It's been a while

It’s been a while since he died.   

And yet…   

He is with me daily as I see him in my children, in my own interactions (when I’m at my best), in how I organize myself, in how I enjoy life, still.  

A marker of time passing.  I have now been alive for longer without my father (alive) than with him (alive).  

He did not live to see me in medicine, as a mother, married, making my way.  

And yet…

As a feminist father, back in the day, he helped me know I could be who and what I wanted to be. He was a kind and patient person, who listened, who cared.  Like everything you would want in a doctor, though he was not in medicine himself.  Like everything you’d want in a father of a mother in medicine.

Did I tell him thank you?  I can't remember.  I hope so.

Which comes first, the pet (companion animal) or the child (companion human)?

Most MiM's probably consider themselves mothers to human babies, toddlers, teens, or to grown children. But a MiM might also be "mother" to a companion animal, i.e. to a pet.

Which did you (you alone or you and your partner/spouse) have first?

The pet as practice for a kid?
The kid as practice for a pet?

Some upsides and downsides either way. Can't learn to breastfeed (or pump) with your pet, but can learn to be responsible, to love a helpless being, to nurture, to teach/train/grow up another living lovable animal.

Toilet training <-----> litter box
Diaper changing <-----> pooper scooper
Taking for a walk <------> taking for a stroll, and then alas those first steps!
Doggy day care <-----> child care

The challenges and triumphs. The shared responsibilities with spouse. The work-family balance. The feeding, sleep training, getting up early, staying up late, clipping their nails, bathing. Not sure if anyone reads to their pet, like they would to a child, but could certainly sing to either!

Taking them to the vet/pediatrician (the two are periodically confused, for that matter). Does a MiM do some of the medical care for their own pet like they might for their own child?

We had our children first, and then (at the daily, no make that TID urging of daughter) brought a bunny rabbit from the local humane society into our house. Was not even a difficult transition (the more the merrier) and quite a learning, loving, sharing experience for us all. The bunny eats better than the daughter (way more kale, greens, carrots). We don't attempt to provide vet/medical care for our bunny (not qualified!) and are recognizing the importance of primary care. Son and daughter aren't quite sure (it changes day to day) if they are "mother and father" to our bunny, or big siblings to the little guy.

Which did you have first, and why?

overheard, son in bathroom, reading my journals

"Mom, you've had that Pediatrics in here a long time," says 5 year old son in the bathroom, seeing my copy of this journal on the step stool aka magazine rack.

"But you know what? I get a new one of those every month in the mail," replies MiM from the kitchen.

"Yeah but this one's been here waaaaaaaaaaay too long," he persists.

Time to get reading? Get the dust off my journals? Move it to my bedside table? Get an iPad/e-reader?

Pediatrics is kids and family

How could I have almost passed up the opportunity to post on topic week about a family friendly career? Perhaps because this week I baked for the kids’ school pot luck and bought gifts for their amazing after school counselors and am working on a grand rounds and revising and resubmitting a paper and tweaking the students’ syllabus and conducting meetings with…

All that, and yet pediatrics, the career, is kids and their families. And as such it could not be more supportive of pediatricians raising theirs. Lots of opportunities for part time work, though I have remained full time with enough of “protected” time for non-clinical but otherwise scholarly work, where much of the flexibility is built in.

I aim to be a serious academic and medical educator (albeit still with appropriate levity with my pediatric patients) but at my own pace. After a few “wins” (first grant, first publication, first leadership role) you can pace yourself, pick and choose things (still say yes to almost everything but learn to say an occasional no) in academia. And grow to be a mentor to others.

And all the while my pediatric colleagues have to understand things like pumping, breastfeeding, being called to get your son from daycare, fevers, falls, school performances, and sports events because this is the stuff of outpatient pediatrics. It happens in our lives as mothers (and fathers) in medicine as it happens in the lives of our patients. When I returned from parental leave after 16 weeks the second time around, squeezing in pumping and speeding to daycare pickups, I reassured my boss that that was the last baby for me, and he told me to have as many as I wanted. That was a breath of fresh air (and the legal thing to say), and it was sincere. I continue to have all my patients as “my kids” plus the two of my own, and that is the right number for me in my very full time pediatric parenting career/life.

