Last Week

My little family had a tough week last week. In addition to the usual chaos of single-working-mom-with-two-kids life, which includes (but is not limited to) two morning drop offs during the week, ballet, play rehearsal, soccer, swim class, my own personal interviews for a potential promotion at work, and a snow day during the week (oh how I could do a single lengthy post on the chaos of being a doctor mom with two kids on a snow day!), three year old E got sick. And we landed in the hospital.

I should mention that my seven year old daughter, M, has immunity of steel. She had the usual colds, fevers, early childhood sicknesses until roughly 18 months old, and then she’s been rock solid since. I can’t remember a time in 5 years that she’s seen the pediatrician other than for a wellness physical.  

And then there’s E. He’s had an ongoing solidly built relationship with our pediatrician which has landed him in her office so many times we all stopped counting. Sometimes I see her so much (and I like her SO much!) I think I should take her out for coffee or something!  For a while it was bi-weekly, for a new cold, fever, cough.  Between the ages of 6 months and 16 months, this kid was hospitalized three times for respiratory problems.  The frustrating thing was he would get overtaken by a cold which would turn into brochiolitis, land in the hospital with hypoxemia, get treated with oxygen (and time) and get better, but no one could really put a name on it.  It wasn’t asthma. He got tested for CF (oh, that was a harrowing day!), amongst other things, and the pediatricians landed on a diagnosis of “tracheomalacia” and told me he’d grow out of it.  So for 2 solid years, we walked on eggshells with this little guy and his tenuous health.  And, slowly, he seemed to get better and the “colds” got less frequent, and I slowly let go of some of my anxiety about him getting sick.

Last week, he wasn’t himself on Monday and had a low grade temperature. I didn’t think much of it because he wasn’t coughing and thought he’d rest a little on our “bonus” snow day. On the morning after the snow day, he still had a low grade temp so I kept him home from school but I needed to be at work. I was precepting for three residents, two of my colleagues were away on vacation, and there was just absolutely not a single soul (believe me, I racked my brain!) who could precept those residents for me. So, I brought E to work with me -- he was psyched! He sat at my desk, drew pictures, played on the computer, got fawned all over by my colleagues, and enjoyed the bonus graham crackers and apple juice in the ‘supply’ closet! He was really acting fine, even a little energized by being at my office, but a slow, barking cough began to emerge.

We left my office midday and went to the pediatrician (it was a covering doc as our usual pediatrician was out that day! Sigh.) to find he had since spiked a fever, and his room air pulse ox was 92%.  He had a right lower lobe pneumonia [ok, this is the part where I confess I listened to his lungs when he was in my office -- which I try to NEVER do, except I did this time -- and thought I also heard a pneumonia but tried to leave that to his real doctor to decide!]. They gave him nebs in the office (I told them they never work, but they always say it’s worth a try) and his pulse ox remained at 92%.  So, we left with our amoxicillin prescription and a word of caution: “You know what to do. You are a doctor. If he gets worse overnight, don’t even call us. Just go to the ED. If you are worried tomorrow, bring him in again.”

I should have known. It always gets worse.  This kid gets sick fast.  So he got his first dose of amoxicillin, and I waited.  You know that waiting -- the kind of waiting moms do -- where we are so worried, need to be distracted so we don’t obsess, then we second guess our judgement, try to convince ourselves it will be ok, exercise some magical thinking that all will be fine as soon as the antibiotics kick in, and the time can’t pass quick enough.  I put E to bed at 6 pm because he was so tired and miserable, and the next 3 hours were unbearable. He would sleep for 5 minutes, cough uncontrollably, wake up and cry, and then be so tired he’d fall asleep again, and then do the same thing over and over. It went on like this for so long. Did I mention I also was getting my 7 year old fed, showered, ready for bed? Oh yeah, that too!

