The most recent month of my fellowship was hard. It entailed the subject matter I am least interested in, a hard to deal with patient population, and as the consult service I was basically at the beck and call of the whole hospital. I didn't see nearly enough of my son or my husband. I was tired and cranky.
Thankfully, that's behind me and I'm now on vacation.
A long weekend in Baltimore. Catching up on the laundry. Reading my articles for work. Playing cards with Dave. Cooking and freezing food for future on call meals.
Staying home all day with Nathan.
What does that entail?
Up around 7am. Morning squirming and wrestling. Lots of smiling. Morning lotion application and struggling to wedge a lotioned-up baby into clothes while he takes evasive action and tries to roll off the changing table. Breakfast with food flung all over. Cleaning up the boy. Playing on the floor (balls rolling down a ramp, lights flashing, monkeys swinging). Sudden outbreak of clinging and whining that signals the need for a morning nap. Nursing. Rocking. Listening to bed time singing over the monitor. A couple hours of sleep while I try to sqeeze in all the other above listed activities. Smiling boy waking up from a nap. Lunch with food flinging. More playing and wrestling. Singing lots of silly songs. Afternoon nap - with lead in same as the first. Cooing boy waking up from second nap. Dinner for all (Nathan eats, blows bubbles in food, throws bits of finger food on the floor, starts to cry and buck before Mommy and Daddy have finished eating and then coos happily when freed from the high chair to play with Mommy's chair/plate/hair/necklace while Mommy tries to finish a lukewarm meal). Maybe a bath. More playtime with Nathan trying to adhere himself as close to Mommy as possible and protesting with every inch of separation. Nighttime application of lotion and steroid cream and shoehorning a squirming mewling boy into pajamas. Brushing four sharp little teeth. Singing. Nursing. Rocking. Asleep for the night.
Until 2am and the next time he wants to eat.
I have enjoyed every second of it, but being on vacation is tiring.
Thursday, September 24, 2009
Sunday, September 13, 2009
House of Horror
Halloween came early to our house this year.
This weekend Dave and I decided that Nathan needed a new toy. He loves balls. He loves lights. He loves music.
We saw the gumball machine and thought it was the obvious choice.
Maybe Nathan finds something threatening it its perky grin, its bubblegum music, or its festive lights.
Whatever the case, he's frankly terrified by it. The first time we set it up and triggered its ball-dropping, music-playing lever he burst into tears and hid his face in my chest. He's happy enough to peek at it in a quiescent state, but as soon as it is activated he scrambles the other way.
I initially found this vaguely entertaining, but it seems to be emblematic of a new stage in our little man's life. The Fraidy Cat stage.
Other evidence? He preferred to stare at our friend Dave from the safety of my arms at breakfast. Being held by someone else? Not so much. Two nights ago he chortled happily when the big green ball rolled in his direction. this afternoon, he cried.
I am so glad that Nathan feels safe in my lap, in my arms. I am actually relieved that as much time as I have spent away from the house in the last few weeks he still sees me as a source of safety and comfort. But I am stunned that my curious little explorer would prefer to be held and to watch. Two days ago he wanted nothing more than to hold my fingers so he could "walk" around the living room. Tonight he would not walk any further than my lap. With a lunge he threw his arms around my neck and settled happily in.
We are trying to desensitize him. I hold him safely and Dave plays with the toy. We are trying to show him that it is safe. And it drops balls, for goodness sake. In Nathan's world balls are tantamount to paradise. He should make friends with the ball giver.
So far, however, it seems we've turned Nathan's home into a house of horror.
This weekend Dave and I decided that Nathan needed a new toy. He loves balls. He loves lights. He loves music.
We saw the gumball machine and thought it was the obvious choice.
Maybe Nathan finds something threatening it its perky grin, its bubblegum music, or its festive lights.
Whatever the case, he's frankly terrified by it. The first time we set it up and triggered its ball-dropping, music-playing lever he burst into tears and hid his face in my chest. He's happy enough to peek at it in a quiescent state, but as soon as it is activated he scrambles the other way.
I initially found this vaguely entertaining, but it seems to be emblematic of a new stage in our little man's life. The Fraidy Cat stage.
