Sunday, November 13, 2016

Letter to my infertile self


*Background* My husband and I eventually conceived our oldest daughter after just over 4 years of trying to conceive and with our 4th round of IVF. We have since been able to have 2 more children without fertility treatments. I am acutely aware that every fertility story is unique and many have a different outcome than ours. Nevertheless, amidst a crowd of my fertile, complaining, peers, I used to spend a lot of time panicking about whether or not I wanted to a mom, and whether I’d like it or even be good at it (I’m not very good at it, but I do like it…) This letter is what I wish someone had told me 8 years ago.

Dear Infertile Camber,

Stop panicking.

If parents are good at anything it’s telling horror stories about parenting. They relish horror stories. They try to outdo each other’s horror stories. 10 minutes in a room full of mothers is all the birth control anyone needs.

Having kids is about as hard as you think it will be. Of course it’s hard. Things that ACTUALLY matter are always hard.

It’s true that most of the things you hear parents griping about will be part of your reality as a mother. Tantrums in public. Messes. Expensive things getting broken. Sticky floors. Sticky chairs. Sticky door handles. Sticky EVERYTHING. Body fluids of all types. Sleep deprivation. Desserts you no longer get to yourself. Being late to everything.

But none of this surprises you. You probably feel depressed about it. “Why spend thousands of dollars to bring a miniature dictator into my life?” you ask yourself. And, “WHY does anyone have more than one child?” (The answer is free babysitting in 12 years).

But.

Love will surprise you.

It’s real. It’s better than you think it will be.

When the screaming child is YOUR screaming child, it feels different. You know why she’s throwing a fit. You know she’s not always like that (unless she’s 3. Then she’s always like that. But really, stay calm). An hour ago she probably threw her arms around your neck and gave you a big wet kiss. Tonight you’ll check on her and she’ll look strangely angelic in her sleep (is this the same kid?)

You will find yourself savoring the little moments because they completely DWARF the bad ones. Like kids snuggled up on your lap to read books, kisses goodbye when you leave, a baby crying for you when you leave because they want YOU. Other people’s babies may seem a tad uninteresting, but you’ll find yourself happy to hold your own baby for hours at a time. Just looking at them. Just feeling their warm weight against you. Just staring at their face.

Being a mom is nothing like babysitting. Put all previous (and sometimes traumatizing) babysitting experiences out of your mind, because the truth is you don’t have to like babysitting to like motherhood. Frankly, you don’t actually have to like kids to like motherhood. Motherhood isn’t about other people’s kids. It’s about YOUR kids. Your kids, which, did I mention, you love more than your own life? More than your sleep or a decent sit-down meal or a whole dessert all to yourself? Motherhood isn’t like teaching kindergarten. Your kids will be different ages and you will love and dislike different things about each age. And they will be YOURS.

Obviously you’ll have to give things up. Forget reading a book for fun in the afternoon or sleeping in on a Saturday. Long, expensive vacations will be put on hold indefinitely. Hot dates become takeout and a cheap movie that’s over by 9PM.

So what? You’re making another HUMAN BEING. You teach them how to walk across a room, how to eat grapes, how to sing ABCs, how to start a movie by themselves or get their own cheese sticks out of the fridge. You will hear your voice in their voices because they will mimic everything you do (except picking up. They hate that. Probably because they know you hate it too.)


Keep on. Keep on trying. Keep on hoping. All of this lousy infertility nonsense--the temping and clomid and embarrassing procedures and mounds of negative pregnancy tests and feeling awkward in a room full of pregnant women and mood swings and painful shots and MONEY--all of it will fade away with those first moments holding your baby. It’s cliche, but there’s no other way to put it. It’s worth it. All this nonsense is worth it. In the end you will find that infertility gives you a present: perspective. Remember the infertility years on the hard days. Remember and be grateful.

Sunday, July 3, 2016

My year as a rookie

Last year, still new on the job as a nurse practitioner, I had a phone conversation with a patient's husband I will never forget.

He said, "This CT scan will cost us $730 out of pocket. My wife is feeling better after the shots you gave her. Are you SURE we need to do this today?"

I looked around desperately for someone to tell me what to do. No one did. Had this room always been so Hot?

I tried to sound confident. "Based on her lab results, I really do think she should have the scan done. I think there's a good chance she might have appendicitis."

Truthfully, I had never seen a patient with appendicitis before. She might be my first, and $730 were hanging over my head.

No one warned me about this kind of thing in school--the pressure of trying to keep costs down while also trying to keep my patients alive.

She had appendicitis.

