My baby boy Leo was stillborn in October last year at 25 weeks +1, and soon after I was told he had gone, the thought of having to go to work again, which popped into my mind as I lay on that ultrasound couch in my initial shock and numbness, was horrifying and terrifying. I thought, ‘how on Earth can I possibly do anything remotely ‘normal’ ever again now? My world as I knew it had just come crashing down around me, how could I just slot back into a ‘normal’ existence after this? Until the bereavement midwife had talked to me, the morning after I gave birth, I had no idea that I was entitled to a full Maternity Leave since Leo was over 24 weeks gestation. With hindsight I can say, why would I have known this information anyway? I wasn’t planning on my child being stillborn. She advised me to confirm this was the case with my employer (which I did, by phoning the HR department; which sounds so easy but in the days after losing a baby was so very difficult as it meant I had to say those words out aloud that my baby had died, which I could hardly believe myself) but yes I should be entitled to a year of Maternity Leave just as if my baby had been born alive. To say I was relieved to hear this would be an understatement. It was as if this knowledge had lifted just a little of the heavy sadness and tremendous pain by me knowing that work could stay furthest from my thoughts and worries where I wanted it to be at that time so that I could begin to comprehend what happened, grieve for my son and work out how I’m supposed to carry on without him now. I’d carried my baby and given birth, been dangerously ill for many weeks of my pregnancy (I developed pre-eclampsia at around 19 weeks), and my baby had died- damn right was I entitled to Leave. Fast forward to April this year; my husband returned to work to a new posting after taking a couple of months out of his programme (he’s a doctor training to become a Consultant). He’d already attempted to return a month after Leo died however in hindsight this was too soon; being at work and trying to function normally was becoming more difficult rather than easier, not helped by the particular post he was in at the time, and so with his own health and developing career in mind he took that much-needed time out before feeling ‘ready’ to start again, stronger and well-supported. At this time my husband had encouraged me to think about what I may do, how I might plan my own return to work in the coming months, and my first step was to have a read through my employer’s Maternity Policy, which my manager had emailed me during my long stay in hospital before Leo died. I’m a Clinical Pharmacist in a hospital; and had not worked since a month before Leo’s death due to the pre-eclampsia developing and eventually being admitted to hospital at 21 weeks. My husband was amazing and had continued to work throughout this period, as well as looking after things at home and coming to see me, looking after my needs whilst I was in hospital for a month, and dealing with the ups and downs of my condition which was difficult to stabilise sometimes. A close female colleague, who had suffered a difficult time around labour and been very ill herself, had been keeping in contact with me since she knew I was in hospital, texting frequently to see how I was doing (still does to this day). I actually went to see her and her little girl about a month after losing Leo; she’d just returned to working part time after her Maternity Leave and so we arranged to meet on a day she was home. She’d offered her support after Leo died and was keen to meet up whenever I felt ready. This was an important thing for me to do, as she, apart from my manager, is the only colleague, whom I now also class as a friend, who has been there offering genuine support and understanding throughout my illness, loss and subsequent grief. I found it was lovely to see someone like this who I knew from work, but to meet as friends, which is all I needed at that time; it wasn’t about work, it was someone reaching out to me, who wanted to let me talk, wanted to listen, and help her understand what had happened to me and my precious Leo. I found it incredibly touching, and realised that after a tragedy such as this, you find out who truly cares about you, and that they may not turn out to be those who you expected. This colleague’s true kindness and compassion is something that I will value forever. Whilst in hospital I was also keeping in touch with my manager by email, giving her progress reports and sorting essential maternity paperwork by post or email; she came to Leo’s funeral with her husband (she was my mentor for my qualifying year several years ago in the same hospital and they attended my wedding some years after that); she was undoubtedly moved by the loss of Leo. So after reading the Maternity Policy and also contacting my colleague friend, I learned what the schedule was for maternity pay as the months go by; basically you get a couple of months full salary but it gradually goes down so that after 9 months you are no longer paid anything. This, I thought, would be a milestone to aim for in terms of planning my return- I knew that after July, I’d be getting nothing, and so I should coincide this with phasing back somehow; at that