Other evidence? He preferred to stare at our friend Dave from the safety of my arms at breakfast. Being held by someone else? Not so much. Two nights ago he chortled happily when the big green ball rolled in his direction. this afternoon, he cried.
I am so glad that Nathan feels safe in my lap, in my arms. I am actually relieved that as much time as I have spent away from the house in the last few weeks he still sees me as a source of safety and comfort. But I am stunned that my curious little explorer would prefer to be held and to watch. Two days ago he wanted nothing more than to hold my fingers so he could "walk" around the living room. Tonight he would not walk any further than my lap. With a lunge he threw his arms around my neck and settled happily in.
We are trying to desensitize him. I hold him safely and Dave plays with the toy. We are trying to show him that it is safe. And it drops balls, for goodness sake. In Nathan's world balls are tantamount to paradise. He should make friends with the ball giver.
So far, however, it seems we've turned Nathan's home into a house of horror.
Monday, September 7, 2009
It's Been A While
Fellowship is a lot of work and I've spent my out of work moments with my boys at home so I apologize for my absence from cyberspace.
I love my job. I like the people I work with. I like the patients. I like the science I am learning and the clinical medicine I am practicing. I am developing my own ways of talking to parents and patients and have received feedback that these ways are not completely dysfunctional.
I'm not terribly fond of benign hematology but I do derive a lot of satisfaction from taking care of cancer patients and their families. I am asked a lot why I chose to do this, and there is a fairly straightforward answer.
Hope.
In my experience working all over a children's hospital, there is no better environment than the pediatric cancer ward. Everyone thinks their patient population is special, but these are truly awesome kids, families, nurses, doctors, child life specialists, and social workers. I have not been anywhere else in the hospital where there is less whining, more resilience, more support and people caring for each other. Kids are kids. They aren't held down easily. They make friends with the people who take care of them week in and week out and everyone develops special relationships with their patients and their families. It's common to see a small band of children, all in crazy spunky hats roaming the halls of the clinic looking for a favorite nurse or doctor to take a picture, give a gift, or play a clever prank.
The outcomes for a lot of pediatric cancers are pretty good and we make a lot of these kids better and let them get on with their lives. Even those with the poorest outlook are treated like survivors by parents and staff. No one ever stops hoping that they get the best they possibly can.
Still, there are hard moments. Telling any parent their child has cancer. Telling a new high school grad that he'll be taking a detour on the way to his adult life. Watching a colleague suffer through the loss of a patient they have known and cared for for years. Looking at a sick little boy and just wanting to go home and hug your own baby knowing there are hours yet to go. Fearing that the karma of telling someone they will likely loose their own child will come back to bite you in the ass.
I often feel bad that I am fascinated looking at pathology slides, that I use the word cool to describe an imaging finding that will change a whole family's life forever. Still, I am here because the science fascinates me. And because the children move me.
This weekend was harder than any yet. In a sink or swim moment I sat with a family and told them that their little guy has one of our hardest to treat tumors and has a coin flip chance of being alive in two years. I did it with out the benefit of an attending physician present. Since then I have had the conversation swirling in my head trying to determine what I could have done better. I have told people before that their baby (aged 3-19y) has cancer but those babies were very likely to live to graduate from college. It's an easier conversation. This one was not.
I hated it but certainly not as much as they did.
I am humbled that the mother exclaimed "Look, E***, it's your friend Dr. Jen!" when I came back the next day.
I feel inexpressibly fortunate to have a healthy, smiling little boy.
I love my job. I like the people I work with. I like the patients. I like the science I am learning and the clinical medicine I am practicing. I am developing my own ways of talking to parents and patients and have received feedback that these ways are not completely dysfunctional.
I'm not terribly fond of benign hematology but I do derive a lot of satisfaction from taking care of cancer patients and their families. I am asked a lot why I chose to do this, and there is a fairly straightforward answer.
Hope.
In my experience working all over a children's hospital, there is no better environment than the pediatric cancer ward. Everyone thinks their patient population is special, but these are truly awesome kids, families, nurses, doctors, child life specialists, and social workers. I have not been anywhere else in the hospital where there is less whining, more resilience, more support and people caring for each other. Kids are kids. They aren't held down easily. They make friends with the people who take care of them week in and week out and everyone develops special relationships with their patients and their families. It's common to see a small band of children, all in crazy spunky hats roaming the halls of the clinic looking for a favorite nurse or doctor to take a picture, give a gift, or play a clever prank.
