independence day

I did want to put the birth announcement up here first, as this is something of my Primary Address when it comes to the internet, but something was weird with the wireless network at the hospital and my computer couldn't connect, blah blah blah (now I'm just boring myself) and besides, everyone is on Facebook and Twitter anyway, right?  But just because I'm a completist when it comes to documentation:

Introducing:

Nina Qiao-Ying Walrath
Born July 2nd, 2012 at 12:05am
6lbs, 13oz
19 inches long

(Her Chinese middle name, picked out by my dad, means "witty" and "intelligent." We figured she'd have a lifetime of people telling her that she was "pretty"--I mean, not that we knew she would be pretty, though she is, but you know what I mean, people always tell little girls that--and we wanted to pick a middle name that would emphasize that there are more important things.  When it comes to first names, we don't make a big thing about choosing first names that have a lot of symbolism, we just go by the "like the way it sounds" school of baby naming, but so far as I can tell, Nina means "girl." So, you know, story checks out.)

Nina came into the world in her own way, which I am coming to understand is determinedly unique and certainly on her own timetable.  You remember I was admitted to the hospital for about 12 hours in what was first deemed to be active and then downgraded to a sort of meandering prodromal labor last week--and I spent the time since then doing exactly what I didn't want to do with the final stages of my pregnancy, which was puttering around, hyperaware of my body, and sort of obsessively cataloguing every squeeze and twinge and thump.  This is so annoying, I thought to myself.  If I was at work, I'd be busy, I'd have more to do than naval-gazing, and I wouldn't be so focused on every little thing going on all up in my junk.  This is a waste of time.

(She said with great PORTENT.)

Sunday morning--the day I turned 38 weeks--I woke up, and Nina, intrauterine, was still asleep.  I had gotten pretty accustomed to her sleep/wake patterns by this time, and usually she would perk up and start kicking around pretty soon after I got up myself, but this morning, she was a little slow to get going.  So I did the usual things they tell you to do.  I had some breakfast.  I had some coffee.  I started counting her kicks.  It wasn't that she wasn't moving around AT ALL--obviously that would have been very worrisome--she was meeting her minimum kick count, which I believe is 10 movements in 2 hours, but it was just different from usual.  She was just kind of pokey in there.

I know that decreased movement at term can be normal--there's just less room in there, after all, and who knows, maybe they sense when birth is imminent and quiet down to save energy for getting borned and all that.  But it was still a change, and though I considered long and hard just going about my day (see above: with the lack of my usual daily runaround, maybe I was just being too obsessive about what was going on inside) but in the end decided to just call my OB and get his opinion.

Sidebar: I cannot recommend my OB highly enough, by the way.  I can talk about it more with anyone who wants a recommendation, but his name is Dr. Brad Moore, here is the website for his office, and he is truly an excellent clinician and bedside doctor--and this is from someone who is well aware of the Pressures of Modern Medicine and therefore very forgiving when it comes to how other clinicians practice.  He is quite simply and unequivocally excellent, so get thee to his practice, pregnant ladies of Atlanta.  End sidebar.

Anyway, I called my OB, kind of apologizing for calling on the weekend about something that could be nothing, I'm not a hysteric, I swear, but he listened and he did take it seriously.  "Come on in," he told me, "we'll check you and check the baby.  You're 38 weeks, contracting, with advanced dilation, GBS positive and a history of fast labors.  If things are in line, maybe we'll just get in your antibiotics, augment you with a whiff of Pitocin, and have this baby tonight."

I think his intent had been for me to check into L&D right from the beginning (since he was on call that weekend he was already in the hospital, puttering around) but because my chief complaint was "decreased fetal movement at term" they sent me to triage first, where the nurse was very clearly of the opinion that I was a hysteric and should be sent home.  "The best outcome here would be to send you home," she told me brightly with one of those tight, forced smiles as she was doing the admissions paperwork, and after she got the phone orders from my OB that I should indeed be admitted to L&D, she made it clear that she disagreed in the way that people do without coming out and saying so outright.  "Well, you're getting admitted.  It's what your doctor wants, I guess..."  I don't begrudge her the sentiment--I don't like being on call for the weekend either, I guess--but I was also glad that I'd called my OB first and that the decision was not up to her.

The actual lead up to delivery was completely uneventful, much with with Cal and Mack.  I got my antibiotics, started some low-dose Pitocin, got my epidural (great stuff, by the way, though it's not an entirely pleasant process getting it placed, and fact that I'm pleased to be reminded of every 3.5 years just for the purposes of patient empathy) and then had my membranes ruptured with my second dose of penicillin hanging.  We were on our way.  At 11:56, the baby's head was at +2, all the players were in the room, and we were ready to push.

"We've still got four minutes to make a July 1st birthday!" Joe kidded, and my OB made a little jokey show of putting on his glove and gowns real fast.  Then we started pushing.

I should mention that up until this point, for the hours we'd been there, the fetal heartbeat monitor was looking really good.  Lots of good variability, perky, with a rate right in the normal range.  When the head was all the way down and we started getting ready to push however, the tracing looked a little more flat, meaning that the rate was still normal, but it wasn't quite as variable as it had been.  I assumed she just didn't like getting squashed.  But then after the first two rounds of pushing, it all kind of fell off a cliff.

Even in an adult, a heart rate of 50 in an adult is slow.  That's what Joe's heart rate is, and he's on beta blockers, for chrissake.  A heartrate of 50 in a neonate is...well.  Let's just say that if I was in the NICU and there was a baby with a heart rate of 50, I would be doing chest compressions on that baby.  After the first two pushes, that's what our baby's heart rate did on the monitor.  The nurse adjusted the Doppler, thinking maybe that the baby was so low down that it wasn't picking up, but no, it was picking up, and it was 50.  So my OB--in a way that was very calm but also very quick and decisive, and I'm convinced that it was this quick response that really saved us from those things we don't like to think about--busted out the obstetric vacuum, applied it to the baby's head, told me to push one more time quick, and pulled that puppy out of there.

