Mommy Guilt Gone Viral

I am reading a book called "Hope and Suffering - Children, Cancer, and the Paradox of Experimental Medicine".  It details the medical and social changes from the 1940's through 1980's; a journey of childhood cancers, specifically leukemia, from unrecognized, to untreatable, to experimental, to largely curable.  It's a great story in some ways because medicine/science really has prevailed.  Leukemia used to be universally fatal within months.  Now about 90% of kids with ALL can be cured for life.  But this progress came at a price.  Kids were basically experimented on for years because parents and physicians were desperate for anything.  Even agents that only bought time and didn't change the eventual outcome were willingly taken because it might keep them alive until a cure could be found.  The meds were toxic, the effects of the disease were terrible, and children and families alike suffered horribly.
But there's another part of it the bothers me and really hits home.  As soon as childhood cancers were recognized as existing as separate entities from adult cancers, the lay press and organizations like the American Cancer Society published material advising mothers to be on the alert.  They stated that they could save their child's life with their vigilance because early diagnosis was the key.  Which was completely bogus.  Science knew these diseases existed but there were no effective cures.  If you had a local tumor that could be completely excised, you stood a chance but the chances of detecting a solid tumor before there is at least nodal spread is so unlikely.  The book is full of stories of moms who took their kids to the pediatrician time and time again and were basically told they were crazy, go home, oh, and by the way the child turned out to have a brain tumor or leukemia or retinoblastoma.
Even now the majority of the parents that I meet blame themselves for their child's cancer diagnosis.  Childhood cancer comes up during a time when parents really are responsible for everything involving their children, and if not for the disease itself they always feel guilty for not bringing the child in sooner.  Still today, many children have seen their pediatrician a few times before anyone realizes it's more than migraines or a cold or constipation.  Uncommon things are uncommon and every child with a headache doesn't need and can't get a CT scan.
This whole book is set in an era when World War II was over and women were expected to come back out of the work force and have babies.  It was the Patriotic thing to do.  For the first time in our nation's history children were treasured as more than just parents' possessions and potential revenue sources.  Women's successes were judged by their parenting.  I just can't help thinking about all those mothers who watched their babies suffer horribly and die and were told by every newspaper and flier that went past their door that it was their fault.  If only they'd been a more attentive mother.

*****

Not that everything always has to be about me, but this is often how I feel when I think about Nate and his allergies and vomiting.  For so long I just didn't think anything could be wrong with my baby and I really overlooked and excused all his symptoms.  And to be fair the first pediatrician that we went to over and over really did tell us that i was being an over reactive pediatrician parent and nothing was wrong.  But now, when I look at my little boy, especially pictures of when he was sick, sick and looked it, I just feel awful, and I want to take it all back, go back and fix it, make those months of his babyhood less miserable.  This isn't going to kill him but it has plenty of power to make me feel like an inadequate mommy.

For this reason the first time I tell a parent that their child has cancer I also tell them it's not their fault.  It has nothing to do with what mom ate during pregnancy or whether they made the kid go to bed at 8pm every night.  I also tell them they brought the child in at just the right time and the job now is to go forward and not torture themselves looking back.

I hope it helps.

Times Two

Nathan is 2.  Really, really 2.  Frustratingly, charmingly, limit testingly 2.  "What's that?, Right Now, and no" are his favorite words.  Dave and I deal with it the best way we can.  Team work, sharing the exhaustion, and the well placed time-out.  Luckily he makes up for all of it with his charming smile and his hilarious statements.

