Keep the baby alive, and other things I have learned about parenting

I visited a friend today who has a new daughter, 16 days old. The baby is extremely lovely. She looks just like her father and just like her mother and already has the capacity for skepticism which is of huge importance in my opinion. She slept in my arms for several hours and smiled in her sleep and stretched a lot and a couple of times opened her dark eyes and made contact with me.

Time changes around a new baby. There is no 11 o’clock or 1:45. There is feeding, rocking, changing, rocking, cooing, smiling, admiring, and so on and on. (There is also losing your mind from boredom and feeling worried about everything and being exhausted beyond limit, but more on that later.) I got to my friend’s house at 11am and it felt like twenty minutes had passed when in fact it was 1:15 and I was late for a lunch date. Also, I am never so much the inhabitant of my physical body as when I am interacting with a baby. Whereas usually my head does most of the work and gets most of the credit, with a baby it’s the curve of the arm, the swing of the hips, the lilt of the voice that is at work. Holding the baby today, I remembered the mammalian existence of my first weeks and months with E, moving slowly from couch to bed to couch again, constantly in physical contact with the baby, our mutual fluids running out of every seam. At the time it felt awkward, this shift from the goal-oriented-success world to eating-sleeping-humming world but now I am so grateful to have experienced it, to still be experiencing it every day with my daughter as she grows: the animal life that is only ever now.

My friend is having a hard time, as I think all new parents do, as I did. She said, as I remember saying, as I say to this day: No one told me how hard this would be! Even though I distinctly remember telling her that the first six weeks of E’s life were super, super hard, that breastfeeding was nerve-wracking and never completely worked for us, I don’t think it’s possible to hear and understand these things before you actually go through them. When people tell you “It’s totally life changing,” you don’t realize what that means: that the life you had before is over and a new one takes its place in which you have much less control and much less freedom. Given that we live in a culture in which both adulthood and success are defined by having control and freedom, this transition can be tricky. We build our identities around the work we do, the people with whom we interact, the activities we enjoy, our tastes and beliefs. When you have a child, all these things change radically overnight. Some aspects of ourselves return over time, others are permanently altered.  Added to these already stressful changes are the avalanche of mythologies and dogmas and opinions around motherhood and child rearing that can really drive a person crazy. Never had I been the object of judgmental looks as much as I have been since becoming a parent — just try mixing a formula bottle at Mom & Baby yoga class, my friends! You might as well put a lit cigarette in that baby’s mouth. All this on top of the sheer hard work and anxiety of it — the nights and days and nights of walking back and forth with the crying child in your arms, worrying all the time about whether or not the baby is still breathing, learning through error what you need to bring with you on an outing (answer: at least two of everything and if your baby eats formula, don’t forget the formula #oops! #ivebeenthere #thebabyisstillalive).

Talking with my friend today, I wanted so badly to palliate some of her uncertainty and exhaustion. I wanted to give her a full-body taste of how much better things get as you learn your child and yourself and find your voice as a parent, as your child grows and can do more for themselves. But of course, everyone has to find their own way there. In the words of Mary Oliver, “Nobody gets out of it, having to / swim through the fires to stay in / this world.” Still, there are some things that might have helped me 16 months ago, so here goes — for my friend and anyone else out there who is staring down at their new baby and thinking “This is the most amazing and perfect creature I have ever laid eyes on” and at the same time thinking “Holy shit! What have I done?!”

1) Here is the core task of parenting: Keep. The. Baby. Alive. On some days, like when you have the flu or you haven’t slept for more than 30 minutes in a row in 72 hours, this in and of itself will seem like a monumental task, but if you accomplish it which you likely will, that day has been a parenting success. Now there all kinds of more nuanced parenting tasks like cutting the baby’s fingernails (anxiety, thy name is infant fingernail clipper!) and getting on the right preschool waiting lists and teaching your child to say “thank you” and “ladybug” but you can’t always be attending to those things because you will have shitty days and that’s ok, as long as you do the things that are necessary to keep the baby alive. Aka feed it and keep the bleach in a locked cabinet.

2) It’s ok if it takes a while to feel fully connected with your baby. Some women pop their baby out and immediately feel connected on every level to that new person. Other people (aka: me) take a little longer. I loved E from the beginning but I was also in a ton of pain and dealing with post-partum complications for the first month. I was struggling through breastfeeding challenges and my own insecurities as a parent (that awkward moment when your fear that you are not bonding enough with your baby makes it hard to bond with your baby). Again, I loved her fiercely, but sometimes when I looked at her in her crib from across the room, I thought: Me? I’m that baby’s mother? And it seemed incredibly surreal. Then, sometime in the second month, we clicked into each other forever with a glue that will outlast time and space. For some women, it takes longer than that. But see #1 above. Your job is to keep the baby alive. The rest will come (as long as you are not suffering from postpartum depression which can throw a wrench in the process and should be treated. Take this quiz and talk to your doctor right away if your score is concerning).

3) It’s ok to do things for yourself. It’s ok to leave your baby in the care of trusted people while you eat, sleep, get a haircut, or talk to your best friend from college on the phone. Your baby needs you but not every single second of every single minute of every single hour etc. If you need to go away for a night for work or, in my case, have seven residency interviews when your child is five weeks old, it’s ok, as long as you have left your baby with plenty of its nutrient source and another loving adult. Some people believe that their child should be with them always and if this works for you, I think it is a wonderful thing. For me, it has worked best to recruit a little love army for E and she has an extended network of people who think she is the cat’s meow. This is working for us. Do what feels good and right to you but if this includes going to a movie while your best friend watches your baby once in a while, it is ok.

