Summer Vacation Comes to an End

It's my last night of my long awaited summer vacation. Ever since I had Toddler almost 2 years ago I have been looking forward to this summer. 

I'm so glad that Past Kicks was looking out for Future Kicks and took a shorter maternity leave to get out of residency a bit earlier. I only had 2.5 weeks to make up at the end of the year this way. There is something sad and lonely about most of your cohort leaving you behind and watching the junior residents step up and fill your roles before you're even gone, and although I love my residency, I was definitely there 2.5 weeks too long.

This summer was glorious. I took about 6 weeks off between jobs. My husband had minimal time off to help with our move, so I was glad I had plenty of time and helpful family members to get settled in our new home in our new smaller community. The weather has been wonderful and Toddler and I settled into a routine with daily adventures to parks, pools, beaches, and libraries. We've spent extended weekends with family and caught up with old friends. I had to remind myself after the first week (in which we went to 3 parks in one day) that this was a time to slow down and relax - after all, we live here now (and hopefully will for a very very very long time) and the parks aren't going anywhere. 

Tomorrow is the day I go back to work - this time as an attending physician in a brand new town in a brand new health system. I thought I would be more nervous, however I've kept myself so busy I haven't had time to be nervous (something I did subconsciously I'm sure). I think I will get more nervous the night before I see my first patients unsupervised without a preceptor for the very first time after the initial orientation wraps up. 

I originally was dreading the return to work, but this weekend has been a little trying between Dog barking at neighbors and Toddler trying out some extra sass, so I do think it is time to see some grown-ups again. I'm sure the initial daycare drop off will be a nightmare (for both of us), but we have gotten over nightmare drop offs before. 

I have one cute story to share from my time off: Toddler and I were out at my parents' favorite local coffee shop when  I learned that Toddler was actually well acquainted with all of the regulars from his times going with my parents. He was handing out fist bumps and babbling along knowingly to several older gentlemen he apparently knew. Toddler then decided (as Toddlers do), he wanted to go out the door and stand on the sidewalk to watch the goings-on outside. I followed. One of the older gentlemen held my coffee so I could follow. Standing outside lasted about 5 seconds before Toddler decided to go back in. The older gentlemen opened the door for me. I tried to explain that he didn't need to help, otherwise he would likely be up and down 10 more times. He slowly shook his head and smiled and looked at Toddler and said "The days are long but the years are short" - which is already exactly how I feel about Toddler, and am lucky to have had these long days to spend together and look back on for years to come. 

Kicks

Saturday AM coffee

The golden weekend begins

I wake up at 7:30 before my alarm. Approx 10 seconds of quiet uninterrupted bliss ensues when I realize I’m the only one awake. I can’t wait to make Saturday morning coffee. Then Dog demands to go outside.

While dog is outside, I read the last few page stories of the mystery I’ve been working on. Toddler fusses. I think “only ten pages to go” and Toddler falls miraculously back asleep and I finish my book.

Toddler fusses again. No coffee yet. Upstairs I find Toddler covered in poo including pieces in hair and hands. Apparently letting him eat that much pizza last night was a mistake. Toddler is protesting in the tub but much much cleaner 5 minutes later. I peek out in the hall for backup, turns out Husband heard the commotion and closed the bedroom door for a little longer sleep in. Hmph.

Toddler is dried out of bath. I sit him downstairs with yogurt and all is forgiven instantly. He smears his yogurt-covered hands through his recently bathed hair as I rinse the poo off of sheets, his pajamas, my pajamas and throw in the wash. Coffeemaker is finally started. I sit down with my own yogurt, which Toddler immediately realizes is different from his own and demands some. We share a little more yogurt.

Toddler gets spot cleaned, and I finally pour my cup of coffee.

It’s a beautiful day. Toddler loves being outside. Dog, coats, boots are collected and I spill a little of my precious “mom juice” on the floor. (“Mom juice” is my explanation to Toddler for coffee, wine, diet Mountain Dew, etc.). Clean floor. I go out thinking I might sit outside a sip some coffee, watch the commotion and listen to the radio. Coffee is a little colder but still tolerable. Spill some coffee on my old white worn fleece

I drag my chair to the sunny corner of the backyard, before realizing I have nowhere to put my coffee down. Coffee sits on little mud pile.Toddler decides he wants to rock with me on the chair, then by himself.  The ball is thrown to dog. Sip. Throw. Sip. Throw. Toddler gets stuck in his plastic car. Extract Toddler. Sip. Run around yard with Toddler and Dog. Sip slightly warm coffee.

Sneak inside to top off cup with warm coffee and grab Kleenex for Toddler.