At 9:30, while holding E in my bed, trying to get him to calm so that he could get some much needed rest, he woke and cried and said “Mama, I need help. I need help.”  So, that’s it.  I sped into action: clothes on, coats, boots, hats, gloves for kids, I woke up M, I put both kids in the car (10 degrees outside!), dropped off M at a friend’s house to sleep over, and drove to the ER.  E’s dad eventually met us there -- another story.

In the ER, E’s room air pulse ox was still 92% but when he fell asleep, he got hypoxemic to the low 80s.  I’m guessing it’s why his sleep was so fitful.  So, we got admitted. And we spent 3 days in the hospital. From the gurney in the ER, I sent emails and texts to my clinic manager, medical director, and colleagues to cancel all my patients and my meetings, and the interviews for the promotion that I’ve been working toward.  The rest of the week was a wash.  In fact, all the stress and chaos of ‘everything else’ just melts away when you have a sick kid. I told myself, “I’ll catch up. It will be ok. Everything else will wait.”  And it did. Time stood still with him in my arms. All I needed was him to get better.

E is fine now. He is back to preschool, and back to his usual self. M had a few days of being bonkers because her routine was off as we figured out how to move all the pieces of the family puzzle while I stayed with E in the hospital (thank goodness for good friends!). But, she was truly a champ during it all. And, we are back to ballet and soccer and swim class and play practice and birthday parties and the crazy of morning school drop off, and I’m back to patients and meetings and interviews. And somehow we are all staying afloat. And we are making sure to do it all with lots of hugs and giggles and a few dance parties mixed in -- the chaos is there, it’s never going away, and we are trying to keep it ‘light’ for now because that’s all this doctor mama can take at the moment.

Silent Day

Silence.

It’s golden right?

Silence.

I’ve craved it. Haven't we all?  As a busy doctor and mom, there’s always something in the background of daily living -- kids arguing, kids playing, kids giggling (my favorite!), the hustle and bustle of the life in the clinic, a shout of “mooooooooom” from upstairs or downstairs, the radio, the stove, the washing machine, the beeper, the pitter patter of fingers on my keyboard.  But, this minute, it’s silence. This hour, and for all the hours of today, it’s silence.

Right now, it’s feeling deep, dark, and deafening. I’m sitting on my couch in my house alone. It’s Christmas Day. I’m Jewish, so it shouldn’t feel sad or lonely. But, this is my first Christmas alone. I’m divorced now and my kids are with their dad. For the past decade, I adopted Christmas and it’s tradition of bringing families together. I cooked and baked and decorated a tree and made new traditions for my then-husband and kids. In those days, when I left work the day or two prior to Christmas, I said ‘goodbye’ to colleagues, wished them happy holidays, and looked forward to making my house warm for my loved ones and kids.  This year, I left on that last day of the work week with dread.  I savored the last few hours I had with my kids before my ex picked them up on Christmas Eve morning -- we snuggled in bed, watched tv, tickled and laughed. And then, they were gone.  And the silence set in.

That morning, I went to work as the ‘on call doctor’, seeing patients in urgent care, fielding pages from the answering service. And then about 1 o’clock, I left the office, got in my car, and wasn’t sure where to go. Others were out and about, finishing last minute shopping, or on their way to see friends and family (I presumed).  I stopped for coffee. And then I went home to The Silence.

Today, Christmas day, I slept in a little and woke to an empty house. I should be rejoicing. Free time to nap and read and sew and listen to music and clean my house is mine for the taking. Except, it just feels sad and lonely. The world is shut down today -- the stores are closed, there is no traffic on the roads, I have no where to be and I feel like an outsider again on Christmas.  My kids aren't with me on a day that is about family.

Late morning, I left the house for a bit to meet a friend and her family for lunch -- they are ‘in between’ religions, unsure how to celebrate this year after she lost both her parents in the last several months. I was glad for the company and an excuse to leave my house, and The Silence, for a little bit.  Her family welcomed me with kindness and warmth with an undertone of understanding that I am feeling like a woman without a country this year. Their hugs were warm, and lingered just a little longer than one might expect -- a subtle acknowledgement of the suffering they knew was behind my smile today.  

