Tuesday, August 6, 2013


Lately, I've been reflecting a lot on my son's short life (what's new?).  It seems like the first year was just a whirlwind.  Sadly, I don't remember much about it.  I know that I was probably very tired and was often in a bad mood (because that's what happens when I'm exhausted) and didn't get out much, so maybe my amnesia is a good thing.  The second year was all about learning and growing.  He grew from an unstable, newly mobile, almost mute lump into a loud and agile runner, climber, and singer.  But during that second year, there were still a lot of signs of baby-hood around the house: diapers (for most of it), high chair in the kitchen, gates at the top and bottom of our stairs. The changes we saw were huge, but in many ways they were very subtle.

Suddenly, as we enter his third year, the progress is more obvious. A couple of weekends ago, the stair gates came down and the high chair, a fixture in our kitchen for the last year and a half, got replaced by a booster seat.  We're teaching manners and expecting consistency with chores (clearing his plate, putting away toys).  Play is more imaginative and independent.  Instead of requiring locks on all the cabinets and drawers, he is able to learn where he is welcome to explore and where he is not.  Most notably, a potty-training lapse forced us to reexamine our routines, which led me to the conclusion that we needed to night-train the little man, as it must be confusing to be expected to stay dry all day but not at night...which meant cutting out liquids in the evening...which meant eliminating the bedtime water cup...which was a REALLY BIG DEAL.

That sippy cup of water has been Asher's pacifier for the last year.  Never a fan of actual binkies and a horrible sleeper most of his life, we let him sleep with formula bottles until he was about a year old and finally started cutting some teeth (note: I don't advocate that because of the potential for tooth decay, but in a kid who has no teeth, I'm not sure it's a big no-no).  At that point, we converted to a spill-proof sippy cup of water, and it became an integral part of the bedtime routine.  He could guzzle the stuff down.  Recently, he even started calling for refills during his wind-down process.  Cutting out the water has been hard on him.  It's the first thing he requests after dinner and the last thing he cries for as he falls asleep.  He is heartbroken, and it breaks our hearts to say, "No."  If I had to name the most monumental change in our household over the last two years, this would be it.

Yet, we have seen big results.  He is learning to fall asleep with real self-soothing, and he's sleeping through the night without getting up at night to pee.  His pull-up stayed dry so many nights that we eliminated it completely, and with that, the Diaper Genie went out to pasture.  He suddenly remembers that pee goes in the potty and not in his pants.  Change can be painful, but often you are rewarded for your struggle.

As I have considered all of this, I have also been struck with the realization that my baby is now a kid.  Part of him wanted to stay a baby.  In many ways, we wanted him to stay a baby too, but at some point, you know what your child needs to grow and thrive, and as a parent, you are compelled to help him.  You know that your kid will be better for it.  Still, there remains sadness for everyone.  Asher cried and tried to put the stair gates back up.  He understood what was happening better than I expected him to.  It's no wonder to me that siblings are often born two to three years apart.   Your one-year-old might be a toddler but in many ways is still your baby.  Your two-year-old is rapidly leaving baby-hood behind.  Decisions are harder.  Protests are louder.  The changes are more bittersweet.  You feel a void.  You fill it.

However, when I look at this more closely, I see an old world opening up to me.  In the last few weeks, I have worked on creating a physical space for myself.  Before Asher was born, our house, though always a work in progress, was furnished and decorated, and I had an office for myself.  I happily converted my office into a nursery, and over the last two years, I convinced myself that it was OK that the house was becoming less and less put-together as the days passed. Toys everywhere.  Furniture rapidly deteriorating.  Piles of stuff all over because there is no good spot for anything.  The dining room was decorated for Christmas for a full year.  Two years into parenthood, I figured that was just what having kids was about. 

And then we hit two, and Asher rapidly transitioned from a big baby to a little kid.  He started wanting to go in a room alone and saying, "Mommy to leave!"  These words crushed me at first, but I soon realized that he relishes his independence and can actually be trusted not to kill himself if left alone in a room for a few minutes.  I started toying with ideas about converting our guest room into a playroom for him.  I started seeing that maybe one day, we could reclaim our house.  Then my husband started encouraging me to make a "playroom" of my own, an idea I had bounced around for a few months but never felt entitled to act on.  But with Asher's new-found independence, I have also started to develop a sense of independence again, a realization that at some point, my life is going to involve something other than making sure that my child is safe, healthy, and not destroying everything in sight.  I might one day soon find more time for my hobbies.  I might get to read a book for pleasure.  I might be able to keep my home looking attractive, organized, and comfortable again.

As fast as Asher's growing-up suddenly is, my adjustment to this role change is as slow as his adjustment to water-free nights.  I have been fighting it.  It took me two weeks to order the sofa for my space, and as I wait for that comfy lounge to arrive, I still can't quite settle into my new area.  But at some point, we'll settle into the new normal.  Asher will stop asking to be carried upstairs "like a baby," and I'll be OK not watching his every move.  Seeing us all move through this transition, although I know we all feel growing pains, I realize that we can't wait to see where this adventure takes us next.

It just gets better and better! 

Sunday, June 16, 2013

The Week of "Yes!"

I haven't posted in a while because I've been busy vacationing.  Yes, vacationing.  It's a bit of a miracle that I can say that. Here's the background:

My husband and I are notorious workaholics, and vacation was always something we put off.  Excuses are always at the ready: I hate flying, the planning required to leave town is daunting, the work that waits when I get back haunts me....I could go on.  Until our son was about 15 months old, we considered the trips we took to visit family and friends "vacations," but as all of you who have to travel long distances to visit family know, those visits are not a real vacation.  We realized that we needed to do something different.

Granted, we come by our workaholism and vacation-less-ness honestly.  Though we both took family trips as kids, the trips generally had a clear purpose and itinerary.  In my case, we took road trips all over California and saw pretty much everything between Eureka and San Diego.  Crockett's family ventured farther, but there were always plans.  Now that I am a parent myself, I can't imagine that those trips were at all refreshing for our parents.  There certainly were moments of great joy and adventure, but the mere thought of wrangling kids (and husband) into the car every morning to head out to a new point of interest and trying to coordinate meals and naps every day is, at least for me, the stuff of nightmares.

As you might imagine, neither of us knows much about the art of relaxation.  We wanted to teach our son something different, so we agreed that every year, we would take a REAL vacation--one where relaxation was the only objective--and we developed a few very important rules defining what that meant.

Number one, and most importantly, our vacation has to be a vacation for ALL of us.  If the trip means more planning and stress than we have at home in the course of our usual routine, it is not a vacation.  This means primarily that there has to be some arrangement made for childcare for at least part of most days.   Clearly, we love our son more than anything, but we love him the most when we aren't responsible for entertaining, supervising, and disciplining him every minute of every day.  Having childcare means that we can have alone time--both as a couple and as individuals--to get the rest we need as well.

The second rule is that our trip should have no objective aside from relaxation.  If we want to visit some sites, that's great.  If we want to go somewhere and do nothing, that's great too.  If we happen to visit with friends who live in the area, fantastic.  If we don't manage to see them, no biggie.  We plan almost nothing and just figure out what we feel like doing one day to the next.  It's a freeing experience.

Finally, we have to be comfortable.  For us, it just isn't comfortable to be crammed in a single hotel room.  We stay in suites and condos, where we can stretch out, shut the boy in his own room to sleep, and have access to a fridge and (sometimes) laundry, which I consider necessities when traveling with a small child.  I am a bit of a hotel snob--I really appreciate a nice hotel and have had the privilege of staying at some amazing ones--but when traveling with a child, I would much rather stay in a less fancy place in order to be able to have enough space for all of us.

And so we arrive at The Week of "Yes."  It turns out that it's not so easy to find a destination that meets all of these requirements, and it takes a bit of work to find the perfect place.  About six months ago, a Google search led me to the Tyler Place resort in Vermont.  I thought I was crazy for considering hauling my little family 3000 miles to stay at a totally unknown locale, but after reading about the resort, I got fixated on the idea.  Fortunately, my husband indulged me and agreed to the trip.  Seven nights in the middle of nowhere, just a few miles south of the Quebec border.  He must really trust me.

What a glorious week it was.

Asher was in "group" for eight hours every day: from 8:30 to 1:30 and then again from 5:30 to 8:30.  It was expected that your child participate in group activities every day, and when your child was there, you were expected to be out of the picture.  "Go!  Do your own thing!  Your kid will have a great time with us!" was the message.  Surrounded by dozens of other parents who embrace this philosophy, I could relax.  No worry about who was watching him.  No guilt for wanting time to myself.  Plus, they had a roving photographer catching glimpses of the kids in their group activities for us curious/obsessive parents who want to document every childhood moment.

In the meantime, Crockett and I could do what we pleased.  We took a pottery class on Monday morning, and on Friday morning, I sojourned to Quebec to fire my pots.  One day, Crockett took an archery class.  Another day, I experimented with a martial art I had never heard of.  Some days we just hung out, napped, read, got a massage, or went to the gym.  There were a lot of activities we could do, but none required much advance planning--sign-up sheets were posted each evening for the next day's activities.  Afternoons for us meant napping and time at the pool, and when Asher napped, even I got to nap because there was no urgency  to complete chores while he slept.  I actually felt rested for the first time in two years.