Back inside. Laundry gets  done, clothes are packed and bathroom gets cleaned. Toddler finds the Swiffer cloths very interesting.. Now off to our parents for a weekend away.

I think I need another cup of coffee.

I can’t wait until I start my attending primary care clinic job this fall (yay!) and this becomes more of a typical than atypical Saturday (minus the poo).

Kicks

Exceptionality

I learned a beautiful new word this week - exceptionality

I am on my community health rotation. One of the best parts of being a resident are the off-service rotations, which means less time at the grindstone of patient care after learning after patient care after learning and a little more time to breathe. I got to spend a day with a public school nurse in the metro area school system. I graduated with less than 50 kids in my rural high school graduating class, so touring a public metro school system was eye opening, especially as I toured the schools where the kids were >90% free/reduced lunch. Both as a doctor and as a mother.

The school nurses I met were all so gentle, patient, and kind. I watched at the elementary school as 3 kindergarteners came together for their pre-recess albuterol inhalers and impatiently watched the clock together with their little spacers in place. We talked about the special needs kids there as well. I don't remember the issue we were talking about in particular for one of the kids, but I remember the nurse saying (instead of "part of his disability is...") "Part of his exceptionality is _______". She said it with a knowing smile and a twinkle in her eye despite what I'm sure was a frustrating and time consuming issue for her.

We never really had a schedule. We floated around an elementary school, a middle school, and a high needs school. The nurses were so proud of their schools and their kids and talked non-stop about their goals and wishes and kept pulling me aside to show me other students that had made great strides. One of the middle school nurses was one of the most reflective listeners I'd ever met, and as she told me about the difficult parent interactions she's had, I thought about how much she could teach us as doctors about how to handle difficult patient interactions.

The last school we stopped at was specifically built for high needs cognitively impaired students. We walked into the school nurse's office just as she was calling an ambulance for a child's third seizure of the day. They told me they call 911 approximately once a month. I was additionally interested in this school because I'd never heard of it before 2 weeks ago - when a new teenage patient with significant cognitive delays and no prior records showed up in my office appearing agitated and on the verge of violence. I had a 15 minute appointment with them and wasn't sure what to do. I was referring him to the appropriate specialists but was debating whether I needed to start behavioral medications in the meantime as his grandma had told me he had been on some medication in the past. I had found out through the school system that he was already getting hooked up with basic therapies and they thought they were meeting his school-based needs at that time. Now I was at that school. I met the therapists, the numerous paraprofessionals, and peeked at the kids in wheelchairs and helmets and in all manner of disarrayed behaviors. I saw my teenage guy too. He waved at me across the cafeteria and when I talked to his teacher, I learned he was a "delight" and they had no behavioral concerns - and they spent all day with him. I learned about their functional based classes and even got to sample a cookie from the morning's cookie class.

I won't be in this metro area much longer. As I've said before, I'm looking for jobs - I have had several interviews and don't have a finalized plan yet, but I probably won't be in this community. It gave me professional inspiration to connect with my future school district and learn more about my community wherever I practice, but more importantly I have a new deep and profound appreciation for all teachers, especially for kids with complex medical/social/emotional needs and even more importantly school nurses. Especially the ones that appreciate the exceptionality. And as a mother of one healthy toddler, I appreciate all those that willingly spend their time among hundreds of children and/or teenagers every day.

May this inspire you to appreciate rather than tolerate an "exceptionality" this week. :)

Kicks

Keep your mama friendships guilt free

I have been so blessed to have several amazing groups of girlfriends, most of whom are mamas. I have a handful of dear friends from high school, sorority line and big sisters who have become like family, my college international housemates, my college friends whose spouses have become my husband's friends, beloved friends from our time in family housing at UNC, my Code Brown Crew from UNC Pediatric Residency, the mamas from the parenting group my husband and I started 3 years ago, and my family - I count my mother, mother-in-law, and great aunt as three of my best friends - these women fill my life with advice and love and accept my text messages and incoming calls day or night. I love, love, love them!

I truly believe that it takes a village to raise a family and it takes a tribe of girlfriends to keep a mama sane and thriving. Over time I have come to realize that it is impossible to be everything to someone and as such I have been able to find over time that all of the different qualities my girlfriends have make for some diverse, sound, and priceless advice. I have never been a one-best-friend type of girl even though I wanted to be and instead do much better with a cadre of lady friends. 

