Live for two months!

A few weeks ago, at the end of a very trying day with the kids, I saw the Mark Twain quotation, "I can live for two months on a good compliment" at the end of a newsletter. How true it is. As I thought back over my day, the high point was a pretty random, but apparently heartfelt, compliment from a stranger. "You are so patient with your children! That is JUST WONDERFUL to see!!" said an elderly lady in passing in Michael's as I quickly picked out 50 cent treasure rewards while playing rhyming games with the two older kids to keep them from running off and attempting to stop my toddler from eating through all the packages of cupcake decorations in the cart. I'm sure she has long forgotten me and that interaction, but I have channeled her repeatedly since then.

I recently started a sticker chart for my 5 and 4 yr old kids at home in an effort to improve behavior. I used a plain piece of colored paper and wrote on it 12 things I wanted them to do (or in some cases, stop doing). Each time they do those things, they get a sticker on the chart. Ten stickers earns a trip to the candy box, twenty stickers a trip to the treasure box (see Michael's above), and thirty stickers a choice between a family trip to our local ice cream shop or to Blockbuster for a family movie night (school night or no, we honor it) with a movie of their choosing. Each time one of the kids gets to thirty, I make a new chart for him or her which may include some of the same behaviors or new things, depending on where we have made progress. It has worked AMAZINGLY well, so I have been thinking about why that is. Well, there's the obvious: Kids love candy. Kids love treasure. Kids love family trips, but especially those that involve movies or ice cream. But they got candy from time to time or little trinkets at stores or trips for ice cream or movies long before we instituted this reward system. So clearly, that's not the whole story. What they are really responding to is being acknowledged and praised, in some cases for things that I expect of them anyway (e.g. be kind to your sisters). They like the fact that my husband and I are pausing long enough to say "Great job", to stop what we are doing to go choose a sticker with them from the sticker folder, to mingle in more compliments amidst the unavoidable "no"s and redirections and scolding that go along with being a little growing human testing the boundaries of the world.

One of the things I like most about my boss is that she is a reliable complimenter. Her compliments are never insincere. They are never excessive. She just makes a point of acknowleding reliability or patience or meticulousness or creativity or kindness. It isn't that those qualities are so remarkable either--indeed, they are expected in physicians and scientists--but she still appreciates them. And that is probably what should drive a lot of compliments, appreciation of another human being, even if they are doing exactly what you expect of them and not one iota more.

I have decided to make a concerted effort to follow her model for a month and see how I feel and how my relationships with others change. So, when my husband found the dishwasher full of clean dishes and took 5 minutes to empty it before leaving for work at dawn during an awful attending month, I called him to tell him how much easier it made my morning with the kids to find it empty and ready for the breakfast dishes before we dashed out to preschool and school. It was empty the next morning too and the one after that. When my son reminded me back at home of something good his sister had done while we were out that deserved a sticker, I stopped and hugged him and said, "That is true kindness. It makes Mommy so proud when you are kind." He beamed and has been what I can only call excessively, concerningly kind to his sisters for the last 24 hrs. And when I told my clinical associate today that I appreciate how friendly she always is to the patients when taking their vitals because it sets such a nice tone for our visit, she looked at me like I was from outer space. But I couldn't help noticing that she walked off with a little spring in her step. And it was only a little smaller than the spring in my own.

please tell me more about how the heart works

The other day a fellow MIM who doesn't actually blog here (as far as I know) recounted a story to me about her child's bedtime routine that I found funny and oh so familiar. Have you found that almost all of them (those children of ours) want to stay up just a little bit later? Indeed they are oh so in tune to what enthuses mommy and/or daddy. And what would allow them a few more minutes (hours??) of wakeful banter? When they want to stay up even later than their working parents already let them, all they need to ask is just one little question...


It goes something like this, "Mommy, can you tell me again how the heart pumps the blood around the body?" Or perhaps "Daddy, will you remind me how the lungs work again?" It can happen whether we're pulmonologists or cardiologists, and even a health services researcher might succumb to a innocent query like "Can you review regression analysis one more time?" We're weak when it comes to an opportunity to explain what we love to do, our primary involvement when we are not with our precious little ones. And they know with that simple question, "How does the food get all the way from my mouth to my large intestine?" they've bought themselves more not-yet-sleeping Mommy/Daddy time.