Nina was born vigorous, with good tone, and she cried right away.  Her Apgars were 8 and 9.  As they were warming her up and drying her off, I heard my OB, from the region I like to call Down There, say, "Oh my gosh, look at this."  Which is not a thing that I like to hear from Down There.  Because when he delivered the rest of the placenta and cord, it looked like this:

(Let me just insert here that this is not a picture of our umbilical cord, it's a picture I got off Ye Internet, though ours looked remarkably similar, only tighter.  That is not to say that we didn't take pictures of this phenomenon, because WE TOTALLY DID, once the placenta and associated works were safely and discreetly deposited in the specimen basin, but they're on our "real" camera and I can't figure out how to get them off, because someone switched the settings so that all our photos from that day are in RAW format.  If someone knows a good strategy to batch convert them in Photoshop so we don't have to do them one by one, let me know in the comments section, thanks--I'll update with those photos once I'm able to extract them.)

In case you can't see for yourself, it was a knot.  What they call a true knot in the umbilical cord, which is pretty rare, and even rarer for it to actually get pulled tight enough to manifest with fetal distress.  The knot had probably already been there for months--Nina had probably tied it earlier in gestation when she was much smaller and there was more room to maneuver, and if you don't read about all the terrible things that can happen with a true knot in the umbilical cord, it's actually a little amusing to thing about her doing the loop-de-loop, then threading the needle while swinging her cord around like a lariat.  A little amusing, until she started to pull down on the cord on her way out and tightened that knot up but good.  Obviously we had no idea until after, it's not exactly something you screen for routinely without lack of other indicators for risk, and there's nothing you can really do to cause or prevent it.  We were incredibly lucky, and we know it.

I also do have to say this here, because these days, what my friend Veronica (also an OB-Gyn) has called "the fetishization of the natural" goes hand in hand with the demonization of the medical.  By no means am I saying that everyone should have the maximal interventions possible (Pitocin and epidurals and C-sections for everyone!) or that people's hearts aren't in the right places when they choose to have births outside of the hospital.  But if I were of the type to elect for a home birth (and let's be clear: I'M TOTALLY NOT) I would have, on paper, been the perfect candidate.  Multiparous with two prior uncomplicated vaginal deliveries, full-term with normal-sized fetus and an uncomplicated gestation.  But if this pregnancy experience has taught me anything, it's that you can't plan for everything, and there's always going to be things you can't expect.  And maybe because it's the anesthesiologist's credo (aside from vigilance), but I live by the idea of hoping for the best and planning for the worst.

This could have been bad.  It could have been catastrophic.  But it was not, and for that, and for our sweet baby Nina, we could not be more grateful.

Cal, upon meeting Nina for the first time in the hospital the next day, gave this assessment.  (Cal's demeanor is often overly serious--we keep telling him to lighten up, kid, for god's sake--and while we mentioned to him about the interesting little finding on Nina's umbilical cord we didn't really go into detail about what it could have meant; Cal's grave little pronouncements just happen on their own.)

"She's perfect." he told me.  "She's the perfect baby and we get to take her home with us."

Yes she is, and yes we do.  And we love her so much already.

Welcome to the family, Nina.  Now get ready to have some fun.

true labor, false labor, and that liminal space between

Hey there! Are you alive? Me too!

I'd been having a pretty rough week at work--on call over the weekend, later days, tough cases--and starting Wednesday morning,  I noticed a change in how my body was feeling.  First of all, Thing 3 felt much lower, like a bowling ball sitting on my coccyx.  I was also noticing an uptick of contractions accompanied by back pain, which is not the usual for me (Braxton Hicks contractions usually concentrate on the front, and I'm lucky that I haven't had much musculoskeletal back discomfort with this pregnancy at all) that would come and go--I'd like to say that I was scrupulous about timing these contractions, but I was at work and running around and I really didn't have time to attend to their frequency until much later in the afternoon, when I finally had a chance to sit down.  I will also say that there were a spectrum some other symptoms that I'm too polite (read: shy) to talk about but that you can read about after searching "signs of labor" in Google.  Something was different.  Something was happening.

I'm more of the type to sort of wait things out until something declarative occured, but the one thing is that for these past two pregnancies (three? I can't remember with Cal) I've been GBS positive, which means that I need to receive at least one round of penicillin prior to delivery.  The window for getting the antibiotics (I've been told--it's been a long time since I've done Peds and I don't purport to know anything about OB except what applies to the anesthetic management therein) is four hours, and my OB pointed out on my last visit, when I was 2-3 cm dilated on exam and 50% effaced, that this is my third child, and as a faster delivery could be expected, that with signs of impending labor I should high-tail it to the hospital sooner rather than later.  "Usually I say when the contractions are every 5 minutes apart," he said, "but for you, maybe every 8 minutes."  At the point in the afternoon when I could actually sit down and look at a clock, I was having contractions about every 5-7 minutes apart.

I sat and debated what I should do for a while.  On one hand, I'd been working all day, which tends to make the old uterus a little more irritable--it could all settle down once I got home.  But other the other hand...the other thing.  I thought some more.  The kids were at home, with our nanny.  The hospital where I work is directly across the street from the hospital where I plan to deliver.  Did I want to go home, relieve our childcare, and then find myself in a situation where I had to rush back in, with two kids in tow?  Also, Joe was working at an office location more than an hour away that day.  Did he need to rush back into town?  Did he need to reschedule any of his patients for the next day, or the rest of the week?  I had no real answers, and I figured the only way to get more data was just to go in to L&D and get checked, even if I did run the risk of being perhaps overly cautious.

On L&D, they noted that I was 4 cm dilated, 70% effaced, and contracting about every 5-7ish minutes. So they had me on a monitor, put me in a bed, and said they'd be back to check me again in an hour, to see if I'd progressed.  An hour later, the same nurse came by to check--I was now having contractions every 2-3 minutes, and by her exam, I was dilated to 5 cm.  She called back the OB on call, who decided to admit me to the floor.

"I guess I should call my people at work," I said hesitantly to the nurse.  "I mean, should I?  Should I tell them I night not be at work tomorrow?"