The outcomes for a lot of pediatric cancers are pretty good and we make a lot of these kids better and let them get on with their lives. Even those with the poorest outlook are treated like survivors by parents and staff. No one ever stops hoping that they get the best they possibly can.
Still, there are hard moments. Telling any parent their child has cancer. Telling a new high school grad that he'll be taking a detour on the way to his adult life. Watching a colleague suffer through the loss of a patient they have known and cared for for years. Looking at a sick little boy and just wanting to go home and hug your own baby knowing there are hours yet to go. Fearing that the karma of telling someone they will likely loose their own child will come back to bite you in the ass.
I often feel bad that I am fascinated looking at pathology slides, that I use the word cool to describe an imaging finding that will change a whole family's life forever. Still, I am here because the science fascinates me. And because the children move me.
This weekend was harder than any yet. In a sink or swim moment I sat with a family and told them that their little guy has one of our hardest to treat tumors and has a coin flip chance of being alive in two years. I did it with out the benefit of an attending physician present. Since then I have had the conversation swirling in my head trying to determine what I could have done better. I have told people before that their baby (aged 3-19y) has cancer but those babies were very likely to live to graduate from college. It's an easier conversation. This one was not.
I hated it but certainly not as much as they did.
I am humbled that the mother exclaimed "Look, E***, it's your friend Dr. Jen!" when I came back the next day.
I feel inexpressibly fortunate to have a healthy, smiling little boy.
Thursday, August 13, 2009
Rue-ing the Goat
Thoughts On Exclusive Breastfeeding From A Dr. Mom
There was never any question that I was going to try to breastfeed my baby. As a pediatrician I wanted all the health benefits. As a sufferer of the economic crisis I wanted the cost savings. As a Mommy I wanted to hold my little warm sweet smelling baby and know I was doing something special. Plus formula smells gross, stains clothes, and makes baby poo look and smell like poo.
When he was just born and failing to gain weight, I was obsessed with not having to give him formula, and I never did. That was despite telling numerous patients and friends that formula was not the end of the world, said nothing about their parenting, and all the accurate blah, blah that makes no impact on an estrogen crazed new mom.
With the benefit of slightly more rational hindsight, I know it would not have been the end of any one's world if I had given some formula. That did not, however, keep me from going insane and spending an entire night sobbing when I started fellowship, my supply plummeted, and I thought I was going to have to give him formula before my arbitrary and self-imposed goal of 6 months.
There I was, a newly minted fellow, busy, nervous, trying to balance home and family with education and the needs of families whose kids have cancer, for goodness sake. So I didn't have enough milk, we went through my frozen supply, and shortly after the short one turned five months old, we decided we had to offer him some formula. My ego and sensitive sense of smell aside, I really just wanted him to be nourished. My son with the highly refined palate who finds sunglasses, carpet, and restaurant tables to be de-licious, basically refused to take formula. He'd be clearly hungry but would prefer to chew on the nipple, spit out the formula and grin. With persistence on the part of the feeder he progressed to disgusted facial expression and finally pitiful mewling. One of his daycare providers said she just felt bad because she wouldn't want to be forced to eat something she doesn't like.
After a month of struggling and never getting more than 2 or 3 ounces into him, we have finally decided that this is OK. He is growing along his own curve. While he is a little guy, he is not genetically programmed to be big and he is gaining weight, height, and head size. Plus he's smart and happy, and gives no indication that he'd like to eat more than he does. He eats what I pump plus some cereal and a few veggies. He supplements this with a hearty daily intake of plastic turtle chew toy, crib rail, and human fingers (hopefully fairly clean). At daycare they still lament that he does not eat enough but his pediatrician and his doctor mom agree that as long as he is doing well, it is not worth the struggle. We have thus decided that if he is hungry and there is no leche de madre we will offer formula and if he is not hungry enough ti take it, so be it.
And so, little man, you have won. Your will is stronger than that of the grow-ups in your life. Mommy will continue take the fenugreek/goat's rue concoction that tastes far worse than formula (and yes, I have sampled) but that also does increase supply. She will also continue to feed you at 1am even though most babies can sleep through the night by now because mommy and your pediatrician agree you need the nutrition and mommy needs the help keeping up the supply. We will watch your weight and decide what to do if you start to fall below your curve.
