The special skills we have

Late last night past whatever passes for bedtime in the summer, tween daughter showed me the abrasion on her knee sustained while swimming earlier in the day.  It was the "lane rope monster" known for sheering the top layer of skin of even the best swimmer's hands, knees, etc.  She asked for me to go get her a band-aid.  Size?  Medium.  Our home is well stocked.

After checking to see that the wound was clean enough (no obvious debris), I applied the 2 inch bandage to the extensor surface of her knee, the "bendy" part.  She bent it, as if checking, testing, and then admiring my work. 

And then, with the complete absence of sarcasm (yes, even in a twelve year old) in this, the edge of the end of childhood, she asked if I went to special school to learn to apply band-aids that well.

For the degrees and formal schooling, it was 4 years college, 4 years med school, 3 years pediatric residency, plus public health and medical educator training along the way.  And most importantly, time spent as a mom. 

My Target Guardian Angel

     I like to think of myself as someone who generally has her sh*t together. Someone who is skilled at multitasking, who keeps her cool when things get stressful. Which is how I found myself at Target last week staring at one cart full of children squirting poop and tears and another piled high with cartons of diapers and wipes. Oh, and three huge containers of animal crackers mixed in there for good measure.

     My plan had seemed foolproof. (Okay, at the very least, doable.) Feeling too guilty to have a huge order of mega-packs of diapers shipped when there was a store nearby and I had a day off from work, I had placed my order online and selected in-store pickup. The next day, I loaded up my sons, two-year-old Bean and three-month-old Teeny, both freshly fed and changed, and headed out. Bean’s naptime still loomed a good two hours away and Teeny usually snoozes happily on and off throughout the day, so conditions seemed ripe for success.

     All went smoothly as we circled the store to grab a few small items and made our way through the checkout line. We headed over to customer service and the guy behind the counter pulled up our record then wheeled out a shopping cart filled with large boxes. He eyed the cart I was pushing, the main section of which held Teeny in his infant carrier and the front section of which held Bean. “Do you need help?” he asked halfheartedly, as I started loading the boxes underneath. I waved him back toward the counter where other customers had begun to line up because, I figured, I’ve got this.

     The tipping point was when I tried to snug two of the containers of animal crackers in the front with Bean. He didn’t want to share his space – in fact, he suddenly wanted out of the cart right now - and began to whine, which escalated quickly to a wail. Teeny, who had woken up a few aisles back but until now had remained quiet, decided that he, too, was done with this expedition and would prefer to be held and fed. It was around this time that he also let out a poop explosion that not only blasted out of his onesie but, as I would later discover, puddled into the carrier, soaking the seat cushion and dripping through the cracks to the coat the plastic base.

     I tried firmness and then bribery with Bean, trying to coax him into letting me stuff several items in the seat beside him as I simultaneously tried to shove another carton of diapers onto the shelf below. I’ll just squish everything together, I thought, as the boys’ cries continued to escalate. It will be fine, I reasoned, with less and less conviction.

     “Can I help you?” a new voice asked. I looked up to see a petite woman eyeing our situation with concern.

     “Oh no, it’s all right,” I said, waving a hand at the general chaos before me. “We’ll be fine.”

     She frowned. “There’s no way you’re going to fit all of that. Here, I’ll wheel the other cart out to your car.”

     “Are you sure?” I asked. “I mean, only if there’s nothing else that you need to do.”

     “Only return a pair of shoes,” she said, “and I can do that after I help you.”

     I sighed. The boys’ chorus continued. I acquiesced.

     “I remember having young kids,” she said as we headed out to the parking lot.

   I wanted to explain that it’s not usually like this. That during residency I resuscitated babies while swollen from belly to ankles as I carried my own; that I managed the ICU with no in-house fellow or attending. That I pride myself in working full time, raising my kids, and keeping our house and lives in order. That complications and multitasking are kind of my thing. And yet as we wheeled our way down one row of cars, stopping so that I could survey the lot in search of my vehicle, realizing only after I spotted it that I driven my husband’s car and not my own (and moments after that that while I was now searching for the correct model of car, the one I was currently steering us towards wasn’t actually ours), I felt like my sh*t couldn’t be less together. I hurried along, willing this interaction to end so I could return to at least pretending to be a competent parent and adult.

     We parked the carts once we reached the right car, and I hustled the boys into their seats, promising Bean that he could have some animal crackers if he would just wait a moment longer. I began loading boxes into the trunk, praying that the woman wouldn’t notice that we were also barely going to be able to fit everything in the car around the clutter already there and wondering from which of my sons the scent of stool was now wafting.

     As I thanked her, perhaps too hurriedly, the woman paused and held my gaze. “This was my random act of kindness.”

     I must have given her my best What, now? look because she quickly pressed on. “One of my friends just lost a baby. Her other friends and I are doing random acts of kindness this week as a tribute.”

     I don’t know what I said next. I’m not even sure what I felt. I know that the woman wished us well and that, sitting in the parking lot with the air conditioning blasting, no longer in a hurry, I ate animal crackers with Bean. I stripped Teeny down, sopping up the poop as well as I could but also knowing that whatever I missed could be washed out later. I nursed him until he calmed and then buckled him back into his seat. I drove my boys home. And I hugged them hard.

             

*Cross-posting with The Growth Curve

A quick intro since this is my first post:
Hi there! I'm Beckster, mom of two little boys, wife of my high school sweetie, and pediatrician in Providence, RI. I love to write and luckily I realized early on that it just might be the thing that keeps me sane through my medical training and practice. I'm currently a fellow is Hospice and Palliative Medicine (and one-year position) and after that will begin a fellowship in Pediatric Hematology/Oncology.

My cherries are damaged!

Ingenious idea, I thought! Youtube, my trusty friend, came through yet again with a genius how-to video to answer some mundane question of mine. We bought some yummy delicious cherries, and TC, my little Toddler Child, loves fruit. I didn't want him to aspirate a pit in a cherry fueled excitement. Last time he had cherries was several months ago when grandma methodically cut the goodness around the pit. But grandma has time and patience that I completely lack. I needed some quick and easy way to pit lots of cherries. Supposedly such gadgets as cherry pitters exist. But (a) I was sitting with a bag of cherries and a hungry toddler, and I needed something NOW and (b) I hate buying useless one trick pony kitchen equipment. Youtube how-to video to the rescue!