4) It’s ok to feel sad about things you miss from your life before the baby. It’s ok to feel sad period. It’s ok to feel bored when you are caring for your baby. It’s ok to feel frustrated with the baby when you can’t figure out why he is crying and it is ok to feel relieved when she goes to sleep and you can get a shower in and watch twenty minutes of The Wire while eating a chocolate pudding pack standing up in your towel, or you know, whatever it is you like to do. There is a lot of crapola out there about how your feelings can hurt your baby. Depression, anxiety disorder, and other mental illnesses that impair a person’s functioning can have a detrimental effect and should be treated pronto, but your average feeling cannot lash out scissor-like and gouge a hole in your baby’s future. Mothers are still allowed to have a full range of feelings, thank you very much! Do not waste mental energy feeling guilty about your feelings.

5) Come to think of it: Do not waste mental energy on guilt at all. Banish guilt as much as possible. Do you try your best to make good choices for your baby? Are you providing a consistent, safe, and loving environment for your baby? Does your baby have nourishment, medical care, and high quality child care? If the answers to these are yes, then you are doing everything you can. Accidents, illnesses, and adolescence will happen to all children and are not your fault.

4) Breastfeeding does not equal love. Breastmilk does not equal love. Breastmilk is good. It’s the best food for babies if it’s safe and available. But if you are not making enough breastmilk or you have an illness or take a medicine that precludes breastfeeding or you cannot or do not want to breastfeed, this does not mean that you do not love your baby. As a person whose first month of parenting was made 80 times more stressful and guilt-ridden by my inability to make enough breastmilk despite pumping EVERY TWO HOURS AROUND THE CLOCK, I think that it would have been better for my baby had there been less emotional drama around the issue and had I felt free to spend less time pumping and more time enjoying my baby. If breastfeeding is easy for you and it’s all going swimmingly, remember to be gentle and kind and nonjudgmental to the mothers who are struggling with it.

5) Don’t let anyone tell you what is best for you, your baby, and your family. This includes friends, co-workers, mothers, mothers-in-law, doctors, lactation consultants, books, or the judgmental voice in your head. All of these except the last two may love you and want the best for you and your baby, but they are living their lives and you are living yours. If working is the best thing for your family, work. If staying at home is the best thing for your family, stay at home. Either one will have sadnesses and frustrations and difficulties and joys and pleasures and advantages. Read parenting books and doctors’ guidelines as a way to inform your choices, but collect their ideas into a larger collage of possible options. Every child is different and no child will fit perfectly into a paradigm. Be skeptical of dogma, advocate for yourself and your child if you are worried about something and doctors brush you off, trust in your own intuition about what your child and your family needs.

6) Anxiety is part of parenting and it’s here to stay. The thing you love most inhabits a mortal body and then develops the capacity to move independently, to put things in it’s mouth, and finally to make bad decisions for itself. You will learn to live with anxiety and manage it. It will wax and wane with the circumstances. Current worries will pass and new ones will arise. It’s tiring but you can survive it and thrive in spite of it. You’ll maybe never sleep quite as soundly again. I’m just being honest.

Having a child is the ultimate adventure, which is a cliche, but apt in this circumstance. It is full of unknowns and good and bad things happen along the way. It’s exciting to watch a person develop and you learn a lot from accepting and negotiating another person’s total dependence. You get to see the world anew through an unjaded pair of eyes every day — again a cliche, but a true one — and this suffuses life with pleasure and meaning and hope. Becoming a parent puts an end to your childhood, but reawakens your child self. Mostly, there is the love, the massive, unconquerable, infinite love. It’s like they always say: there is nothing like it.

Here is my favorite meme of all time, which kind of says it all.

Slavery, freedom, depression, resurrection: you know, the usual

Can it be that it is almost April? Can it be that almost a month has passed since I last posted here, since I last stepped back and thought a thought? Who am I again?

Here’s the thing about being a mother, or an intern, and especially a mother who is also an intern: Every moment you spend doing something is a moment that is stolen from something else. My time with my family is time stolen from my job and by extension from my patients. Time for myself is time stolen from my family. Time for friends is time stolen from doing taxes which is time stolen from cleaning something which is time stolen from catching up on sleep which is time stolen from writing which is time stolen from spending time with my family which is time stolen from the practice of medicine and around and around we go. I’m tired of stealing and tired of having to steal. Right now I’m fifteen discharge summaries in the hole, E is sick for the fourth day in a row, I did not sleep more than 30 minutes at a stretch last night, and the list of topics I need to read about is about a year long. But I’m sitting down to write because it reminds me of myself and these days I really need the reminder.

This year I spent Passover at the home of a new friend of mine. I was with E, who lost interest after about 10 minutes, so I spent the rest of Seder chasing her up and down the hall. All she wanted was to lunge down the stairs headfirst and I had to stop her again and again. We had to leave right as the meal was being served because it was an hour past bedtime. But for some reason I was really paying attention this year. There’s a part in the seder — two actually — where you wash your hands as part of the ritual. My friend suggested that we name something we would like to wash ourselves of in the coming year. When it was my turn, I felt unexpectedly that I was about to cry. “I’ve been so, so negative at work,” I heard myself saying. “Just seeing the darkness in everything all the time. I want to be free of this constant negativity.” I looked up and I couldn’t tell if what I was saying was resonating at all with the other people at the table. Eliana shrieked and I was off running down the hall again.

Jews are commanded each year to see ourselves as having been slaves, as having personally come out of the land of Egypt. I’m not sure if this injunction was intended to inspire contemplation of one’s own figurative enslavement or liberation, but I’ll admit, I am feeling like a slave. I know that I am not a slave. I am a person being paid a wage to work a job that I chose. I have a home, a family, and means to provide for them. Hell, I just spent $60 on music classes for my fifteen-month-old. #firstworldproblems. But I do not feel free. Every day as I leave my family to go to work for 12, 13, 14, 15, 16 hours, every time I put Eliana to bed knowing that I will not see her for 48 hours, I feel powerless. Every time I am castigated for something outside of my control at work or make an error that affects a patient out of fatigue, competing stressors, or just lack of knowledge, I feel powerless. Every time I make a commitment to someone I love and have to cancel, every time I answer an email with the line “Sorry for the long delay” (aka every time I answer an email), I feel powerless. Over time this feeling of powerlessness is adding up to a phenomenon that I hesistate to invoke because it carries so much cultural baggage, but at the same time needs to be spoken out loud more often by people in medical training: depression.