Perhaps most glorious of all, as an all-inclusive resort, meals were a no-brainer, and it was adults-only dining at every meal (kids ate with their groups).  No fussing with a toddler at restaurants or trying to plan where or when we were going to eat next.  No worry.  No stress.  Real conversations with other adults who, similarly, were not distracted by their children.  Perhaps too much dessert, but who cares?

One of the women I befriended, an ophthalmologist from Tucson with four children, said her husband was worried mid-week because she was acting strangely--she didn't project the usual degree of anxiety.  For the first time in their life with children, she had nothing to worry about.  I could relate; I had never been so relaxed and carefree in my life. 

I wasn't the only one who was happy and carefree.  I realized toward the end of the week that everyone's family dynamics had shifted.  Kids didn't fuss.  Time-outs didn't happen.  Boundaries were respected.  It was amazing.  As one parent described it, it was The Week of "Yes!"

Every family needs this kind of week.  Vacations are not about breakfast with Minnie Mouse or seeing the tourist-traps in New York City.  They are about re-charging and letting go of the day-to-day stresses of life.  Since our return, many people have seemed perplexed about what we did while Asher was in group, and I have realized how much we parents have devalued our own happiness.  I want to shout, "We had lives!"  Contrary to what many parents believe, this is possible, though it takes some work and sacrifice.  It might mean flying cross-country with a 2-year-old or taking a shorter vacation so that your budget will accommodate sitters and a suite. Whatever compromise you have to make, finding this kind of retreat for your family will pay you back with a new kind of closeness that few families are able to achieve. 

I feel fortunate that we have found this kind of retreat and will be able to return year after year.  In the future, we will probably tie in some goal-directed side-trips, like a few days in Boston to see the sights or an extended lay-over in Washington, D.C., to catch up with friends.  But the essence of this trip will always be fun, relaxation, and coming together as a family.

Just fifty-one weeks to go....

Friday, May 17, 2013

Being the Biggest Person

It probably would surprise most people to know that there are very few actual rules in medicine.  Being a doctor is a whole lot more art than science.  But still, there are a few rules, which often seem quite arbitrary but are actually based on science.

Today I was trying to decide on when to induce one of my patients, and I was struck by a dilemma resulting from one of those rules.  We followed some rules and settled months ago on May 30 for this patient's due date (OK, so maybe this story is about two rules).  She and I both want to induce her labor because she lives quite far from the hospital and is worried about delivering on the side of the road, but this kind of induction is essentially elective, which means that we can only do it a week before her due date.  This rule is one of the biggies.  Choose to deliver a baby too early, and you risk delivering one who isn't ready to breathe on its own, among other things.  Frustratingly, I am on call the day before we are clear to induce her and then have a  lot going on the rest of the week, so for convenience reasons, I would really like to fudge things a bit.  In fact, the patient and her husband both thought her due date was the 29th.  Oh, how I wish that were written in her chart!

Here's where it gets even stickier: I am the sole OB/GYN on a committee that reviews cases at our hospital.  Recently several cases came up for review for patients who were electively delivered a day or two before the 39-week mark.  All of my colleagues on the committee were irritated: how much difference could one or two days make?  I found myself defending my department and my specialty.  Yes, a day or two probably doesn't make a difference most of the time, but we've got to draw the line somewhere; it's a slippery slope between one or two days and four or five days or more, and there are few errors worse than delivering a baby who isn't ready for life on the outside without a really good reason.

As thoughts about fudging things entered my mind, I thought back to my role on the committee and my whole-hearted belief that people need to stick to the rules.  Most rules are there for a reason.  And so, with a somewhat heavy heart, I stuck with the patient's established due date and scheduled her induction for a day that is super inconvenient for me.

As a mother of an almost-two-year-old, I find myself internally debating this same issue all the time.  We set rules for our kids for one reason or another--I generally try to limit myself to those with a real purpose--but often enforcing them becomes a burden.  Just this evening, I was trying to get Asher to help me feed the dog, which is one of his "chores," and he was totally unreceptive.  I was too tired to fight that battle any longer and decided to do it alone.  His father was annoyed that I had caved like that, and I knew he was right.  Kids need us to be consistent with our rules.

Now that I have some time to contemplate my day, I have a couple of thoughts.

The first is that as parents we need to be the biggest person by setting a good example for our children.  This includes sticking to our own rules.  At work, that means not breaking a rule just because we know it doesn't really make a difference.  At home that means being consistent with our rules for our children and the consequences of breaking them.  It also means living by certain principles ourselves.  If you don't want your kid eating junk food, you need to stop eating all those cookies and chips and learn to love your veggies.

The second thought is that none of us is perfect.  I feel somewhat guilty for even having thoughts about breaking the rules at work, and I feel even worse that I let Asher slack off on his chores tonight.  In both cases, the offense is miniscule, but the slippery slope lies ahead.   Consistency with rules, which sometimes means being the bad guy, is my weakest point as a parent.  I always feel the pull to be lenient "just this once," but how many "just this once" incidents are too many?  I will always have days when I just can't summon the energy to fight the battle, but hopefully by reminding myself of the importance of consistency, I will be more mindful, and the battle won't seem quite so challenging.

Doing the right thing can be a challenge, but as parents, it is our duty.  The great thing about parenthood is the opportunity to grow along with our children.

Wednesday, May 15, 2013

MY Mornings

It all started in college.  My freshman roommate didn't have much of a social life, so pretty much the only time she wasn't in our tiny room was when she had a class.  Fortunately, her classes were always earlier than mine, so after she rushed off to her 8:00 lab, I had the room to myself for a few precious moments before my 10:30 lecture across campus.  Every morning, my CD player would wake me up to the same song--"The Kiss" by The Cure--around 9, and then I would get up, make coffee (the good stuff--I was probably the only kid in the dorm with a coffee grinder, and my mom would ship me my favorite roast from a shop in my hometown), nibble on a bagel or some sourdough (also shipped by Mom), and waste time on the internet, which was just starting to be a big thing.  It was the time I was most comfortable and the most myself.  There are a lot of things I don't remember about my years in school (SO many years!) because the moments got bulldozed by the knowledge I was acquiring, but those mornings when I was eighteen are still vivid.  The first measure of  Kiss Me, Kiss Me, Kiss Me takes me right back there.

I realize now that that year was the start of a lifetime of being a morning person.  I love having some quiet time after I get up.  It's the one time I can always think clearly.  Now Asher has joined me in a new early morning ritual.  He rises earlier than I would like, but fortunately he also likes to luxuriate in the quiet and slow pace of the morning.   Now we get up together, lounging on the couch while he has his morning milk.  We talk about the dog and cat, who have also just gotten up and had breakfast, and we chat about the plans for the day.  Sometimes, especially on Saturdays when we have extra time to be lazy, we watch a little Thomas or Zoboomafoo on PBS.  Most days, we move slowly for the first couple of hours.  I suck down a couple of cups of good coffee and check my email here and there.  Breakfast happens eventually, as does toothbushing and, sometimes, getting dressed (the beauty of having a nanny is not having to gear up for daycare every morning), but mostly we just chill out until the nanny arrives.  After that, it's a mad dash for me to get showered and ready and out the door.

I can't remember the last time I slept past 6:30, let alone 9, and the soundtrack is different, but my morning ritual continues, and I love it.  I don't truly appreciate how much I need that morning time until something interrupts it, like a surgery scheduled at 7:30.  Or a helpful husband getting up with the child so that I can sleep.  He wonders why a lot of mornings I get up and let him sleep even though it is "his" day.  The reality is that as tired as I might be, my Asher time is my new morning ritual, and without it, my day just isn't right.

One of the wonders of motherhood is how we change to accommodate the new little person in our lives.  The essence of who we are isn't gone, but it manifests in new ways.  In my case, those early hours are when I am most myself and most connected, and I can't think of another person I would rather share my mornings with.

Monday, May 13, 2013

Strut Your Stuff, Hot Mama!

Yesterday was Mothers' Day (I like to put the apostrophe there because it's not about just one mother--not sure what the official punctuation is), the one day a year when some women actually get to think about themselves.  A crazy concept, I know.  I've seen a lot of ads advertising "Mother's Day specials" on esthetic services like facials and manicures, and I venture to guess that those services are the focus of a lot of Mothers' Day gifts.  Though well-intentioned, I'm not sure I like the message that this one time out of the year, Mom should be allowed to primp and preen.  And, as is my opinion about most motherhood "problems," a lot of the attitude starts with us.

This is one of the two cards my husband got me for Mothers' Day this year.  I don't see myself this way at all.  It is a clear reminder of how we can view ourselves so differently from how others view us.  As thankful as I am to
have such a supportive husband, it doesn't remedy the problem.

After we have children, our focus changes.  It doesn't matter what we're wearing as long as our kids look cute (after all, we are always BEHIND the camera).  Our bodies might have changed after pregnancy.  A patient whose daughter is three told me last week that she wears pretty much the same thing every day because nothing fits.  One of my close friends held out hope and put off buying new shoes for six months after her feet grew during pregnancy.  We're always hoping to go back to the person we were before baby, even though that's rarely a possibility.  Even if we are the same weight, we are inevitably changed by the experience.  Then there's the lack of time: I have yet to see the toddler who is patient enough to let his mother try anything on at the store.  I know that many of us resort to throwing things in the cart at Target while we're doing the rest of the shopping, hoping that something will actually fit.  Besides, it's hard to find fashionable clothes that are affordable AND easy-care (heaven knows how much schmutz is going to end up on them).  Not to mention that at some point you realize that no matter how much makeup you pile on, you still look tired.  And those ponytails are so convenient, which means more time to play with the kid before work....The list of reasons not to get put-together every day goes on and on. 

