To The Rock Star…

Radio City Music Hall in New York City

“Don’t tell Dad I broke the plate, OK?”

“But it was an accident, sweetheart.”

“I know he won’t be mad but I still don’t want him to know.”

He cares what you think about him.

“Mom, I miss dad.”

“He’ll be back before you know it.”

“Can we set a place for him at the table even though he isn’t here?”

“Sure!”

Your presence is missed when you are away.

“Mom, I let her have the rest of my Gatorade even though I really wanted it.”

“Because she wanted it, too?”

“Yeah. It was the right thing to do.”

He is paying attention to the example you set.

So… thank you. Thank you for being such a great dad!

Chimera

Small white flower bloom

I read the chromosomal analysis.

Partial trisomy of sex chromosome… mosaicism…

Well. What was that going to mean? I needed an answer before I called this baby’s mom. She had been waiting anxiously throughout her pregnancy after the initial testing had showed a probable genetic anomaly. Mosaics are tricky. Some cells are normal. Some are not. The end result can vary. I searched everywhere at my disposal professionally. 

Nothing. 

So then I turned to Google. 

“Likely no developmental delays. No fertility issues. Phenotypically normal appearance.”

I breathed a sigh of relief. I was still sending them to genetics but I wanted to be able to reassure the family if I could. It had been a very emotional pregnancy.

And since then I have been thinking about this more and more.

Now that OB/Gyns are offering, and sometimes pushing, these more advanced genetic tests during pregnancy I wonder what it is going to mean for the babies as they grow up. We would have never known there was an issue genetically for this child 10 years ago. We just would not care. They would have grown up as a “normal” child. Now this kiddo will have “sex chromosome anomaly” hanging around their neck for the rest of their life. 

Is more information really better? Just because we can do something… should we?

Maybe not.

Fecundity

“Mommy, when I have a little sister, I want to name her Leia.”

“Leia?” I swelled with pride at my young padawan’s name choice.

“No! Not Star Wars. Lee-yah!”

Oh.

“Hey, Mom, I want a little brother…”

Every evening, my daughter says a prayer asking God for a baby sister. Then she punches her brother when he prays for a baby brother.

The kids are ganging up on my poor uterus. What’s left of it, anyway. Between us, I think the hot flashes are its retaliation. The kids just don’t understand, no matter how many ways I try to explain it, that the physiology is impossible and I am not ever adopting another baby. 

No way. 

No how. 

I was asked by DearLilyJune, “In what ways does being a doctor help you in being a mother? Vice versa?” And HotplateKate asked, “As far as questions, mine would be about the struggles you (or others) face combining medicine and motherhood.”

There definitely pluses and minuses. 

For instance, I now understand the funny looks moms gave me when I asked if they were brushing their toddler’s teeth twice a day. Yeah. Twice a day. Hell, once a day is generally all you can manage when you work full time. And you know what? That is just fine. 

Also, I now understand the whole first time mom pathology. I have felt that craziness myself and I am so much more forgiving and patient than I used to be.

When I have a sucky day, I can get some good hugs and kisses that make it 95% better. The kids make enduring the crap so much more worthwhile.

That being said, the kiddos also make things more stressful. I have to pick them up by 5:30 every evening, no matter what is going on at the clinic. I have to get them ready and drop them off every morning. I have no extended family that can help out at this point if the kids are sick or if they are off of school for a holiday. Their father steps in a bunch and is a huge help but there are times he simply can’t.

Why don’t you just get a nanny? I get asked that a lot. To be honest, that is a difficult proposition but even if I could arrange it easily, I want to be a parent. I want to be a mom. So I choose to engage in a precarious balancing act. So far, I am making it work. I love medicine and I love my kids. I am glad that I have enough flexibility that I can do both. 

The Rewrite (Part Three)


She did not know why she had lied about it.

Perhaps because she was trapped?

The man held her down, his breath stinking of alcohol. It made her eyes burn as he panted and grunted so close to her face. She had no more fight left. So she let him do what he had to do. When he passed out she locked herself in the bathroom and cried. Her hands shook as she tried to clean his seed out of her.

Please, God.

But her mother always told her that God does not listen to harlots. A month later there was a thin blue line next to a pink one. 