NaNoWriMo

You may or may not know that November is National Novel Writing Month, also known as NaNoWriMo. The goal of NaNoWriMo is to write a 50,000 word "novel" in one month. (50,000 words may be a little short for a novel, which is why December is National Novel Finishing Month.) If you finish your 50,000 words, then you can say that you "won" NaNoWriMo and they give you a little banner you can put on your blog or facebook or wherever.

I won NaNoWriMo back in 2006. It was a lot of work, more than I thought it would be, but also a lot of fun. Then in 2007, I had a baby and between that and residency, I decided that participating in NaNoWriMo would be just short of child abuse. More of the same in 2008. I felt bad about it though, because part of the purpose of NaNoWriMo is for busy people to finally force themselves to sit down and write that novel.

Now I'm finished with residency and have more free time, so I'm going to be participating in NaNoWriMo 2009. I think my chances of winning this year are a lot lower than three years ago, but half the fun is trying.

I invite all you mothers in medicine, as well as all you non-mothers not in medicine, to join me in my overly ambitious attempt to write 50,000 words in one month.

The post where I gush about Pauline Chen

I had the recent opportunity to listen to physician-writer and fellow mother in medicine, Pauline Chen, speak at a university function. I had read some of her columns in The New York Times (she has a weekly column, "Doctor and Patient"), and I've always been impressed by how honestly and thoughtfully she writes. Her book, Final Exam: A Surgeon's Reflections on Mortality, is a New York Times bestseller.

My colleague had helped to arrange her visit, and when I arrived to the building, I ran into him into the hallway. He introduced me to her before the talk and I got the chance to speak with her for a few minutes. What struck me about her was how she makes you feel like the most important person in the room when she talks to you. She is sincere, engaged, kind and so warm, she casts a glow. I felt gleeful to be able to connect with her, even for a short while. I even mentioned Mothers in Medicine and what we write about here.

Her talk was fabulous. The entire auditorium was captivated and hung onto her every word. She shared a couple of patient stories that were so exquisitely written and told, I had shivers. Her message was all about compassionate care, especially compassionate care at the end of life. She shared regrets and interactions she wished happened differently, but mostly, it was about hope for being the best physicians we could be. There have only been a couple times where I've listened to physicians speak and thought to myself: I would want to be her patient. Her patients are so lucky. I thought this about Pauline. (The other was Rita Charon from Columbia University. That woman rocks.)

I left the talk feeling inspired. Inspired to write and inspired to keep striving to be the best physician, the best listener, the best patient advocate that I could be. I thought about all the family meetings I've been involved in recently - the ones where we have to break cancer diagnoses and sometimes discuss options for palliative care - about helping patients and families through the stress of chronic or end-stage illness, and feeling at least thankful to be the one to help them through this. Emotionally taxing on me, yes. But if I can make an unthinkable situation a little bit better, to be the voice of compassion and comfort, then it is all worth it. It makes a difference.

Pauline, thank you for doing what you do. Thank you for inspiring each of us sitting in that auditorium to be our best selves.

Seriously, I wanna know...

Will you vaccinate yourself and/or your children against H1N1?

Contending to be Content

From the moment my first visitor came to see me in the hospital, as I was holding my brand spankin’ new baby boy, they all began to echo the same message “Enjoy every minute! They grow up so fast!” Each mom would get slightly misty eyed when they talked about how it seemed like just yesterday their ‘little one’ (who was sometimes college age) was that size. “I miss when I could just cuddle them in my arms for hours” they would say. I would smile and nod, wondering mainly when I would get some sleep. I noticed recently, I’ve fallen into giving the same advice when I round on my postpartum patients each morning.

