On being a gay mother in medicine

I was so excited to find this blog! I have been reading MiM [Mothers in Medicine, where I recently guest blogged] for a few years and always longed for posts from gay MiM. I am gay (as well as a third year med student in NY) and have not met any physicians who were openly lesbian (I know they are out there – but right now I am in [a place where there are apparently not a lot of out gay people]). Would you be willing to write a post or share your experiences on what it’s been like for you being gay in medicine, especially being a gay parent in medicine.  —  New reader extraordinaire

Dear new reader extraordinaire:

Thank you so much for reading! I am here to tell you that there are lots of gay and lesbian doctors. Come join us in the major metropolitan areas and we can be the objects of warm tolerance and slow political reform together! I was happy to get your request, but to be honest it made me a bit uncomfortable. But more on that later.

Let me tell you about a dinner I attended recently. I was lucky enough to have the opportunity to dine with an interesting and accomplished professor in my chosen field, neonatology. Attending the dinner were several of my co-residents and another faculty member. The topic of families came up and I proudly showed pictures of my little E (dear everyone: do you enjoy seeing these pictures as much as I enjoy showing them? i’m going to assume yes), which prompted the six words that are the having-birth(ed)right of gay mothers everywhere:

“So, what does your husband do?”

This question is both my favorite and least favorite moment of being a gay mother in medicine. It contains so much: an assumption about my sexual orientation. An assumption about my marital status. A probably subconscious attempt to locate my family in a class category. A friendly attempt to get to know me, which I appreciate despite what is about to be a very awkward minute or two.

Here is why I hate this question: It forces me to embarrass the other person and then in turn be embarrassed by their embarrassment. They have made one or more incorrect assumptions (what if I were a single mama? Awkward!) and unless I lie (I do lie sometimes when I just can’t do it), I am forced to expose that assumption. If people are “socially liberal” they often feel compelled to tell me about their gay sister who is getting married in Vermont or their favorite college roommate who is having twins with a surrogate. While I enjoy hearing these stories of my people far and wide, they are not necessary. I do not think you are a homophobe because you assumed I have a husband. Conversely, that you have a gay sister does not reassure me that you are not a homophobe. If you find yourself in a situation where you have made such an error, my suggestion is to simply switch pronouns gracefully and move forward with the conversation.

Also, I hate this question because I haven’t found the right way to answer it. Usually I do this shrugging thing with my shoulders and say “Actually I have a wife and she’s a filmmaker and a professor” where the first part is thrown out at the top speed and the end part is drawn out Southern-style. In the complicated but successful gender ecology of my marriage, “wife” is not really a term I ascribe to C, but it gets the point across more clearly than “partner”. Sometimes I say “Actually, I am married to a woman” but this is also not quite right and seems more intimate, too intimate. Sometimes I just say “She’s a filmmaker” but if the person isn’t really listening, it can prolong and exacerbate the awkwardness.

Here’s a fear that I have: when I am forced to come out to people I barely know in this way, I worry that it makes them think about the way I have sex. I’m not sure if this is true or not, just a hunch/fear that I have.

Mostly, I hate this question because it distracts people from the aspects of me that I want them to notice: my stunning competence as a doctor, my thought-provoking thoughts on science and society, my long brown curls which are having a really good day. In all seriousness, when you are trying to build your career in the EXTREMELY CONSERVATIVE field of medicine, you just don’t want your sexual orientation to be one of the main things that people remember about you.

Did I mention that medicine is an incredibly conservative culture? There are hierarchies. There are spoken and unspoken codes of conduct. There is little room for social error. Here’s a joke: What does a medical school applicant do to rebel? She wears navy shoes with her black suit! You get my point. Within medicine there are political gradations all the way from left of Marx to right of the wicked witch of the West but still there is a shared aspiration toward a kind of collective social perfectionism centered on benign neutrality. And here is a dirty little non-secret: Most major medical institutions (much like the world at large) are still run by straight (or permanently closeted) white men in their sixties and seventies who rose to positions of influence in a time when women, let alone gay people, were mostly absent. In this milieu, it is not comfortable to contravene prevailing social expectations.

On the flip side, medicine is also a world in which people are trained to maintain a calm and neutral expression regardless of what they are being told. As doctors, people tell us things that they probably wouldn’t tell their own reflection in the mirror and we are the custodians of their confidence and their positive self regard. We aspire that they feel comfortable telling us these things without shame or fear of judgment. As such, when I am inevitably forced to execute the big reveal at an awkward moment on rounds or better yet, in a pin-drop quiet OR while holding open a gaping abdomen, it is likely that I will never know what the receiver actually thinks about my sexual orientation. I usually count this as a blessing because it allows me to go about the business of surviving medical training without being forced to swallow huge anger hairballs.