My job has made me especially lazy because I can get away with wearing scrubs every day.  I noticed recently that over the last six months, scrubs have become my regular uniform.  It's not that scrubs actually save me much time--I still shower, put on makeup, and dry my hair (a short hairstyle that became a necessity after Asher was born because I didn't have 45 minutes to do my hair every morning)--but somehow I justified that my mornings were busy and scrubs were simply easier.  And cheaper.  And never went out of style.  And hid a multitude of figure flaws.  And, hey, I was still taking the time to do my hair and makeup, so that's taking care of business, right?

The reality is that wearing scrubs every day was reflecting an inner frumpiness.  I had gone from being a professional, confident woman to being a working mother, and I wasn't completely confident in either the "working" or the "mother" part of that equation.  My identity was drowning in a sea of "blues," smudged by snot and spilled milk, among other things.

Then, about a month ago, I decided to use some store credit to order a new dress, shades of pink in a geometric print, bright and perfect for spring.  When it arrived, I let it sit in the box for a couple of days.  Hubby couldn't understand why I didn't want to try it on, but I was scared--if it didn't fit or simply looked awful, it would just confirm the insecurity that I was already feeling.  Finally, on a weekend when no one else was around, I tried it on...and it fit...and looked damn good.  And I couldn't wait to wear it to work.

Since then, I've bought a few more dresses: comfy but bright and colorful and feminine, and all purchased online at a deep discount price from one of the same outlet sites I usually look at for toddler clothes and paraphernalia.  I have only worn scrubs on the days that really require them.  As a result, I find myself standing a bit taller and feeling more confident.  I admit that part of me wants to run and hide whenever anyone comments on what I'm wearing--I have spent so long hiding behind those scrubs--but I'm sure that if the trend continues, it won't seem like such an anomaly, and eventually, the attention won't feel so foreign and uncomfortable.

More importantly, I have reminded myself that I'm still a woman who deserves to feel good about herself all the time, not just on special occasions.  It doesn't matter how impatient the toddler, or how much your shape has changed, or how tight your family's budget might be, you deserve to look at least as good as your kid, and there are ways to make it work.  It's time to start showing who you really are.

Thursday, May 9, 2013

A Friend in Need...

Most mothers are challenged by healthy children who are ready to take on the world.  We worry more about unplanned pregnancies than the possibility that pregnancy might not be in our future.  The day-to-day stresses of mothering and trying to have a life wear on us.  And then things are put into perspective by a friend who is not so blessed.

Unfortunately, I have several such friends.  Friends who have struggled with infertility and abnormal pregnancies.  Friends who have successfully made it through pregnancy but find themselves months later with a child whose development just doesn't seem normal.  Friends who fill out hundreds of pages of forms to get their children the special education they need.  Friends who put their careers on hold to take their children to hours of various forms of therapy every week.  Friends who love their children dearly but cry every night about the hand they were dealt.  I know I'm not alone.  We all have these friends.

With Mothers' Day approaching, I am especially mindful of the great luck I have had in having a child who is brilliant and healthy and thriving with minimal work on anyone's part.  Despite coming up on two, we are having an amazing, wonderful time.  But I also realize the tinge of guilt I feel about this when I think about my friends who are not so fortunate. I am embarrassed to gripe about the normal everyday toddler stuff (number one on my list: the incessant babble) when I think about what my friends are facing every day. Working in a small community, I see this happen to my patients too; the scenario where one patient miscarries and her best friend, also a patient, has a completely uneventful pregnancy happens all he time.  The new mother feels awkward about the miscarriage and doesn't know what to say to her best friend.  It puts a wedge between them.

I know that in my own case, I am not the friend I wish I were.  I feel awkward, not sure what to say or what to do.  I know I can't fix the problem, and that makes me feel powerless.  I am afraid to share anything that is going on in my own life because I don't want my friend to compare.  I simply don't know what to do, so sometimes that means I just avoid contact.

What I do know is that real friends share in each other's joy and pain.  We are thrilled when a friend's child succeeds; we feel sorrow when a friend's child struggles.  And while we might feel a twinge of jealousy over one another's good luck, we never feel that the other's success is at our expense.  The reality is that as parents, we are all working and struggling to keep up, and every child has his talents and limitations, and every woman needs her friends to keep her afloat.

My pledge this Mothers' Day is to be a better friend.  I intend to stay mindful of the feelings of guilt that have kept me from providing the support my friends need.  And when my need to gripe about my own life creeps in, I WILL gripe...because I am a friend in need as well, and we're all in it together.

Monday, May 6, 2013

Bullies on the Playground

I am very confident about some aspects of parenthood: providing a healthy lifestyle, choosing a good education, teaching love for all living things, fostering a loving home environment.  There is one big aspect that leaves me quivering in my pumps (or clogs if I'm on call): discipline.  I would do almost anything to avoid confrontation, and even with my child, I am insecure at times.  Add another parent and her child to the mix, and I am totally hopeless.  Put me on a playground with a bunch of these people, and I want to cry.

Now, don't get me wrong.  We are actually really laid-back parents as far as the discipline goes.  We believe that children learn best when they experience the natural consequence of their actions.  We only intervene when there is actual danger.  We let Asher do all sorts of daring things that a lot of parents think are too risky.  We figure that if he gets a little bump on the head or is frustrated when he can't solve a problem, it  helps him learn about the world.  But we're also sticklers for manners and rules ("please" and "thank you," cleaning up after yourself, etc.) and are trying to teach Asher to use verbal communication to express his needs.  Too bad he's learning this from the queen of non-confrontation.

This problem became apparent about a year ago when I took Asher, who was just barely walking, to a playground in our neighborhood, where we met a little boy who was just a couple of months older.  They were interested in each other.  The little boy had a couple of big brothers running around, and Asher was fascinated by the three of them.  Until the little boy hit Asher.  And not by accident.  I had no idea what to do.  I quietly told the other boy that he wasn't being nice and then told Asher, half-heartedly, that it wasn't a big deal, hoping that he wouldn't freak out.  The other mother laughed it off, saying that he had learned that behavior from his older siblings.  Flustered and frustrated, I kept my mouth shut and, shortly thereafter, declared that my pallid child had been in the sun too long and that we needed to go home, and so we made a cowardly exit.  I realized that I had chickened out.

What I've learned in the last year is that I have a child who is by nature non-confrontational, just like his mother.  When other kids want his toy, he lets them take it.  If a kid pushes him down, he doesn't cry.  He might look bewildered for a second, but then he finds something new to do.  Similarly, if he's interested in someone else's toy and that kid won't give it up easily, he moves on.  He's one of those smiley kids that everyone wants to be friends with.  He's incredibly charming and incredibly versatile, and I never worry about how he's going to mix with other children. 

I know a lot of you are wondering right now how this could possibly be a problem.  Yes, having a child who is contented and easy-going and polite in his interactions with others does spare me a lot of the usual kinds of toddler discipline.  But it leaves me with a whole different set of problems: how do I teach my kid to stand up for himself without spoiling his happy-go-lucky attitude, and how do I keep the bullies from running all over him?  Today was a prime example.

I had the afternoon off after being on-call this weekend, so Nanny Becca and I decided to use a Groupon that I had bought a couple of weeks ago to take Asher to one of those bounce-house facilities where they have a bunch of inflatable slides and things to play on.  I was encouraged when we arrived that there was one other child there, a boy about a year or two older, and he seemed pretty energetic.  I thought he might be able to show Asher the ropes.  Unfortunately, I was wrong.  While his mother spent the whole outing on her phone, presumably checking email or playing a game or something, this kid set out to own the "playground."  Anything that Asher touched, he wanted.  And if Asher showed any interest in what the other boy was touching, the boy got physical.  I had no idea what to do, and this kids' mom was not doing a damn thing to teach her child how to play well with others.

At one point, I realized that Asher needed to learn to ask directly for what he wants, so we started learning a new phrase, "May I please...."  Amazingly, this bratty kid heard him and then responded by telling him what Asher could and could not touch.  I realized this was the key to teaching my less dominant child how to assert himself.  They were actually getting along.

Then Mom saw what was going on and, assuming that he was being his usual domineering self, yelled at the little boy and gave him a time-out.  And then she went right back to her phone.  And then he got up and again started taking things away from Asher and trying to push him off the equipment he was playing on.  And then, when Asher was happily running across the floor, he checked him (in the hockey sense).  I have no idea where the kid learned this move, but he was clearly an expert.  Again I was stuck in the same playground situation: what to do when another kid is nasty to Asher?  How do I make it not too big a deal for Asher while at the same time teaching the other child that the behavior is wrong? 

I am without an answer.  Again, I told Asher that the other boy's behavior wasn't nice but that he wasn't hurt.  Asher, who didn't cry or show anything besides shock at what had happened, started saying, "Sorry.  Sorry," because he knows that is what you say when you've done something hurtful to another person (or animal, as is most often the case in our house).  It broke my heart.  The little boy eventually was instructed by his mother to look at Asher and apologize "like he meant it," but I'm quite certain he doesn't really get it.