I have always known that the holidays are a hard time for people. Facebook feeds and tv ads are filled with the perfect storybook moments of families coming together on the holidays.  They don’t make commercials about the hearts of single parents breaking when their kids leave for the holidays.  They don’t tell you what to do all day when everyone else is home celebrating, and you are alone. No one posts a ‘’selfie” on facebook with a comment, “here I am all  by myself on Christmas. Happy Holidays everyone”. When I got a group text from a friend today, “Merry Xmas to all of you! Hope you are enjoying the day with your families!” I chuckled a little when I read it, and then felt nauseous, forcing myself to ‘stay positive’. My fairy tale family is split up and we don't fit into that cookie cutter holiday description anymore.

I don’t write this with self pity. It is more of a conscious exploration of this uncomfortable state of being. I am in a new chapter of my life. There are new realities that I need to accept about my life and my kids and my former relationship. I’m trying desperately everyday to be a mom who is present, navigating these treacherous seas for my kids and helping them get through it all, with all the usual background noise of work and schedules and a busy life.  While I should welcome today’s silence, I fight it and argue with it, and sit with it uncomfortably.  We are not friends.  

In a few short hours this day will end. We will all slowly get back to our routines. At the end of the week, I expect my house to be loud with the usual noises of kids and this heavy loneliness will abate for a time.  I’m hoping it gets easier someday.  

If you were lonely this season, I know how you feel.  No one has said that yet to me, but I'm going to say it to you. May the New Year bring warmth and light, joy and happiness. May we continue to harness our courage and strength to get through difficult times, and find ourselves better on the other side of them.  May silence someday feel golden and welcome, and envelope us with the promise of self care rather than with the dread of loneliness. I wish that for me, and I wish that for you, if you are out there and you know what I mean.

The Soul Condition

The day to day practice of General Internal Medicine can be particularly challenging and trying, but also thoroughly rewarding. I have found that the most incredible moments of privilege and wonder in this profession come in the most unexpected times and places. Especially during this past year, which has been particularly trying for me personally, just when I think I can’t bear any more suffering, there is a surprising glimmer of light that penetrates the darkness. I’m thankful for those moments, and being mindful of recognizing them when they present themselves.

One morning recently, I entered an exam room to see a patient of mine during a busy Tuesday morning clinic. He was sandwiched in my schedule between a lovely middle aged woman with a newly diagnosed metastatic lung cancer (sigh) and a young adult patient with a sore throat. I saw him on my schedule for that morning and smiled – he was a lovely elderly man that had a difficult past few years with depression, obesity, and was ever skeptical of my western medicine approach to his longstanding hypertension. Despite it all, we always found a way to have a good talk, able to cross the chasm of our cultural and religious differences and find a way to speak a common language with each other. I take care of his wife and his adult daughter, as well, so I have a multi-dimensional sense of his life at home.  In the flurry of the day, I closed the door finishing with the patient across the hall and stepped in the doorway of his exam room to say a big hello. I looked up and barely believed my eyes – “Oh my goodness, how are YOU?!” I said. There he was, big sparkling smile, bright eyes, “Hello there, doc!” He looked twenty years younger than his 74 year old self, and strong and happy.  This was such a stark contrast to our last meeting, about year ago. “Well, doc, I thought you’d be proud. I lost 70 pounds.”

I smiled. I paused. I looked at him lovingly and proudly and then squealed with excitement as I gave him a hug. “How did you do it? And how do you feel?”  He went on to tell me how he feels terrific, both physically and mentally.  When we last saw each other about a year ago, he was sad, lacking motivation, irritated with his wife who was ‘nagging’ him, and about ready to move away to a warmer climate.  He was morbidly obese, had aching knees, and just didn’t feel like himself. I recall distinctly (one of these moments that just are quite captured in the EMR documentation!) at that visit we talked about “why are we all here?” –I had referenced a friend who had recently passed away at the age of 49 and I was feeling great loss at the time – he too was feeling loss and disappointment about moments in his life and was reflecting on his 73 years, having an existential crisis of sorts. We hugged at the end of that office visit. And now here we were, a year later, and he is bright and happy and has lost so much weight. 

