absolutely puke my brains out. And I think, “Oh, I must have eaten something bad. I have a little bit of a stomach bug.” And then I go back to do more paperwork, I’m like, “Nope, back to the bathroom.” And then I go upstairs to the call room and I lay down and now I’m in like, kinda severe pain and I’m like, “What the F is going on?” And again, it’s like severe right abdominal pain. 

 

Dr. Fox: Right. And it’s at night now, right? 

 

Dr. Melka: Yes. It’s probably like 9:00 at night now. And I call you because you’re my backup and I’m like… 

 

Dr. Fox: Because I’m your wingman. 

 

Dr. Melka: Yes. You are my wingman. I’m glad you finally got it right. 

 

Dr. Fox: Because I’m your wingman. 

 

Dr. Melka: And I remember saying, “I’m in a lot of pain. I need you to come in.” And you were like, “What do you think’s going on? What are you gonna do?” I’m like, “I don’t know. I’m gonna page my doctors and go check in downstairs.” And I page and I think Meredith was on and I’m like, “I don’t know what’s going on.” And I think she’s like trying to do the doctor thing and asked me questions. And I’m like, “No, I don’t have anything else. I’m just in pain. I’m going to the labor floor.” She’s like, “Okay.” And then, like, I go downstairs and I have the sense to, like, ask Dave Lubell to watch our tracing of our induction or something. Meredith has now called the labor floor. Diana, the charge nurse, thinks this is a joke because, again, I was just there all day, did a delivery, everything was fine, and they’re like, “Melka is coming in at a ton of pain.” And they’re like, “No, she’s not. She’s fine. She’s like right over there.” 

 

They bring me in the room. I need three narcotics to finally get my pain under control. I called Giles. I’m like, “I’m in a lot of pain. I don’t know what’s going on. You should get here.” And he’s all flustered. He comes in. We do a sonogram. And I’ve got hydronephrosis, the tube connecting my kidney to my bladder is enlarged, so we’re all like, “Great. A kidney stone.” So, we call urology, go back on the floor. And again, you and Meredith and Giles are all in the room. I’ve now… 

 

Dr. Fox: I was technically your MFM consultant at the time. Meredith is like…Because we work with Meredith and [inaudible 00:20:34] all the time. She’s like, “Are you able to do a consultation on Melka?” I was like, “Yeah.” 

 

Dr. Melka: You’re like, “Done.” 

 

Dr. Fox: “You bet I can.” All right. 

 

Dr. Melka: And I remember sitting there and, like, watching the wheels turning in everyone’s head because I’m now on…I’ve gotten morphine. I’ve gotten IV morphine, IV dilaudid, and then IV fentanyl. God bless Venturi for being on call that night being a saint and coming in and, like, getting me somewhat comfortable. 

 

Dr. Fox: The anesthesiologist. 

 

Dr. Melka: Yes. 

 

Dr. Fox: Right. And I can definitely testify to the fact that it did not knock you out because you were quite potty mouth. 

 

Dr. Melka: Yes. 

 

Dr. Fox: If you ever dropped…it was an R-rated triage. Dropping F-bombs left and right. That’s how much pain Melka was in. 

 

Dr. Melka: Yes. Yes. 

 

Dr. Fox: It was pretty gruesome, I mean, to see someone in that much pain and also…First of all, I know that you’re not a complainer, right? You’re not gonna be complaining about pain unless you’re in terrible…Number one, you would never, you know, call me in, call Giles, call your doctor unless you thought, like, “I’m gonna die. I’m in really, really terrible pain.” And you could just tell, your writhing is just horrible. And so yeah, and that’s a tough spot to be in. 

 

Dr. Melka: In my mind, by the way… 

 

Dr. Fox: Go ahead. 

 

Dr. Melka: …I did censor myself once because I was about to say something, I’m like, “I can’t say that in front of Fox. That will offend him. That’s too dirty of a curse word for him.” 