Here are the facts: Depending on the study you read, 2530% of interns experience depression during internship. In one study, up to 12% reported having suicidal ideation at least once during residency. Articles cite many potential contributing factors including long hours, skewed effort-to-reward ratio, stressful experiences of patient suffering and death, lack of control, inadequate time for self-care, sleep deprivation, medical errors, stresses on marital and parental relationships, lack of feedback on performance, and many others. All of these are true. I will add to these a term that I have come up with over my years in medicine: hierarchical stress, the stress of negotiating all the nuanced politics of the medical hierarchy. As an intern, you have to consult anywhere from 1-5 people before making most decisions and any or all of these people might be rude or humiliating or dismissive or condescending or have a bad plan that you are forced to execute. Multiply that by hundreds of decisions per day and that’s a lot of hierarchical stress.

It is comfortable to hide behind statistics and large cohorts. Here are some different kinds of facts: Almost daily on the way to work I fantasize about being in some kind of accident that will render me partially disabled. On worse days, I have suicidal ideation — not the kind where you buy a gun or practice your slip knot, but the kind where you irrationally imagine that some relief might come of it but are not in any real danger of committing the act. I cry either on the way to or on the way home from work at least 2-3 days per week, and sometimes at work. When I get home, I have to remind myself that E brings me joy. I have to consciously remind myself of the possibility of joy and then kind of pretend until I rediscover the emotion. Most of the time, I feel either irritable or drained of all emotion entirely, flat and resigned and without soul. And I am not alone. Multiple of my fellow interns have reported the same experiences, down to the uncanny details. It is for them that I am writing this, because the taboo against discussing it is so strong. It is time for someone to ask the question: Is this the right way to train doctors? Should the people tasked with hearing our stories and healing us have as the foundation of their professional training an experience of profound and prolonged dehumanization? Negative experiences with doctors are a common tale and this does not surprise me. Working 80-90 hours a week may improve your clinical judgment but it does not lead to a greater capacity for empathy or greater compassion at the suffering of others. If anything, survival demands that you become more self-focused, not less.

During the first months of medical school, a lecturer asked us to go around the room and say why we went into medicine. I was the first or second person to go and I answered honestly: I went into medicine because I wanted to gain a better understanding of what it is to live a human life and also to work to alleviate suffering. When I think back on that earlier version of myself I am both proud and a little embarassed at my own naivete. Oh, the things I did not know. Since that time, what has come into clearer focus is that medicine is a business as much as it is anything else. I have taken on a crushing amount of debt that I will be paying off until I die. As a result, money has entered my career calculus to a degree I never expected. Money is also part of my awareness at work to a degree I never expected. We see more patients in less time than ever before. Hospitalizations are shorter and turnover is higher than ever before. Different options are available to public insurees vs private insurees vs out-of-pocket international patients. Someone is getting rich of all this (read this article if you care about health care in America), but it isn’t me, nor would I want it to be me. After all, sick people are not in a position to bargain and thus our ethical position with respect to charges is a tenuous one. The ever presence of money is part of my disillusionment with medicine, but what did I expect?

Everyone says it gets better and I have to trust them. I will survive this year and residency. After that, I hope I can rediscover the wonder and mystery of the human being’s journey through time in a body, and the sense of privelege in being able to serve as a guide and witness to that journey. I hope I can find a way to practice medicine that is both evidence-based and spirit-based, that is efficient and safe but also reaches beyond these towards higher goals. I hope I can heal myself and be the kind of partner and parent I want to be — present, engaged, and at least at times unfrazzled. I hope I can honor my commitment to medicine while also continuing to nurture the dreamer and the poet in me because there are things of importance that cannot be subjected to the scientific method. I hope I can stop being a thief of time and start being a contented inhabitant of it. If in twenty years I am a country doctor (are there country neonatologists?) living off the grid and growing my own rutabaga you will know why: because what is a career if there is not also a life?

Passover and Easter coincide this year, so both freedom and resurrection are on the menu. I think of my grandmother who spent several years in a concentration camp and my grandfather, who liberated her from a cattle car. They helped smuggle Jews through Europe on their way to Israel. Freedom was not a metaphor for them, but a reality lost and found again. In the face of that history, there is a limit to how much a gay Jewish woman living out and in the open can complain (see above re: #firstworldproblems). That said: I hope to be free from debt one day. In other words, I hope my profession feels like a choice again one day. As far as resurrection goes, all doubt and depression and critique aside, I’ve seen it with my own eyes: the limp, blue baby who takes its first breath after a few minutes of positive pressure ventilation. The child who almost died from overwhelming infection who is sitting in your primary care office telling you about their report card. The former substance using teenager who has become an amazing mother and provider. It’s enough to keep me going day after day after day, which feels like its own form of resurrection.

For me, the concept of freedom is embodied by Nina Simone singing the following song. I am including both the recorded version and a blow-your-mind live version that cuts right to the bone.

Recorded version

Live version

2013: The Sabbath Year

It is 8:56pm and I am in the house alone. C has taken E to Pittsburgh to visit her brother’s family. This is the first time that I have been at home and E has been elsewhere, which is a small but, as it turns out, emotionally significant variation. I have traveled several times during her life, but she has never been out in the world far away from home without me. I ache with missing her. It’s not that I want to be the sort of mother for whom separation is difficult. I want to be the sort of mother who can enjoy her alone time, who can find a measure of freedom and pleasure in the quiet glass of wine, the sort of mother I was a few hours ago at 6pm, sitting in a great new-to-me coffee shop, writing. Now I just want to be kissing my child’s belly while helping her chubby legs into pajamas. Parenthood and addiction are not unrelated phenomena.