I really have tried to relished every moment. It has not been our choice that we have an only child, and my prayer is that we will have another someday. However, I was recently thinking how this unplanned spacing between children has allowed us to truly enjoy each stage with our son. From the crawling, to the talking, to the first day of school, I have tried to soak up every second of parental joy I possibly can. We take obnoxious numbers of pictures and fill journals with stories. Ok, so potty training was not a hoot, but still it had its funny moments. I see so many of my patients with several children under the age of 5, and while I am envious of their full quivers at times, I also see so many who are just trying to survive…. If I can just get this one sleeping through the night, if I can just get this one out of diapers, if I can just get this one in school…. THEN I’ll be able to really enjoy them. There are so many people who ‘WISH” away their life.

I think the same attitudes can apply to the medical training process. With a minimum of 12 years of training, you just HAVE to try to enjoy some of it or you will go crazy and waste half your life. Yes it is grueling, yes the hours are intense but there is nothing like it. The things you see in residency are crazy. (Hopefully) You will not see near the insanity/ fun/ adrenaline filled nights when you are an attending. The lessons you learn will stick with you forever. Those crazy, on call practical jokes will make you chuckle to yourself for years to come. To this day when I see a CPR mannequin I laugh so hard I nearly pee my pants! I miss those days when all I did was surgery from sun up to sundown, interesting cases with no office follow-up. I worked with so many people who were just counting the days till the end: I wish I was a resident, I wish I was a chief, I wish I was in practice. Then once in practice, they began counting the days till they were partnered. There is always something to look forward to, but the art becomes enjoying where you’re at while you’re there.

So I’m trying to practice what I preach: enjoying my job and son to the fullest, as I somewhat patiently wait to adopt baby #2. I feel thankful and blessed, that I have gotten to spend so much precious time with my son. Obviously, there are days where life becomes all about survival, but for those many good days I pass on this same somewhat cheesy advice to all you residents and med students that I do my postpartum moms: “Enjoy every minute of it (your training) that you possibly can!”

$$$$$$$

When someone makes a comment about rich doctors, I want to punch them.

The median med school tuition for last year according to AAMC is about $40,000. That is just tuition, not including room and board, academic expenses (some schools require laptop purchase), health insurance, or gas money. I think it's safe to tack on an extra $15,000. So that brings the grand total to $55,000 per year for four years. Doing the math: that's $220,000 in debt before you earn your MD. And that doesn't even count any debt from college.

You would think that after accumulating that kind of debt, you'd be able to go out an earn some money. Not so. My residency salary right out of medical school was $40,000 per year. Are you sick yet?

Then you do something insane like go and have a baby during residency. You need a bigger apartment and now a nanny or daycare. Once we had a child, my entire salary after taxes went directly to the nanny. But I accepted it, telling myself it was just temporary while I was in training.

I swore to myself that after I finished residency, I wouldn't worry about money anymore. Then I found a fellowship that I wanted so badly, but I knew the salary was nowhere near what I'd make in the private sector. It was a job I knew I'd love (and I really do), but part of me felt sick accepting it, considering the high cost of living around here.

So here I am, in my 9th year of medical training, still pinching pennies, making less than some of my friends made right out of college. Everyone asks me when I'm going to have a second child, but when I do the math, I simply can't afford it without having a negative monthly balance. I'm a doctor and I can only afford to have one child. Something about that seems a little off to me. People look at me weird when I say it.

I think to myself, "Did I do something wrong? Why am I still struggling to make ends meet?" I could moonlight, but that would involve working extra weekends, when I had vowed to spend more time with my daughter when residency finally ended.

I was at the ice cream store yesterday with my daughter. I was staring at the menu, struggling to decide if I wanted to pay an extra dollar to get the medium instead of the small. The small will be enough, I told myself, it's not worth the extra money. The ice cream is such a rip off. And as I contemplate this, I think to myself, "This is crazy, this is ridiculous, I shouldn't be worried about spending an extra dollar on ice cream... I'm a DOCTOR."

And then I get the small ice cream.