 

Dr. Fox: I wouldn’t know what it meant. I don’t know. I’m too innocent. You’re at a different…You have like a Ph.D. in this and I’m like at a… 

 

Dr. Melka: I know. I have to teach you about it. 

 

Dr. Fox: …at a high school level. I don’t know anything. So, I’m…Yeshiva education did not teach me enough in this regard. It’s hard. So, I’m just trying… 

 

Dr. Melka: At some point…I don’t know if we’re gonna delete this out or not, but… 

 

Dr. Fox: No way. 

 

Dr. Melka: They figure it’s a kidney stone and Meredith is like, “Great. Call urology.” Brittany Roser, the resident who was an intern at the time, pages this resident at home, gets her to come in. And the resident comes in and is like, “Oh, we see this all the time in pregnancy.” And I remember you and Meredith looking at each other, Giles looking confused. And I think I was like, “F off. No, we don’t,” or something like that. 

 

Dr. Fox: Like, “We might see this a lot, but not like this.” Yeah. We… 

 

Dr. Melka: I was like, “No.” 

 

Dr. Fox: Like, “Wrong. Next answer, please.” I’m trying to…Tell me, aside from being, you know, partially stoned on all the medication they gave you, what are you thinking? Is it pain? Is it fear? Is it, like, irritation that you know this is gonna, like, lay you up for a long time? What is actually swirling through your head at this time? 

 

Dr. Melka: When I… 

 

Dr. Fox: Because you know more than you should. 

 

Dr. Melka: When I first got into room 24, I remember in my mind, I was still, like, analytical about it and not scared, but I was like, “I don’t know what this is.” It’s not my appendix because I’m not throwing up more and it came on so quick. It doesn’t seem like preterm labor. Am I abrupting? But I’m not bleeding. Maybe this is what an abruption feels like. And in my mind, I’m like, and it’s not my kidney because I don’t have back pain. Because typically, when it’s a kidney stone or a kidney infection, it’s always back pain. And I think even when I was in the call room upstairs, I was like, hitting my back. I was like, “Are my kidneys okay?” So, I had gone through all that and I was like, “What is going on?” And then when I finally got in the bed and got meds, I was just like, “I’m done. You guys are here. You can figure it out.” 

 

Dr. Fox: Yeah. Just keep the fentanyl coming and I’m gonna outsource the… 

 

Dr. Melka: Yeah. And it was just… 

 

Dr. Fox: …the thinking to you guys. 

 

Dr. Melka: Yes. It was just an unbelievable level of pain. I can’t even explain it. And then I think I was getting more comfortable and I was falling asleep, and then I would wake up and, like, curse again. I think I remember Meredith being like, “Well, you seem a little bit better.” And in my mind, I was like, “I think I’m just snowed.” 

 

Dr. Fox: Yeah. Listen, obviously, it was very clear to anyone around that you were in a ton of pain. And it’s, sort of, the same thing. I know we were thinking the same things. “Well, what is this? Is it this?” And we’re going through the same things you’re gonna be going through until your brain wasn’t working anymore. But at a certain point, you do have to just relinquish this and say, “All right. It’s not me. I’m just gonna, like, try to sleep here and let these people figure out what’s going on.” Was that something that you were concerned about or you’re just like, “I trust these people, I’m done?” 

 

Dr. Melka: No. I had zero concern. 

 

Dr. Fox: Yeah. 

 

Dr. Melka: I mean, when I… 

 

Dr. Fox: Some people have a very difficult time with that, even if they’re not doctors. Some people just cannot give up that control over the situation to others. It’s hard. 

 

Dr. Melka: And I remember, like, that all, kind of, going through my mind and thinking like, “This is what it’s like for patients. This is really freaking scary.” Imagine if I had no idea what was going on. And, like, I can remember, like, you know, Diana, again, came in the room, put in my IV, like, drew bloods, like, the resident came in and, like, ordered whatever needed to be ordered. And I remember just thinking like, “I’m so happy everyone is here.” 