"Oh no, you're not going in tomorrow," the nurse said.  "You're having a baby tonight."

So...OK.  I got an IV.  I got my antibiotics.  I settled in for the night with a toco monitor and a fetal heart rate monitor strapped to my gut parts.  Our nanny stayed overnight with the boys.  Joe came in with the bags and slept on the most uncomfortable couch sleeper ever.  Since I was only 37 and a half weeks at the time (I'll be 38 weeks on Sunday) they actually couldn't give me anything to hurry the process along (I've gotten Pitocin aumentation for my prior two deliveries) and I guess that was fine, because overnight, the contractions started getting more irregular, spaced out, and then kind of petered out to every 10-15 minutes.  In the morning, a new nurse came in, the kind of nurse that I would have been terrified of as a med student but now as an attending I love--a gruffly, senior nurse, direct and to the point--and told me, "You know, I don't think you're in true labor."

I said I kind of wish I had been told that before our little slumber party, but I knew in actuality it had been a tough call.  3rd pregnancy, GBS positive, seemingly regular contractions with progression on exam on admission--I don't fault the original team for tilting towards caution and admitting me "in labor."  I think my OB was torn too.  "We have two choices here," he told me.  "The risk of fetal lung immaturity at this stage is really very low, but because it's a possibility, the literature tells us not flat-out induce prior to 39 weeks.  However, it's hard sending someone home who's 4-5 cm and contracting.  I guess if we gave you Pit it wouldn't really be an induction so much as an augmentation.  But then again..." he thought some more, "you're not contracting as much now.  You said you came straight from work yesterday?"  I confirmed that I did.  He kind of cocked his head, considering the options.  "It's a bit of a tough call.  I think we have two choices.  One is we can keep you here and watch you.  The other thing is we can send you home and wait until you declare yourself there."

Having already spent a night in the hospital, I was not crazy about spending another day there unless, you know, I knew I was getting a baby out of the deal.  Also, as a former Peds person, I knew he was right--that at 37 and 4/7 the likelihood of lung immaturity, especially for a baby girl, is very, very low.  Yet...we spend our lives minimizing risk for our kids, and if she wasn't quite ready to come out yet, then I didn't want to be the one making the decision to force her out.

Don't get me wrong, I'm as ready for this pregnancy to be over as the next lady, but also, you know, I want to be a rational person about things, not like those ladies who show up to L&D at 37 weeks on the dot demanding TAKE THIS BABY OUT OF ME NOW.  I could handle a little more discomfort and waiting.  The uncertainty I'm not crazy about, nor the idea of having a precipitous delivery in the car, but...we live pretty close to the hospital, and we have a pretty fast car.  I told him I that if it was OK in his judgement, I would like to go home.

So, that's why I'm home.  After some deliberation (and I know this will seem crazy to many of you, but my OB even said that medicine is the only field where he's encountered people that are determined to work up until the very second the baby is crowning) I have decided to start my maternity leave five days earlier than scheduled.  On one hand, it kills me to not be at work when, you know, I'm not doing anything else (I've always said that a single day spent on maternity leave without a baby is a DAY WASTED--yes, I get paid for work, but it's more than that, it's the idea of being at a place where people need you and you're useful and where you're sharing responsibility with others) but I think that at this point it's the best idea.  I have to remind myself that I'm not doing my patients or my partners any favors by weeble-wobbling in at 5 cm dilated with the omnipresent risk of having to leave their case unexpectedly and emergently right before, you know, the cross-clamp comes off the aorta.  I know it sounds like an obvious decision to most people, but believe me and try not to judge too hard the medical culture when I tell you: it feels a little like a cop-out to me.

So!  Here I am!  At home!  Contracting some, a little uncomfortable but feeling basically the same (they confirmed that Thing 3's head is at -1 station which probably explains why I feel like I have a baby coming out of my butt) and I'm hoping that we'll declare ourselves one way or the other and head back into L&D sometime soon.  Today my plan is to walk around, like, a lot, though yes, I will be safe and not over-exert and hydrate adequately, given that the 5 day weather forecast for Atlanta looks a little something like this:

Did I mention that I'll be 38 weeks on Sunday?  And the next time we feel the need to go into L&D for a little visit, we're not leaving without a damn baby?  Lord.

For the craft-minded, I made that skirt (love seersucker), made a pair of boxer shorts for Cal out of the same leftover fabric, and last night made a flannel fitted crib-sheet for the baby after I realized while in the hospital that if we'd actually brought her home today, she'd be sleeping on a bare Ikea mattress.  Might as well be useful somehow, right?

the first step is admitting you have a problem

OK, so this ain't no craft fair or anything, but just humor me on this one, because I am so proud of my ingenuity which is probably not at all ingenious and no doubt detailed in similar form in at least 100 different sewing blogs, all probably featuring the word "upcycling."  I'm talking the talk you guys!

I think we've probably established that Thing 3 has no pants.  First of all, she's going to be born in July, and second of all, the clothes we got for her were on sale after Christmas, when we thought she was going to be a boy.  I have been on this sewing kick lately (YOU THINK?) and have thus been trying to make her little things here and there, but one night when I was lying in bed awake (because that's apparently what I do now in glorious third trimester fashion) I had an idea that was beautiful both in its economy of time and money.  I could turn my old T-shirts into baby pants.

See, because I have a lot of old T-shirts that look like this.  Especially in the winter, I wear a long-sleeved shirt to work under my scrubs, and despite the fact that I have quite a few colors in my rotation (I prefer getting long-sleeved kids T-shirts from Target in a large size because they're cheaper, come in a lot of colors, and because they're for kids have slightly shorter sleeves than adult long-sleeved tees, which seems somewhat more hygienic for work), after a year or two of weekly wear they get a little icky.  Note the lovely underarm deodorant patina--I almost didn't post the picture because I thought it would be unseemly, but look, this is real life, and it's not like I'm running for president or anything like that.  Anyway, they're nice T-shirts, soft and comfortable, but you have to retire them at some point, right?  Purple T-shirt, your time has come.