Here’s where I will tell you about the worst gay joke moment of my medical training thus far. I was once in the OR of a renowned cardiac surgeon who asked me what field of medicine I had chosen. I was on an anesthesia elective at the time, on the happy side of the surgical drapes, so I was honest and told him that I was going into pediatrics. He proceeded to tell the following anecdote which I’ll partially redact to eliminate the boring parts: His colleague in medical school went to his surgeon father and disclosed that he had decided to become a pediatrician. His father sighed and said: “Well, at least you’re not a homosexual.” Har har har, the surgeon laughed uproariously as he made a small incision in the patient’s aorta. (He didn’t know I was gay. It’s like double word points in Scrabble. Double douchebag points!)

Thankfully, these moments are rare. Mostly, people are openly supportive or just don’t care one way or the other. I am lucky to have amazing colleagues in my residency program who ask about C and E and understand how important my family is to me. Maybe there are people who are secretly grossed out or who are praying for me or who wouldn’t want their kids to have me as their pediatrician. Maybe there are potential mentors who decide to invest their efforts elsewhere, but I have always been able to find spectacular, generous mentors (all women thus far…. discussion for another day). In short, I do not feel that my daily experience of being a doctor or my career development are negatively impacted by homophobia. But you have to make smart choices about where to train, practice, and reside.

Here is one thing, though: I never, ever talk about my partner with my patients. I don’t know if straight people do this. Usually I don’t talk about myself or my life with patients at all. Our time together should be about them, not about me. Sometimes I invoke my daughter when I am reassuring new parents about newborn things, but that’s as far as it goes. If they asked me about my “husband,” I would just use masculine pronouns. In part I fear their reaction and the possibility that they would see me as a threat to their children. In part I don’t want to use up our time and risk them feeling embarrassed or uncomfortable. I’m there to take care of their kids, not win over hearts and minds. Patients have made derogatory comments about gay people (not to mention black people, East Asian people, Mexicans, women, men, old people, mentally ill people) in my presence and I usually say nothing or muster up a weak “now, now” and redirect the conversation. I’m not sure if this represents cowardice or good therapeutic judgment, but I’d be curious to hear how other people handle these moments.

But back to the question. “So what does your husband do?” Here’s the thing I love about it: It forces me to be myself. I said at the beginning of the post that your request made me uncomfortable and the reason is that I am generally a person who doesn’t like to ruffle feathers (social anxiety: maybe a little. Maybe a lot. Y’know.). Though I am out everywhere I go in medicine and otherwise, I handle the issue by normalizing it as quickly as possible and moving on. When you asked me to write about my experiences as a gay mama in medicine, I had a feeling similar to the one I have when someone asks the aforementioned question: Oh lordy, here we go. But then, for a minute or two or in this case on the internet which is forever, I give myself permission to be important to myself, if not to anyone else. For that moment, it’s not about everybody else’s expectations and value systems. It’s not about what they want to hear. It’s about my right to exist. And if there’s one thing I’m passionate about, it is the right of every person (and animal and plant for that matter) to have singular importance. It’s one of the reasons I went into pediatrics, to defend the right-to-exist (and thrive) of children, whose singular importance is often overlooked. So every time I say “Actually, I have a wife”, I hope that more space is created for everyone to be themselves, to fulfill their own potential without fear of being bullied, or fired, or, in some places, stoned to death. This applies not only to being gay, but also to all forms of difference from what everyone else expects. At the minimum, I hope that if there is anyone else in earshot who is gay but afraid to be out, that they might email me or find me in the halls or at least feel less alone. This may all sound super lofty, but it is what gets me through the awkwardness every time.

To recap: Being gay in medicine is better than being gay in many other professions. It’s better when you live in a place where lots of other gay people live and where there are other gay doctors. It does take some courage but it also teaches you courage.

