Stumbling Through The March For Our Lives With Little Kids

Genmedmom here.

As a primary care physician with strong public health and clinical research roots, and as a politically engaged mom with serious concerns about our kids' futures, it made perfect sense to take our kids to the March 24th March for Our Lives Boston.

One complication: Hubby and I have been shielding them from the news, especially school shootings news. Babyboy is extremely sensitive to the topic of death, dying, and violence. He'll have "bad memories" for weeks after hearing or witnessing something along gun violence lines. This may be a normal little kid thing rather than an autism thing; they're only seven and six years old, after all.

Given all of this, it was actually very difficult to explain why were marching.

The Women's March and the March for Science were so, so much easier! Yesterday, Hubby and I found ourselves searching for explanatory phrases that didn't include references to school shooting deaths or the words "being shot" or "being killed". We ended up stammering, stumbling, and not successfully conveying the point.

Many organizations have offered guidance on how to talk to little kids about tragic events and disasters, such as the American Academy of Pediatrics and the American Psychological Institution. Major news outlets regularly publish advice about talking to children specifically about school shootings (which is definitely a statement about the states of affairs in this country). Two recent articles on TODAY.com and Cnn.com are actually pretty helpful.

So, this is something we clearly need to work on, as the kids' school runs lockdown drills and the #GunControlNow, #Enough, #Gunsense, and #MomsDemandAction movements spur debate and action.

Regardless, their taking part in a massive live social change movement is a powerful lesson. We emphasized that in many other countries, citizens aren't allowed to gather and protest, that we are very lucky to have this privilege, and we have to use it.

Overall, I'm glad that we took them and that they got to see freedom of speech, political activism, public health awareness, and social altruism, all at once and in person.

Mau Man and the Chronicles of a Low Birth Weight Mama

BIRTH:

In early March, I became a mama for the second time. We have nicknamed our new little one Mau Man. Our home birth didn’t feel all magical like the pictures I see on the Internet but maybe after continued exposure to oxytocin while nursing I’ll change my story and in a few years I’ll tell you all about how magical it was (feel free to call me out on it!). It was intense and brief (he came within 3 hours but it felt like days). Similar to our natural hospital birth with our first Zo, the details are hazy and I feel traumatized. Did a human just burst forth from my body? Yup! He did. Did I feel like I would give up. Heck yeah, I felt like throwing in the towel a few times, but I didn’t. Was I scared. You bet I was! Did I feel powerful afterward? You know what, I sure did! And super tired too, just like with Zo. I feel like no matter where you deliver, birth takes over you, it takes hold of your being and you just have to submit to the intensity of the process.

LOW BIRTH WEIGHT, THE CONTEXT: Now we find ourselves with our newest little one who is healthy in every single way except he was tiny at birth. 2360 grams (or 5 pounds 3 ounces). Under the low birth weight cut off of 2500 grams. I have read countless studies of how Black women like myself, regardless of socioeconomic status, are at a higher risk of pregnancy complications, maternal and fetal mortality, preterm labor and low birth weight. At my Baby Sprinkle a few months ago, a group of my closest friends and I spent considerable time discussing this topic. Pretty morbid but we are all Black doctors, educators, and health care professionals. But somehow I thought, I would be insulated, I would be spared. I took my vitamins, exercised, meditated, saw a chiropractor twice a week. With all of the complications and losses friends and patients have had I realize that low birth weight is manageable but it still hurts. After our own loss last year, I realize that regardless of how small he was I get to hold him and touch him and smell him and snuggle him and nurse him and I will do everything in my power to get his weight up.

LOW BIRTH WEIGHT, THE COMPLICATIONS: Flash forward to Day of Life 3. His weight loss was more than what our Pediatrician and I liked and he was at risk of hypoglycemia and dehydration. He had a good latch but he just couldn’t muster up enough energy to transfer milk out of my breasts fast enough to grow. I had to start nursing and feeding him every 1.5 hours and start pumping several times a day to provide expressed milk to supplement him with. We worked with an amazing local Lactation Consultant friend first at our home and then in her office and started using a Supplemental Nursing System or SNS. This is a little tube that you attach to a syringe to feed babies at the breast or using a finger to help train them. This helps prevent nipple confusion by delaying the introduction of a bottle. Day of Life 4 was a blur with a ton of feeding and pumping. Day of Life 5 - he had begun to gain weight and his parents were exhausted. We were allowed to space him out to every 2 hour feeds. Day of Life 9 back to birth weight. Day of life 18 weight up to 6 pounds.

And this is where we find ourselves: Nurse and reposition the SNS 10 times. Pump. O finger feeds with SNS in the early evening so that I can sleep for a few hours (this is priceless! Many thanks to Lactation and our old school Pediatrician who made this a key part of our process). Smile. Cry. Have a melt down feeling guilty that I couldn’t make him fatter. Listen to a podcast. Take a lactation supplement. Play with Zo for a few minutes. Tell Zo to be gentle and not climb on me while I’m nursing. Get a pep talk from the hubby. Repeat.