Yesterday, when Dave picked him up from day care, his teacher lamented that he had not been very obedient all day.  When asked to do or to stop doing something he said "No" and occasionally required physical relocation to get him to pay attention to what he was supposed to be doing.
Dave asked the (to me) obvious question "What did you do?  Did you put him in time out?"
"No," was the answer "we aren't allowed to do that.  We just redirect them."
Soooooo, you have a 2 year old being willfully disobedient and disrespectful and you plop them down in their favorite couch with their favorite book to "redirect" them?  That sounds suspiciously like rewarding bad behavior.
Am I crazy?
Maybe.
I'll admit that I am terribly naive.  I never asked about discipline.  He was 5 months old when he started day care.  I was worried about what they would do with the two swallows of breast milk he left behind in a bottle, not what they would do when he started chucking Legos at other kids.  I mean, I knew they wouldn't beat him.  I just sort of assumed there'd be some form of age appropriate consequence.  Time out, brief loss of a favorite privilege, unplanned toenail trimming.  Something to make it clear he'd crossed the line and it was not OK.
But no.  It seems they are not allowed to do that unless parents specifically OK it.  And I guess you have to independently volunteer your approval because I certainly never got any sort of time out permission form.  I would have signed that in a heart beat.
It seems, after an informal survey of the folks I know with kids, this lack of consequence is the norm for day care.
It really, really bothers me that this is the policy.
More, it bothers me the response I got from another mom.  "Well of course" she said, as if I was some sort of nut case "I don't want someone else disciplining my kid."

I don't think it is the day care's responsibility to teach my baby right from wrong.  Our job as parents is to teach them values and to flog them with wet newspaper until they internalize the rules.  I know that.  I spent a lot of time and energy and waistline in search of the privilege of doing just that.  But the unavoidable fact is that my child, and all the others in his class, spend more time with the day care providers than with us, the parents.  They spend all day with this peer group, these adults, and it does seem reasonable to expect or to at least empower them to set limits and dole out consequences.  It's not a wolf pack.  It's supposedly an environment where children are learning social skills.

The developmental job of a 2 year old is to test limits.  He's learning the rules of the world.  Someone has to teach him those rules.  The worst thing that can happen is for him to grow up thinking the rules don't apply to him (sociopath) or only apply in certain situations when certain people are looking.  No wonder bullying is becoming such a problem in our schools.  Children are coming to schools from day care where when they knocked a kid over to take their cookie the teacher pulled them aside and made them play on the computer to stop them from being mean.

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Hunger

I read the "Little House on the Prairie" series when I was in first grade.  I've reread it many times since and one or two things hover in my mind.
In "The Long Winter" Laura goes to a party where she receives an orange as a party favor.  "Imagine," she thinks in awe, "having an entire orange all to yourself."
I found myself thinking about this the other day when the "kids meal" came and included an obscenely large hot dog and more fries than Dave and I could eat together.  It cost nine dollars and we threw almost all of it away.

We think about food a lot in our house.  Nathan has had so many problems with food and weight gain that we know the calories and nutritional breakdown of a stunning number of foods.  Traveling, even going out to eat, brings up the "what-will-we-feed-him?" anxiety.  Dave's dad's recent brush with the reality of heart disease has thrown our eating habits into sharp relief.  Dave and I have both eaten too much crap and exercised too little since our little man came along.  We worry about eating out and finishing leftovers before they go bad.  Everyone has breakfast even if it makes us a little late for work.  I worry about waste - food bought and uneaten because Nathan didn't like it or we worked late too many nights in a row to cook it all.

All small worries compared to that shared by 1 in 5 American children.

Twenty Percent of American children live in homes where, at least once a week, they run out of food and don't have money to buy more.

Twenty Percent.

That means that in a class of 30 children 6 of them may not have had breakfast and may not be expecting to have dinner.  Six children whose grumbling stomachs will distract them from learning to read and write.  Six who may bully someone else out of their lunch or pick a fight or ditch a class or talk back to a teacher because they just feel so bad.
Some of these children don't have food because their parents have spent the money on cigarettes, alcohol, or drugs, but some of these children don't have food because a parent has lost a job and the cost of keeping a roof over their heads and the heat on is much more than their current income.

Feeding our children is possibly the most basic role of parenthood.  God gave women's bodies the ability to nourish the next generation.  It is believed that one of the many causes of the obesity epidemic in America's children is that parents don't like to tell their children "no" when they ask for food.  The reality in our country, however, is that 20% of our children are mildly malnourished because of the unreliability of their food source.

I don't pretend to know what the answer is.  Nutritious school lunches can help the children.  A declining unemployment rate would help whole families.  A single parent household has twice the likelihood of going hungry so decreasing that prevalence would make a real impact.