A year has changed so much of who we both were. I was about to hear about his year long journey. Over the last year, I had seen hundreds of patients while I tried to keep my own tattered life afloat. My marriage broke up, I sold my house, I moved, and have tried to weather the storm of a messy divorce while parenting two little kids who were trying to understand it all. I couldn’t help myself as these thoughts rushed in--the year since we saw each other last had affected us both so profoundly. And here we were, again. And I think we found unspoken strength in each other.

“Well doc, this is all about my ‘Soul Condition’.”  I looked up, saying nothing, but my eyes gesturing ‘tell me more.”  He went on to tell me that he thought a lot about his life after our last appointment. He realized that his poor health habits, for him, were about failing to care for himself and his ‘soul’. He realized at some point he is worth more than his poor health habits, so slowly he started eating better and exercising. He said “Doc, you told me to go for a walk. So, I’ve gone for a walk everyday ever since I saw you last.”  Wow! I admit I had a moment that I couldn’t believe someone actually listens to me!  We went through the rest of the visit, me with genuine joy for him, him with the pride of a child reporting back a good deed to a parent.  And then we finished, as he and I somehow always do, sharing tidbits of our lives and hopes, and he teaching me more about the Soul Condition. He said “Doc, if you are unhappy, just work on your soul. You should tell your other patients that. I’m not even tempted to smoke or drink alcohol, or eat ice cream. Why would I now that my Soul is so happy in this body?”

I’ve thought of him a lot since that day. I could certainly learn a few tips from him – or at least my Soul needed a new kind of condition after all I’ve been through this year.  I couldn’t help but wonder if he saw it in my eyes, if he knew I needed this advice.  Divorce is ugly and bitter and deeply devastatingly sad – it does break a soul as it breaks a family.  I bear witness to so much human suffering on a daily basis in my role as physician, and sometimes the only thing I can do is sit with a patient and listen and hold his or her hand, offer a supportive word or a hug.  I have found it an incredible burden to also carry my own suffering into the room with my patients as I listen to their stories, offer kindness, support and advice. I’ve often wondered over the last year if I’m good for any of them and if I could possibly bear any more. During that 20 minute appointment, I earnestly rejoiced in his improved health and happiness and learned from his wise counsel. 

Just like my patient worked to make his Soul happier, I’ve learned I need to deliberately take steps to do the same. I savor my kids’ giggles, and give more hugs, and spread more love, and have learned my own needs count.  I have long taken care of others, and I’m just now learning the skills to recognize my own Soul Condition, and tend to it.  Today I went out of my way to spend time with a long lost friend, take a walk, and bake banana bread. I went slowly through my day, took note of how I felt, and listened to what my Soul needed today.  I also held my son, as he cried in my arms for a half hour after coming home from a weekend with his dad. He wanted to know “why can’t mommy and daddy just live together?”  And so I hold these things, some so difficult, some so beautiful, and think about what we all need to care for ourselves and our Souls. In this moment, my heart ached wide open for my sweet child, and was also warmed by his earnestness and his openness and his absolute softness in my arms.  My Soul has a little farther to go to feel healed, but I’m listening and trying. My patient is a beautiful man and a special, special Soul. May both our Souls triumph in a beautiful year ahead of us, until we meet again.

Fighting back

Oh, the astounding advice that comes to you on a daily basis during a time of crisis. 