I don't want my child to learn to be a bully, but yet, I want him to learn to stand up for himself.  It's not my job to fight his battles, but I am responsible for giving him the tools to function in the world.  And here I am battling the enemy--the parent who doesn't provide these tools for her own child--myself.  What do I say to her?  How do I balance teaching my child how to get along in the real world without letting hers get away with nasty behavior?  How do I encourage mine to communicate his needs directly when all she does is punish hers for expressing himself physically?  How do I keep my kid "nice" without making him a target for the bullies?

Uncharacteristically, I am without an answer.

Friday, May 3, 2013

Let It Out

When I first started working in private practice, I was informed by someone that a bunch of websites listed me as a psychiatrist in Los Angeles (my awesome hubby has since fixed that error, thank goodness).  I found that a bit ironic, given that my least favorite rotation in all of med school was psychiatry.  And yet, it turns out that I deal with mental health issues almost every day both at work and (no shock) at home.

Today I jokingly mentioned to a couple of patients, who were both apologizing for breaking down in tears during their appointments, that I don't feel like I'm doing my job right if I don't make at least one person cry every day.  Obviously, crying is not exactly my goal.  But I guess part of me knows that I'm providing a therapeutic environment when patients feel comfortable crying in front of me and telling me how they really feel.  I can honestly say that it is a rare day that I don't see any tears or talk about sensitive, painful issues with someone. When I picked my specialty, I never realized how much of this my job would involve, and yet, unlike my psych rotation, which never really clicked for me, this feels a bit like my niche, and as much as I sort of dread appointments that are likely to involve tears because I know that they will be draining, I always feel a closer connection to those women.

Dealing with depression and anxiety and other big emotions can be intimidating, but I think the biggest hurdle for a lot of people is facing the person crying in front of them.  The tendency is the shove a bunch of Kleenex at her and hope she'll perk up.  The crying is uncomfortable to watch, especially when there is just silence cut by sobs.  All we want is for her to stop crying so that our discomfort will end, but, as you might imagine, just telling her to stop will only alienate her and teach her that her emotions are not OK and that you don't care.  On the other hand, if you can suck it up and sit through the crying and help her express what's wrong, you might be able to start to understand what the problem is, but it is not an easy thing to do.

The big news here is that it's the same with our kids.  We all hate when our children are upset and crying and throwing tantrums.  Most of us try to hush the offending child, telling him that he's fine or ordering him to stop crying or trying to distract him, but even if that diffuses the situation, which it often does not, it doesn't fix anything.  Worse, it just teaches him that his parents don't really care what's going on with him and that his feelings are unimportant.

Being mindful of our discomfort and feelings of insecurity when people are expressing big emotions can help us respond more empathetically.  If we can join in our children's tantrums in a more empathetic way, we teach them to process their feelings rather than just shutting them out.  They learn mindfulness, which is a key to being able to respond in a positive way to stress, rather than a way that emphasizes stuffing the pain away.  Imagine what it would be like if, instead of saying, "Oh, you're OK.  Get over it," you said, "I can see you're upset.  Tell me what's wrong."  Granted, what is wrong might be something that seems trivial to us, but asking your child to put the problem into words will start helping him learn to identify his emotions so that he can have some control over them.  Your toddler's tantrums probably won't stop overnight, but when he starts understanding better where his feelings are coming from and he starts to feel that his parents are really engaged with him, tantrums will become increasingly less frequent and more productive.

But the change has to start with you.  You've gotta let the tears roll down.  When you see tears, hold out the tissue box to offer help, but don't try to stop them.  Then, when the sobbing subsides, offer a caring ear.  It will connect you in ways you never imagined.

Thursday, May 2, 2013

Carpe Diem(s)

OK, so my Latin isn't so hot.  No idea what the plural of "diem" is, but you get the idea.

Anyway, onto the real topic of today's post.  The other day I picked up a preschool application for Asher.  We have sort of planned all along that we would start Asher in preschool in January 2014, when he'll be a little over two-and-a-half.  Because he is an only child, we are always concerned about his exposure to other kids and the lessons they can teach him about getting along with others.  And because he is so energetic and physical, we are also concerned about him learning some self-control and order.  Both of those lessons are hard to teach to a kid who stays at home with a nanny and, therefore, whose world revolves around him.  Preschool is the remedy.

This preschool plan was mostly MY idea, but when I pulled into the parking lot and walked into the door of the school, I felt overwhelmed.  Like most parents, I couldn't believe my little boy was big enough to be taking that step, even though that step wouldn't come for almost nine months.

So, a little vulnerable and sad, we moved into yesterday, when my husband and I started talking a bit about trips for later this year.  I have been thinking for a long time that next winter would be a good time for a trip to Disneyland--Asher will be old enough to enjoy it but young enough to qualify for free admission.  In considering that, I realized that we would have to do it before school starts in January because I wouldn't want to pull him out of the new routine we were trying to establish.

And then the reality of him starting school set in.

The thing that is great about having a young child is that you aren't hampered by HIS schedule.  Sure, you've got your own stuff going on, so you aren't totally free, but you also don't have soccer games and cub scout meetings to muck up your plans.  I purposely keep Asher free of commitments on my Thursdays off and try to keep him out of weekend activities so that we have the freedom to do whatever we want with my non-work time.

 Then school happens.  And then it's the school schedule plus all the stuff that goes with it--birthday parties, fundraisers.  And then organized sports happen.  And then other extra-curricular activities.  And then you have no time.

Or at least that's how I imagine it.  Having never been a mother of a preschooler before, I wouldn't really know.  But that's my fear.  I see all of our carefree family days slowly vaporizing.  This year, our big family trip will be to a resort in Vermont, where we get a discount because we're traveling before the height of the summer vacation season.  Next year, Asher will be in school, and we'll be taking our summer vacation at the same time as everyone else.  So long, carefree days.

So getting back to the title of this post.  When Asher was a newborn, I got totally fed up with hearing from old women at the grocery store about how I should "cherish every moment" with him.  The reality is that there are a lot of un-cherish-able moments when you have a newborn, and as much as I thought I understood the gist of what they were saying, I was annoyed.  But now I feel like one of those old ladies in the checkout line: carpe diem.

Take advantage of those flexible, pre-preschool days. Take your vacations at odd times.  Don't over-plan your weekends.  Have fun with your freedom.  You might not cherish every moment, but those free days will be gone before you know it.   

Wednesday, May 1, 2013

Comfortable in Your Own Skin

Apparently, when I was a little girl, I decided to run out of the house and down the street naked. The older boy who lived across the street found me and delivered me home.  My husband has similar stories, although in his stories, the police are involved.  It seems that the cops were less busy in his hometown than mine.  At any rate, it turns out that kids like to be naked.  A LOT.

Since Asher has been potty trained, there has been a lot more naked time than before.  Part of this is because we don't worry about accidents all the time, but most of this is because we are a bit lazy--we don't have to help him with his pants every time he gets the urge if the pants are already off.  This leads to a lot of--ahem--self-exploration.  It turns out that toddlers like to touch themselves, and since they don't have the social training we do when we are older, they do it a lot, right out in the open for all to see.  As much as I understand the biologic reasons for all for all of this, it makes me undeniably uncomfortable.

Fast-foward to yesterday when I got home from work and sat down on the stairs to talk to Asher about his day.  Immediately, he flipped up my skirt to look for my (non-existent) penis.  This was a moment only slightly less embarrassing than the time my bikini top flew off on a waterslide when I was in high school (not sure who saw that, and, frankly, don't want to know, so if you were there, please keep the truth to yourself).  What is a mommy to do?

Clearly, I am no expert on child-rearing, but my work has taught me one huge thing: teach your children the names for their parts.  I saw a teenager the other day who had some concerns, and her pediatrician had told her that it was "just her fluff."  I was totally perplexed as to what the issue might be (not to mention somewhat horrified that she couldn't explain it better).  Kids need to know what things are called so they can communicate effectively and they need to know that their parents support this verbiage.  As awful as it sounds, if your child is abused in some way, s/he needs to be able to express what happened and feel comfortable talking to you about those parts.  

It becomes more complicated and uncomfortable when your child wants to talk about YOUR anatomy.  I don't have an educated answer to that.  But I do know that if you take a deep breath and explain things simply and logically, you'll probably get the point across without making it too big a deal.  My explanation: "Asher and Daddy have penises.  Mommy doesn't."  This seemed to do the job.   A friend just asked if Asher also knows about vaginas, and no, he does not, but my guess is that he will soon enough, given the kind of phone conversations I have from home when I'm on-call.  I'm sure we'll take the same no-big-deal approach to that one.

The bottom line is that we all need to be comfortable talking about our bodies.  It is uncomfortable for parents to talk about all of this stuff with their kids, but it is vitally important.  It has nothing to do with sexuality--that comes later--but everything to do with being familiar with your own body and being able to care for it.  Verbal communication is probably the most defining human characteristic, which means that we need to be able to talk about who we are physically.

Tonight Asher looked at me, both of us fully clad, and said, "Mommy, no penis."  Yes, my little buddy, you speak the truth.

