After every winter, spring...

always comes.

Always.

But my life's progression to "spring" was blocked by an awful behemoth in my path--and I could see glimpses of this thing titled "spring", but I couldn't get there. So it has been a long, long winter, and I have been away from here for a long time. This thing, divorce, loomed in my life for a while, sat in my way, blocked my life and taunted my psyche. It was this big, ugly, hulking, ill-defined beast that sat defiantly between me, peace, happiness, future. It blocked the path between who I was and who I wanted to be...who I had the capacity to be. And avoiding it was causing me to become a person I increasingly disliked. So I introduced myself to it, squared up my shoulders, battled with it, and took it down. I ran, leaped, tripped, yelled, triumphed, paid (tears, money, frustration, adrenaline, fear) and then, officially---it was....over. The ink was dry. And truth be told, the marriage was over long before the divorce was--just as a piece of paper doesn't make you truly married, a piece of paper doesn't make you truly divorced. These pieces of paper simply symbolize what has already taken place in your heart, I believe. And they exist for the protection of property and children. That is all.

The initial months after my ex-wife moved out were a blur of pure relief, loneliness, freedom, calm, financial stress, happiness, and much needed solitude. I never looked back. I never doubted my decision to leave, not one time. I knew I'd done the right thing, as hard as it was to enact. As time passed, I dated a few women, but no one in particular really struck my fancy. I never found anyone who I thought was really special. Nice, kind, smart, attractive? Sure. But that wasn't enough to keep my interest in anyone in particular, and after a while the dating world was....tiresome. I had no real connection with anyone, no real chemistry. The thrill of being single, being free, being wanted, flirting was...getting dull. There I was wandering aimlessly around a romantic virtual world, without any real destination in mind. So I'd delete the app for a bit, roll my eyes, and drink/hang with friends. Onward....maybe someday I'd find someone again, but I sure wasn't in ANY rush--the very last thing I wanted was A Real Girlfriend. I didn't want to be anyone's person--I didn't want the obligations, the expectations, none of that. I wasn't sure I could do that again. Been there, done that, and in some ways----I'd failed miserably. It had been such a tall order before and I'd not measured up....right?

While I dated casually, I also worked to heal myself from the damage that our marriage had caused.  I was in therapy, and I fought to delete the list of ways that my ex-wife had said I'd failed her, failed our marriage, failed our children--all by initiating the divorce, which was the only way to a better life that I knew (after thousands of dollars in marital therapy and two separations). I realized that I had recreated my self-image according to her feedback, not my self-knowledge (or the knowledge of others who really know me)--and I was angry and disappointed in myself for having done so. I had actually believed all of the things she'd told me about me--things she'd said over the years out of anger/need/frustration/hurt, time and time again, as I repeatedly failed to meet myriad unspoken and seemingly mysterious and randomly presented expectations and needs.

I didn't know what was true anymore, and it was terrifying. Was I Person A or Person B? I fought to redefine (rediscover, really) myself for myself, to believe my voice about myself instead of her voice/story about me--and it was impossibly hard at times, and I did not always succeed. Some days were interminably long and painful,  and I worked to feel valuable, attractive, intelligent, worthy of anything--love, respect.  I worked to make eye contact with another human, some days. I worked to summon the energy to go to work, to engage with my patients beyond lab data and physical exam findings. My therapist was my reality check, when I wasn't sure which way was up some days, when I wasn't sure who I was anymore.  She was my mirror through all of this--she showed me the little tiny bit of myself that was still there, that was unchanged, the essence of ME, that was going to be ok--that had always been ok and that always would be--no matter what. Her unwavering belief that I would be ok was steadfast and solid; some days I counted on her belief in me far more than I ever believed in my own ability to be ok. I had to take her word for it. And I did. And some days, it saved me.

Fast forward a few months. The dust had firmly settled. I could see the good in life again. I realized that I am an ok person. I was in a new routine with life, work schedule, kids. I was single. Spring was ...here.. I think? I felt pretty good in my body, my mind, my heart. I'd dated a bit, and it'd been fun. I I was happy, and not seeing my therapist as much. The worst of things was over...life was looking good again. So I opened a dating app, while I was standing in the middle of my kitchen--and I don't know what made me do it, I just... opened it. And there was one of the most handsomely gorgeous women that I'd ever laid my eyes on--my inner dialogue was "Oh my goodness....!", I had a run of a-fib, and I sent her a message. And I wasn't so sure I'd hear back...I mean, she was so damn cute and...I'm just..me. But something about her simply took my breath away. Something.