I also don't have an agenda.  I just think it is horrifying that this country, that overeats and throws food away and spends so much of our GNP trying to solve the problems of others, can't feed our children.  I think a lot of people don't realize how high the numbers are.
If you want to read more check out the Food Research and Action Center.
And please, think about donating some healthy food to your local food bank.  It is the only safety net that many families have.

Bothersome

One of the unfortunate facts about the hospital I work at is that it abuts a very old cemetery.  Through very careful forethought and planning there are no patient rooms that have a view of gravestones.  It is visible, through the trees, from the library.  The PICU family grief room originally had a clear view of marble mausoleums until they installed some stained glass to blur the harsh reality.  Otherwise, it is the physician offices and work-rooms that have the gorgeous views of ancient trees marching through the seasons. 

I don't mean to imply that we should hide the concept or possibility of death.  Our bodies all die eventually.  I just think that there is something unsettling about struggling with the illness or injury of a loved one and, needing a glimpse of the outside world, looking out a window to see a funeral procession.

In the oncology world we wrestle every day with life and death discussions, how to talk to children and their parents.  Some people want cold hard facts with no sugar coating.  Some want vague generalizations.  We're honest with all of them though the language changes.  We work hard to make our clinic a space of hope and to give all the happiness we can to families who spend many of their days worrying about what the last day will be like.  Kids run around the halls chasing a favorite doctor or nurse.  They do crafts while they wait.  The teens hang out playing pool or Guitar Hero.  Santa always comes.  Hope, as it has been said, springs eternal.

We do what we do for the kids.  That includes decorating for every holiday including Halloween.

But we also do it for the parents, and I wonder if any of them find this bothersome as they check in for a blood count and chemotherapy.

I'm not an activist by any stretch of the imagination.  Not to say I don't care or I don't have opinions, but I've never considered myself to have the discretionary time necessary to do anything big about it.  Still I do believe that many people performing small actions can effect as much change as one big action.  In this vein, I have decided not to buy gas from BP.  It's the closest to our house, the most convenient by far, but certainly not the only choice.  I've been torn between the rationale that they need all the money they can get to fix this mess in the gulf, and the thought that they don't need my money to support their ongoing pursuit of profit.
In the end, I decided to pump my fuel elsewhere.

Until today, that is.  This afternoon, I heard an ad, a plea really, from the owner of our local BP franchise. 
I'll paraphrase:  "I live here in your community.  I employ your friends and neighbors.  It's not my fault that the BP well exploded.  BP is trying to fix it.  Please don't blame us.  Please buy gas from me." 
It was much more eloquent than that but that's how it broke down.

It made me think.  We know that the fishermen in the gulf are suffering.  We know the tourist trade is declining.  We know the effects of the oil in the ocean can be shown on computer models to be catastrophic if it is not stopped.  But what about the BP franchise owners in Pennsylvania, Missouri, and Washington?  Nowhere near the water, and definitely not on the news, but being driven out of business, loosing their livelihood and savings nonetheless.  All because people like me want BP to know, in a small, small way that we disapprove.

The excuse for inactivity is so easy to make.  My single gas purchase makes no difference and is not felt one way or another.  It is only the cumulative effect of many that makes an impact.  That's true for BP if I don't buy their gas, and for the local franchise owner if I do.  But I do have to choose.  I do have to decide if I side against the large corporation for their non-malevolent negligence or with the local small business owner and a community that has already been financially bludgeoned with the relocation of the steel industry.

Tonight I'm not sure.  I continue to struggle, and I'd love to know what you think.

Fine Young Cannibals

I think of myself as a pretty relaxed parent. 
Nathan bounces around on the ground a lot.  He is, after all, perfecting his walking/running/climbing/exploring skills and a few head bumps/pinched fingers/little scrapes are just all part of the process.
I was, however, completely unrelaxed today when my son came home with teeth marks on his baby skin. 
It's not the first time.  On his second day in the toddler room we took off his shirt at bath time and there was a perfect dental imprint written in broken blood vessels in the middle of his back.  Today, apparently the same offender got out of control and bit my little guy's shoulder.
And drew blood.
When Dave arrived to pick him up, our tear-stained boy was surrounded by day care workers, ice packs, and incident reports.  The mother, an attending I have worked with on more than one occasion, was mortified and apologetic.  Nate's teachers were similarly distressed.  They are supposed to keep "the twins"  and their teeth separate from the other kids, but today there was a breakdown in the system.
I'm not OK with this.
I'm not OK with biting.
Nate has spent exactly 3 minutes in time out and all 3 of them were after the first and last 3 times he bit anyone in this house.
I am glad I wasn't there because I am not sure I would have settled for time out if I had actually seen the little boy nearly twice Nathan's size trying to make a meal out of my baby.  Caning is still legal, isn't it?