Looking to History for Mothers in Medicine

Here are few remarks excerpted from a talk I gave about a travelling National Library of Medicine exhibit on women in medicine that is currently at my school and may come to others. The exhibit is very worth a visit, even from an overbusy motherdoc. The students in the audience seemed to share my thoughts--many are struggling with the same concerns we have all had about integrating our many roles:

"I graduated from medical school in 1977. A picture of my class could have found a place on one of the panels of a history of medicine exhibit, as it was, I believe, the very first class at my medical school to have more than a token number of women—30% rather than 10% or fewer. What that meant to me concretely was that my male classmates could look around at their peers and professors themselves for models, inspiration on how to build a life and a career in medicine. In school, I could look to my peers for ideas on how to remove the smell of formaldehyde from my hands. Later they showed me how a woman can be an effective teacher or begin a research career, but for inspiration, I had to look backwards in time to the women sporadically flung up by the tides of history. Reading about the checkered history of strange and sometimes misguided study and treatment of disease by strange and sometimes misguided practitioners helped me form a realistic view of medicine, to lose the naïve assumption that one had to be a genius to enter this profession and that once in, one could never make a mistake.

Elizabeth Blackwell, of course, was the subject of various biographies for children that I read in elementary school and every other book about women in medicine that I read after that. I admired her determination and commitment, but I was always troubled by her detour away from what was called allopathic medicine into homeopathy, as well as by her unmarried and apparently unmarriageable state. In my college, which had originally been an all women’s school, I stumbled across Dr. Edward H. Clarke's publication Sex in Education; or, A Fair Chance for the Girls (1873). Clarke was a professor at the Harvard Medical School, and seems to have been panicked at the sight of blood. Aside from unbending prejudice, that was the only way I understand his argument that women were so weakened by the menstrual blood loss that they could not possibly tolerate the rigors of secondary education, much less enter any of the professions. He suggested all women should lie in a quiet room for a week every month, to conserve their strength to bear healthy children. Clarke’s contemporary on the faculty, Oliver Wendell Holmes Sr, clearly knew this was nonsense, but all he ever did to counter it was to state in his eulogy for Clarke that he knew Clarke sincerely believed in his own thesis. I was thrilled when I learned that Mary Putnam, another early woman physician, had demolished Clarke’s work by rigorous research conducted during her post graduate training in Paris. Her complete and influential refutation of Clarke in fact laid the groundwork for the creation of elite women’s colleges around the country, and accounts for the emphasis they placed on athletics as well as scholarship.

Still looking for models for myself, I was also very relieved to read that Putnam not only succeeded in influencing the whole of her profession, she also married and was the mother of two children. Still seeking a guide on my own path into medicine, I found her story a bit intimidating, given that I could not imagine having her commitment to science, or her critical intelligence. She saw clearly the inadequacies of her own training in the US, and went off to remedy that in nearly complete isolation from friends and family, not to mention other women physicians.

Regina Markel Morantz’ article comparing Elizabeth Blackwell and Mary Putnam Jacobi clarified a lot for me. These two women represented different poles of feminism—ones still relevant in my era in college in the 1970s and even today. Blackwell was a “difference” feminist who believed that women’s unique nature would lead them to be more understanding, more gentle and feminine in their professional practice. Ironically, since Blackwell herself was never a wife or mother, it was Putnam (Jacobi) who was what has been termed an “equity” feminist. Despite (or perhaps because) of her personal adoption of the conventional roles of wife and mother, she successfully argued and demonstrated that women deserved the same opportunities to achieve as men, given their equal abilities. I could only sit on the sidelines of history chanting the “right on!”, the 70s equivalent of “You go, girl!’, though I did become convinced that I could handle being in medicine, and would not have to abandon my hopes for a family as well."

I wonder if other bloggers find history as important as I do as a way of understanding the way our current context influences how we feel about ourselves and our choices?

Guest Post: House of Cards

It really does take a village to get anything done.

I have a village all coordinated and well planned out to get done what I and my family need in order to get through each day. I even have decent scenarios for emergency coverage.

But not for tomorrow.

Tigercub 3 is feverish and needs to stay home tomorrow, again.

Nanny asked for tomorrow off a month ago for much needed personal issues.

Tigerdad will be out of town all day tomorrow from sun up to long after sun down.

And I have a weird thing on my skin and managed to get a coveted dermatology appointment for tomorrow afternoon perfectly timed for after my patients and before I have to pick up the cubs at school. Why? Because their blessed school has last minute after school coverage available.