Exactly one week later, I had the opposite conversation with a patient. He had similar pain but looked much less sick than appendicitis lady, and his labs were perfectly normal. I consulted with another doctor, and then told him he probably didn't need to do the CT scan (he also had a high-deductible plan and faced high costs for it).

"I'm already at the hospital and prepped. The pain is worse. If it's OK, I'd like to go ahead and have the scan done."

He had appendicitis too.

Thank GOODNESS he followed his instincts instead of mine.

Sometimes my job freaks me out.

One thing that is difficult for a new healthcare provider is to find the balance between thinking every patient is on the brink of death and thinking everyone is perfectly fine.

Most people with abdominal pain don't have appendicitis, most kids with coughs don't even need antibiotics, more sore throats are not strep throat than are, and most chest pain is not a heart attack.

BUT some chest pain IS a heart attack, and truthfully the only way to know (depending on symptoms), is to run the appropriate tests.

I've only seen one patient having a heart attack so far, surprisingly (out of a dozen or so that I've sent to the ER to be checked), and it wasn't the guy that showed up with crushing chest pain that radiated down his left arm, who looked sweaty and a little out of breath.

No, it was the lady that showed up with one complaint: excess burping. I'm serious.

Sometimes my job FREAKS ME OUT.

Although the majority of what I see is upper respiratory illnesses (sinus infections, coughs, ear infections, and sore throats), I'm often surprised at the variety of what comes through the door.

I have told 2 girls they were pregnant.

I diagnosed someone with type 1 diabetes.

I have pulled an ear bud out of someone's ear, a popcorn kernel from a toddler's nose, and sticks too large to be called splinters from arms and feet.

I have seen quite a variety of broken bones, treated migraines, backaches, stomach aches, rashes, pink eye, burns, eye injuries, abscesses, STDs, and on and on and on.

I have sutured eyebrows and shins, chins and fingers, knees and bottoms of feet. Sometimes I suture under perfect textbook circumstances, and sometimes I just really wish someone else would come in and rescue me from my job. The most miserable I've ever been at work was suturing the bottom of a toddler's foot while his dad held him. It was a bad angle to work from, he kept kicking his leg, and I bent 3 needles trying to get that thick skin pulled together. Zero fun. Maybe negative fun.

Some of my interactions with patients are funny. Like the time a fully-grown, obviously athletic man was terrified of getting swabbed for strep throat. ("How far back do you have to put that thing?") Every time I came near him with my swab he dodged me. I told him to hold still. "I'm trying!...Please don't tell the nurses out there about this..."

Some of my interactions are heart-warming. Kids that are SO excited if I let them listen with my stethoscope, or that try to comfort their siblings when sick or scared. Grandparents that light up when I ask about their grandkids. Patients that come in terrified of a procedure that leave saying, "That wasn't so bad."

There have been diagnostic wins, such as finding whooping cough or mono, suspecting aspiration pneumonia or urosepsis and being right about it, or basically any time I figure out what someone's rash is.

There have also been diagnostic FAILS, which are inevitable but discouraging. I have sent patients to the ER thinking they had something serious going on which turned out to be something minor. Something I could have treated, saving them an ER visit. Sometimes I think someone has appendicitis and they don't. Sometimes I treat people for an illness and they don't get better.

Sometimes I just have NO IDEA WHAT'S WRONG. This is just as discouraging for me as it is for my patients.

Sometimes I go to bed at night worried about patients I've seen that day. I question whether or not I did enough for them. Sometimes they even find their way into my prayers. Inevitably the kids are the ones I worry about the most. I recognize the look of worry on their parents' faces as the same look on MY face when MY kids are sick, even with all my training.

More than a year and a half into this business, the misdiagnoses and treatment failures remain deeply disheartening, but I've also learned that they continue to happen even to seasoned providers. Turns out none of us will ever know everything. But we all keep learning. All the same, I'm sure the wonderful, truly kind doctors I work with tire of my incessant, "rookie" questions.

But at least they're less incessant than they used to be.

I'm making progress.

Sunday, February 21, 2016

Two Kids

I still need a little practice at this "2 kids" thing. (Moms of 3+ kids, kindly hold your fire).

I think of having kids as a little like learning to play the piano. Students can play the notes separately just fine, but the first time I ask them to play two notes at the same time they look at me like their brain might explode.

That's what 2 kids feels like to me.

I have faith that I will get better at this, but there's this thing called "leaving the house" that leaves me feeling exhausted by the time I make it to the driver's seat. Mary requires extensive negotiating at each juncture. Putting socks on. Putting shoes on. Keeping the shoes on. Putting on a jacket ("But mom! I like being cold!") Getting IN the car. Getting IN the carseat. Getting in the carseat with bum down instead of out. Last-minute delays: "I need WAAAAAATER!"
One of Mary's cuter delays: "I giving myself a hug!"