You will eat only what pleases you. (And though it has now pleased you for 2 days in a row to take a small bottle for formula, we will not discuss that out loud in case it is a fluke.)
The trouble I am having is this. Since we have been having this struggle, I have heard countless stories from other moms whose exclusively breastfed babies refused formula when the milk dried up. What, if anything, do we do about this? Again, as a pediatrician and a mom I know that breastfeeding as much as you can is best for mom and baby. I also know that giving formula early on can decrease mom's supply leading to more formula and less breastfeeding. But what about this? What about the inevitable fact that a working mom's supply will drop and this woman who has been martyring herself with pump and herb will come head to head with the inflexible will of a five or six month old? What about the fact that early baby foods provide basically no protein and the only source for that is milk or formula? Are we doing the wrong thing for our babies by trying to do the right thing?
Input is welcome.
There was never any question that I was going to try to breastfeed my baby. As a pediatrician I wanted all the health benefits. As a sufferer of the economic crisis I wanted the cost savings. As a Mommy I wanted to hold my little warm sweet smelling baby and know I was doing something special. Plus formula smells gross, stains clothes, and makes baby poo look and smell like poo.
When he was just born and failing to gain weight, I was obsessed with not having to give him formula, and I never did. That was despite telling numerous patients and friends that formula was not the end of the world, said nothing about their parenting, and all the accurate blah, blah that makes no impact on an estrogen crazed new mom.
With the benefit of slightly more rational hindsight, I know it would not have been the end of any one's world if I had given some formula. That did not, however, keep me from going insane and spending an entire night sobbing when I started fellowship, my supply plummeted, and I thought I was going to have to give him formula before my arbitrary and self-imposed goal of 6 months.
There I was, a newly minted fellow, busy, nervous, trying to balance home and family with education and the needs of families whose kids have cancer, for goodness sake. So I didn't have enough milk, we went through my frozen supply, and shortly after the short one turned five months old, we decided we had to offer him some formula. My ego and sensitive sense of smell aside, I really just wanted him to be nourished. My son with the highly refined palate who finds sunglasses, carpet, and restaurant tables to be de-licious, basically refused to take formula. He'd be clearly hungry but would prefer to chew on the nipple, spit out the formula and grin. With persistence on the part of the feeder he progressed to disgusted facial expression and finally pitiful mewling. One of his daycare providers said she just felt bad because she wouldn't want to be forced to eat something she doesn't like.
After a month of struggling and never getting more than 2 or 3 ounces into him, we have finally decided that this is OK. He is growing along his own curve. While he is a little guy, he is not genetically programmed to be big and he is gaining weight, height, and head size. Plus he's smart and happy, and gives no indication that he'd like to eat more than he does. He eats what I pump plus some cereal and a few veggies. He supplements this with a hearty daily intake of plastic turtle chew toy, crib rail, and human fingers (hopefully fairly clean). At daycare they still lament that he does not eat enough but his pediatrician and his doctor mom agree that as long as he is doing well, it is not worth the struggle. We have thus decided that if he is hungry and there is no leche de madre we will offer formula and if he is not hungry enough ti take it, so be it.
And so, little man, you have won. Your will is stronger than that of the grow-ups in your life. Mommy will continue take the fenugreek/goat's rue concoction that tastes far worse than formula (and yes, I have sampled) but that also does increase supply. She will also continue to feed you at 1am even though most babies can sleep through the night by now because mommy and your pediatrician agree you need the nutrition and mommy needs the help keeping up the supply. We will watch your weight and decide what to do if you start to fall below your curve.
You will eat only what pleases you. (And though it has now pleased you for 2 days in a row to take a small bottle for formula, we will not discuss that out loud in case it is a fluke.)
The trouble I am having is this. Since we have been having this struggle, I have heard countless stories from other moms whose exclusively breastfed babies refused formula when the milk dried up. What, if anything, do we do about this? Again, as a pediatrician and a mom I know that breastfeeding as much as you can is best for mom and baby. I also know that giving formula early on can decrease mom's supply leading to more formula and less breastfeeding. But what about this? What about the inevitable fact that a working mom's supply will drop and this woman who has been martyring herself with pump and herb will come head to head with the inflexible will of a five or six month old? What about the fact that early baby foods provide basically no protein and the only source for that is milk or formula? Are we doing the wrong thing for our babies by trying to do the right thing?