Monday, April 29, 2013

I Love Being a Working Mom...I Think

Recently I happened upon this article http://www.huffingtonpost.com/wendy-sue-swanson-md-mbe-faap/i-love-being-a-working-mom_b_3156152.html?ncid=edlinkusaolp00000003, and it got me thinking.  I admire the author's dedication to her profession and her desire to make a change AND to instill that desire in her child.  Yet, it really didn't hit home with me, and not just because I will never be flown to the Netherlands to do a TED talk or any other sort of public speaking.  I feel like she missed the real-life, day-to-day reality of being a working mother and how awesome that can be. In fact, I think she missed the boat entirely.  I think her viewpoint is definitely doctor-centric, and I don't think it speaks to women in other lines of work.  Being a working mother, for me, has little to do with charging my child with social responsibility and is in no way connected to what I actually do for a living; it has everything to do with providing me with the balance that I need.  I suppose my outlook could be considered selfish, but I believe raising a healthy child starts with being a healthy parent.

As working parents, we miss out on some things.  Asher is one of two kids in his mommy-and-me class who attend with a nanny.  Lately, he has been singing a color song to the tune of "Twinkle, Twinkle Little Star", unbeknownst to me.  For days I thought he was just singing gibberish until Becca joined in the other afternoon.  Mostly I feel gut-wrenchingly awful about this.  It's hard enough knowing that your child spends most of his day with another person, but it's even worse when you have clear evidence that someone else understands your kid better than you do.  On top of that, I worry about judgment from the stay-at-home parents in Asher's classes.  I would love to meet his friends' moms, but I honestly worry about what they'll think of me, the absentee mother who lets a nanny do all the dirty work.  The secret of working moms that a lot of stay-at-home moms don't know is that we see them as a higher order of mother in some ways--part of us wishes that we could do that ourselves, but the reality is that we know that we couldn't be kid-focused all day long--and we're pretty sure they look down on us.

On the other hand, I know that I am a better parent because I'm not parenting every minute of every day.  At work, at least to a certain extent, the part of my brain that is fixated on scheduling and enforcing rules and, essentially, trying to create order out of chaos turns off.  I can focus.  I can think.  I can have adult conversations.  I get to learn about what's going on in the world around me.  These are things that only happen at naptime when I'm home, and I notice that when I go too long without turning off the parenting part of my brain, the caring, loving, fun mommy part of my brain starts checking out.  In order to be the emotionally connected parent I want to be, I need to not be a parent for a good part of the day.  I need to have the freedom to connect to other parts of myself.

That said, there is a fine line between working enough to stay in touch with those parts of my brain and working too much.  Earlier this year, my work schedule had changed so that I was working fewer days but those days were each unbearably busy.  I came home exhausted and checked-out.  It's a matter of finding a way to giving enough time to each part of me without any part taking over.  When I notice one part dominating at the expense of the others, I know it's time to change things.

 Being working parents certainly teaches our children a lot about the world and their role in it.  I like to think that, by seeing his mommy work as a physician and his daddy run a web development company, Asher will learn the value of hard work and not take what we have for granted, that he will learn how to work ethically and treat people (clients, patients, colleagues) with respect, and that by seeing what we do professionally and how it evolves with time, his mind will be opened opportunities that aren't necessarily the 9-to-5 cubicle grind.  More importantly, though, I expect that he will learn to take care of himself in a more holistic way.  He will see the struggles we have to keep a balance between work and family and the mindfulness it takes to realize when balance is lost.  He will also learn the importance of understanding and respecting his own needs.  He will understand that in order to care for others, he first must care for himself.

These are all lessons it has taken me years to learn, and I constantly have re-examine myself and adjust things accordingly.  The hardest and most important lesson is that no one can really "have it all" in the more traditional sense, and trying to do so just brings pain.  You must identify what's important to you and what you need to be happy, and then you must work to make those things a reality.  Then you will have it all, and so will your kids.  It really doesn't matter one bit what your employment status is.

Sunday, April 28, 2013

The Perfect Day

Spring is always so busy for us, and this year has been no exception.  Between trips across the country to visit family and birthday parties and holidays, it seems like there is something planned every weekend.  Add to that me being on call every six weekends or so, and there just isn't much time left.  I try to plan just one big thing every weekend so that we aren't totally frazzled.  This weekend I made an exception, and I am really glad I did.

As I mentioned in my last post, we have all been crazy busy.  Crockett has been stressed with work piling up, and he expressed a need for some time this weekend.  We had plans on Saturday to spend the evening with some close friends to celebrate the impending arrival of a new baby boy, and normally this would mean an unscheduled Sunday.  But because I knew Crockett needed quiet time, I decided that Asher and I would have the first "Mommy-Ashie Adventure Day" in a while and go to Gilroy Gardens, a toddler-oriented amusement park about an hour from our house.  We had heard great things about it and had bought a season pass sight-unseen when they went on sale at Costco, so I was anxious to go.  I had doubts this morning when Asher woke at 6:20 after a restless night, but I decided to throw caution to the wind, and at 9:30, we were off.

My grand plan involved a nap in the car on the way there, and that didn't happen until 5 minutes before we reached the parking lot, so I was pretty sure we were screwed.  I was going to just wait it out, but it was 10:30 and sunny and getting rather hot, so I took a reckless course once again and decided that if Asher needed to sleep, he could do it in the stroller.  Come Hell or high water, we were going to do this thing.  Of course, he woke up immediately, and we were off.  First stop, the carousel for rides on several different horses.  Next, a ride on a swinging strawberry.  All were enjoyed with an ear-to-ear smile throughout.  Pizza lunch up next, and then the train, more rides, a run under the waterfall, a hot dog, another trip the carousel before we left.  Smiles and laughs all around.  The best day ever.

The funny thing is that if you dissect the day, you probably wouldn't understand how it was perfect in any way.  I forgot to put a pull-up on Asher before we got in the car, and, for the first time in ages, he had an accident during his short nap on our way there.  There were brooms and dustpans in every bathroom, which he always wanted to play with, and there was a small amount of screaming when I led him away every time.  Lunch took half an hour to eat, most of which was spent spacing out and counting trash cans.  He was trying to be so naughty while in line for the train, and yet, there was just enough going on to distract him into submission.  I almost had a panic attack on the ferris wheel (not a fan of heights), and then Asher tried to take a nap on the seat as the attendant came to let us out of our cabin.  The hot dog request came completely out of the blue, less than two hours after lunch, and was revealed on a whim as we were passing by a restaurant that does not serve hot dogs; I had to walk nearly the entire park to find the damn hot dog--there is only one restaurant that serves them--but we got it, and life was good.  Last, but not least, on the final carousel ride, I was told to "LEAVE!!!" by this increasingly independent child (unfortunately for him, he isn't tall enough to ride alone).  Such love.  And then I had to fight a little to get off the carousel; he wanted to try a horse in every color.  During the five minutes it took at the end of the day to convert our Costco voucher into a real season pass, the few remaining bits of hot dog went flying, a protest for taking away the fun.  On our way out of the parking lot, a pitiful, exhausted utterance, "Back in....Back in...."

That's the most amazing part of living these experiences: there is nothing particularly wonderful about any of it, and yet it is all wonderful.  There is some sort of magic chemistry that makes it perfect.  How often do you spend eight hours with a two-year-old and not get frustrated?  Almost never.  This was one of those rare days.

But I know life is short and childhood even shorter.  His yearning for independence is a blatant reminder.  I feel a need to commemorate it all.  I'm usually the one behind the camera, trying to preserve the memory.  I tried to capture the moments, the smiles, the laughs.  However, unlike most outings, on this one, I had no back-up, and my only camera was my phone.  I became more aware of how I usually miss the full experience of the moment by trying to preserve it somehow.   In the process of accepting my limitations, I became more whole.  Contrary to what I expected at the start of the day, by not being able to record it audio-visually, our outing became better recorded emotionally.  I was more there, and because of that, I will never forget it.

It was the perfect day with the perfect iPhone self-portrait to prove it.

Saturday, April 27, 2013

24+ Hours of Mommy Fails

The last 24 hours have been tough around our house.  I am exhausted after two nearly-sleepless nights in a week.  Asher has been discombobulated by my absence and more baby-sitter time than usual, and he has been busy all week with activities.  Crockett is stressed about a lot of exciting but work-intensive projects.  It should come as no surprise that this all takes a toll at some point.

It all became apparent last night.  Asher and I took a shower, and while I was straightening up afterward, I let him run around naked for a while.  As I came out of my room, I saw him proudly peeing on the hall carpet saying, "Clean up!  Spray soap!"  Ugh--the downside of having a kid who loves to clean and is obsessed with spray bottles.  Needless to say, he did not fish his wish.  Instead, we soaked up what we could with a towel, and then I declared an early bed time.  I stuck to my guns with the usual three stories in the chair, one story on the potty, and then to bed.  I thought I was so smart.  On the webcam, I could watch him rolling around, sipping on his water bottle and getting settled in bed.  I was sure he'd be asleep any minute.  Then 20 minutes later, shrieking.  Eventually, I went in, rubbed his back and reminded him that it was time to sleep, and when he seemed nice and calm, I left.  Another few minutes of silence, and then more shrieking.  Finally, about an hour after we had first said goodnight, I caved.  I got him out of the crib, sat back down in the chair, and held him until he fell asleep, something I hadn't done in ages.

This morning he woke up about 20 minutes earlier than usual, and he was cranky.  We made it through the first part of the morning without too much trouble, and at 8:00, I handed a seemingly happy kid off to the nanny before I headed off to an appointment.  A couple of hours later, I had planned to meet them at the children's museum, where they had a playdate scheduled with one of Asher's friends and her nanny.  There was a large school group on a fieldtrip there, so the nannies decided they would rather go elsewhere.  I wanted to squeeze a workout in before heading to the office for an afternoon full of appointments, so I took Asher back to the car and said goodbye.  Apparently, I underestimated the effect my brief appearance would have.  By the time he got home, he was tired and frustrated and upset that I hadn't been there.  Oops.