Matthew is too little to require negotiating, but inevitably I'll forget something crucial on the looooong list of stuff to remember when leaving the house: diapers, wipes, binkies, blanket, extra outfit, nursing cover, water for me, burp clothes, and so on.


Sometimes I successfully pack it all and then leave the diaper bag by the door as we drive away. Leaving the house FAIL.

And mealtimes are always a crisis. Not one of us is very cheerful when hungry, and at lunchtime we all seem to be hungry at the SAME TIME. Poor Matthew always wears part of my lunch on his face. (I'm not that good at eating left-handed while nursing him).

A 3-year-old and a 3-month-old are easy and hard in opposite ways. Mary eats when I do, takes only 1 nap a day, can feed herself if I provide the food, and doesn't need to be carried anywhere. But she has OPINIONS and her OPINIONS rule my life. Matthew has almost NO opinions, but requires hours of my day immobilized on the couch feeding him, while trying to read a book to Mary that she is balancing on Matthew's head.

In the middle of all this, we just bought a home and moved into our new house. Three days in a row I haven't unpacked a single box during the daytime. THREE DAYS. Isaac is a tactful husband but I can sense a little confusion in his carefully worded, "So, um, what did you do today?" Fed the kids, gave them baths, and made dinner, thank you very much. So what if that took ALL day?
Bad memories of packing...

I keep telling myself that in the history of the world probably billions of women have had 2 kids. (Pull yourself together Camber!)

Then I tell myself most of those women didn't have to get their toddlers into carseats.

TWO kids! And yet, sometimes I feel kind of awesome. Like when I successfully carry a wobbly-headed baby and a 30+ pound 3-year-old down the stairs at the same time. Or when I manage to get all three of us taking a nap at the same time. Or when I catch Mary taking a binky to her crying brother and telling him, "It's ok! Your sister's here!"
At Matthew's baby blessing

There was a time when I doubted whether we'd have one kid, let alone 2. Ungraceful as I am at handling both of them I feel blessed beyond measure. And, though I admit that some days I want bedtime to come an hour early, the kids are no sooner in bed than I start thinking affectionately on them, no matter how hard the day. I'm pretty in love with my 2 kids.

Thursday, January 7, 2016

Gift of God

I am happy to report that the numerous fears catalogued in my previous post have proven to be unfounded.

Our baby boy is here.

He is healthy.

He has a name.

And, it turns out, I can love a boy. (Actually, I'm smitten.)

Meet Matthew Dennis
His arrival started on his due date, as Mary's did. My doctor stripped my membranes and by that evening, my contractions were coming stronger and more frequently than the braxton-hicks I'd been having for weeks. I warned my sister-in-law about this before we went to bed, in case we needed to bring Mary over in the middle of the night.

A few sleepless hours into the night, with contractions continuing, I went downstairs to watch Home Improvement reruns and pace around in between contractions. When Isaac came to check on me, I told him to go back to bed and sleep some more, but he wanted to stay with me. So we watched Tim Taylor break stuff and timed contractions. An hour later we called my doctor, dropped a sleepy Mary off with my sister-in-law, and drove to the hospital, where I was 4 1/2 cm dilated. I was admitted and my doctor broke my water.

Then I had a dilemma. I didn't get an epidural with Mary, and Sarah was an emergency C-section. Since I was hoping for a VBAC (vaginal birth after cesarean), my doctor had previously recommended getting an epidural in case of uterine rupture, which would require another emergency C-section.

To this end, I didn't plan for an unmedicated birth, and looked forward to a nice, relaxing labor with an epidural when the time came. When I showed up at the hospital, however, my doctor told us that in almost 30 years he's only had 2 uterine ruptures, and with an IV in they could always put me under if an emergency C-section was needed. So I didn't HAVE to get an epidural.

Well, shoot.

It's one thing to get an epidural because, darn it, my doctor made me do it.

It's another thing to get an epidural because I "couldn't handle the pain."

And as I lay there in my hospital bed, watching yet more Home Improvement reruns (a movie seemed like too much commitment), contractions getting stronger, I kept thinking of how soon I could ask for the epidural.

When I get to a 6? When I get too tired? If they have to start pitocin?

As it happened, my contractions started stalling a little, and they did have to start pitocin. But I still felt a little sheepish asking for the epidural. I told myself over and over again--next contraction FOR SURE I'm asking for one.