An empty wine bottle. Check. Chopsticks. Check check. So I spent the next 10 minutes pitting a lot of cherries. I may gone a little overboard, but there is something oddly satisfying about excising the pit out of a cherry with precision in one swift motion. Ten minutes later I proudly presented TC with a bowl full of "safe" cherries whose pits he wasn't going to aspirate or break his newly sprouted teeth chewing on. At first, TC let out an excited "Chays!". Yes, TC, delicious chays, dig in! TC picked up the first cherry, and his smile was quickly replaced with confusion. How strange, the first cherry was damaged with a hole. He continued to pick up cherry after cherry and putting them back, now with full-on disgust. I knew it was coming, and there it was! TC tossed the entire bowl of cherries on the floor, laid his head on the table and sobbed his lungs out for half an hour. Because his cherries were damaged.

Anyhoo, with that story as an introduction, I am excited and delighted to be writing for the MiM community! I found MiM a few years ago when I was pregnant and freaking out about how I was going to swing this whole motherhood thing while going through med school. As for all life advice, I turned to Dr. Google, who directed me to this blog. Through the years this blog provided me with some  reassurance that this whole mothering and medicining process doesn't always look pretty but there are others out there in the same boat who are making it work. And they are willing to share those messy stories. I felt that it was time to stop lurking and start giving back and putting my stories out there. You can find more about me in the about page of this blog. I also write my own blog, Mrs MD PhD, where you can find more about me. Feel free to regale me in comments below of how your toddler (or not so toddler) child(ren) laid waste the fruits of your labor and/or cunning.

Don't forget they are someone's baby

Living in DC and taking the metro regularly provides me with ample fodder for social analysis and ample opportunities to be upset and amazed by humanity. For example, I get upset when able-bodied people see disabled, elderly, or pregnant people standing and sit in their seats anyway. Especially while pregnant, I spoke up very loudly (ex. As able-bodied men crowded on an elevator as I waddled to catch the door for a man in a wheelchair. I stared everyone down and said someone needs to get off so he can get on; we were obliged begrudgingly.). I am amazed when folks step in and help someone in need during an emergency.

An issue of growing contention in my neck of the woods is middle and high school students getting onto crowded trains. They are loud and there is often cursing involved. However, I have noticed that most of the adults regard them in a very unfriendly way or simply ignore them. The local listservs I am a member of are far worse; the disdain for these children is palpable and I have had to step in several times when the racism and classism became unbearable as well-to-do grown folks called children thugs, crooks, and goons. It literally hurts my heart!

I personally make it a point to acknowledge these teenagers every chance I get with a smile or a hello; sometimes I’m ignored or begrudgingly acknowledged, but oftentimes you can tell these young people relish the positive attention and are surprised to have been seen. I remind myself regularly that they are someone’s baby no matter how “hard” they are appearing to be. No matter how many tattoos they may have on their young skin. No matter how many curse words they and their friends yell. And I try to remember that someday my little Zo will be one of these students taking the train and I hope that others will treat him well knowing that he too is someone’s baby. My husband and I are well-read in the studies that show that Black boys like my Zo are seen as being older than they are by the majority and less innocent than they are by police (see FURTHER READING below). We know the sickening statistics of disproportionate violence against boys that look like him. We pray that folks will remember these children are someone’s baby and that he is ours.

To bring it back home to the DC metro, the other day on the train a handsome young man with beautifully styled locs and sagging skinny-jeans and a uniform high school shirt  entered the train with a young woman I assume was his girlfriend. His new-aged rap music (the kind old hip-hop heads like me can’t understand and abhor due to the crazy amounts of auto-tune) was blasting. Adults bristled. Some sucked their teeth. He walked on the train and I smiled at him, he was visibly surprised, smiled back sweetly and sat directly behind me. Every other word of his song was f--- this and blast that. I turned and said as gently and respectfully as I could “Sweetheart, don’t you have headphones or something? My old ears just cannot take all of that cursing.” He said quickly “Ohhhhh my bad! My headphones broke and I don’t have another pair, My bad!!!” I pulled out a set of headphones from my bag and said “here, you can have these!” He smiled and said “For real?!? You serious?!? Thank you so much!” And just like that - connection. Respect. Compassion. His mama would be happy.

It could have ended differently. Someone else could have started cursing at him. He could have rebuffed my offer and cussed me out. But it ended wonderfully. And I modeled appropriate, compassionate behavior for children and adults alike.

I exited the train at my stop and wished him and his lady a good day and he did so too.

___________________

FURTHER READING:

http://www.npr.org/2014/03/19/291405871/consequences-when-african-american-boys-are-seen-as-older

http://www.apa.org/news/press/releases/2014/03/black-boys-older.aspx

http://www.theatlantic.com/national/archive/2014/03/cops-tend-to-see-black-kids-as-less-innocent-than-white-kids/383247/

Gratitude

Not my gratitude. My kid's gratitude.

I will preface this by saying that Eve is almost always a delight. She's smart and funny and passionate about her friends and deeply upset about injustice; she usually does what she's asked without (too much) complaint and she is almost completely self-sufficient (laundry, room, homework, etc.)

And she's 16, and so she sometimes asks for things that she's not going to get, and when it becomes clear she's not going to get them, she has the typical adolescent reaction. This includes sighing, eye-rolling and detailing the ways in which her life is soooo harrrd. Our five-bedroom house is too small., Our backyard lacks a pool. We've only renovated one bathroom, and it's not hers. The hundreds of dollars she is given for a clothing budget is inadequate. You get the idea. She's not grateful.

I am not alone. A lot of my friends have the same experience. Our kids are incredibly privileged; they have rooms of their own, clothes with the right labels, and money to spend. At a more basic level, they have loving parents and safe homes and electricity and food and drinkable water. And we are shocked and somewhat hurt that they aren't grateful.

This reaction troubles me. I have the same impulse - tell me you appreciate all this. Tell me you recognize how lucky you are, how many children around the world have nothing, how many children in this country go to bed hungry while you're complaining that we don't have a backyard pool. I hear Eve rail against injustice and wonder why she can't make the connection to her own complaints. And then I answer myself: because she's 16. Because she still thinks she's the center of the universe. Because the terrible reality of poverty and war and famine and racism is too much to bear and she wants to look forward to being a grownup.