What is more shameful? Carrying the child of a man you did not love or carrying a child conceived in such a way?

She lay next to him in the dim light of evening and wove her words around the lengthening shadows. She rewrote her story. She lied to the man she did love. She lied about what had happened that night.

She had too much to drink and drowned her sorrows in another. It was a bad choice, a wrong choice, but it was her choice.

The instant she said it to him, she wished she could take it back. His eyes flashed with pain that lived there from that moment on. 

She expected him to leave her.

But he did not.

She wanted him to know that she had imagined her body as a temple, a shrine to him, but it had been desecrated and defiled. The words never came. She buried them deeper.

And then she lied to herself. She lied so often that she started to believe it…

You don’t deserve happiness. You don’t deserve joy. You don’t deserve love.

Sometimes, she found, you are so far down the path of fiction it feels there is no possible way to redeem yourself. How do you find the truth again?

But in that baby’s eyes she found it.

Babies transcend all evil. They are the hope of love, our rebirth from the ashes. They have the power to save us all.

Then she knew….

With every truth there is pain, with every lie there is a price that must be paid, and by its nature death always follows after life.

The truth was she had something else to live for now.

A Cry in the Night

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My daughter screamed bloody murder from the day she was born. 

What was I doing wrong?

At first I thought it was because my milk supply had not come in but then that was no longer a factor and still she did not stop.

She was well fed. I changed her diapers. I dressed her in adorable clothes. I cuddled her. I played with her. There was nothing wrong medically. 

What was I missing?

I went through everything I knew how to do everything they teach you in medical school and residency, all of the advice I always gave parents struggling with this. I scoured the internet like other desperate mothers. All worthless. Once she started screaming, I could not make her stop.

I was a failure but not just as a mom. I was a failure as a physician.

When I look at pictures of her early infancy now, I am ashamed. I missed out on so much of the joy and love I should have felt then. Instead, I used to wear earplugs just so I could be around her. 

What kind of mother DOES that?

The only thing that would calm her down was bouncing on an exercise ball. I bounced for hours. When it was her fussy time, God forbid I ever stopped bouncing…

Wails and wails and wails.

Which is worse? Sore thighs and butt from an exercise that never seemed to make them smaller or the painful high pitched unrelenting screech of an angry infant? In time I felt imprisoned by her. Trapped. I didn’t want to keep bouncing on that goddamn ball, I didn’t want to listen to her scream, either. Bouncing with anyone else was not cool by her.

I desperately wanted to send her back.

Eventually, after a few months, it did stop. Colic always does if you can just endure, and while the scars have dissipated to some degree now years later, they still remain. I never appreciated how disruptive it is, how much it wounds your heart, until I lived it. Colic robbed me of being the mother that I thought I was, the one that I wanted to be… doting on my beautiful baby girl.

So much for fairytales.

We survived. I love her. She loves me. She screams but not for hours and hours and when she does, I can now put her into time out until she cools off. Interestingly, I still find her to be terribly temperamental and prone to tantrums. But is that really the case? Or do I just judge more harshly because of our past? 

My heart still hurts when I remember and even today I don’t like to talk about it, but the advice I give to parents is much different now that I have lived it myself. 

Jumping Back In

  

I had big dreams as a kid. Somehow I just knew I was gonna be somebody when I grew up. I wanted it so badly that I could feel the ache in my toes, the gnawing in my gut… every single day.

Medical school became a reality and I figured I was well on my way. 

After residency, I started a job with a large group of physicians. Within two years I was elected to the executive committee (essentially the clinic’s governing body). A year later I was on the hospital’s quality committee, the hospital executive committee, and then was elected Chief of Family Practice. I was on the Patient Satisfaction committee for the entire system and helped make system wide policy. I had plans. I wanted more. Chief of staff? Board of directors? Yes, please.

Then I got pregnant. 

Pregnancy was NOT in the plan. I never, ever saw myself as a mother. I did not understand those women who were and regarded them generally with scorn and suspicion. I knew that to BE somebody by my current definition I could not also be a mother. If there was one thing medical school taught me, it was how babies were made. I was on the pill and by golly I took it religiously. I tried to avoid sex as much as a married woman could and required the use of condoms whenever I could not.