Finally, at 8:30 AM, only 6 cm dilated, and with the decision made to up the pitocin dose again, I meekly said, "Would it be bad if I got an epidural?" With such slow progress I was envisioning labor lasting well into the afternoon, and I hadn't slept a wink all night. I wanted a break.

Isaac said, "Well, sure, but I think you've got this!"

My nurse said, "Honestly, once we up the pitocin again, you're going to progress really quickly. I predict you'll be done in an hour, hour and a half tops. I think you can do this."

My spirits soared when she said this--I could be DONE in an hour? I decided to go for it unmedicated. What choice did I have, with that kind of peer pressure?

The problem was, I knew what was coming. In childbirth, things only get progressively worse as you go. I remembered from Mary that the baby only comes after you've already reached the point of pure despair, suffered the loss of all dignity, and wished for a swift death.

I tried to put such dark memories out of my mind. My nurse suggested having Isaac put pressure on my knees during contractions, to give my mind another sensation to focus on during contractions.

Believe it or not, it worked. The contractions were still intense but somehow the knee trick made them bearable, along with the deep relaxation and controlled breathing I was already doing.

I'll spare you the details of the final, ugly moments of childbirth. A nursing student came in for the birth and I told her, "I'm about to show you how unglamorous natural childbirth is." And it was terribly unglamorous. The final moments were just as despair-inducing as I'd remembered.

But he came, and despite a brief tense moment when it looked like his shoulders might get stuck, I was able to push him past that and out he came. The first comments I heard were, "Wow, he's chubby!"

Out of pain. And in love.

And he was--all 8 pounds, 2 ounces of him. We were, honestly surprised by this--I measured small my whole pregnancy and never showed all that much. Mary was 7 pounds even. To this day I don't know where I was keeping that baby.

He was crying, he was chubby, I was out of pain, and everything about it was different than Sarah's birth. I snuggled him right up to my chest and just loved him and his healthy self.

As the birth approached, I found myself leaning towards the name Matthew, because it means "Gift of God." I could never commit, though. Perhaps I was waiting to see if he would be okay. But moments after birth, when Isaac asked if we could pick a name already, I just wanted to name him Matthew. Our gift from God.
Proud Daddy.
Proud sister.
Feeling profoundly grateful.
And smiling because NEXT time I'm getting a dang epidural. 

Monday, October 12, 2015

Tales of a Pregnant Worrywart

I am 34 1/2 weeks pregnant with a little boy.
From family pictures a few weeks ago, almost 32 weeks pregnant.

I have handled the past 8 months or so in the most rational state available to me: near panic. 

Yes, I'm grateful for another chance at a baby. Of course we're thrilled and befuddled that we managed to conceive again without IVF. And I have been, naturally, quietly freaking out.

I think everyone knows in the abstract that things can go awry with pregnancy. Working in the medical field, I've always been ever more acutely aware of this, and now, after our own experience with Sarah, I'm left to wonder, How do people make producing babies look so...easy?

We have had a lot of discussions with our really great perinatologist, who is the same doctor that first discovered Sarah's brain abnormalities. Neither he nor Sarah's neonatologist felt like we were any more likely to have a repeat of Sarah's condition than your average couple. That is reassuring. Each new milestone reached has been a relief, and at this point the baby still looks completely normal, so we have fingers crossed and prayers said that little Mister will make it here safe and sound.

So, panic about the baby's health aside, I have another, equal source of anxiety that keeps me up at night:

Can I love a BOY?

If the baby boy clothing selection at the store is any indication, we are in serious trouble.

Everything seems to be sports-themed or camoflauge.

Even worse, there is a disturbing lack of bows and headbands to mask bald spots or general homeliness.

Can I possibly love a bodily-functions obsessed, rough-and-tumble, nothing-you-can-do-if-he's-funny-looking boy like I love sweet, innocent little Mary? (Who is, by the way, back in diapers, after deciding 3 or 4 weeks into potty-training that she was going to fight me tooth and nail every time I mentioned going potty? And who recently announced, screwdriver in hand, that she wanted to kill her doll? Most disturbing moment of my parenting career, hands-down).

Well, she's not actually sweet and innocent ALL the time. But she really is that adorable:
Don't worry. It isn't actually possible to kill a doll.
Plus she kind of melts our hearts. 

And while I'm opening up about pregnancy worries, there is another thorny issue about this one that I should bring up: THE NAME. 

We have never disagreed on a baby name before. With both Mary and Sarah we both agreed on a name within 24 hours of finding out the gender.  This time we're well over 4 months past and still have no idea how to come to any agreement. Flip a coin? Arm wrestle? (No good, we already know who would win). Paper rock scissors? Arbitration?