moment I didn’t know how, but I knew that it made sense because I didn’t want to be in a position where I wasn’t bringing in any salary at all and watch my husband carry it all; plus I thought it would be the right time to put my little toe back into the water and take some gentle steps, as I didn’t know how it would go, how I’d find it, and I’d have a chance to hopefully join back at a gradual pace not just jump back in as if nothing had happened, and it would take me up until the one year mark at the end of October. I knew I’d have to do it gradually as that was the only way I could see it would work. To think of just turning up and picking up where I left off after so long, after the terrible things I’ve been through, and what I have to learn to live with each day now, there’s no way I’d have considered that. Yes I knew I had to return to work one day, even though it was the last thing I wanted to do- in fact my priorities changed since I got married and began trying for a baby – making a home and family had been the most important thing to me since then, and right now following my loss I feel this more than ever. I see work now as a necessary evil, rather than something I was excited and very enthusiastic about when I first qualified as a pharmacist several years ago; it is part of ‘moving forward’ through this journey which I couldn’t delay forever, and I had to do it my way, so that I could stay in control. I’d read about the Keeping in Touch (KIT) days which you are entitled to as part of Maternity Leave i.e. you can work for 10 days, without it affecting your Maternity rights. I thought the KIT days sounded like a good way of being able to start stepping back and getting exposure to the work environment again, being paid for each session at my usual rate, yet still not being ‘officially’ back, so colleagues would be aware that yes, I have to do this gradually and it’s not like a ‘normal’ maternity leave after which some colleagues did not even take their KIT entitlement. Anyway, I didn’t have a growing baby at home after all (I often think how things should all be so different now…) and it seemed like the KIT sessions were a perfect opportunity for someone in my situation who has been coming to terms with the loss of their child over the past months, and who is trying slowly but surely to regain some semblance of ‘normality’ into their life. Besides, although I was very skilled at keeping myself busy, I was running out of significant tasks to do in our home after all the improvements and decorating we did, all the wardrobe sorting, draw-tidying, clearing out, cleaning jobs , and general ‘nesting’ I was able to undertake over these months. I emailed my manager in May; this was shortly after I’d had the ‘all-clear’ to try to conceive again from my renal consultant; this was yet another milestone and so I felt ready to take the step of contacting her and arranging to meet up. I didn’t say specifically to discuss returning, I just kept it open as I thought it would be an achievement to actually be able to meet again and have a chat. I knew I wouldn’t be able to go into the department at that stage; I’d have to do it in little steps and asked if we could meet in the Coffee shop within our hospital, which she was happy for. I was nervous and anxious to say the least, about meeting, as the last time had been at the funeral and work had been the last thing on my mind in those early months; I felt like a different person, not that Pharmacist any more, but Leo’s Mommy; I’d got another identity and the thought of me trying to be that other person again one day soon, the ‘old’ me who spent 37.5 hours a week plus the on-call duties working, was something I found and still find very worrying and daunting and wondering if I will ever get to that, or even if I want to get to that again; certainly the on-call aspect can wait, to put it politely, maybe forever, as I’ll have climbed 10 more mountains once I am simply managing to do my 37.5 hours again… I felt apprehensive and shaky, my heart was beating fast as I made my way to the hospital and waited for my manager, but once we greeted each other and sat down with a drink, started to chat, it was ok; I’d go as far as saying it felt easy being there talking to her, or that her nature and understanding made what was a difficult task for me feel as relaxed and comfortable as possible. It was like having a counselling session or talking to someone who had been through this themselves, like she knew, she got the fact that the psychological barriers for me regarding returning to work were an enormous thing; she likened it to something akin to Post-Traumatic Stress Disorder, which I thought yes, that’s actually a very good comparison, that’s what it’s going to be like for me. We got onto the issue of my return, and I broached the KIT days; telling her I was hoping to start doing something in August. She agreed it was a good starting point and she’d think how they could be structured. She advised I’d need to see Occupational Health, which she’d book for me as a manager’s referral, and that I should see my GP so that I’ve got the medical opinion as well on my proposed return. We agreed on those action points and that we’d ‘touch base’ again after these steps. Before I left, my