The empathy toggle switch

In our clinical years, our medical school has instituted a program in which we do learning modules along with our in hospital experience and didactics. I was happy to see a module on empathy for my second month of surgery. The last question to be answered in this module was: "Although the studies on empathy are very consistent other authors have indicated that medical students are really not losing cognitive empathy, rather they are learning to engage in a “toggle switch” approach to patients where one side of the switch is “associated with the patient” and the other is “disassociated from the patient” which is necessary in order to perform medical procedures. Please discuss this and use example which you have seen or in which you have been involved."

Here is my answer:

I am not sure if I agree with this. Yes, there is a certain amount of disassociation that may have to happen in order to get through the day, and I guess I felt a “toggle switch” moment when I was first in the OR, and the patient was not a patient but more of a sterile field surrounded by drapes. But, I think there are complex layers of desensitization, not just an on/off switch situation that happens.

I participated in a dilation and curettage on a woman who was experiencing an incomplete abortion. I was in the room before the procedure and the OR nurse offered to let me do a pelvic exam on her, since the patient was already anesthetized. Although I was fascinated by the opportunity, and initially was tempted by the learning experience, I didn’t want to do it without her permission, and made myself consider her as a patient and a person, not as a pathology or anatomy in front of me. Yes, I knew she was going to have a pelvic procedure that she already consented to, and I even had the opportunity to introduce myself to her before she was anesthetized, but I knew it wasn’t diagnostic for me to do a pelvic on her in this situation, wouldn’t change the course of her treatment, and questioned the ethics of it. I knew I would have plenty of opportunities to do pelvic exams on awake and aware patients whose humanity I would face directly and whose informed consent I would be able to directly assess, and I was willing to wait for that opportunity.

I did promptly forget about the patient and what she was going through when I was observing the procedure with the physician. I was more fascinated by the tools I had seen used in other applications and in workshops, but never used in a real D & C. I was eager to listen to the physician and thrilled that he was a willing and excellent instructor, and wanted to explain everything he was doing in great detail. I suppose there must have been some sort of toggle-switch moment where the patient was no longer a patient, and I was only cognitively aware of dilators and an os, and the integrity of a previously scarred uterine wall that was attached to a nameless, faceless body.

After the procedure, I happened to come across the patient in the holding room immediately post op. She was not doing well. She was feeling incredibly nauseous, and felt like the room was spinning. I was saddened that she was alone. I summoned the nurse, and the nurse tended to her needs medically by getting some anti-emetics on board. Still, I stayed with her and talked to her about how she felt, emotionally, about what she was going through. It is hard enough to feel nauseous and dizzy, but it has to be even harder when one just definitively ended a much desired pregnancy. Also, her family was not with her in this recovery area, and I felt bad for her for being so alone. I guess if I was ever switched off, I was definitely empathetically switched back on at this point.

I hope that if I do get my career in ob/gyn, I do continue to consider my patients as patients. I know there is a crisis in ob/gyn in which obstetrics is turning more into a game of avoiding liability and “moving meat”, and I hope my switch won’t get flipped to the point where my nameless, faceless patient is just a medicolegal liability or a long labor to be avoided by an unnecessary surgery.

Cross posted at Mom's Tinfoil Hat

Get confident, stupid!

I've now been an attending for less than two months and I've received all of the following comments*:



The latest was yesterday, when I asked one of my patients if she recognized me and she said, "Of course. You're that little one that everyone thinks looks like a student."

Great.

My usual response is, "I'm older than I look." Inevitably, the patient will then ask me how old I am because when you're either older than 80 or younger than 10, you can ask whatever the hell you want. My reply is, "I'm in my thirties and I have a child." That usually satisfies them.

Now don't get me wrong. I like being told that I look young. What woman doesn't? I mean, if it really bothered me, I'd stop yanking out those gray hairs, right? Sure, we sit around and complain about how "annoying" it is when patients tell us we look young, each trying to top one another with our stories. One of us will complain that a patient thought she was in college, another will complain a nurse thought she was a high school student, and another will say that at her last delivery, nobody could tell her apart from the newborn. We're all secretly flattered though, trust me.

