straddling

I had to take our minivan to the dealership for a physical (I don't know--what do you call it when you have to take your car in for a visit to the car doctor? A well-car check? I plead ignorance and this parenthetical is now threatening now to take over the whole intro) and at the dealership they have honest to god carrels in a room off the waiting area, like a damn library. On one hand--how great! A quiet area with a desk and a chair and a power outlet to get some actual work done! And on the other hand--how long do you expect that I'm going to be sitting here, exactly?

Well, nothing like a stretch of captivity to force you to update your foundering blog. Ahoy hoy.

Last week was my last week of working full-time. My first "official" week of working at a 60% schedule is actually the week of Labor Day, but I had this week fortuitously scheduled as a week off from almost a year ago, like I planned it this way the whole time, for transition. It's not so much a vacation as purely a maintenance period for our family (MAINTENANCE! That's the kind of car visit I'm at now! Le mot juste!) meaning yesterday I took Mack to the dentist and tomorrow I'm taking Nina for her one year well-child check and now I'm here looking at a wonderful hubcap display and wondering if I should get purple under-light effects to make our suburban splendor-mobile that much more splendid. I mean, it seems excessive and yet this pamphlet makes such a compelling case for them...

I am so excited to enter this next phase of being more engaged or at the very least present for my out-of-hospital responsibilities, but I acknowledge that various internalized cultural attitudes have been a little difficult for me to shake. Namely, I find that I really have to check myself from being too defensive when people talk to me about my part-time status. 

JOE

(As we are engaged in high-level strategy talks about managing yet another week of juggling 

call schedules, OR and clinic times, childcare, meal timing, and after school activities)

Man, this is hard. I can't wait until you start slacking off at work a little bit.

MICHELLE

SLACKING OFF?

JOE

I mean...not slacking...I mean...you know what I mean! Working less! Working less at the hospital!

MICHELLE

THERE IS NO SLACKING INVOLVED HERE. NO SLACK. 

ALWAYS WORKING! HARD WORKER ME!

Or possibly this:

CO-WORKER

So, you're going part-time, huh? Sounds nice.

MICHELLE

(Cautiously)

Yes...

CO-WORKER

Gotta go be mom. I get it. I wish I could do that.

MICHELLE

DO YOU THINK THIS WAS AN EASY DECISION OR SOMETHING?

BECAUSE IT WASN'T! NOTHING EASY! EVERYTHING HARD!

CO-WORKER

Uh...

(Starts backing away, feeling for the doorknob)

And also:

RANDOM PERSON

Hello--

MICHELLE

(Pointing)

AND YOU! I'LL HAVE YOU KNOW THAT I HAVE AN EXCELLENT WORK ETHIC.

RANDOM PERSON

Aha. Huh. Well, as I was saying, "Hello, and welcome to Target."

Anyway, sorry world. Obviously I am having feelings. It's like I'm all messed up on my Erikson's stages. Instead of "Generativity vs. Stagnation" I've regressed back to "Identity vs. Confusion." (Also, can we all acknowledge that the fact that I even remember any of this from second year med school psych is pretty fucking impressive? OK, not so impressive, but notable at least.)

I don't know why I default to the defensive--maybe I need to prove to myself and everyone that I'm not "slacking off" or "opting out" or taking some slow boat to Shangri-La. Not that anyone has implied that, I think it's pretty clear that going part-time at work amounts more to scaling back on one type of (rewarding, highly-paid) work and scaling up on another type of work which is both unpaid and elicits a less direct, calculable form of appreciation. Not that I need my head patted constantly, but I think many of us have experienced the Moebius strip that is the endless cycle of keeping a three-kid household running smoothly, and how the loss of old workday landmarks can make things both easier and harder.

I know I'm probably stomping all over the landmines with this but just hear me out, I'm sitting in the backroom of a Toyota dealership waiting for them to finish checking my brake fluid or god knows what else so this is a bit of a rush job. I realize that my defensiveness is just part of my natural adjustment to our new situation (see also: guilt at bringing home less bacon than I was before, particularly after many years of being the primary or equal bacon...herder) but this all makes me happy that I have the option to partially scale back as opposed to having to make a binary choice to be all in or all out. The identity loss I'd have without some career focus would definitely be traumatic, and I think that this option, the part-time option, might allow me the best of both worlds. That's the theory anyway, and hopefully once I see that, I'll stop alternately taking everyone's head off and showily doing one-armed push-ups to prove that I'm JUST AS POWERFUL AS I EVER WAS.