 

Dr. Fox: Right. It’s interesting because as doctors, we sometimes forget that because…I don’t mean as the patients, like, as the doctors. We, sort of, start thinking immediately like, “Okay. Is it a kidney stone? Is it appendicitis?” And we start going through in our heads and we’re, sort of, like, rapidly trying to process this, you know, “What is happening and what do I need to do?” But on the patient’s end, most of them don’t have that level of knowledge that you have. And so sometimes all it takes is for one of us to say to the patients, like, “You’re not gonna die. You’re gonna be okay. We’ll take care of you. And your baby is gonna be okay. I don’t know what this is, but I know what it’s not. And you’re both going to be okay.” 

 

And we sometimes forget to even tell them that and we just start going through, “Is it this? Is it this? Is it this?” And they’re thinking not, “What do I have?” but, “Is my baby gonna live? Am I gonna be okay?” And it’s one of these things on our end to really…we have to go back to the basics, like, what are people actually thinking about in that situation? And most of them are not poking their back to see if it’s a kidney stone versus an abruption. They’re like, “Am I gonna die?” because it’s such a horrible place to be, and that’s on us to remember to do that to reassure people. Okay. So, you’re in the hospital, and ultimately, we made…What was the diagnosis for our listeners? 

 

Dr. Melka: So, the next day, I get a CAT scan because they’re like, “Okay. It’s a stone. Let’s get a CAT scan. Let’s see what it looks like.” And on CAT scan, there’s no kidney stone. There’s now fluid around my kidney. So, we like to say my kidney exploded. 

 

Dr. Fox: Kaboom. 

 

Dr. Melka: And it was basically my uterus compressing my ureter, which was preventing the kidney from draining fluid. I don’t know if I ever told you this. While I was in radiology, I was…or as I was going down, I texted a patient of ours that I delivered who was a radiology resident at the time and I was like, “Hey, I’m pregnant. I think I have a kidney stone. I’m getting a CAT scan. Are you around?” And she came over and is like, “What the hell is going on?” And then I get the CAT scan and she comes over to me and is like, “Hey, the attending is reading your films now. Do you wanna see it?” So, I’m like, “Sure.” So, I’ve now got the IV pole, the hospital gown, walking into the radiology reading room and I go, “Hey, there’s a baby in there.” And they all just look at me and I’m like, I don’t know, I thought that was the funniest joke in the world. And I’m like, “Where’s the stone?” And they’re like, “There’s no stone.” I’m like, “What do you mean?” 

 

Dr. Fox: “Your kidney exploded, ma’am.” 

 

Dr. Melka: Yes. 

 

Dr. Fox: Someone put a grenade inside your kidney. So, on the one hand when the diagnosis is made, was that a relief to you that at least you know what it is, or was it scary or just, like, cool? 

 

Dr. Melka: Just, whatever. 

 

Dr. Fox: Yeah. Of course. 

 

Dr. Melka: It was just, like, a name to this thing, and okay, now what? 

 

Dr. Fox: Yeah. That’s the thing that we always talk about, like, your biggest risk factor is being an OB, like, of course, something crazy is going to happen to you. 

 

Dr. Melka: Yes. 

 

Dr. Fox: I mean, we see this complication definitely less than once a year. So, it’s less than once in a thousand. And, of course, you have it. 

 

Dr. Melka: Yes. 

 

Dr. Fox: And ultimately, what did you need at that point? 

 

Dr. Melka: So, I needed a nephrostomy. So, then the urologist, Neil Grafstein, who was wonderful, comes in, Giles is there, and he’s like, “All right. Two…” 

 

Dr. Fox: And you know Neil. 

 

Dr. Melka: Yeah. I had worked with him as a resident, so I knew of him peripherally and I’m like, “Oh, yeah. I did a case with him when I was a chief. He’s great. Okay. Whatever.” 