I’ll keep you posted and can’t wait until I can throw this SNS out. I pray for the day he is exclusively breast fed and that breastfeeding soothes him.

My world at night: our 30mL  syringe, the SNS premature baby feeding tube, my 2 pumps - my Spectra electric pump for daytime pumping and my NatureBond silicone manual suction pump for easy night time pumping - I pop it on the alternate breast while nursing/SNS feeding. 

REFERENCES:

Adverse birth outcomes in African American women: the social context of persistent reproductive disadvantage. https://www.ncbi.nlm.nih.gov/pubmed/21213184

Black Women Disproportionately Suffer Complications of Pregnancy and Childbirth. Let’s Talk About It. https://www.propublica.org/article/black-women-disproportionately-suffer-complications-of-pregnancy-and-childbirth-lets-talk-about-it

Racial Discrimination and Adverse Birth Outcomes: An Integrative Review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5206968/

What’s Killing America’s Black Infants? Racism is fueling a national health crisis. https://www.thenation.com/article/whats-killing-americas-black-infants/

Mommy time/ whenever I can get it

How do you fit your "mommy time" in?

I love residency. I love what I do, love my work colleagues, and am so thankful for my attendings and program director. I could not have imagined a more supportive community. 

One thing I'm grappling with right now is keeping any sort of structure for my kids when I am at home. When I am at work, the house runs like clockwork. My husband gets them to school on time, the nanny has them fed, brushed, bathed, and in bed by 7:30. No fuss, no problem. 

But when I'm around, it's chaos. And not the controlled choreographed chaos of the ED. It's pure, unpredictable, chaos. For example, this morning, all before getting to school by 845 (very late- they start 745), my daughter "ran away" from home down the block, the kids put on a puppet show, everyone ate pancakes, and only then did we start getting ready for school. 

As an EM resident, my schedule is varied. I work a lot of later day shifts (10-10) or mid shifts (2-2) and at least 2 full weekends a month. I usually average about 1 dinner/bedtime/bathtime home a week. During that night, we try to fit in all the homework for the week, I try to hear all the stories about their friends, cuddle time, book time, story time, song time, just-be-with-mommy time. Needlessly to say, bedtime gets substantially pushed off. On the mornings when I'm home before shift, I'm usually exhausted, but, as I have not seen them for 2 or 3 nights already, we morning cuddle, make pancakes, read books, play dress up, etc. Trying to fit all this "mommy" time into the 1 hour or so between wake up and school is impossible. So we are late. Consistently. 

I know that once they are older, getting to school on time will be more important, but it's been a challenge to balance between maximizing every second I get to be home with them with sticking to a routine. Some days are better than others, but I'd love any tips! 

How do you maximize quality time when you don't have the quantity time to give? How do you balance discipline/structure with just enjoying their company?

Financial Wellness?

Do you know how social security works? Are you maximizing contributions to your retirement accounts? Have you ever heard of a 529 account, or a backdoor Roth IRA?

I combed the archives of this blog, and while there are a smattering of posts on money and costs of being in the field of medicine, I didn't see much about money management and financial planning. It's not a topic people commonly like to discuss, and yet it's so important to our overall well being. Physicians are notoriously horrible at managing money, and yet many in our profession shoulder a huge debt burden, one that can amount to hundreds of thousands of dollars by the time all the training is over. And at that point, the last thing most people want to do is continue "living like a resident", so they commence with lifestyle inflation and remedies for their delayed gratification.

                             

Last weekend I had the pleasure and opportunity to attend the first Physician Wellness and Financial Literacy Conference, aka the White Coat Investor Conference. It took place in beautiful Park City, UT with two days of CME talks, broken up by mid-day skiing time. The conference featured valuable information presented by physician experts in the areas of finance, financial independence, and burnout, along with some financial professionals (who did not have an interest in charging huge fees to physicians for their services, an issue common to many physician-targeted financial advisors). There was even a talk by one of the only female physician financial bloggers, Miss Bonnie MD, who also happens to run the very active informational goldmine Women Physicians Personal Finance Facebook group.

On day two of the conference, I represented both PracticeBalance.com and Mothers in Medicine on a panel of six bloggers for a Q&A session. Despite being the only blogger there who does not primarily blog about finance, it was a lively discussion with lots of inquisitive attendees. It left me with inspiration to blog more, and blog more about financial issues that I deal with!

Over the course of the weekend, I met so many inspiring people - especially women - who are taking control of their finances so as to not become an "underwater doctor" statistic. We often say in my household that debt = slavery, and that sense of lost control is what often leads to burnout for many professionals. While debt is for most people unavoidable on some level during medical training, we physicians have the power to manage it and at the same time plan sensibly for the future. I felt so much more empowered after attending this conference, and I highly recommend that you all check it out the next time it comes around. At the very least, take a look at the blogs (linked above) by the White Coat Investor, Physician on Fire, and Miss Bonnie MD. They are a great starting point on the path to proactively managing your money.