Well, I heard back. And back. And back some more. And now we're heading into our sixth month of dating and I love her in a way that I didn't think my heart was capable of loving. Nor did I think my heard was capable of receiving such love. I have loved before, and she has loved before--we've been on the planet too long to not have, and the loves we have had have helped craft us into the humans we are today--and for that I am thankful for us both. But I've never loved like this before. It's different; it's more complicated. It's more complete. And I didn't know that this kind of love, this kind of seemingly unconditional love and non-transactional love--the kind of love where someone loves you simply for who you are--not what you do for them, the money you make, what you say or what you look like or what you provide now or could provide or anything else---could ever be a part of my life-I assumed it would forever be beyond my reach, that it wouldn't happen in my lifetime. Thankfully, I was wrong. "BB" suddenly landed in my orbit and I knew that spring had definitely arrived.

To be continued...

ZebraARNP

Not everything that ends is a failure.

I’ve been gone for a while. A lot has changed in my life and some of the more peripheral activities within it (like writing for this blog) have necessarily been on pause. But I’m returning to this space now that I have the time and energy for it. In the past many months, our one family has morphed into two families --my marriage of 12 years ended. This was after a couple years of marital therapy, a trial separation (in which we lived in separate homes) a few years ago, and a lot of tears, gut wrenching atrocious fights, heart ache, issues within ourselves, issues between us, commitment, recommitment, more therapy and then…our marriage needed to be over. I truly feel that we turned over every rock looking for a solution to it all, and one could not be found.

We are recasting ourselves in our roles as co-parents only, and perhaps someday we will recast ourselves as friends. I firmly believe that a marriage that ends is not a failure, that the standard of “forever or failure” is just…ridiculous.  Does a marriage have to be life-long to be considered a success? No, it doesn’t.  We did not fail. We had a successful 12 year relationship in which we raised 3 awesome kids, bought a house, overall had a damn good time-- and I’m proud of all of that. And I'm grateful for the years we had together and I wouldn't change anything--life unfolded as it did.

But after much soul searching and countless tears, I realized that despite every good intention (on my part and on hers), and despite every effort (from us as individuals, as a couple, and by those in our families/community supporting us), I could no longer be the person that I wanted to be in my marriage any more—and even worse than that, I was becoming someone I did not want to be because I was so unhappy. This affected me more and more, and it was time for a change. I cannot speak to her unhappiness other than to say I think it was profound. And all of our combined unhappiness affected our children, without a doubt. And that was not tenable. 

In the meantime, she has moved out (and lives nearby), and the kids have started living in two homes. There have been bumps in the road, of various sizes—of course there have been. But I have every confidence that we will survive and we will all thrive, as we find a more peaceful existence. Families have survived far greater challenges than this, and our three children have two parents who love them immensely (and grandparents, and friends) and who will support them in whatever ways necessary. I am hopeful. 

ZebraARNP

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.    

MiM Mail: Advice for an ex-husband of a MiM-to-be

Hello!

Being a father not interested in medical school makes me a somewhat non-traditional reader I imagine.

I am ultimately writing for advice. I read a number of great posts on your blog, but I am coming at this from a different direction and was hoping one of you would be able to point me in the right the right way.

My ex-wife is a brilliant woman in her Junior year of her undergrad and planning to start applying for medical schools. We have a good co-parenting arrangement and try to do our best by our three boys (4, 5 and 7). I am no longer in the medical field but do have 8 years experience as a critical care paramedic so I can appreciate both how talanted she is and how hard her road is going to be. She is going to apply locally but is also looking at the Virginia area due to family there. I am willing to consider relocation if I can find appropriate work (I work in IT in a rather specialized area).

My question is, how can I best approach the subject of custody? I don't want to take the kids away from her by any means (she is a fantastic mom!), but I am concerned that raising three young school age boys while attending medical school will be overwhelming. She can accomplish anything she sets her mind to, but even she can't accomplish *everything*.