I am sitting at my desk which is cluttered with evidence of our life: E’s body lotion which I have been having to apply each night while chasing her around the house; my stethoscope and the pediatric code card I carry at all times while at work; claritin, sudafed, and pepto bismol, because that is how we roll these days. To the right of my mouse (alert: if you find fingernails gross, this will be gross for you) is a little pile of E’s fingernails from this morning’s looney tunes mani-pedi (note: bugs bunny is an effective but very short-lived pediatric paralytic) which I didn’t have a chance to throw out before E was off to her next death-defying adventure.

When I was growing up, my mother kept a little porcelain container with my baby teeth in it. At the time I found this a little creepy and a lot disgusting, but now I understand it. As a parent, your child’s body — its every part — is suffused with your love and your worry and your desperate desire for their life. Precious does not begin to describe it. I am glad that I experienced the ecstatic, terrified love of parenthood before becoming a pediatrician. I have a lot of empathy for the worried parents of ill-but-overall-well children, and even more empathy for the parents of truly ill children. Other people complain about anxious parents, but I just feel for them. In the words of Yehuda Amichai: As for my life, I am always / like Venice: What is just streets in others / in me is a dark streaming love.

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It’s almost the new year and I was reminded by a friend’s lovely blog post that it is time to make New Year’s resolutions. Ordinarily, there is nothing I love more than a self improvement opportunity. Here is a small sampling of the books on the shelf nearest my desk: The Seven Habits of Highly Effective People, The Now Habit, Uncomfortable with Uncertainty, Zen Mind, Beginner’s Mind (all recommended, by the way). I have been to meditation retreats. I have been in therapy. I have bought apps to keep me focused, to track my time, my calories, my money, and the books I read. I have been a vegetarian and a vegan, have eaten no refined sugar whatsoever for a period of 10 months in 2003, and have been following the zone diet on and off since 1999. I have swum and walked a lot of miles and when my midwife told me to train for labor, I woke up every morning at 6am for three months and took my whale-self to the trail along Lake Michigan. One might say that I have made New Year’s resolutions into a year-round side career.

I tell you all this so you can appreciate the gravity of what I am about to say: I feel like I am doing an okay job at life these days. My life is more crowded than ever and as a consequence I make more mistakes than ever. The pile of unopened mail has never been taller and I haven’t been to the dentist since George W. Bush was president. E’s favorite food is Kraft macaroni and cheese and she co-slept with us in our bed every night from birth through twelve months despite my intimate knowledge of the AAP recommendations on SIDS prevention. I am still bad at returning emails, only I’m even worse than I used to be. But every day I get up and drain every last drop of myself in the doing. I am a smoky fire.

There was a time (aka B.C.E., Before the Coming of E), when I devoted time every six months or so to revising my personal mission statement a la Franklin Covey. My mission statement used to extend over two pages. It featured nine separate roles and my goals for each role. It had specific line items for physical exercise, eating well, keeping the house clean, remembering birthdays, meditating, swimming, writing, keeping up with my photography hobby, communicating with my in-laws, sustaining positive mentoring relationships, being a good sister, traveling, and acquiring more scientific knowledge.

Now my mission statement goes something like this:

Be the best parent and partner I can be. Be the best doctor I can be. Try to write as much as I can.

That pretty much covers it. Everything else is extra credit. I have neither the energy nor the time to improve myself. I am just going to have to make do with the me that I already am.

In Judaism there exists the tradition of shnat shmita, or the Sabbath year. Every seventh year, a year of rest and remission is to be observed. Debts are forgiven (here’s looking at you, Sallie Mae). Slaves are freed (here’s looking at you, ACGME). Fields are allowed to go fallow. Planting and harvesting stops and everything that does grow is “hefker” or ownerless, free to everyone. Basically, the machinery of human commerce reboots. The practice is still observed by religious Jews (though notably not by credit card companies). The last actual Sabbath Year was 2007-2008, so the next official one won’t be until 2014-2015 but I’m thinking we may need to move it up a bit and reframe it in more personal terms. It’s Shnat Shmita, my people! Perfectionism is out. Interdependence is in.

So I invite you to join me in resolving not to resolve, in being self-aware but yet filled with humor and gentleness. Let us be no thinner and no more organized. Let us validate ourselves and each other because we are working hard and trying our best. Let 2013 be the year of consolidating our strengths, asking for help when we need it, and setting realistic expectations. Let us view ourselves as we view our children and/or dearest friends: with love and admiration and tenderness.

Happy New Year!

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Epilogue to maternal loneliness: C just sent me this picture of our little E, delighting in the company of her cousin in Pittsburgh. He’s her new bestie, basically. She looks so grown up — it blows me away! She’s having a fabulous time and building the relationships that will sustain her long after her Baba and I have left this life. Meanwhile I am about to go to bed so I can wake up at 5am and go take care of 17 other babies who are just at the beginning of it all. There is much to be grateful for.

E and A

Fracture Lines, Suture Lines

E broke her arm last week. That’s not entirely accurate. She didn’t break her arm. Her arm was broken. But no one broke it. The most accurate way to describe the situation is: There is a fracture in E’s left forearm. Yes, our ten month old is currently sporting the world’s most tiny cast.

How did it happen? The truth is: we do not know. C dropped her off at day care one morning and she was fine. When she picked her up that afternoon, she was refusing to crawl. No one could offer us any history of trauma or episodes of unusual crying. No one noticed that she couldn’t crawl. Did it happen hours or minutes before pick up? We have no way of knowing. In the day care’s defense (just for the record, there is no defense), she was using the hand for all the usual eating, playing, grasping, and pulling up, just not crawling.