Number 7

When I was growing up my only interaction with football was watching the Super Bowl with my dad. I went to 1 high school football game and my college didn't even have a team (to my father's great chagrin). I moved to Pittsburgh in 2001 knowing practically nothing about the sport apart from the shape of the ball.


Living in Pittsburgh, however, you can't miss the Steelers. Football is the city's religion. Pittsburghers are on a first name basis with their players. The proscription against idolatry does not apply to Troy and Hines and Ben.

The team's defense has led Ben Rothlisberger to 2 Super Bowls while I have lived here, and in a town of this size, it is impossible not to get caught up in that excitement. So yes, Dave and I are Steeler fans. Not the type to get our hair buzzed into the Super Bowl logo. Not the type to stand in freezing rain to watch the parade, but the type that put our 2 day old in too big Steeler gear on Super Bowl Sunday and had a little party.

So now our quarterback, "Big Ben", has gotten caught being stupid.
Again.

It wasn't enough that he drove his motor cycle into some unsuspecting motorist while taking full advantage of the inexplicable repealing of the helmet law.
Then, he was involved in an "incident" with an unwilling girl but nothing stuck.
Now, for a second time, allegations have been made by a young woman that he made an unsolicited effort to introduce her to "Little Ben". And while in America one is innocent until proven guilty, a virtual herd has come forward to report on inappropriate things they witnessed on the night in question.

What embarrasses me, however, is not Ben. It's the response of the city.

A few days after this hit the news, I was listening to my morning radio show discuss the fact that Ben had as yet said nothing in his defense. "He doesn't have to," the guy said smugly, "once they announced there was no DNA, there's nothing to say."
OK. So no proof of intercourse but maybe an apology for the rest of the evening's behavior and for again embarrassing the team would be in order? Maybe if Steeler Nation weren't all rushing to his defense he might take a little responsibility for himself.

Many of the team's fans are more outraged by the sanctions (a 4-6 game suspension) being imposed by the NFL than by anything Ben may have done. Some, including a few I previously respected, refuse to hear anything bad said about their hero, and can muster up a lot of vitriol about "that girl".

I just don't get it. This guy is hero and role model to a lot of kids. And their parents don't care that he's running around acting like an irresponsible, unethical frat boy?
I care. I am glad he is being publicly punished. I hope he doesn't hurt anyone else before the city comes to their senses.

Bravery

Cold weather has come early to Pittsburgh, as, I suppose, it is to the rest of the country.

I was driving home from work, cold rain on the windshield, thinking about whether I would make it to day care on time and petulantly contemplating the failure of my car heater to adequately warm my toes in the completely non-sensible shoes I was wearing.

That's when I saw her.

A determined mom pushing a stroller full of groceries with one hand, holding an umbrella with the other, and carrying on her chest a blanket covered baby carrier with a little pair of pink fleece feet swinging as she walked.

I was struck by how much strength it took this woman to decide to go out in the weather, shield her child from the elements, in the pursuit of getting food for her family. I could feel the agony of needing things and yet worrying with every step about keeping her fragile baby safe. I wondered how she would be able to get everything on and off the bus. I wondered if she had anyone to help her out at home.

There are things in my life that are hard, but my day to day activities are so blessed. I go to the market in a car that affords me the luxury of wearing strappy shoes in freezing rain. My baby is always warm and dry unless I screw up. My husband carries the groceries.

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.

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.