I've also noticed that men don't complain nearly as much about being told they look young, possibly because the Doogie Howser comments actually bother them, not just fake bother them like us.

So in summary, I don't mind being told that I look young. (Or thin. That's okay too. Thanks, Woman With Hip Replacement.) But I am bothered by the lack of respect that seems to accompany some of these comments. When an inpatient I've been seeing for weeks calls me "kiddo," that makes me think I'm not being particularly respected.

I suspect it's a matter of confidence. Confidence makes you seem older. As a brand spankin' new attending at an unfamiliar hospital, my confidence is not super high and I'm not good at faking it.

I'm not sure what I can do to build my confidence. I see other physicians (usually men) who have less experience than me under their belts saunter into the room and act like they know it all. Do they truly think they know it all? Do they know more than I do?

And then I see other physicians, older ones, who are so effortlessly confident. They know the answer to every question I ask... or if they don't know the answer, they can tell me why there is no answer. I wonder if I'll ever be like those attendings and have that level of confidence and knowledge. Is it just a matter of time and experience? When does it happen?


*Cartoon cross-posted to my blog, A Cartoon Guide to Becoming a Doctor

Grand Rounds at my place!

This week, I'm hosting the infamous medical blogger Grand Rounds over at my blog, A Cartoon Guide to Becoming a Doctor. Please check it out. It's supposed to be funny or something.

MiM Mailbag: Is it worth it?

Hello,

I am 21 (just about 22 years old) and in the process of applying to MD schools. I have worked very hard throughout my undergrad experience and (at least according to my advisors) will likely be admitted into medical school. I have been following the blog for a really long time, and I can't think of any other place to pose this question.

Is it worth it?

I am going through this journey without the financial aid of my parents, and having done some research, I have read that malpractice insurance/taxes take about 60-70% of a physician's salary. Knowing that I am going to have over 200,000.00 in loans, it almost seems like following this path means committing myself to a life of financial agony. I have dreams of Doctors Without Borders and inner city clinics, but my dreams do not even seem feasible in light of this. I know my personal financial issues are of little relevance to any of you or the blog, but my question is this. Is it worth it to pursue this dream? Or if given the chance would you have pursued a Physician's Assistant position or something similar?

Thanks :)

Love the blog!

First Day of School

On the first day of school eve, Sicily lost a tooth. Her sixth. I say sixth, she says seventh. She is convinced that there was a third in her top two front that just isn't growing in a new one because there is no room. I can see her confusion - the little snaggletooth.

I got up early to run and dress nicely in a skirt and blouse - I wanted to look good for them both. Wandered into Sicily's room at 6:45 to wake her.

I sang a good morning song, one that my Mom sang to me when I was little. Peppy and light.

Sicily (7) rolled out of bed, sleepy-eyed and disheveled. She reached under her pillow and seemed unimpressed by her tooth fairy money - an amount that would have staggered me when I was little. She announced her breakfast choice at my urging, got moving, and I went into her little brother Jack's (5) room.

Another round of the good morning song. Jack squinted his eyes, looked up at me, and announced that he wasn't going to school. "Jack H. won't be there." His best friend from last year transferred to a new school, and he was sad. He injected the emotion into the morning. He refused to eat breakfast, announced he would not get dressed, and retired to his closet cross-legged on the floor in his underwear. I sighed, still trying to be cheery, and went to find Sicily.

Sicily was lying supine on the couch in the kitchen, rumpled in malaise. I chided her to get up, brush her teeth, brush her hair, and get her shoes on. While I was juggling breakfast and Jack's foul mood, I heard a wail from Sicily's room. It seemed that the shoes she had bought with my Mom less than two weeks earlier didn't fit, and there was no other option. I discussed with her the fact that new shoes sometimes need to be worn in, but even without the shoelaces she decided she couldn't even take two steps. So I wrote a note to her teacher promising to address the problem in a timely fashion and put her in forbidden crocs.

I asked her, "Sicily, would you please try to cheer Jack up while I am fixing breakfast? Help him get excited about his first day of school?" I had checked - he was still sulking in his underwear.

"How can I get Jack excited when I'm not? My best friend is in another class (she had seen it on the roster). I'm miserable."