I wonder why it's so important that they be grateful. For some reason, this makes me think of Oliver Twist. "Please, sir, may I have some more?" Eve is not a waif on the streets, thank God. I trust she will never have to cower and beg for favors, and be grateful that someone granted them.  Eve was adopted; there's an extra layer of all the people who tell me she's so lucky to be our child, and she should be so grateful that we took her, and how we rescued her. Since I think we're the lucky ones, and I know we didn't rescue her - she has two biological parents who love her as much as we do - I shrink from that idea.

I realize that what I really want is a kid who appreciates - who appreciates her parents' efforts to make a comfortable home, and the work we do that makes the money to buy the clothes, and the thoughtful choices that mean we went to Paris and don't have a pool. I also want her to appreciate her privileged place in the world. I also want her to claim what is hers without apology; I want her to feel that she belongs so that she can use her secure base to advocate for the justice of which she speaks so passionately. She's sixteen. Sometimes her pendulum swings over into the petulant. I will try to take the long view and trust that it will land in the balanced center.

Quality Time: What Is It, and How Can I Create More of It?

Genmedmom here.

Typical morning clinic day: I'm up at 4:50 a.m. and out the door before 6 a.m. to catch the train. The commute is prime time to skim the news/ blogs/ email/ social media, or, order groceries for delivery. I arrive at work early to prep charts. My patients are scheduled from 7:40 a.m. to 12 p.m. (and clinic usually runs over). Then, it's patient calls/ prescription refills/ results/ all kinds of paperwork/ maybe some writing until somewhere between 4 and 6 p.m. Then, I run for the train, ride back, run to my car, pick up kids at my mom's. Wrestle kids out the door, stuff them into the car, and herd them into our house. If Hubby is not working or traveling, we make a good effort to sit down to a nice dinner, usually warmed up leftovers from a weekend pot of soup. We tag-team on the evening stuff: get kids to eat if they haven't eaten, feed the cats, unpack schoolbags and yucky lunch boxes, identify any major school communications or homework, make lunches for the next day, wash dishes. The kids start getting super-silly and disobedient around this time, so I cattle-prod them up the stairs, out of their heinously dirty clothes, and into the bath; attempt to wash their hair (which usually has food in it) and yell at them for splashing water all over the place. Get kids out of tub, then chase after them as they actively evade me, giggling and taunting. Pull pajamas on, force them to brush and floss teeth, read books. Read more books. Read JUST ONE MORE BOOK PLEASE MOMMY?

Sigh. By the time the kids are asleep, I'm exhausted, and I realize with great sadness that I've spent most of our precious few hours together yelling, nagging, scolding, threatening, and counting to three about fifty times.

The few minutes we have snuggling in bed reading quietly (well, truthfully, it usually stretches into thirty minutes reading quietly) is the only real "quality time" we've got.

I know there are doctor-moms out there with busier schedules than mine (I only work four days a week).

Busy doctor-moms, how do you create quality time with your kids? What does it look like? When do you fit it in?

Analyzing My Kid

Genmedmom here.

Our pediatrician had noticed something was up with our son at eighteen months. We were in complete denial until he was two years old. At that point, it just got too ridiculous. He couldn't say a word, only scream and bang his head on the floor... We finally made some phone calls.

Once we got connected with Early Intervention, we started to see and understand. Kudos to the very talented staff who gently- but firmly- suggested a possible diagnosis, and recommended a developmental evaluation.

Months later, we knew for sure. (I wrote about this: So Our Son Is Autistic, And It's Going To Be OK.)

Now, he's five, and he's doing great. Yeah, there's issues, but who's kid doesn't have issues? In his case, he's difficult to understand, but we are so very thankful that he's verbal. Toilet training is an ongoing frustration, but we know he'll get there. He's in a co-taught Kindergarten classroom and he loves his special ed teacher; he's got speech and behavioral therapy and OT, he and his little sister are best friends, and he's a happy kid.

We think he's fascinating, because his mind works so differently from ours. Hubby and I, we're both avid readers and writers. Though he's a sports broadcaster and I'm a doctor, we're both required to be advanced communicators: he describes and dissects sports action for the audience, and I translate medical information for my patients.

But our son is like, a little mechanical engineer. Hubby and I, we struggle with Ikea furniture assembly instructions. Hubby couldn't figure out how to install those little plastic cupboard door locks. I've had a car for three years and I can't remember how to open the hood, I have to look it up in the guide every time. Our son is such a different creature from us, in many cool ways.

He's absorbed by maps: He loves the maps app on our phones, and he studies the weather radar maps and draws out the storm patterns. Below, he's studying a map of Boston. We had to stand there for a long time. I can't even explain how many drawings of maps he'd done... Maps and highways, cars on highways. He talks while he's drawing: "Here's a map of Boston, and here's the cars going out of Boston on the highway, this is Route 93..."

He draws alot of complicated pictures, many moving parts. Below there's a picture he drew during a time of some upheaval in his little life: he was about to start at his new school, with a new teacher. The man in the middle is saying "Help" and "What should I do?" and chaos is erupting around him. He draws what he's feeling, what he's imagining.

He draws, I'd guess, probably between twenty and fifty pictures a day. Many of these, he will assemble into "books": he staples them together and then "reads" them to us. He's able to recite the same storylines over and over, even with his books that he made over six months ago. He seems to have a photographic memory.

He loves to take photos, in that he likes to study a subject by taking a gazillion photos and then examining them. Below, our big fat lazy cat; and then, me cooking. Studies of our home life...

I know that every parent is absolutely taken with their child. Of course. We're in love with this kid, like any parent is in love with their kid.

But, we're also trying to figure him out. We're still learning how his mind works, and just now beginning to truly engage with him. It's really accurate, the autism symbol: the puzzle piece. He's our little puzzle.

MIM Intro - It gets better and better

I finally did it.  I wrote a blog.  I have been dragging my feet for weeks!  You see, I had been told that I had stories to share, and I have always been a champion for mothers in medicine, but I have always told myself that I wasn't a writer.   I am going to change that this year.

I can't remember when I started reading some of the posts of the MIM blog.  When I was in  fellowship I had my first daughter,  and I used a breast pump behind a shower curtain in the small nephrology fellows office.  Often times, the other fellows (all male) would come in and talk to me over the rhythmic whirring of the pump while I was behind the curtain.  I have to give it to those guys - they were brave! And respectful.  I had a hard time making enough milk, mostly due to fatigue, and so I joined my first listserv, PumpMoms.  My online community experience had begun.  I learned so much, and felt so supported by other moms that I was elated to find the Mothers in Medicine website.  It does seem to be so very different being a mom in medicine rather than not.

