Doctor's visit

Melly had her three year old doctor's check-up today and I couldn't have been more proud of her. She sat quietly while the pediatrician measured her height and weight, took her blood pressure, listened to her chest and tummy (and she told the doctor where her heart was), looked in her ears, and looked in her mouth. It got to the point where I was wondering what this obedient child had done with my daughter.

Then she had to get a fingerstick and I knew this was when the tears would surely start. But to my utter shock, she didn't even whimper when the nurse stuck her and squeezed out a tiny test tube's worth of blood. "I bet she'll cry when the bandaid comes out," a nurse said. But she didn't.

This is a kid who is routinely reduced to tears by her desire for chocolate milk. I'm kind of confused.

Back in my peds clerkship, I would have been blown away by a kid like that (little do they know what goes on behind the scenes). Looking in the ears was always a guarantee for screams. I remember I would just take out a tongue depressor and the kid would cry bloody murder.

I'd like to think part of the reason she's so good at the doctor is that she knows her mama is a doctor. She's got a doctor's kit and we play with it a lot. I look in her ears with the toy otoscope and tell her she's got a family of owls living in there. She cracks up. If she's really good, we pull out my real stethoscope and I let her listen to her own chest. There's a toy syringe in her doctor's kit and after her doctor's visit, she pretended to give us all shots.

"I shot you, Mama," she said.

Snowday without Children

Ode to Warm Socks

Stuck in this Blizzard, sleeping on cots
The joy of my day—a pair of warm socks.
Stuggling through blizzard from office to ward,
My job lies before me, those names on the board.
My feet feel so damp, cramped into these boots,
But a doc can’t go sockfoot, the patients would hoot.
The nurses are heros; they work shifts end to end,
While after my rounding, I’ve no one to tend.
So I slip off the boots, put the socks on the heater
Spend a few hours to make my space neater.
Still it keeps snowing, in buckets, in torrents
We’re glued to the news in a state of abhorrence.
But me, I’m contented, my children are grown
I fine where I am, don’t need to be home.
I can just watch the snow fall, all night by the clocks
And wait for the day with my pair of warm socks.

The things they ask, tell, and strive for

A few things any MIM might hear from her child at any given moment, as mine asked recently...

The question: How do the babies get out?

Different day: How do the babies get in?

A declaration: I know there are a lot of things in the body that are... pink

Overheard, to her friend, Oh, did you hurt yourself because my mother is a doctor so she can help you. And the friend responds, I know you've told me that a million times.

And aiming to serve: I'm going to be a waiter

In the other room, the laptop idled

In the darkness, his face looked like the image on the ultrasound monitor. The soft rounded closed eyes. The thumb at the mouth. I couldn’t remember the last time I held him while he was sleeping. It had been too long.

Now, his body was much bigger, stretched across mine diagonally, like a pageant sash.  My arms wrapped around him, my hands feeling the soft stubble of his blanket sleeper and his warmth. His breathing, though, was noisy. Rhonchorous, like I imagine his lungs underneath. Horns. Percussion. The music hitting all the wrong keys. His chest heaved as he breathed in and out, in discomforting noise.

I rocked.

I rocked and thought that this might be the last time I’d go through these mothering motions. Comforting an uncomfortable baby to sleep was a power I enjoyed. Is this really the last?

I didn’t want to disturb his hard-won sleep but couldn’t help but stroke the side of his face in a moment of mother adoration. To lightly brush his warm forehead, blushed with fever.

The time marched on in that rocking chair. I wondered what time it was, and what time I should get up and place him back in his crib.

Just another minute.

Instinctively, I pulled him into me a little bit tighter. Don’t grow up so fast. Be well, but don’t grow up so fast. I need these moments to slow down too.

Trying to Diagnose Disease - Med Student Style

My best friend from medical school is wickedly smart. She is currently a successful ophthalmologist, married to a great guy, and mother to an almost three-year-old girl. She's coming in town tomorrow, and we are going to see Avatar. I can't wait.

We used to stay up late studying together at Barnes & Noble, quizzing each other from old test banks after all the important solo work was done (interrupted, of course, by phone calls about the latest doings on "Days of Our Lives." I think soap operas were designed for sensory-deprived medical students - I can't imagine stomaching the repetition and inanity in my current life stage - but it was incredibly fun to dissect at the time). She is a former coffee-shop waitress, and introduced me to the flavored steamer - a nice hot pre-sleep milky drink that subsequently carried me through both pregnancies. She always made a few points higher than me on our tests - she was like the proverbial carrot that kept me studying.

On our third year clinical rotations, she developed hives. It was strange. We immediately assumed the role of medical student detective, trying to determine the source. She tried the non-latex gloves in the OR, to no avail. I remember one weekend, we decided to put all of the plants in her apartment on her back porch, to see if they were the culprit. We regarded her fish Kumar, named after the author of our second year pathology text, suspiciously - even though he was an unlikely candidate for her troubles.