For several hours on the way to the ER and awaiting the X-ray results we wondered whether someone had hurt her. I knew a new kind of hysteria: the hysteria of unfocused rage. But the fracture turned out to be of the type caused by falling on an outstretched hand, most likely from some height. So no one hurt her, but someone did not supervise her adequately, someone did not catch her as we catch her 20, 50, 100 times a day.  She is lumbering around on her first legs and a set of capable arms needs to be constantly at the ready.

When I tell people what happened, there is a shocked pause. I can actually hear the person on the other end of the phone processing a moment of deep doubt at our parenting abilities. Even those who love us most cannot get on our side on this one.  “I’ve just never heard of this happening to a baby before,” they say. “Oh, it’s actually quite common,” I say, in my pediatrician voice. But the truth is, I’ve never heard of it either. I’ve read about it, seen it in older children, but it’s never happened to someone I know at such a young age. What can I tell them? We love E beyond all bounds of imagining. We took her to day care and something happened there. We are doing the best we can.

Maybe no one is judging us. Maybe it’s just me that is judging us.

Having to take your child to day care is a compromise. You can dress it up however you want—she loves being social (she does), she’s bored in our house all day (she is)—but the truth is that placing your child in the care of near strangers does not feel right. Added to that core uneasiness is the Herculean task of finding a spot at a day care and affording said spot. When we were looking, most of the places I called had a waiting list of 8-12 months or cost more than our monthly rent, or both. We needed day care in two weeks. When we visited the Day Care That Shall Not Be Named, I liked some aspects about it, but it seemed a little threadbare, glued together around the edges. But they had a spot and the director was a warm person. C was starting work in one week. We signed up.

In retrospect, it seems unimaginable that we settled for less than the best, but we were up against a reality that felt impossible. Every day these days feels like that old cartoon where the sailor is trying to keep his boat afloat by sticking a finger in one of the many leaking holes. Perfect is no longer an option. After the fracture, I sent an SOS email to a group of my fellow doctor moms asking for child care recommendations. I got twenty-five emails in three hours with stories of child care disasters, near misses, and last minutes switches. It made me feel a little better. We are all trying our best.

E is her usual sparkly self. She is crawling on the cast, continuing her quest for bipedal mastery, avid as ever for discovery, for novelty, for height. Every time I look at her little cast, two thought-sensations run through my head. How could I have let this happen? Followed by, thank god it wasn’t worse. The dual mantras of parenthood.

Needless to say, we are looking for a new day care. In the meantime, my parents are stepping up as they always do with extra days of child care each week and we are bleeding money through every orifice hiring our wonderful but expensive babysitter for the rest of the days.

It takes a village to raise a child, but sometimes you have to move to a new village.

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Did I mention that things these days are pure desperate madness? Still there are these moments of grace.

I am on my way to present a poster at one of the national pediatrics conferences. The conference is happening in New Orleans. When I tell people about it, they are of course excited for me. “How exciting! You get to go to New Orleans!” What I am thinking is: “Can’t they plan the national meeting in a major air travel hub where people I know live?” Boston? Washington, D.C.? Chicago? It is clear that the planners of the conference are not interns with small children supporting a family on one and a half incomes. There are no direct flights. I got up at 5 a.m. to catch an early flight, will present my poster this evening at 5pm and will be up at 5am again tomorrow to fly back. My main goal for the trip is to get back to the hotel by 9pm so that I can get eight straight hours of sleep for the first time in 18 months. When I heard there was an evening cocktail party that I “should attend for networking purposes,” my first thought was: “Doesn’t anybody care about me at all?” Hard won wisdom: Chronic sleep deprivation results in irrational egocentrism. Don’t get me wrong: I’m honored to have been selected to present and there are always interesting things to be learned at these conferences and there are worse things than spending the night in a nice hotel.

In my prior life, I would never, never have planned a flight that required me to be up at 5am. These days, I am excited because will be no traffic on the way to the airport. This shift in perspective is one of the ways I know that I will one day die.  I browse the New York Times from 6:10-6:15am while eating my off-brand Greek yogurt. Me time! I throw the dental floss in my bag on the way out, imagining flossing my teeth in peace while watching HGTV on the hotel TV. More me time! On the other hand, I should probably use the time to catch up on overdue discharge summaries.  Work-life balance should be called work-life death match.

On the way to the airport, I listen to Shawn Colvin’s rendition of one of my favorite songs, Bob Dylan’s “You’re Gonna Make Me Lonesome When You Go.” It’s a live version. It’s not perfect. But it gets to me. Something in the strumming. Plus, heartache and bittersweet love loss is more convincing to me in a female voice. That’s just me. I lost my glasses somewhere—I think I gave the case to E to play with in the stroller at some point—so I have to slow down at each sign to decipher how to get to economy parking. The person behind me is clearly unhappy, but really, I am incapable of caring about it. Here is one thing that being an intern and a parent have given me, and pardon my language: I just do not give a fuck what other people think anymore.

For example, none of my clothes fit. I lose a size every 2-3 months since E’s birth and I’m not complaining about that, but my clothes budget cannot keep up. So I’m wearing the size 12 stuff until the weight loss plateaus and it’s safe to go shopping. My pants are constantly in danger of falling off mid-stride. Also, under my “loose-fitting” jeans, my legs are incredibly hairy. This might be TMI, but see above re: I’m kinda past that. I have not had an hour to get my legs waxed since mid-August. This morning I tried to shave them in preparation for the conference presentation — it’s going to be 80 degrees in New Orleans. Don’t these people understand that I’ve transitioned to the cold weather hair management schedule? (see above re: egocentric irritability) — but I discovered that the only razor in the house was dull. So there is just a single strip of socially-acceptable, hairless girl-leg on my left shin. No matter: I will wear black tights under my “loose fitting” dress. Problem solved.