It is a factory-made T-shirt, though, so as such is has a nice factory finish, with machined hems and whatnot.  Hems are a pain in my ass.  So it occurred to me during one of my many insomniac nights, I could not only repurpose the fabric of the T-shirt itself, but I could preserve the hem at the bottom and save myself some work.  Less work means more time for tomfoolery!

So see, I sliced off the bottom of the shirt just under the fossilized armpits (some deodorant sludge still remained but fear not, they will be excised in the next step), leaving basically a tube of fabric.

I folded the tube width-wise (keeping the hem on the bottom even--it's on the right side of the picture) so that I basically had four layers of fabric with an axis of symmetry down the long way (oriented parallel to the top of the screen)...

And then using a folded in half pair of 3-6 month baby pants that we do have as a guide (they are baby blue, of course), I cut out two symmetrical pieces of pants from the T-shirt fabric.  The sides that I cut off were where the side seams of the old T-shirt were--I figured the fewer the seams, the more comfortable--and I allowed a little extra fabric up top for the hem and elastic casing.

I'm not really good at this kind of thing, nor do I need to re-invent the wheel, but the way I sewed the pants together after this point was based on this tutorial--it's for leggings instead of pants, but the concept is the same--I just like a wider leg because I figure it will fit better for longer.  As for the results, I'll let you judge for yourself.  The pants on the left were the store-bought pair that I used as a model, and the purple ones on the right were the ones I made.

Even for a novice like me who was kind of flying by the seat of her (ho ho) pants, it was actually pretty easy, and didn't take that long, so then I went ahead and hacked up another old T-shirt (this one wasn't stained but it was always overlarge and unflattering so I never wore it) and made these.  Like I said, this T-shirt was slightly bigger, so I was able to make the pants a little bit bigger too, for room to grow.

And then that went pretty well, and was pretty easy, so then I made these, out of another unflattering T-shirt (teal makes me look like the undead, and an overdeep scoop neck is not a good look for the flat-chested--that shirt had a more narrow cut, so with less fabric I made these more leggings-like than the other two).  Why do I have so many clothes in my closet that don't look good on me?  These are the mysteries of the ages.  At least they're proving their usefulness now.

I think you can see where I'm going with this.

SOMEONE HELP ME I'M TRAPPED IN A PANTS MAKING VORTEX.

The good (bad?) thing is that we actually live right near (I mean right near--we could walk to it if anyone in Atlanta ever walked anywhere) a consignment store, where you can get a whole mess of pretty decent soft T-shirts in all kinds of colors for, like, a dollar.  Jersey knit fabric bought by the yard at the fabric store is kind of boring, not to mention expensive, but for little baby sewing projects, you don't need a whole lot of fabric.  So in order that I don't slice up all the rest of my clothing, I also have a reserve stash of thrifted cotton T-shirts for future projects.  Don't worry, I'll make something other than pants at some point.  But oh, I do love those stripes.

HELP SEND LITHIUM.

edna mode (and guest)

I wonder if it's a more common phenomenon for medical bloggers to update on a reverse schedule, meaning updates exclusively on the weekends, and rarely during the week.  Because who has the time?  Anyway, it's been a particularly hectic week at work, stacked with all the things that make life exciting (occasionally to excess): codes, emergencies, various Oral Board scenarios brought to life.  But at least I had the weekend off.  I'm on call next weekend, my last weekend call before my scheduled maternity leave, so if I can just get through that (weekends on call are always rough, because aside from the weekend itself, you're basically working two weeks in a row non-stop without a break) I think we'll be OK to sail into the home stretch.

The thing with having a busy job and working full-time is that you really feel that you don't have enough time with your kids.  That's just the fact of it--if that's the path you're eyeing, male or female, you will feel this way, it's simply a matter of resource allocation and during the week, especially, the time just isn't there.  In the medical field, particularly, even nights and weekends at home are not a given, so you just have to kind of carve out time when you can.  Weekends here, post-call days there.  Usually nights don't find me at my best--after work usually I'm in a state of fatigue that brings me to "I wash myself with a rag on a stick" territory, but you know--sometimes there are earlier days off, and sometimes you get a break to do something fun.

I got out from work a little early on Wednesday this week (post-call of course, because ain't nothing in life is free), so I decided to do this with my time:

I know, it doesn't look like anything, but the inspiration was this: I got Mack these super cheapy superhero costumes at Christmas (actually I can't remember who actually got them for him--I get enlisted to get gifts for the kids from various relatives, and it might even have come from "Santa" himself, who can remember now).  They were ignored for months, until one day, suddenly the kids decided that superheros were THE COOLEST and dressing up like superheros and making laser sounds while fake-punching your brother in the head with your Bat Fist was OMG THE BEST GAME EVER.  So the costumes have been getting some use.

As you can see, they are pieces of crap.  Thin, fraying nylon, just a simple apron-type construction with a back tie.  All the kids can see is the logo and the Superness, but now that they've got some miles on them, all I can see is how much they are falling apart.

I was at the fabric store the other day when I saw this crazy metallic fabric on sale.  It was a reflective polyester, which is as sleazy as it sounds, and I thought to myself, "Who would buy that shit?"

And then I realized: I WILL.  I WILL BUY THAT SHIT.  WITH WHICH TO MAKE SUPERHERO COSTUMES.

I think I've already explained my affection for Things Reversible when it comes to kids, not the least benefit of which is that if I'm going to put in the effort to make one superhero costume, I might as well get two out of the deal.  The other benefit is that you can be two different characters--I made one costume each for the boys, both identically reversible (red with a gold cape on one side, blue with a silver cape on the other) so that they could choose to be on the same team, à la "The Incredibles," or on different teams if they preferred.  So far they've mostly chosen to be on different teams.  So they can FIGHT.  And make LASER NOISES.  And I personally have been unable to stop saying, in the voice of Samuel L. Jackson, "Where's my super suit?"

So anyway, that's fun.

The next step in the plan was for them to design their own superhero logos and for us to glue them on the chest with felt shapes, but we ran out of time, so it's still a work in process.  Still, even plain, they're very super.

