Being The One

As a pediatrician, I got the chance to preview parenthood in more detail than many people likely do. The five-year-old little boy who clutched his mom during bedside rounds my intern year stands out even now: he buried his head in her chest as soon as we entered the room. She whispered, "Does something hurt or are you scared?" He managed to whisper that it was the latter and she held him tight, soothing and reassuring him while she listened to the plan for the day.

I carried that rosy picture along with many others as a boon of future parenthood. The chance to cuddle, to protect, to take complete care of my own little person someday - and, yes, in all honesty, the chance to be so important, to be the one. The one a child immediately turns to, relies on, needs.

Since that encounter, I have had two sons, and it thrills me to know end to be, along with my husband, their person. Nothing compares to the sound of little boy feet running toward the door with the greeting of a wide smile, a "Mama!," and eventually, "Mommy's home!" To the high-pitched voice calling your name in the middle of the night because of a scary dream or a need for water or just some extra cuddles. When in shyness they hide behind me, hugging my legs, my heart bursts with joy and wonder at the chance to be part of this classic, perhaps cliched but no less endearing, image of a child clutching his mother for comfort.

A few months ago, I saw a teenage boy in my office for consultation. I'm training in pediatric hematology/oncology, so trips to my clinic can be nerve-wracking for patients and families. This young man's sheer terror at what he feared were symptoms of cancer (happily, they were not) was visible, audible, nearly palpable. When I sent him to have blood drawn and imaging done, I heard him say to his mother, who had accompanied him, "I need to call [insert girl's name here]."

His reaction startled me. I could appreciate the anxiety, but the realization that, even with his mother beside him, his instinct was to turn to someone different - presumably his girlfriend - took me by surprise. Once I reminded myself that it was, in fact, developmentally appropriate for an adolescent to be developing relationships and establishing independence from his family, I was left with sadness. Someday, far sooner than I hope, my boys will turn to someone else as their person. Someone other than me will be the one.

I sit with that sadness even now. With each milestone, it mixes in with the joy and pride. And as my children grow and I grow, my work continues to provide examples of the realities and possibilities of parenthood. So when I encountered another adolescent who, facing a challenge, had little support and no peers, romantic or platonic, to whom to turn, my apprehension and sorrow began to abate. I want my children to grow and develop, to have healthy relationships and support, even if they must eventually come from someone other than me. 

For the time being, though, I'm fortunate to have my days peppered with eager footsteps, warm hugs, and sticky kisses. And when I dropped my older son off at school yesterday, after we had said our goodbyes, he ran back for one more hug. I savor every single one.

Goodbye hormonal birth control

It’s kind of hard to say goodbye to hormonal birth control when it’s been so good to you for so long. I started taking the pill as a teenager. My father is a teen parent and my mother instilled in me such a huge fear of early pregnancy that I stayed prepared, mostly to avoid her wrath! Talk about the teen brain in action; birth control was a very concrete option. Avoid pregnancy or be beaten, possibly at school in front of all of your classmates. YouTube videos of parents beating teens wasn’t around then, but if it had been, I’m sure this nightmare would have included my Aunt videotaping and putting it on the Internet. (note: I am totally over-dramatizing this and my mother and Aunt are two of my dearest friends now. They loved me fiercely and kept me from all types of danger including a few college boyfriends who were up to no good.)

I still remember sneaking to Planned Parenthood (it was across the street from a busy metro station) in order to get my first pack of pills. I was sweating, I was scared. But larger than my fear of being seen was my fear of getting pregnant and having to tell my parents. I knew getting pregnant before college would make my dreams of becoming a doctor even more of difficult to achieve, if not impossible. I had my share of providers over the years. I remember one male doctor that tried to shame me by drawing horribly graphic pictures; I wanted to yell at him but was too scared. I remember some outstanding older nurse providers (one super cute grey-haired lady in particular) who were very sex-positive and helped me try various methods.

Methods I have tried to date (in semi-order): combined oral contraceptive pill for years, the patch for less than a month,  Depo-provera for a few months, abstinence, emergency contraception, pills again, the ring for a few cycles, the Mirena IUD for 3 years, a healthy planned pregnancy 3 weeks after discontinuing the IUD, breastfeeding and the mini progesterone-only pill for a few years, and finally my second IUD.

