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TRANSCRIPT:

Emily Silverman

You're listening to The Nocturnists, Stories from the World of Medicine. I'm Emily Silverman. Sometimes our emotions can feel like quantum states inhabiting multiple dimensions at the same time. We're sad, yet we're cozy in our sadness. We're excited, yet we're anxious and uncomfortable in our excitement. We're exhausted, yet we're exhilarated. In today's story, physician Tiffany Albrecht describes one of those moments when joy and grief washed over her simultaneously, leading to a catharsis so massive, it was almost funny when it was abruptly interrupted. After the story, Tiffany and I talk about what it looks like to navigate the extremes of life, from death to birth and everything in between, and ultimately, what it looks like to embrace the hope of a new beginning. Tiffany completed her residency and chief residency at the University of Minnesota and is now a med peds primary care physician in Inver Grove Heights. These days she's embracing her roles as doctor, mom, bonus mom, widow and wife. Take a listen to her story, Labor and Loss, which was performed live in Minneapolis in 2023.

Tiffany AlbrechtFluorescent lights in my eyes, blue scrubs bustling around me, blue drapes marking the sterile field, arms, voices hands, prepping my body for surgery. My baby and I, we've been working pretty hard for the last 18 hours. I feel the chill of the bags of IV fluids. And I'm nauseous, trying to get this baby out. I feel another wave of nausea. That sour sweetness and I turned my head to the side. I'm on the operating room table. There aren't that many options. There's a student nurse sitting at the head of the bed beside me and she holds out an emesis bag. It's blue, like the sterile field. Not so blue after I throw up. I tried to get the vomit in the bag, but most of it lands on my face. The student nurse takes a damp washcloth, wipes my forehead and then wipes the vomit off my face and as she's doing so, accidentally swiped some in my eye. I feel the sting. The miracle of birth. And through my blurry vomit-filled vision, I look towards the doorway and there's my sister, Jennifer. She's usually pretty fashionable in fact, she chose this outfit tonight. Right now she's in this ridiculously oversized blue jumpsuit, her hair in a bonnet, a mask on her face and even through that I can see in her eyes how horrified she is at the vomit and the eye situation that just transpired. She rushes over. Replacing the student nurse indignantly, sits down next to me, holds my hand, brushes my hair out of my face, whispering words of encouragement. My personal cheerleader. A blue drape comes up at my chest. A few seconds tugging, pulling, pushing so much pressure. I know what happens beyond that blue drape and I'm trying not to envision it too vividly, not really going to help that vomit and nausea situation. Then suddenly, I hear a cry. The blue dream comes down, and there in front of me is my baby. Leo. I've been waiting so long to meet him. It's two weeks past his due date. And finally we come in for this induction. Finally, here he is. Even through the nausea, the shaking, the pain, I can still feel myself smiling, seeing my baby. Jennifer leans down and says, Kurt would be so proud. I never imagined that I'd be giving birth to my second son as a widow. My husband Kurt was diagnosed with a brain tumor in January of 2021. What started as mild headache progressed to personality changes, and sudden episodes of vomiting. A week after New Year's we found ourselves in the emergency department. And when he came back from the brain MRI with both the attending and the resident, I knew that this wasn't good. The attending sat down next to me as the resident pulled up the images on the computer screen and there in front of me was Kurt's brain with a giant fluid filled mass occupying the frontal