A Matter of Respect

I have speculated before how this year would be different for me. As a medical student and resident I was always very subservient. The hierarchy in medicine is very well defined and while it is more flexible in pediatrics than other branches of medicine, it is still definitely observed. I was always painfully aware of where I fit in the hierarchy which was basically at the bottom.
I had a year off, however, and worked as an attending, definitely closer to the top of the hierarchy. Accentuating the position difference was the fact that I worked at an adult hospital where the nurses call you doctor, instead of using your first name like they do at a children's hospital. I really felt like an in-charge professional. In addition, I had Nathan and my priorities underwent a major frame shift. Because of those things I knew I would be less content to be subservient and be a much better advocate for myself and my time. Until now, I really had not been tested.
Yesterday, however, I did something I would never previously have done. I walked out on a conference.
I was at a conference that was supposed to start at 4pm. Now, no one really expected it to start at 4pm because the attending has a reputation for perpetual lateness. His patent quote? "The name means good time, not on time." It's supposed to end at 5:15 but it basically ends an hour and a half after it starts, no matter when he deigns to arrive.
I am the opposite. I am almost pathologically on time. I know I used to make my mom crazy because to me, on time was actually late. I firmly believed that the only way to ensure being on time was to be early, and got a little hysterical if my chauffeur did not support me in this. Today, I still feel that way, preferring to be the first to arrive rather than risk being late. I find being late extremely disrespectful to the people who are waiting for you. Its sends a message that the person being late believes their time to be more valuable. I used to put up with it, but I no longer believe my time is less important than anyone else's. I have a lot of things to do and a lot of people depending on me, and I put in an effort to be on time. I deserve nothing less.
Yesterday, it was 5pm and the 4pm conference had not yet started, and I just snapped. I knew that he expected to walk in when he was ready and find us all sitting there expectantly waiting to be taught. I also knew he would offer no apology and that it had never crossed his mind to call and tell us he would be late. So I left.
A little finger of guilt nagged me as I walked out the door, but it was gone by the time I got to day care to pick up my boy; someone whose smile is undeniably more important to me than the good opinion of someone who doesn't respect me at all.

Fathers, Part I: The Bad

I have mentioned before that we like to watch a few TV shows around here. One of them is "Family Guy". This is the perfect storm of comedy. A family whose characters never age. An intelligent talking dog who is understood by one and all. A "Pinky and the Brain"-esque baby with a homicidal streak whom no one understands except the dog. Spoofs, musical numbers, complete non sequiturs, and just enough of a plot to hold it all together. Sure, I've never understood the chicken fights, but the clip with the head of the maid's union is the funniest 10 seconds of TV ever.

I do have a problem with the show, however, and that is Peter. If he is an example of American fathers we should not be surprised that so many families are breaking down. He is an undereducated bumbling oaf who is always doing something he shouldn't. His children don't respect him and even his dog talks disparagingly to and about him. His interactions with his kids walk a line between oblivious disconnection and slightly taunting mockery. He often makes sexist comments but nevertheless, his affection for his wife is actually as believable as cartoon love can be, and he does have the good sense to recognize that she's the best thing he's got. That said, he is in a constant state of trying to trick her or hide something from her.

Now, here's the thing. Peter is funny exactly because he is stupid, racist, and misogynistic, but his comments, quoted to another in the context of a real life relationship, would be belittling and unkind. I don't pretend to think that anyone looks at the Griffins and thinks "That's the role model for my family!" but I do think that people quote him because they think he's funny. I also think that argument made against children watching violent programming holds true here. If we can become immune to violence, then why not disrespect and ridicule? Do we really want to fill our heads with people acting in a way we would not want ourselves or our loved ones to act? Even if we are mature enough to know it's just TV, how much does it affect our subconscious?

I don't know the full answers to all these questions but it is food for thought. I know that I think the show is funny. I know that I'm going to keep watching. I know that I don't want Nathan to watch. Lastly, I know that I am glad that neither my Dad nor Nathan's act like the elder Griffin.

Yesterday, May 26, was my four year wedding anniversary. It was also the day the California supreme court ruled to uphold the ban on same-sex marriage. This coincidence led me to a reflection on marriage, mine and the general concept, that I'd like to share with you.

