the day before tomorrow

Today is my last day of maternity leave, and if you're thinking to yourself, "well, that went quick," I totally agree.  Not as quick as my five week leave with Cal, or my six week leave with Mack, but it still didn't seem much longer than those other times, somehow.  One's perception always expands to fill the timeframe allotted I guess, which is probably why, no matter how long I had or when I started, my papers in college were always finished at midnight the night before.  (See also: why I did not major in the humanities.)




I am something of a planner (this is what Joe calls me, though I think this is charitable--I have what might more accurately be described as a crippling attention to detail with a vivid imagination for catastrophe and outlay for at least three contingencies) so I've been gearing up for going back to work for, oh, at least the last month.  I knew I had to go back to work August 31st, so naturally I started stressing about it August 1st.  SHUT UP, I'M NORMAL.  So here's what we have going on.

Naturally, the milk.  I started pumping when Nina was probably about three weeks old (with the boys I started pumping sooner, both because I had less time was not as worried about weight gain with them than with Nina--she was on the smaller side when she was born and I didn't want to, you know, screw with the system until breastfeeding was firmly established) and I think we have amassed a goodly stockpile for my re-entry.
As I think I've mentioned before, the pump I'm using is the Medela Symphony.  I used the Symphony with Cal, lugging it into work with me for six months on the subway (it's not, like, 50 pounds or anything, but it's a hefty hospital grade pump so I crammed it into a giant L.L. Bean backpack and looked every bit like the former Hunter student that I once was: monstrous square backback on the subway at dark o'clock every morning--at least I wasn't reading "The Grapes of Wrath" or "The Chosen").  When the rental company I was using with the Symphony folded, I bought a Pump in Style, which I used for another six months with Cal, and then for almost a year with Mack, and it worked fine.  But now, returning to the Symphony, I have to say--it's a much better pump.  It's just solid, and it works more efficiently too, which is great when you need to pump but have only a short amount of time to get the job done.  Obviously it costs more too, but you can rent it, or buy it an resell it like I plan to.  (Since it's a hospital-grade pump, it operates on a closed system and is therefore approved for multiple users--the new owner would just need to get a new collection system and fresh tubing.)  I would also like to point out, for anyone else in the same boat, that the purchase of a breast pump can be deductible on your medical flex account if you have one for work.  (I printed out that article and stapled it to the receipt when I submitted it to my business office, and had no problems.)

I know a lot of people use those plastic baggies to store their milk, but I never have--experimentation in the medium led to a lot of spillage and of course the solid waste over the course of a year is not inconsiderable.  So for the third time in a row now I'm using this Mother's Milkmate system, which is basically a series of wire racks and little bottles (the bottles store up to five ounces I think but I never fill with more than four, because it can get messy, and of course if you end up freezing the bottle there's no room for expansion).  I obviously think this system is the way to go since I've gone back to it twice, because it easily shows you how much milk you have and dispenses the stash from oldest to newest in a way that satisfies my neuroticism attention to detail.  (If my use of masking tape labels color coded by day doesn't tell you everything you need to know about my personality, I'm not really sure what will.)




Some pro tips: get a few packs of extra storage bottles to have around, because between having some in the freezer and having dirty ones in the dishwasher, a good percentage of the bottles are going to be out of circulation each day and you want to have enough clean ones lying around to pump and store.  The rack itself comes with ten bottles those bottles screw directly into the boob horns of the pump setup, which means less pouring and transferring of your hard-won bounty. As an added plus, you can also screw on any standard-sized nipple (the Medela ones or the freebies they give you at the hospital fit fine) and feed directly from the storage bottle itself, which is very convenient as long as your baby isn't particular about bottle feeding.  (We didn't get one of these non-particular babies, however.  She's a woman of discriminating tastes, about which more later.)