manager asked how I’d feel about walking with her back to the department, just until the doors; I considered it was a yet another big step but something I should do, that I had to do, and not pass up the opportunity; so we walked around together, chatting about the department and staff as we went; I even came across, and said a tentative ‘hello’ to a couple of colleagues along the corridors, which I considered to be yet another ‘bonus’ achievement- I’d been worried, even scared perhaps, about actually meeting colleagues other than my manager, so for it to have happened ‘unplanned’ was probably the best way. As I left the hospital I felt an enormous sense of achievement and was on a high for a while after. In the meantime I saw my GP to discuss my intentions; they agreed I seemed ready to take those steps and allowed me to explain what I felt the psychological barriers were and how I felt at that first meeting. I explained as I did with my manager, that as well as not having being there for some time and having zero confidence, especially about trying to do my job again, and feeling totally vulnerable after what I’ve been through, and worrying about what colleagues will think, what their reactions are, whether I will have a break-down when I’m back in the environment. This was the hospital where I was failed by the antenatal and foetal assessment clinic; they failed to respond urgently when I presented with severe pre-eclampsia at 20 weeks, and perhaps my baby would have lived in the end had they not messed me about for those 2 critical weeks, losing precious time to intervene, before I was admitted through an out-of-hours GP… This was the hospital where I was becoming dangerously poorly whilst still trying to work because antenatal refused to recognise my condition; this was the hospital where I’d had a threatened miscarriage (the second one during my pregnancy), colleagues around me oblivious to the blood pouring out and running round to A&E by myself; this was the hospital where I’d spent 2 weeks as an inpatient before being moved to specialist care as the doctors there realised they weren’t able to look after me and my unborn baby any longer… does that explain my psychological issues about returning to work there…?... The GP also advised me to meet some colleagues outside of work such as coffee or lunch as a bridge before seeing them in work again, particularly those I was closer to, as they would be the ones I would lean on most when I am back; and she advised that the approach of a gradual return was right. She suggested reading a little professional material whilst at home to help mentally prepare for being in the clinical environment again, so I wouldn’t just be jumping in. Also she suggested I should start working again before becoming pregnant again ideally as this will mean I have more positive balance in life again rather than becoming consumed by one thing only. I thought it was all sound supportive advice, which I would definitely take on board, and felt reassured that she agreed I was ‘ready’ for getting back to work. Next I saw the Occupational Health nurse, which formed my ‘Risk Assessment’ towards returning to work; she offered practical advice such as doing a couple of ‘informal’ visits into the department, lasting around an hour, just to get me through the doors and break the ice, to get that first time over with; she suggested to take in some biscuits, cake, anything like that, to leave in the tearoom and just get some ‘hellos’ over with and begin sensitising myself to the environment again. She told me that to everyone there, what happened to me would seem like a very long time ago and far from their minds, even though to me it is very recent; but it will help me with re-integrating as well as them appreciating that I have thought of them despite my circumstances. The nurse seemed to understand my predicament and gave me chance to tell my story and how I was feeling about the prospect. She reassured me I could come back to see her whenever I felt I needed to, if I should need further psychological support etc. She later summarised the outcome in a letter for my manager and forwarded it to me also. I had arranged to meet a few female colleagues for lunch in the canteen after this appointment on the same day; this came about as my colleague had texted the evening before asking how I was, so I jumped on the opportunity there and then to ask her if she and a couple of other girls would like to meet me the next day seeing as I was coming in. I surprised myself with my spontaneity and felt like I was moving in leaps and bounds suddenly; it made me feel slightly uncomfortable and overwhelmed yet at the same time extremely pleased with myself; I figured it was meant to be, and that I should just keep going with it as I was going in the right direction. As the Occupational Health nurse had said would happen, at that moment I knew I had encountered the ‘snowballing’ effect. As I stood and waited for my colleagues to appear in the canteen, I felt quite vulnerable there on my own with the rest of the world (i.e. staff) getting on with normal life around me, having lunch, chatting together, and I realised how far away from all this I felt; I was looking back at my old life and at that moment it felt plain