But that one damn night… 

All it takes is once, folks. Get a little cocky, a little careless, let love/lust get in the way of rational thinking and BAM! You are changing poopy diapers.

I put the positive test in the top drawer of my desk. For weeks between patients I would peek into the drawer and stare at the pink line feeling the panic well up from my uterus.

What was I going to do?

At the time I was practicing both inpatient and outpatient adult medicine and pediatrics. I was there for meconium deliveries and ICU admits at all hours of the night. I worked many Saturdays doing the acute care clinic when I was not on call at the hospital. Then, there were all of those committee meetings.

How would I breast feed? How could I work a sixteen hour day on my feet while 39 weeks pregnant? What about a sick baby or sick toddler? Childcare?

So I walked away from it all. 

I moved to another clinic where I would only do outpatient medicine. I gave up my hospital privileges and committees and meetings and ambitions. I was no longer the Chief of Family Practice. 

At first it felt odd. 

Empty. 

Disconcerting. 

But when my son was born, there was no question I had made the right decision. Evolutionarily speaking, this is why babies are so cute. They HAVE to be to survive. My definition of who I was shifted and interestingly I was at peace with that. 

Mostly.

I hate just griping and complaining. This blog is therapeutic but I like being involved in a solution. Doing something instead of merely pacing the floor, wringing my hands. Now that my kids are older I am ready to get into it all again, just not to the level I was before.

Last year I applied to join the EHR (electronic health record) committee for the system only to find out my arch nemesis was now the gate keeper for all system wide committees. I promptly received a rejection letter hand signed by him with what appeared to be extra flourish (I admit I may have imagined that extra flourish) and I resigned myself to staying involved only at the clinic level until he retired at some unforeseen date many years in the future.

Then, an email…

An invitation to join an EHR subcommittee arrived in my inbox last week. Just like that, I am back in the game. Section chief? Board of directors? President of the system? Nah. I don’t want any of that anymore. I just want my voice back. 

The White Room

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“You have protein in your urine and your blood pressure is up very high. We need to go ahead and take the baby.”

I thought it would be a simple routine check up. I was going to go get some groceries afterwards with the food stamp allowance that just came yesterday. We ate canned beans last night, the kids and I. It was all I had left in the apartment.

My doctor sat next to me on the hospital bed beforehand, had me sign all of the consents for the C-section while they waited on my lab work. He said he would be there, assisting during the surgery.

He is too young. He still thinks he can save me, save the world. He asked me if he could pray for us… Pray? For me?

“Do you have a name picked out for him yet?” he asked, smiling.

I laughed. I actually laughed just a few hours ago. I laughed and said, “I will name him for you, doc, just make sure he gets here OK.”

Now, I want to tell them all to get the fuck away from me. Just bring me my baby so I can see him. Hold him. Touch him. 

I haven’t even seen him yet.

There is something in my throat. I try to pull it out only to have two nurses cry out and hold down my arms, tying them to the bed by the wrists.

Don’t DO that! I can’t hold my baby if you do that.

There is another doctor suddenly standing over me, a lady wearing blue scrubs. She has red hair. I don’t know her. The room is too bright, too white. It hurts my eyes.

“Your heart stopped and you stopped breathing. We had to put the tube down to help you.” She is so young. Too young. Where are the real doctors? “Everything is going to be alright but you are bleeding and we are having trouble stopping it. I need for you to stay as calm as possible. Ok?” 

I nod.

Having a machine breath for you is a terrible feeling. It reinforces the fact that you have lost all control.

Your liver is showing inflammation and your platelets are down….

The little doctor, the prick who did my C-section, is prancing around the room, fighting like a cock in a ring, trying to peck everyone’s eyes out.

Where is MY doctor?

I ask the lady doctor in scrubs if I am dying. My words are only ghosts formed around the plastic tube, no sounds. I can see how scared she is. She seems to understand. She tells me, “Yes, but we are going to help you.” 

I don’t believe her.

I can feel the blood gushing out from between my legs. I can see my belly getting large again, like having a second baby growing on video played in fast forward.