Input is welcome.
Sunday, August 9, 2009
Roses and Thorns . . . It's been a while
Thorns:
- There is water leaking from the bathroom into the dining room. We think it's the toilet so we are going to the basement to relieve ourselves. This is the second time since we moved in here that going to the bathroom in the middle of the night has required shoes. This time it also requires disabling the burglar alarm.
- We continue to catch mice in the trap in the living room - I think we're up to 5. Plus 2 or 3 in the kitchen and 2 in the laundry room. All this after the wildlife expert/exterminator assured me, in a friendly but vaguely patronizing way that mice don't hang out in houses during the summer. They like it better outside. I guess we are breeding domesticated mice.
-The driver's side window on my car is stuck open again - 4th time since I got the car, 2nd time in 6 months. I don't think I make extraordinary demands of the window - just that it roll up and down roughly twice a day.
- This is week two after the Great Dishwasher Explosion of 2009 and we are still without a dishwasher. Why are white kitchen appliances special order??????
- Due to the day care plague that nearly killed Dave and I, we missed floppy hat night at PNC Park - a game the Pirates actually won, and a mighty cool hat.
Roses:
- We are contributing to the education of American youth by putting our plumber's son through college.
- We are no longer finding mouse poop on the kitchen counters in the morning.
- My car's mutinous actions have not resulted in any more near death experiences, just inconvenience
- I have managed to hand wash our newly sharpened knives without slicing off any appendages.
- We have recovered from the day care plague and I finally have my voice back (after a week of squeaking and being referred to as Dr. Froggy by the hospital page operators).
- Nathan is 6 months old and per his pediatrician doing all the growing and learning he is supposed to for his age. We think he is doing a teensy bit more - learning, that is, not growing.
Wednesday, August 5, 2009
Heard at My House Today
"Please don't smear the carrots with the hand Mommy just washed"
"Oh my goodness, you have carrots in your eyelashes!"
"Your hair smells like sweet potatoes . . . but you ate those yesterday"
Mommy: "Yum, yum, yum, yum, yum"
Nathan: slurping, sucking, smiling
All in all, starting solids is a lot of fun.
"Oh my goodness, you have carrots in your eyelashes!"
"Your hair smells like sweet potatoes . . . but you ate those yesterday"
Mommy: "Yum, yum, yum, yum, yum"
Nathan: slurping, sucking, smiling
All in all, starting solids is a lot of fun.
Saturday, August 1, 2009
Not Just Another Proud Parent
I'm pretty sure my 6 month old isn't actually supposed to do this. He's not supposed to cruise either but he's starting to do a little of that, too.
Yep, he's motor advanced.
He rolled over at 3 months and I actually looked askance. After all, the pediatrician in me knew that early rolling could be a red flag for neurological problems. But he seemed to be otherwise normal, so I just shrugged and smiled. He sat at 5 months. Not super early but surely not late. And now this. According to "What to expect . . .", by the end of this month, he "should be able to bear some weight on legs when held upright". Some weight. By the end of this month.
He can't read yet, so he doesn't know he's exceeding expectations, but he looks mighty proud of himself when he manages to creep from monkey to frog on his rain-forest-play-house-of-wonder. We're proud of him too.
Neither I nor Dave is sure of the source of his skills, but we have a few theories.
1. He has superpowers.
2. The freeze thaw process selects zygotes that have superior physical strength.
3. (And probably most likely) We have always challenged him. He had all the tummy time he could handle early on. We plop him on the floor with a toy just out of reach and let him work for it. We put him in the Bumbo chair when he was 2 months old and the Jumperoo when he was 3 months. We have airplaned him and held him sitting and standing as much as he seemed to be enjoying it. We always smile and laugh and clap and encourage and let him know we're proud of him, he's perfect, and it's all for fun.
He is a source of awe and joy to me every day. Every thing he learns to do, from smiling, to cooing, to raking the proverbial raisin, looks like a miracle. He seems so big and grown up and then, at the end of the day, he curls up on my chest and sings himself to sleep, and I am reminded that no matter how soon he learns to walk away, he'll always be my baby.
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