I eventually had to head to work, again leaving behind a seemingly contented kid.  Little did I know that a volcano was about to erupt.  Nanny leaves around 4:00.  At 4:20, I got several calls to my cell phone, which I could hear from the exam room where I was talking with a patient.  Finally I decided something must be wrong, so I went out an answered.  Crockett wanted to know where I was, forgetting that I had to work that afternoon even though Thursday is usually my day off.  Asher was a mess, crying and fussy and inconsolable.  Apparently he had been like that for a while.

When I finally got home, Daddy and Asher were both exhausted and vegging out in front of some A-B-C youtube videos.  We had dinner and planned an early bedtime for the little guy.  Normal bedtime routine, and again, the shrieking.  Again, Mommy held Ashie until he fell asleep.  Goodbye, sleep training.

Weeks like this, lots of thoughts, mostly self-critical ones, enter my mind, ranging from doubt about my understanding of my own child and wondering if stay-at-home moms have a better sense of what to do to frustration with myself for not sticking to the cry-it-out method of sleep training that we've used for months and concern that I've ruined his ability to self-soothe permanently with the last two nights.  This time, I even wondered if my assumption that we have successfully potty-trained him--something I have been so sure and proud of--was premature.  I wish I could see the glass as half full: my child loves me; he misses me when I'm gone; despite having a working mother, he has secure attachment.  While it's normal for a mother to worry about her child, and I suppose it's healthy to examine your parenting behaviors, I think it's sad that we hold ourselves to an imaginary standard of perfection.  We all struggle.  We all have bad days.  We all have moments when we misinterpret our children's needs.  We all cave from time to time.  But few of us are willing to admit it.  The good news is that our kids are resilient, and so are we. 

Besides, it feels damn good to snuggle up together in that big chair. 

Thursday, April 25, 2013

The Toddler Ten

You've heard about the "Freshman Fifteen," that weight gain young women often undergo when they leave for college due to an over-consumption pizza and beer, right?  I'm coining a new term: the Toddler Ten.  For a lot of women with young children, weight is a big issue, and I am convinced that in most cases, the kid is to blame.  I am living proof.  No, I don't want anyone to give their two-year-old a hard time about this.  What I mean is that a lot of aspects of having a little kid in your life that not only make it more difficult to lose weight but also probably contribute to weight gain.  Until you identify how these factors play into your lifestyle, you will never be able to make the changes necessary to stop gaining weight and, hopefully, start losing.

I know that most of you who know me in person are rolling your eyes and groaning right now.  True, as an adult, I have always been thin and haven't had to think much about my weight. Even trying to gain weight during pregnancy, I only managed to pack on 15 pounds.  Yet, I realized something was wrong when I looked at some pictures of myself about eight months ago.  To my horror, I discovered that I still looked pregnant.  The scale said the same thing.  Though I was down to my pre-pregnancy weight about six months after delivery, I didn't stay there. What was happening?

Pondering the changes in my lifestyle and eating habits, I realized that it was all the little man's fault. Here's why and how I changed things for the better:

1. Lack of time for exercise.  Especially for those of us who work, there is little flexibility in our schedules to carve out time to exercise.  I used to be able to get up super early in the morning to get my workout in, but when you're waking up at night to care for a baby or toddler, any extra sleep you can squeeze in is important.  For those who don't work, unless you can do everything--exercise, clean, cook, etc.--during naptime, you need a sitter for you to get some exercise, and most don't have that luxury.  Joining a gym with childcare might be an option, but with all the kid expenses, that might not be in the budget either.  Things get even harder as your baby become a toddler and cuts back from two naps to one (and on bad days, none).  And not to burst anyone's bubble, as tiring as it can be, chasing a toddler around the house does not count as exercise from a fitness or weight loss standpoint.

I  had grand plans before I delivered.  Somehow I was under the delusion that I would have a kid who would love to ride in the jogging stroller while I ran every day.  I think the folks at my office suffered from the same delusion because they gave me a BOB stroller at my shower.  As it turns out, I actually fear running with my antsy kid because I'm pretty sure he will lose his mind two miles away from the car, and I'll have to find some way to get us both back there without losing my mind as well.  I needed an alternative.

The reality is that your child needs you to be healthy to care for him, so you need to find a way to take care of yourself.  In my case, solo runs are great, but only if I don't have to spend a lot of time driving to my starting point.  Unfortunately, my house is at the top of a big hill, and my legs simply can't tolerate running that hill day in and day out, so the hubby and I started looking into home exercise programs.  "Insanity" was as hard as the name implies, but I could do it at home without any special equipment, so I could do it easily during kiddo's naps.  Recently, I also rearranged my office schedule so that I have time at lunch to squeeze in a run on the flat land near my office at a time when I already have childcare.  Hubby does the same thing.  On the weekends, we each take shifts so that the other can exercise or do whatever else is important at the moment.  We might not get out as much as some families whose weekends are packed with activites, but we're healthier for it.

2. Toddler snacks.  Little kids like to eat a lot of starchy, fatty, sugary foods.  So do adults.  The difference is that kids actually need fat and calories in these foods; you and I do not.  If your pantry is full of cheese crackers, fruit snacks, and worse, it's natural to be tempted by these things.  The easiest way to avoid this stuff not to buy it in the first place.  Your child can still have plenty of tasty, easy snacks.  Try cheese, fruit, toast with peanut butter, cereal with milk.  There are a lot of ways to provide good snacks without tempting yourself.  My kid eats hummus with a spoon. He loves my healthy creamed spinach.  Toddlers aren't biased the way we are.  They are naturally drawn to a lot of foods that we dub "health foods" as adults.  Let your kid eat health food (just don't limit his fat and natural sugar intake).  Get the junk out of the pantry.  If your child is older and protests when the chips and cookies disappear, be strong; you are the adult and get to call the shots.  Remember that teaching your children to appreciate healthy food is helping them make better choices later in life.  If you show them that eating well is important, they will carry on your legacy.

3. Dinner time.  Many studies show that families who share meals produce healthier, happier kids in the long run.  From an adult diet standpoint, eating as a family is easy when babies are eating purees; once they can handle table food, it's a whole new ballgame.  I found myself trying to find meals that my boy would/could eat (his teeth have been slow to come in and at nearly two, he is just starting to get his canines and still needs a set of molars), and they all revolved around a starch--mac and cheese, spaghetti, fried rice.  I'm not anti-starch, but it's hard to get really full on a meal of mac and cheese without eating way more calories than you actually need.  I started thinking about things a new way: prepare and serve what the adults eat and let the kid learn to eat that way too.  Now we have a more balanced meal.  Lots of veggies and protein in addition to the starches. I try to make sure that all of our meals have some component that he will eat, but I don't make the meal revolve around his preferred diet.

[Note: studies show that it can take at least 20 tries for a child to willingly eat a new food, so if your kid protests at first, try again!]

4. The tempting tray.  We ALL start snacking off our kids' plates at some point.  I'm not sure why this is.  We probably serve bigger portions than a child can eat and don't want to see so much waste.  We are also serving our kids foods with more starch, sugar, and fat than we generally allow ourselves, so there is a huge temptation to eat the leftovers.  I have never seen a parent who doesn't do it, though some patients deny it.  If you want to get rid of those extra pounds, stop eating your kid's food, or at least factor that into your own daily intake.  This is especially important if you don't eat your meals together.  Because I know I'll probably finish my son's dinner for him, I serve myself a lot less than I used to, and as absurd as it sounds, there are times that I literally talk myself out of "tasting" what's left on the tray.

5. Starving yourself.  If you aren't eating throughout the day, your child's food is going to look especially tempting.  You'll eat fewer calories and more healthfully if you keep up with your meals and snacks.  When I'm at home, I feed myself when I feed Asher.  At work, I stick to the same schedule.  This reduces the chance that I will overeat because I'm not starving when I am around food.  Also, your internal clock knows when it is used to eating and will tell you your hungry at certain times of the day, even if you've just had a high calorie meal.  I know a lot of people who will eat a big breakfast on the weekend and say they'll skip lunch.  Not sure how well that works for them, but I personally am always hungry when lunchtime rolls around.  If you're anything like me, it helps to keep your meal and snack times relatively consistent. 

6. Not doing unto yourself....  We all take better care of our families than we do of ourselves.  How many moms spend a good chunk of time each week packing lunches for their kids but rely on a run to the closest fast food joint for their own lunch?  I always make sure we have plenty of cut up veggies and fruits for the little guy to snack on when I'm away.  One day I caught myself thinking that I should bring a snack to work but not wanting to take "Asher's food."  Weird, right?  It occurred to me a second later that I was spending a lot of time on food prep every week but didn't personally benefit from all that work.  Increasing the number of peppers and cucumbers I cut up each week took minimal effort, but now there was plenty for the whole family to enjoy.  Now Asher has veggies for his snacks, and we have veggies to throw into salads to take for lunch.