Fast forward thirteen years.  I know, I wouldn't doubt that I am the oldest blogger on the site.  My oldest daughter just celebrated her 13th birthday.   I have three daughters ages 8, 11 and 13 and two bonus daughters ages 10 and 13 and a husband who is a pilot and not keen on blood at all.  Most people's jaws drop and then pat my husband on the back giving him kudos for living with so much estrogen!  We have two small boy dogs, but I have to say that they are  prissy dogs and don't add a whole lot of testosterone to the mix!

Many of you may be visiting this site trying to find peace or solace about your choices regarding when to get pregnant, how to breastfeed, find child care, whether to work full-time or part-time and  how to shape your career along the way to accommodate the ferocity of motherhood that can overtake you.  I have been there, struggled through all of those events, had many, many funny stories, buckets of tears, and loads of self-doubt as I worried it if were all going to turn out ok.

But here I am, thirteen years later, pretty well settled into a full-time position at an academic university with all these girls to raise.  I still have a lot of great stories, still cry from time to time, but I am reassured that all will be well if I continue to listen to my heart.  It has guided me pretty well along the way.

As part of my first blog, I wanted to share the story of my daughter's 13th birthday party.  It was a rare day.  Seems like all 4 of the other girls had something to do that day, as well as my husband - that NEVER happens.  My oldest had invited two of her best friends to shop, visit the makeup counter and head to dinner and a movie for the evening.  My presence was requested at the make-up counter as my daughter was nervous about approaching the sales lady for a makeover for the three of them.   I met them that afternoon, made the requisite introductions between the makeup artist and the girls and gave minimal instructions about "light" makeup.  I headed off to browse the jewelry counter and give her some space.  At the end, three lovely ladies emerged only slightly lovelier and we proceeded to dinner.

You know, once your daughter is thirteen, you struggle with the fact that she is slowly separating from you.  You know that this is necessary and unstoppable, but you so desperately want it to be like when they are little and want to always sit in your lap, fix your hair or climb into bed with you.  When your daughter is thirteen, you anticipate the  increasing possibility of eye-rolling, one syllabic answers to your questions and that your presence will be undesirable. So, I offered to sit at the bar so that my oldest could be with her friends alone.   Instead, my daughter said she really wanted me to sit with her and her friends.  What a rare opportunity to participate in her life and see her interact and engage with her friends.  I had the best time at dinner, and my fears of ugly adolescence were totally put out of sight.  My mother heart was overcome listening to the three of them talk about difficult relationships with girls at school, their occupational dreams, where they would like to travel, and what they thought of the charcuterie board we ordered.  It was an experience that I shall not soon forget, and one that I hope I can have with all the girls individually along the way.  She is growing up.  I cannot stop it, but I am going to enjoy the heck out of it!

 All those decisions about how much I was working, whether I was always present in the moment at the playground while answering calls from the office, was it ok to skip that meeting to go home early?, did anyone think I was crazy for pumping behind a curtain? It was one of those experiences where you tell yourself - I did ok.  Self-doubt getting smaller by the year.

That way you talk

I was in the office speaking with a parent and her kids at some point in the past year (how's that for sufficiently anonymized).  The mother was gazing at me for just a little too long.  She could have been pondering my most recent question, or may have been lost in thought, but at that moment I opted to ask her gently if she was okay.  And she simply said, "I'm sorry, I just love the way that you talk with my kids."

Oh how that made me feel that I'm right where I should be and doing what I should be doing.  She saw the way I really ask, really listen, and aim to motivate. It's working, at least in this case. 

You've probably heard similar positive comments from time to time about how you communicate with your patients.  And yet, if I could only do so at home!  I can be ever so calm and motivating, building partnerships, and serving as a measured and informed voice of reason at work.  And while I want to consistently do the same at home, I CAN'T HELP YELLING. AT MY KIDS. SOMETIMES. GOT TO WORK ON THAT.  You?

How Do You Discipline Your Kids- In Public?

Genmedmom here.

Last week, on my usual Thursday off, I was on kids' dropoff and pickup duty, and I had a very difficult time with pickup.

Both kids are in preschool: Babygirl, almost age 3, loves her Bright Horizons daycare/ preschool, and Babyboy, age 4, is becoming more fond of his public Special Ed preschool program, as his teacher has really connected with him. Getting them up/ fed/ dressed/ out the door is always a bit of a challenge, but manageable.

Pickups, however, are getting dangerous. And not just for me, but also for my mother, who is most often on pickup duty.

Given the timing of school dismissal, we need to pick up Babyboy first, and then swing by Babygirl's school. Since you can't leave a four-year-old in a car by themselves, he has to come in with us to retrieve his sister. For the past month or so, once inside, Babyboy finds something he wants to play with in her classroom, and won't leave. He gets obsessed with completing whatever project he's invented, like lining up the construction toys or building something with Legos. I get it, he's autistic, and tends to have these sort of OCD-like moments. If you try to stop him before he's done with whatever it is he's determined to do, he throws himself on the floor in a tantrum. A loud violent tantrum. Even when he doesn't engage in something in the classroom, when it's time to leave, he gets wild, and runs away down the hallways, laughing at me when I call to him.

Babygirl is also now commonly protesting leaving, and has thrown herself on the floor, or also run away, giggling.

All of this is totally disruptive. Not only for the kids in her classroom, but for everyone in the whole school, as my kids scream and shriek and wreak havoc. Heads pop out of doorways, teachers checking on us, kids asking what's going on. If I yell, I'm just contributing to the mayhem.

Last week was the worst for me. It was him running away, and her tantruming. We were in the hallway, me kneeling on the floor trying to dress Babygirl to go outside, as she rolled around screeching, fighting me. I gave up on forcing her into rain gear (it was pouring) and hoisted her up, flailing and screaming. Meanwhile, Babyboy was running up and down the hallways, throwing himself on the carpet and rolling around, laughing defiantly. I had to chase down my son, grab his arm, and struggle out of the building. This was while carrying Babygirl, her lunchbox, raincoat, and backback.

I lost the backpack somewhere (and didn't realize until we got home), probably when I opened the heavy door. I had to let go of Babyboy in order to open it, and as soon as I did, Babyboy bolted out, across the driveway, and into the parking lot. In the rain.