But only for healthy cubs. So who can look after cub 3?

Mother in law can only cover part of the day.

My mother cannot do any part of the day.

So what to do?

Cancel all of my patients, of course.

And take the cub with me to the coveted derm appointment.

-Tigermom

Cross-posted at www.twowomenblogging.blogspot.com

MiM Mailbag: Family Dinners?

A study just released by the National Center on Addiction and Substance Abuse at Columbia University found that teenagers who have infrequent family dinners--less than three a week-- are more likely to drink, smoke, use marijuana and be able to get prescription drugs within an hour.

 Are they a priority? Why? What extremes do you have to go to make them happen? If you can't pull them off regularly, do you feel guilty or defensive?



A reporter is interested in speaking with working parents of tweens and teens about family dinners. If you would like to be interviewed about your experiences, please email us at mothersinmedicine@gmail.com.

Flu shots

We took Melly to the pediatrician to get her flu shot today. I am absolutely insane when it comes to flu shots. As soon as September comes, I'm immediately looking around for my flu shot. I got an email at work saying that the flu shots would be available soon and I immediately sent back an email, saying, "Where? When will they be available? FOR THE LOVE OF GOD, WHEN CAN I GET MY FLU SHOT??" They emailed me back, basically telling me to chill out.

So anyway, we were planning to take Melly to the aquarium today and got her all excited about it, then realized we had made an appointment for the flu shot today. Oops. So instead, we got her all excited about going to the "doptor." She hasn't been to a doctor in such a long time, I don't think she realizes that it's not something to get excited about.

The thing that made me nervous was that she knows Mommy is a "doptor." So I was really scared that when she got her shot, she was going to make that horrible connection and think that I was some sort of Mengele-like figure who was sticking needles in defenseless children all day.

So we got her into the room to get her shot. The nurse came in and with the needle and said to Melly, "Look at Mommy."

But she didn't look at me. She looked at the needle, fascinated. She looked at the needle as it went into her arm and the nurse injected her and then put on the band-aid.

And wouldn't you know it: NOT A PEEP.

In fact, she was totally excited to get the band-aid, then a second shiny band-aid for the cut on her knee, then an Elmo sticker. I thought she was going to freak out any second, but she left that office super-psyched about her Elmo sticker. I feel like she must be the first two year old in history not to cry during a vaccination. We both hugged her and told her how proud we were of her.

I kept thinking about how she watched that needle go into her arm with such fascination, and on the trip home, a thought suddenly occurred to me:

Me: "Melly, do you want to be a DOCTOR when you grow up?"

Melly: "No."

Oh well.

Welcome to our MIM Childcare Topic Day

Topic days are days on MiM devoted to a single topic, featuring posts from many of our regular contributors as well as guest submissions. Today, the topic of the day is Childcare. We're writing about daycare and nannies, costs, wait lists, dreams and nightmares. Posts are scheduled throughout the day, so check back often!

Thanks to everyone who contributed!

Scroll down to find the posts...

Third time's a charm...Tempeh's 11th hour topic day post on childcare

I always remember Topic Day at 11pm on...Topic Day, so here I am, dead last.

Wow, I could write thousands of pages on this one, but since it's late and I am leaving for work in t-8 hrs, I'll focus on the nanny issue.

We started out with my firstborn in a reputable traditional daycare down the road from our house, which is about 45 minutes away from our jobs. With no traffic. That lasted all of 7 weeks, during which time my son (a winter baby) was sent home for three distinct infectious illnesses. When he started there, I was an oncology fellow and my husband was an internal medicine resident doing his ICU rotation. When we would get the alarm bell that my son had a fever of 101 and needed to be picked up within the hour, it was a panic to figure out if we could even GET THERE in an hour if we dropped the chart in our hands and ran. Not to mention that you really can't just leave as a resident or fellow. It was constant stress. When I walked in to pick him up one day unexpectedly early and found him lying on a mat on the floor crying while his "teacher" balanced her checkbook, that was it. I took him home and we never went back. Thank God it was a Friday!