I think a side benefit of pediatrics as family friendly is it helps in child rearing. You learn the tips, the things we parents struggle with, you read the latest on development, and you can even draw upon your job when you minimize your kids’ screen time, ensure they brush their teeth, buckle up, among other less obvious things. I have nearly said to my children, “If your parents weren’t pediatricians then maybe you could eat that hotdog while playing with matches and then take a ride in the front seat, but….” Furthermore, my children hear me take call by phone some evenings or weekends for our outpatient community-based academic pediatric practice and have nearly become mini-pediatricians themselves. Even though they’ll probably be a rock star (say, Elvis) and an artist (she who draws mostly mermaids).

I didn’t choose pediatrics because I thought it would be family friendly, but much to my joy and satisfaction, in most cases it can be and has been.

We will all go down (and then up again) together.

Seeing and hiking the Grand Canyon through the eyes and feet of a 5 and a 7 year old. With husband. Which family member thought which thing?

• There is no railing.
• There are lots of large mules with large body parts and large piles of poop.
• I'm thirsty.
  
• There is vast beauty, and vastness in general.

He who notes there is no railing (husband-pediatric-researcher) also notes that there are many death defying curves and rocks and edges and did I mention there is no railing? On the very top rim there may be a railing, but what about on the hike down into the canyon? Nope. No railing on our trail. Mules? Check. Mule poop? Check. Spectacular views? Check. Opportunities to fall to one's death? Check.

What, me worried? And yet for some reason I was not. Probably because pediatrician-researcher husband did enough worrying for more than both of us.

It was truly awesome, not in the like totally 80's way, but in the I am just a speck in this immensely astounding planetary way.

Yes, they could fall over the edge, get heatstroke, dehydrate, burn in the sun, fall over the edge.

Holding hands. We will all go down (and then up again) together.

Mothers who lie

Okay, someone I hold in high esteem (basically one of the most intelligent women I know) is a philosopher by profession and recently wrote a chapter in a book. But not a chapter in a book that is too hard for us non-philosophers to read, but one we can all get into. I wouldn't say it is dumbed down, but just that it is very readable. It essentially delves into the philosophy of motherhood. Please believe me that this is not a "buy this book" post (no link to Amazon here); I'm telling you the truth. And therein lies the issue. That's what it's about. The chapter is entitled "Lies and the Lying Mothers Who Tell Them." With proper mention of Kant and Bok and Augustine and Mill.

What lies have you told to your children, as a mother and/or as mother in medicine? Perhaps some creative mothering? Maybe:

• If you jump on the couch that way you will crack your head open.
• That's a beautiful drawing.
• Your little brother did it by accident, I'm sure.
• You will grow nice and tall if you go to sleep right now.
• It's very late.
• The tooth fairy _______ (fill in the blank).
• Don't touch that! It will make you sick and you will have to miss your party tomorrow.
• You will literally turn into macaroni and cheese if you have that for dinner again tonight.
• There are no monsters upstairs in your bedroom closet (okay, that one is true), but if you don't get dressed right now they might start wearing your clothes.
• We are leaving this store right now.
• This won't hurt.
  
• I'm almost done (with this email, post, tweet)
• I'll be home soon.

Is it okay to lie to your kids? Is it for their benefit? Wishful thinking? For the greater good? What lies have you told to your children, as a mother and/or as mother in medicine?

Battles: health vs not health

The battles begin, continue, and at times seem to never end. And while I'm defining "battles" quite loosely, such is parenting. For at least one of my two children, (glass half full, that's 50% of my kids where parenting goes smoothly!) we battle over things we humans needs to do. In a pseudo-valiant attempt on my part to limit battles to those things that would impact one's health, I've let lots of things go, but not when it comes to her health... so what really constitutes health for this MiM? Might depend on the day and my patience.