You didn’t ask for advice, per say, but I can’t resist. At the risk of repeating myself for the nth time: Choose a residency program in a gay-friendly place. Once you are there, be out to everyone. At least you will know who your true allies are. Don’t be afraid to be important to yourself, even when being liked or accepted or hired or promoted feels more important. This applies not only to being out, but also to shaping the kind of career and family and life that will make you most happy. It will serve you not only when someone asks you “So what does your husband do”, but also when you want to craft a part-time position to be home with a young child, or leave a good-on-paper position for one that excites your curiosity but pays nothing. Medicine will always try to be more important than you, but it isn’t. Patients are, but medicine isn’t. Be a strong advocate for your patients and for yourself. Do I worry as I write this that it may affect a future fellowship application or job offer? A part of me does. But would I want to be part of a club that wouldn’t have me as a member? No, I would not.

A picture of E? I thought you’d never ask! What I love about this picture are the accessories, and the tummy, and the feet, and the off-the-shoulder Salt-N-Pepa-in-the-early-nineties hoodie look.

E with accessories

When the Pediatrician Calls the Pediatrician

I am excited to be guest posting on a great site, Mothers in Medicine, re: the awkwardness of calling the doctor when you are a doctor, the patients that travel with you forever, and the anxiety of the unlikely-but-still-possible. Thanks for reading!

http://www.mothersinmedicine.com/2013/01/guest-post-when-pediatrician-calls.html

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

Resonance (magnetic and otherwise)

It’s the holiday season once again. I am in a Starbucks enduring the overdriven cheer of the Starbucks Christmas album. As sometimes happens, I am struck by a moment of gratitude for my job. There’s lots to complain about, but I don’t spend six straight weeks listening to synthesized sleigh bells and Frank Sinatra wannabees crooning about the most wonderful time of the year. When it’s my turn to order, I try to share a moment of fellow feeling with the employee behind the counter who is wearing a baseball cap from which two plush reindeer antlers emit. “If I had to listen to this album over and over again, I would go insane,” I say. “Oh, it’s not so bad,” she says, cheerily, “I love Christmas!” It occurs to me that she may be wearing the hat by choice. As often happens, I am struck by a moment of personal disorientation: Am I a huge Scrooge who needs to lighten up  and feel the spirit or a lone prophet screaming truth into the wind as human civilization crumbles? I am neither. I am a very tired person, about to enjoy a mocha latte in the middle of the afternoon as a group of undergraduates beside me discuss the precise definition of usury for their take-home final. In other words, it’s the most wonderful time of the year: vacation.

Some people spend their vacations in places like this:

woman bikini

(Note: this is exactly how I look in a bikini, only not as good.)

Whereas, I am spending my vacation here:

physical therapy 1

in physical therapy.

It’s a long story, but I’ll make it short: Sometime during pregnancy or after, my left sacroilliac joint became too loose. You don’t really notice your sacroilliac joint in the course of life until it’s too loose and then every third or fourth step becomes excruciating. The pain started at the end of May during our move and has slowly chipped away at my ability to function at life’s core tasks — picking the baby up, carrying the baby, and working, to name a few. Up until several weeks ago, I had the full expectation that this pain would resolve on its own if I just didn’t think about it (note: denial is up there with gravity in terms of forces that are strong). Then I started needing a cane to walk at the end of the day, at which point C gently informed me that it was time to seek medical attention. (As I have mentioned before, marriage saves me from myself again and again.)

The calculus of life being what it is, the total breakdown of my physical vitality happened to coincide with the most challenging rotation of intern year: the neonatal intensive care unit or NICU. I had been dreading the NICU ever since I chose pediatrics. The schedule is grueling, the knowledge base is totally foreign to the rest of pediatrics, and the ethics are complicated. Babies are being resuscitated as young as 23 or even 22 weeks gestation now and many of these babies go on to have a number of chronic medical conditions, including cerebral palsy, blindness, chronic lung disease, developmental delay, and hearing impairment. Then again, some percentage of them go on to be normal, happy children and there is no way to tell in advance which babies will have good outcomes. Even for those who don’t, it is impossible to objectively determine what level of quality of life merits investment. Where is the line between the mercy of sustaining life and the mercy of letting go? Millions of dollars are spent sustaining these fragile lives in their first weeks and months. From afar, it seemed like an ethical quagmire best avoided. But the calculus of life once again being what it is, it turns out that I love the NICU. As in: I think I may become a neonatologist, the one thing I absolutely knew I would never become.

What I didn’t realize about the NICU is that when you work there, you attend deliveries. When there is any concern about a baby that is about to arrive — a maternal fever, a concerning fetal heart tracing, a mother who did not have prenatal care — pediatricians are called to be at the delivery, receive the baby, assess and rescuscitate them as needed, and decide whether they need to be admitted to the NICU or not. In our hospital, pediatricians are present at about 40% of deliveries, which works out to 2,000 deliveries per year, or an average of 5.5 deliveries per day. That’s 5.5 babies per day who are delivered into the arms of a pediatrician. What greater honor, what greater work could there be than to be that pediatrician? The delivery room was the site of my first contact with the world of medicine as a doula and it was that experience that made me decide to become a doctor. So things have come full circle. For me, it’s been one of those rare moments when the narrative of life seems to make sense after all.