My initial thought is to offer/ask to take the custodial role, freeing her up to apply herself 100% at school while still affording the boys a stable home life and predictability in routine. I don't know for sure how she would receive this, but suspect she would at least be willing to consider it. Then again, as a divorcee my ability to mis-read her intentions is a matter of public record. : )

There has to be a mutually beneficial way to handle this situation that benefits all of us, and I am looking for advice on where I could look for information. I have looked at some of the schools websites for information on family services offered by medical schools but it's hard to find in a lot of cases.

If you have a moment, would you be able/willing to point me in the right direction, or even offer some insight from your own experiences?

Many thanks for your time!

The End… and the Beginning

When I was first queried about writing, specifically for a blog like this, I was excited, nervous, surprised… would other mothers in medicine actually want to read what I have to say? Would this be an opportunity for me to reflect upon my own clinical and academic practice? Would this enable me to grow as a physician mom? 

Like many things I’m sure you all can relate to, this idea fell to the back burner, simmering. I now find myself at a critical point in which the stew that is my professional and personal life are bubbling, coming to a boil and I find this the opportune moment to jump in. This comes on the heels of a gentle reminder from KC, for which I am thankful. 

I am approaching the final stages of divorce. In order to proceed with finalization, I have been required to attend parenting classes. I won’t go into just how asinine I thought this was given he has no requirement to attend said classes. Nevertheless, I showed up with intent to learn as much as I could that I’ve not already discovered through trial and error in the co-parenting adventure. I was surprised that they started with Elisabeth Kubler-Ross and the stages of grief. I took that with a big arms across the chest eye roll, then softened a bit as I thought more about each stage and the fact that this transition does in fact mark a loss… I’ve since considered my own transition through the stages and thought back on the years we were together. 

It’s taken nearly three years. I asked him to leave almost three years ago with our eleven month old son on my hip, seething with anger and pain. Eight years of emotional roller coasters. Eight years of infidelity. Eight years of me not acknowledging my own value. In that moment, that decision, I chose myself and my child. I chose to remove myself from a relationship and marriage which was so far removed from anything I wanted to model for my progeny. I had finally come to the complete realization that my husband would not every remain faithful and tend to his responsibility and commitment to me as a life partner. I did not want my little one to watch and live in an environment where a person whom is purported to be loved is treated that way. I have come to terms with the fact that I have zero control of half of this equation (my ex), however I have full control of my own actions, behaviors and decisions. 

So, if you will, walk through the stages with me. 

DENIAL 

Every single time I found out about another indiscretion of infidelity, I refused to believe it or give it any power. I denied how devastating his actions and betrayal had been. I denied that he’d made a seemingly meaningful connection with anyone in this world other than me. I denied that he’d violated my trust. I denied that I deserved to be treated with respect, dignity, love and commitment. I denied my value. I denied my intelligence. I denied my sex appeal. I denied everything and assumed it was my fault. I stuffed my emotions and hurt into a little box and told myself he’d be better. I denied my visceral sense that his behavior would never change. I denied my better sense. I denied my friends’ pleas to remove him from my life, over and over again. 

ANGER 

This emotion is incredibly primal for me, particularly in regard to this situation. My instinctual, somatic response was long buried due to a longstanding practice of compartmentalization. The trouble with compartmentalization is that it is both protective and destructive. I put those sad, hurtful, scary, heart wrenching things in a box, I lock each box, then I dissociated from those feelings with the hope to never, ever have to feel those terrible feelings again. I felt comfortable, or at least I felt that I was well enough in control of my life to go about my day to day. Then there come times when I’ve run out of capacity in my emotional compartments and for me, that’s usually when I feel least in control of this primal behavior. On the surface, I perceive myself to be fairly calm, cool and collected. When my fully stuffed compartments start to overload, the anger floods over me, forcing my hand to process what’s in those boxes. This is also the crux of that inherent destructive nature of compartmentalization as well. 

When this happens, my transition to anger is a painfully exhausting one. Each of us experiences it differently, but I can tell you how it feels for me. I develop an ache in my chest, then my heart rate quickens, blood rushes to my head, my jaw clenches, my nostrils flare, my posture becomes more erect and inevitably, my left eyebrow raises. My hair stands on end, my pupils dilate and I coil into position to strike. If it happens too quickly, it blends with the hurt and tears well up alongside my venomous words. At the same time, the sense of power that comes with anger is intoxicating. If it happens more slowly, I can calculate my response, choose my words and actions in a much more strategic way. I feel much more in control and strong. It’s a delicate balance, however, between the primal emotion and the controlled response. My ex, whether intentionally or not, can always find ways of awakening the beast within me. I’m still learning my own triggers and how best to turn each experience into something productive rather than destructive, with particular focus on self preservation. That, however, is for another conversation. 