• Brushing teeth? Health. Must happen twice daily. Worth the battle
• Brushing hair? Jury's out on that one. Might be health. Battle not worth it, but still occurs
• Washing hair? See above
  
• Wearing coat? Survey says: Not health. No battle.
• Eating vegetables, or even one vegetable, even one time? Health. Worth the battle, but losing it.
• Eating fruit? Health. Mission accomplished.
• Refrain from antagonizing brother? His health. Battle would ensue, but tenets of role modeling would say to avoid battle and let them work it out.
• Going to bed at a reasonable hour? Health-related. Battle prolongs time awake. Fail.
• Letting this MiM sleep a few more minutes in the morning? My health-related. Battle sets bad tone for the day and promotes wakefulness anyway. Resolve not to battle.
• Hugging and making up? Ahhh, that's what it all comes down to, what are we battling for???
  

An exercise in work life balance

I can’t get no… exercise. That’s what went. It left me sometime around the second trimester, about 7 years ago. Previously near daily jogger and once even a marathon. I have the rest of the balance, most days, between what I do at work and what I do at home with daughter, son, and my life partner. As an outpatient pediatrician I only rarely have weekend or evening obligations such as taking phone call, but as an academician I am working for fun (ha!) from home during the late (after the kids go to bed late) evenings because I’m often productive at that time. And then it “frees up” more time during the work day to 1) drop off my kids at a reasonable hour, 2) pick up my kids at a reasonable hour, and 3) interact with other people at work.

But back to the exercise, that is what I gave up, and I am feeling off balance about it. When I read my MIM peers who carved out that time, I am jealous, but the other thing I can’t do is get up early to do it. Love my sleep in the morning, right up until and including those little snugglers who, well snuggle in with us most mornings. I can stay up late at night, too late, easily, but other than using our brand new Wii, I don’t have exercise equipment at home to use in the wee hours. I think for my next big birthday I’ll get a treadmill for our basement. Or maybe Wii bowling will do the trick. Doubt it though. A recent development, while both kids are in non mommy-and-me swim classes I do get to use the workout machine, overlooking the pool at the Y, so that's once a week. Not enough, but have to start somewhere.

Got to get you into my life, exercise.

what's your own "wikileaks" moment?

Have you had anything leak out about you that you hadn't intended? Something your colleagues found out that you had wanted to keep personal. Or something your significant other, kids, family found out about you? Or are you a wikileaker yourself??

One of mine, albeit minor, occurs whenever anyone finds out I was a cheerleader in junior high school. Whoops, there, it's out. Though I am surprised and kind of proud that my feminist mother and egalitarian father "allowed" me to be a cheerleader... cringing as they both must have been until I found tennis. I think about all this anew with my own daughter.

Oh, and future wikileaks on my horizon, when my kids find out I drink a LOT of diet pepsi.

scary doctors?

...for Halloween, that is. Anyone's kid dressing up as a doctor? Girl (6) is choosing to be a veterinarian (close!) and boy (4) is choosing to be a, well, Michael Jackson (who shall we say, had enough doctors). Any Halloween plans? We happily hay-rode and picked and carved our pumpkins way too early, kept them inside on the countertop safe from squirrels, hence the mildew and caving in on themselves, before we donated them, alas, to said squirrels. All in advance of 10-31.

not blogworthy

I fear I am guilty lately of not blogging enough to warrant suspicion of revealing any concerning details.

And I fear that I am guilty most of the (blogging) time of not revealing enough about that with which I wrestle.

I self-censor in a few ways, mostly thinking about whether or not something that I've experienced, thought about, struggled with, is, well, blogworthy.

I also ask if this is a topic MIM-worthy. Is my online journal post-to-be just about being a mother (or a parent for that matter) or is it just about being a pediatrician, rather than the interdigitating of these two major roles in my life (plus SPOUSE, daughter, sister, and all that).

Often at the laptop in the evening my husband chides me with a gentle "are you blogging" (kind of like the "do you like clogging" line from some Jack Black movie). I want him to want to read what my fellow MIM bloggers are writing, to be as into the fun, the heavy, the sad, the puzzling as I am. But mostly I just pull up the latest doccartoon and we laugh, cringe, and reminisce together over those.

