work-life balance

Fracture Lines, Suture Lines

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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.

In medias res

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There is nowhere to begin but in the middle.

In two weeks, we will be moving across the country with our five-month-old so I can start my residency in pediatrics. I will go from spending all but twenty hours of my week with my daughter to spending eighty hours a week at work. My partner, who has been in graduate school thinking about art full time, will become the primary caregiver. We will be in a city where we know no one. Clearly, this transition will be seamless.

Now you might be thinking: Surely, you knew this day would come. It’s not like I had one too many drinks in Vegas and woke up with a medical degree. I went through a six-month application process to secure a residency spot and six months of fertility treatment to become a mother — no surprises there. So yes, I did know this day would come, in the same way that you know death will come. But as with death, you always feels like you probably have one more day.

When I was thinking of having a baby, I asked every woman I met in medicine who has children when is the best time in training to take the plunge. I even met a woman who had had a child in medical school, one in internship, one during fellowship, and one as a new attending — a one-woman data set. The consensus from everyone was threefold: There is no good time. Not during intern year. The best time has already passed. So we decided to go for it during a gap year between medical school and residency. I looked around at all the residents, fellows, and attendings in the hospital with their breast pumping bags and I figured “If so many people are doing it, it must be possible.” And so is born hard-won-wisdom #1: If everyone is doing it, it is probably possible, but no one will tell you the truth about the costs. Because women are rarely honest about a) their weight, b) how much childbirth really hurts and many other puerperal realities (more on that to come), or c) how &*%@ing overwhelmed they secretly feel (more on that also to come).

So now we have an absolutely stunning daughter, and I say this with all the objectivity of a mother — I mean pediatrician. She is a happy, curious, active child who miraculously fit in from day one with the rhythm of our family. She can really work a room–lighting up everyone in her path with her full-face smiles and piercing, wise-before-her-years level of awareness. (Where she got this natural social talent, I cannot tell you — yes, over here, I’m the one asleep on the couch because I drank half a beer too quickly.) In short, Little E is a gem. When they say “It’s all worth it” (second only to “They grow up so fast” in terms of aphorisms most often heard as a new parent), they do not lie.

To put it simply: I do not want leave her to begin residency. I REALLY do not want to do this. It feels unnatural, violent, insane, like traveling back in time to have dental work before novocaine. But there are other simple truths: I am in a hole of student loan debt that only a medical career can fill. And more complex truths: I love working. I love medicine. I am at my best when I am in the hospital, and then better as a mother when I come home — sharper, softer, more able to attend, more grateful and humble and in awe. I miss her so much when I have to be away, but feel restless and unused when I go too long without exercising my doctor muscles.

I don’t know what the right answer is to this conundrum, just that for the moment, I have to move forward and try to give myself as fully as I can to both endeavors. I’ll be honest: I don’t know how I’ll do it. I don’t know if I’ll be able to do it. It’s not that I doubt myself, just that I can’t imagine it. But soon enough, there will be no need for that–the pendulum of doctor-mommy will be released and I’ll either be swinging it, or getting knocked repeatedly in the head. I hope you’ll join me on the ride. I promise to be honest about how great it is and how much it sucks.