As our lives have ebbed and flowed, sometimes the calls are more frequent, sometimes months or even  years go by without communication. But the love is always there. After months of not speaking I have done consults on sick kiddos, talked to family members who had medical questions, done an emergency contraception consult for an adolescent volunteer visiting the United Arab Emirates (it is dangerous in many countries to have unmarried sex). I have walked with friends through infertility, infant loss, miscarriages, marriage challenges, spousal communication issues, school issues, health issues, you name it. 

As my life has become busier I have been doing more lately to immediately send a text when one of them crosses my mind. Just a quick "you ran across my mind, it's been so long, sending you a big ole hug. How are you and the family?!?". Which leads to a flurry of updates before we have to run. And if I really feel compelled and have some alone time in the car, I pick up the phone and call. Some of those impromptu catch up calls have been life changing for me and for the other ladies. 

I have incorporated a saying recently when the inevitable "I am so sorry it's been so long" is uttered. I quickly say something like "Girl!!! Our lives are so busy ain't nobody got time for mama guilt! Call or text me when I run across your mind and I'll do the same for you!" and then we laugh and continue to catch up in the few minutes we have.

So to all of the mamas out there. Call or text your friends when they run across your mind. When you talk, carry on where you need to. If you feel the need to apologize for it being so long, be gentle and forgiving with yourself and stop yourself! Let's minimize the guilt we have in our lives and do what we can when we can unapologetically. If your friend apologizes, tell her you refuse to have any guilt in your relationship when life is already so complicated and you promise to do what you can when you can to stay in touch. Here's to keeping your mama friendships guilt free and full of love! 

How do you keep in touch with your friends? How do you minimize guilt in your relationships? Please comment below!

5 months in - just breathe, just love!

5 months into being the mother of 2 little boys and I barely have time to breathe sometimes. I work as a Pediatrician but I had completely forgotten how very very very very very very (can I just type the word “very” for the rest of the post?!?) hard mothering a newborn is. Add to that some complications, a rambunctious, highly intelligent 6 ¾ year old, a husband 2 years into his tenure-track and 35-year-old bones and you have a recipe for fatigue that rivals the best of them.

5 months of cuddles. Of tears. Of such profound joy that it takes my breath away. For example, I remember the first time Zo told us how very much he loves his “baby bro” and how he’s his “best buddy”. Mothering for the second time has also been very humbling. When we found out that our little one was losing too much weight and could not exclusively breastfeed I felt like an utter failure. I KNOW how to breastfeed a baby after successfully doing it with our first and I thought if I powered through, me and Mau would get-it-done! But I had to come to terms with the fact that sometimes a mama’s body and a baby’s body just can’t power through, you just can’t will enough strength in his little low-birth-weight jaws to muster up enough energy to be a good breastfeeder. It took lots of letting go, lots of submitting to our reality. And y’all know I cry, a whole lot, so this made me weep and gnash my teeth like nothing else! But as I snuggle his now chubby little thighs, I remember the donor breast milk, the formula, the supplemental nursing system, the bottles, the reflux and I can smile. And it’s all okay even if it’s not what I envisioned.

So 5 months in, I know why my patients miss follow up appointments. Even with my father here with us almost full time I am inundated with Early Intervention, Cardiology, Ophthalmology, and other appointments. He’s perfectly and wonderfully made (took a while for me to be able to say this) but his little life requires a team for him to thrive. And thrive he is! We have all overcome so much and we have so much more to go. To all of the mamas out there in MiM land - wishing you and your babies so much love, health, and happiness. Even when mothering isn’t what you envisioned just remember that you and your baby were meant for each other. Learn all you can. Teach all you can. Be gentle with yourself and your baby.

5 months in. Inhale. Exhale. Smile. Inhale. Exhale. Smile. “The greatest thing you’ll ever learn is just to love and be loved in return” (Nat King Cole).

I Get To...

I had just survived one of those hyper-scheduled "days off." Early morning short work assignment at the fertility clinic, my daughter’s first gymnastics class, squeeze in a quick workout for me (as long as she agrees to stay in the gym daycare), back home for a fast lunch, then out for a mid-afternoon doctor’s appointment with babe in tow because I couldn't work out childcare. It was the kind of day that used to get me very frazzled, but I’ve been working on my organizational techniques lately, which has really been helping. I won’t lie, though, it’s hectic making that many logistical moves in a day with a two-year-old. It can be as busy or busier than a day in the OR! As the sun was going down, I pulled out my journal to reflect on all the day's events. Instead of the typical narrative you often hear from moms like us, “It was so busy today, I had to… (insert long list here)”, I decided to turn it around. I wrote at the top of the page, “I get to…”

I Get To:

• Wake up at 5 AM to provide anesthesia for two women at the same fertility clinic where I was a patient, giving them hope and reassurance that they too will someday be an IVF success story

• Take my daughter to a Mommy & Me gymnastics class on a weekday when I don't have to be in the OR

Warming up in Wednesday gym class

• Do a workout for myself, since after suffering for months with both a back and a shoulder injury, things are slowly resolving and I'm able to perform some of my favorite exercises such as the overhead press and barbell deadlift again

• Spend more time with my lovely daughter by bringing her to my doctor's appointment (she surprisingly behaved perfectly)

• Argue with my husband about what wording to use in a text to a landscaper, who we are fortunate enough to afford to pay for landscaping services, as opposed to arguing with my husband about something less frivolous (such as where our next meal will come from or how we're going to pay bills, etc.)

