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.