Whew. This was not the way the first day of school was supposed to go. I marched into Jack's room and got tough. He was whining and begging me to put his clothes on. "Jack. You are five years old. You can get dressed yourself, or go back to the pre-school class and take naps. If you can't get ready, I will take away tickets and you might not get to pick out of treasure chest on Friday."

They finally made it to the breakfast table and we had a short reprieve of happiness and interested guesswork about their new year as they both ate a hearty breakfast. Then, as I was trying to find my pager and get the camera for pics, they dissolved into picking at each other and fighting. Sicily refused to be in a picture with Jack, and he howled and banged on the piano. I finally convinced her to let him be in the picture, and here is what I got:

Not perfect (why is the font suddenly blue? Oh well) but I love it. That's us. Not perfect, but we do our best.

As I pulled into the carpool line both kids screamed excitedly as they recognized teachers and students from the year before. They tumbled out of the car at their respective drop-off points happy and smiling. I was glad to hear tonight that they had a great day.

The Start of Something New

In a less than a week, I will be a full time university student for the first time ever. I'm 27, I've been married for over 9 years, and I have an 8 year old son and 5 year old daughter, but somehow this milestone still feels enormous.

My husband and I are both transferring to the university after many years of on and off attendance at our local community college, interrupted by marriage and child birth and sudden medical issues with our youngest child. He is a criminal justice major and I am biological and physical sciences major, working steadily to complete my premed requirements. Last semester he and I alternated nights in evening classes during the week, and on Saturday I spent the day in Biology II. Add in his full time job and my volunteering at the hospital, and we were like two ships that passed occasionally to hand off the children and their information and we generally managed collapsed into the same bed at night, except when KayTar (my youngest) was sick and demanded his place in the bed.

This semester is promising. He is able to complete the remainder of his degree online, and I am finally able to take day classes. We may have some semblance of a normal family life for a few months! KayTar will be starting Kindergarten, which means both of our kids will be in school for full days. KayTar has a slew of special medical needs (that are mostly well-controlled at this point) and gets sick frequently, but my mother has agreed to keep her when she is home sick from school. She knows how to tube feed her, check her urine for ketones, test her glucose levels, and administer her medications. She knows her favorite books and television shows. She is one of KayTar's favorite people and I know they will be fine. And yet? I'm nervous and I feel a little bit guilty. I've been KayTar's primary care giver, in sickness and in health, ever since we realized things were not quite right with her. Stepping away from that, even in a small way, is going to be a bit of an emotional adjustment for me. KayTar is already excited about spending her sick days with my mother!

Our schedule is still a little bit wild; shared drop off and pick up from the kids' school, driving to and from downtown to get to my school, volunteering at the Children's Hospital, volunteering at the local free clinic, volunteering at the kids' school, shadowing physicians, baseball and cub scouts for BubTar, dance and twice weekly therapies for KayTar, along with interspersed appointments with her various doctors...hopefully we don't have any ER visits or urgent surgeries this semester like we did last semester! It is going to take a lot of teamwork to make this work, but I think it will be worth it. Wish us luck!

Peptic ulcers notwithstanding

Much like I feel like I deserve an award for bringing my two young children to IKEA and returning home with the same two children, so do I for finishing my 15th letter of recommendation for fourth-year medical students each Fall.  Sure, some letters are easy:  those whom I know well and can share insightful anecdotes about basically write themselves.  But, then there are the students who I know less well, or worse, have reservations about, where the objective is to write the most positive letter I can without lying. After writing fifteen letters, it’s hard to sound fresh and engaging. I’m just hoping to use the correct pronouns consistently.(1) Then, after I send that last letter off to the Dean’s office, I’m left looking around for the man with the medal who is supposed to say, “Thank you for your service, Ma’am. Here’s that medal I promised you.”

Like being a mother, being a clinician-educator is full of thankless tasks.  There are no trophies for remembering to buy enough diapers so your child doesn’t have to wear swim diapers (again). There are no engraved plaques for having a one-hour feedback session with a student who is not performing at an acceptable level, but doesn’t agree with that assessment. There’s not even a blue ribbon for winning first prize in “Guess what this abstract finger painting is of (Hint: not your first instinct),” or “Pin down the last evasive attending that needs to give their input before the final grade computation.”