weird and scary. I had grown used to the protective bubble of my home and family and memories of Leo surrounding me, and this was suddenly ‘unsafe’ ground where I was open to attack. I saw a couple of staff from my department and my instinct was to move and hide from them as I felt I couldn’t cope with speaking with them, although I gathered the strength to stay where I was and allowed myself to meet eyes with them; it was fine and they gave me a hug, we exchanged a few words; they’d heard I was thinking about coming back and I briefly explained how I was feeling about it all, and they went on. I didn’t get ‘‘I’m so sorry what happened’’ from either of them, and I realised very few people will mention my loss and that it’s down to me to ‘remind’ them or give them ‘permission’ by talking about it myself or saying Leo’s name so they know this will never go away. After that encounter, still whilst waiting for my colleagues for lunch ( I was a bit early), to my disbelief I met a registrar from Obstetrics who had seen me a few times during my pregnancy; she didn’t know I’d lost Leo and I had to summarise what had gone on. She was genuinely sorry and sympathetic; I was glad to have met her although annoyed at the same time as I concluded that there had been no education from my old consultant within Antenatal about how they had failed me and subsequent events, otherwise surely she would have been well aware. Anyway I believed it was fate that I was meeting these people, and was pleased with myself that I hadn’t ‘hidden’ but instead ‘confronted’ them, I confronted some of my anxieties and fears. I finally met my colleagues and we had lunch together, chatting about all sorts; I couldn’t believe how good it was to see them, to interact like this, and they were really happy to see me again; there was four of us (including my above-mentioned friend) and it just felt so ‘normal’; for a change I didn’t feel like ‘the one who lost a baby’ and for a few minutes I felt like I was back being the ‘old’ me; I felt so much more confident just from those 45 minutes in their company. They allowed me to talk about what happened and about Leo and they realised I wanted to be open about everything and were grateful for this; I asked if they’d like to see Leo’s album which I had with me, for the two girls who I’d not seen since, so they both looked and became tearful, especially one of them who is a mother too. It helped their understanding and gave them a short insight into ‘my world’, I think it allowed them to be in my shoes for a brief moment, and it helped us all to see some of the ‘old’ me, to see that I am still that person they knew but just that I’m also now a mother who is experiencing the grief of losing her child at the same time. We agreed that we’d really enjoyed spending this time together and I’d be seeing them again soon; I told them my next step was to come into the department, and that no doubt I’d need their support! We parted on a happy note and I felt yet again like I’d achieved the impossible that day. Before my informal visit to the department, which I undertook about a week later, my colleague suggested it would be better for me to arrive at a quieter time i.e. after lunch about 2.30pm, as there would be very few staff, if any, left in the tearoom so I wouldn’t have to face a crowd. I took homemade cake with me, with a little note-card, and tentatively made my way from the car park into the building towards the department. I was ready, but felt very vulnerable as I used my pass-card and let myself in. The first area where computer benches are situated was quiet as most staff would have been in dispensary or out on wards, but there were a couple of faces and I said a quick hello. I headed for the tea room armed with cake and met the secretary and another couple of admin staff; they were really welcoming and pleased to see me, gave me a hug and asked me to sit down for a while, made me a drink, and had a good chat. They all appreciated my cakes and had some straight away; another colleague came in and I greeted them too. I thought, well this is ok, it’s fairly quiet as planned and told myself I could do this, I was doing it, and to carry on, I could leave as soon as I’d had enough or if it got too much. I felt nervous and my heart took a while to slow down, for me to compose myself and breathe normally. It was a strange and sad feeling to be in that same place where I had been pregnant the last time I had sat there. It was quite surreal and made me think, so much has happened to me, my world has been turned upside down, yet everything her e is just the same, ticking along as normal all this time… a very odd sensation… I felt almost like everything that’s gone on has happened to someone else not me, because there I was where I’d left off, everything looking normal, or like I’d been in some parallel universe, or like it was all a horrible nightmare perhaps… my manager had seen me on her way into the meeting room when I came in, and had invited me to go sit in there; I said to the secretary I wasn’t entirely certain about going in, especially if it was a room full of colleagues, as I could only deal with a few people at a time; she kindly went to check what the situation was for me, and reported that there was just a