Dave is my husband. He is also my best friend. No one in the world knows more about what goes on in my heart and mind than he does. We share values, hopes and dreams. He knows my sense of humor and I know his, even if all we can sometimes manage is a pained groan at the other's jokes. We often finish each other's sentences or give voice to the same thought at the same time. We are not the same person but we complement each other well. We make the other want to be better. I can't imagine the way my life would look without him in it.

This was true the day before our wedding. Getting married didn't make it any more true. Looking around my life before I got married, I didn't have any great role models for marriage. I knew a fair number of people who probably would have been happier out of their current state of wedlock but stuck around for various practical reasons - none of those reasons related to the fact that they had taken a vow to stay with the other person. In fact, the happiest, longest lasting, most functional couple I knew were not and still are not married. A fact that does not diminish their commitment to each other or the care they give to each other. Dave and I were an inseparable pair - the Lambsters - before we exchanged rings, and for me, at least, the wedding didn't make me any less likely to walk away when things got hard. I love him no matter what is recorded in the annals of the Keystone state.

So why get married at all? For one, it is the gateway to a host of social benefits and responsibilities. But Dave didn't marry me to assume responsibility for half of my six figure education loan debt and I wasn't trying to get my hooks into his 401K. For me, marriage is a kind of choosing. It sets a boundary around yourself and your partner that the world sees as more inviolate than simply dating. It is a public way of saying "This is my family. This is forever. What you do to one is done to the other." It is a public declaration of what is already true in our hearts. For me, marriage is about commitment and bringing two lives into one.

Maybe I'm naive, but I don't understand why anyone would want to deny a fellow person the right to that public declaration. Is the world so perfect that we would demean and belittle any offered expression of love? Why does anyone care who wants to marry who? I would certainly be protesting in the street if someone told me I couldn't marry Dave. Why does the government care who I love? The thing that really blows my mind, though, is the vocal outcry of religious groups against gay marriage. Why, why, why, why, why, why, why, why? It seems to me that do unto others . . . and love thy neighbor . . . are supposed to convey acceptance and love not hatred and exclusion. (Of course, it is that evident hypocrisy that always turned me off to organized Christianity, but that is a subject for another post.) In any event, with a rising unwed teen pregnancy rate, a whole segment of the population choosing to practice serial monogamy, and the divorce rate around 50%, it doesn't seem to me that the heterosexual population is doing so well with marriage and lifelong commitment. I say that anyone who's brave enough get on the scary roller coaster of matrimony deserves a chance.

Of course, the legal system doesn't care about love and the joining of souls. Proponents of gay marriage get a foothold in the courts by arguing matters of equal rights and fairness. ie. If heterosexual couples can assume certain social rights and responsibilities, denying them to homosexual couples is discrimination. And it is. I do not see another way to answer that issue. If one pair of people have the right to throw theirs lots in together and take on the world as one, then ANY two people should have that right. Period. In America, these days, we all get to sit wherever we want on the bus, and while I know there are people who wish that wasn't the case, who fondly yearn for the days of Jim Crow, at least those views have been soundly rejected by those who make our laws. I can only hope that when Nathan is old enough to discuss such things, he will be shocked and appalled to learn that this discrimination against gays stands in our history. . . and not in his present.

Trouble With Technology

Before Nathan was born, Dave and I spent a lot of time talking about what we wanted for him. All parents do, of course, but a lot of our conversations centered on how to keep him active and healthy and smart and social in a society (and home) dominated by technology. I read A LOT as a child, teenager, young adult and am convinced that has a lot to do with my intelligence and success, (And no, I see no reason to be humble here. I'm doing pretty well for myself.) I also played outside and wandered the neighborhood with a pack of children, going backyard to backyard to climb trees and put on plays. TV makes you fat and stupid. Science has proven that. People who watch TV eat more and exercise less. Children who watch TV are more insensitive to violence and have smaller vocabularies. It truly is mindless entertainment. But it sure is fun.

These days Dave and I like to hike and swim and snorkel and explore, but we also have a Play Station and a Wii and like to watch baseball and a few TV shows. Before Nathan was born we thought we just wouldn't have the TV on when he was awake. This worked just fine when he was a newborn and slept all the time, but it has proved a little unrealistic now that he is older and awake so much more. We still don't get involved in any plot based entertainment when he is awake, but we like to watch some news or have a baseball game on while we putter around.