After I finished crying for about 12 hours out of guilt over leaving him there, we called my mom to come and contacted a wonderful local nanny agency. In our desperation to find someone to watch our son in our home ASAP, we tried to persuade ourselves that her references, who said our nanny-to-be "was more emotionally needy than our preschool aged kids" and "left us abruptly when we told her we were pregnant with a second child," must have had an axe to grind. She was kindly and at ease with our almost 5 month old son, and he seemed to take to her even at the interview. SOLD! Within a few months, she self-referred for PT for "the earliest signs of carpal tunnel syndrome" and started scheduling her PT appointments during her work hours because that was the time slot her preferred therapist in the practice had open. It would often take me an hour or more to get out of the house in the morning because she wanted to talk about some, usually quite minor, mishap in her day. Invariably, she would cry and want hugs--like actual hugs--which I would patiently deliver day after day while watching the minutes of my already very short workday (the fact that we decided to hire her only 26 hours per week will be a topic for another time) tick down over her shoulder on our kitchen clock. When we unexpectedly got pregnant with our second child when our son was 9 months old and shared this news at about 20 weeks gestation, she told us the following morning that she was quitting due to her worsening carpal tunnel and was gone a week later. She did stop by a couple of months later reportedly just to say hello. I noticed she was still wearing her splint. She told me that she missed nannying and had just come from an interview with another family who had one baby boy and lived just a few minutes from us. That was what had made her think of us. They called for a reference shortly after she left. When they asked why she had left us and I mentioned that her carpal tunnel had gotten worse, the mom said, "What carpal tunnel?" I asked whether she hadn't noticed the splint. Turns out she wasn't wearing the splint at the interview. The mom mentioned that she was almost 40 and wanted to try to get pregnant with another child within the next few months. My advice to her: "Run! Save yourself!" Lesson 1: Believe the references. Nanny history repeats itself!

For our second nanny, we decided that it wasn't worth paying the steep nanny agency referral fee a second time. We used an online DIY type of nanny agency called enannysource. It let us post a family profile with as much or as little detail about our family and our needs as we wanted. And we could search nanny profiles by the same details in our zip code. Like magic, a 36 yr old woman, the mother of a 9 yr old boy, saw our profile and emailed us to express interest within 24 hrs. She came to interview the following day. She had a degree in early childhood education but had never worked because her son was born shortly after she graduated college. She had gotten divorced due to marital stress over her son's medical issues (he was deaf, bipolar, and on the autism spectrum) when her son was a toddler and had remarried within the past few months. She was young, energetic, direct, and clearly a very devoted mom, which I thought would bode well for us since we were hiring her to be sort of a part-time mom. We were a little worried that her son's issues could cause her to be pulled in two directions, but what mom isn't? So we put it out of our minds. We needed a nanny, and she was otherwise perfect. I was visibly pregnant with my second child, which did not daunt her one iota. Ahhh, I thought, she'll stay with our family forever. So we hired her. Flash forward a few months, and there we were: scrambling to get home over and over because her son needed to be picked up from school or because he had a doctor's appointment or because his school was closing early for snow, etc. All reasonable, all issues we ourselves faced as parents. We felt like hypocrites to say anything about it. We knew how hard it was. A few months later, I gave birth to my daughter, and she fell madly in love with her. So in love, in fact, that she decided she actually wanted one too. Six weeks later, she unexpectedly dropped in at dinnertime with her husband and son to tell us that--GREAT NEWS, YOU'LL NEVER BELIEVE IT!!--she was about 1 minute pregnant, and they were over the moon. The next several months were a marathon with hurdles--morning sickness that made her unable to stand the smell of our kids' diapers, insomnia making her emotionally unable to deal with our tantruming toddler and colicky daughter, and ultimately, the deal breaker, back pain that got worse with having to carry our kids around. Lesson 2: If your nanny has kids of her own without iron-clad childcare, and you/your spouse don't have a VERY flexible job, you are in for trouble. Lesson 2, subpart 1: It may be illegal to ask a nanny of childbearing age if she plans to get pregnant (unless she brings up the topic first), but it's not illegal to talk about it at night in bed with your husband if your nanny candidate is in her late 30s and newly married. Especially if you have or are about to have a delicious little newborn who could plant such a seed in her fertile brain.