Yet, I’ve also found that, like mothering, being an educator means you do these thankless tasks out of love. Because your job and who you are is why you do what you do. You know that they will grow up and, at some point, hopefully, appreciate the time, the patience, and the energy you put into everyday. And, even if they don’t ever say “Thank you for ruining your body forever by having me,” or “Your investment in me made me a better doctor,” deep down inside you know you made a difference.

The labor of love that is parenting and educating is one and the same: at times painful, occasionally the cause of a peptic ulcer, but, in the end, unbelievably rewarding.

Still, more awards (or medals) for both jobs would be nice. A girl can dream.


(1) NB: some to all parts of this post are written tongue-in-cheek. Please do not send hate mail or actual medals.

MiM Mailbag: First intro to medicine

first of all i want to say i love all of your stories. they inspire me to go through school and achieve what each and every one of you have achieved.

i have connections to a hospital and was told that i could shadow a doctor. i was given pretty much free reign as far as my choice and i'm supposed to tell them what i'm interested in and they will arrange who i shadow by what i tell them.

well, i'm interested in obstetrics...but i have a feeling that might be kind of awkward to shadow. other than that i have no real preference.

so my question to all of you lovely ladies is this: what area of medicine do you think would give me the best experience? this would be my first intro to medicine and i want to pick something that would be a positive experience and that would be able to show me a basic "day in the life of".

thank you!

Why I loved having a nanny

I've made no secret of the fact that Melly was a nanny-baby, and it's a decision that I'm very grateful that we made. We loved our nanny.

For those of you struggling with the nanny vs. daycare question, as I was, I wanted to share a post I wrote on High Heeled Mom about the pros and cons of having a nanny.

Seeking inspiration for inspiration

We have a new first year class staring in two weeks. A colleague asked me to suggest something they might read about a physician to provide inspiration. We agreed that books about heroic doctors going to dangerous places were not suitable, but I couldn’t come up with anything else. I also realized that most doctor-heroes—at least the ones who inspire others to write about them—are men, often men motivated by religious faith or medical missionary zeal. The women doctors who have fascinated and inspired me all come from the pioneer period, when just going to medical school was itself an act of heroism. For this class, in which women are the majority, those kinds of accounts would likely seem quaint at best. Who inspired you? And who do you think might foster the spark in the class of 2014?

MiM Mailbag: Having kids during med school

Hi Mothers in Medicine,

I love, love, love the blog and use it as a nice way to procrastinate from studying when I need a break. It's medically related, so that makes it okay, right?

I thought I would submit a question with something I am struggling with in hopes that I can get some advice from all the mommy-doctors out there.

I'm currently a rising 2nd year and I would like to have my first child while still in school. However, I am battling with the timing of it all. I realize that the entire process of parenting doesn't necessarily work out as planned, and that we may not conceive immediately, but ideally I would like to conceive in November so that the baby would be due in August since I would like to take off a year to stay home with the baby and the natural break in the summer would be perfect for that.

So, my options are either have the baby between second and third year, or between third and fourth year. I found my passion this summer while shadowing, so I know without a doubt I want to be an emergency medicine doc.

Here is my assessment of the two options for 'baby having'.

Between Second and Third year-

Pros: natural break in curriculum between class and clinic medicine, when I do start back in 3rd year I will be still be sharp in 4th year during my ER rotation for a rec. good letter, starting family sooner (28 instead of 29 if we wait a year)

Cons: Being preg. during 2nd year when the courses are tough, being pregnant while trying to study for the boards (I've heard 'pregnancy brain' can really affect your memory), and being very pregnant (7~8mos) while actually taking the boards (bathroom breaks?), having a 1 year old during 3rd year rotations when time is limited and not your own


Between Third and Fourth year-

Pros: Not worrying about how pregnancy may have effected my board scores, having 4th year coming up which is considerably lighter than the first 3 years of medical school

Cons: Since I would be off an entire year between 3rd and 4th year, I'm worried that I may be rusty on my clinical skills and I really need to impress during the ER rotation which is during 4th year, Being pregs during 3rd year and how this may effect those grades which are more important than preclinical grades.