handful so I should be fine. I thanked her and went along to the meeting- it was my manager with a few Pharmacist colleagues discussing a current issue; I sat amongst them and said hello. It felt odd again, as if I didn’t really belong there, that I was a stranger, and that I had no interest in what they were discussing, like I didn’t really want to be there but back at home where I was safe. I also felt in general like I wanted to hide, which I knew just stemmed from the feeling of vulnerability. The thought that I should have been going in carrying my new baby proudly, showing him around, instead of bringing cakes and feeling like a scared child, sprung to mind. I also felt people would think ‘why has she been off on Maternity leave as she hasn’t actually got a baby’, and almost felt guilty for my absence… most probably not the truth but just my thoughts… Despite the minefield of thoughts and emotions, I was feeling very proud of myself still, and was encouraged at my progress, which I realised fully only after I had left, what an enormous and significant milestone I’d achieved. I managed to meet my close colleagues, who were all excited to see me back there again, and even sat down with a senior colleague whose rotation I was working in before I was sick; it felt really easy to chat to him and he disclosed that his sister had suffered a stillbirth, so he had some insight into the depth and meaning of such a loss. I was conscious of time as I’d been there over an hour already and prepared to leave, however some more colleagues saw me before I went and again I was able to talk with them for a few minutes about my experience and they seemed to have some understanding, which meant I felt comfortable being open about it all, which they appreciated; I showed them my necklace with Leo’s footprints on the pendant, which they admired. One of the ladies had had a premature baby due to pre-eclampsia in the later stages and so I think it touched her heart in particular as she would have been thinking about her own son, also a Leo, who fortunately she got to keep unlike me. I left the department feeling overwhelmed by the warmth shown by the colleagues I’d met during my brief visit; it helped to restore some faith in human nature and made me believe that some people do want to know and learn what this is like, and are aware of the significance of what I have gone through. I felt a strange sense of elation like I had done something huge- to me it was anyway, it was one of many hurdles which I had to jump, and which would allow me to progress further in this journey to the next step. I arranged to meet my manager again about three weeks after this visit so we could go over my plan for Keep in Touch days, and to give me another ‘informal’ visit to the department. In the meantime she had asked me to devise my own plan for these sessions, so as I could include what I felt I needed to, from my perspective, spreading the sessions to my own liking and to help me feel in control. I sat down with my diary at home one morning and came up with a schedule which was more of a guide to my Keeping In Touch time, rather than specific activities on specific dates which would be too rigid; it would then be open to amendment and finer tuning as necessary by myself and my manager and as I progressed through the sessions. I was sure to list everything that I could think of which in my opinion I needed to do in those sessions to help me get to a stage where I felt comfortable being back in the environment and in taking up my role as a clinical pharmacist again, at a pace I was comfortable with. There were a lot of very simple yet very important tasks for the beginning, which I did not want to overlook and which may have seemed silly to another person, but which for me meant I couldn’t progress further till those were done- things like sort out computer access and passwords, find my ‘clinical’ folder and other admin tasks like clearing emails, progressing onto working in the dispensary, and on to working on a ward again. Another key area was mandatory training, which every member of staff has to keep updated, so I needed to factor time in to book onto and attend such sessions or do any online training. My aim during these sessions was to get exposure to all aspects of my job, in both the settings of the Pharmacy department and out on wards, whilst gradually rebuilding my confidence being in these environments and around colleagues, as well as confidence in myself as a practitioner. My manager really appreciated me taking the time to put this together as there were things I’d listed which she would have probably underestimated the need to do if she was devising my plan instead. I also very much appreciated the opportunity to be able to do this myself as it showed her how far back to the beginning I needed to go to get myself back into my role and achieve it successfully but without going too fast and missing out basics. Part of this time would also require me to begin the mandatory dispensing and accuracy checking logs, which anyone who may be involved in such activities irrespective of the extent, needed to do after an extended period of leave like mine. So I visited the department again as planned, this time taking some chocolates with me for the tearoom. It felt significantly easier than before, as I was hoping, and I had a quick chat with a couple of colleagues before sitting down with my manager to review my plan. It was very helpful to do this as she answered a lot of my questions about the department and systems which I’d annotated on my plan. One of my questions was ‘which ladies are currently pregnant?’ I felt I needed to know this in advance in order to mentally prepare myself; as I figured it would be better for my psychological well-being to have warning rather than suddenly see a big baby bump (or several bumps) as soon as I started back. In fact, protecting my psychological well-being was really the main rationale behind the seemingly pedantic list of initial tasks and questions I had drafted in my plan, and my general apprehension about the whole prospect; so I had to do myself justice through my plans for Keep-In-Touch sessions, making the most of them in order to help myself, and my manager understood this. Going in for my first session finally was somewhat daunting and mostly it felt weird getting ready and going out to work again. I told myself it was just for a morning, and I could get straight home afterwards, and recover before my next one if it was terrible- the way I’d spread them out was such that they were every few days, at the start just one morning a week and slowly increasing towards my ‘official’ start date (1st November 2013) and end of Maternity leave. So I could get used to the routine of going in and being there, having a regular contact so it felt I was making progress, yet still having time at home in between so that I developed a balance I was happy with and could cope with well. My manager welcomed me, as did several other staff who I encountered after arriving. Some greeted and chatted with me easily, and warmly, mostly those who I had a rapport with previously; and some others seemed to find it hard to look at or acknowledge me at all, however the ones that mattered came forward, and were hugely supportive and understanding, which made such a difference to my anxieties about being back. It was a positive achievement and milestone, being closer to my ‘new normal’ yet at the same time I felt a lingering sadness, because this was my reality, however it should have been very different; I should have been worrying about leaving my new baby behind for the first time, not worrying whether I’d make it through a few hours at work without becoming a wreck and carrying the grief of losing them. I surprised myself with the way I progressed through tasks, right from that first day, and it started feeling more ‘normal’ the more I went in; my manager was occasionally checking how I was doing and feeling, guiding me along and suggesting what I might like to do next. I actually felt a relief as I was ticking things off, and I felt hopeful that I could do this, and that yes it would take time to work through all the mandatory training and assessments, but at least it would give me chance to do what I had to do without any demands from others on my time- once I was ‘officially’ back, this would change, but I wanted to make the most of this period and try to be as productive as possible each session that I did. I needn’t have worried about not remembering things when it came to the clinical part of my role, as this seemed to come naturally when I reviewed drug charts and outpatient prescriptions; even going around to A&E to discuss an issue with a doctor felt good as I just felt like the ‘old’ me and how I used to enjoy the interaction with the clinicians. It was more the practical bits which I was worried about, such as where something is kept in the department, getting my dispensing log started and without making errors and such like. When I shadowed a colleague on a ward for the first time I was ready for my chance to step back into a ward environment and it felt like I’d stepped right back into where I’d left off- as it did within the department, because everything was just the same as I’d left it… it also was a bit strange that no-one there apart from my colleague knew my hidden pain, and it was one of the many ‘firsts’ since Leo died that I’d had to overcome through this journey. As I was shadowing, it meant I had chance to absorb the atmosphere and ‘get a feel’ for it again, remember the routines and tasks involved in ward work and whilst sharing some of my colleague’s workload I could picture myself back in action doing the very same thing in the not too distant future. As I experienced different tasks and started exercising my clinical expertise again I felt relieved and encouraged because I was reminded of what ‘normal’ felt like before, of what capabilities are within me, and what I used to do, and what I can be- as well as ‘bereaved mother’ I was reminded of what else I actually was; that I belonged to this ‘outside’ world too not only this secret world of baby loss which I have been living in this past year (yet a private club which I’d be a member of forever) . I knew that through all of these steps I’d taken and through all that lay ahead, my very own little guardian angel would be right beside me, holding my hand, giving me the strength to go on. Lisa Raveendran Mommy to Leo Michael Raveendran, born sleeping 30.10.12.