For nanny #3, we again went back to enannysource. This time, I was wiser. I spent hours and hours every night after our kids went to bed sifting through nanny profiles, word-smithing our family profile, reading between the lines both ways. It took us almost 5 months to hire our next nanny during which we officially used up every favor we were ever owed and got a 40 yr or so advance on future favors with our parents, siblings, friends, and a few babysitters turned temp nannies where they were available. To say that it was stressful doesn't even begin to describe it. Fortunately, we had reached a point in our training when we had more flexibility so we could arrange to go in early and come home early and the other spouse go in late and come home late. It wasn't easy, but we made it work. When we met our third nanny, whom I had emailed back and forth repeatedly and interviewed by phone (along with dozens of others) for about 90 mins before bothering to invite her to our home, we knew that was it. She was 26 yrs old, single, energetic, had taught in the public school system but wanted to work with kids on a more individual basis, and she shared our values. Her references, which weren't really in childcare, loved her across the board. Over and over, they described her as loyal, reliable, honest, flexible, optimistic. Music to our ears. Our only reservation was that she was kind of...well, sloppy. But, we said, we can live with that. And when she described what she had done with kids at an in-home daycare she had worked at several years prior, we noticed that all of the activities sounded like...well, a huge mess. We had a moment of reservation as we surveyed our light carpet and pastel-colored sofa and chairs, but, hey, kids are washable, and that's the fun of being a kid. Our shy then 2.5 year old son kissed her goodbye at the end of the interview! We hired her. That was 3+ yrs ago, and she has been an absolute joy to have in our family. She loves our kids, makes them handmade gifts for every birthday and Christmas, remembers my son's Epipen and chases me up the driveway with it when I forget, and is more patient and creative than I will ever be. She even makes us dinner when she knows we are going to come home exhausted, which is more often than not. She joined the Y so she could take our now third child, who is a complete water baby, swimming while the older two are at kindergarten and preschool. She is loyal, reliable, honest, flexible, and optimistic. Our only complaint: she's...well, sloppy. And the things she does with the kids--things like painting refrigerator boxes with non-washable tempera paint on our kitchen floor--are...well, a huge mess. But, hey, we can live with that. Lesson #3: Trust your instincts. Know the things that are deal-breakers for you. And the things that aren't. And see lesson #1!

Which reminds me, A, that you deserve a raise!

Admitting I need help

I recently let me my nanny of four years go, just after having my third kid - yes, I know it sounds crazy but I was having an identity crisis. I decided to take an extended leave from work to enjoy being 'mom' and I was sure that with the older kids (4 yrs and 2yrs) being in school half days that I could manage without help. I've always thought that I can do more than what's normal, in fact, now that I think about it, I think I define myself by being able to go 'above and beyond the call of duty'. Well, sadly I was wrong. I struggled through two months of life with the three kids and found myself tired, disorganized, snapping at my kids, craving time with my husband and over-using my Mom for help.

I've finally come around to the conclusion that it's precisely because I want to be a great Mom that I need help at home.

The challenge is not just finding one, but also managing one. I had a nanny for four years and despite my ability to manage difficult patients on an internal medicine ward, challenging residents in a large academic program and three kids with all different needs (well 4 kids if you count my husband), I find that it is the most challenging to manage my nanny. I realize now it has a lot to do with mother's guilt. I just do not want to see my nanny as an employee, a housekeeper or a babysitter. I want to see her as an extension of myself so that I can say to myself, that my kids are in good hands. For a long time I had a problem with the thought that the same person who would look after my kids would clean my bathrooms - so for a long time, I didn't ask my nanny to do anything but look after the kids. But this meant that when I would come home from work, I would do all the housework while she continued to play with the kids - something is wrong with that picture!
So as I now look for a new nanny, I have come to terms with the fact that firstly, I need help and second, that I need someone who will look after my kids AND my house. I met a family today visiting from Pakistan. The Mom had 3 kids exactly the same age as mine and she said she doesn't know how I do it - because where she lives, there is so much help - for the house and for the kids. She said, where she lives, it's easy to have three kids! After meeting her and after a long few months without help, I now can comfortably say that I need help with both my kids AND my home.