(Psychological problems! I has them!)

*          *          *

I was going to write some more stuff here, but in the interest of just getting this up and saying BLOG UPDATE: MISSION ACCOMPLISHED I'm going to save that for next time. My goal in general, by the way, is for there to be a next time more consistently, and to do a little more writing in addition to the other thousand things that I've been neglecting in the past year. And now I have no idea how to end this  entry so I guess I'll just put in this video of Nina lurching around because didn't you hear, she's a toddler now.  Unreal.

recalibrating

I know there's a touch of irony in adding this disclaimer given that I haven't updated this blog in, like, half a year, but: LONG ENTRY AHEAD.

There's a snippet of a cartoon I remember from my childhood--I can't remember if it was "Tom and Jerry" but if it wasn't it was in a similar vein--where a mouse is reclining in a hot tub. He's sitting back with his arms along the rim of the tub, maxing and relaxing as cartoon mice do, wearing that look of smug satisfaction he was prone to. (As an aside: I never liked Jerry. I always thought he was a real jerk to Tom, a cat who was just fulfilling his evolutionary imperative after all. Ditto Road Runner. Ditto those capering harpy kids that keep taking the Trix away from the rabbit. JUST GIVE HIM A BOWL, YOU ASSHOLES.)

So anyway, the mouse. He's enjoying the hot tub. He's relishing the water, the heat. But the water starts to get a little bit hotter. And a little bit hotter still. Suddenly it's not so comfortable anymore. Not hot enough that he wants to get out of the tub or anything, but just...hotter. He starts sweating. His fur starts getting a little frizzy (from the humidity, you understand). Then, finally, he turns around and notices the cat behind him, slicing onions and carrots to add into the now boiling water. (My memory of this part is not quite as clear, but the cat may have been wearing a chef's toque.)

I've thought of that cartoon clip a lot in the last year.

But let me back up for a second.

If you've ever followed this blog with regularity in the past (though I'm sure with my sporadic updates I've winnowed that number down to only the die-hardest of die-hards) you've probably noticed that I haven't had the time to write much of substance since I went back to work after my maternity leave last September, and that I haven't updated basically at all since December. The reasons are all those that you could probably expect: busy job, three kids, and the responsibilities and duties associated therein. The explanations are always boring because everyone's reasons for being busy are pretty much the same, but to put it in medical terms: it's just a matter of triage.

It's hard to know where the tipping point was--though I have to presume that it was at least in part associated with the addition of our much-beloved third child into the mix--but at some point in the last year, things started getting hard. Not impossible, not un-doable, but subtly, Joe and I started to notice just how tight things were getting. Time was tight, at home, with the kids, with each other. Emotional resources were tight. Patience was less of a resource we could reliably depend on. The days and weeks started becoming these things that we were enduring, rather than living, let alone enjoying. Again, the imagery from an old movie comes to mind--inmates in a prison, grimly notching off yet another day on the wall of their cell.

I don't mean to imply that our life is a joyless dirge--far from it. We love our family, we love our jobs. Even working the hours that we do, we try carve out quality time when we can--long weekends, holidays, family vacations where they fit in. We bolus our family time because our basal infusion rate is so parsimonious, but we do make an effort to compensate. And we liked to tell ourselves that this bolus dosing was sufficient, and it worked...not well, but well enough.

But it didn't change the fact that over the past few years, and over the last year in particular, the feeling of our everyday lives becoming something that we were tolerating started to feel more an more pervasive. When you only see your kids for an hour or two at the very tail-end of each day, only to perform the most basic of maintenance for them (bath! brush teeth! yell at them for not taking their baths and brushing their teeth quickly enough because I'm tired and they're tired and everyone's tired so LET'S ALL GO TO BED AS SOON AS POSSIBLE) you start to feel like you're consisting on a diet of discarded crusts in an otherwise empty pizza box. Maybe you can piece together a life in these scraps of the day, but split between three kids, it's simply not enough time.