At the rate we're going, "Baby Boy" may end up on his birth certificate.

So here's to 5-ish remaining weeks of pregnancy anxiety.

Then bring on the new baby anxiety.

Tuesday, August 18, 2015

The case against potty-training

A few weeks ago we decided to just go for it and potty-train Mary.

She is 2 1/2. She's smart, she communicates well, and we wanted it done before we bring home little Mister.

I asked for advice on Facebook and got, of course, a little more than I needed. It seems that there are as many opinions on potty-training as there are parents.

It also seems that most parents remain scarred for life after the experience.

Knowing that struck deep fear into my heart of the process.

I thought it over and chose the potty-training method that fit our personalities the best. "Wait until she potty-trains herself" isn't my style, and neither is the "just let her run around naked until she figures it out" method. I wanted a system. So I chose the "Toilet Training in Less than a Day" (Azrin & Foxx) method. This involves about 4 hours of time where ALL YOU DO is potty-train. You practice going potty, have the child teach a doll to go potty, stay off the carpet at all costs, and reward any successes shamelessly with junk food (M&Ms in our case). Also you shove as many fluids down the gullet as possible to, of course, increase urinary output. Because when they pee more, they practice more.

Two weeks later, Mary is, I'd say, about 90% there with potty-training. She wears pull-ups at night, and I frankly don't care if she keeps that up until she's 10. Accidents are getting pretty uncommon (we're still working on pooping), and all in all I think she's done as well as can be expected for a child her age. She was already starting to get it by the end of the first day. (In spite of what I'm about to say, I was very pleased with the book we used. I plan to use it again on future kids.)

Nevertheless, no experience with parenting thus far, not even the newborn stage, has made me question my decision to bring children into this world like potty-training has.

By day three I started panicking. What had I done? I'd created a monster! I'd left the blissful life of the diapered child. On purpose, no less!

Why on EARTH would any parent willingly give up the freedom of diapers? Who are these parents that push potty-training at absurdly young ages? Or that complain about having a child in diapers?Sure, they cost money, but they are a PORTABLE TOILET the child wears ALL THE TIME.

That day I hit a wall. Would I ever leave the house again? Would the fear of an impending accident forever cloud my sense of well-being? At one particularly low point, I looked down at my own expanding belly and thought to myself, "What have I done? Why am I having another? I'M GOING TO HAVE TO POTTY-TRAIN THIS ONE TOO?!?"

I started surveying parents of toddlers in diapers with pure jealousy.

With Mary in diapers, I never second-guessed what surface she sat on. Sure, sit on that couch! Wondering how I would clean pee off of it never even crossed my mind. Marathon grocery trips? No problem! Road trips? Big deal! My bladder reached capacity long before her diaper ever did. Leaving the house? Piece of cake (compared to now, anyway)! Because I didn't lose 15 minutes in negotiations, trying to get her to pee before we left. ("I'll give you anything! What do you want? Chocolate? Chips? A pony? Just sit on the dang toilet!")

The panic is starting to subside and I have, in fact, left the house successfully with Mary in tow. I am clinging to the hope that my decision to potty-train before kindergarten might not actually ruin my life.

All the same, I plan to outsource potty-training with the next kid.

Sarah's First Birthday

Sarah's first birthday was last week.

I've had a long time to think about her birthday. I've talked to other Angel Mommies. I've reflected on what her life means to me. I've watched other babies due around the same time as her hit milestones that Sarah is missing.

We decided her birthday should be fun--at least in part. We want our kids to look forward to her birthday, not dread it. WE want to look forward to it. We also decided that finding some small ways to give back would also be nice. Never have I experienced such an outpouring of generosity from others--friends, family, and strangers--as we did during her life and after her death.

This in mind, I busted out my almost-non-existant sewing skills and made a few quilts to donate to the NICU where Sarah stayed for a few days. When I finished, I vowed, as I always do after a sewing project, NEVER TO SEW AGAIN.
Here's hoping that whoever gets these doesn't look too closely at the seams...
We had a full day--going to an LDS temple to worship (one of the places I feel closest to Sarah), visiting Sarah's grave and having a picnic there, showing Mary the photo book of Sarah's life, going to the NICU to drop off donations (some family members also made donations), playing at a park, going out for dinner, having birthday cake, and watching a movie (Mary's all-time favorite activity).

Taking flowers to Sarah. Reading her book to Mary.
Also, Mary was happy to take the job of blowing out Sarah's candle for her.