Then I think about professionalism, over-sharing, living in the moment instead of blogging about it, and basically I go back to overthinking it all anyway. Blogging IS one form of reflecting, of which I'm a big fan. But it is also doing so publicly, whether or not "out." I am guilty of posts that are real, but maybe read too much like they've been put through an IRB???

In life I am a person who is not afraid to emote, to tell it like it is, to feel, to cry. I don't know if I am that blogger however.

The last diaper and other things I do and don't miss...

My baby is turning 4 (years) tomorrow. Soon there will be no massive car seat, just a booster. Got me thinking about the other things that end or go away, and those that I miss but don't miss.

The last clean emergency use diaper, in the trunk, glove compartment, bag.
The last dirty diaper (emergency use?) in, well, you know where it goes.
No more potty seats (yay) but still helping to wipe their bottoms...

But on to another theme. With losses and transitions I find a happy and a sad. Good bye to pumping (yay), breastfeeding (awwww).

Last power outtage where we have to worry about losing all the stored frozen breastmilk in the freezer (yay), but still threw out lots and lots of chicken nuggets.

Love reading all good books to the kids all the time (and bad books some of the time) , and wondering if daughter is needlessly worried that we won't read to her now that she can read (not true, honey!!)

Didn't realize that with kids (or even just one) comes that last time I'd get to sleep late! But that will hopefully return someday.

Gave away the swing, bouncy seat, and play-yard! More space. Filled with more stuff.

Goodbye high chair. Still some laps!

Goodbye stroller. Still some carrying!

Last day of daycare. First day of Kindergarten.

Last maternity leave. Last return to work from maternity leave.
Last labor.
Last baby.
But very full lives together ahead and of course oh so many firsts to celebrate!

Some lasts are more momentous than others. You just never know. Hoping not to have any last hugs, last kisses, last sharing, last snuggles, last giggles...

What do you and don't you miss?

Combining words and at least half intelligible

That's a TWO YEAR OLD for you! MIM is two now, and my favorite posts are all of yours, especially finding out what each of you do on a typical day-in-the-life. I am thoroughly honored to have been surrounded by such talented, funny, thoughtful, thought-provoking women.

A lot has happened since I saw the gaping cavity (a lot of brushing and flossing and visits for fluoride varnish), and it's May/June/July again where I remind myself to slow down. But when I reflect on "my" accomplishments over the past year, these include successfully taking the training wheels off the bike (Daughter, this weekend!), actually playing tennis again (Me, last weekend), renewed job satisfaction (Husband), memorizing the entire Beatles box set (Son), and learning to read and reading for pleasure (all of us). And there are also the accomplishments and needs of my patients and students that keep me going.

And being with MIM turning two, indeed growing and developing exceptionally well. Beginning to show some defiant behavior and increasing independence. Walking so well that we're running. Some make believe play, following simple instructions, and scribbling on our own. And enthusiastic to be in the company of each other. Alas, KC, though an internist in real life, is no doubt MIM's pediatrician and highly skilled at it. Thanks for guiding and serving as a role model for us all. I hope you see us all through adolescence...

It's only Mother's Day because of you!

That's what I told my kids tonight in the tub in between shampoo and conditioner. Yes, I only get to celebrate because you came into the world 6 years and you 3+ years ago. But remember, I told them in all seriousness, mother's day doesn't start til at least 8am tomorrow (Sunday) morning, so let momma sleep. (Hmmm, should I have pushed for 10am? 11am?).

While those might have been the "good old days" of sleeping late, I was just In Medicine then, 6 years ago, In Medicine and proud, but not nearly as fulfilled as these very full and filling days, as a Mother In Medicine.

Happy Day! The one day which, really, is just like all the rest!!!

How Do Duals Do It?