The other kids project I did yesterday was to make a freezer-stencil T-shirt with Cal.  (Tutorials for freezer paper stencil techniques are all over the internet, just Google it, but I will heartily endorse the pursuit, it is easy and satisfying and as you can see, even a child can do it.  Well, maybe not the part where you cut out the design with the razor blade, but otherwise.)  Cal chose the design himself--it's Boba Fett, for you non-nerds out there.  He actually requested Jango Fett (Django?) on the basis that Jango is cooler ("He has two guns!") but since they look the same I think this tracing of Boba Fett (originally off a pumpkin carving tutorial) sufficed.

I made a shirt for Mack too, but I just kind of did it myself since he's a little young for the whole activity.  I toyed with doing a different Star Wars design but decided in the end on this, since Mack, as a three year-old, lives in a world not unlike that of John Malkovich after going into his own portal in "Being John Malkovich."  Malkovich Malkovich Malkoviiiiiitch.

Anyway, this has partially been in answer to the people who ask how I have time to do all the things that I do.  The short answer is: I don't.  My honest assessment is that I probably don't spend enough time with my kids, but luckily, I work as part of a team, and between the time that all of us put in, the kids are OK.  Otherwise, I just try to maximize the quality of the time that I do have to spend with them (as energy allows), and like I always say, they'll tell me in the end if it was good enough. But we try hard, and it's what we have for now.

And at the very least they'll have some really cute clothes to wear to family therapy.

Speaking of having kids...hey, let's play this game now!

34 weeks:

35 weeks:

36 weeks:

About a week ago Joe observed independent of me (this lends validity) that he thinks Thing 3 has dropped down a little bit--engaged herself, if you will--and I have to agree.  Since it's my third kid, I don't think it means anything much (meaning it's both less and more comfortable, but I don't think I'm going into labor tomorrow or anything) but it's certainly the next thing, for what it's worth.  Also I enjoy going around saying "ENGAGE" in the voice of Jean-Luc Picard, so who says the third trimester can't be fun?

Have a good super week, everyone.

making it work

I have to write this in a hurry because it's A SCHOOL NIGHT but I realize that after that last entry and at this point in gestation, not checking in is just inviting people to think that I'm dead.  So.  Hi.

The mild hypomania that characterized my initiation into sewing is nothing--I say nothing--compared to how it's been since I started making those little baby pinafores.  Joe is alternately amused and throwing around words like "obsessed," because frankly, once I figured out how to make a few of these easy sewing projects, it's been like, "I CAN'T BELIEVE I'VE BEEN PAYING FULL PRICE FOR THIS STUFF ALL THESE YEARS."  (I wear a lot of skirts.)  Here's a little of what I've been doing.

Above is the second skirt I made for myself.  It's just a regular elastic waist skirt, made based on this very good tutorial here.  The first skirt I made for myself actually turned out even better (it was with a lighter weight blue shirting fabric, so, you know, more flowy and such) but I dropped a forkful of Chipotle on it earlier this week so it's in the wash.

This was a flat front pleated skirt that I made based on this tutorial that turned out pretty well.  It's elastic in the back, so, you know, nice for the pregnant ladies.  Also, can I tell you how proud I was that I made a pleat?  And it was easy!  Again: I think I have been overpaying for simple skirts for the past two decades.

These pants I made for Cal based on this tutorial were kind of a fiasco.  I made my own pattern, so I think the inseam turned out a little bit small--also, even though I measured about a trillion times the waist was still too big for him.  They are flat front elastic-backed pants, but I sewed the elastic itself in so I can't cinch them up any more--next time I think I'll use that kind of button hole elastic like they do for all those Old Navy kid pants and leave a little more leeway for the crotch.

Every novice sewer needs to make a tote bag, right?  Also: no matter now many tote bags we have around this house, they always end up getting filled with detritus and then scattered to various corners of the earth, so what the hell, more tote bags for everyone.  Liberally adapted from this tutorial here, though I eschewed the outside pocket for two inside pockets and improvised a contrasting lining.

And then I bent my sewing needle, because apparently when you try to sew through, like, four layers of heavy fabric, you need to switch a thicker needle.  I know, duh.  I'M A DOCTOR, GUYS.  Also: can you tell I like chevron fabric?

The elephant bag was my failed attempt at making a flat-bottom bag that could stand up on its own (I love these canvas bags that we have from Lands End beyond all reason, but my own attempts at reproduction have been slouchy at best.  Then Cal decided he wanted to make a bag too, so we worked on that this evening.  I must be getting better at this, because it only took about two and a half hours, even with all the "help" I was getting.  He picked out the fabric himself (that is my diplomatic way of telling you that I did not pick that girl-ass fabric for him, he went for it himself--I just brightly told him that it looked "very Christmas-y") and the young master has already filled it with nerd accoutrement.

Next up I think I'll revisit the boy pants with hopes of improved outcome--I have this beautiful blue seersucker fabric that I think would look great on Mack for the three minutes that he'll be able to wear it before spilling something irrevocably staining on it.

So!  Craftiness!  It's fun or whatever!

I've felt basically normal after our scare on Wednesday morning.  A little woozy at work on Thursday morning but I took my blood pressure, and since it was basically normal I just drank some water, ate some crackers, and went about my business.  For what it's worth, I'm staying away from high-fat foods just in case my gallbag is to blame (again, there's nothing definitive to say that it was, but it's as good a guess as any), and so far, there have been no more surprises.  I have been a little...touchy, I guess...with people in my life (there are just a few) who imply that I overreacted or say stuff like OH YOU PREGNANT PEOPLE ALWAYS WORRY SO MUCH PROBABLY JUST HAD REFLUX I HAVE REFLUX TOO SOMETIMES AND ANYWAY YOU PROBABLY JUST ATE TOO MUCH because--well.