Frosting Sarah's cake
In the end, it wasn't a depressing day. Obviously there were sad parts, but grief isn't always the horrible thing we make it out to be. Sometimes I think it's even okay to seek out chances to grieve, to choose to feel the hurt in a sense. But I will say this: we remembered her, and we grieved her, with gratitude, not bitterness.

And we've learned that remembering, and even grieving, can be beautiful.

Sunday, June 28, 2015

Low-Maintenance

I thought of a new name to explain my girliness impairment. "Tomboy" brings up this image in my mind of a 10-year-old girl climbing trees and wearing jeans with holes in them.

No. That's not me. I'm not 10. So I've settled on "low-maintenance".

Here's the thing. I hate clothes shopping and decorating, I'm a mediocre housekeeper at best, I'd rather wear T-shirts and flip-flops than anything else most days, and I may never change my hairstyle until the day I die.

I am amazed by beautiful woman that put together outfits with matching jewelry and shoes. But my way is cheaper--I have 2 or 3 pieces of jewelry tops apart from my wedding ring. I buy a lot of my clothes at thrift stores, and I'm willing to wear the same styles for years at a time.

[I'm still on the fence about skinny jeans. Aren't some things better left to the imagination? Like thigh circumference?].

So how on EARTH is it that I find myself raising a daughter?

I used to think it's so I can help her avoid a lot of my own youthful pitfalls, including (among others):

-Don't wear your brothers' T-shirts if they are 3 sizes too big for you.
-Actually, don't wear your brothers' clothes ever.
-Even if you brushed your hair yesterday, you still need to brush it today.
-It's ok to own more than 1 pair of shoes.
-When the original color of your shoes is not identifiable, it's time to get new ones.
-For your own sake, you probably shouldn't let your mom (ahem, me) pick out your clothes.
-There's this thing called "outfits." Ummm... you're on your own. Google it or something.

But then I realized that maybe I'm raising a daughter so the world can be graced with one less high-maintenance woman. 

I'll admit that I find myself buying princess flashlights and umbrellas for Mary, dressing her in pink, and collecting for her an excessive number of bows (far more than my own accessory limit). We have tea parties with pink and purple cups, watch Disney princess movies, and she loves to twirl to music in skirts and dresses.

A princess tea party. Princess glasses.
Princess shirt. Excessive bows (I'm ashamed to say this isn't all of them). 
Then again, at a recent trip to a children's museum her happiest half hour was spent in the trucks room (she could have stayed there all day). Cars is one of her favorite movies. She loves trains and she loves pretending to fix things. She builds towers and loves to knock them over. I buy almost all of her clothes second-hand (seriously, she's just going to get stains on it within an hour anyway). She is hardly a prissy girl.

The truck room at the museum. "Horseback" riding.
The tower she's about to knock over. Loving her first roller coaster.

I wonder sometimes what kind of daughter I want to raise. I want her to be a little less awkward in middle school than I was. But I also want her to be confident and kind. I want her to be educated and well-read and loving and full of faith. I want her to work hard for the things she wants and to be grateful to people around her and to God. I hope she'll love music. I hope she'll love serving people.

And I don't particularly want her to be beautiful. I had someone at a grocery store once tell me that I should enter her into a baby contest because she was, I think objectively, a CUTE baby.
WAY cuter than I was at this age. 

I thought about it. And decided not to. Her looks are not her greatest asset and I don't want them to be. They are not wasted if they go unrecognized by the world.

There are plenty of beautiful women in this world. If she chases beauty as the source of her self-worth she will always fall short. Maybe that's the real reason I want to raise a low-maintenance daughter. I want her to find value in herself that doesn't require mirror time.

Or maybe it's just because I don't know how the heck to raise a girly daughter.

The first reason sounds more noble.

Sunday, May 10, 2015

Why I refuse to hate Mother's Day

I've been hearing a lot of people complaining about Mother's Day.

Everyone has their own reason for dreading the day (and I'll admit these are legitimate reasons):
  • They never knew their mothers or lost them prematurely (or ever). 
  • They have strained, complicated, or otherwise lousy relationships with their mothers. 
  • They long desperately to be mothers and aren't--whether because they're unmarried or infertile or have lost a child. 
  • They have as many children as they want and feel guilty on Mother's Day for not being perfect at raising them.
I have been thinking about this a lot this week, since reading a blog post by a woman with infertility and another by an overwhelmed, inadequate-feeling mother. Both found ways to come to love Mother's Day. 

My own path to motherhood has hardly been smooth, but for some reason I've never hated Mother's Day. Even during the height of our infertility I didn't hate Mother's Day, nor do I hate it now when I have a daughter to miss.