The hives worsened, and became a chronic problem. She visited an allergy-immunology expert, and was loaded up on a triple-drug regimen, in order to try to gain relief on a Christmas trip with her parents to visit her brother in Italy. One night, shortly after returning from Christmas vacation, she called me frantically from the grocery store.

"I am standing in the aisles, looking at the signs for aisle content, and I can't read them. They're blurry. I've always been able to read the signs. What can this mean? I'm scared."

She went to an ophthalmologist, the next week. The ophthalmologist listened to her history, gave her an eye exam, and told her - let's look at your sugar. I am worried. It was sky high. She was diagnosed, in her early twenties, with Type 1 diabetes, about six months after her hives presented. As soon as her diabetes was treated, her hives disappeared.

I spent the next few years sharing the effects of being diagnosed with, and learning to manage, a chronic health problem. Her fears of mismanaged sugars were physically manifested in her patients at the hospital - gangrenous limbs and kidney problems. I witnessed her denial, anger, and ultimate acceptance of having to daily monitor and manage her condition by administering insulin shots. Her struggle with deciding to use an insulin pump - worries over having a constant physical reminder of her disease and ultimate relief over not having to worry so much about leaving the OR to administer her shots.

Last week, she gave a talk in the town she practices in about her experience with diabetes. We e-mailed back and forth - me reminding her of small details she had forgotten, and she sharing with me struggles I had missed - I must have been busy with a new baby or a difficult stretch of residency, and hadn't been the person she leaned on, at the time. She emphasized, at the end of her talk, that she was in charge of her illness not because she was a doctor, but because she gathered information and tools, and chose to live a healthier lifestyle. She was interviewed by a local TV station. She called me, when it was all over. I asked, "How did it go?"

"Well, a lot of the audience had Type 2 diabetes. And I think I spoke to them. But the most rewarding part was when a 14 year old girl, who had just been diagnosed with Type 1 diabetes, came up to me with her parents at the end of the talk. They were all practically in tears. They were still stuck in the overwhelming stage of new diagnosis, and so happy to find a resource, a successful one (if you can consider me a success - she is so humble), and they got my number. They want me to be her eye doctor."

I am so proud of my friend. She is a success. I can't imagine having to grapple with a chronic illness in medical school, but I have encountered many others who have, in med school and in my residency and attending career. Testicular cancer. Breast cancer. Heart transplants. It amazes me. Makes being a mother in medicine seem not so tough, after all.

“Lack of Patient Preparation for the Postpartum Period and Patient’s Satisfaction With Their Obstetric Clinicians”

When I read the title of this article in this month’s Journal of OB/GYN (the ‘green’ journal), I literally laughed out loud. This could be because, at the time I was holding a fussy 2 month in my left arm while holding my green journal in my right hand, walking the room. I was trying to read, console baby and keep 6 year old entertained, all at the same time, so husband could finish working on a project upstairs. How can I prepare my patients better for their ‘postpartum experience’ when I can’t prepare myself, I thought?

As I read the article further, it mainly discussed the physical symptoms associated with post partum such as bleeding, hemorrhoids and breast tenderness, with just a small aside on anxiety and mood swings, written blandly in technical writing. I laughed again. Seeing someone try to quantify the emotions that go along with having a baby in a ‘prospective longitudinal cohort study’ seemed absurd.

There is nothing that can fully prepare you for having a baby. No amount of books or advice. Not even being board certified in OB/GYN. When my oldest was born I was a 3rd year resident. I could rattle of the top of my head the physiology of delivery, risk factors for postpartum depression and I could have resuscitated/intubated my newborn if needed. I thought I knew what I was doing. I had read books on baby care and breast feeding. Then after a difficult delivery, I was home with a newborn, who did not ,in fact, read the same books that I had read on how he was supposed to act! I remember being so sleep deprived I literally couldn’t see straight. I had reasoned before delivery that if ANYTHING could prepare you for postpartum, then it was residency, but the truth is that NOTHING can truly prepare you. I finally let him occasionally take a bottle so I could sleep and recover from my cesarean section. After a couple weeks I got into a flow and he did eventually get on a schedule…. Sort of. I learned to be less anxious and just enjoy every minute with him.

We recently adopted baby #2 and the ‘postpartum’ time has been significantly better. Some of this is the lack of physical recovery of course, but I think a lot of it is just knowing what to expect. Additionally I now live closer to family and have more social support.

In my practice I think the people who have the hardest transition to postpartum are the women who have it the most “together.” The executives with their blackberries who have everything all planned out and the nurses who know it all already and won’t ask for help. These are the patients that I try to take the extra time with to prepare for postpartum. Usually they smile and nod patting their baby books on their lap, thinking NO not me! But at their postpartum visits they almost always say you know, you were right! This is the hardest thing I’ve ever done.