 

Dr. Fox: Yeah. He’s a good dude. 

 

Dr. Melka: Yeah. He was wonderful. He’s like, “So, we could do a stent, you know, and put a little tube in the ureter and it’s gonna cause some discomfort and you’ll probably gonna have spasms and need to be on pain medication, but it’s there. Or we can, you know, basically, put a tube through your side and drain your kidney into a little pee bag for a couple of weeks. And that’s…You’re gonna be fine. People tolerate it really well, but you have a pee bag out of your side.” And I was like, “Sign me up for the stent.” And he’s like, “Well…” He’s like, “Look, I’ll do either, but you really should…” whatever. And then he’s, like, talk about it. And he leaves the room and Giles looks at me and is like, “You remember when we said that you were gonna listen to your doctors?” And I was like, “Fine.” 

 

Dr. Fox: So, for our listeners, assuming everything is…Well, we have two kidneys, one on the right, one on the left. They’re, sort of, in our back. And what was proposed to Melka is they’re gonna basically take her to the radiology suite, give her some, you know, numbing medicine, but basically, poke a tube through the skin in her back, through her back… 

 

Dr. Melka: Into the kidney. 

 

Dr. Fox: …into her kidney, leave it in there, and then basically attach, like, a little hose to that thing to drain into a bag that is strapped to her leg, essentially, for the next, I don’t know, two months or so. And so your right kidney is draining into a bag and your left kidney is still working. So, you still do pee also. 

 

Dr. Melka: Correct. Yes. 

 

Dr. Fox: Right. So, you get double whammy there. And that’s just gonna be there. And that was the plan. So, how did that go? 

 

Dr. Melka: It went really well. Friday that they scheduled the case for, Rocco, who’s my anesthesia friend who’s been like a good friend since med school and is like… 

 

Dr. Fox: It’s her birthday today, isn’t it? 

 

Dr. Melka: It is. 

 

Dr. Fox: Yeah. Happy birthday, Rocco. We love you. 

 

Dr. Melka: She’s like my personal anesthesiologist. She’s doing the procedure. And when she’s talking to me about it, I, again…and like, this is like the fentanyl haze I was in. I was like, “You should have one of the OB anesthesia fellows join you because they need cases that aren’t deliveries.” And because I, like, had that conversation with, like, Balen [SP] and Zahn [SP] two weeks ago and I’m like, “Why is my mind going to this stuff?” We go to IR. And again, it was the same thing. The fellow came and is like, “So, I have to talk to you about the risks and benefits.” And I’m like, “You know what? I don’t know that much about this. Go for it.” 

 

Dr. Fox: Right. Pretend I know nothing. Yeah. Pretend I know nothing. Yeah. 

 

Dr. Melka: So, I’m in IR and like… 

 

Dr. Fox: Interventional radiology. 

 

Dr. Melka: Yes. 

 

Dr. Fox: Yeah. That’s the radiology suite. Okay. 

 

Dr. Melka: So, basically, they do, like, a CAT scan again and look and they give me, I think, IV Versed. Something where I’m just, like, happy and sleeping. And then they numb the skin. It’s like, bottom of my, like, rib cage on the right side. 

 

Dr. Fox: Yeah. On the back. Yeah. 

 

Dr. Melka: And then while they’re doing x-ray, basically, like, jab in a giant needle and then put a little tube in, and then pull out the needle and the tube stays. 

 

Dr. Fox: Right. It’s almost like an IV, but instead of going into a vein, it’s going into a kidney. 

 

Dr. Melka: Into a kidney. 

 

Dr. Fox: Yeah. 

 

Dr. Melka: Yes. 

 

Dr. Fox: Well, conceptually, it’s the same thing we do for a lot of things, but it has to be, you know, make sure you get in the right spot. 

 

Dr. Melka: Yes. 