Anyway, I pull into economy parking and this beautiful song is playing, and the sky is just turning from black to blue. The airport shuttle pulls up to the nearest stop, but I decide to finish out the song (see above re: me time). I allow myself to imagine getting on a random plane and ending up somewhere else, but the fantasy holds no appeal. My two loves are at home in bed and that is where I most want to be. I start to cry. Why? Because I am so, so tired.  Because in that moment I remember the dreamer traveler that I used to be and I miss that person. Because I am alone but never really alone. Because I am so grateful for my little family. Because I fear losing contact with the sublime forces in the world but I haven’t yet.

*             *             *             *

I’m working in the newborn nursery this month. What this means is that every 5-90 minutes a brand new human being is delivered into my temporary care. Day of life zero! No amount of mindless bureaucracy (so. much. paperwork.) can dull the wonder of it. Here are some of the observations I have been able to make:

1) Every human being grew inside a women. This is self-evident, but cannot be too-often noted and celebrated. Even more amazingly, the majority of us emerged through a vagina. Crazybeans!

2) A person’s unique selfhood is present from the very beginning. You need only examine twenty newborns a day to begin to feel that nurture pales in comparison with nature in determining life’s trajectory. Each of them is so resolutely themselves already! Here is what I take away from this: Relax, my fellow parents. Keep your children alive and they will largely do the rest. Ok, don’t let them have everything they want. But go out to the movies once in a while! Our children’s lives are intertwined with ours but they are also separate. In the first few minutes, hours, and days of life, you see this best. The mother is trying to recover, awkward, exhausted, labile, high and bereft. The baby is awash in sensation, ravenous, and knows no clock. The needs of the mother and the baby are at odds but yet they are uniquely suited to fulfilling each other’s needs. This complicated dynamic continues for life as far as I can tell.

3) Evolution works. Evolution is majestic. How else to describe the skull sutures that remain unfused to allow the baby’s head to pass through the birth canal? Every time I examine a new baby’s head, the pulsing spaces between the skull plates shock me anew.  Sometimes the plates even override each other like the tectonic plates deep beneath the ocean beds. Evolution found the point of intersection between the maximum brain size and the minimum pelvis size and so our skulls mold to fit the exit tunnel. You can always tell a baby who was born by planned C-section because their heads are perfectly round. I wonder if this creates a new existential category of human: people who have not had to yield in order to come into this world.

4) There are too many babies being born. Too many people have too many children. How will the earth support so many people? I’m not sure what to do about this. I guess we’ll just have to wait and see what happens. Meanwhile, maybe I’ll have another one. What’s one more?

Which brings me to the most disturbing side effect of working in the newborn nursery: it makes me want to have another baby. Not at some point in the future, but now. This is proof positive that the reproductive drive is a subcortical process. Or a mental illness. Thank god C and I cannot get pregnant “by mistake.” On the other hand, I wish we could get pregnant “by mistake.” But thank god we can’t….. and so on.

The newborn physical exam is one of the most important tests a human ever takes. It is the test that asks the question: Were you made correctly? It contains a number of check boxes that need only be checked off once in a person’s entire life. Once you’ve verified that a baby’s anus is patent, it’s a question that never needs to be asked again. Ditto with the cleft palate. Five fingers and toes. Closed neural tube. I love examining a brand new baby. They are a text that has never been read before.

When I examine the babies I catch myself calling them by E’s pet names. “Hi smoosie boosie,” I say. They cry and undulate and then suddenly open their eyes and regard you with an expression of sober contemplation. Are these a phalanx of anthropologists from another dimension, you wonder? Then they are back to rooting and burping up milk. “Hi boose boose,” I say as I run my hand over an oddly shaped head. “Who is gorgeous?” They all are.

*             *             *             *             *

Once in every ten days or so, E forgets entirely what is supposed to happen in the middle of the night. What is supposed to happen is that she awakens crying, drinks a bottle, and effortlessly falls back asleep. What happens on these fluke nights is that she awakens, but instead of crying she gives us the biggest smile you can imagine and starts clapping your hands. How can one gesture evoke such delight and at the same time such desperation? Hand clapping is the sign that you are basically screwed from a sleep perspective.

Last night was one of these nights. Ordinarily, we try to put her back asleep. This process can take 1-2 hours, is accompanied by lots of crying and dramatic thrashing about, and leaves you feeling more exhausted than if I you simply stayed up all night. Last night, after several rounds of unsuccessful rocking in C’s arms, I decided to just go with it. Was I secretly excited at the chance to spend some stolen time with E? I was. I work a lot of hours and my time with E in the evenings is all tasks. Dinner time, then bath time, then bed time.

I took E downstairs, turned on the light, and sat down with her in front of her toy box. There were still tears on her cheeks from the sleep attempts. She took a few seconds to adjust to the light and then spent several more seconds with her mouth open, trying to figure out what the hell was going on. Then slowly, she figured it out—Playtime! No more sleep attempts!—and her face was transformed into an enormous, electric grin that I hope is the last thing I remember before I die. She lunged into my arms, so grateful, so excited. We turned to the business of stacking blocks and using them as eyeglasses. I brought a pot in from the kitchen and she played a new game: Earnestly Filling a Pot with Objects. She is capable of an astonishing degree of attention and she spent 20 minutes exploring the buckles on her stroller, every so often looking at me as if to say, “Are you seeing this total and complete awesomeness?!” and “Is everything I’m doing ok with you, Ima?” I got to watch her, tickle her, laugh with her, catch her as she tumbled about with her little purple cast clanging against the sides of things.

The nice thing about parenting is there is just so much time for things to happen. It is the most time-intensive relationship in life. You spend hours upon days upon months in the constant company of your child. Every once in a while, at an unexpected moment, your orbits go into perfect phase. It’s like you’re on the best date of your life, where everything you say is funny and everything the other person says is smart. That was us last night, just enjoying each other in the pool of a lamp’s light in the otherwise sleep-silenced night.