Why is that?

It's because Mother's Day is something different than we think.

It's not about celebrating perfect moms. No one is a perfect mom. It's not about celebrating perfect families or perfect kids. No one has a perfect family or perfect kids.

The woman who founded Mother's Day, Anna Jarvis, never married or had children of her own. Her own mother had at least 11 children, and only 4 of them survived to adulthood. Does that sound like the perfect family to you? Both of these women are just the type that would feel resentful about Mother's Day today--a childless woman and her bereaved mother.

Motherhood is messy.

Conception and pregnancy and childbirth are messy. Along the way you find miscarriage, morning sickness (sometimes severe), pre-eclampsia, gestational diabetes, premature births, birth defects, still births, traumatic birthing stories, stretch marks, C-sections and their scars. Then you find NICU babies, some that make it home and some that don't. You find SIDS babies. You find allergies and reflux and colic and genetic defects and autism and behavioral problems and on and on and on. I think almost every mother out there fits something on this list.

Having kids is not glamorous or efficient or tidy.

And moms. Moms are exhausted and inadequate. You have working moms and stay-at-home moms, both feeling a little guilty for opposite reasons. You have married moms, divorced moms, widowed moms. You have moms that are too young and moms that feel too old for the task. You have breastfeeding moms and bottle feeding moms, overweight moms and underweight moms. You have overly strict moms and overly lax moms. You have overwhelmed, exhausted, resentful, inadequate, temper-losing, letting-my-kid-watch-too-much-TV moms, sick moms, and mentally ill moms. But all moms are, to some extent, trying. 

And we love our moms, even though they are all just...human.

Mother's Day isn't meant to honor perfect moms. It's meant to honor imperfect moms and their ability to still, somehow, leave a beautiful mark on the world.

Today is a day to feel grateful for what I do have, not for what I don't. And I think most women have much more than they realize.

I have a really amazing mom.



But in addition to my Mom, I have a thousand moms. They are the women that told me I was good at school. That encouraged me to go to college. That taught me silly campfire songs. That loved me, comforted me, helped through hard times, listened to me, fed me, gave me rides, and did other things any mom would do. My moms also include grandmas, aunts, cousins, sisters-in-law, my stepmother, and my mother-in-law.

The truth is, no mom can be everything and do everything for her children. My Mom has blessed my life but so have my other moms.

I have 2 beautiful Children.



But I also have a thousand children. Every patient that I see is temporarily my child. I comfort, listen, and try to heal. My children are the little ones I babysit for friends, my nieces and nephews, children that I share our snacks with or teach about Jesus or the abcs or comfort when their Mom is not around.

Someday my parents may live to a ripe old age and become frail. If that happens, I will, in one of life's beautiful reversals, be my Mom's mom.

I am a daughter of a Mother. I am also a daughter of mothers. I am a mother of Children. I am also a mother of children.

On Mother's Day I honor the women that have touched my life and been my mothers, including my own amazing Mother. I am also profoundly grateful to be a mother--of Children and also of children. I am grateful that, as a woman, I can touch lives, inside and outside my family. I can leave my own beautiful mark on the world.

May Mother's Day prove to be happy for more of us. 

Friday, April 17, 2015

What I want my patients to know about antibiotics

I saw a patient recently that had been very ill for quite some time with a variety of weird symptoms, some of which were very concerning. I recommended further testing to help us narrow down what the problem might be.

Her response: "Can't you just give me an antibiotic?"

Ohhhhhh no. I tried to explain that I can't just "give [someone] an antibiotic" if I don't know what disease I am trying to treat. I explained again that she needed more testing so we could figure that out, and maybe, if appropriate, start an antibiotic.

She never had the testing done. She wanted to start feeling better today.

Working in urgent care as I do, I prescribe antibiotics every day. People are often miserable when they come to see me and the request for antibiotics is frequent. They want a quick fix. I often hear, "Well, I have to do this huge presentation next week at work, so I want an antibiotic so I can be better by then."

The reality is, their immune system is the one that is going to have to dig them out of this miserable illness, and the best care I can give them is to try to alleviate their symptoms in the meantime.

Here are a few things I wish every patient knew about antibiotics.

1. Antibiotics aren't harmless

The most common side effects of antibiotics are nausea, diarrhea, and vomiting, along with allergic reactions. They are hard on your digestive system. There is also the risk of yeast infections among women, and pathological diarrhea, C. difficile, which can also result from antibiotics.