Joe and I have been discussing for years our long-term outlook for modifying (read: decreasing) the work hours for at least one of us to have more time with the kids, and for the longest time, our party line has been: soon. We're going to do it soon. "Maybe in a few years or so," was the stock phrase. But there was always the next thing. We'll think about it when I finish my fellowship. We'll figure it out it when I get more settled in my job. We'll do it if I make partner in my group. Later. We'll do it. But later. Meanwhile, time marches on.

Then: I was talking with one of my partners at work a few months ago. He has four kids, the oldest of whom had just turned eight. "I just realized," he said as we were chatting in the front hall of the OR, sidestepping a stretcher careening down the hallway from the PACU, "that he's eight. In another eight years, he's going to be in high school, driving, getting ready to go to college. Half my time with him is already done. I mean, they come home after they go to college and all, but you know what that's like. It's not the same. Half my time of having my son in my house is over already."

There feeling that I had after having that conversation was not unlike being wrapped in a piece of wet burlap and gently asphyxiated. Because Cal was turning eight too. Half our time raising our oldest son in our home was done, and not only had this particular calculus not ever occurred to me, but looking back, I can't say I really know where those eight years went.

Because see, we've always lived like this. Cal was born when we were residents. His entire life--and thus of course, Mack and Nina's entire life too--we've worked. Both Joe and I have worked our tails off. We're not residents anymore of course, and some of the specifics of our jobs have changed from year to year, but the fact of it is that we each work on average 50-60 hours a week, more if we're taking weekend call, and although we've been saying for years that we were going to try to get more control of our work schedules to put some more time into our family life, it hadn't happened yet. The decision point was always pushed off down the road. Later. Soon. Not yet. Someday. And now Cal was turning eight and I have no idea how time passed so fast.

If I'm going to be completely honest with myself I'm sure some of this particular grim inertia was also linked to a perverse macho pride. I've always spoken a lot about work-life balance in medicine and how these antiquated notions, about doctors functioning as around-the-clock automatons sacrificing their personal lives for the greater good, would have to evolve along with the rest of the world. But I think that in some ways I felt safe championing the choice for others to go part-time because I myself chose to work full-time. You do what works for your family, everyone's definition of work-life balance is different. But saying it from the vantage point of someone with three kids and still worked full-time herself felt like a secure platform from which to proselytize, like I was somehow above reproach from people who might accuse all part-time doctors of being lazy or uncommitted. DO WHAT YOU NEED TO DO; BUT AS FOR MYSELF, I AM DOING ALL THE THINGS.

And to be honest, we were getting by. It wasn't wonderful, but it was OK. We were surviving. Maybe we weren't "living our best life" to invoke an Oprah-ism (and I don't even know how I know that since I never even watched Oprah) but...day to day, we were getting by.

And then, the week before Memorial Day, our nanny of five years quit. With no warning, and giving zero notice. She just left one day and mentioned on her way out the door that she wasn't coming back.

Boom. Game-changer.

I'm not going to talk too much about the nanny thing because frankly, after probably the most stressful two months of our lives, I'm just over it. It wasn't even so much the issue of finding a new nanny--though that, obviously, was a huge part of solving our problems, at least in the short term.  But the larger and more important part was having to honestly evaluate our life, our choices, and just how much time we did indeed spend at work, away from our children. It was like turning the stark, faintly buzzing fluorescent exam light onto the fish-white underbelly of what kept things functioning at a level that passed as "OK" for the past five years. And what we realized was that: it really isn't OK. Having to outsource this much of our children's care--of our children's lives--to someone else, particularly someone who after five years could walk out on them without so much as a backwards glance...is not OK.

(This is putting aside the obvious logistical difficulty of finding a non-live-in person to work 50-60 hours a week. It's a tough sell to say the least. One suggestion, perhaps less helpful than most, was that we should just hire two nannies. To which my reaction was, if you have to hire two people to take care of your kids while you're at work, it's possible you're not spending enough time with your kids.)