There were no cars coming at that moment, thank God. But I yelled and yelled: Get back here! You hold mommy's hand in the parking lot! It was a safety issue. I had to get him and us out of the driveway and the parking area, and into the car. I yelled, I threatened, but he would not cooperate. Then Babygirl hurled herself down and I had to wrestle her back up, while attempting to run after a defiantly giggling Babyboy. The more I yelled, the worse he got. I caught him, and fairly dragged him to the car.

Finally, I jammed Babygirl into her seat and buckled her in- safe at least! And threatened to do the same for Babyboy. He got in his seat.

I was fairly shaking by the time I got into my seat. My throat hurt from yelling so much. It was so embarassing... What do the teachers think? What do other parents think?

"You both were very bad today," I admonished. I wasn't sure what else to do. They're in the car, so can't do a time-out. I'm not sure a delayed time-out would be helpful. I think spanking solves nothing, and would look awful in public as well!

They've been much the same for my mother all this week. So me, my husband, and mother have talked about this. We're struck with the difference between the kids when they're together, and when they're apart. One-on-one, they're little angels. Barring hunger or naptime, when it's just one by themselves, they're model citizens.

And, occasionally, they're OK together. I've taken both kids to restaurants, just me and them, and they've been wonderful. Random elderly women have complimented us: "Good as gold!" "So nice to see such good behavior!"

We can't figure out why Babygirl's school pickup has become such a trigger for terrible behavior. Sibling rivalry, like, they're competing for attention? Normal toddler/ preschooler defiance, like,as their sense of self forms and they're establishing independence?

We have consulted with a child psychologist in the past, and we will again. But I know there's alot of experience out there. Anyone else sometimes struggle to control their kids in public? What sort of discipline tactics work?

Genmedmom

I Spanked My Kid.

Genmedmom here.

I spanked my oldest last Wednesday. Twice. He's only four, he's autistic, and I hadn't seen him all day. I am such a jerk.

My day had started at five a.m. I had several extremely complicated and sick patients and several extremely complicated phone calls and a load of logistical paperwork and an inpatient to see and it was downpouring when I left work and I had to walk a mile to my car and the afternoon rush-hour traffic was standstill in the tunnel and I was forced to breathe car exhaust and I felt sick all the way to Nana's house blah blah blah.

I had been truly looking forward to seeing my little man and my little bug. But all the way to my mother's house (she picks the kids up from school/ daycare), all I was thinking was that I had to get the kids rounded up and in my car and back home for baths and bedtime, and I wasn't sure what time Hubby was coming home. I was stressed that I might be solo for the whole night-night routine (Panic!!!!)

When I got there, Babyboy had a poop and a terrible diaper rash, and he didn't want to be changed, so he twisted and turned, and he started grabbing things and throwing them at me, including poop-covered baby wipes, and I yelled STOP IT and swatted him on his butt. Then five minutes later he shoved a throw pillow at my infant niece, and I yelled THAT'S IT and I spanked him.

Now I feel terrible.

I've yelled and spanked before, and it always makes me feel like the most ineffective, inept, stupid, bad mommy. I intend to avoid this primordial parenting technique. But when I'm exhausted, and I can't seem to get control of my kids, I just get so frustrated and angry, and I can't seem to access any of the more advanced parenting skills I've read about.

And, spanking works. In the very short term. Very, very short term. Babyboy stopped throwing poopie wipes the first time, and he stopped shoving pillows the second time. But he cried and wailed for Nana, who never loses it and is always calm.

So, obviously not a great parenting tactic. And if my colleagues and patients saw me lose it and get physical over poopie wipes and pillows, I would be mortified.

The best book on parenting an autistic child that I have encountered so far has several wonderful lessons and suggestions on this very topic. I've dog-eared the pages and read them several times.

The book is Ten Things Every Child With Autism Wishes You Knew by Ellen Notbohm (Future Horizons, 2012), and chapter 9, "Identify What Triggers My Meltdowns" is applicable to any parent of any child who ever throws a tantrum for any reason.

She writes: "If you react with anger and frustration to your child or student's meltdowns, you're modeling the very behavior you want him or her to change. It's incumbent upon you as an adult, at all times and in every situation, to refrain from responding in kind. Be your own behavior detective. Figure out what triggers your own boiling point and interrupt the episode before you reach that point. When your thermostat zooms skyward, better to temorarily remove yourself from that situation."

In my case, Babyboy may have been overstimulated, and then protesting. There were many family members in the house and in the room; I had just arrived; the television was on; it was stormy outside... and I was pinning him down to the unpleasant and even painful task of a diaper change. When he acted out, I could have held in all my frustration, got the poop reasonably cleaned up, and put Babyboy in time-out in another room, away from everyone. That may have avoided the second outburst and spanking.

Of course, there are many people who feel that spanking is acceptable parenting behavior, and Ellen Notbohm has these questions for those folks:

"Consider:

Does spanking follow careful weighing of alternative responses and a reasoned decision that, yes, striking someone one-quarter our size is logical, provides a good example for them to follow, and will produce the desired long-term result? Can we be sure that it teaches the child what she did wrong?

Does it give her the knowledge and skills to correct the behavior? Or does spanking spring from aggravation, wrath and desperation?

Does it foster respect and understanding, or humiliation and bewilderment? Does it enhance the child's ability to trust us? Is it a behavior we want the child to emulate?"

Of course, this all makes perfect, clear, sane sense. And I've read it, and I get it. But in the moment, I haven't been able to consistently refrain from yelling and spanking. And I'd like to.

I think the real answer is in identifying Babyboy's triggers and trying to avoid them. In my case that day, there was an even better potential solution: I could have taken him to another, quiet room to change his diaper, and, after a bit of cuddly mommy time, I could have given him some control over the process, a job to do, like handing me the wipes or unfolding his clean diaper.

That response would have been ideal. It would have required some thoughtfulness, some space, some time.

As Ellen Notbohm writes, "Many will be the wearying moment when the root cause of your child's meltdown won't be immediately evident. There may never be a time in your life when it's more incumbent upon you to become a detective, that is, to ascertain, become aware of, diagnose, discover, expose, ferret out..."

As a physician, I am so accustomed to multitasking, problem-solving, wasting no time, get the job done... With Babyboy I need to slow down, breathe, and think. Study him, and anticipate the acting out, the outbursts, the tantrums, and steer around, or make them disappear. I do think it's possible...

Has anyone else out there had any similar experiences/ got any suggestions to share?

Online Mothering Mentor

Her name is Catherine Newman.

I've only commented on her blog once or twice.

I found her when I was pregnant with Cecelia, and she was pregnant with her daughter Birdy. That was 12 years ago.