lobe. "Likely a glioma", they said, "an aggressive, incurable cancer." Kurt and I had always wanted kids. After our first son was born, Kai, we loved being parents. We loved the house full of laughter, daddy jokes, weekend morning snuggles. Ever since we were dating at 17 years old, we've been talking about family planning. After the cancer diagnosis, after two craniotomies, chemotherapy, radiation, and a recurrence in the brainstem, we started having different conversations about family planning. In the face of imminent death, we chose to embrace the possibility of life. And despite the medical teams warnings about the risks what might happen if we conceived while Kurt was on his treatments, we chose to stop actively preventing a pregnancy. A few months later, while we were moving to our new home in the middle of December, I missed my period. Yikes. I think this is what I wanted. I'm not really sure. I put off taking a pregnancy test. I went on to Amazon, bought a 20 pack of pregnancy tests that were shipping from China and bought myself a few extra days of blissful ignorance. Jennifer, who was in town to help me move, found out when she generously offered to buy some alcohol after getting home decor. She rushed to target in disbelief, bought a pregnancy test, came home, shoved her night into the bathroom and waited. In the bathroom, I looked up in the mirror and saw the man who I had married, just a little bit older, a little bit more tired. And as I placed the pending pregnancy test next to the sink, a pale pink line appeared below the control. We're going to have a baby. We smiled at each other in the mirror, joy filling our hearts. And then fear crept in. Would Kurt even be alive still to meet this baby? I pushed out the fear, letting the joy and let myself hope. So far, Kurt had exceeded his medical team's expectations. Who was to say he wouldn't live another nine months, or maybe even for years to come? Kurt and I held each other tightly, embracing the joy, hope, fear and doubt. We knew that together, we could face it all. The hope became harder to hold on to with Kurt's third recurrence. A year after the initial diagnosis of glioblastoma, the tumor had spread throughout his brain. Three months pregnant, I stood in our living room, Kurt sitting in the white sofa, our two year old son Kai standing next to him holding his stuffed animal Snoopy. Kai hopped into daddy's lap. And Snoopy hopped up daddy's shoulder, sniffing his nose and then sniffing daddy's craniotomy scar that traversed his scalp. Kai giggles, uninhibited by daddy's overall lack of expression. In the years since Kurt's diagnosis, I've been holding it together, rejecting the image of a helpless wife with a husband who was diagnosed with cancer. Once a colleague asked me, "How are you doing, Tiffany?" I answered, casually describing my life "Oh, you know, night shifts, parenting a toddler. Sometimes parenting a husband whose frontal lobe had rendered him somewhat like a teenager after surgery." My colleague looked back at me with concern, and in that moment, I realized how desperately I was clinging to the facade of being okay. Because if everyone else believed that was okay, then I had a chance of actually being okay. As my colleague asked more concerned questions, I quickly turned away. "You look busy and I gotta go bye." In the living room, watching Kai and Kurt, Kai leans in to give daddy a kiss and Kurt stares blankly ahead. Maybe the hint of a smile. The lack of emotion is heart wrenching. And I know in that moment that the man I married, the partner I chose, is slowly drifting away. Yet I channel my son, love his daddy, love my husband, I channel love, those parts of Kurt that are still there, so I can shield myself from the overwhelming grief. At least he's still alive. Some of him is still here. This isn't toxic positivity. This is doing what I have to do to hold things together.