 

Dr. Fox: Okay. 

 

Dr. Melka: So, then I’m there thinking, like, “Yeah.” When we talk…It was fluoroscopy, so it’s the fancy radiology stuff. I’m like, “This is like the real deal, like, radiation that you tell people, like, “Yeah, if you had to get it like once or twice at a pregnancy, it’s probably fine.” And I’m like, “And, of course, I’m laying here right now. What the hell?” 

 

Dr. Fox: Right. Right. Yeah, I know. The fear with fluoroscopy, it’s a lot of…it’s live x-raying and so there’s more radiation exposure to the fetus. Generally, it can be done in a way that’s safe, particularly if it’s in your kidney and this, but yeah, I need to talk about it. You wouldn’t do it, you know, for no reason whatsoever. But the alternative is really there is no alternative. I mean, because, yeah, we could deliver the baby at 33 weeks and that’d relieve your kidney, but then you have a preterm child and there’s a risk to that too. And so it’s tough. And when we were speaking about this saying it’s a hard situation, and afterwards for your recovery, that was an interesting thing about whether you go to work or not. And I remember that was…you eventually had to just give up. 

 

Dr. Melka: So, yeah, the procedure went fine, I went back upstairs. And it was amazing, like, I got off fentanyl right away. That area was a little bit sore, but I was like, “This is great. Okay.” And then, like, the next day, like, it was Meredith on call again and is like, “You’re taking off work next week.” And I was like, “I don’t want to.” And then she’s like, “Stop it.” 

 

Dr. Fox: “I wanna go to work.” It was a Thursday night when you were on call initially, I think. 

 

Dr. Melka: Wednesday night. 

 

Dr. Fox: Wednesday night. Right, right, right. So, this is… 

 

Dr. Melka: Because I used to do Wednesdays and then the procedure was Friday and I went home Saturday. 

 

Dr. Fox: Yeah. Okay. 

 

Dr. Melka: It was actually Bender as the voice of reason that’s like, “You have a tube going into one of your organs. You are not setting foot in the hospital and getting MRSA or God knows what until you’re ready to deliver. And I was like, “But…” And he’s like, “Stop it.” 

 

Dr. Fox: Right. Enough. 

 

Dr. Melka: Yes. Pretty much. 

 

Dr. Fox: Enough, young Melka. 

 

Dr. Melka: Yes. And again, I was like, “All right, fine. I know.” 

 

Dr. Fox: Yeah. And I remember because we had that conversation and you’re like, “Listen, I just…Meredith doesn’t…” I was like, “It’s not Meredith. Just don’t work.” 

 

Dr. Melka: I know. She doesn’t…Yes, I am out of my mind. You know this. 

 

Dr. Fox: Right. It’s a good point. Or you’re in your mind, but your mind is off. I mean, eventually, you…After it was like three weeks you were in the office, you would see some patients. 

 

Dr. Melka: I went back to the office. I think I worked like 8 to 3 or something, so that way I could drive in and out without, like, a ton of traffic. Because I also told Meredith, I was like, “I’m not staying home. I feel fine. What am I gonna do? Like, sit at home and do nothing for seven weeks now?” So, yeah, I just sat in the office and I would see patients. 

 

Dr. Fox: Did the patients know that this had happened to you? Could they see your pee bag? 

 

Dr. Melka: They couldn’t. So, the beautiful thing about maternity clothes, because they have that, like, big elastic thing that goes all the way up. You could just tuck the bag in the side and just sit there and never knew. 

 

Dr. Fox: Wow. 

 

Dr. Melka: There were a few patients that I told because, like, I was supposed to have delivered them, and then we had to cancel. I think you ended up delivering one and she was, like, worried about me. And then she’s like, “Are you okay?” And I said, “Yeah.” 

 

Dr. Fox: And say, “Why aren’t you worried about me? I’m delivering you now instead of Melka. I could be home with my family. You’re worrying about the wrong person. She’s at home having a Pepsi.” No, no, no, no. We worry about Melka. 