So. Joe and I discussed and agonized and number crunched and evaluated. We talked to a lot of people. We agonized some more. And what's going to happen now is this: as of September 1st, I will be going part-time at my job. Joe and I would have been fine with either one of us working less, but because of the ways our jobs are structured, it makes more sense right now for the part-time working parent to be me. My new schedule will have me working three days a week, mixed in with my share of nights, weekend and holiday call. And my main goal for the other two days of the week? To do some of the things that I've never been able to do with my kids because I've haven't had the time. Simply to be around more.

I know this all seems unnecessarily melodramatic of an announcement to some, because plenty of people in a multitude of fields choose to work part-time. But for me, it is a big deal, because to be honest, when you're accustomed to following a prescribed path, swimming against the current for a change can be scary. And there are a lot of issues--job guilt, fear of resentment from co-workers or being perceived as less than fully committed to medicine, concerns about crippling my career potential--that I'm working through having finally made this decision. There's a fear of not wanting to let people down.

But that's it on the other side too, isn't it? I don't want to let people down. I want to do my job well. All my jobs. And I think that right now, I need to spend more time with my kids. Nothing's broken, I still love being an anesthesiologist, and the fact that I've worked full-time for the first eight years of parenthood wasn't the wrong call nor has it damaged our family. It's just that our choices then are not the same as our choices now, and when we have better options we owe it to ourselves to take them. We could be making more of this life. We could be doing better.

I'm not going to be there hovering in the periphery for every single second of my kids' lives, nor frankly should I be. But I'm looking forward to just being around more.

So that's what's going on with us. In most ways, it's really no big thing. But in other ways, it's the biggest thing.

indian summer vacation

The way Joe and I schedule our lives we end up planning most of our family vacations more than a year in advance, and around the Spring of 2011 we made plans to rent a cottage in Jamaica for summer vacation the following year. Well, turns out that despite my neurosis about planning things well ahead of time, you actually can make plans too far in advance, because it turns out we were a little busy this past July. Luckily, the rental place was very nice about allowing us to reschedule once we told them the reason, and so we took our family summer vacation and moved it to a week in the fall. To this week, as a matter of fact.

It actually doesn't take that long to fly from Atlanta to Jamaica, but we did have to take a car to a shuttle to a monorail to a plane to a van, so it ended up being a fairly grueling trip for the three kids. Luckily we now have no other plans for this week other than to hang around and let the kids beach and pool themselves stupid.  So you know.  Vacation.

We invited my parents to come along with us for the trip too, because it's nice for the kids to be able to spend time with them, and also (selfishly) it's nice to have another two sets of eyes around to make sure no one's playing with anything dangerous/inadvisable/flammable.  Here are each of them holding the only remaining grandchild who will agree to sit on their laps.  In the picture on the right, Nina, like Kuato, wants you to open your mind, Quaid.

(I should also note that my dad came into town one day early so that Joe could do a blepharoplasty on him, which is why his eyelids still look a little bruised.  He would also want you know to know, however, that he got this done only because his lids were drooping and obstructing his vision, and not for purely cosmetic reasons.  Now, I don't know nothin' about no oculoplastics, but I do know that doing a good blepharoplasty is sometimes a tricky and subtle business--particularly on Asian people--but even just three days post-op, I have to say that Joe did a really amazing job.  First off, my dad can see better, so already: success.  But as someone who has been looking at my dad for my entire life, I also have to say that even this soon postop, he also looks really good and natural and himself, which is important.  So good for him, and less good for, you know, Kenny Rogers.)

Anyway, so we're here.  Cal's having fun swimming, Mack's having fun bobbing, and Nina's having fun lying in a variety of shady spots and looking at the ceiling fan in the bedroom.

I suppose there might come a time where our travels might not so reliably involve going to the beach.  Just probably not anytime soon.

Vacation!

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.

party of five

Hey everyone.  I meant to update sooner, but you know, NEW BABY.  Always needing stuff, they are.

Nina's been doing really well.  I was afraid, after having two pretty easy babies with Cal and Mack, that we were going to strike out with Thing 3 and be granted some kind of hellion.  But Nina's much like her brothers were, in that she's a good, sweet baby who is easy to please and whose cuteness makes up for the rest.