Tiffany Albrecht

I put my hand on my belly and felt the kicks of our second son. Two months later, Kurt died in our home, his body in our bed. Our family washed it with lavender infused water, and I held Kai at the foot of the bed, his legs dangling around my pregnant belly. And we signed one last I love you to say goodbye to daddy. The funeral home came, placed Kurt's body in a quilt. And as they brought him out, they warned me, "You might not want to watch ma'am. This is hard for most people." But I knew I did. I wanted to be present as Kurt's body left this world. Life was put on pause. Grief pause, goodbyes pause, and I tried to press play, move on from the grief. The day after Kurt died, I ran a 5k, bringing Kai in his Hooked on Daddy shirt so he could run his first race. I went back to work the next week, answering caring patients questions about whether my husband was excited for this new baby boy, and how my husband felt about me still working when I was this far along in my pregnancy. I went to all my OB appointments, I got haircuts. I cleared out Kurt's closet, bringing a bunch of the items to Goodwill so I could replace them with baby items, diapers, wipes. I organized a tree memorial, hiked into the forest with my family, so we could bury Kurt's ashes at the foot of a maple tree. And that night, I crawled into bed feeling the emptiness beside me. Kurt's body no longer there. No more catheter to check on. No more shaking of the bed as Kurt tossed and turned at night or when he had a seizure. No more labored breathing. No more Kurt. Sometimes I'd cry. But often I wouldn't, I lay there feeling the emptiness. Wondering why it was so hard to feel the grief. Aren't I supposed to be losing it? Aren't I supposed to be this incapacitated widow? She can't take care of herself, let alone her family. I have to get this over with before the baby comes. I took step 1 before I did medical school rotations, step 2 before applying to residency, step 3 before becoming a real doctor, step incapacitated widow before having a baby. Right? But my body and mind had other plans. Grief on hold, life held together. In the operating room, fluorescent lights, blue sterile field. Jennifer had the head of the bed beside me. Kurt would be so proud. The nurses whisked Leo away and I can hear his cries from across the room as they placed him in the warmer. Scenes flashed through my mind of Kai's birth, Leo's birth, Kurt dying, memories filling that emptiness, that massive void that I felt since the moment that Kurt died. Now I know what I'm grieving. Now I know what I have to say goodbye to. Kai's dad, Leo's dad, my husband. Jennifer stands. "They asked me to go hold Leo", she says and I cling to her. "No, I need you right now." I need her to be with me. As I feel all of this. I'm laughing while I sob. I'm crying and smiling, letting all of it wash over me, the grief and joy, the longing and wonder, the worry and relief, life, birth, death. And as I'm letting go of control, letting myself feel all of this, finally letting myself feel the emotions, a voice comes from beyond the curtain. "Could you just hold still please, I'm really trying to place this nerve block," says the anesthesiologist. I laugh. "No, don't don't laugh either. That's too much movement."Jennifer looks furious. And I hold it together like I have this whole time. I let the anesthesiologist do her job so I can feel a little less pain over the next few days. And I hold my baby, feeling the shaking and nausea subsiding. And I'm grateful for the piece of Kurt that our baby has brought back into the world.

Emily Silverman

I am sitting here with Tiffany Albrecht. Tiffany, thanks so much for coming in today.

Tiffany Albrecht

Yeah, my pleasure.

Emily Silverman

So, Tiffany, I think your story might be one of the most emotionally powerful that we've ever had at The Nocturnists. And I was wondering if you could take us back to the moment that you decided to send in the story as a submission for this show? Because I'm so glad that you did.

Tiffany Albrecht

Yeah, I have thought a lot about submitting stories. And when I saw the call for stories for the partnership with CFAM and The Nocturnists, I remember thinking, "Hmm, this sounds like an even cooler opportunity than anything that I've ever thought of." And then I felt this pause and I was like, you know, I really shouldn't over commit to things. I got enough going on in my life. And then I remember scrolling down in the email, and I saw that the topic was rebirth. And I felt like it was just the universe telling me, "Yeah, you should probably try to submit your story." Everything that happened was still pretty fresh. You know, my baby was just born. A few months ago, Kurt, my first husband had died not that long before that. So I did wonder for myself, "Am I emotionally in a place to share my story?" And after reflecting on it for about a day, I came to the conclusion that it would not only be something that I'm ready to do, but would also be a part of my healing process to share my story with others. And so I recorded the audio in my bathroom with my baby sleeping in the next room and I was like, "Yeah, this feels good."

Emily SilvermanI'm not sure any of the stories fit more squarely into the theme than this one. This story of simultaneous life and death and rebirth, just as the theme was, obviously, there's a lot here in the story, there are so many different angles, we could have taken so many different aspects of the story, we could have uncovered everything from Kurt's illness to Leo's birth to your relationship with your sister, Jennifer. There were even parts of the story having to do with your, I think birth doula or death doula that we talked about maybe including. So let's talk about how you took this monumental story and how you thought about how to pick a moment or an arc to zoom in on to compress into this 10 to 15 minute monologue, since it's a very small contained amount of space on stage. And so we had to talk a lot about what to leave out and what to put in.