I’m not sure that being a mom makes me a better doctor, but it definitely helps me understand/ counsel the postpartum patient. When my staff asks if I’ll see a postpartum patient that has shown up late for their appointment, I ALWAYS say yes. Just making it out of the house with a baby is difficult, let alone making it on time. Actually, I usually even will see them first, even if others have been waiting longer.

No offense to the author of the article. It was a well done study and she's right we do need to better prepare our patients for postpartum issues. I just don't think an extra brochure is going to do the trick.

I would love to hear our readers input on their personal “preparation” for their postpartum recovery (especially any OB/GYN’s out there).

Planning for the future

My daughter is very into birds and ducks. She has this game where the baby duck is looking for its mama, which she makes us play with her over and over again until we want to vomit. Anyway, yesterday we were playing this game with her and my husband (a.k.a. Captain Obvious) commented, "She sure likes birds."

Me: "Yeah, she really does."

Husband: "Hey, maybe someday she'll be an ornithologist."

Me: "..."

Husband: "You know, someone who studies birds."

Me: "Um, yeah, maybe..."

It seems like we spend an awful lot of time trying to figure out what her future career is going to be. I have to wonder if anyone can predict such a thing at age three.

As for me, my mother wanted me to be a doctor, so I was trained to name "physician" as my chosen career as early as age four or five. But I went through a few other career options in my mind before I took the MCATs at age 20 and got my first med school acceptance at age 21. I don't think the idea of going to med school really solidified until the latter happened. (Sometimes I think I'm still not 100% sure.)

So my question to the masses is: When did you decide that you wanted to be a doctor? Or else, when did you decide you wanted to be a [insert chosen career]?

Getting Home

I was snowed in to a small town thirty miles outside of where I live, for a couple of days. The South shuts down in bad weather, since it only happens once every other year or so. I had to work at a smaller hospital I rotate at, occasionally. So I holed up in a hotel. It was kind of fun. I watched the snow fall all last night - an anomalous weather moment, in this location, for me. It was gorgeous watching the giant flakes hit the covered swimming pool outside my window.

Today, I slept in (not a workday!), read in bed, had a long run and shower, and packed up to head home. I waited until one or two in the afternoon to leave so A) all of the sanding trucks had done their job and traffic would be at its peak and B) so I had plenty of daylight hours left for possible mishaps.

At about 1:00 p.m., I headed across the street from the hotel to eat at Subway. I was feeling super cool in my twenty-year old combat boots, jeans, and purple t-shirt covered by an open plaid flannel button-down shirt I had in college. How fitting that I was in my college town. I didn't dry my hair, so I was sporting what my partner Michelle calls my "sexy bed head look," a statement to which I laughed and replied, "no, it's my New Year's Resolution. The lazy, I'm not drying my hair everyday look." I had on my fingerless IPhone gloves. I was wearing bad weather gear that rendered me unrecognizable, the day before, at the hospital I rotate at. When the guy that was staring at me in Subway honked while I was crossing the street back to the hotel, I was pretty sure he thought I was cute and wasn't honking because I had just slipped and almost fell on the ice (but I could be wrong). I climbed in my car - ready to face the road - get back home to my kids. Blared some good, muddy blues, a guy whose voice is so rich and soulful I just want to climb inside it and live there forever. Called my dad, who was doctoring in my home town today, and had first-hand familiarity with the road conditions. Told him, five minutes into my interstate drive, that I had it all under control, roads were great, I would make it no problem.

It is this kind of moment that we all need to watch out for. The ones where you feel supremely confident, happy, almost ego overinflated. Because that's when it all comes crashing down.

I was driving down the interstate gazing dumbstruck at the scenery. My old college town looked like a little Swiss village - I wasn't used to seeing it this way, and it was so beautiful. All of a sudden my windshield wipers, which I had checked and cleared prior to leaving, stopped working. They became re-glued by snowy debris and ice that was flying up from the hood. I decided, well, it's not really snowing, maybe this won't matter. Then four trucks flew by me at 70 miles/hour, knocking up sand and snow and mud and dust all over my windshield. It mattered. I slowed to a crawl, peering through the muddy windshield. I turned the music down to concentrate. I suddenly realized two cars were behind me, and put my hazards on so they would know I was in trouble, and not just stupid. I was going to have to pull over on the icy snowy banks, to fix this.

About the time I was fighting to see though the mud, I had come to the realization that I had somehow gotten off on the wrong exit. I was going the opposite direction from home. I was stupid. I was heading into worse weather, and I could tell by the dicier roads. It would be easy to fix this, I would just have to turn around, and I was trying to remember the nearest exit where I could do this. I already knew, based on talking to my Dad, that the town I was staying in had gotten hit a lot worse by the weather than the big city I lived in. Good Lord. But first, the windshield wipers.