I may not always be winning the work-life death match and but E and I are still what we are to each other, two people who were at one point separated by the thickness of only one cell. We are separated now by time, by my responsibilities, by her curiosity about other people and other things and that is how it should be. Her life is her own. I’m just here to catch her when she falls.

Happy New Year!

Tonight is the Jewish New Year. We were supposed to celebrate with my family, but since E started daycare last month, there has been about one illness per week and I just couldn’t face packing, traveling, unpacking, packing, returning, and unpacking in the space of several days. It’s work enough just keeping everyone hydrated these days.

Instead, we bought a rotisserie chicken from the supermarket and lit Ikea tea candles. Instead of wine, we blessed a bottle of Beck’s. Instead of challah, we blessed the heel of a loaf of multigrain bread. I was sad not to be with my family, but this version of the holiday was somehow fitting for our current life. E was able to eat all three of the foods in our meal. For some reason, this new fact of her culinary competence delights me every time. I love taking the food right off my plate, cutting it into tiny pieces, and watching her feed it to herself. It may sound odd, but I find it more satisfying than breastfeeding, perhaps because I am in no way anxious about it. What’s mine is hers, no nipple cream required! After dinner, while C put her to bed, I swept and mopped our dining room floor (not as common an occurrence in our household as it should be).

Jews count the years from the creation of the world, from “molad tohu,” or birth from nothing. Apparently some rabbis calculated backwards from the destruction of the Second Temple using the record of successive generations and came up with Monday, October 7, 3761 B.C.E. as the first moment ever. So now it’s 5773. Part of me thinks this is totally ludicrous and part of me is attracted to the ballsy exactness of it. I love that religion continues to stand its ground in the face of overwhelming evidence favoring other explanatory models. Well, I love it minus the bigotry, violence, xenophobia, misogyny, homophobia, and confusingly hypocritical social policy that seem to go along with it. Basically, I just want there to be space in the world for mystery and for that which cannot be articulated. But religion is doggedly specific in its ideology and demands, and thus it’s Ikea tea candles and Beck’s for me!

But back to the first first:

“In the beginning, God created the heavens and the earth. Now the Earth was unformed and void, and darkness was upon the face of the deep; and the Spirit of God hovered over the face of the waters.”

I love the existential and linguistic bravery of these lines. Sure, it’s impossible for there to be something before the first thing, but language forces us to imagine just that. The book could have begun with that first line “In the beginning, God created the heavens and the earth” and gone straight to the third line “And god said, “Let there be light” (the first speech act! I can’t get enough!) but instead the author wants to tell us what there was before anything was. The second line has always slayed me, from a poetics perspective: And the Earth was unformed and void and darkness was upon the face of the deep. In the original Hebrew, there are internal rhymes, alliterations, a cadence that suggests both howling wind and stasis. It’s good stuff. The face of the deep: who has not seen that unseeable face? It’s the kind of language that can be spoken a billion, a trillion times and still remain fresh.

Molad tohu has new meaning for me this year, having been witness to the growth of E from a sub-micron in my darkest insensate recesses to a completely extant being who got tiny broccoli stalks stuck in her eyebrows from playing peek-a-boo during dinner. I have studied every step in the biological process that contributes to this remarkable transformation and yet it retains the quality of total mystery. The science of it does not negate the miracle of it. The science of it IS the miracle of it, and yet, for me, the miracle of it extends beyond the science into the realm of that which cannot be named, that which is unformed and void.

All of which is to say: Happy 5773, that is also 2012 years since the birth of Christ, plus or minus, that is also 13+ billion years since the birth of the universe, that is also a completely subjective experience that each of us is having beginning when we are born and ending when we die. Pass the apples and honey!

May the year be a sweet one.

Long time no

I haven’t posted in over a month. Every day, after I have worked from 6-6 or 6-7 or 6-9, driven home, bathed and put Little E to bed (on the days when that is possible), I am faced with a “decision”: stay in bed or get out of bed and try to do something. Invariably, E has placed her tiny hand across my arm as I hum our bedtime song over and over again and I am so deeply exhausted that there is really no decision. I slip into the comfort of sleep leaving the rest of me fallow for yet another day. The sleep I get from 8:30pm-midnight beside my baby is the sweetest and the only reward I have these days and I am reticent to give it up, even for just one day, to get my shit together in life’s other domains. And so: no writing. No responding to emails, no exercising (I am about as strong and vital as a bowl of tapioca pudding these days), no doing writing for the research projects that I am still ostensibly participating in. Just sleeping, waking, working, and doing whatever small amount of mothering I can do in the hours between.

It is hard to know whether to tell the truth about internship. Doing so seems like a betrayal, but of whom? As in any hierarchical culture (think: the military), there is an unspoken taboo against speaking out about how it feels to be at the bottom of the pile. We instinctively identify with the system that we are trying to enter and to speak about its flaws is to risk being exiled from it. The first rule of intern year is: You do not talk about intern year.

But, I did not join the military or fight club. I decided to become a doctor, a healer, a person tasked with the care of those who are suffering. And right now, I am exhausted, uninspired, and in an unhealthy place physically, spiritually, and emotionally. I find myself wondering about the merits of the current culture of medical training, whether it produces the kind of doctors we want caring for us, whether it is the system or me that requires reform.

So here’s the truth about internship: It’s really, really hard. I have never felt so exhausted, so consistently pushed past my limits. After a lifetime of working to cultivate an open heart that is strong enough to face suffering, I find that I have to encase it is armor just to survive the days. There is just no time to process and integrate everything that I am experiencing. Instead of being wiser than ever about people, I am less and less wise, harsher, more judgmental, and less patient. I am in constant physical pain, unable to do the exercises and get the rest that I need to keep my back healthy. I resent my job every day because it does not allow me to be the kind of parent and spouse that I want to be. I began this path hoping to become a strong warrior, guide, and advocate for those who are suffering and now find that I am the person who is suffering, who is in need of guidance, of compassion, of healing and recovery. Perhaps this is the deeper intention in this training model?