Somewhere around age 30 and my pregnancy, I began to have hormonal headaches each month around ovulation and changes in birth control. Now that Zo is well out of diapers, we are ready for baby number 2. So I said goodbye to my second IUD. Hubby and I decided this would be the end of hormonal birth control for us until we decide to have someone’s tubes tied. I am still holding out hope he’ll see me waddling around pregnant and will decide to get a vasectomy.

I know this country tends to shame sexually active teens, but I was one of them, and I turned out alright in my opinion. I’m a pretty successful Pediatrician, married, with a child. I have friends who used various methods and ended up teen parents and now as an adult I have countless friends dealing with infertility. I wasn’t promiscuous (though I won’t shame those who are), but I always knew that avoiding pregnancy and infection were top priorities for me (referring back to my mother who wanted no parts of being a young grandmother). Now that infection is virtually impossible (if anything goes down hubby will have some ‘splaining to do) and we actually want to expand our family, I say goodbye to my old friend hormonal birth control. Thank you for keeping me safe and allowing me to follow my dreams.

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/

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.

Girl Bonding 101: Moving Beyond Netter

I am in a state of slow, silent, ever-evolving panic.

I just looked over at my 10-year-old daughter (soon to be 11), and for a second I saw a young woman sitting in the armchair. Or at least, a young pre-woman. Ack.

She has shot up several inches and a couple of shoe sizes this year. I feel like she goes up one Tanner stage every week or so. Her face has gradually acquired subtle, more mature angles, and let’s not even talk about the rest…

She builds sand castles at the beach and sleeps with her teddy bear. But she also notices attractive young actors or singers, and her comprehension of the nuances of flirtation is accelerating at an alarming rate. She is bubbly and all smiles and hugs one moment, irate and scowling the next, at the slightest provocation. She can still enjoy Sponge Bob, but she can also start to discuss American politics and social issues. I am amazed and thrilled and in awe and totally distressed.

I want to tell her pituitary axis: whoa! Slow down! Childhood’s short enough! But it’s useless.

It’s time to have THE TALK.

No, not that talk. We had that talk when she was eight, because the kids at school were already disseminating all sorts of sketchy information about reproduction and childbirth. I told her I was okay with her discussing reproduction and childbirth but I wanted her to have the right information – and who better than her doctor-mom to provide it, right?

Now, I am sure there are lots of people out there who can describe the “right way” and “wrong way” to handle sex education. I myself got “educated” in a bit of an unusual way. I was in a book store when I was five and saw a book entitled Where Babies Come From, or something like that, illustrated with some cartoon-like illustrations. I had been reading for about a year. I picked up the book, learned the facts of life, and, bored out of my mind, put the book back on the shelf. My mom was a little surprised, I think, when, after she expressed doubt that I actually knew about intercourse, I explained the process to her fairly accurately. It was only later that the more abstract concepts came within reach.

When my daughter asked me where babies come from, I said, “Cells, of course. Remember how I told you all our bodies are made of little, tiny things called cells? Babies start out as little clumps of cells inside their mothers and grow bigger and bigger with time. The parts of the body develop as our cells make more cells.”

That explanation satisfied her for a while, but then the inevitable came: “How do the cells get inside the mommy? And is it true that mommies push the baby out through where they pee?” That was the part the kids at school were talking about.

That was the part that made me thankful I'd hung on to my Netter Atlas of Anatomy from medical school. I sat my daughter down between my husband and me and we explained the relevant mechanics of reproduction step by step. I explained a little bit about menstrual cycles. I drew simple diagrams of female internal organs and used Netter as a supplement. Last but not least, my husband and I both expressed our personal values regarding the place of sexuality in the context of human relationships. As our daughter listened I felt proud, because she seemed to be listening so thoughtfully.

Lately, though, now that she’s a little older, she has acquired a kind of embarrassed reluctance to discuss “woman stuff.” When she was eight we could almost sense a certain pride in her at being entrusted with these more “adult” concepts. Today, however, she’d really rather not talk about them. But I feel I have to get us talking about them, not only to reinforce the idea that it’s okay for us to talk and for her to have questions, but also to make sure she doesn’t feel anxious or uncertain or ill-informed. Sometimes it seems like it's almost easier to get patients to open up about personal things.

I wanted to have the talk about menarche. I think it’s imminent at this point. But how to create a level of comfort about the subject? And to make sure we’re prepared, together, before the moment arrives? I want her to feel good about growing up, to celebrate each milestone instead of dreading or being unpleasantly surprised by it.