One of the very first lessons we were taught in medical school--one of the most important lessons, I suppose--was being able to distinguish a patient who is Sick from a patient who is Not Sick.  Meaning: the difference between a patient who just has a fever versus a patient who is septic.  A patient who is just bleeding versus a patient who is in shock.  A patient with abdominal pain versus a patient who has volvulus.  Even if you can't make the exact diagnosis right away, that's the key first step: distinguishing Sick from Not Sick.  I was Sick.  I say this as someone who hates going to the doctor, avoids the hospital (as a patient) at all costs, and as someone who has had two prior pregnancies and spent a total of two weeks hospitalized for periotonitis in medical school.  Maybe I wasn't Sick in a lasting way (and thank goodness for that--certainly I'm not looking for trouble), but if I saw a patient like me as a physician, I'm pretty sure I would say that I was Sick.  I have some perspective, and I like to think that I don't catastrophize. Certainly the episode was transient, but certainly it was real and it happened.  And also certainly I'm all sensitive about it because I try to live my life not complaining and being a good sport about things and trying not to be That Pregnant Lady that thinks every creak and pain is OMG THE BABY IS CROWNING.  But give me a little credit, people.  One should never voluntarily go to the ER unless they're fairly concerned that they might be having a medical emergency, but if they are, that's exactly what the ER is for.

Anyway!  If you want to follow along with some of the easy sewing projects I've been collecting, you can follow me on Pinterest--the sewing bulletin board is the only one I have going right now, but who knows, maybe I'll get obsessed with something else, such as, uh, collecting pictures of cats that I like.  Hope your weekend was as good as mine: that is to say fun, relaxing, and a little bit too short.  Have a good week, all.

colic, ahead of schedule

Let me start the story by telling you that yes, this was my arm at around 3:00am this morning.

But maybe let me back up for a moment first.

I was overnight call last night.  At our hospital, because we don't have OB or a significant trauma population, we take home call, meaning once the scheduled cases and add-ons are done for the night we can leave the hospital and come back in if there's an emergency requiring anesthesia.  I left the building around midnight and got in my car.

On my drive home (I only live about 10-12 minutes from the hospital, so we're not talking a real long drive here) I started to get some epigastric pain.  Up high, under the xyphoid, but intermittent, diffuse and colicky.  It did not feel like Braxton Hicks contractions, that much I could ascertain by just poking at my stomach with a finger--one of the many benefits of having had two other kids is that I know what uterine contractions feel like, which is where the consistency of your uterus as palpated from the outside basically goes from feeeling like a Nerf soccerball to a regulation bowling ball.  This was not that.  It also felt different from the reflux that I've been having on and off for the past few weeks.  I wouldn't even really classify the reflux I've been experiencing as pain, more of an annoyance--kind of a fullness and urpiness with some occasional ascending pressure--but I had a bottle of antacids in my work bag and when I stopped at a red light I went ahead and took two of those.  Before I got in my house I went ahead and took two more, because the first two didn't seem to have helped at all.  The second two didn't either.

Everyone in the house was sleeping when I got in, so I tried to hobble upstairs quietly to get changed.  The pain was much worse.  Epigastric, diffuse, severe, worse with movement.  So I thought maybe I should just like down on the carpet until it got better.  It didn't get better.  Somehow I wormed out of my work clothes (I was still lying down, so "worming" is actually a very accurate description of my efforts), put on a tank top and a pair of boxers, and kind of shambled into bed, thinking that the soft surface would help, and hell, this had to let up soon, right?  I'd had nothing special for dinner (you know, a sandwich, some iced tea, a handful of chips--eaten hastily between cases but not much more so than usual) and possibly one of those things were disagreeing with me.  I particularly cast a jaundiced eye on the sandwich, which, while it was freshly prepared that morning in front of me in the supermarket and had been in the fridge the whole time until I ate it, I suspected was the most likely culprit.  I know everyone tells The Pregnants to stay away from cold cuts because of the risk of listeriosis, but I've never really listened to that--how can you work in a hospital and not eat sandwiches?    I mean, I won't eat cold cuts that have been sitting our for hours or anything, but otherwise, late nights, I would have nothing.  Anyway, I don't get listeriosis under normal conditions, right?  Whatever.  The damn sandwich, am I right folks?

The pain was beginning to get much, much worse.  I couldn't lie still, for one--each wave of pain had me writhing around, and there was no comfortable position to be had.  I could still feel Thing 3 squirming around inside, which was reassuring, but also excruciating, because every well-aimed jab at the fundus or foot to the ribs made the pain, like, ten times worse, as was any effort for me to engage my abdominal muscles at all to sit up or move.  I've had two kids and this pain was far worse than anything that I experienced during either of my two labors (and granted, I had epidurals for both, but it's not like they popped them into my back the second I walked in the door--I know what unmedicated active labor feels like, even augmented on Pitocin.)  The closest thing, honestly, that this felt like was when I went to the ER with a raging peritonitis when I had that perforated appendix in med school.  And that was pretty bad, not to mention dangerous.

So I started considering my options.  Like most medical people I tend to minimize when it comes to triaging my own ailments (part of it is that we see so much worse stuff in our patients day-to-day that it seems indulgent to catastrophize your own--the other part of it is that we know being a patient in the hospital is THE WORST) but when I was thinking through the differential and the worst case scenario for waiting versus heading into the ER, it did seem like there might be a time-sensitive element to going in sooner rather than later.  Basically my two main concerns were pre-ecclampsia/HELLP syndrome or some grade of placental abruption.  Would I feel worse going into the hospital for a false alarm or worse waiting at home for it to blow over and having something potentially catastrophic happen with the baby?  It was a no-brainer.  I knew I had to go in.

(It also should be said that anytime you get a pregnant patient on the Anesthesia oral board exam something terrible happens to them and everyone dies, so yeah, maybe I was thinking about that a little bit too.)

I crawled over to Joe in MEGABED (I couldn't really stand up that well anymore) and woke him up.  "I think I should go into the hospital," I said, and explained what was going on.  I really didn't want to wake the kids up (it was past 1:00am at this point) but I didn't think I could drive myself in anymore and short of calling a cab, I wasn't really sure what else to do.  Joe immediately jumped into action--getting things ready, getting the kids dressed, gathering the appropriate materials.  I, meanwhile, crawled over to the bathroom on all fours and started making friends with the toilet.  I wasn't throwing up or anything, but I felt kind of sicky and remember, the retrospectively ill-advised white berber carpeting.