I work at the same place now as I did when Mack was born, so luckily I have my pumping logistics and geography pretty much down.  Since the year I pumped with Mack, the hospital has actually added a lactation room pretty close to the OR, but from what I've heard they've missed the mark a bit because while it is a room with a door and a chair, it apparently doesn't have a sink.  People, you need a sink, both to wash your hands before and to rinse your pump parts after.  Sure, you could carry your stuff down the hall and rinse them in the lounge, but believe me, people get awfully squeamish when they have to see your lady gear.  So I'll do what I did last time, which is pump in the bathroom of the female doctor's locker room.  It sounds kind of grim, but it's actually leagues better than where I pumped as a resident--it's reasonably clean first of all, and there's an overhead light, which seems redundant to mention in this modern age, but believe me, it's not a given.  Also, 100% fewer dirty mops are stored in this particular bathroom.  So basically it's like Shangri-La.

So you need a place to pump at work.  Here's what you really need: a pump, a platform to put it on (desk, table, bench, what have you--I put my pump on a hamper), a sink, a door (for the sake of workplace discretion), an electrical outlet, a fridge, and an insulated bag with some ice packs to get it all home.  The electrical outlet is technically optional I guess, but using a battery pack to power a pump over the long term is going to cost you bank because those things eat batteries like Cookie Monster eats cookies, so just do yourself a favor and just park near an outlet.

Let me say here that although I've nursed all three of my kids, I have a problem with people being a little too adamant about breastfeeding as the be all end all. Feeding your kid formula is just fine as I and millions of other formula-fed humans will attest, and what you feed them is probably somewhat lower on the list of things that are essential to their health and well-being than, you know, loving them and being attuned to their needs and safety, all that jazz.  So I have a problem with people making moms feel like they're failures if they can't/choose not to breastfeed.  Look, breastfeeding is great if it works for you, but it's not as important as many, many other things you can do for your baby, like, for example, getting them vaccinated against dangerous childhood diseases.  BUT I DIGRESS.

Anyway, what got me to that last point is that I was going to say that the more militant of the breastfeeding literature says that if you're going to dare to go back to work and tear yourself away from your tiny human, that you should ideally be pumping every two or three hours during the day.  (Pause for laughter.)  I don't know anyone who has a job that allows them to pump every two or three hours, do you?  I mean, maybe if you work from home, but even then, I bet it would be rough, because of the actual "work" part.  So just get that out of your head.  It is impossible.  I pump maybe two or three times a day total.  Once in the morning before I leave for work.  Once midday, around lunchtime.  And once later in the evening, if I'm working late.  I also usually take some sort of galactagogue--with the boys I took domperidone, and with Nina I've been taking this Lactation Support stuff (basically fenugreek with other herbal jazz) and supply has been pretty good.  Once I get home, I just nurse on demand, which basically means I have a baby attached to me all evening and all night.  Good stuff.

Ironically, it was much easier to find time to pump as a resident than it is now that I'm an attending.  This seems counterintuitive, but the reason is that as an anesthesia resident we were mandated to get a thirty minute lunch/bathroom break midday, during which time I knew someone was covering my patient and I had no explicit clinical responsibilities.  As a grown-up (that is to say, now that I'm an attending), I don't get lunch breaks anymore.  I mean, I eat lunch (usually), but I just grab it between other things to do, because I can be (and am) called to do something constantly throughout the day.  A thirty minute break is the stuff of pure fantasy.  So when I pump at work, it's kind of like playing Frogger.  I eye the rooms I'm supervising, calculate how long it will be until they need me or until my next patient shows up in pre-op or how long it's going to be before the surgeon removes The Big Clamp or starts dissecting around The Pulsating Thing--and then I just run for it.  Really, I just need ten or fifteen minutes, because I have everything in place and for the most part assembled.  So I run in to pump, give the parts a cursory rinse and dry (I do the real wash at home, in the dishwasher--the heat effectively sterilizes everything) and run my stash to the refrigerator, all hopefully before I get called to do the next thing.