There are other things I love about the NICU. One the one hand, there’s the acuity and the pace of an intensive care unit. The actions you take as a doctor there have the potential to be lifesaving in real time and that feels satisfying. On the other hand, a percentage of the babies at any given time are just feeding and growing, and might spend anywhere from days to weeks to months in a stable state as NICU patients, so there is the opportunity for a longitudinal relationship. It’s like doing intensive care with a little side dish of primary care. There’s also the opportunity to interact with parents in the most fragile, nascent stage of their parenthood. As a recent new parent myself, there is a river — a huge, gushing river — of empathy and tenderness for these parents, whose entrance into their new role is not made easy by the NICU environment. I can’t pretend to know what they are feeling, but I imagine it is a mixture of gratitude that the child is alive and mourning for the normal course of things that was expected. I want to be one of the people who help to ease this time for them. Mostly, though, I just love the babies, with their impossibly tiny yet perfectly formed fingers, their totally distinct and individual faces, their resolute presence in this life against all odds. I am reminded of a speech by one of my favorite authors, Haruki Murakami, as he accepted the Jerusalem Prize. He was speaking, bravely, about the Palestinian cause. “If there is a hard, high wall and an egg that breaks against it, no matter how right the wall or how wrong the egg, I will stand on the side of the egg.” I’m not sure the analogy is perfect, but it’s the closest to describing how I feel as I peer into the isolettes each morning at these little humans whose life is a complicated gift: I will stand on the side of the egg.

But back to the pain in my ass (which is, by the way, the technical term for the sacroilliac joint). So by day I’ve been, you know, helping to save the lives of babies. By, night, I’ve been hobbling on a cane, barely able to climb stairs, writhing every time I have to lie down or get out of bed. I went to a specialist who got X-rays that showed osteitis condensans ilii, a non-specific benign sclerosis of the sacroiliac joint which happens in women who have borne children as a consequence of the stresses of pregnancy. Aka: things I already knew. She sent me to another specialist who ordered more X-rays, an MRI, some labwork, and physical therapy. In regards to the MRI: let’s just say it was not something I was looking forward to.

I scheduled the MRI for a Sunday, my only day off. The hospital was quiet, stripped down to only essential staff and essential activities. Weekends and nights are my favorite times in the hospital for this reason: less hierarchy, more just taking care of people. The radiology reception area was dark with just one light behind the employee assigned to register patients that day. She took my information and handed me a gown. I stripped down to my bare skin then signed a form swearing a blood oath that I wasn’t harboring metal anywhere in my body.

I was almost to the MRI waiting area when I realized I was still wearing my wedding ring. It’s not a thing I like to be without, especially when faced with 30 minutes in a tube, but off it went, leaving behind a dent in it’s sacred spot on my finger. When the tech came to get me from the waiting room, I was in fending-off-anxiety-with-cheer mode. As I chatted (how can something bad happen to you when you’re being charming?), the tech scanned my consent form and paused over the only “yes” answer. Are you claustrophic? Yes. Yes I am. Not so much claustrophic as claustropanicdisordered. Claustro-catastrophically-freaked-out. “You’re claustrophic?” she asked, weary. “Yeah,” I said, “but I’m thinking I’ll be fine.” She got me situated on the narrow metal table and gave me a plastic bulb to “squeeze if you need me.” She started to roll the bed into the tube and my entire field of vision was engulfed by beige metal, only three inches from my face in every direction. “Get me out,” I squawked in the most controlled voice I could find, “Get me out!” She rolled me back. “How about we turn you around and put your feet in first,” she suggested. “Jesus Christ,” I wanted to shout, “Yes, fucking yes. Who wouldn’t choose that option?!” But instead I said, “Hmmmm, yes, let’s try that.” My body went into the tube and as my neck approached its mouth, I shut my eyes and resolved not to open them for the duration of the test, which turned out to be harder than I thought. The human organism is not a fan of constraint.