Tiffany Albrecht

That was a journey, it was not easy. And I remember the first time sitting down with Molly and talking about the story, and there were so many elements that were significant. But it was kind of a hodgepodge at first. And in thinking about the theme rebirth, that's what we ended up going back to. What was it that was actually reborn? And that is how we ultimately came to the story that I told because there were a lot of elements that felt like they were a really cool part of the story, but maybe didn't fit in that rebirth part. And it was also thinking about what story I wanted to share at that time of my processing, because there were a lot of different iterations of the story. And when I practice certain ones, they didn't necessarily feel right to where I was, in the moment. But then really focusing on Leo and Kurt and Kai, they were really the people who seemed most relevant in that actual rebirth story.

Emily Silverman

I remember in some of the story development sessions, we were talking about this moment, when Leo is born, and the rush of emotion that came over you, and how complicated those feelings were, obviously, a lot of happiness and sadness all rolled in together. And I remember us as a group collectively trying to really figure out what was in there. And I just feel like onstage you conveyed it so beautifully, and was wondering if you can talk about that journey. Because I think at the beginning, you weren't quite sure what was all rolled in there. And then together, we worked on teasing it out. And that was really fun and gratifying for me. And I'm just curious how that was on your end.

Tiffany Albrecht

Each time I practiced the story, it felt different too. And I distinctly remember one of the times that you pointed out that the voice that I was using, the tone, was totally different from how I usually sounded. And I realized in that moment that it was still pretty heavy for me. And when I told it, I was still having that grief and sadness be the predominant part of the story. And then, after you pointed that out, I had this moment of realizing, "Yeah, Leo's birth wasn't all just sadness. Obviously." It clicked for me, in the storytelling and in my emotional processing of everything that happened to me too. And then every time I practiced it after, and especially when I told it on stage, it felt like it was a reminder to myself that there was a lot of sadness in this and a lot of grief and excitement and joy. And wow, how amazing to have Leo born after everything that Kurt and I and Kai went through.

Emily Silverman

I think one theme that we talked about was how there was this window of time in between when Kurt died, and when Leo was born. I can't remember how many months that was, but you describe it as like time stopped. And it wasn't until Leo was born that you felt like time could start again. So talk about that because grief is so mysterious, and it works in so many mysterious ways. And just bring us into that window of months and what you mean when you say that time stopped.

Tiffany Albrecht

That language was something that Molly and I worked on a lot because it was so hard to describe. The feeling that I had during that period. And it was as if the processing of grief couldn't happen because I felt like I had to be responsible for something else. And that was the birth of my son, and that it wasn't safe to be totally absorbed in my grief. And I didn't know what that would look like. I thought a lot about how much stress I wanted to be under. And I think just in general, I have a tendency, and many physicians, I think, have a tendency to suppress emotions that feel scary or unsafe, because we need to be doing our job and move on and take care of the next patient after we just had another patient die. It felt very similar to that. I just witnessed my husband die. And I need to take care of the next person in my life. And what does that mean, especially when it's a fetus in my body? Yeah, I don't have time to be stressed and emotional and dysregulated, I really need to just suck it up. And I can be sad, I can cry. But I can't just totally dissolve into grief. And that felt like actually stopping something like, "Okay, I'm gonna just put everything in slo-mo in this grief processing, because that's safer. Especially for my son." And for my sons, I think it also was thinking about how much the transition of Leo being born would affect Kai, my older son, and thinking like I really need to be emotionally present for my toddler right now. Because he's going to have to deal with his baby brother being born on top of his dad just dying. And I think back to that, now that Leo's older, he's 16 months now. And sometimes there are tidbits of his personality that are different from Kai's. And of course, they are, they're individuals. And sometimes I'm like, "huh, is that related to the stress that I was under? Or is it related to me just not really having as much energy and physical strength to actually breastfeed him or as much time to heal?" Those questions pop into my mind a lot.

Emily Silverman

As doctors, we deal with people who are having illness and dying all the time, and we deal with grief on the doctor end. And then going through something personally, can shed new light on the grief experience. And so I'm wondering what was it like to be going through this and also to be doctoring? And did it bleed into your doctor life in any way, shape, or form? Or were you able to compartmentalize that?