 

Dr. Melka: Of course. 

 

Dr. Fox: What was it like shifting from, sort of, a pregnant patient to “now you’re a high-risk patient,” all this stuff going on, your people worrying about you, seeing all these specialists? Was it just like whatever? 

 

Dr. Melka: It was just, sort of, like throw my hands up in the air and I was like, “Whatever.” 

 

Dr. Fox: You’re like, “Of course, this is gonna happen to me.” 

 

Dr. Melka: Yeah. And then, like, I think when I was seeing Grafstein, and he’s like, trying to figure out like, “When do we take it out? What imaging do we do?” And he was, like, asking me something. I’m like, “Whatever you want. I don’t care.” 

 

Dr. Fox: “I give up.” 

 

Dr. Melka: I think he, like, felt bad and wanted to try to take it out sooner, but what if it wasn’t ready? I’m like, “I appreciate it, but I don’t care. Whatever you want.” 

 

Dr. Fox: Yeah. Whatever is best. And then at what point did you deliver? 

 

Dr. Melka: Forty-plus weeks. 

 

Dr. Fox: Wow. You went all the way to your due date. 

 

Dr. Melka: I did, which was also funny because I remember some of you guys…I think, where Barber was like, “I will just deliver you at 37 weeks. Like, you have a tube.” And you were like, “No. Why? You could wait.” 

 

Dr. Fox: Yeah. 

 

Dr. Melka: I had asked early on, like, “Could I just have a scheduled section?” They were like, “Yeah, we would.” But then by that point, I’m like, “Yeah. Let me just not do that.” 

 

Dr. Fox: Right. Right. No. I mean, it’s one of these things where there isn’t a right or wrong answer. Yeah, you can get delivered a little bit earlier. And it’s probably fine for the baby and it’s probably fine for you, but there’s a little bit risk going earlier. And you can wait longer and it’s probably fine for you and probably fine for the baby, but there’s a little risk on that end too. And ultimately, you were doing really well and you wanted…it did increase your chance probably the vaginal delivery waiting a little bit longer. And it worked out. 

 

Dr. Melka: I will say… 

 

Dr. Fox: And in retrospect, it was the right decision. 

 

Dr. Melka: Yes. When I was admitted, one of my friends at Sinai had texted me and said, “I’m really sorry. I noticed your name on Epic. Is everything okay? Can I do anything?” And I was like, “Oh, boy, let me tell you what’s going on.” And apparently, when the residents signed out each morning, they never said it was me. So, like, half of the labor floor didn’t know it was me on Thursday until I’m, like, getting wheeled through on the stretcher going down for CAT scan. Everyone is like, “What the hell?” 

 

Dr. Fox: Right. You’re just…Yeah. 

 

Dr. Melka: “Wait. You’re the one in 24?” 

 

Dr. Fox: Right. You’re just SM, 33 weeks, with the right pain. 

 

Dr. Melka: Yes. So, actually, it really did speak to people, like, you know, honoring my privacy and not, like, you know, talking or anything. 

 

Dr. Fox: Right. And then how did the labor and the delivery go? 

 

Dr. Melka: Oh, God. Very long induction. Induction started at midnight, and then I delivered 27 hours later by forceps after pushing for an hour-and-a-half, which, again… 

 

Dr. Fox: [crosstalk 00:37:36.174] Yeah. 

 

Dr. Melka: …when somebody asks, “Can I have a scheduled C section?” they will always end up with a long labor and long pushing and forceps. 

 

Dr. Fox: Right. But it is poetic that you were delivered by forceps because it’s one of the things you do yourself and so, bring it. 

 

Dr. Melka: Yeah. 

 

Dr. Fox: Yeah. Okay. But that’s great. 