I cried in my boss’s office today. Like one of those bad, ugly kinds of cries that you just don’t want to do as a woman in front of your male boss.  Except, in the case of my particular male boss, it’s sometimes borderline acceptable because he is a kind, wise soul. I would never overuse his kindness in this way. I’ve cried exactly two humiliating times in front of him, today being the second.  The waterworks started while we were talking about something I’m struggling deeply with these days -- my professional persona in light of my personal life collapse. See, I work in a leadership position in an academic institution. I’m one of few women in leadership positions, and there is a bit of a propensity at this place, and particularly in my field, for young female physicians-in-training to pass by my office informally and ask questions like “how do you make it all work?” And, in that nonchalant passerby question, they are referencing things like simultaneously juggling knives while also making it work with marriage, kids, teaching residents, and taking care of a panel of primary care patients.  And, so, in a world where I trained with very few female role models who were “having it all”, I took it upon myself to be that kind of path builder. It was a conscious decision to open my life up to the generations of female physicians who were maturing into their multi-faceted roles as women, doctors, mothers, partners, and allow them the freedom to pass by my office and come in when the door was ajar, and ask me what it was all like in “real life”.  I certainly never sugar-coated it -- it’s hard for everyone -- but I wanted to give them faith that a fulfilling life, both personal and professional, was possible. I did have that for a time, until I didn’t.

Today, in my boss’s office, I reflected on my failure to be this person I aspired to be, and who I thought I was. I also talked about my failure to be the role model I wanted to be for my residents.  I humbly asked his advice about how to handle it. It wasn’t so much that I wanted his advice on how to handle my divorce and all of the emotional muck that goes with that (it is so deep), but how to negotiate this space where most of my trainees know me as married, two kids, physician, teacher, academic. At this moment, my new identity is single mom with two kids, physician, teacher, academic. And I’m struggling on every single one of these fronts. And frankly, it’s hard for me to struggle. I’m a perfectionist by nature -- good survival trait for a physician, but it turns out to be a harmful trait when everything in your life goes up in smoke.

Poof.  

I’m noticing that I’m deeply clinging to my sense of self as physician and leader, but I feel this person (or who I thought she was) slipping away. In the last nine months, I haven’t lived to my own standard, nor been the person my residents think that I am. So, am I a fake? A fraud? An impostor?  

Poof.

At one point during this talk with my boss, with tears and eyeliner cascading down my cheeks, and both nostrils completely clogged with snot, I said “I’m fighting my way back. I’m doing the best I can right now (sob, sob), and I know it’s not my best. But I’m really trying. And it’s super important to me that you know that, and you don’t lose faith in me.” He sat there. He nodded. And he sat there some more. And I cried a little more. And, you know, like a good primary care doctor, he just let the silence be the space between us for a while.  And then he said softly “I think, really, if I was going to give you any advice, it would be to let go of the concept of fighting to come ‘back’. You’ll never, ever be back, Frieda. You will be somewhere, but let go of the idea that you will be back where you were before. Nothing is ever going to be the same.”  

Poof.

And, so it was burned in me, under my skin. These words. This wisdom. It was so right. How come I hadn’t thought of it before? In some ways, a liberating thought. In most ways, it deepens my grief.  I’m a fighter. A bootstrapper. A resilient woman. I’ve been putting all my energy into paving my way “back”. Literally every ounce of my soul, strength and breath have been put toward getting one foot in front of the other everyday to get back to where I was -- and I suddenly realize I’ve been deluding myself. It’s so simple, in fact, but I’ve just been unable to see it. It begs the question, so just where am I going? Forward? Then what?

The Bottom Step

My six year old was crying. She has a flare for the dramatic, but this was real. She had just come home from dinner with her dad at his house. We are newly separated, though I feel as though it’s been an eternity that I have been emotionally and psychologically separated from him, and the person that he used to be.  The physical separation is only a few months old for my three year old son and six year old daughter, but they have settled into a new “normal” and have managed better than I thought they would. But tonight was a difficult night. Instead of kisses and hugs and a quick goodbye at the front door, my daughter wanted to be with her dad. She followed him back out of the house to the car, and the hugs and kisses continued as she tried all her tricks to prolong the goodbye. After some prodding, she eventually came inside, shut the door and fell to the kitchen floor, first with a “Hmmmph!” and a face of real anger, followed quickly by tears.