Of course, pumping the milk is just the first part of going back to work if you breastfeed; you also have a way to, you know, get the milk inside your baby.  With Cal and Mack, I introduced the bottle in earnest at about two weeks, and they had very little trouble transitioning between the two (something that made me seriously doubt the phenomenon of "nipple confusion" that people talk about) but Nina has been a little more of a tough nut.  She really, really, really strongly prefers to nurse over bottle feeding.  I started having my high-level surrogates (sorry, I just rewatched the entire run of "The West Wing" in its entirety over my leave and my mind is still half in the Santos-McGarry campaign) giving her a bottle or two a day starting around three or four weeks, but she just kind of hated it for a while.  We tried a bunch of different nipples and bottles, but so far what works best for her is the same thing we used for her brothers, which is this Playtex nurser system set.


It's marketed as better for breastfeeding babies, and I don't know if that's just a bunch of hooey but it does have the widest nipple base of any that we tried (how many times have I said the word "nipple" in this entry?  NIPPLEZZZ!) and I think that she's the most comfortable with it because it's the most boob-like non-boob that we have in our arsenal.  I also like it because it uses these drop-in liners, which not only means that we don't have to actually wash a bottle (the plastic "bottle" is really just a tube-shaped frame to hold the plastic liner and for you to grab onto) but it allows you to really squeeze out all the air from the milk reservoir before feeding, not unlike priming a syringe.  (Yeah, I just said that.  WHAT?)  For a happy refluxer like Nina, this ability to minimize the air swallowed is a nice benefit.




Nina's smart though, in that she will rarely agree to take the bottle from me, probably because she knows that when I'm there she has better options.  Sometimes she won't take the bottle (or will at least fuss more) if she knows I'm even nearby--this leads to the hardest part of transitioning out of maternity leave, which is: leaving before you really have to leave.

I knew I was going to be on call my first day back at the hospital, and would be away from her for maybe fourteen hours or more.  Obviously that's a long time, and I didn't want my first day back (stressful for many other reasons) to be all the more shocking to the baby because OMG WHERE DID THE BOOB LADY GO?  I wanted Nina to know well before it was time for me to go back to work for real that even if I wasn't there, there were other people there to hold her and feed her and love her.  Maybe it was more for myself than anything else, but I needed to see for myself that she was going to be OK before I actually left.  So starting a few weeks ago, I started "leaving" during the day, for increasingly long periods, a few hours at a time.

We are very lucky to have a nanny that has been with us since before Mack was born, and she knows and loves our kids, which has made it a lot easier.  But still, I will tell you that the hardest part of these "trial separations" is being in the house, hearing her cry, and letting someone else get her.  I've literally had to sit on my hands a couple of times.  Which is probably why I end up leaving the house during most of these "training" periods, and why Target has all of my money.  But Nina now takes the bottle during the day, she and our nanny now know each other pretty well, and we have our little schedule and routine pretty set, including coordinating school pickups and drop offs for the boys with the baby in tow.  I'll be sad leaving tomorrow morning but I won't really be too worried, because hey, we practiced.  We got this.

It's both wonderful and terrible to be needed so much by someone, but then also see that they're OK with someone else too.  I remember when I went back to work after Cal was born, thinking, "How can this little person possibly survive without me?"  But he did.  They all do.  But I guess this period is the act of parenting a child in a nutshell.  They'll do fine, but you try your hardest to prepare them for success and happiness the best that you can.  And look, I know, DRAMA QUEEN, you're just going back to work, not joining the Foreign Legion.  But these little transitions can be hard on everyone, though hopefully with all the prep it will be harder for me than for her.


Hey guys.  See you at work tomorrow.

emergence

The remarkable thing about maternity leave is how much free time it seems like you should have, but how little free time it is you actually have.