Over the last two days I have seen something that makes me a little ill. Nathan is mesmerized by the television. There I am blowing razzberries and making faces and he turns the other way to watch the confusion of color and motion that is playoff hockey. I suppose the attraction for him is conceptually no different from the music box on his playgym. It's not like he's actually rooting for the Pens. But still, it bothers me. It reminds me that balance is hard (says the girl who played DDR until she had stress fractures in her feet) and that Dave and I will have better luck setting an example than speaking a lesson. Though no normal child makes it through without a couple hours of "Bob the Builder" or "Thomas the Tank Engine", it's up to us to set limits and offer an alternative.

He's not going to build a treehouse on his own, but if we turn off the TV and go with him, magic can, and will, happen. For all of us.

Musings

We didn't have the easiest road to having a child. By comparison, we didn't have the hardest either. Now, with baby drool on the couches and bags under my eyes from midnight feedings, I can say it was the perfect path because it was the way to this perfect baby.

Dave and I were very candid with people about what we were going through. Surrounded by friends who decided they wanted to have a baby and were pregnant the next month, we really had an enthralled audience full of people thinking "But for the grace of God . . ." And if anyone thought we were doing the wrong thing, if anyone was thinking about unwanted children the world over or carried a conviction that the zygotes we were playing with were actually people, no one beat us up about it. We got nothing but good wishes and for that I am grateful.

I didn't want to do IVF. I repeatedly told my husband I wouldn't, but with a failure of Clomid to do anything, we ran out of options so very quickly. And before I knew it, there I was, staggering around with ovaries the size of grapefruits, praying for a million eggs, a million zygotes, but just one baby at a time, please. And because I live a charmed life, that is more or less what I got. Nathan's name means "gift of God" and I believe that he is. And God made use of some amazing science to bring him into being.

It blows my mind to look at this picture and know that my son was once tiny enough, and frozen enough to live in one of these little straws. It also blows my mind that stored in a vat of liquid nitrogen are many more of these straws housing little clusters of Dave and I. Nathan's potential sisters and brothers, chillin' in suspended animation. All that potential is a staggering responsibility. While I feel firmly that zygotes are not people, I also feel firmly that they are of high value and not to be treated lightly. When they told me that we had made a small army of zygotes, I was excited and felt immediately oddly protective toward them. When they told me that I was pregnant I was elated. When they told me that there was one healthy baby growing in side me I was ecstatic . . . and a little sad. They had, after all, put two zygotes in, and the presence of one baby meant that another, Nathan's potential twin, had not made it. Having another baby someday means that another little zygote may be defrosted and not implant, not fulfill it's potential.

Some, I know, say that's murder, and I say that is ridiculous. First, you can't murder what is not alive. Frozen in liquid nitrogen with no consciousness and no ability for independent existence is not what any thinking person would define as alive. Second, you might as well say that any sexually active woman who menstruates is committing murder, because chances are good that an unimplanted zygote is being washed away at the end of the month.

Watching the so called "Octomom" on TV made me crazy because she is crazy, her doctor was irresponsible, and no one suffers but the babies (and perhaps the American taxpayer). But it also made me crazy because she portrayed herself as so sure everything she did was right and perfect. As if IVF was black and white. That, for me, is the proof that she is crazy or simply hasn't thought about it. IVF involves risk for mother and baby and yet in the right hands it is very safe. It uses expensive medical resources for an elective procedure and steals research dollars from other causes. It gives hurting adults the chance to be parents but may then close their home to a baby who already is in the world and already needs their love. I am glad Nathan is an only child and I wish he had a twin.

There are endless contradictions in this process, but one thing is crystal clear: I love my baby fiercely. I do not think every day of where he came from, but I do think every day of how special he is and how I would do anything for him. Much like any parent I suppose.

It's National Infertility Awareness Week. Please think twice before supporting any legislation that would make the government responsible for sorting through these shades of grey. Leave it up to the parents!

Babyless Rant

I apologize to those who have not read the books, but surely you are at least aware of the"Twilight" phenomenon? Boy meets girl. Boy turns out to be vampire. Girl loves him anyway, Girl then spends more than 1000 pages trying to get herself turned into a vampire. I haven't read the fourth book yet, so I'm not sure if she succeeds.