 

Dr. Melka: And again, like in labor, I was just like, “Okay. Whatever.” Towards the end, I was like, “How low is the head?” And I think Michelle Silverstein who delivered me, like, kind of knew what I was getting at. And she was like, “It’s almost low enough if I had to.” I was like, “Okay, good. That’s all I need to know.” 

 

Dr. Fox: That’s great. And so tell us about your baby. 

 

Dr. Melka: So, Allison is now…She’ll be 3 in March. So, I don’t know when this episode is gonna air, but… 

 

Dr. Fox: Probably March. 

 

Dr. Melka: Great. 

 

Dr. Fox: She is, like you, a loquacious young lady. 

 

Dr. Melka: Yes. Getting ready for delivery, you know, one of the things we’ve talked about is how are you feeding the baby, are you breastfeeding or whatever? And I, like most people, was like, “Well, of course, I wanna breastfeed, but let me see what happens.” And as I was going through all of this and it was just becoming, like, worse and worse, I was like, “Now I understand why people really wanna breastfeed.” It’s something normal about an entirely miserable process. 

 

Dr. Fox: Right. It just, sort of, brings it back to, like, “Okay. This is how it’s supposed to be,” in a certain way. And so you deliver, forceps, Allison is healthy, everything is good. How long was that sucker on your kidney? 

 

Dr. Melka: Came out about a week later. 

 

Dr. Fox: Yeah. And then after that, did you basically feel, like, normal, I mean, I guess, like any postpartum woman would? I mean, your kidney was fine? 

 

Dr. Melka: Yes. Yeah. No residual problems. Had a sonogram a couple of months afterwards. I did sleep pretty well when I had it because half of my urine was going in a bag, so I didn’t have to get up and pee every three hours overnight, which was nice. 

 

Dr. Fox: Pretty cool. 

 

Dr. Melka: That was the only good thing about it. 

 

Dr. Fox: Yeah. All right. That’s an interesting…that’s a good sell. After the nephrostomy, the fancy term, the kidney tube, after it came out and you’re in your postpartum period, number one, what do you think about coming back to work after that point? Because now you’ve worked while you’re pregnant. You were really, you know, like, military in a sense. And now you’ve delivered. Did you feel like, “I need to come back really soon?” You’re like, “I’m just gonna, you know, take my time with my daughter.” What was your thought process initially? 

 

Dr. Melka: Take 12 weeks off. 

 

Dr. Fox: Twelve weeks. 

 

Dr. Melka: I was like, “I’m gonna do that. That’s the most I can take. I’m gonna do it.” And then I think around week 10 or 11, I was like, “I’m kind of ready to go back. I miss people.” 

 

Dr. Fox: Yeah. Right. 

 

Dr. Melka: And, like, work is part of who I am. And I was like, “Well, she’s great, but, like, a 10-week old does nothing but like eat, sleep and poop.” 

 

Dr. Fox: Yeah. I mean, I have friends like that also, but…Okay. So, looking back at this whole experience, I’m curious. The first thing I wanna ask you is, you’ve had this experience yourself as a doctor, as a mother, you know, complicated pregnancy, and fortunately, everything went well, but it was certainly quite rocky and more “exciting” than you thought it would be. The fact that you’ve had, A, a pregnancy and delivery, and B, sort of, a more complicated one, how does it affect the way you treat patients now? Does it affect it at all? Do you feel any different about how you treat patients compared to maybe before you got pregnant? 

 

Dr. Melka: I think it’s made me a lot more sympathetic. But I think early on I had a little trouble connecting with patients, and now I have something concrete. And I also get why very minor things are very frustrating. People who are like, “Oh, I can’t exercise the way I used to,” or, “Oh, I’m not sleeping that much and now I have to sleep more on the weekends.” I used to just say like, “Oh, whatever, that’s pregnancy.” Now I’m like, “Yeah, that’s pregnancy, but I get it. It really sucks.” 