I do think that some of it is due to her innate good nature, but I also think that our easy time of things is framed by expectation.  With a new baby, people mostly complain about the lack of sleep, and the constant neediness of the newborn--so much feeding! so much holding and rocking! where one diaper change ends, the next one begins!  And so forth.  The thing is--that's what babies are supposed to do.  And what I'm doing on my end--holding her basically all the time when she's awake, feeding her on demand, changing many many teeny little poo diapers and scanning her pee diapers with almost clinical intensity to assess her degree of urobilinogen excretion (though now, linking to Wikipedia, I am realizing for the first time that urobilinogen is colorless--all that wasted observation!)--that's what I'm supposed to do.  So I don't really think I'm having an appreciably easier or harder time than anyone else with a new baby, we're just all doing what we're supposed to be doing, and everybody's happy.

Anyway, I'm pretty firmly of the belief that if you want to sleep all night, you probably shouldn't have a baby, much the way that if you want to be well-rested, ever, you probably shouldn't go into medicine.  See, it's all about framing your expectations.

Hey, wanna see some pictures?  Most of these are on my Tumblr already, but I know not everyone is my buddy on the twitters et al.  It's fine, little technophobe, we'll just churn some butter and make some corn husk dolls right here by the flickering light of this here computer screen.

I knew that Cal would do well with a new baby (little old man that he is, I knew he would relish the expertise conferred by being not only seven years her senior but also a veteran older sibling) but I'll admit that I was a little concerned that Mack, who has spent the last three and a half years marinating in his baby-of-the-family status, would be jealous.  And I'm not saying that he's not ever going to be jealous or competitive (just wait until she starts getting mobile and his slavishly guarded collection of superhero action figures comes under siege) but so far, he is in love with his baby.

"Mom, I love baby Nina," he'll say unprompted.

"Baby Nina is so pretty."

"Can I kiss her?"

"Can I rub her and smell her?"  (He means rub her head.  We talked about the fontanelles and the importance of using his flat palm instead of poking her brain with his fingers, but then Cal was like, "She has a HOLE in her HEAD?" and then we had to kind of soft-pedal the anatomy lesson lest everyone freak out.  Mack also particularly likes smelling the baby.  I understand the appeal of smelling a new baby and much as the next weirdo, but the way Mack goes after her, you'd think she's one of those really fascinating second generation scratch 'n' sniff stickers that really really for real OMG smell like food.  Like the buttered popcorn one.  Or that one that smelled like pepperoni pizza that I was fascinated with as a child because wow, they made a sticker smell like pizza?  THE FUTURE IS HERE.)

Anyway, sibling rivalry averted for now.  Cal and Mack seem to have reserved all their petty animus for each other ("MOM! Cal looked at me!") but Nina, so far as they're concerned, is a princess.

I'd meant to post this up earlier today (because I'm pretty sure no one's going to read this now when I'm posting it, almost 11:00pm on a Friday night), but see above: baby, comma, care of.  There are a couple of other posts that I'm working on in my head to post hopefully in the next week or two when I have a free moment, including but not limited to:

• Private practice anesthesiology: a day in the life

• Breastfeeding and pumping after returning to work, my experience and strategies (warning: boobs will be alluded to though not depicted)

• More sewing projects that I done did, culled of the more embarrassing mishaps (like the time I got confused while making a pair of leggings and sewed half the seams on the outside, half the seams on the inside)

Any other post topics you guys interested in hearing about while I'm on maternity leave and have some time for such extracurricular pursuits?  Aside from wanting to see more pictures of Cooper to prove that she didn't die a year ago and I just somehow never mentioned it here?  I'm working on that post too--I'll get her to hold a copy of today's Wall Street Journal in the pictures, you know, as a proof of life.  (Not to joke about our dog dying or anything--obviously we care deeply about our dog.  But we're just no longer in the phase of life where we treat her as a child by proxy.  Rest assured that she is well loved and taken care of and just got a new memory foam dog bed that she is very pleased with.)

Anyway.  Have a good weekend, everyone.

make your own baby video monitor

Hey all.  Forgive me if this is too "uh...duh" for some of you, but I promised I would share the execution of this idea with someone at work who was having her first grandchild (hi Maree!) and am actually quite pleased at how well this is working.