I am wondering how the women of dual physician couples have shaped their careers to manage their children and families. My husband and I are MD/PhD students nearing the end of the end of the programs and trying to decide what we should do for residency. We have a daughter who is about 1.5 and may have another child before I graduate. I knew exactly what I wanted to do until I had my daughter and now I am feeling very confused about my career. First, I haven't found any examples of dual physician couples with children who both work full time jobs at academic centers and do research etc. Second, even if I could, I am not sure I want to be away from my children so much. Here is what I have observed. 1) The mother doctor works part time. She therefore doesn't do research and usually works in a more private type practice. 2) The mother doctor works full time and her husband has a job that is more flexible and not in medicine. 3) Both people work 3/4 of a job - share a practice. 4) Both people are trying to do everything in a field they like but it isn't working and they have to choose easier/more flexible options in their field or do a bad job (ie fail to get a grant). 5) Both people choose specialties that demand the fewest hours possible. 6) One person does only research. I would like to know how dual physician couples have shaped their lives in order to accommodate their families and careers. Specifically, did your children influence what field you went into, or the center where you practice, or the amount of research vs patient care you do? What is the best strategy as a student deciding on a career after med school and what are the options?



- 7th year MD/PhD student

At times I find myself still wondering as well! But nonetheless I will attempt to answer as an academically inclined MIM married to an academically inclined physician who is also mostly in medicine, primarily doing health-related research for the government. You (yes you, 7th yr MD/PHD student and reader of our MIM blog!) have the answer, many various answers, included right there in the question you so thoroughly posed. Starting with "I knew exactly what I wanted to do until I had my daughter." That’s it precisely, we have certain ambitions and interests which we tackle full force, and then we are moved to incorporate the new people (little people, big people) into our lives as new, sometimes unanticipated (sometimes unintended) passions of ours.

The other set of answers to your questions are all there too…. in your proposed answers #1 though #6 or some combo (choose all of the above), over the course of your careers. All the while having a heightened awareness to recognize that doing a bad job (or a bad parenting job) means something has got to change quickly. You might sometimes work part time, and that might mean part clinical and part research so you have (or make) the flexibility to alter/design your schedule. Or, your partner sometimes does so. You or your husband might take a more flexible job, even within your field of medicine/research. And you might change what you do over time, or your partner might. And so on.

In my situation, I'm in pediatrics, some would say a "less demanding" field, and my husband, also a pediatrician, is primarily a health services research for the government. He does have flexibility, yet he does both research and a small amount of clinical time. I do a quite a mix of clinical, medical education, and research. The mixture keeps it interesting and allows for some tweaking or major alterations throughout the course of one’s career. We had children a few years after my residency and while his residency was coming to a close. So I guess that makes us a little older (though I didn’t have any gray hair until just recently). We found the mix that worked for our family, and we work hard; that is we work hard to get home for a family dinner every night. By dinner I don't mean spectacular meal, but rather time together mostly around the table, chewing and talking and listening to each other (vying for each other's attention, mostly!). And we work hard by day (for the most part) to get home to pick up our kids and be fully present for them, until after they go to sleep, when I tend to do a little more work (husband opts not to).

Back to your primary question: For us, having children didn't influence our choice of field (we were already pediatrician and graduating pediatric resident) but it did influence the ways in which we fulfill our academic goals. At times we do so more slowly, for example, I used to work weekends and evenings (even if not clinical, I mean work on various academic projects) and go to many academic conferences (pre-kids), and nowadays weekends and evenings are family time (when the kids are awake at least), and I now go to fewer (no?) out of town meetings or evening/weekend events. One tip, always plan to present at the national meetings that happen to be held locally in your region! Collaborate, and pace yourself.

I will mention that pediatrics does tend to be family friendly, because while we take care of others' kids all day, our colleagues understand when one's own children's issues have to take precedence. Work among people who support each other. Keep the discussion open with your partner/husband so that you can serve as a support to one another and also as a reality check as to whether the work-family arrangement is working for all of you. And remember, your kids (and we hope your husband/partner) are with you for the duration, in sickness and in health, and all that… but you or your husband/partner can tweak or even overhaul your career choices over time.

The things they ask, tell, and strive for

A few things any MIM might hear from her child at any given moment, as mine asked recently...

The question: How do the babies get out?

Different day: How do the babies get in?

