His Four Front Teeth

To the tune of "Come out and play with me" (click for original words and music)

Oh, Mr. Toothbrush, come out and play with me
and brush my little teeth
and make them so shiny.

We brush the front sides,
we brush the back sides too,
and we'll have shiny teeth, forevermore
One, two, three, four.

Over the last four months I have taken care of two children, one 7 years old and one 3 years old, who had to have almost all of their teeth removed prior to starting chemotherapy because the horrifying contents of their mouth posed too large an infection risk to an immunocompromised patient.
Neither family felt too strongly about oral hygiene.
One father sort of shrugged and said he figured she'd get new teeth anyway.
The other father told me he just felt it wasn't worth the fight. He did seem embarrassed that a pair of college educated medical professionals had let their child get into this state.
I also watched an infant with hemophilia spend time in the ICU with bleeding complications after having all his rotten baby teeth removed.

So, I wrote Nathan a toothbrushing song.
Twice a day, in the morning and at bedtime, I brush his teeth.
Nathan likes the song and doesn't mind the brushing at all.
Dave had to learn the words because he garnered some furrowed brow confusion from Nathan when he tried to make up his own version.

It's just a little fingerbrush, but it's setting a precedent and forming a routine. When he's one and two and beyond this will just be something he's always done. I don't pretend that we will never argue about it, that he'll never refuse or pout or moan, or that we'll never a skip a night 'cause we're late or a morning 'cause we're late for school. Still, I will not have a baby/toddler/child with rotten teeth or a mouthful of silver when a little parental attention can go so far to prevent it.

His teeth, though troublemakers, are so darn cute now, and I am looking forward to playing tooth fairy and tucking those tiny pearly whites away in a keepsake box. I have to polish my future jewels and keep them blemish free.

Gimme, gimme

Nathan is talking to us.
Sort of.

The last two days have been the best of the last 2 weeks because I have been able to leave the hospital at 5pm, pick my boy up from day care and spend the evening with him. Last night I watched him swim with his dad and fed him a huge and varied dinner. (Who doesn't like roasted butternut squash with cinnamon sugar? And Cheerios?!?) Tonight we played and sang and snuggled.

And he talked to me.

At first I didn't realize he was doing it. I was carrying him around getting his dinner ready and he was waving his right hand. Fist closed. Hand going up and down and up and down and up and down. Pediatrician-mommy was starting to think he was having a partial seizure. I fed him some dinner and cleaned him up and palyed on the floor with him. The whole time he was intermittently waving that little fist.
Fist wave. Food in mouth.
Fist wave. Crawl into Mommy's lap.
Fist wave. Rubber duck into mouth.
Fist wave. Belly scoot over to music cube.

And I still didn't get it.
But finally, I wised up.
Dave and I were sitting on the floor eating dinner and to distract Nathan from our oh-so-attractive bowls of pasta I brought out a bag of Cheerios.
Wave, wave, wave went the fist as he lunged at the bag with mouth open.

Light bulb above Mommy's head.
Ah Hah! He's trying to tell me something!

The path through Mommyhood is paved with good intentions, but I never have managed to buy that book on baby sign. I have made an earnest effort to teach him "more" and "all done", the signs I know, but the fist wave was new to me. It was also news to me that the ladies at day care try to teach them baby sign, a fact that Dave confirmed.

We had to look it up, but we found out it's the sign for "milk". To Nathan, however, it seems to be the sign for "give me that please". Or just "gimme".

I am thrilled that my boy is talking to me.

He's so smart!!!

His Two Front Teeth

Nathan has four front teeth. He cut his two bottom teeth simultaneously at 5 months old. At 7 months the bottom two popped through on the same day. He took teething with the same equanimity he takes everything else. He didn't fuss or sleep badly. He chewed like mad on his rubber ducks. And fingers. But that was about it.

****

I was looking at Nathan's little teeth and it struck me that they seem awfully small. He will have these teeth until he is in elementary school. They have to chew up all the food he needs to nourish his little growing body and brain. They have to shine in his charming little smile for years. No doubt they'll be tools in fiendish 4 year old projects. He already uses them to balance himself when he is pulling up on his cruising toy. They've been used to scrape onion and crack Cheerios. All that work for such tiny little teeth in my big boy's jaw.

****

He has the "Lamb space" - a largish gap between the top two teeth, passed from my Dad through me and into my little Beaver-Bunny.

****

The top two teeth may prove to be the end of breastfeeding. It is physiologically impossible for a nursing baby to bite with bottom teeth while actually eating. The tongue forms a nice little barrier. When the top ones come in, however, all bets are off. He bit me once, experimentally, when he had only bottom teeth. He didn't do it again until he had two top teeth so he could trap my tender tissue between two razor-sharp, steel-hard, crushing-cutting implements. There were two problems. One was the bleeding lesion. The other, more egregious, problem was that my loud, fierce, soul-rending "NO" caused my little darling to start, stare at me for an instant, and then giggle. After all, the "make-a-funny-loud-noise" game is one he loves, being an adrenaline junkie. It seems I will have to find another biting deterrent, but it's hard to think rationally when I am suppressing the urge to toss him away and whimper. So far, I am perservering, but I am a little nervous every time I bare flesh for the newly minted vampire I am raising.

****

Looks like he could be getting molars for Christmas.

I've been busy this last month, but so has Nathan.

He has:

- become an expert commando crawler, scooting around at shocking speed

- cut his two front top teeth, simultaneously, allowing Mommy to see an eruption hematoma in real life

- learned how to put balls on his ramp

- pulled himself to stand on something other than parental fingers

- proved that he will eat anything: peas and wild rice (blech-gag), banana, watermelon, grapes, sweet potatoes, pumpkin, apple, carrots, toast, avocado, waffles, tomato, and even raw onion

- started swim lessons

Vacation is Hard Work

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.

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.

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.