My three year old son, fairly oblivious at first to all of the evening’s drama, was playing with his trucks in another room and was calling for me to play with him.  My daughter was still crying in the kitchen. After a long day of work, multitasking every minute, I find myself pulled between the two most important people in my life -- wanting so badly to just play with my son and keep everything “normal”, and being drawn into the sadness and fear that was so openly being displayed by my daughter. I quickly settled the little one, and picked up my daughter and brought her to sit on my lap at the base of the stairs.

As we sat on the bottom step, I held her and she cried. Slowly, she calmed herself and the tears were less frequent and the sobbing slowed. I continued to hold her and quietly tell her I love her.  And daddy loves her too. And this is a hard time for all of us.  I don’t have anything more to say to make it better, though I desperately want to. I started to cry and I told her “I’m so sorry you are hurting. I wish Mommy could take all the hurt away. But we are going to be ok.”  Sometimes I believe we will be ok, and sometimes I don’t, but I always tell her we will -- and then I go back and think about it late at night, and wonder how I could have landed here. Me? But, then I remember that the how doesn’t matter anymore now. I’m a mom, and I have to guide these two little delicious, precious people through this storm. They don’t deserve this, and I didn’t plan this, and I never ever would have willingly put them through this, but we are here and we will be ok. We have to be.

M wanted to know why we all can’t be together. “Why can’t Daddy live with us anymore?” And then she asked me, “Remember all those special things we used to do all together?” From there, like a window opening on a cold day, her memories of special times blew in and they startled me. How did she have such vivid memories of these times at just six years old? “Remember the time, Mommy, when we were at the beach and we found all those sand dollars, and we went on that long walk together? And Daddy was with E, and we just did that together.”  And I told her that the beach was a special place, this hideaway in Maine we’ve traveled to as a family every summer since she was a baby, and that Daddy was still going to take her and E this year.  They could look for shells and sand dollars and hermit crabs and do all that fun stuff this year. During most of this conversation, she sat in my lap, with a downward gaze. Then, she looked up with her big, blue eyes and said “Won’t you be coming with us this year?”  I lost my breath.

 
This is just one of many, many, many difficult conversations I’ve had with M over the last 5 months.  They break my heart a little bit more each time. It’s that pain that only a mother knows -- when your child is sad and you can’t make it better. The kind of pain that makes you start to well up, breath deep, pause, and swallow hard while instincts tell you to suddenly “keep it together” and you figure out the right thing to say or you give a hug of just the right warmth and length and you get through the moment.  What’s worse about all this, and perhaps the hardest to bear, is that I feel responsible for her pain.  A fall on the playground, an illness, an argument with her friend -- all of those hurt, but they are the acceptable challenges of childhood, the kinds of things you expect to shoulder as a mom.  I never thought I’d be here. I never thought I’d get divorced.  How it all happened is a story for another day, though I’m certain with the deepest of conviction that I could not stay in my marriage.  But, she doesn’t understand that now. My friends and my family tell me “someday, when she’s older, she’ll get it. She’ll understand why you had to do it.” I think that’s true, but someday is a long way away. Right now, I have a six year old, with a six year old heart and brain, sitting in my arms crying over her “broken family” -- her words.  I tell her it’s not broken, it’s just different. I’m not even sure what I believe, but that’s what I tell her.

The moment passes. She feels better talking it through and looking at some pictures of a family trip from a few years back.  I take a moment and think. Silently, E crawls in on the other side of my lap, instinctively cuddles in to my chest, and asks “why are you cryin’, mama?” In this moment, we are all here sitting on the bottom step of the stairs of the house we are about to sell and move from.  And, it feels really real that we are on the bottom step of our new life.  There are 12 steps to the second floor of our current house.  We all walk up together to get ready for bath and bedtime, little E on my right hip, M holding my left hand. I can’t help but think that 11 more steps will be hard to climb, and I don’t know how we will do it, but we will get there.