I followed her weekly "blog" on babycenter.com before blogs even existed.

I read her book, even though I didn't need to because I read all those posts.

I followed her when she left to start her own blog.

She now writes on Dalai Mama, among other things.

She is a fantastic cook. She posts recipes, and when I try them once or twice a year when I have time they are fantastic.

Her crack broccoli is a fave go to at my house for a veggie on a school night. Her fried eggs with sizzling vinegar is one of my most beloved dishes.

I occasionally read what she is reading. Buy the games she is playing with her family. Recommend them to my friends.

I am still catching up on blogs from when I did not have internet on vacation last week. Catherine has been writing articles for New York Times on Motherlode over the last year or so. I read one today that brought me to my knees. It's not the first of her articles to do this to me.

That's why I'm writing this post. To share this fantastic article. Give kids your undivided attention - Or no attention at all. I'm taking an evening weekly six week parenting class from a highly experienced social worker based on a book her husband co-wrote - Parenting the Strong-Willed Child.  She trained in urban Atlanta and rural Mississippi and has two grown children. Catherine's article reminds me of what I am learning there to supplement my own awesome but lacking in some areas (aren't we all?) parenting. Strategies to gain control of your relationship to your kids and help them prosper and grow with capability and responsibility and love. I've got fountains of knowledge from this class from both the social worker and other parents despite only being halfway through it.

Thanks for everything Catherine. You don't know me but I love you!! Thanks especially for all the substitute mothering.

A bursting moment

We signed up the whole family to run our school's annual 2K/5K Family run this past weekend. Last year was our first year running it together; despite my protests at the time (I might die, go into rhabdomyolysis, etc etc given my baseline inert state since having kids), I ended up having a really fun time. It even got me into running regularly for the past year. Granted, I've been running short distances, around 2-3 miles at a slow pace, but I'm doing it 2-3 times a week without fail and have come to enjoy it. (Added bonus is watching TV shows while on the gym treadmill which I would never otherwise be exposed to, including Long Island Medium and Hoarders: Buried Alive. Fascinating.)

Being in better shape and actually used to running made me much more excited to run the 2K this time around. Also running it would be Jolie (9), JL (6), our au pair M, and my mother-in-law. I convinced my husband, an Ironman-distance triathlete, to do the 5K instead of running with us since he'd lap us anyway by the end. Our 3-year old would wait on the sideline with my parents.

Now, last year, JL ran with me while holding my hand the whole time. Yes, this was sweet, but making it physically more difficult to run. Believe me, I did not need any added difficulty. He told others after the race that maybe he could have won if he didn't have to run with (running-challenged) Mommy. Gee, thanks, kid.

At the start, everyone took off way too fast. I tried to keep up with Jolie and JL and keep them in my sights. JL, in particular, zoomed off- could not believe how fast he was going. I had to go much faster than my usual pace to catch up and run with him. We were flying and passing people. Probably about 3/4 of the way done, JL started to feel it.

"I need to walk!" he said. "My legs hurt!" "I'm tired!"

I switched to rally mode. "C'mon, JL! We're almost there! You can do it!"

He really wanted to walk. I told him he could walk, but that I would keep going and he could catch up to me later. This got him to push it out more. He didn't want to walk alone.

We kept running. He grabbed my hand. We ran for awhile like that. I kept cheering him on - Let's go, JL! Let's finish it! I know he was struggling. But, I also knew we were almost there.  Just a couple of more blocks and then we'd turn and see the finish line.

He was a trooper. He kept pushing it. We held hands. When we turned the corner and saw the end with the banners and the crowds, we dropped hands and he spurted ahead to finish.

We crossed the finish line within a couple of paces of each other - triumphant but totally spent.

We watched as others came through - a couple of his friends from Kindergarten and their parents. We saw Nana come in, we saw my husband come in for the 5K, then M and Jolie.

When the awards were announced, we heard JL's name announced for first place finisher of the 2K for his age group (6 and under)! He ran to the podium to receive his medal, and I could see his heart bursting with happiness. BURSTING.

This is a boy - the middle child- who is often in the shadow of his big sister and more-needy baby brother. He needed this moment.

As I watched him glow, showing his medal to everyone afterward, seeing that smile on his face, I was filled with a special kind of mothering joy. If I wasn't there alongside him, he would have likely given up, started walking, falling behind. And isn't this an amazing part of what we can do as parents? Being there, cheering them on, helping them do what they think they can not. Helping to make the moments that are filled with confidence-growing, heart-fluttering, self-celebrating pride.

For me, helping JL win that medal was the best Mother's Day present I could ask for. I am so glad I was there, helping him have a bursting moment.

The Question Box

As a pediatrician who is constantly answering children’s questions --my own (staving off bedtime) and my patients who ask everything-- I love Red Humor’s approach of simply and directly answering the “landmine” questions her children ask, in her recent post.   Her post artfully discusses questions about our treatments for people who are very sick, some of whom get better, and some who don’t.  Sometimes when kids ask where people go after they die, they may be asking literally, what happens to their body, see this from KidsHealth and this from the NIH.  There’s a list of books at the end, and a favorite that I can’t get through without crying is The Tenth Good Thing About Barney by Judith Viorst, or even The Giving Tree by Shel Silverstein (just about growing older).  It’s okay to let them see you tear up (and then feel better again) if you are so inclined.

About 3 years ago, stemming from my sister the philosopher, I had written a post here about "mothers who lie" and creative mothering.  But a friend of mine used another idea that works sometimes called the "Question Box" which you can use when you either don’t know the answer, or you don’t have the emotional energy or the actual time needed to fully answer, or you want to bring in your partner on the answer, or if you are asked something very private in a very public place, and so on.   It goes something like this, “that is such a great question, here is a short answer now, but I think we should write that down and put it in our question box so we can answer it more fully this weekend when me, you, and daddy are all together” or “…so we can look up the answer in this great book I have on the human body” or “I don’t think I have a good answer to that right now, but let’s make sure we look it up together.”    But then you have to get to that question box at some point!

Another fun approach to a different kind of question box question is to just lay it out there, “You are never going to believe the answer to this question” and then go ahead and tell them exactly how that baby really comes out of the woman’s body.  Tell them the people in their 2^nd grade class at school may not know this information yet, and they can wait until their own mommies tell them the answer. And, you can wait a wee bit longer on telling them how the baby gets in there.  Just the facts, ma’am.