Lying in the tube with my eyes closed, I could not escape the thought: “We are born alone and we die alone.” In the interest of full disclosure I will say that I have this thought with relative frequency (normal? abnormal? unsure) and it is a source of both anxiety and comfort. But lying there, holding my emergency bulb and willing my eyes to remain closed, it felt closer than ever, the irreducible reality of every being’s solitude. There are things, moments, feelings that are unshared and unshareable. Naked under my gown I thought of all the babies I have seen emerging from their mothers this month, equally unprotected.

The machine began to make loud rhythmic sounds — buzzes, vibrations, fizzes, and clangs. It was beautiful. I wanted to record it, to play it for C at home, but then realized no recorder would make into this metal-free room. (See above: re: the unshareable.)

“You OK?” the tech asked. “Fine,” I said, watching the fractals behind my eyelids.

I was afraid to fall asleep, for fear of waking up and opening my eyes by accident. So I just experienced the time passing. I thought of C who has spent time in a sensory deprivation chamber and loved it. Um, no, I thought. No thank you. Sensation is much to be preferred as far as I’m concerned. But I was doing ok. We are born alone and we die alone. And nobody knows (tiddly pom) how cold my toes (tiddly pom) how cold my toes (tiddly pom) are growing. Between scans, I turned the emergency bulb over in my hand to make sure my hand was still there.

Then it was over. I’ll say this: I wouldn’t do it for funsies, but it’s not as bad as I feared. Just make sure they slide you in feet first.

The MRI was normal — no spinal tumor, which is what I thought I might have all along and which is what I think was secretly preventing me from going to the doctor all that time. I’m embarassed to admit it but it’s true. So on to physical therapy or rather on to three weeks of waiting for my vacation so that I could have physical therapy, which only occurs during business hours. Meanwhile, I attended deliveries, did my first, second, and third lumbar punctures, intubated a patient, placed two central lines, rounded and rounded and rounded and rounded and rounded, fell more in love with neonatology, barely saw my own baby, didn’t have a day off for 17 days in a row, and finally came out on the other side: vacation! So now I’m here in the Starbucks after my daily physical therapy session with my mocha latte. I can’t really remember life before now, but I think it’s the best vacation I’ve ever had. (Actually, I do remember some of life before now and I have had better vacations (ahem, Paris) but this sounds good and brave so I’ll leave it in.)

It turns out, my core is very weak. The muscles of my core are not stabilizing my pelvis and so one tiny muscle, the piriformis muscle, is doing all the work and has become too tight and is pulling the sacroilliac joint even farther out of alignment. It’s a vicious cycle of core weakness and pain. As a poet for whom language is allowed to expand and expand, I am of course concerned that this reflects a weakness in the core of my being, rather than just the core of my pelvic floor, but I don’t have time for psychotherapy in addition to physical therapy, so we’re sticking with the pelvic floor for now. Maybe the one will take care of the other. My therapy consists of a series of exercises involving subtle contractions of my abdominal muscles, a few stretces, and one exercise in which I sit on a huge exercise ball and pretend to unsheath a sword and fling it high in the air sixty times on each side. Also, before my exercises, I spend ten minutes on a treadmill walking backwards (if that’s not a metaphor, what is?) and then the physical therapist gives me a butt massage. It’s not the Bahamas, but it is covered by insurance.

It’s 1:16pm now and my parking meter expired 16 minutes ago, so I guess I’ll go home now and tidy up the house (aka put everything in the closets) because the cleaners are coming, then I’ll go pick up my daughter from day care (pure bliss! pure bliss!) and we’ll play and eat and bathe and go to sleep. I’ll say this for intern year: it robs me of my life but then, for three weeks of the year and assorted weekends, it gives it back to me as the sweetest gift imaginable. And so this is my holiday wish this year for you: that you too will know your very own life, in all its banal details, to be the sweetest gift. (No ninety-hour work week required.)

Happy merry hannukahkwanzaamas!

Happy Birth Day

One year ago today, E came through me into the world. I still can’t quite believe it, when I look at her now, that she grew inside my body. It’s not particularly cool, and even inappropriate to talk about birth in polite company, but I’m here to tell you, it blew my mind and still blows my mind. It changed me and continues to change me and it’s the craziest, most cosmic, most vivid thing that has ever happened to me.

In my opinion, there is no more compelling evidence of the cultural power of men than the silence and shame that surrounds pregnancy and childbirth. If men grew humans and then labored them into the world, the details and challenges and glories of this experience would be spoken about constantly. Politicians would reference their labors in speeches. Fifty percent of movie plot lines would involve pregnancy. Novels, operas, frescoes, and poems would feature the cries of the laboring man, the moment of crowning, the placenta, the milk. Birth analogies would replace war analogies in the language of struggle. Instead of “battle scars,” they’d be called “stretch marks.” And boy, would there be paid maternity leave. For, like, six months or better yet, a year.