Like most people, we had a baby monitor.  Actually, we only had one for Mack--when we lived in New York, I think we were actually able to hear Cal in the next room because that's apartment living for you--but it was just an audio monitor, really nothing but a glorified one-way walkie-talkie.  But it worked OK and Mack is still alive, so...monitoring success, I guess.  We still have the audio monitor, I just kind of stopped using it when I got sick of it basically being a broadcast of the kids arguing with each other in the basement of our old house.  Just share the damn toys guys, dag.

With a fresh baby though, everyone gets a little more vigilant (read: paranoid), and though I like to think of myself as laid back, it crossed my mind that a video monitor might be nice for peace of mind, to be able to see the things that don't make any noise that a monitor can pick up (blanket over face, malevolent stuffed animals come to life, what have you).  The only thing is, I can be kind of a skinflint about certain things, and it just seemed to me to be an awful lot of money to spend for something with somewhat limited lifespan and utility.  And then I had an idea.

(Again, forgive me if this is too obvious, but I was proud of thinking of it, especially since it used equipment that I had already.)


What you will need:

- A transmitter (I used an old iPhone that I saved--I was on AT&T originally but reception was crap at my hospital and I was continually paranoid about missing calls, since that's that primary way we communicate between ORs and such.  Anyway, my point being that when the new iPhone came out I upgraded and switched to Verizon--therefore I have a phone-plan-less iPhone kind of lying around that still works on our home WiFi.  But really you can use anything with a wireless connection and a camera.)

- A receiver (you can use your phone, a 2nd or 3rd generation iPad, your desktop or laptop computer, whatever.  I've been using my iPad because it's light and easy to carry from room to room, but again, it can be pretty much anything, it just has to have wireless connectivity and a camera.)

- Two Skype accounts (I just use mine and Joe's--the accounts are free to sign up for, and at bare bones, calls made over WiFi are free and unlimited so far as I can ascertain)

- Optional but helpful, depending on what you're using for your transmitter: a tripod, some creative velcro strapping, etcetera.

OK, so here's what you do.

STEP 1: Get a baby that you want to stare at.

STEP 2: Figure out where you want the monitor to be.  You're somewhat limited by the fact that streaming a video call over Skype used a lot of juice, so I would choose a place near an outlet, but more importantly, find a place where you can fixate your transmitter, be it over a crib rail or on a nightstand or what have you.  I apologize for the noise in these photos, but I was under low-light conditions for what I assume are obvious reasons.

(Here you see I have my old hobbled iPhone on a tripod and then Velcro-ed the tripod to the corner of the crib.  I don't think you absolutely need a tripod, but I had one from a lens kit that I got for iPhone photography that I rarely use and it's pretty handy in general--it also allows you to put the transmitter on a flat surface instead if that's your preference.  Just make modifications as you see fit--for example, if your baby is old enough to pull up and grab things, you probably don't want to have that phone just dangling there on the edge of the crib rail, but in that case, you know, put a table next to the crib out of reach or put the camera on a shelf, whatever.)

STEP 3: Make sure you have Skype downloaded on both transmitter and receiver devices.  There's a free Skype app for iPhone/iPad/iPod on iTunes (iKnow, this is starting to seem like I work for Apple but I swear I don't, it's just what iHave in my house.)  Log in with one account on the transmitter and the other account on the receiver.  (I use Joe's account as the receiver, and my account is the transmitter.)

STEP 4: Use one end to call the other end.  Doesn't matter which one initiates the call, just make sure you're placing a video call because that's the whole point.  Accept the call on the other end.

STEP 5: If you're using something like an iPhone for your transmitter that has two cameras, make sure that you change the preferences such that you're using the "back facing camera" or whatever they call it--that's the higher quality camera anyway, it'll probably give you a better image, and that way you're not shining that screen in the baby's face.  

STEP 6: And there's your call on the other end.  Now continue to silently and creepily spy on your offspring.

in which I either save you money or get you to spend more of it

Hey, can I give you a completely unsolicited, unsponsored product recommendation, if for no other reason than to get that gory cord photo down below the fold?   OK then.

Like many people, I like the aesthetic of American Apparel clothes for kids--for babies in particular, it seems like the only place to get plain, bold-colored (meaning non-pastel) clothes not cluttered with pictures and logos for various things.  The only problem is the price.  I mean, $11.50 for a onesie?  Are you shitting me?  I love my kid, and you know, it's nice that they're American made and everything, but...no.