Tiffany Albrecht

I think about that a lot. And it was something that I had entertained putting into this story, but ultimately, it felt like it was trying to fit too much. But certainly when Kurt was in hospice, and when I was pregnant, there were a lot of patient experiences that felt like they were reminders to me, especially when I would be talking to patients and giving them guidance on self care or compassion for themselves. In difficult times when they were dealing with their own health issues, or because I'm in primary care, a lot of patients share with me personal stories about their own caregiving experiences. And because I'm a pediatrician, parents are sharing with me their fears about their child. Each time I told a patient, "I know you love your husband or wife, and they're ill right now, but it's also really important to take care of yourself." It felt like it was a reminder for myself too. And it was also something that felt familiar. I went to school to be a doctor. I did not get any lessons or training on how to take care of a dying husband while pregnant. So work actually felt like a safe haven for me, a lot of times in a space where I had the bandwidth to remind myself that self care is really important and that I don't have to be perfect. And that my family is the most important thing. And I know how to take care of them.

Emily Silverman

And you kept quite active after Kurt died. I think you even joke a bit in the story about how you ran a 5k. You did your holiday shopping, you did this, you did that. It was almost comical, the way that you listed all of these different activities that you did. And you know, some people might say, "Oh, this person's in denial." But I can also see how, like you said those activities could be a safe haven where keeping busy is actually really helpful and really useful. So did you view that as a form of self care? Or was there some element of "I'm using these activities to stop time", like you said, or how did you think about self care in those months after Kurt died?

Tiffany Albrecht

The most important thing to me was giving myself grace. And it's really tempting when I feel tired to think back on the last few days, and think, "Oh, gosh, why did I put so many things on my to do list?" and then beat myself up about it, that's not self care. And that's just not really helpful. If I kept busy, I could keep that grief paused better, because something has to be running in my brain. So doing all these things that are familiar that I know how to do, I'm just going to keep doing those because the grief thing is what my brain will default to, if I don't keep something running on play. And that was a really good learning experience for me too, and how I talk to patients about self care, how I talk to my colleagues or other trainees in medicine, especially because sometimes staying busy is what feels the safest and is what we need in that moment.

Emily Silverman

You say in the story, on some level, you felt like you're supposed to be an incapacitated widow. But your mind and body had other plans. And it seems like you followed what was true to you. And that that worked for you. And then when Leo was born, that pause button came unstuck. And it was like time started rolling again. And you felt everything that you had been maybe suppressing or holding back and this is the climax of your story. And the part of the story where I felt myself welling up with emotion where you said, "I feel all of this, I'm laughing while I sob I'm crying and smiling, letting all of it wash over me, the grief and joy, the longing and wonder, the worry and relief, life, birth, death". And you're having this cathartic moment. And then a voice comes from behind the curtain that says, "Can you just hold still, please, I'm trying to place this nerve block?" And the way you delivered it on stage two was just like such perfect comedic timing. Talk a little bit about that section, because that, to me felt like the core of the piece.

Tiffany Albrecht

I found that to be so authentic to my experience during all of those life events, because humor and playfulness really got me through a lot of really, really tough things. And when things felt overwhelming, and I questioned my ability to get through something that seems unimaginable. I would go back to something that was funny. And her and I laugh together a lot during his really, really difficult treatments and physical symptoms. And we laugh about things like poop and vomit, which you know, like, usually are kind of sad and gross. But if we could laugh, it felt like things were less overwhelming. And when I told that part of the story, and when we were working on it, that's exactly what I was trying to express. Because that moment, even though it was cathartic, and I really felt like it was powerful, and I needed that to happen in my life, it also was scary and overwhelming. Like all these things I had suppressed and suddenly the dam has opened, what in the world is going to happen? So having this hilarious interruption that is also so familiar to me because I'm in medicine, and just taking some time to laugh about it really felt good.Emily SilvermanLet's talk about Jennifer for a moment because we didn't get to expand too much on her character just given the time constraints of the story. But there's this really wonderful line, you ask her to stay, you say "I need you", which is such a vulnerable thing. And that sister sister relationship I know was so important for you as you were going through what you went through. So bring us into that sisterhood for a minute.