I finally figured out what bothers me about these books. It's the utter weakness of the female character. Here we are in a time when teen pregnancy is on the rise again and somewhere around half of marriages end in divorce and the adolescent book craze is about a high school girl who "falls in love" with someone she has barely exchanged three words with and then spends all her energy trying to get him to either a) have sex with her or b) make her one of the undead so she can spend eternity at his side. Preferably a) then b). Furthermore, she does all of this while reiterating to anyone who will listen that there is no way she could ever be good enough to deserve him. And then, when he tells her he will sleep with her . . . after she marries him, she tells him she is not "that girl". You know, the kind who humiliates herself by getting married right out of high school. Eternity of craving human blood? Fine. Marriage? I should say not!

They are "in love" but the shared ideas, principles, goals that their love is based on are conspicuously absent. It's an sophomoric "love at first sight" infatuation. And don't get me wrong. I have no problem with that in principle. I just disagree with setting that as the standard for girls to measure up to when they are deciding who to have sex with or pledge their life to. I don't think she should marry him. I also don't think she should give up her humanity for him. That she wants to give up her humanity for a boy at all, horrifies me.

She does contemplate, for about five pages, spending her life instead with her best friend who makes her feel warm and happy and good about herself. This is someone who she has gotten to know, who understands her and whom she understands in return. (Don't get me started on the fact that he is a werewolf. That stretches credulity beyond the breaking point, in my opinion.) But no, despite the beauty of the future she can see with him, she chooses the one who makes her feel bad, inferior, and usually miserable. Sweet.

I am also rankled by Bella's pitiful lack of self esteem. "He's too good for me," is a chorus that plays in almost every chapter and her desperation to hold on to him despite that belief is demeaning and embarrassing. When they are temporarily, though she thinks permanently, apart, she considers her life basically over and engages in a barrage of escalating risky behaviors designed to "hallucinate" him back into her life. Eventually these behaviors do bring him back. Again, what is the lesson being taught?

Having said all of this, there's no way I could stop reading. They're ridiculously easy to read and addictive in a trashy Harlequin romance kind of way. Plus, I hold out hope that maybe in the end Bella will realize that she is beautiful, smart, and desirable, that half of the high school male population is in love with her, and decide to consider her options and get to know Edward a little better before allowing him to exchange the blood in her veins for ice. Maybe, just maybe, there's a modern girl in there trying to get out and set a real example. but I'm not going to hold my breath.

Seeing Spots

There are six confirmed cases of measles in southwestern PA.
Measles. In the same zip code as my not-yet-old-enough-to-be-immunized child. In children old enough to be immunized. Who should have been and weren't.

With more and more parents opting out of childhood vaccines, herd immunity is waning and an epidemic is waiting. How about polio? Our parents breathed a sigh of relief when immunization wiped that disease from the U.S. But this generation of parents doesn't remember. Will it take a return of the iron lung? How quaint. Leg braces? Permanently paralyzed infants? What tragedy will be required to remind people they are lucky to live in a developed country with all the advantages that entails?

As a childless pediatrician I could calmly listen to parents enumerate their many reasons for not wanting their kids vaccinated and patiently counter their usually uninformed or misinformed opinions. I was shocked by the tragedy when I would see a child, near death in the ICU, fighting for their lives against a vaccine preventable disease. I felt awful for the parents who would have to live with the guilt. Worse for the children who didn't have a choice. But it wasn't personal.

As a parent, my stance is simple and selfish.
Vaccines do save lives.
They do not cause autism.
Don't cheat your child out of the best preventative care measure in history.
And keep your unvaccinated potential reservoir for preventable disease away from my angel until he is fully immunized. Stay out of the schools, libraries, McDonald's PlayPlaces. When measles comes, with Darwinian precision, for your child, I don't want mine caught in the tide.

Stepping off my soap box now.

Rest assured that as a pediatrician I can still carry on a reasonable conversation about the subject if required. But I will not hesitate to bring up the measles here in our area or to remind them that their children are breakable and only they can protect them.