I realize there is no "right" time to have a baby during this training process, however, I was wondering if I could have some insight from women out there who have been through it and have children now. Obviously, I have no idea the amount of energy and time a child needs, so from women who have been through this arduous process of medical training and know what it entails to be pregnant and to be a mother, what would you do if you were me?

Many thanks in advance.

MiM Mailbag: CRNA or MD?

Hi, I'm looking for advice from mothers in medicine. I am a biology major, in my senior year with a 3.9 gpa. I also have a 2 and 3 year old. I'm debating whether to pursue medical school or CRNA. Even though these paths are separated only by 2-3 years, I am leaning towards choosing CRNA because of having a family. I fear that the medical school and residency experience will be too great of a sacrifice of family and time. Can you offer any advice? I am worried that I will regret my decision, regardless of which one I choose. If I choose CRNA, I will regret not achieving my own personal best or ultimate fulfillment. If I choose M.D., I may regret losing countless hours with my family along the way. This of course rides on the assumption that the CRNA route, although comparable in measurement of years, will be much easier in terms of time invested (hours of study, etc.) I would really appreciate some insight from those who have chosen the M.D. route and may be familiar with that of CRNA and could make a comparison or at least shed some light on how manageable medical school and residency are with young children, and if you believe that you would do it again if you had the chance to turn back time.
Thanks you so much!

C.C.

Mommy/daughter day

I wasn't working today, so I took Melly to a local pool. She really, really likes that pool. But it's not heated, so I mostly just sit in the water and slowly turn blue.

While we were "swimming," I ran into a one year old girl with her nanny. I was chatting with her a bit, while she bounced the baby around.

Me: "She looks like she likes the pool."

Nanny: "Yeah, she does. But her parents can't take her in it because they're both doctors and don't have time."

Me: "..."

Nanny: "Well, I guess they could take her on the weekend maybe."

I was tempted to say something, but I didn't.

Anyway, for the first time in over three years, I have a day off during the week to spend with my daughter. It's heaven. It's what I've always wanted. Except I'm not sure what the hell to do with her all day.

Last week it was too cold for the pool, so things really got crazy. We went to this tiny park nearby and acted out the following scenario:

Melly: "I'm Supergirl. You be Superman. I have to rescue you."

Me: "I'm Superman. Help me, Supergirl! Save me!"

Melly: "Here I am to save you!"

Repeat x 10 million

After less than an hour in the park, I was ready to shoot myself in the head. We ended up fighting a lot and I eventually just plopped her down in front of the television.

This week was better. We had the pool, we did laundry, then we drove to the supermarket and bought cookie ingredients to bake cookies from scratch. It was actually really fun till Melly decided she wanted to eat all the cookies immediately and stormed off to her room, declaring she didn't like me anymore.

Those of you who spend days alone with your preschoolers, what do you do to entertain them? I don't want to take any long excursions because she hates the car, but there must be something we can do to entertain ourselves all day. Maybe more recipes that are mommy/daughter friendly?

Easy Bake Oven

I'm not much of a cook.

I could fill you with stories - like how I accidentally read the wrong page while trying to bake the Christmas Rum Cake when I was home for break from college, and ended up mashing the ingredients for two different cakes (the other one was strawberry, I think), necessitating an extra trip to the grocery store on Christmas Eve. Or the time I attempted Chocolate Mousse for a supper club and wasted three cartons of eggs. My final mousse had the consistency of chalky pudding. Or the time I was cooking dinner at an evening shift at the home for people with schizophrenia in college, and ended up almost setting the kitchen on fire trying to follow one of my client's recipes for home fried potatoes. Or the time I decided to bake chocolate covered peanut butter balls with my daughter for all of the teachers at her school for Christmas, and I got the wrong kind of chocolate that wouldn't solidify unless it was refrigerated (not to mention that I forgot peanut butter wasn't allowed at the school, so me and my cold peanut butter balls were ushered frantically out of the building the next morning by a teacher's aide - you would have thought I was trying to smuggle cocaine into preschool). Luckily the temperature was in the twenties, so I enjoyed all the peanut butter balls myself as they sat happily in the front seat of my car over the next week.