Tiffany Albrecht

I'm the big sister, I'm four years older than Jennifer, and this whole experience, we reflect on it a lot. Because it was a turning point in me feeling comfortable, being vulnerable and showing weakness. I think that's also something that a lot of us in medicine tend to do is feel like we have to create this facade of being all omniscient, knowing what to do, being perfect, and being independent. And all of a sudden, when all of these things were happening in my life and I really was looking to people who knew me well, Jennifer was the person that I was like," I know I want her to be my birth partner." She doesn't live in Minnesota. So when she came to Minnesota to wait with me for Leo's birth, and we were just sitting at home waiting because Leo was born two weeks late, I felt really guilty. Like this is me leaning on somebody asking for help. I am not being independent here, I am actually being an inconvenience for my sister. And that felt scary. That moment in the operating room was a similar thing. She was excited about the birth. And she also was emotional and wanted to connect with Leo. And I'm not typically comfortable asking for help. So the fact that I spoke up and said, "I need you" was part of that opening the dam. And saying, "Yeah, I'm ready to acknowledge that we're all connected, and that there's much more to life than being hyper independent and caring for myself without asking for help."

Emily Silverman

This didn't make it into the story, but I remember talking about Leo being overdue, and Jennifer flying out. And it's like the due dates coming, the due dates coming. And I think she may have taken time off from work or you know, left her own life behind. And then the due date came and went and then, you know, a few days came and went and then a week came and went. I think there might have even been a moment, correct me if I'm wrong, where you turn to Jennifer and you said, "You can just go back home." And then what did she say?

Tiffany Albrecht

Yeah, so when I told her that she could just go home if it was too long of a time away from her home and work, she was offended. She was like, "I thought we were in this together. I thought we were a partnership. And you telling me that you could just drop me did not feel good." And she was really honest when she said that. And it was a reminder to myself that being needed and wanting to help a loved one is a really important part of others healing as well. And for me to take that away from Jennifer, who had already spent a lot of time waiting with me for Leo was not helping her which in my head, I had somehow convinced myself that telling her she could go back would be a helpful thing. Her telling me no was a really helpful reminder.

Emily Silverman

So was anyone in the audience from your family or any friends or any colleagues and what was the experience of getting up there and telling the story and how was it received in the next couple of weeks? What was that like, metabolizing that process?

Tiffany Albrecht

I had a lot of loved ones and colleagues in the audience. Kurt's family, his two sisters and his parents were there. My parents couldn't make it so they're really excited about this episode that's coming out. Jennifer was there. My boyfriend at the time who is now my husband was there. And a lot of my co residents were there who had been at my side for really all of it. And when I walked off the stage, and one of the other storytellers, who's a co resident, Anthony, came up to me, I just started crying. Because it was a reminder of all of us supporting each other and how powerful community is. And connection is, because that story that I just told was about some of the most emotional, heartbreaking difficult times in my life, and also the most exciting, joyful and beautiful, and I got to share it with so many people who are in this audience, in person in real time. And now I just got to share it at the Parkway Theatre, with The Nocturnists. And it was so incredible, and was its own overwhelming, emotional moment.

Emily Silverman

So how are you and Kai and Leo doing now? And what's next for Tiffany moving forward?

Tiffany Albrecht

We're still on our healing journey. We are blending families. So my husband, Wes, and I got married in November. And he has a six year old daughter, Valerie. So all of us in this family of five are learning to process difficult things that happened to us before. So there was my story that I shared, and Valerie and Wes have gone through a difficult time too, in which there was separation and divorce. And we reflect in order to think about what we want for our family. And it's really wonderful and feels meaningful and purposeful and telling my story was an important part of that journey, to share with others and also to reflect myself on what it meant to go through this amazing rebirth.

Emily Silverman

Sounds like the rebirth stories just keep continuing. Well, I just want to thank you again for sharing that part of you and of your story and of your life with us and coming on stage and coming here today. Like I said, I feel very close to this story just because I was more involved in bringing it out and its come to be one of my favorites, I have to say. So thanks so much again, and I'm wishing you a fruitful and wonderful and joyful future with your new family.