There is a somber gray haired man in the corner, standing with his arms crossed. I don’t know him but he looks like he knows something. “How many units now?” A pause while someone I cannot see calculates. “Fourteen.” He looks up heavenward and closes his eyes. “She needs more FFP.”

Do you think God loves drug addicts with Hepatitis C? Does he love their babies?

The red headed doctor is holding my hand. “It is going to be OK,” she lies. “Do you hurt anywhere?” 

I try to tell her around the tube that I want to see my baby but she cannot understand. Frustration turns to tears and I cannot stop them.

“She is bleeding it out as fast as we put it in.”

The rooster doctor is yelling threats from outside the room. Why is he so angry?

I want to go to sleep but I am afraid I won’t wake up.

“I won’t leave you. I’m going to stay right here. You keep fighting.”

Another lady doctor with long, black curly hair whispers something into the red headed doctor’s ear. I can’t hear what they are saying. She shakes her head solemnly and says quietly, “See if they can bring her baby. Tell them if he is stable to bring him right now.” 

Yes. Please! Please bring him.

I am so tired. The alarms are going off. A hand reaches up to turn off the monitor. Everyone stops rushing around. Silence. 

Everything must be OK, finally.

I close my eyes and open them. The room is still white. 

There he is, just beyond the door way. A nurse is holding him, wrapped in a blue blanket. My beautiful boy. I walk to him and brush his little sleeping cheek with my finger. My little boy.

Childhood

 Black and white chains from a swing set set against the sky. 
“You are indeed pregnant.” The girl nodded her head, resigned.

She already knew.

Her mother started sobbing. Great, body wracking sobs with tears streaming down her face.

“Mom. It’s just a baby.” The girl rolled her eyes.

“YOU are just a baby!” Her mother snapped back. “I wanted so much more for you..”

To my right there was gleeful male laughter. I turned around to find the teenage boy sperm donor staring intently at his phone giggling over some apparently hilarious YouTube clip.

“Hey!” I snapped.

No response.

“Hey!” I said louder. Giant red headphones covered both ears. 

Still no response.

I slid my wheeled chair over and covered the screen with my hand, causing him to finally tear his eyes away from the screen to meet mine.

“Take off the headphones and turn off the phone or get the hell out of my office.” I almost shouted.

He shrugged, indicating he didn’t understand what the big deal was, but he lowered the headphones to his neck and tucked the phone reluctantly into his pocket anyway.

“That was incredibly disrespectful.”

“Sorry?” He offered defensively but made it clear he didn’t really mean it.

“Not to me. Disrespectful to the mother of your child.” His eyes widened. “Yes, you are going to be a daddy. Pay attention!” 

He was not cowed. In fact, he developed an almost imperceptible swagger. He had marked his territory in her. 

She was his forever. 

Oh, there would be others. Many others. In fact, I had seen this fellow before, dozens of times, at various stages and various ages. This pregnancy had not been accidental as far as he was concerned. It had been a calloused, calculated move. 

I hated him.

In a matter of minutes, he had pulled the phone out of his pocket and was watching something else, though this time without the headphones and he was careful not to laugh.

They were all out the door after we had discussed prenatal vitamins, finding an OB, and the meds that were off limits during pregnancy.

Happy fifteenth birthday.

I could see in the girl’s eyes that she loved him still, somehow, but that would just be a matter of time…

First Post Challenge (Enhanced*)

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My first post from 2/26/14.  Thank you Edwina’s Episodes for the challenge.  Time travel is fun!

This morning I dragged two very cranky children to daycare kicking and screaming. I was running late after fighting with them…potty, dressing, cough medication…and before it was over with each of us was crying, for different reasons. My daughter wanted her blankie. My son wanted to NOT go to “school”. Me, I just wanted to stop feeling like the worst mother ever.

How many other women lived this today?

By the time I got to the office, my first patient had been roomed. Running late REALLY stresses me out. I spent a minute or two trying to choke back the tears and frustration, because let’s face it, no one wants to hear about their doctor’s problems and then ran into the room apologizing and smiling, praying the bloodshot eyes were not terribly noticeable.

Then, my next three patients did not show up.

This does not happen often. Usually I am terribly overbooked, so when I get a no show, I feel…lost.