Instead, birth is the Bermuda triangle of cultural production. No one goes there, no one returns from there. Death, sex, money, love, politics, fashion, weather, crime, divorce, architecture, genius, religion, music, dance, botany, food: these things sell books. People write hit songs about these things. Movies about such topics are well reviewed. Placentas: not so much. At this point, women are just as guilty as men in perpetuating this reality. We have jobs, we make money, we have market share and the vote: it’s time for us to start talking about what it’s like to push small humans through our vaginas! Not to mention what it’s like to care for them and raise them.

I intended to continue by writing the story of E’s birth, but everything I write feels too raw and too private, and perhaps this is in part why birth remains unspoken. Suffice it to say the following: When I was pushing E out of my body I felt certain that I would be split in two and that I would die and I consciously accepted death so that E could be born. Thus, though I doubt many things, the fierce nature of my motherhood is not one of them. This is one of the gifts that birth can give a mother, the knowledge that she is capable of staring down death to protect her child.

In the course of being pregnant, giving birth, and raising a child through her first year, I have become a less well-put-together, kinder, less appropriate, more open, less perfectionistic, more efficient, less guarded, more focused person. My compass points in only one direction and that is E’s direction. Here are a few of the things I have learned:

1) We have almost no control over anything. You can research strollers all you like and put a big lever arm over your toilet seat to prevent drowning, but the gauntlet of prenatal development, birth, and illness is outside of our control. You love your child so much that the thought of their death is enough to evacuate the spaces in your body that are supposed to contain air, but still the possibility exists. For me, this has made me softer with everyone. Some of us will have to live through this impossible possibility. Let’s all be grateful and kind to one another! Also, the fact that I have no control over anything has made me less anxious about controlling everything, but more anxious about ensuring that I am paying attention at all times. If I can’t control things, I might as well try to catch them early!

2) The body is shared. We share a body with our mothers, then we share a body with our children. We inherit energy from the sun through the plants we eat, we eat the eggs of other animals, we eat other animals. We drink the milk of cows, we lactate and feed our pumped milk to our babies. We are all of us mortal bodies and will die. I used to have a lot of critique of my body, and it would be a lie to say that now, with it’s stretch marks and saggy sections, that I don’t have my share of self-loathing thoughts. But giving birth made me realize that this body is not for looking at. It’s for living through and for sharing with others in ways that are life giving and life sustaining. This body is part of a network of bodies that spans time and space. It’s not for me to hate this body that so many other bodies have contributed to making. (None of which is meant to diminish a woman’s right to choose. Raising a child has made me more pro-choice than ever. This shit is hard! No one should be raising children who doesn’t want to be raising them.)

3) There is no possibility of perfection in this life. This is a great relief. Having a child sweeps you into time. There is no time to plan and then execute anymore. You are in pure execution mode. This means that at times you are feeding your child a well-rounded meal including broccoli and free-range chicken and at times you are feeding them boxed macaroni and cheese. Likewise, at times you are at the top of your game at work and at times you are exhausted and cotton-brained but you still show up and do your best and rely on your team mates to help you. Before I had a baby I feared mistakes, I feared others seeing me in a vulnerable state. Then suddenly I was pushing a baby through my vagina in front of ten strangers and then needing the help of strangers to go to the bathroom afterwards and then calling the pediatrician’s after hours line in the middle of the night for one tiny worry or another despite the fact that I am myself a pediatrician and I realized: I am not perfect and I need help. Things have gotten better in many ways as a result.

4) Parental love astounds me with its force. I go to work day after day after day after day on almost no sleep and endure dehumanization at the hands of the medical training system so that I can continue to make money and provide for E’s needs, so that one day I can get a job that makes more money, so that my child will have security and piano lessons and a world of possibilities. The single thought of E keeps me oriented to my responsibilities at all times. How do I know I will keep going no matter what? I know this because I am E’s mother, because I pushed her into the world.

Here are some pictures of E in her first days, and then today. It’s hard to get a great picture of her these days, because she is never at rest unless she’s asleep. She is exploring the world around her at all times, and this requires motion. But I managed to catch her in a series of moments of being completely herself. I am so grateful to be her mother.

E fourth Efirst E second E third Enow4 Enow2 Enow1 Enow3

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.

*             *             *             *

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.