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.

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.

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.   

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.

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.

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?

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!

Moving Day Madness

Yesterday was a big day in my office: we grew!  More precisely, "we" had grown over the course of a couple of years from five docs to seven, without adding any office space.  Quarters were tight, and everyone's office hours were cut back so that we could share the exam rooms.  Yesterday our physical space grew.  And I was the lucky girl who got to work in that space.

You realize at times like this that you take for granted the systems you have in place.  Where does the medical assistant put charts to indicate that a patient is roomed and ready?  Which computer do I use?  How do I call my assistant in to help with an exam (for now, it's just a shout out the door, so I'm a bit hoarse from screaming, "ANGELA!!!" all day long--it turns out the new office space is quite large)?  And I got quite a workout running back to the main office to gather all the little things that I use throughout the day.  Then there was the grumpy guy putting in the phone lines who was yelling at his assistants too.

All of this led to some serious mental chaos.  This was my "desk" AFTER cleaning up.  Note the open purse spilling all over the place, charts strewn about, the stool that is way too low for the counter height.

Good thing it was a slowish day for me because not much work got done.  Not a single afternoon chart note got written.  Between the mess and the grumpy phone guy yelling in the background, I simply could not concentrate.

I couldn't wait for the day to end, but if you look, you can almost always find something positive amid the madness.  I see at least four lessons in all of this that definitely apply to real life.

1. Messes slow mental function and disrupt concentration.  Have you ever seen your kid over-stimulated?  If not, you haven't been paying attention!  We try to stick to one big rule in our house: before you get out a new toy, you put the last one away.   We don't always stick to it, but I've noticed the less mess on the floor, the less frantic the boy's behavior.  This rule applies other places as well.  For example, the fewer morsels of food we put on his plate at a time, the more he eats in the long run.  Simple, calm, and tidy always gets us better results.

2. We all thrive on routine.  I definitely felt out-of-whack yesterday.  Today back in my normal environment (the docs in the office rotate between different work areas), I'm back on track.  Yesterday one of my patients commented that she has been stressed out because her grandsons, ages six and seven, have recently moved in with her and they are "bad kids."  They've never had a stable home and haven't been taught basic manners and rules.  Children need consistency to learn and grow.  My least favorite part of parenthood is having to enforce the rules I've made, but it is vitally important.  Rules and expectations make kids feel respected and loved.  Likewise, never underestimate the value of a bedtime routine, meal schedule, or reading and re-reading a favorite book.  Having a rules and a system for things is comforting.

3. Change is hard, even when it's a change for the better.  For me, more office space means more time available to see patients, which in turn means that I can schedule more down-time into my day.  This is all good.  But living through the change is difficult.  You might even mourn the loss of the old way a little--I definitely felt that way yesterday.  This is true whether the change is a new exercise program or a new bedtime routine.  It's important to acknowledge the difficulty but also remember why you made the change in the first place.  Sometimes you have to work to get the life you want.

4. Change is exciting.  Despite all of the stress and frustration, part of me can't wait to work in that part of the office again.  It's new and different and interesting.  It reminds me of the excitement we had as kids eating breakfast for dinner or spending the night in our sleeping bags on the family room floor rather than in bed.  You've got to balance the routine with the thrill of the unexpected!