It’s about creative mothering and telling the truth.  And being in a special place because of what we do at work every day.  And being there for our own children’s growing minds and emotional development.  With lots of questions and some well-timed answers.

PICU and the Biting Beast

I don’t know when it began, but somewhere in between finishing first year of residency and starting in the Pediatric Intensive Care Unit (uggghhh, acckkkk, poooo), my cute talking toddler became a biting, hitting, aggressive little beast. Sometimes he’s soo sweet and soo cute and I forget that at any moment, when we run out grapes or he can’t find his motorcycle, things could get very ugly, very fast.

When it’s ugly, he hits, he bites, he smacks. Who? Me, my husband, his favorite friends, his not-so-favorite classmates, his bath toys, his Froggy. Oh yes and when we recently tried to redirect him by holding his hand when he swats at us, he even tried a head butt. My husband and I sat stunned, where does he learn these things?

And did I mention I’m in the PICU?!? It makes everything worse. The guilt I feel about his aggressive behavior is exacerbated by my sheer emotional and physical exhaustion. I arrive home sometime during twilight outdoor playtime only to take him away from his beloved friends and the sandbox. I then clean him up and prepare him for bed while he wails and hits. Daddy pours the wine, puts his headphones on, and begins his nighttime graduate-student-writing routine. The only respite I get is story time, where Zo picks out his favorite books and says, “Sit down Mommy” and pats the couch beside him. Then I rock him to sleep as he cuddles and rubs my ears. After that I sit mindlessly perusing the internet for the countless hours while my husband repeatedly says, “Don’t you need to go to bed, don’t you have to get up at 4:30am?”

I have begun polling friends and have gotten: smack him, give him time outs, redirect him, it’s a developmental milestone, this too shall pass. Knowing that this phase is developmentally “normal” means nothing when I pick him up from daycare for the first time in weeks and his teacher says, “Sorry Miss, but Zo bit a friend, again” as she points to the cherubic chunky boy Zo has taken to like an apocalyptic zombie.

I can now proudly say that PICU is over and I learned a lot. I can also proudly say that Zo has made it 3 days in a row without biting anyone besides his toys, we celebrated at school today with dancing and he seemed very proud of himself. He starts everyday with a new family mantra “No biting people!” It’s the little-big victories; we have at least temporarily slewed the PICU and the Biting Beast.

When shared parenting means you are no longer number one

Recently, my daughter went through a period of preferring my partner, her other parent. For about a week, I would come home from work, starved for time with her,  and she would run to my partner and make a big show of hugging her and demanding to go into the kitchen with her. At dinner time, she refused to be fed by me, accepting food only from my partner, her Baba. At bathtime, I would have to pry her from her Baba and endure her bitter tears as we trudged upstairs for what is usually our most joyful time together. I was on a particularly miserable month, working the longest days I've worked all year and feeling resentful, bitter, and guilty almost every waking moment because I was spending so little time with her. When this theater of cruel preference happened for the first time, I went upstairs, turned on the bathroom faucet, sat on the tile floor, and sobbed for fifteen mintues. Then I came downstairs and tried to be as cheerful as possible as I sat next to the high chair and watched dinner progress without my participation. The situation was no fun for my partner either, as my time at home is the rare window of relief when she can check her email and recede into her own mental world for a while. Only E seemed to be having a ball, cocking her head to one side and making flirty toddler eyes at my partner while pushing my hand away from the food on her tray.

A male colleague once complained to me that his son prefers his wife, even to the extent of screaming and pushing him away when he goes to to pick him up in the morning or comfort him at night. As he told me this, I'm ashamed to admit that I thought, "Well she is his mother," as if motherhood is synonymous with being a child's primary go-to, as if a father should be resigned to being second pick. Well, here I was faced with the same situation and I was not resigned. 

I am not my child's primary caregiver. As an intern, I work until 6pm on the best days which are few, 7pm on most days, and 9pm on the worst days which happen at least 1-2 times per week. I have a week each month where I am gone from 6pm - 9am six nights in a row. The rest of the time I leave the house before my child wakes up and then I do bath and bedtime whenever I can, which is 3-4 days per week. Every day I have off, every evening hour that can be squeezed from the stone, every hour I can delay going to sleep post call, I do, but it still doesn't add up to 50%. Not even close. So I am not my child's primary caregiver, but up until the aforementioned week, I was pretty sure I was her go-to, her first draft pick. After all, I carried her and birthed her and nursed her and I am the only one in this family who takes rectal temperatures, let the record show. Prior to this episode, she had always been pretty happy with either or both of us, absorbing the love and care and attention of whichever of us was available at the time, so the assumption I had made about my being somehow more sacred and important had never been tested.

It was not a pleasant situation. In fact "My child will prefer her other parent" is probably number 2 on my list of top fears about being a working mother, right after "My child will be maimed or die while in someone else's care." I googled "My child prefers her other parent" and discovered that this happens to lots of people. Some children prefer their working-outside-the-home parent to their working-in-the-home parent and for some it is the other way around. In families where both parents work, the preference cannot be so easily explained away. Sometimes the preference is temporary and sometimes it is more deeply ingrained. In families with multiple children, one child might prefer one parent while another child prefers the other parent. None of these preferences seem to fall easily along gender lines. It was comforting to read post after post about this problem, but none really addressed my fear which was that by working so much, I was losing the right to be my child's number one. (Of note, I encountered not one post from a man complaining about this. Do men just not post on online parenting forums? Is this something that does not disturb them? It's an interesting question.)

When I was forced to examine my need to be number one, I realized that the whole construct is flawed and not relevant to our family. I was our daughter's primary caregiver for the first six months while my partner finished graduate school, now she is the primary caregiver while I am in residency. We have divided the work of parenting in a way that feels natural to us and that has nothing to do with traditional divisions of labor. My partner cooks. I deal with illnesses and sleep. We both work and make money, though my job is currently more time-intensive and less flexible. I'm good at helping our daughter achieve developmental milestones, my partner is good at structuring her days and giving her the downtime she needs. My daughter has two parents who work cooperatively to meet her needs and I'm very proud of that.

I'm not going to pretend that this transition in my thinking has been seamless or complete. There are still moments of panic and jealousy that my partner is so much more present in my daughter's life, for now. Thankfully, the phase passed and my daughter is back to taking the love from wherever it cometh, but I can't deny that I am secretly pleased and relieved when she leaps ecstatically from my partner's arms to mine when I come home. But I am teaching myself to be just as happy when she leaps from me to my partner, because the net of safety and love that protects her is so much stronger than it would be if she were relying on only one person to meet her needs. If I weren't working so much, things might have played out very differently in the dynamics of our family, so in a way I'm glad that necessity has created the opportunity for a more shared model to evolve. Ok, I'm not glad. But I do think some good has come of it.