By the time the kids were dressed Joe was looking very concerned.  "Do you want me to call an ambulance?"

"Nah," I gritted out, "It won't...be any...faster...let's just...drive in."  And then I writhed around some more on the floor and tried to breathe a little bit between the painful gut twisting.

Joe called the ambulance.

We explained to the 911 operator that we really didn't think it was premature labor (see: uterine contractions, lack thereof) but anytime you are 34+ weeks pregnant with excruciating abdominal pain, obviously that's what people are going to think.  Joe helped me down the stairs (I really couldn't walk at all by this point), the ambulance pulled up, and after a very quick history, we scooped and ran.  We tried to shoo the kids away back into the bedroom so they wouldn't be traumatized, and I kept reassuring them that MOM'S FINE, JUST A LITTLE SICK, EVERYTHING'S GOOD (giving them increasingly manic smile rictuses/thumbs ups) but they seemed more fascinated than anything else, especially when the ambulance and the fire truck pulled up.  (I guess they always call the fire truck in tandem, even without overt fire.  Not really sure why.)

The pain started getting better once we got to the hospital, and after some monitoring and labs, I felt almost normal again.  (Joe confirmed also that I was looking 100% less like death.)  My OB wanted to get an abdominal ultrasound to rule out gallbladder pathology (with pre-ecclampsia and abruption mostly off the table I think that's an abundantly reasonable diagnosis) but that failed to qualify as an emergency scan so I stuck around L&D urgent care for another couple of hours until the ultrasound techs clocked in at 8:00am.

The long and the short of is was...nothing.  They didn't find anything.  Labs were normal.  Urine was normal.  BP was high in the ambulance (though not too surprising, see: pain, ambulance, very bumpy hospital transfer) but came back down to almost normal over the next few hours.  Abdominal ultrasound of kidney, pancreas, liver and biliary system was unremarkable--if pushed, the tech thought maybe the gallbladder looked a little contracted, maybe, but that seemed more to me like a desire to give us some explanatory finding rather than anything definitive or concrete.  No visible stones or signs of inflammation.  Best guess--maybe I had a small stone that passed, causing pain and explaining the ultimate resolution.  Possibly.  But who can say, really?

They made me eat some breakfast to make sure that wasn't going to set me off again, and after recording one more strip of Thing 3 (reactive, perky, hates being monitored and kept swimming away from the doppler) they removed my IV and sent me on my way.  Luckily, though I was actually on call last night, I didn't get called back in.  Also luckily, because I was on call last night, I'm post-call off today and so I didn't have to miss any work.  And I know 75% of you right now are groaning, like, who cares if you missed work, you were in the ER, but many of you who work in medicine or other similar jobs understand--you don't like to call in sick, ever, even if, you know, you kind of are.  I'm feeling pretty much normal now, so if everything stays cool, I'm all set to get back to the hospital tomorrow.  My own hospital, I mean, as a doctor.  Where I can put the IVs wherever I want.  (What is it with the Emergency Department and anticubital IVs?  Seriously guys, save that one for the Hail Mary--if there are other choices on non-bendy parts of the arm, those are far more functional.  That said...a billion thank yous for taking such good care of me--I don't really care, stick me wherever you want, I love you.)

In the end, it's sort of an ultimately unsatisfying patient encounter I guess, because there was no answer to what caused the pain, which I maintain was among the worst episodes of pain I've ever felt in my life.  But we turned over most of the big, potentially disastrous stones and found nothing--I'm fine with not ever knowing honestly, so long as it's not dangerous and (fingers crossed), doesn't happen again.  Anyway, at least the kids got a free adventure out of it--they'll be talking about it for days.  Cal was so excited that he grabbed his journal before Joe stuffed him into the car and had this whole entry written by the time he got in to memorialize the happy incident.  (The "salty" smell he's talking about is the ubiquitous odor of the hospital antiseptic.  I mean, I hope that's what he's talking about.  Otherwise, I don't want to know.  Also, ew.)

So, what, like four, five more weeks of being a ticking time bomb?

it's in the bag, baby

It occurred to me that now that we're about a month out from delivery, I should probably think about having a hospital bag ready.  This is my third kid so I have a fairly good idea of what I'll need (and more importantly, what I won't need) but even with Cal, I tended not to overthink my packing strategy.  Part of it is that I like to idealize as little time in the hospital as possible, but I admit the other part may just be my reactionary response to having worked on L&D (both as a Peds and an Anesthesia resident) and seeing moms who brought in, like a living room's worth of stuff and realizing that they were most going to have to pack all that up and carry it back home in 24-36 hours.  So I keep it simple.  Anyway, if I forget anything, Joe can always run home and get it later.  You know, like all my potpourri sachets and serenity talismans.

(That was a joke.  Sorry, potpourri enthusiasts.)

So first, obviously, is clothing.  What clothing is comfortable, adjustable, shapeless, and most amenable to getting stained by biologic fluids?  Why, scrub pants, of course.  The world's most perfect garment.

I bought a fair number of those "nursing tops" when Cal was born (the kind of tank tops with the snap-down hooks and panels for easy boobage) but subsequent to that have realized that, for the less well-endowed of us who are less modest and/or have more experience breastfeeding, a regular shelf-top cami works just fine, and can be found for pretty cheap pretty much anywhere.  I have a bunch of these types of tops from Old Navy, Forever 21, and even Costco. (Kirkland brand, ho! The other benefit of the Costco brand is that they are extra stretchy and cut very long, so I've been able to wear them as a layering piece for the entire pregnancy.)

Hospitals tend to be chilly so I packed two cardigans also (essential feature being that they are a coverup that opens in the front--you could bring a sweatshirt or whatever, I guess, but it would be a pain in the ass for breastfeeding, and anything with a zipper front might get scratchy near a baby's face).  The tank top and soft elastic-waisted skirt are going-home clothes for me--again, just soft, stretchy stuff that can go right in the laundry.