BARGAINING 

Anger is powerful, but it’s also energy intensive and exhausting. That adrenaline rush only lasts for so long and in general, I’m a big softie. So, let’s get to part of my own challenges with him. The mind is strong, the woman is strong, the flesh is weak. I rationalized that if I reclaimed him, I somehow won. Then I’d turn the blame onto myself. I’d make lists of the things I was or was not doing that must have somehow had an impact on his behavior. If only I wasn’t studying so much, if only I spoke another language, if only I were more exotic, if only I wore more makeup more often, if only I were thinner, if only I were funnier, if only: insert any markedly self-deprecating phrase, he wouldn’t have strayed. I’d consider what I could change about myself to keep him from doing it again, maybe if I were more shapely, or if I colored my hair, or if I wore more makeup, or if I spoke another language, or if I had perfect skin, or if I had perfectly manicured fingers and toes. I was just certain that I could do something to inspire change in him, then in my depression, he’d feed into the bargaining and do bargaining of his own: “I’ll delete her number, I won’t work with her anymore, I’ll delete that email account, I’ll go to counseling, I love you, not her, I don’t know what’s wrong with me.” On and on. Of course, this spoke to the caretaker in me as well. There must be something wrong with him and I can help him! What a poorly rationalized thought which cost me the better part of a decade and emotional scars which will eventually heal, but not disappear. 

DEPRESSION 

I spent eight years ping ponging between denial, anger, bargaining and depression. It happened so frequently that it just became the norm and an expectation. It was just a matter of time until it would happen again, then pieces of my heart would chip away, I’d become furious, buried in anger and wanting to lash out. When he, the person in my life to whom I’d given everything I could possibly think of giving betrayed my trust and discarded me as if I was worthless, I became worthless. I devalued myself. My life lost it’s color. Everything was grey. Tears ran until there were no more tears. The ache in my chest became colder, darker, then numb. I anesthetized and dissociated myself from the situation, from our life together. I ached for connection. I ached to be desirable. I drank, a lot. 

The most marked period of depression in all of this was not actually after I finally asked him to leave. It was when he told me he didn’t love me and wanted a divorce. I packed my bags. I had no idea where I was going. I searched frantically on Craigslist and found a furnished studio which fit into my budget. It was close to the subway. It was close to a grocery store. The grocery store had wine. I could get to work. I could get food, not that I had an appetite. I became a hermit, a one to two bottle of wine per night hermit. One day I woke up and realized that this was not at all in my best interests and pulled back on the alcohol, found a 10 mile race to train for (I’d never run that far in my life) and redirected my energy. Slowly, the depression lifted which softened my heart and he came back into the picture, again. In my softened state, I let him back in, of course, but that’s a story for another time. 

ACCEPTANCE 

This may sound strange to you, but the last time I let him back in, I knew it wasn’t going to work. I had decided that he was not going to change, but I was going to give it one more go. You may be thinking to yourself, “WHAT?!?! Is she crazy?” Maybe, a little bit. We all have our own pathology and demons and this was my path to take. My decision to let him back into my life and my heart was complicated, as these situations often are. As was our cycle, there was wooing and there was romance and of course there was sex. Then one day I realized I was incredibly sensitive emotionally, my breasts were swollen and sore, and GASP! I was late. I immediately ran to the drugstore, bought a pregnancy test, walked to nearest coffee shop and went into their bathroom, and melted into the bathroom stall as two pink lines showed up. Did I forget to mention that I was tapped as a chief resident for the next academic year just one week prior??? 