I put an embryo on a daycare waitlist

September 2001

One year and three months into a two-year residency, I give birth to my daughter. I am eligible for one year of maternity leave, and have every intention of staying home with my sweet, big-eyed Saskia for all fifty-two weeks.* Pete and I haven't yet decided what we'll do for childcare when the year is up, but daycare isn't even on the table. I grew up understanding that daycare was for the unfortunate children of selfish mothers. It was fact, just as neighbours who mowed their lawns on Sundays could not be Christians.

January 2002

I sit at the desk in our loft, looking at a list of home daycares. The nine remaining months of residency loom over my days with my infant daughter. I have an irrational fear that I will have a series of consecutive pregnancies - defying all contraceptive measures - causing a perma-maternity leave and precluding any possibility of ever finishing residency. I am desperate to be done with it.

My residency program agrees to my request to return half-time, five mornings a week. We have no family nearby, a nanny seems like overkill and I am prejudiced towards group daycare, so in-home daycare seems like the best option.

Saskia lies on a blanket on the floor next to my desk in a fuzzy purple sleeper, arms waving, and as I dial the first number I feel sick to my stomach. It remains one of the most profoundly distressing moments of my life.

I dial and wait for the kind voice of soft, grey-haired caregiver. A man answers instead, hands the phone to his wife. I can't do it. I imagine my daughter in a stranger's basement rec room, husband and teenage sons coming and going, and I hang up.

I resort to calling institutional daycares. The only one that has an opening is attached to the local high school and cares for the infants of teen mothers so they can stay in school. I take it.

February 2002

It is a relief to be back in residency, end in sight. I love immersing myself in medicine again, and trundling Saskia home in the stroller in the early afternoon is ideal. I do have some anxieties. After the first week of daycare I marvel that she hasn't been abducted from the centre yet. Somehow it seemed that the moment she left my arms she would be in imminent danger.

Months later, a video of the daycare is shown at a gathering of Vancouver's who's who to raise funds for the support of teenage mothers. Several physicians recognize me in the footage and are confused.

Summer 2002

I've waitlisted Saskia at all the best daycares in Vancouver. A spot opens up at my top choice, a daycare attached to a hospital that has an infant, toddler and preschool division. Now I sign in Saskia and hang up her poncho alongside colleagues in medicine, research and physiotherapy instead of fifteen-year-olds.

We bring Saskia every day to energetic ECE-certified women who love their jobs. The child-teacher ratio ranges from 1:3 in the infant room to 1:4 in the preschool. Daycare doesn't call in sick, move out of town or take vacation. Saskia thrives and we are relieved and grateful.

2003

I finish residency. We reduce Saskia's childcare to two days a week and I work part-time.

I conceive and put the embryo on the daycare wait list. Eight weeks later we announce the pregnancy to our parents.

Spring 2005

A spot opens for my three-month-old son, but he's not eligible to attend until he's six months old. To retain it I pay full daycare fees for those months. I am ashamed that we resort to this, but it's common practice in daycare situations and the truth is, we'll do almost anything to get and keep a spot in a daycare with over eight hundred families on the waitlist.

When Leif finally joins the daycare, his caregivers in the infant room are the same ones that cared for my daughter three years ago. There has been virtually no turnover. They love him as they did my daughter.

Summer 2006

We move to Deep Cove, a half hour away from the daycare, and don't even consider changing our charmed childcare situation. Daycare close to work is much more convenient that daycare close to home, anyway.

I have my third child, Ariana, and we repeat the embryonic registration and retainer fee scenario that occurred with Leif.

September 16, 2009

My two oldest are in school, and Ariana still attends the same daycare two days a week, taught by the same teachers that cared for Saskia and Leif. I've been buzzing myself through that red front door with a little backpack on my arm for over seven years now. It's a comfortable part of our routine. So comfortable, in fact, that - behind on laundry this week - I sent Ariana to daycare in a pair of her brother's briefs, knowing I wouldn't hear a whisper of judgment.

* I am Canadian