Medical residency was at the start designed for unmarried men who committed to live in the hospital for the duration of training, hence the term “residency.” There is much nostalgia in medicine for the time when the ardent mission of medicine was all-consuming. There is certainly precedent for this kind of professional training. In prior times, apprenticeship in many fields required a period of servitude to a master, often of a live-in nature. Perhaps the gravity and complexity of medicine requires a period of complete 100% commitment in order to master. In which case, perhaps 32 year old people who are also parents and spouses are simply ill-suited to the acquisition of this profession.

But then I think of all the other people in the hospital–nurses, psychologists, chaplains, radiology technicians, the list goes on and on. These people are all protected with respect to the amount of time they are expected to work. In fact, it would be considered unsafe for many of these people to work more than a certain amount per day or per week or per month. How exactly are doctors different? Are we immune to the effects of chronic exhaustion and life deprivation or do we just think we are? I get that doctors are the people who have to made difficult decision and judgements in the toughest moments for very sick people. I get that some training under pressure is necessary to be able to rely on people to consistently make these decisions correctly. But does it have to be so relentless for so long?

I challenge myself to think of a better training model, but to be honest, I am simply too tired. My brain is in survival mode. I guess the best thing to do is to keep my head down and keep going day after day, and hope that when it is over, the person I was is still in there somewhere, ready to care and feel things deeply again, ready to find a sustainable balance between service and self-care.

Good to the last drop

Yesterday morning my body stopped making milk. I don’t know if it was the chaos of moving, the stress of starting an extremely demanding, high stakes job, or the fact that I have been sleeping for part of the night apart from E in another room in order to add some sleep to my reserve for the long nights of residency, but my body reached a minimum threshold of contact and milk demand and decided to close up shop. When I got in the car and put on my pumps (pumping while driving = how I have survived the past few months), I knew something was forever different. Thirty minutes later, adrift in the endless rows of cars in the hospital parking lot, I looked down at the empty bottles attached to the pumps  — oh loyal, maddening, tireless pumps! — and made the realization that was also a decision that my milk-making adventure was at an end. I called C and told her to save the three ounces that were in the fridge from the previous day — I wanted to give it to E myself — and removed my pumps for what will be the last time for a while.

There is no question that this is a case of my body’s wisdom outpacing my own. Time has never been more scarce and I want to spend all my time outside of work either with E, or, in the 30 minutes after she goes to sleep each night, studying to be a better doctor and writing to keep my humanity intact. Oh, and keeping some kind of live connection with my partner. These will all be daunting enough when I am on a week of seven straight days, not to mention the month of November when I will be working 28 days in a row with only one day off. In this equation, twenty minutes of washing and sterilizing pump equipment morning and night, thirty minutes of pumping three times a day, and night-time feedings do not add up to success or happiness. My job now is to be the best mother I can be under the circumstances and this necessitates that I focus on being present in every sense as much as possible, not sitting on the couch pumping or falling down from lack of sleep.

Still, I cried. Sitting there under the gray morning sky, I remembered those crazy, ecstatic moments in the delivery room when they put her squirming blue body on my chest and I felt her latch on for the first time. I remembered all the middle of the night nursings during that first month when I didn’t know anything about anything and would take E into the living room, turn on the light, and nurse her on the couch, both of us fully awake for several hours each time. I could see her in my mind’s eye, nursing while gazing meditatively at her own hand, then at me, then at her own hand again. Our two bodies have been in such contact! It defies my attempts to fully integrate it, this intimacy we have shared.

But then I was late and had to stop crying and get myself together. To everything there is a season, and in the life of a resident, it is almost always either the time to plant or the time to harvest.

I felt the urge to mark this milestone. The problem with living outside the context of organized religion (Jew-ish/lapsed Jew/can I substitute a decade of therapy for a decade of services?) is that there is just no framework for these moments in life. I googled “weaning ritual” and page after page talked about talking with your toddler about weaning and planning the ceremony with them. Does weaning belong only to the people who have been breastfeeding for over two years? Am I by virtue of having breastfed for six months ineligible to celebrate and be sad? Still there were helpful ideas. Tell the story of the child’s birth as you nurse them for the last time. Say a blessing. Plant a tree. Good ideas all.

So after work today I bought E a little plant that, if tended well, can live as long as she will. I came home and we had a little dance party (aka E plays the Casio keyboard while I do interpretive dance). I showed her her new plant and explained that I will be watering it and tending it as I nourish and tend her, with all my love, that it will be hers when she leaves to begin her adult life (but never really leaves, right??). She looked at it, agape with curiosity and skepticism, and then turned to play with her blocks. When she was ready for her nap, I put the last three ounces of my breastmilk in a bottle and took her up to bed. While she was eating lazily, I thought in a way that was both ode and prayer:

Your life is a double gift: our gift to you and your gift to us.

Thank you so much and you are so welcome.

In Judiasm, there is a prayer that is said over the child, so I said that too: Ye’varech’echa Adonoy ve’yish’merecha. Ya’ir Adonoy panav eilecha viy-chuneka. Yisa Adonoy panav eilecha, ve’yasim lecha shalom. May God bless you and keep you safe. May the light of God shine upon you, and may God be gracious to you. May the presence of God be with you and give you peace.

I don’t believe in a someone in the sky, but I want all these things for E — blessings and safety and light and peace — especially the safety part. Please, universe, keep her safe!

E left half an ounce in the bottom of the bottle and so my last act as her breastmilk-making mother was to pour it down the drain. I like to think it was an offering.