I got out of the car, and started hacking away at the snow and ice with trucks flying by, honking and knocking up more snow and mud on me and my car. One car slowed down, with blinkers on, and pulled up in front of me. I was scared and felt vulnerable. Here I was trying to fix a problem, and I was going to be raped or murdered on the side of the road. A guy about my age got out, he had a funny hat on, and asked if I needed help. I know that 99.9% of people are good, probably this one included, but I wasn't taking any chances. I called out to him that I was OK, just needed to get my wipers working. I thanked him for his offer. He smiled, nodded, went back to his car, and drove off. He probably sensed the fear and desperation in my voice. He was a good guy, and when it took me 20 minutes to get my wipers working again, I silently cursed myself for not taking him up on his offer for help.

Safe again, back in my car, wipers working, I drove to the next exit. It was a very small town, one that hadn't had much traffic or sanding trucks. I drove slowly over the overpass, praying I wouldn't end up like so many other abandoned cars I had seen on my short stint. Made it, and realized it would be tough merging back onto the cleared interstate from the snowy, icy exit ramp. I waited for a break in traffic, and jumped in. Cranked up the music. Drove back home.

The only other bad road was my own street, but I got home fine. Walked inside the house and melted from hugs from the kids. Sicily and John were so excited to see me, and we began to prepare for the dinner guests we were receiving - a couple and their two kids from Sicily's old school. They had us over, back in September, and it took an alarming four months for us to coordinate our schedules to return the favor. We ate spaghetti, drank wine, and the day's challenges melted away.

What we go through for our jobs. It's not just me - all of the lab technicians, supervisors, and gross room assistants were fighting bad weather, and staying in hotels, to keep the hospitals functioning, and take care of patients. I felt such camaraderie, and satisfaction from a job well done. There is so much drama in this world - so many people attacking and suing and fighting and reacting from whatever the hell they missed out on in childhood. So it's especially nice to experience moments like this, when all of the good comes out in everyone.

Guest Post: When They Say It's Gonna Be Hard, They Really Meant It.

I write this post as I have just concluded 2 hours at a coffee shop studying with a classmate, drove home the 40 minute drive listening to an audio CD of board review, got home at 7:30pm to try to work out to an aerobics DVD for 40 minutes (not before scarfing down a slice of strawberry cheesecake.. FAIL), then scramble to put together 2 powerpoint presentations on postpartum hemorrhage and placental abruption and anesthetic managements thereof. And oh yes, showered as well. And I'm already past my bedtime. (and I managed to skip dinner in all of this)

And this was done without my husband at home nor my 9 month old baby boy. Imagine what my day after work would have been like if either of them were home.

When hubby and I were discussing when would be the right time to have a child, I vehemently told him that other residents in our program had babies during our 2nd year of residency when we were primarily on consult months (i.e. easy rotations). I kept telling him we should do it, I really wanted a baby during residency b/c I didn't want residency to be the sole reason why we would decide not to have a baby. I failed to note that most of the other residents didn't have attendings as husbands, or if their husbands were physicians or residents, their schedule was more reliable than an emergency medicine attending's schedule which varied day to day, shift to shift (and hence make daycare virtually not an option).

Everyone said it was gonna be hard, but I knew in my heart I wanted this baby and I was going to make it work. When our little C baby arrived, I was towards the end of my 2nd year of residency (and hence, the end of the easy consult months).. welcome to the world of 3rd year of anesthesia (and subspecialty rotations)... back to back cardio-thoracic anesthesia rotations... throw in a month of pediatric anesthesia, and oh yes, mix it up with some vascular anesthesia, add a lil ICU... all the while with a crying pooping fussy little baby boy... AND breastfeeding/breastpumping every chance I could get. All the meanwhile with a hubby who was working nights 7pm to 7am every couple of days.

Yeah I knew it was going to be hard, but this was a whole 'nother area of stress I wasn't accustomed to.

Luckily my parents have helped out immensely, but they are 45 minutes north from where we live. Parents in law are 25 minutes away as well, and mother in law stays with us when hubby works a span of a few days/nights. And when she can't stay with us, we haul C baby to my parents and he spends the nights there. A nanny would have been a great option, but since hubby works sometimes 3 days and then gets off for 5 days and then another few days and off for a few days, the varying schedule just was too difficult.

So now I'm sitting in an empty house with nobody here but our C dog passed out on the couch next to me as I type this. And even without anyone home, I still find that I just don't have enough time to do everything that I need to do. But I welcome sleep now... even though I won't be able to snuggle up next to my C baby, at least I have my iPhone with my 52356 pictures/videos to look at before I go to sleep. And 5AM I start this process all over again.