7. Stress with a capital S.  Moms and dads are stressed people.  We have a lot more responsibility and worries than childless people. Stress contributes to weight gain.  Whether it's because of hormonal changes triggered by stress or simply the over-eating for comfort that stress promotes, I'm not sure--I'm guessing the latter because despite a lot of stress in college and med school, I was always under-weight due to not eating as a coping mechanism.  Either way, a lot of people gain when stressed, so if only from a weight perspective, it is important to find an outlet. Exercise is a great one, but if that doesn't do it for you, try meditation, journaling, baking...whatever gives you a moment to breathe.

I'm not saying that any of this is easy--it is serious work--but before you start calorie counting, think about where those calories come from and the barriers that are preventing you from burning them off.  Consider the little changes you can make to your current routine that might make a big difference.  Do this before you try the newest fad diet or ask your doctor for a weight-loss pill.  Your children will learn from you and will be healthier and happier people for a lifetime, and so will you.

Tuesday, April 23, 2013

What's in a Name?

When I was a resident, I had a very interesting and unusual patient, CH.  She had very little wrong with her medically, but she needed a lot of medical care, and there were days that I honestly dreaded being her care-giver.  I was reminded of her today when I received a message from a patient that included the comment that my name was M-D, MD, "Cute."  CH was the only other patient who has ever mentioned that to me.  Immediately, I flashed back nine years.

I first met CH during my first year of residency.  She had become a regular patient of one of my senior residents, Dr. T.  At time she was homeless and without resources.  He happened to be working in the Gyn ER when she turned there looking for help for a minor medical problem.  They connected, and he started letting her stay there when she was in need and the place wasn't busy.  Eventually, her life got a bit more stable, but she was stuck to him like white on rice.  I worked with him for several months out of my first year, and so, inevitably, I became acquainted with her but had little real contact.  She needed him for support, and not the kind of support that physicians in training, who are focused on the medical side of everything, usually have on the mind.

And then, like all residents, Dr. T. graduated.  As his graduation approached, he warned her that she would need to pick a new doctor and gave her a list of the people with whom he had worked and thought she might like.  She looked at my name and decided that "M-D, MD" must be a sign and chose me.  I was not excited about this.  She was notorious for showing up unannounced anywhere Dr. T. happened to be working.  I was busy and focused and didn't need the extra work.

Our first few meetings were awkward.  I couldn't figure out what her actual medical problems might be, and I couldn't figure out why she needed to be seen so frequently.  To make matters worse, though she had an appointment for the first visit or two, soon thereafter, she started to show up every afternoon I was in clinic and create a stir by demanding to see me.  I admired Dr. T. and wanted to do right by him but couldn't bear the thought of seeing this woman.

My dedication to Dr. T. won out and I kept seeing her.  Eventually, the clinic staff just knew that she was coming and didn't argue.  I had at least twelve patients booked every clinic afternoon and adjusted my practice to get them seen and still have enough time to talk to CH for a while, usually half an hour or more.  I eventually set some boundaries and got her to come later in the day so that I could get most of my work done before she arrived.

I learned a lot about her in the three years that I was her doctor, and very little of it had anything to do with her medical history.  I learned about her childhood and younger adulthood. I learned about the challenges she faced throughout life.  I learned about how she had become homeless, and I watched her slowly climb out of homelessness.  I learned about her love for literature and writing and her desire to go back to school and get a masters in fine arts.  I learned about the difficulty acquiring Chapter 9 housing so that she could move out of the shelters.  Later, I learned about her hatred for the kind of life she was living in Chapter 9 housing.  I learned about the frustration of the public medical system when all you need is dentures to replace the teeth that were pulled because of damage from your history of binging and purging and it takes years to get them.  I learned about the trials of taking the bus from Long Beach to the East Side of LA every week to see your doctor.  

Above all, I learned from her how to be a better doctor.  I learned to set side my curiosity about how I could help from a medical standpoint because she helped me understand that sometimes helping doesn't always mean doing something.  In fact, I did almost nothing medically to help her.  Over three years, I managed to work the system to get her bone density checked and kept her up-to-date with her pap smears and mammograms.  Other than that, I was just a sounding board, an empathetic listener at times when there was no one else.

When it was time for my own graduation, saying goodbye was hard.  I wouldn't miss the stress of trying to cram so much work into so little time in order to create space to talk to CH every week, and yet, I cried a little.  We had a connection.  Moving ahead with my new life, I thought about her a lot at first but less as time moved on.

Fast-forward to 2011: letter arrives in the mail shortly after I return from maternity leave.  An update from CH.  She has completed her MFA.  She is doing well.  Life is good.  So much has changed for both of us.

It would probably come as a surprise to all of my friends from residency for me to say that my time with CH was one of the most valuable parts of my training, but six years later, I truly believe that.  She taught me so much about the importance of listening and empathy, and she forced me to learn how to provide that kind of attention while at the same time providing quality care to other patients.  Largely because of her, I can stop the business-as-usual of medicine and be present for a patient with other needs and then re-engage to provide the medical care other patients need and still stay--at least relatively--on schedule.  Most importantly, I have learned when to stop being such a "doctor" and start being a "supporter."

Who knew having this name would get me here?

Sunday, April 21, 2013

Travelin' (Wo)Man

This evening I am leaving for my first business trip in over two years. In fact, it's my first solo trip of any kind in the last couple of years.  It's a quick flight to Denver to observe surgery tomorrow, and I'll be home tomorrow night, but I am dreading it.  It's not my first night away from home since Asher was born--as you might imagine, there are some nights that I just don't make it home because L&D is busy--and there are even more nights that I'm home to sleep but miss Asher's bedtime and wake-up, but somehow having to go on a plane and planning to sleep in another bed makes feel more "away."  Mommy is not handling things well. 

Being a physician in private practice generally means staying close to home.  Whereas some docs travel a lot to conferences and training gigs, those of us in private practice don't get out much.  It's one thing when your employer pays for these kinds of trips and doesn't dock your salary.  Unfortunately, I don't pay myself for time out of the office, so most of my continuing education comes from reading and local meetings.  Honestly, it's what I prefer.  I am definitely a homebody.  I've never wanted a job that would acquaint me with airports all over the world.  My fear of flying might have something to do with that.  I am happiest in my own space, with my own stuff, and surrounded by my own people, even moreso now that "my people" means my little family.

I left the house much earlier than necessary.  I could have carpooled with someone, but that would mean leaving the house right at dinnertime.  Certainly not an ideal time for me to say goodbye.  But I think I realized that the longer the day wore on, the harder it would be for me to leave.  We tried to explain to Asher about my trip and how I would be home to see him in a couple of mornings.  The fantastic thing about two-year-olds is that he really didn't need an explanation.  Tomorrow he will be surrounded by people who love him--Daddy and Nanny Becca--and though he might think about me a lot, it won't really occur to him too much that I'm gone.   Most of me was hoping for a panicked, tearful goodbye from him.  Only a small part of me can acknowledge that this kind of goodbye was better for all involved.

So here I sit in the San Jose airport, about 3 hours before my flight is actually going to leave (an hour delay...so far).  The few belongings I need for this whirlwind trip are packed into the diaper bag I no longer need since it's the only bag I have that is remotely the correct size.  I realize now that it's been ages since I've traveled so light, and the bag is a not-so-subtle reminder of the 25-pound cargo I left back home.  I feel self-conscious about it all, feeling like I don't fit in with the rest of the Silicon Valley business travelers for whom today is just like any other Sunday.  Unlike the other travelers, I've got a super cute cuddle bug to spy on via webcam while he sleeps tonight.  Can't wait for bedtime!

Saturday, April 20, 2013

The B Word

No, not THAT one.  In fact, with Asher's love of the ABC's, my life is full of a lot of B words right now.  But the one on my mind at the moment is BREASTFEEDING.  It came up a few times at work this week, which reminded me that it was one of topics I most wanted to talk about here because I think (or at least hope) that my input has helped a lot of my patients keep their sanity.  However, I have to admit that I'm a bit nervous to post this publicly because breastfeeding is such an emotionally-charged subject these days.

So that none of you miss the take-home message of what I'm about to say, it's this: Breastfeeding is best, but for some of us, it's hard, and although breastfeeding has a bazillion benefits over formula, the most important thing for your child is having a sane mother.

First of all, I am totally pro-breastmilk.  Aside from being cheap, convenient (no supermarket runs at midnight when you run out), and safe (no need to worry about contaminants in the water), it delivers immunoglobulins and other substances that even the best formula can't and apparently even boosts your kid's IQ.  Nursing has even more benefits: bonding time for mom and baby and even more convenience.  Plus, there are long-term health benefits for mom as well, including, but not limited to, increased calorie-burning = postpartum weight loss, decrease in the risk of postpartum depression, and decrease in the risk of breast cancer.  When breastfeeding goes well, it is a great experience for mother and baby, or at least that's what I've been told.

My experience was not so great.  My kid latched almost as soon as he was placed on me in the recovery room.  I thought it would be a breeze.  Then the actual nursing started.  Latch was good, but for some reason, day after day, my little guy lost weight.  By day 3, he had lost 12 ounces of his whopping 5 pound, 5.5 ounce birth weight.  Finally the pediatricians admitted that something wasn't right.  That's when the pump came out.  I was instructed by lactation consultants to nurse him for as long as he wanted, then pump and give him by bottle whatever I got out.  Then they left the room.  And left me all alone with a starving newborn.