• Clean up potty training messes x 3 ("Oops, mama! There be poo poo on the seat/floor/etc."), including a wipe down of the whole bathroom each time, and then bathe my beautiful baby by candlelight before laying her down in her bed, where we read books and sing songs and have a cuddle-fest

• Have a few minutes of silence to myself after everyone in the house is asleep, where I prepare healthy foods for lunches the next day, and then reflect like this on my "crazy" day

What did you "get to" do today?

Mothers in Medicine: THE BOOK

I am thrilled to announce that we've been quietly working on a book that assembles the best advice, wisdom, stories, and insight shared on these pages since the blog started back in 2008. This is the heart-to-heart, girlfriend-style kind of advice and reflections that I would have loved to have when I was just starting out as a woman in medicine, with many questions about the best time to start a family, making it "work" in terms of work-life integration in my specialty, practice considerations as a mother in medicine, and even negotiation advice for landing that job and asking for what I need to be the most successful in my role.

The chapters are organized by theme and cover all of the above questions, as well as separate chapters on having children during medical school or residency, navigating life challenges such as divorce, infertility and financial hardships, the mother in medicine's village of support, and even sharing the humor of being a mother in medicine. Many of the authors are voices readers of this blog know well (T, Cutter, Fizzy, Genmedmom, Jay, m, Gizabeth, Emeducatormom, PracticeBalance, Beckster) as well as special guests who bring unique experiences to lend to their chapters. We're honored to have a foreword written by the accomplished writer, Danielle Ofri. The final chapter is a compilation of our most frequently asked questions from readers posed on the blog, with a summary of answers from our community.

Importantly, the book reflects the thoughtful, honest, supportive tone of this blog community that has featured over 1500 posts and over 14,000 comments since 2008. Our ultimate goal is to support women in medicine at all stages of training and hope it is a useful, contemporary resource for years to come.

So, stay tuned for more book announcements! We're hoping for a late 2017/early 2018 debut.

Thanks for reading!

clocking

I have never been one to track my periods, but then life happened and now I am tracking them religiously.

I think back to when it all began. I was one of the last of my friends to get my period. Even though my mother had prepared me with books and talks, I still thought death was imminent when it started. So once they occurred regularly, I just went with it. No charting. No tracking.

Fast forward to my mid-twenties as a medical student. My husband and I decided to have a child before starting residency because it seemed like a good plan. Thankfully Little Zo established himself promptly after discontinuing my IUD. 3 weeks after. I had little knowledge of how truly a blessing that was.

And then life happened. The stories of loss and infertility began to trickle in. A cousin whose first child was conceived in our 20s using in vitro fertilization and who is still paying bills for it; she has been trying for years for baby #2. The friend and aunt who have both suffered multiple miscarriages. The friend who experienced a molar pregnancy and had to consider radiation therapy. The best friends who suffered a stillbirth that I wrote about here: http://www.mothersinmedicine.com/2013/07/life-loss-and-celebrations-of-love.html

Once settled into attendingdom, O and I decided to try again in order to give Zo that sibling he sometimes mentioned. I wrote in my post on December 29, 2016 entitled “(all is not) lost” about our miscarriage (http://www.mothersinmedicine.com/2016/12/all-is-not-lost.html). It was devastating.

And now, without even realizing it, I have begun tracking my cycles. 3 after the IUD was removed and then we were pregnant with number 2. And then the miscarriage.

My D&C surgery was in January 2017. And every month thereafter I prayed my cycle would return. Was that pinch the beginnings of my cycle? Was that the beginning of ovulation. 3 months later, my cycle returned. And each month that went by we still weren’t pregnant. And then. Last menstrual period May 17, 2017. We are overwhelmingly happy, frightened, joyful, petrified, and elated. Big brother Zo is happy. Thus begins a new clocking of days, weeks, and trimesters. Second trimester begins this week. So thankful.

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.

Gratitude

Not my gratitude. My kid's gratitude.

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

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

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

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

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

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