Nina is a sweet, delicious baby (again, I note our culture's predilection for comparing babies to confectionary--however, if you've been with this baby, you would understand, she's basically a giant lump of fondant shaped into human form) but she, like all babies, is fairly time-consuming.  That, and she enjoys being held, ideally constantly, unless she's asleep.  Actually, even when she's asleep, she prefers to sleep like this, which is why I have since switched to one of those Tom's of Maine hippie dippie deodorants that--sorry Tom--barely deodorizes.  Everyone step back three feet.




People probably have different schools of thought on this when it comes to babies, but I sort of tend towards the thinking that newborn babies can't really be spoiled, and that all they need to learn at this point is that they're going to be taken care of.  So if she wants me to hold her all day long, well then, by gum, that's what I'll do--it's why I'm on maternity leave, after all.  However, it also means that I can't really do much of anything else (I do have a growing list of dinners that can be cooked one-handed while the other hand is holding a baby, the Cliff Notes version of which is: cook not anything that requires peeling or a can opener) and that's my roundabout way of explaining why I haven't updated this blog in more than a month.  It's not that I can't type, but anything that requires more typing than can be accomplished with one thumb on an iPhone is perhaps more bimanual dexterity than I have been able to reasonably accomplish recently.

Cue gratuitous baby photos...and go.









(On a related note: if you've e-mailed me in the past month or so with a non-emergent message, I really apologize if I haven't returned it.  Life is triage, and so I've been somewhat unplugged from some of my outside obligations as of late.  Lo siento, etcetera etcetera.)

I started (well, multiple times) to write about the life of an anesthesiologist, pecking away at it until my fingers were damn near bloody bone stubs, because that entry was not even half finished and it was already, like, a skrillion pages long.  But then about two weeks ago I got an e-mail from someone at the AAMC (funny trivia: if you Google "AAMC," it will ask you, "Did you mean AAMCO?" and divert you to a page with links to mufflers and transmission changes; but no, as many of you know, AAMC stands for the Association of American Medical Colleges) who is doing an article series on medical specialties, and will be featuring the noble specialty of Anesthesia in September.  So since I'm going to be doing that interview anyway, I figured I'd just link to that when it came out instead, and add bits and pieces to it or field questions as opposed to posting a dense and possibly stultifying brickwork of text not unlike The Cask of Amontillado.  Fair?

So here's what else we've been up to.




Well, school started.  Actually it started the second week of August, which seems just shy of barbaric to me, but such are the regional variants of the academic year in the South.  I think the reasoning is that they time it such that the first semester ends right as the kids are breaking for Christmas (as opposed to having the semester end at the end of January like it did for me growing up--a two and a half week holiday vacation is a more natural break point) and as another plus, school ends usually the week before Memorial Day, which enables us to do things like this.  But the downside is that we live in Atlanta, and August is monstrously hot.  So pick your poison.




The transition to third grade has been pretty good so far.  As expected, the fact that we were making this transition after finishing up first grade in full made the switch much more natural--new class, new teacher at this point in the year is par for the course, so Cal blended in with his classmates pretty seamlessly.  There is one girl in his class who towers over him by a full head, but on the whole, he's not that much smaller than his classmates (despite being one to almost two full years younger than some of them), and that has helped.  He's also making friends, which is a huge relief.  (Somewhat on-topic: I still remember when the term "playdate" entered my lexicon--growing up we just called it "going over to [insert friend name here]'s house" but my sister, ten years younger than I, was set up on "playdates" in a semi-regular fashion--and at the time, the terminology seemed overly formal, like saying that your four year-old had a pressing engagement at the sandbox.)

Veering back on topic, Cal is making friends, and while it seems that the size and age difference isn't a really big deal so far, Cal's lack of working knowledge about miscellaneous juvenile pop culture ephemera is.  "You don't know who Usher is?" one of his new friends asked Cal.  Cal did not.  Ditto Justin Bieber.  He did, however, just finish reading a biography about Albert Einstein, but somehow the conversation didn't quite take off with that one.  So maybe we should consider some remediation with respect to such topics, though honestly, I myself wouldn't know where to begin.  (Something something vampires?)