It was a hellova hard journey and it still is hard, but it was worth every minute. Especially when I hold my baby in my arms and he holds me back and happily sucks on my cheek when I get home.

(That doesn't mean I don't cry every single time I have to leave him for a few days. I still do. Even though I know he will be fine... I'm his mommy first and always)


I'm a 3rd year anesthesiology resident in the South, married to an emergency medicine physician. We have a 9 month old baby boy, C baby and a 3 year old Maltese doggie, C dog.

Hey, Jealousy

I am jealous of my husband. There, I said it. A little over a year ago, when our lives were too chaotic to manage with both of us working full-time, Mr. Whoo quit his job in the world of finance to stabilize the home front and get us prepared for the upcoming move. No doubt, it was the best decision ever. Our lives got exponentially better. Shopping, laundry, and errands got done. The kids were no longer in day care 10 hours a day, and we functioned much better as a family unit. Fast forward to now. We've been in Newville for about 6 months, now, and despite a concentrated effort, there are no desirable/worthwhile jobs in my husband's field of expertise. He did decide to take on a "partnership" in a business run by his cousin (which, don't get me started on that cluster, I'm not sure it was the greatest idea) in which he generally manages financial affairs, billing, accounting, and marketing, all for a pittance (not that it matters, but still). This is all done via computer and telephone, so he still is doing the lion share of household chores and kid wrangling to and from school. Here's where the jealousy part comes in...he can do whatever he wants, whenever he wants to do it.

Most mornings, I leave the house before everyone gets up, so he gets the kids ready for school and out the door between 7:30 and 8 am. Then, the day is all his. He can go work out, any time he wants to do it. Then, if he wants to work, he works for a little while. There is no agenda, no set schedule for the day, it is his with which to do what he pleases. The problem is, I'm not really sure exactly what it is that he is doing! Kids are in school until 4-4:30pm. Shopping, laundry, and dishes still get done, but other chores have really fallen by the wayside (we used to have cleaning ladies to do all the "real" cleaning, so that is not getting done regularly and when it is it is done "man-style"). The rental in which we are living is crowded and too small for all of our "stuff" so it never looks uncluttered, and I'm not sure if that is contributing to the decline of cleaning activity or if it is something else. Now, unless I give him guidance, he is waiting for me to get home to tell him what to make for dinner, and I am starting to get a bit frustrated. Not only am I jealous of his autonomy, I am starting to feel like I am starting to judge what he does with his days...and this is not good for our marriage. I know he can' t do it all, but sometimes I feel put upon when he has all. day. long. to figure these things out.

The worst jealousy of all, however, is how much our kids favor him over me. I noticed it when he moved the kids to Newville a few weeks prior to my job being completed. When I finally got to Newville, Bean, who up until that time was very attached to me, was all about Daddy. Understandable, I thought, this will pass. Only it didn't. Now that I have more time to spend with my family, it seems my kiddos want less and less to do with me. My son fusses when it is my turn to lie down with him and night, and says hurtful things like how he is only "Daddy's son, not Mommy's." CindyLou criticises everything I do, because "Daddy doesn't do it that way." I know I shouldn't take it personally, because I know that they love me, and I have been working for so long of course they are going to attach to the parent they see the most. It still hurts, and I am jealous of his place as primary caregiver in their lives, because, well, I'm the *Mommy* dammit. For now, I am doing my best to spend the time that I have with the kids, and enjoying the activities that we never got to do as a family when I was working in my previous job. There is blame to lay on my shoulders, as well. I am trying not to come home and just disengage from the family because I spend all day long problem-solving and taking care of strangers, and therefore have little more to give emotionally. It is exhausting.

Hopefully, it won't be long until we navigate our way through this new life that we have found here. I still believe that having Mr. Whoo at home is far better for our overall family life when compared to having him work outside the home. How do you find your balance as a family? Anyone else married to a "stay-at-home" spouse? Any tips for thwarting resentment and insanity? Ways to reconnect with your kids? I value your opinions and advice!

What IS the secret?

My husband and I awoke last Weds to a text message on my cell from my father-in-law saying "Hope this doesn't mean you are single-parenting again." We had no idea what he meant--had we been attacked? were things escalating in Afghanistan suddenly? Over the next few hours, we learned of the earthquake in Haiti and came to appreciate the seriousness of it, which was so remarkably underestimated by the first reports. We have both done international medical work. It is part of who we are. We hope to return to it as a couple when our kids are through with us. So, I told my husband (a military physician) that if he wanted to or had to go, I was behind him and the mission 100%. I said the V word with my blessing: Volunteer. Eight hours later, I got another text, this time from my husband, telling me he was leaving on Saturday evening and would be gone for 1-2 months. We began to scramble. The next day, yet another text from him: he was now leaving on Friday morning and would be gone for 5 months. Within this time, our nanny of more than 3 yrs gave us notice that she planned to leave ("just ready for a change"?!?!?!) in the middle of his deployment. I was having my own little tiny earthquake with little warning at home. At times, the only thing that kept my problems in perspective was the catastrophic enormity of the real earthquake, of which the people of Haiti had no warning at all.