What Would You Do: An Encounter At The Playground

So I had some free time on a lovely Saturday morning a few weeks ago. I wasn't on call, and I had no major errands to do. Babygirl was due for her nap, so I left her with her dad, and took Babyboy out in the jogger stroller, to the playground.

The playground is very large, with a baseball field, a grassy stretch, and several sets of gym equipment, slides, swings, and a sandbox. Babyboy always aims right for the sandbox.

There was a dad there, with two kids, a boy about 4 years old, and a toddler girl. The boy was doing his own thing, digging under the swings, and the dad was following the toddler around. We didn't interact really, except when Babyboy ran over and grabbed one of the boy's shovels and took it back to the sandbox. The boy didn't seem to notice; I apologised; and the dad nodded that that was fine.

I was sort of playing with Babyboy and sort of spacing out for awhile. It was a clear, sunny day. I heard the Dad say something like, "Son, your sister needs a diaper change, so I'm going to go do that, alright?" I figured he must have brought a diaper bag.

Some time later, I idly turned towards where they had all been, and there was only the boy, still digging under the swings. The dad was off in the distance, carrying the toddler girl,  probably a good football field's length of distance away. I watched as he kept going, down the road, up the stairs to a house, inside, and shut the door. He never even looked back.

Now, this is a big playground, with parallel fences on two sides, and parallel roads on two sides. The road entrances are not gated, they are open to traffic. One of the roads is heavily traveled. It would never occur to me in a million years to leave any age child unattended there.

Though the little boy didn't seem worried that his dad had taken off, he did suddenly seem to notice us. He saw me watching him and smiled. I felt terrible for him, being left alone like that. I felt responsible. I smiled back and called over to him: "Hey, want to play in the sandbox too?"

He got up and ran to us, happily, and both boys dug in the sand, not really interacting. Then he hopped up and ran to the slide, and went down a few times, running around it and giggling. Babyboy was taken by this. Babyboy doesn't seem to like slides much, but is fascinated when other people go down them. The kid kept running around and Babyboy watched.

I thought about this dad leaving his kid alone in the playground. He didn't even ask me if I was willing/ able to watch his kid for a few minutes. What if he had? I would have said yes, but I would have felt a bit put out. We weren't planning on staying there forever. Also, he didn't even know aything about me. He didn't know I was a responsible physician. I could be a kidnapper. Or just irresponsible, and leave the kid totally alone.

I thought all of this, and wondered if I would say anything when (and if) the dad ever got back.

Then, after a total of about ten minutes, the dad reappeared at the far edge of the playground, with the daughter. But they didn't come right back to where they had been. They dawdled way on the other side, while she toddled around on the grassy area.

Meantime I was kind of annoyed. Babyboy and the abandoned boy were sort of digging in tandem. Babyboy kept grabbing things from him though, and he was getting feisty. I kind of needed the dad to moderate.

As soon as he came close enough I planned to pack it up. He did walk over, calling to his son that it was time to go.

I didn't say anything.

What would you do?

Trayvon

Mothers in medicine is my refuge, my voice and my forum. So today, I am going to post about Trayvon. Today I will go to work with a hoodie on, I plan to do this every day until Trayvon’s murderer is arrested - AT LEAST ARRESTED. I’m sure some will wonder what this had to do with being a mother in medicine, and although it may not specifically apply, being a mother in medicine is pervasive in every part of my life. My heart aches for this innocent little boy and for his family because I now understand what it feels like to have a child. My heart aches because I have a little brother, who is my heart, who I love so much, who at age 17 wore hoodies all the time and he LOVES Skittles and Sour Patch Kids, and he is a brilliant, beautiful person, and I shudder to think that could have been him. My heart aches because the hoodie I will wear to work today is my husbands. It is the hoodie he wears home from the gym or basketball games after work. The hoodie he wears at night, in the dark and I know he is also no different from all the Trayvon’s in the world. My heart aches because I have seen first hand the violence of a bullet on human flesh. I have found the offending bullet in bodies that have, in an instant, been destroyed by a tiny yet destructive force. I have walked to the special room outside the ICU to deliver news of this destruction. My heart aches because every loss is huge and at the very least, when facing these huge horrible losses, every family deserves justice.

Gap tears

I started my fall shopping over the last couple weeks. This year’s gap hoodie is size 5T. It dawned on me, that very soon I will be shopping at Gap kids and not baby Gap. This is blowing my mind right now. We attended a private school fair recently. Everytime I answered “Kindergarten” to the question “What grade will your child be in next year?” it got a little harder to hold back the tears.

Time is going by so fast, I just want to treasure every second. I don’t know if this is because he’s my only child that I’m feeling this so strongly, or perhaps because our journey for number #2 has been such a long one. Perhaps, everyone feels this way and I’m just more vocal about it. I’m hoping that perhaps I’m “pre-grieving”. When my grandpa died, about a month before he passed I had a day where I realized the end was near. I mourned for a week, but when the actual funeral came, I was at peace. So hopefully by the time school year rolls around next fall I will be at peace with it… otherwise prepare for multiple teary posts.

Four Months

I came back to residency from my maternity leave when Melly was two months old. By the time she was four months old, I had gotten the hang of things, but it was still rough. Sleep was a frequent issue and between taking care of her and doing night call for work, I was constantly tired. I wrote this one night:

Melly seems to have developed severe separation anxiety in the past week. Leaving her for 5 seconds, or even just putting her in a bassinet, makes her cry. She's cried herself to sleep the past 4 or 5 nights because no matter how late I stay up with her she never wants to be left in her crib alone. I feel terrible.

I was also breastfeeding, so my entire existence seemed to revolve around the boobs. I was always looking for an opportunity to sneak off with my pump. By the end of the day, I was nearly desperate to get home so that I could be "emptied out". It was all I could think about, aside from her tiny little face.

As wonderful as that time was, new baby and all, it was very hard. Very very hard. I felt like I was being pushed to the edge of my limits, keeping things together only by some miracle. But yesterday I realized that as difficult as it was for me when she was four months old, it could have been worse.

At least I wasn't running for Vice President of the United States.

(Or is residency harder?)