The schoolwork is very manageable so far, Cal doesn't seem to be having a problem with it (even with French class, which I was the most worried about because it seemed like the class that most needed to build logically from one year to the next and for which Joe and I are the least equipped to provide help).  But there is more homework, and it's a little more free-form and independently generated (for example, learning to write expository essays and do research, as opposed to mindlessly filling out worksheets as in first grade) and that has created some dramatic frission in the afternoons.  I'm still on leave until the end of the week so I've been able to help him get it going up until now, though I have some concerns with how he's going to handle it after I go back to work and won't be home until after The Homeworking Hours at least four out of five days of the week.  But we'll deal with those problems if and when they come up.  We have a meeting with his teacher on Thursday to discuss how the transition is working, but from all indications, he's doing well.




Mack has been on the difficult side of perfection lately.  Likely it's his age more than anything else--Cal at three and a half made me seriously consider the risks and benefits of tubal ligation--but I'm not ruling out that some of it may be reacting to being usurped as The Baby by, you know, a real baby.  But it's nothing unusual, just the usual battles over control, stubbornness, whining, perseveration on details and assorted other miscellany.  If there's a reason that siblings are rarely spaced four and a half years apart, I am convinced it is because most three and a half year-olds are nightmarish maybe 20% of the time, and what might be euphemistically described as "cheeky" another 40% of the time.  But on the whole he's a pleasure.

The thing about Mack is that, after Cal, he's just so reassuring.  Cal is, to put it gently, a little bit of an unusual child (nothing pathologic, he's just kind of peculiar--overly cerebral is probably the best description, with an overlay of quirky) and so we naturally worry about him because worrying is what we do best.  But Mack is, in contrast, the prototype of Boy In Early Childhood.  He runs and plays and pretends and makes his action figures talk to each other.  He jumps off things while making rocket blaster sounds.  He loves cars and light sabers and wrestling, and has a bin full of superhero costumes that he cycles through on a near-constant basis.  (Current favorite: a Spiderman costume with foam muscles built into it.)  He can be a stubborn fool, and he can scream very loud when he wants to, but he's our screaming stubborn fool, and he's a delight.  You know...most of the time.




I'm on call Labor Day weekend (everyone I tell this to thinks this is cruel and unusual somehow, but our holiday call schedule was actually determined almost a year ago, before I was even pregnant, and the timing is such that my maternity leave would be close to ending anyway so I'm more than pleased to fulfill that particular responsibility) so I'll be back at work bright and early on Friday morning.  I won't lie, maternity leave has been really nice.  Yes it's been nice to have a slightly different pace to my day (though I'm not really getting up much later nor getting any more sleep than usual), but mostly I appreciate having so much time to spend with Nina.  For the rest of her life, she's going to have to share me with her brothers, and I'm going to have to share her with, well, everyone.  But these past eight weeks have been, for the most part, just about the two of us being together.  And that's been really, really special.

I know that me going back to work doesn't mean I'll never see her again, and this being our third time around we have most of the larger issues of scheduling and childcare largely blocked out.  But it's still going to be hard to leave that first morning, and every morning after that.  I work full-time, take overnight call and work long hours, so it's hard not to feel (and I felt this way with Cal and Mack too) like I'm giving away huge swaths of her babyhood away for someone else to enjoy.  Is this the ideal solution?  Is this the correct balance for us?  It's hard to say at this moment, and I know that this is something that everyone struggles with, and that I'll continue to struggle with--what worked well with two kids may work differently with three, after all.  But I am lucky in that I love my kids, and I also really enjoy my job, so while my daily life does feel like living between a rock and a hard place, at least I like the rock, and I love the hard place, so finding the right space between is hopefully worth the blisters.