My husband's last two deployments were planned, which gave us months to make all sorts of arrangements, time to ready our kids and ourselves emotionally, time to get the house and cars in good repair, etc. We had a nanny who gave no signs she might leave us. We got things in such order before his departures that I could keep up our usual family routines and standards for the most part. My husband just returned from his second deployment in two years 5 months ago. We thought we were going to be living normal united family life with solid childcare for at least another year. Who could have predicted all of this?

Ok, here's the weird part. Things are easier than usual. Way easier, strangely. Colleagues at work, neighbors, friends, people at my gym, checkout people at Costco who know us are all gawking and expressing condolences as they see me traipsing everywhere with our three small kids in tow with a fairly relaxed smile. "You are making this look EASY! What is the secret?" a lot of fellow moms have asked conspiratorily. Finally, after not answering the question enough times, I realized: I DON'T KNOW. But they are right. And it's not just an appearance. It is kind of easy.

The last two days, I have been preoccupied with this. Why IS life easier during this unplanned deployment of uncertain duration with childcare that now feels tenuous? It certainly shouldn't be. But it is. I finally made kind of a log of my day for the last few days and had a EUREKA!! moment. It's just a few things:

1) I am doing everything with my kids instead of for them. There is too much work in the household to be done now to do it all alone. I would never sleep. Or finish. Usually, I would be making dinner while the kids watch a TV show or unloading the dishwasher while the kids play after dinner or folding the laundry when they go to sleep. Now, we are pulling chairs up to the counter and they peel or mash while I chop--we are making dinner together. We are unloading the dishwasher together. Each kid even has a post-dryer laundry job (the 2 yr old finds all the socks and collects them in a pile, the 4 yr old sorts the clothes by owner and does some folding, and the 6 yr old does most of the folding with me). They love the independence and the chance to be involved. Suddenly the work doesn't feel as much like work to me or to them. I'm less resentful that I am a 24/7 servant because I'm not, and they are less resentful that Mommy is preoccupied 24/7 with chores and can't play with them because it's no longer the case. The work of our family has become a family activity. And because it's divided more ways, there is more time left over for real play. The results aren't all perfect, and it's not all being done the way I would do it, but it's good enough. And, at the moment, good enough is perfect. The new perfect. Which brings me to...

2) I have let go of perfection. Completely. Now, let me be clear, I let go of perfection to a large degree with the birth of my first child 6 yrs ago. But I mean REALLY REALLY REALLY let go. So the floor has dried Cheerios and who know what else stuck on it from breakfast. Yesterday. Who cares? The reality is that if I stay up late at night and clean my floor, the kids will just get more Cheerios on it again at breakfast. Of course, we can't leave it there forever, but we can leave it there for a day or seven. There is a pile of mail mounting on the dining room table like a volcano. Who cares? Maybe it will prompt me to write to that place in Farmingdale NY again and get off all those junk mail lists. Friends are coming over and the house is a mess. Who cares? Either they will be bothered, in which case they will feel sorry for us and we can have the playdate at their house next time (sounds good to me), they won't notice because their houses look like that too, or they will be secretly relieved because their houses look like that too. Everybody wins. And having let go of perfection brings me to...

3) I have more free time. Given the emotional impact on the kids of this deployment(my 4 yr old is taking this the hardest, but my 6 yr old has also struggled since his Daddy left the day before his birthday), I feel an urgency to sit down and play with them, read to them and not just for bedtime, be more engaged than I might otherwise be. Though I am not a fan of filth or clutter, I have to tell you that it's frankly kind of a relief to sit down amidst the dried Cheerios and piles of mail and read a book to my kids on the giant beanbag in front of the fire instead of cleaning up the house. It feels like I'm finally living the way I should have been living all along, focusing on what really matters. And, I would be remiss not to mention...

4) I am saying yes. Kids want to go see Princess and the Frog, on a school night--why not? The kids stare with wide eyes and big smiles when I say yes. They're in kindergarten and preschool. They'll probably still get into college. Friends invite us for dinner, I ask what time with one hand on my cell phone and my other hand shooing the kids out the door and into the car. If anyone offers help, I am accepting it. And not feeling bad about it. If they offer, I am assuming they genuinely want to help. And if they don't, well, that will teach them for offering! I find that we are spending a lot more time with friends, not just for the token Saturday playdate, but dinner on a random Tuesday evening, an impromptu s'mores party right after school for no reason whatsoever. And our extended family is offering to come for weekends that they otherwise would feel too busy to pull off. It occurs to me: I miss our friends. I miss our family. I don't see them enough. My kids don't see them enough. It shouldn't take an earthquake to make us spend more time with people who are important to us.