When I went to pick out a birthday present for my daughter Sicily's 7th birthday last March, I thought the Easy Bake Oven was just the thing. I remembered having one when I was little, enjoying baking tiny brownies, and decided it would be perfect for me and her to do. I would create fond memories with her, baking tiny desserts that required little to no cooking ability.

It's now August, and the Easy Bake oven has sat unused in a cupboard for months. My daughter pulled it out this morning.

"Hey mom! I think I'll finish this sock puppet on another day." She pulled out her sewing kit from Ramona this morning and made a wonderful sock puppet with a lime green sock, a button eye, and hair made from the cut off fingers of an old mulberry-colored mitten. They end result was fabulous. My only assistance was threading the needle in between YouTubing barracuda attacks with my son Jack. "Can we do the Easy Bake oven?"

At first I hemmed and hawed about how we didn't really have time and it would take too much effort.

"Please mom? I don't remember who got me this, but I'm really excited to use it. You can even pick out what we make first."

I felt guilty at the months that had gone by. "I got it for you." I looked at the clock - only 9:30 a.m. Her dad wasn't coming to pick her up for lunch until 11:30. "OK. Let's figure this thing out."

Luckily, my dad set it up with the proper bulb back in March so it would be ready to use. I plugged it in, thinking the 15 minute warm up time would be too much to prepare the mixes. I was wrong. While Sicily was back in her room making her bed, I asked Jack what he wanted to make. "Chocolate chip cookies."

When Sicily returned, Jack convinced her that I decided on the chocolate chip cookies. "Come on, mom, don't you want to bake a cake?" I told her if the cookies worked out OK maybe we could do both.

I found the recipe and we poured the tiny packet of powdered mix into a bowl. I prepared butter and paper towels to grease the tiny pans and made a little plate of flour for shaping the cookies. I read 3/4 on the amount of water to add to the mix, and realized after pouring less than half of 3/4 cup of water into the mix that it was way too much. I consulted the recipe and quickly realized my mistake. 3/4 of a teaspoon, not 3/4 cup. Oops. We started from scratch with a new mix.

After Jack and Sicily each made three cookie dough balls to place in their pans, I grabbed the plastic pan holder and attempted numerous times unsuccessfully to shove the pans backwards into the oven through the cooling rack. Finally Sicily said, "Mom, maybe it goes in this way?" I told her that wasn't likely, it was probably a design flaw, and searched out the instruction booklet. She was right.

8-9 minutes later (isn't that the same time it takes for regular cookies?) we had tiny conglomerated flat cookies that looked like they weren't fit for our snake. Sicily looked crestfallen, but I assured her that looks aren't everything, and they probably tasted OK. She and Jack happily devoured their cookies, and we moved onto the cake.

Once again, the amount of water to add was negligible, but the consistency didn't seem right, so we added a little drop by drop (I felt like I was back in Chemistry class doing a pH lab titration). The frosting was similarly difficult. Sicily became angry when Jack ate all of his frosting, so instead of a two layer cake we just made a tiny cake sandwich with a chocolate frosting center and I found some tube icing and sprinkles in the cupboard to decorate the top. The entire process took about an hour longer than if we made a regular cake, and the end result was paltry. Despite liberal greasing by Jack, the cake came out of the pan piecemeal like a uterus in a laparoscopic hysterectomy. Jack took two bites and wandered off to his room to play. Sicily cut the half dollar-sized piece of her cake into three pieces - nibbled one, gave me one, and gave the other to her dad when he arrived.

While we were waiting for the second layer of cake to bake in the oven, Sicily was enjoying the last bites of her cookie flatbread and absentmindedly cleaning the flour from the table with a baby wipe (Love them! Still use them! Make-up remover to counter top cleaner!). "Mom, isn't this just wonderful? Isn't it the most fun you've ever had? Can we do it again soon?"

A better cook might me more successful than myself with the Easy Bake Oven. But as Sicily smiled up at me this morning with cake batter and cookie dough spattering her mouth and cheeks and flour dusting her nose, I had no regrets on the money I'd spent for her birthday present.

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?