Then, when I was tooling around the internet looking for some plain T-shirts for our freezer paper stencil projects, I found this company called Rock Bottom T-shirts, and among many other things (I think they mostly deal in plain T-shirts and sweatshirts and things of that ilk) I noticed that they sell, huh, what do you know, plain, bright-colored onesies not cluttered with pictures or logos.  I thought there was a pretty good chance that they would be made of that really rough, scratchy cotton, but I ordered a few to check them out and no, the cotton is nice and soft, good construction, washes up well, and the colors really are very bright.  I would compare them favorably to those Gerber onesies that you can buy in a big five-pack.  These shrink up the same way, but to my hand, they are softer.  And the colors!  Love the colors, want to lick them.  For the price, I could not say no.  At the time I ordered the onesies, they were actually having a sale, so they were even a full dollar cheaper than they are listed for now (and if you don't need a snap-bottom onesie, these short sleeved lap tees are a good alternative and also at a full dollar cheaper) which means I was able to get this big, admittedly indulgent pile for the price of two American Apparel onesies.

Will they hold up?  The real question is, do they need to hold up?  We're talking about baby clothes, after all.  It's a race to the Goodwill bin anyway, so who cares?

(And yes, when I have things in different colors, I need to order them all ROY G. BIV--I can't help it, it's a disease.)

At Nina's third bili check in as many days, she's down to 13.8, and an ounce shy of her birth weight. We're going to keep letting her get some sun (our house is unfortunately a low-ceilinged ranch devoid of natural light in most rooms, but the kids' playroom was a sunroom in its former incarnatiom so we'll just hang out there as much as possible for the weekend. One more weight and bili check on Monday, after which poit, hopefully, we'll be released on our own recognizance.

(Gorgeous quilt a gift from the lovely and talented Ramona Bates, a plastic surgeon, prominent medical blogger, and quilt-maker extraordinaire.  It must have taken a lot of hard work, thank you so much again!)

glow worm

Hey, thanks for those in the comments who helped me convert the RAW files to JPGs.  Insert Eddie Murphy's "Raw" joke here!  (I don't even know what that joke would be, I just like to say "Eddie Murphy's 'Raw'".)  A few more pics from Nina's birthday.

Yikes.

Big ups to Dr. Moore.

And now, Deep Thoughts.

I had lying-down-for-too-many-hours hair.

So today we brought in Nina for her first Peds check after being discharged from the hospital.  We didn't have any real concerns--she's been doing all the things that she's supposed to do, she's less than an ounce shy of her birth weight (my milk came in yesterday afternoon--we'd been doing some supplementing with formula up until then to avoid dehydration and jaundice) and she's just been generally delightful.  So we were a little surprised when a quasi-routine heel stick for bilirubin turned up levels in the high-risk range.  (She was about 82 hours old when the blood was checked, and her level was 16 point something.)  Honestly, she doesn't look that yellow to me, I almost wonder if hemolysis from heel-stick sampling plays a role in the number being high (does it do that?) but whatever, better safe than sorry.

WHO'S THE GREEN LANTERN NOW, MACK?

Apparently we have this really shit health insurance that doesn't cover bili blankets via home health nursing--the nurse says in the past when they've had patients with our insurance needing phototherapy the only thing that has been covered has been those baby tanning beds in the isolettes, which would be TERRIBLE, since you're supposed to just leave the baby in there all the time, by themselves, for 24 hours or more, only taking them out for feeds and diaper changes.  Boo-urns to that.  

However, the Peds group that we're with has a bili blanket system that they loan out for just this kind of situation--thankfully no one else was using it.  (Actually, from the equipment log, it looks like no one has needed to borrow it since February, which either means no babies need phototherapy or everyone has better health insurance than us.)  NO MATTER.  We were so very grateful to have this option, and to be with a Peds group that has a loaner unit because they know that babies need to be held and touched even if they are busy isomerizing the double bonds in their excess bilirubin.  Two thumbs up for the Children's Medical Group of Atlanta.

We're going to go back in tomorrow afternoon for another bili check, aiming for at least a two point drop in her level after about 24 hours on the lights.  Let's hope we're already moving in the right direction.