So, there you have it. I love my husband to pieces. I can't wait to have him home. And when he does come home, I think home is going to be an even better place. But since he left, I have been forced to change the way we do business. I am happier, the kids are happier, and bonus: since I am no longer a perfectionist, I don't edit or proofread, I just post. Which means I am finally posting again, too.

Getting Wired

I thought it was a good idea to link NY Times articles, so I thought I would link this one: If Your Kids are Awake, They're Probably Online. I read it today while I was waiting to go to a molecular meeting, and it scared me.

We've been reluctant to take the technological plunge, in my household, for kids. But this year my six year old Sicily was begging for a Nintendo DS, and it seemed unfair to make her share it with my four year old John. So they both got one, and we caved in and got a Wii as well.

After the initial excitement, the Nintendo's have largely remained on the kitchen counter, plugged into their chargers. Out of sight, out of mind. Sicily enjoys the fashion and cooking games once or twice a week, and John likes the cooking and PacMan. Now the novelty has worn off, like any new toy. I think they are a little young. With the Wii, they both are more satisfied to create little Wii Mii's and drop them into the mall than play any other games, as of yet. Now that they are back at school and activities - piano and swim - and we are into the swing of reading at night, the Wii is rarely on.

I worry about exposing my kids to too much Internet - as of right now it is largely limited to weekend mornings when my son grabs my laptop and brings it into my bed in the morning. We look at YouTube videos of snowstorms, tornadoes, and earthquakes, as well as snakes and spiders. We always end up on the birthday ecards at American Greetings - they both have enjoyed them for years. There was a hairy moment when John clicked on that Christina Aguilera and friends video "Lady Marmalade," advertised at the bottom of the screen, and we listened for a little bit, until Pink started massaging herself (Yikes!). I worried about the message he was getting, at four, so I closed it out and said the battery was dead. He still asks for that video, weeks later. "Mom! Play that song with the pretty girls dancing!" I claim it is lost.

Their school has an Apple lab where they are learning basic computer skills. But I dread the day when they will need computers and the Internet, for their assignments. I have heard about restrictions that can be placed on Internet access by cable connection lines, and I am all for that, even thought I don't know the details or logistics yet.

I think, based on my parent's decision to not have TV's in our room growing up (about which I groaned on a regular basis, but am ultimately glad of), that I will do the same for computers. Place one in a central location, where they can be monitored using them at night. No smart phones (easy to say now), and I definitely plan to place strong restrictions on access to the computer and video games. The studies in the article are compelling, and they just make good sense.

I am posting this because I am strongly interested in comments or ideas, especially from people with children older than mine who are already tackling this issue. I got some of my best nursing, sleeping, and eating advice -- when my kids were younger -- not from books but from mothering blogs and chat rooms. The moms in the trenches, or those having just crawled out, seemed to have the best advice. And since every child is different, I learned I had to try and fail a few times before I found a solution that worked for each of my own kids. Thought I might start a little early with the Internet, after reading this article.

Are we over-snacking our kids?

I came across this great article in the New York Times about snacking. It's ironic timing for me as yesterday when I went grocery shopping, I was scouring the cookie/cracker isle for packaged, semi-processed, almost-healthy snacks I could grab along to the kids' activities. (Of course, I ended up with so many boxes there's no room for them in my pantry).

Anyhow, this article talks about the culture in American society that we now expect that there will be snacks for kids and adults at EVERY activity that kids do - regardless of duration. That instead of coming home and going outside to play, kids now come home and seek to satisfy their cravings. And because so few of these snacks are home-made, this must be contributing to the declining health of our youngsters.

I can speak for myself that as an internist, I worry a lot about the obesity epidemic in this country, especially among children. Yet when it comes to my kids, I don't think much about the QUANTITY of snacks, but I try to get the 4 food groups into the day, try to make sure there's at least one vegetable on the table at dinner and try to avoid purchasing processed foods from the grocery store. I think about the quality of snacks but I really don't' think much about the number of snacks. In fact, I'll be the first to confess that I use snacks as a way to get the kids into the car, out of the house, avoid tantrums ... really it's my most frequent bribe because I considered it relatively harmless.

I'm not sure I'll change my parenting style but this article has definitely made me think about it!

MiM Mailbag: Advice on marriage survival and being a resident mom

Hi,

I just came across your blog and really enjoyed reading the posts (while I put off another question set as I procrastinate studying for Step 3).