A declaration: I know there are a lot of things in the body that are... pink

Overheard, to her friend, Oh, did you hurt yourself because my mother is a doctor so she can help you. And the friend responds, I know you've told me that a million times.

And aiming to serve: I'm going to be a waiter

Which Day?

I have no adequate way of selecting one typical day to post about, as part of the joy is the variation inherent in a career of education, research, and clinical care, and two ever changing kids and a supportive husband. If I was a better writer, could be a memoir instead of a post!

Morning:
Awoken by happy child, other child wakes, was happy but she wants more snuggle time, downstairs for breakfast, play some music, make some music, move lunches from refrigerator to car, socks on, brush teeth, pee, finish getting dressed myself, get in car. I take one to school, husband takes other to daycare. Off to fight traffic.

Or, should I describe a typical day where I take the whole morning to go on a class trip with one of my children? Or take them to the dentist? Or pick them up early for a special concert performance?

There’s the occasional day where I have to leave so early to lead a morning meeting that the kids are just waking up as I kiss them goodbye.

And the day that where I use my “administrative” time to be academically productive, surfing PubMed, online journals, checking personal and professional emails, catching up and making plans scholarly and otherwise? Attending noon conference, meeting with trainees.


And when I spend the afternoon at our pediatric health center with (in 5 to 30+ minute intervals):
· a teen who doesn't think she’s pregnant and is;
· a teen who thinks she’s pregnant and isn't;
· a newborn, it’s his first visit but we know the family as the 8 other siblings come to our practice as well;
· a mother who wants H1N1 vaccine for her child, but we’re out of the supply;
· a mother who doesn't want H1N1 vaccine for her child (once we have a good stock in)
· a former resident’s baby for a well check
· quick: what’s that rash
· not so quick: a teen who is about to be kicked out of school, needs residential treatment for his addiction, in my office with his mom, both wanting help
· pre-op physical and can you see the sibling too for her cold
· phone calls and school forms intermixed with above
· and a few others

Rush home. Finish my electronic medical records securely, but from home, after the kids go to sleep. Will this be a good commute day or a bad one? Often depends on the weather.

There’s the periodic 5pm meeting that I phone in to so I can commute home in time to make dinner.

And twice monthly when I am on call, which means I answer my pages by phone in the presence of the kids from 5pm-8pm, so they know as well as I how to respond to a parent of a child with a gastro or the appropriate Tylenol dose for fever.

Evening:
Some arrangement of the village picks up the kids, quick dinner prep, not real cooking but is healthy enough, kindergarten homework, all eat together (wow!), competition for who gets to hold a conversation with whom, try to make tomorrow’s lunches while doing dishes after dinner, reading books, playing music, 30 minutes of video time, get in the bathtub, brush teeth, books books books, pee again, one more book, one child to bed, more books with older child, pee again, finally both are sleeping.

Rest of evening:
Catch up with spouse, more online time, maybe a little bit of TV, crossword, finish something for work, finish electronic medical record notes, read residency program applicant’s interview for the next day, maybe take shower, more spouse fun time, sleep…

please tell me more about how the heart works

The other day a fellow MIM who doesn't actually blog here (as far as I know) recounted a story to me about her child's bedtime routine that I found funny and oh so familiar. Have you found that almost all of them (those children of ours) want to stay up just a little bit later? Indeed they are oh so in tune to what enthuses mommy and/or daddy. And what would allow them a few more minutes (hours??) of wakeful banter? When they want to stay up even later than their working parents already let them, all they need to ask is just one little question...


It goes something like this, "Mommy, can you tell me again how the heart pumps the blood around the body?" Or perhaps "Daddy, will you remind me how the lungs work again?" It can happen whether we're pulmonologists or cardiologists, and even a health services researcher might succumb to a innocent query like "Can you review regression analysis one more time?" We're weak when it comes to an opportunity to explain what we love to do, our primary involvement when we are not with our precious little ones. And they know with that simple question, "How does the food get all the way from my mouth to my large intestine?" they've bought themselves more not-yet-sleeping Mommy/Daddy time.