Then there is the risk of increasing the prevalence of antibiotic-resistant bacteria. These pathogens require the big guns to treat and there a few strains out there with no known antibiotic to treat them. Often these bacteria are kept in check by other bacteria in and on your body, but if the "good" or "less harmful" bacteria are frequently killed off by antibiotics, it increases the risk that these resistant bacteria will be allowed to flourish.

Last, there is a multitude of research coming out now about the Microbiome--the colonies of good bacteria living in your digestive tract. This research is interesting and exciting, because scientists are increasingly finding links to the types of bacteria in your gut to allergies, autoimmune diseases, digestive disorders, metabolic disorders (like obesity and diabetes), mental illness (believe it or not), and others.

There is a lot of need for more research in this area, but some studies are suggesting a possible link between early antibiotic use and childhood allergiesasthma, and inflammatory bowel diseases (like crohn's disease or ulcerative colitis).

[I don't want any parents out there freaking out about what I just said. We don't know for sure what the link might be. I'm just making a point that some caution is merited.]

2. Antibiotics aren't always necessary or even appropriate

The number one thing that I see in urgent care is upper respiratory illness: coughs, sore throats, colds,  and sinus infections.

The number one cause of upper respiratory illnesses is VIRUSES. Antibiotics treat bacterial infections. They do not treat viral illnesses, or illnesses caused by fungi, parasite, or protozoa.

Even if your snot is bright green, that doesn't necessarily mean you have a bacterial infection. The green color is caused by your immune system doing its job, and there hasn't been much correlation in the literature between mucous color and type of infection.

Antibiotics don't treat the common cold, most sinus infections, most coughs, or most sore throats, so I usually don't give people antibiotics for these.

I am frequently a heartbreaker.

To help you out, here are some of the guidelines I follow:

1) I never give antibiotics for the common cold
2) I try not to give antibiotics for sinus infections unless they are quite severe or have been going on close to 2 weeks
3) 75% of ear infections will clear up on their own within 7 days, and antibiotics usually only shorten the course of symptoms by 1 day. Current recommendations suggest waiting 48-72 hours to see if it will improve alone before starting antibiotics. The exception to this is young kids, especially less than 6 months old. The first treatment for ear infections is tylenol or ibuprofen for pain control.
4) I rarely give antibiotics for coughs (including bronchitis), unless I really suspect pneumonia. 90% of bronchitis is viral.
5) I rarely give antibiotics for sore throats unless someone tests positive for strep. If you have a sore throat with no fever and have a cough with it, there's a really good chance it's not strep.

3) Some times when you really should go to the doctor

That said, antibiotics, when used like they should be, are amazing! They save lives every single day. I'm not an antibiotic hater by any means.

Here are some times you really should get to the doctor:

1) You strongly suspect strep throat. Strep (the bacteria) can travel to other areas of the body and lodge there, including your heart (rheumatic fever) and your kidneys. If you truly have a full-blown infection, you need to treat it.

2) You have a raging UTI (urinary tract infection). Some UTIs will clear up on their own with lots of hydration. The ones that don't, however, may travel up to your kidneys, where they will make you incredibly sick. Sometimes once bacteria reaches your kidneys it has easy access to your bloodstream, which can cause sepsis (an infection in your bloodstream). By no means will every UTI do this, but they are worth treating.

3) You have a fever and a cough or your child's breathing scares you. If you have a fever and a cough together, there are two things I'm concerned about: influenza and pneumonia. You may not have either. But knowing you have influenza gives me the chance to get you on medication for it (if appropriate, especially for someone very young or with asthma) and also to tell you to stay the heck away from other people! Never go out in public or allow your kids to go to school with influenza. It kills thousands of people every year.

Pneumonia can also be very serious (sometimes life-threatening), and I always treat people with pneumonia.

If your child is having difficulty breathing or their cough is so bad it's freaking you out, COME IN! There are a couple of things we can do for that. Antibiotics may or not be on the list.

4) You have vomiting or diarrhea along with high fever, significant pain, dehydration, or bleeding. Most vomiting and diarrhea will clear up on its own, and diarrhea may linger for 2 weeks or so. Dehydration can be dangerous, however, and some types of bugs that cause stomach flu symptoms can also be dangerous. They are worth investigating if some of these "danger signs" are present.

5) You're worried about yourself or your child. There are hundreds of legitimate reasons to look for medical care, and my intent in writing this isn't to scare anyone off from coming to the doctor's office if they're sick or worried! Come. Sometimes I find people that felt reluctant about coming in are actually very seriously ill.

But remember this: if you go to the doctor, and you leave without a prescription for antibiotics, that's not always a bad thing.