For a whole hour and fifteen minutes I had no patients! I used the time to get caught back up on all of the charting and paperwork that I am responsible for, but in the back of my mind the frustration was mounting. This morning I had felt as if I had incarcerated my children in some awful foreign gulag with strangers that would surely torture them given the opportunity. My son had begged and pleaded with me, sobbing, to stay “Just one more minute, mommy!” My daughter stared at me accusingly with pain in her eyes as big, wet tears of sadness rolled down her cheeks. Why? So I could go to work and do nothing. Never mind the fact that these missing patients may have had mornings like mine, or worse.

I started fantasizing about quitting my job, becoming a stay at home mom. My student loans are paid off. I could do that. For a year.

Then the self pity started. No one understands what I go through every day to be here. They don’t know that I worked all while pregnant, praying that I did not go into labor early because I could not find a locum to cover my practice. They don’t understand when I have to take a day off for family emergencies or a long overdue vacation so I don’t go crazy or for studying to retake my boards (yeah, another ten years gone by). No one cares how little sleep I get, how many hours I work on charting from home, or how hurt I feel when a patient gets ugly with me, or that when they are calling the “on call doctor” that I may be in the middle of cleaning up toddler vomit. Blah, blah, blah.

I need to tell someone!

The truth is that I think we all want our physicians to have it all together. Give me an illusion of a capable individual who has everything in hand any day. Particularly if you are going to be operating on me. I don’t want to know that your are frustrated with your kids or your spouse right before you cut me open to resect my colon cancer. Or before you do a pelvic exam. Or talk to me about my depression.

The afternoon was a whirlwind, running from one room to the next, and kept me from thinking any more until now. The kids are fed and in bed and peace has returned to the house, and to my heart. As I hold my daughter’s little hands as she is drifting off to sleep I remember these important things:

Children make your life terribly complicated. But they also make enduring the other crap in your life much more worthwhile.

A hug and a kiss and an “I love you, Mommy!” can make it all go away better than a martini. Most days. Sometimes I still need that martini. Just not as often.

Being a physician is an honor and a privilege and worth working hard at. I wrestle daily with motherhood and work and how to balance it all. Sometimes I feel guilty that I find my job so fulfilling. Then a patient says, “Thank you!” and gives me a hug and I find peace again.

And now….

The dishes are not going to wash themselves!

*Enhanced because I did not start including photographs for months but I went ahead and added one here.

Forest for the Trees

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“Mommy, I want to be a baby again…” Tears were welling up in my son’s eyes as his voice wavered. His grip on my hand tightened.

“Why is that, sweetheart?” I resisted the urge to tell him that he would be my baby forever. I remember wanting to roll my eyes whenever my own mother would say that. It never made me feel better about anything.

“Because when I was little you could cuddle me better.” He sniffed, wiping snot with his free hand. “Can’t I be a baby again, mommy?”

“No can do, darling.” I hugged him. “We can’t turn back time.”

I had not rembered the fact that I, too, had mourned the passage of time similarly as a child, but it all came flooding back as I sat next to him in the glow of the rocket ship nightlight. 

Growing up was exciting and bittersweet: Deciding that I should not suck my thumb or cuddle a stuffed animal at bedtime seemed like a good idea until it got dark, but I could not back down once I said it out loud. There were times I would stare longingly at my teddy from my bedroom, but grown up girls don’t need those silly things, right? I remember developing boobs and finding it terribly upsetting that my knees would never again touch my shoulders. Growing out of that beautiful red and white frilly dress hand-me-down from the “rich” girl at church with the stiff petticoat that made it stand out and swirl like a dream when I spun around.

Then adulthood.

Realizing that I did not have a bedroom to come back home to when it was converted into a guest room.

Turning thirty.

The first time that I understood that “Coopers Droopers”* was a real phenomenon. 

Turning forty. 

Whose face is that again?

It actually gave me some peace to realize this is not anything new for me or him or anyone else. We all mourn and grieve our youth, the march of time, and hopefully move on and that is just fine. I am not vain or flawed. I am human and that is a beautiful thing.

Photo taken somewhere in Switzerland…

*Coopers Ligaments are part of what make breasts “perky” and they get lax with age. In medical school we referred to them jokingly as “Coopers Droopers”. I can tell you now that it is not a joke…