My first word of advice is that if your kid is hungry and there is no milk available, give formula.  Fortunately, I had a pacifier (taboo, I know) with me, so I shoved that in his mouth to keep him "pacified" while I pumped. I quickly realized that at some point, I was going to have to pump a little extra in order to get ahead so that there wasn't a delay in getting him a bottle after our attempt at nursing.  With my milk just barely coming in and feeding every 2 hours, that wasn't an easy task.  I finally got around to that the following day.  In the meantime, every feeding was a bit of a nightmare for all involved, but I was determined not to give evil formula!

And so it went on.  Every 2 to 3 hours, nursing, bottle-feeding, pumping.  The whole routine took about an hour.  With a baby who was barely sleeping, this meant almost no sleep for me either.  Meanwhile, he was growing in size and appetite.  He was fussy and crying.  The amount of milk I actually pumped was pathetic, just 1-2 ounces total after half an hour.  Finally my husband convinced me to let him open the formula canister.  I felt like a total failure, but I was exhausted and had started to realize that Asher was getting almost all of his calories from the bottle and not from nursing.

At that point, I decided to do an experiment and skip the nursing part of the feeding altogether, just to see how much he needed to become satisfied.  Immediately it became apparent that he was probably getting nothing from the breast.  As I was slowly losing my mind from chronic sleep deprivation, I realized that if I was going to give him breast milk, I was going to have to be an "exclusive pumper."

It turns out that the exclusive-pumping club is not as exclusive as one might assume from the name, but the membership roster is short because very few can stick with it for long.  A lot of my patients have latch issues; eventually their nipples are torn to shreds, and they resort to pumping for a while to let themselves heal.  For a few weeks, it seems like pumping is an easier alternative than trying to get their babies to latch properly.  But in order to make it work well, you have to pump at least 10 times a day, which also means getting up in the middle of the night.  Any less than that, your supply won't come in and stay in. Add that to the nighttime feedings and playtime, and you are only getting a couple of hours of interrupted sleep each night.  Even with a supportive partner helping you out at night, it's exhausting.

Those were my nights.  Crockett took the early shift, from about 9-1; my shift was the second part of the night, though I still had to set an alarm to get up at some point during his shift to pump.  It was easier during his shift because all I had to do was pump.  My shift was harder.  I would get up with the baby, but if he didn't go to sleep after his bottle, I was up trying to entertain him while also trying to pump for 30 minutes.  Many nights I was hooked up to the pump while bouncing him around--thank goodness for those pumping bustiers--and trying to make sure I didn't spill any milk.  A lot of milk got spilled, and there were a lot of tears.  Very little sleep happened.  I continued to lose my mind, and my milk still didn't come in as planned, despite pumping 12 times a day and taking fenugreek religiously and staying nourished and hydrated.  I was incredibly frustrated and exhausted and cried a lot.  I loved Asher dearly but sometimes wondered if I had made a terrible mistake.  So much time was spent attached to the pump that I couldn't enjoy the newborn stuff as much as usual, and in some ways, it was a sad time.

A little over three weeks into it, my brother got married, and amid the stress of preparing to spend a weekend in a hotel for the first time with our newborn, I realized that I could not continue down this road.  A new experiment: what would happen if I pumped less often?  Amazingly, I produced as much milk over the course of the day but with much less effort.  And so I embarked on a new normal: pumping about 6 times a day and supplementing with formula as needed, which was about 50% at that point.  Asher continued to grow and thrive.

When Asher was 7 weeks and 6 days old, I returned to work.  Being self-employed has its benefits, and some flexibility in my schedule is one of them.  I don't have an office of my own, so I would shut myself in one of the exam rooms while I was pumping and charting.  Eventually the medical assistants learned that if the exam room door was closed before office hours or at lunchtime, I was pumping and they should just leave me alone.  Every activity was planned around my pumping schedule, and a pump went with me basically everywhere I went.  I even rented a hospital-grade pump to leave at work, and I bought enough extra pump supplies so that I only had to wash them once a day.

However, by the third month, my supply had begun to dwindle.  The day before we were supposed to leave on our first cross-country flight with Asher, I came home from work with only one ounce of milk to show for a total of an hour pumping.  I made the decision to stop.  It was one of the hardest decisions I ever made, but I realized that the stress of scheduling life around pumping was doing me in, and it just wasn't worth it anymore.  I cried as I bottle-fed Asher that last ounce.

And so started a period of shame.  I felt like not breastfeeding was my first failing as a mother.  I was depriving my son of the number one best thing I could give him.  I had trouble cutting myself slack and wouldn't give myself credit for trying as hard as I could and using every trick in the book.  I also felt like I was a hypocrite and terrible doctor.  How was I in any way equipped to counsel women about breastfeeding when I couldn't do it successfully myself?

Gradually, I began to see that I wasn't alone, and I realized that I was able to use my challenging experience to help my patients not just be more successful with breastfeeding but also be more forgiving of themselves when they were struggling.  I was also able to see when it was truly ruining a woman's experience with her newborn and felt more qualified to give her "permission" to supplement with formula or to stop nursing entirely.  I had a distinctly new sort of empathy.

It turns out that no matter how much you know about breastfeeding, there are some factors that are beyond your control to some extent, including your baby's cooperation and your supply.  And even if you have all the support in the world and follow all of the recommendations, sometimes it just doesn't work out.  That can be a very hard thing to accept as a new mother.  It seems like the most dire problem at the time, but in the grand scheme of things, it's a minor point.  A lot of us were formula fed and turned out pretty awesome (my brother and I were both formula-fed, and we both turned out OK).  What really screws kids up is having absentee parents or parents who are too stressed to connect.  Making yourself physically and emotionally available for that connection is far more important than what you feed your child.  It's easy to see now in retrospect but was difficult to understand in the moment.

When my incredibly bright child snuggles up with me to drink his sippy cup of milk (now, cow's milk), I know I did OK.

Thursday, April 18, 2013

The Easy Way Out?

The elective cesarean section.  At some point along the way, it occurs to a lot women that just having a c-section and getting it over with might be the best way to go.  No muss, no fuss.  You schedule things and just go to the hospital and get the baby out.  Perfect for the type-A personalities out there, right?  Wrong.

I'm here to say that there is NO EASY WAY  to have a baby.  I was reminded of this today while I was on call.  I spent the entire night pushing with a patient (for real, the entire night; EIGHT hours of pushing--a new record for me).  She, of course, questioned whether she should have just chosen a c-section from the start.  However, she ultimately delivered vaginally a vigorous baby girl.  The question becomes, is a vaginal delivery after a 38-hour induction and incredible physical, mental, and emotional fatigue the best way to accomplish things?  That, of course, completely depends on your perspective. 

An important disclaimer here is that I personally had an elective cesarean section, and I do elective c-sections when that's what my patients ultimately decide they prefer.  My point here is not to say it's the wrong thing to do, just that it is not an easier way to go.  When I discuss this issue with patients, I give them the pros and the cons and let them decide.  This is one place I know that personal experience has made me a better doctor.

A lot of people, especially those who have had uneventful vaginal deliveries in the past, wonder why any of us would have elective surgery.  The reasons vary: fear of trauma to the nether-regions, concern for fetal well-being, worry about pain, anxiety about the unknown, shame about pooping while pushing.  In my case, the reason was all of the above, but the over-riding fact was that I knew I would be overly anxious about labor.  I knew I would have to be induced because of some complications (at first, just a history of high blood pressure; later on, the list of issues grew), which I knew would be a long process, and I knew that I would be watching the fetal heart rate the entire time and would ask to go to the operating room with the first abnormality, no matter how mild.  Some of my colleagues just ask to put the heart rate monitor outside the room; that is not something I can conceive.  I guess I'm a bit of a control freak.  Anyway, it just made more sense for me to nip it in the bud and just go to the OR from the start.  But that decision was made, of course, with a very clear understanding of the down-sides of having a c-section.

 Although the data show that a planned cesarean section is probably not any more dangerous for mom and baby than a vaginal delivery, there are some real disadvantages.  The biggest ones are postoperative pain and physical limitations.  I always tell people that you get pain on one side or the other--either during the labor itself (few women get their epidurals so early in the process that it's not at all painful) or afterward.  Vaginal deliveries often result in a sore bottom for a few days, but it's nothing like the pain of an abdominal incision, which takes weeks to heal.  You don't realize how much you use your abs until you've had surgery.  Hard enough with just a newborn to deal with, but so much harder with the second (or third, fourth, etc.) baby, when you have older children to care for.  If you're not supposed to lift over 20 pounds, how are you going to manage your 2-year-old?  Then there's the additional day or two in the hospital.

Then there are longer-term effects: the once-a-c-section-always-a-c-section reality in many communities (including mine), the scar tissue caused by surgery that makes any abdominal surgery in the future more difficult, the lingering numbness and tenderness of the incision years later.  More serious issues include the higher risk of serious complications in subsequent pregnancies, particularly an increased risk uterine rupture (when the scar on the uterus tears open and can result in stillbirth if the baby isn't delivered immediately) and of placenta accreta (when the placenta grows into the uterine wall and usually results in an emergency hysterectomy at the time of delivery).  Not minor issues.

Time will tell how today's patient feels about her delivery in the long-run.  All things considered, I still feel that an elective cesarean was the right decision for me, and I'm still open about that fact when discussing with my patients.  But my circumstances were very different from most women's, and I definitely had deeper understanding of the risks when making that call.  From my perspective, I am also very glad that my patient this morning stuck with it and had a successful vaginal delivery.

And when baby Elizabeth is older, I'll be sure she knows how much thanks she owes her mom!