The other night an opportunity arose. I don’t quite remember how. But the subject came up, and I asked her if she had any questions about periods.

“No,” she answered emphatically, casting her eyes down. I could almost hear her mortified mental voice asking me, Please don’t give me an awkward, long-winded lecture; please don’t start looking for “ins;” and please, whatever you do, don’t ask me if I’m sure about not having any questions.
“Are you sure?” I asked, stupidly. So predictable.

Then I started to babble. I told her she could always come to me if she felt unsure or worried about something. I told her it wasn’t at all scary to get a period if you knew what to expect. I told her I would go with her to the drug store when the time came to look at the options in terms of supplies.

Then it happened. I got my “in.”

“Actually, that’s the part I wasn’t sure about,” she said, looking up again.

“What’s that, honey?”

“The supplies part. I don’t exactly understand how they work.”

Relief! She had given me a concrete way to nurture and support her! Hallelujah! I launched into an enthused discussion - not, I hoped, an awkward, long-winded lecture - about the pros and cons of various types of supplies, demystifying the “anatomy” and mechanics of each with appropriate exhibits. I explained what I liked and didn’t like about each option.

Sometimes, whether it’s a patient or a beloved child, it can be so tough to talk about so-called “sensitive” issues. And somehow it can be much easier to be direct with total strangers. “Are you sexually active?” we ask during a comprehensive medical history. “With one partner or more than one? Male or female?” I can do all that "doctor stuff" without batting an eyelash, but somehow when it comes to the mother-stuff of making sure my daughter’s emotionally okay, or figuring out if I’m asking too much or too little, saying too much or too little, I feel much less certain that I’m doing an adequate job. There’s no Netter Atlas of Parenting, after all.

I guess I just have to take my cues from her.

Photo: reusable menstrual pad with Kokopelli motif from Wikipedia article on the history of sanitary napkins

Link of interest, for the historically inclined: Museum of Menstruation

Bees and Birds

“Douche bag!” My tween son hurls at his brother in the car on the way to a picnic.

“What was that?” I counter.

“Douche bag.” He returns sheepishly.

“Do you know what a douche bag is?”

“No, not really.” Will replies.

“Well let me tell you.”

And so continues our snippets of car talk. One would think that talking about sex and sexual matters would come easily for a pediatrician. Conversations about sexual matters and children are a daily occurrence in my practice. Yet a different element exists when I am trying to convey information about sex to my own children.

Trends in our family would suggest that there are some universal truths about sex education. The first is that the topics my children seen to have the most questions about aren’t covered widely in any book I know about. We’ve covered the basics – mostly in the car – about where babies come from and the real words for male and female anatomy. Sometimes it is all I can do to stay on the road. Then there are these other topics like defining a douche bag or masturbation. One time after an Oprah episode my eldest wanted to know what a pedophile was. Okay, where do I begin?

The second universal truth is that I am my sons’ go to girl for information. I am the token female in our family and it is my job to educate them about the female gender. Yeah, right. My job has globalized into ISM specialist or Information about Sexual Matters specialist. As I strive to keep these lines of communication open and honest, I am having epiphanies of understanding for all the parents who struggle with these topics. At one point I had aspirations of writing a coaching guide for mothers of boys to tackle some of these topics. I bought as many books about puberty and boys as I could find on Amazon.com. If I educated myself, I might be able to educate others, right? As the project sits stagnant on my bookshelf, the books have provided practical punctuation for Will’s sexual education and fodder for more conversations to come.

Lastly the universe has decided that we will have these conversations whenever and wherever. Car, movie theater, restaurants. No place is excluded. As a new parent, I assumed that “the talk” would take place in the privacy of our home. When my boys ask questions, they seem out of context because 90% take place out of our house. The silver lining to this truth is that the conversations are usually short – literally snippets – and ongoing. This is a key concept I try to share with families in my practice. The talk really should be an ongoing thread woven into daily life. Break off small pieces to feed your kids on a regular basis. It is less overwhelming that way.

“Sorry about the language, Mom.” Will say at the end of the picnic.

“I’m just try to teach you before someone else does.”

“I know.”

“I don’t want you to be embarrassed by a teacher or someone else’s parent. You need to know the real meaning of the words you use.”

“Thanks, Mom.” Will kisses my cheek. Mission accomplished (for today).