I’m an Internal Medicine intern, and I have a 10 month old baby boy. I had a mentor prior to medical school - my boss (a psychiatrist) while I was a research assistant for her had two kids in the beginning of her research career. She told me several times “being pregnant during your 4th year of medical school would be ideal.” My husband and I are a little older than the average medical student and wanted kids sooner rather than later, and thus our son was born right before match day.

This year, as I’m sure most people can relate, has been tough, being a new mom and a new doctor. My program is a rigorous academic center where few women have children and as one attending said in my first month on the wards back in July “oh you have a baby? Wow… good luck.” And chuckled. And she was a woman.

Now, I’m so tired. So so tired. I just finished up three months of call (one of which was q3 in the ICU) and capped it off with two weeks of night float duties. And now I’m on a short clinic rotation but spending my precious three day weekend studying for step 3. I can’t seem to catch my breath.

I’m pleased to say that through all this, I still find moments where I love my job (strangely enough in the ICU, never thought I would actually WANT to be there) and my son is thriving. My marriage, however, is taking a hit. I just don’t know how to stay connected to him. He is not in medicine and seems less and less interested in the cool stories about patients that I have. We still definitely bond over our baby and he is doing an amazing job with him while I’m at work. I know intern year is hard on every couple, but if there are any other stories out there about marriage survival when you have a child and a resident, I would love to hear them. I need a little boost to help me through the rest of the year (because every R2 and R3 keeps telling me “don’t worry, it gets better next year…” – and I’m really counting on that).

Again, thanks for all the great posts on this blog. I will keep reading (when I have time!).


-NiqueKee

Breastmilk vs. Formula: the epic battle

Breastmilk vs. formula is one of those topics that is highly controversial on the internet. When my daughter was of breastfeeding age, I was scared to even broach the topic on this blog. However, she's almost three now, which is an age where I would probably be given a lot of funny looks for breastfeeding, so I feel safe talking about it without being accused of child abuse.

I think most women would agree that breastfeeding is better than formula. However, there's a culture of women (very vocal on the internet) that will yell at any mother who does not breastfeed. You must at least try to breastfeed. Any woman who doesn't breastfeed is selfish. Formula is full of chemicals and is harmful to your baby.

But for a physician mother, especially one still in training, it can be hard to provide exclusive breastmilk for a baby. I know women who are great mothers who just couldn't swing it with their schedule. Giving your baby formula is not child abuse. Saying that is an insult to babies who actually ARE neglected or abused, of which there sadly are many.

My story:

I struggled with breastfeeding initially. I wanted to do it very much, but it was not one of those things that came instantly and easily to me. I had a very hungry, jaundiced baby who wanted to suckle nonstop, which was becoming more and more painful. With a rising bilirubin level, I consented for my daughter to have a couple of ounces formula in the hospital, which she sucked down in about five seconds. I felt guilty about this, because people told me that if she was given formula, she'd get nipple confusion and it would hurt my supply.

When I brought her home, I was determined to feed her only breastmilk straight from the source. She had a voracious appetite (she was at the 50th percentile for height/weight at birth, but was at 95th percentile by two months and stayed there) and I didn't get much pumping done, so we had no supply tucked away early on, which meant that I had to be up for every single feeding. I was stubborn and wanted to do it all myself. But when I was hospitalized with 103F fever at two weeks postpartum, my husband and I decided that he would give her one bottle of formula per night so that I could have the luxury of four straight hours of uninterrupted sleep.

I told this to a friend of mine who had been giving me advice about breastfeeding, and she belittled me for allowing my daughter to have a bottle of formula per night for the sake of my sleep. I was being selfish. Once again, I felt guilty.

When I went back to work, I was attached at the hip to my pump. I would hook it up while I returned pages on my cell phone, praying nothing would come up that couldn't be put off for fifteen minutes. When I came home from work and saw a bottle of breastmilk on the counter that was half empty, I'd be furious about the wasted two ounces of milk. We did have a can of formula in the cupboard, but I was proud of the fact that we rarely used it.

At six months, I moved on to a much more demanding rotation where I was the only resident looking after twenty patients. I put away my pump and just nursed in the morning and at night (until one year, when my daughter self-weaned).

When I look back on all the stress I had worrying about my daughter getting a few ounces of formula, I feel angry at myself. I was a loving mother. I cared about my baby and took very good care of her. It was stressful enough to manage residency and a baby without feeling like an ogre because my daughter was getting a few ounces of formula. Whenever a working mother tells me she gave up nursing because it was too hard, I immediately give her my sympathy. I would never say anything judgmental, because I'm sure she gets enough of that, most of all from herself.

If I have another baby, I don't know if I will do anything differently. I loved nursing and I think I stopped at the right time. But I definitely will keep a can of formula in the cupboard and not allow myself to feel guilty if I need to use it.