He never wanted to have children. I could just not tell him. I could cut him out of my life forever. I’d always wanted to be a doctor and I’d always wanted to be a mom. How in the world am I going to do this alone? I knew he was going to completely flip out. It would be so much easier to not include him. Alas, that wasn’t the right thing to do. So I told him. He was livid. “How could this happen?” Ummmmmm, I know you’re not a doctor, but seriously? Remember all those times I reminded you that I wasn’t on birth control anymore because I didn’t think it was necessary given I was alone in a studio apartment drinking my life away and maintaining solitary confinement? Well, we had many conversations about termination, so much so that I went to Planned Parenthood for a preliminary appointment. This was followed by a call in tears to my best friend in the entire world about how there was no way I could do this alone and that I couldn’t count on him for anything, so wouldn’t this just be easier. Thankfully, she talked me off of the ledge. She knew that I wanted to be a mother more than anything and that all of the excuses I was coming up with were silly in the grand scheme of things. I’m a strong woman and I thankfully have a wonderful circle of friends and I would figure it out. I would be ok. We (my kiddo and I, at least), would be ok. 

Then it became clear that he was still involved with tomfoolery with one of the many women from his past. She got involved and there were text messages and emails. I have to say, the level of class demonstrated by all parties is fodder for another time. Ultimately, he cut ties with her, promised to go to therapy for his “sex addiction” read “narcissism.” By the time I was eight months pregnant, he’d demonstrated sufficient amounts of commitment that I finally moved back in and we planned for the arrival of our baby. 

I knew it wasn’t going to work. I. Knew. It. Was. Not. Going. To. Work. I felt compelled to give it one last go for the sake of our little one. I also had an inner dialogue that was determined to figure out how to at least be a parent with this man. We made a small person. I’m stuck with him no matter what happens between us and our relationship. I have to tell my child when they’ve grown bigger and understand more of the world that I did try to make things work. I also had to give my ex the opportunity to be a father, though he never thought he wanted to do that. I wanted to be able to look into the eyes of my pride and joy when they ask why mommy and daddy aren’t together and speak frankly, honestly, that I did everything in my power to make things work… and they just didn’t. I want to say that we both love our child and have our child’s best interests in mind and want them to grow up happy and healthy. 

So, when I was in the midst of my first year as an attending, spending a fair bit of time as a solo parent with our newborn given my husband’s work related travel, and my little was 9 months old and I got a phone call from my father-in-law. He was nearly hysterical as my mother-in-law had just had a CT scan with a mass and mets EVERYWHERE. I knew what this meant. My father-in-law had an inkling, but not a full understanding. He’d tried to call my husband. No answer. I tried to call my husband. No answer. Text. No answer. Another phone call. No answer. I called the hotel where he was supposed to be staying for his work related conference. “I’m sorry, ma’am, there’s no one by that name in this hotel.” Call to his boss. “I don’t think he’s checked in to the hotel yet.” After trying to reach my husband on an emergent basis for two and a half hours, he finally called back. How do you deliver bad news to the love of your life after you’ve been unable to contact them for a prolonged period of time? You don’t ask too many questions about where they were, who they were with and what they were doing… after all, their mom is dying and they don’t even know it. You take a deep breath, tell them you have some difficult news and follow that with as much promise of support as you can. I told him they’d found a mass, it was very concerning for widespread cancer and we needed to figure out how to get him home and us on a plane to see her. I called my colleagues, got shifts covered, booked our flight, headed across the country. 

My husband stayed. I came back to work and essentially be a single parent. I facilitated conference calls with specialists, primary care physicians, hospice providers, and my husband, father-in-law, brother-in-law. I was the tele consult 24 hours a day, while caring for our infant, managing a nanny who left a bit to be desired, managing my board exams and finding my way as a new attending. My mother-in-law didn’t want treatment. She wanted quality of life. Her sons and her husband could not fathom this. My father-in-law understood her desire, but his heart was broken. He was watching his love slip away right in front of his eyes, in his own home. The boys on the other hand were going through their own grief process. My husband was distant. I expected this. I figured it was his process. At the same time, just hours after we celebrated her life in a remembrance ceremony after her death, the text message that came from his paramour, while not unexpected, her timing was audacious. “I think he’s lying to us both. I hope he comes clean with you.” 

That was THE moment of acceptance. I knew it would come. I just needed to go through the whole process. That was the moment our marriage and relationship was over. Now, don’t get me wrong, there certainly followed moments of depression and anger and a sense of loss, but there was no bargaining and there was absolutely no turning back. That was the point of no return. I am worth more than this and my child deserves to learn that I will not accept being treated this way. My kiddo deserves at least one parent who strives to demonstrate the value of meaningful and lasting relationships built on communication, openness and trust. I refuse to accept that life anymore and am moving on with my new life and my little one.

Here's to new beginnings.