 

Dr. Fox: Do you find that the patients feel the same way, like, they feel a stronger connection because you’ve been through this or is it just a way for you to, sort of, you know, reach out to them and connect to them? 

 

Dr. Melka: Yeah. I think it’s just more me reaching out and connecting. I sometimes feel weird if I’m bringing in too much of my own experience because I don’t want them to think I’m, like, taking it over and making it a comparison. One thing, for example, is forceps. I’ve done a bunch of them in the last couple of months. And after the delivery, I’ll always say like, “Oh, my daughter was born with forceps.” Then they’ll go, “Oh, that makes me feel so much better.” And I was like, I don’t wanna say that beforehand because I don’t want it to seem like it’s like… 

 

Dr. Fox: Right. “Because it was fine for me, it’ll be fine for you.” 

 

Dr. Melka: Exactly. Yeah. 

 

Dr. Fox: I had this conversation with one of our “Healthful Woman” podcasts with Steph Lam [SP] about, you know, this concept of as a doctor, is it better to have that personal experience, is it neutral, or is it worse? It’s like we never expect our oncologists to have, you know, survived cancer in order to be good oncologists, right? One has nothing to do with the other. And so does having an OB who went through pregnancy, is it better, neutral, or sometimes potentially worse? And I think it really just depends on the attitude. On the one hand, I think there’s an advantage because, again, you can have that, sort of, personal empathy, like, “Oh, I know what you’re going through. I went through that.” On the other hand, it’s not like you need that in order to empathize. 

 

But I do think that some people take it to a degree where it makes it worse, where, you know, as a patient, you’re like, “Dude, your pregnancy is not mine. Just because it worked out well for you, it doesn’t mean it’ll work out well for me, or just because you weren’t afraid of something it doesn’t mean I won’t be afraid of something. And, like, enough about you. It’s supposed to be about me.” And I think that, again, it’s really on us as doctors to be balancing how much we share and, sort of, try to, you know, connect in that sense versus how much we not stick our business into her pregnancy. And I’m not saying I know what the right balance is, but it’s always interesting in that sense. 

 

It’s mostly unique to women OB/GYNs, but even for me, like, you know, sometimes we’ll talk about my wife’s pregnancy and I don’t have the same symptoms but I, sort of, say like, example, “My third was also born forceps.” And I do tell people that. I say, you know, “One of my kids was born forceps.” And I think, you know, just to, sort of, give a sense that I trust them that I think that they’re, you know, safe and that it can be done. But I think that is a really interesting aspect about being an OB and then being pregnant during everything. And I’m also curious, if you had to go back, right…So, now you’re three years older, you have a 3-year-old daughter, you’re three years more mature, you’re three years more senior. Would you’ve done anything differently yourself, you think, during that pregnancy, you leading up to it or during that, maybe, you know, compared to before? 

 

Dr. Melka: I don’t think so. 

 

Dr. Fox: All right. You’re about the same. 

 

Dr. Melka: Yeah. 

 

Dr. Fox: Excellent. Melka, thank you so much for coming on, telling your story. 

 

Dr. Melka: Thank you for having me. 

 

Dr. Fox: I know it, I was a part of it, and it’s awesome, and I’m sure our listeners will appreciate it. If you are interested in telling your birth story on our podcast, please go to our partner website at www.healthfulwoman.com and click the link for sharing your story. You can also email us directly at hrbs@highriskbirthstories.com. If you liked today’s podcast, please be sure to check out our “Healthful Woman” podcast as well where I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. Have a great day. 

 

The information discussed in “High Risk Birth Stories” is intended for informational and entertainment only and does not replace medical care from your physician. The stories and experiences discussed in our podcasts are unique to each guest and are not intended to be representative of any standard of care or expected outcomes. As always, we encourage you to speak with your own doctor about specific diagnoses and treatment options for an effective treatment plan. Guests on “High Risk Birth Stories” have given them permission for us to share their personal health information.