Drop offs and pick ups

Day care, preschool, kindergarten, after hours (and before hours, which we have not yet needed)... it is almost too overwhelming to reflect upon. We've been fortunate to have had very caring providers, some smart, some funny, some artistic, some traditional, and most of all interested in the growth, development, and well being of our kids. Perhaps it is my hypothetical pink contact lenses which make the situation seem so rosy, ultimately along the lines of "it's got to be good" because we didn't have too many other options! Initially no relatives nearby. And our being a Mother and Father in Medicine.

I did two years of drop offs and pick ups when Now Five was our Only, and in a day care center right next door to Mommy's work. It's coming back to me now, indeed I could not contain myself, literally I could not stop bawling when I visited the center, the week prior to the very first drop off (that was over 5 years ago!). But my huge outpouring of emotion (so many tears I could have dehydrated myself) was therapeutic and allowed me to feel good, subsequently, in time. Breastfeeding and providing pumped breast milk helped maintain our special bond.

Two years later along came her brother and a new job for my husband, and a fabulous new daycare ("school") for both kids. NAEYC accreditated and all that jazz, and it was jazzy in a low key sort of way. From that point on my husband became the main dropper offer and picker upper since it was next door to Daddy's work. Though I made sure to pick up at least twice a week so I could see, help, do, share.

I remember fondly those child care providers who were easy to talk with and be with, who gave me unsolicited pictures of my kids caught in the act of having fun, who taught me things (any interest in "stool withholding" for another topic day???), who taught my kids. Early lessons in social interactions. Early lessons in graham crackers and not having peanut butter. Other lessons like sharing is good, but it's not good to share your lunch (again, it may have peanut butter in it!). And, alas, the other less interesting providers do not loom large in my memories.

There were the many opportunities for field trips, some we could attend, some we heartbreakingly (ours and theirs) couldn't. And the performances, school birthdays, and holiday parties. International Day, fire drills, Music, Dance, even Yoga, all at the day care. And the fevers (fortunately few and far between) and the rare snow days. Enjoyed many of the other parents too (good thing, since birthday parties are with parental accompanyment at these early ages).

Never picked up too late, officially speaking, but then again, sometime not quite early enough. Often late for work, but that's the new normal. And did some "work" at daycare, discussing pediatric matters and other practical medical advice when asked.

Was it all rosy? At least the least desirable aspects have become funny with time. And eventually, you rush out of work and in traffic to pick up and find your little ones immersed in an activity, oh so important that you could come back in a few, take 5. Did I wish they weren't at day care? Not once I saw how much enjoyment they got from the interactions with their peers and teachers. Did I sometimes wish they weren't there for so long in the day? To this I'll admit. But then that's where the skipping out early and catching up on things after they go to bed comes in. Late bedtimes for napping daycare attendees and working parents, that's another story. Zzzzzz

What is that I see?

What is that I see?

Can it be?

A cavity?

Are you are kidding me?

A mother in medicine, a mother in pediatric medicine, a mother who has been trained in primary prevention of dental caries, a mother who has been trained in how to teach pediatric residents about primary prevention of dental caries...

Could this mother have a sweet little twenty-toothed three year old with a cavity? And one so large that it recently became blatantly obviously visible to this mother?

Couldn't be.

But it was.

And not 1 cavity, but let's just say more than one.

Self doubt, blame, shame, worry, sorrow, guilt.

Relinquish my hypothetical license to mother and my actual license to practice pediatric medicine?

With the MIM degree comes connections with pediatric dentistry division chiefs and friends in psychiatry and other caring colleagues who help me see the bigger picture, one that continues to contain a twenty-toothed (more or less) beautiful smile inside and out.

I think of all the things this is not, and feel better.

I think of all the ways this could be worse, and feel better.

I think of my own bad teeth and think no less of my own parents.

I think of my patients and their parents and feel more like them.

I think of my daughter with no holes in her teeth except the joyous one that is about to be there when her first loose tooth falls out (could be any day now).

I take comfort in realizing that Mothers in Medicine need not be perfect nor have perfect kids.

I seek to re-define perfect as a work in progress.