Oh, PRO TIP: anything that the hospital offers you that is disposable, including but not limited to: diapers, pads, underwear, those freezy ass pads, squirt bottles, those big water jugs with the straws--you take that shit and you bring it on home with you.  I packed two pairs of my own underwear just in case they've cracked down on the giveaways, but I will just tell you that I took care only to pack black underwear, and if you need to ask why, you probably don't really want to know the answer.

Baby's going home outfit.  I know it's all very plain and the pants for sure are going to be, like, way too big (they're 3-6 months) but I hardly bought any newborn clothing because it's proven to be such a waste of money in the past, and whatever 0-3 month clothing I do have is very, very boyish.  Like, they literally have the word "BOY" on them.  And to be clear, I don't mind that one bit--it is my contention that babies can't read and I'm standing by that--but I just want to avoid weird looks from the nursing staff.  I don't even think the baby really needs pants even--we're talking about Atlanta in July--but, you know, I'm thinking about fussing with carseat buckles and those skinny little chicken legs that they have at that age should probably be encased in something.

Not pictured:

• Toiletries (I used the hospital toiletries for my first two kids, but this time I think I'll bring my own because I'm so high maintenance like that, me and my products--also the hospital-brand toothpaste is very gritty feeling and barely minty, so it feels like brushing with caulk)

• A nicer, non-iPhone camera that I'll probably hardly use at all because it's such a pain to get it out of the bag and download the photos in order to e-mail them, blah blah blah, first world problems.  Actually, the camera on the iPhone is really pretty nice, I find that I'm using my "real" camera less and less, but it seems kind of mean to the new kid not to even bring it, so OK, into the bag it goes.

• Nursing pads (I like to use these but if anyone has any better suggestions I'm open to them)

• The usual wallet, keys, laptop, power cords, assorted hospital paperwork, etc.

And...that's it.  Keeping it simple.  It's basically all I used in the hospital for the first two kids, but if there's anything essential and awesome that I never knew I was missing, let me know--there's still plenty of room in there.

almost heaven

Hello there.

We're spent last weekend in the North Georgia Mountains, which is a thing that people do down in the South (see: John Denver's entire catalogue).  With the exception of going camping an hour away last year, we've never been, but no surprise, it's really very pretty.  For reasons that are boring we ended up staying at a cabin different than the one we originally intended to, so instead of a creek and a cornfield we got a river and some train tracks.  But they were very scenic train tracks.  Also: OMG TRAINS.

Anyway, there was Nature's Majesty and good weather and s'mores, and not to put too fine a point on it but inside the cabin was a TV that got both The Cartoon Network and Spike TV, which should, in my opinion, be renamed "The Star Wars Network" since that's basically the only thing it plays in the evening.  Not that anyone here is complaining.  (I'm outnumbered, obviously.)

Oh, the weird chemical salt crystals that we got to throw into the fire to make it all rainbow and mystical worked very well, by the way--the kids were impressed.  We just had to make sure that we were done with any fire-based cooking before we threw them in, because I'm pretty sure that eating foods cooked over copper salts and whatnot is probably not the healthiest thing in the world.  Then again, neither are s'mores, so whatever.

And whatever, I know that looking at other people's vacation-y photos is mostly boring so I'll spare you the entire set, but OK, just a few more.

Here Cal found a bird feather and was like, "Look Mom!  Like Harry Potter!"  And I was like, "Oh, that's nice, what a pretty fea--AUGH! DROP IT!  WASH HANDS!  WASH HANDS!" when I noticed the rest of the bird carcass, mostly picked clean but still with very readily identifiable calcific anatomy scattered clustered in a heap, about three feet away.  Nature's Bounty indeed.

(No, I didn't take a picture of the bird carcass.)

I read a bit about tubing on the river before we headed down, and I kept wondering how exactly it is that you get back to the starting point after you're done with your tubery.  I mean, isn't it far to walk back?  And isn't it unweildy to have to carry your tube overland all the way?  My more outdoorsy sources tell me that most people either plan a ride or have two cars, one for the starting point and one as a pickup vehicle downstream.  Which seemed...complicated.  Also, more planning than we were willing to put into the endeavor.  Our solution, therefore, was to just tie a rope to our tubes and drag the kids around in the waist-deep water like we were walking the dog.  A little labor intensive, but it worked fine, and we were able to recover 100% of our children at the end of the day.  Even the spare child.

(WHICH ONE IS THE SPARE?  I'll never tell you.)

(It's Cal.)

Anyway: the Blue Ridge Mountains!  You are very nice, and I would like to subscribe to your newsletter!  If it also looks like this little getaway fulfilled my major criteria of taking vacations in places where seemingly no other people are, your perceptions are largely correct.  I mean, I'm not exactly sure where all the people all were--it was a holiday weekend, after all, and it's not exactly some remote secret getaway spot (it seems, in fact, like the default weekend getaway spot for a lot of people because it's so close by--kind of like the Hamptons is for New York except more rustic and with 99% of the snobbery and exclusivity excised) but with the exception of hearing our neighbors once in the evening and seeing a few kayakers hurtling by, we hardly saw any other people the whole time we were there.  Which, to be clear, was fine with me.  Interacting with humans is very taxing, you know.

(And no, as usual, we didn't actually catch any fish.  That said, it didn't seem to detract from the experience at all, so who cares.  Live on, little fish.)

*          *          *

I'm posting pictures anyway, so here, this thing:

32 weeks

33 weeks

I would describe pregnancy at this point as inconvenience and discomfort tempered by impatience anticipation.  People keep asking me how long I'm going to keep working and I tell them all that I'm going to keep showing up to work all the way up until this baby deplanes, because really, it's the fastest and most interesting way I know to pass a seemingly interminable span of time.  Getting through the third trimester at times is like the graph of y = 1/x.  As x approaches zero, time approaches infinity.

So what, like, four to six more weeks, right?

Tick tock.