Category: COVID-19

COVID, finally

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Well, after 2+ years of avoiding COVID-19, we finally all got it.

It started innocently enough. My husband had an intense work week pulling all-nighters. That Friday evening, he started to cough. I reflexively antigen tested him and it was negative. “Must be sleep deprivation,” he concluded. Pro tip #1: antigen tests are crap.

The next day, he began to have symptoms of a gout flare. One of his feet swelled up and he was fairly immobile. Still had a bit of cough and was more tired than usual, but a repeat antigen test was negative so we chalked it all up to gout. Gout and sleep deprivation.

Sunday night he experienced chills and I began to have a slight cough. I was still coughing the next day but otherwise felt totally fine and I myself was now antigen negative (and he was STILL negative as well). However, by the end of my morning clinic, I began to feel worse. Muscle achy, runny nose – just generally unwell. So I drove myself to occupational health for a PCR. I needed to know for sure before going back in the next day for a full day of clinic. (Of note, I still wear an N95 mask + surgical mask + eye protection in clinic and was wearing all of the above when I saw the few patients I did that morning.) I decided to pick the boys up from camp early just in case. But, it turns out that I left my lights on when I parked the car, so when I came back to it after my test I couldn’t turn it on!

I had to call my husband to pick me up and deal w/ the dead battery while I went to pick up the boys and relieve or nanny. Truthfully, I was most worried about our nanny. She is vaccinated and boosted but also pregnant, and I was most concerned about her and her baby. More on that later.

When I finally got everyone home, I felt terrible. I took ibuprofen right away and lay on the couch. My husband made me soup. We somehow made it to bedtime and that’s when I got the result: positive PCR. Crap. I contacted our clinic manager to cancel all of my clinics for the week. I told our nanny to stay home and monitor for symptoms. I reached out to the kids’ camps and told them they would be staying home due to COVID in the family. Interestingly, the policy is that kids with a home exposure can still go to camp (and I definitely knew of two moms who had COVID who were still sending their kids to one of the camps), but with two positive parents, I knew we wouldn’t be able to isolate. I had also decided that we weren’t even going to try. This was probably a gamble on my part, and maybe a risky one since we did have two unvaccinated kids at the time (under 5), but I didn’t want to start a game of domino COVID, whereby we’d have one kid at home at any given time, with no childcare since we wanted to protect our nanny, meaning an even longer work disruption than just two weeks.

The next 2 days were rough. My husband started feeling like crap. Not only did he definitely have COVID (he kept testing antigen negative until I finally had him confirm on PCR and that was positive), but he had a gout flare that was so bad (TWO feet affected) that he couldn’t even walk. I can laugh about it now, but it was a rough few days. Four kids 7 and under at home with only one parent who could physically participate in caring for them, and that parent (me) had fairly symptomatic COVID. My symptoms were fever (to 102.8), sore throat, runny nose, muscle aches/pains, fatigue. But, we somehow made it through those 2 harrowing days. The kids started to develop symptoms and/or become antigen positive in close succession. Everyone was positive by the end of the week. Our unvaccinated kids had the most symptoms: 2 days of fever. One of our vaccinated kids had a sore throat and one night of fever. One of them coughed twice and a had a slight sniffle, but since we were waiting for it, we tested him and it was positive.

The days were a bit of a slog. My husband took off most of the first week and even during the days when I felt like crap, I tried to get the kids outside for a bit. We could only frequent places that were outdoors, where we were guaranteed to not be close to other people. I’m sure for the kids it was quite the adventure – both parents at home, unstructured time, a loosening of rules, exploring new outdoor spaces. I’m sure one day I’ll look back at the time with rose-colored glasses. But right now I’m finding myself under a mound of work – actual job and life – with little time to catch up since I had to add so many clinics back to make up for 2 weeks of lost time.

Pro tip #2: once positive, the antigen tests take forever to become negative. I wish someone had told me this. The rules for work and camp are 5 days of isolation and you can test out after 5 days if your antigen test is negative. So like a crazy optimist, I antigen tested everyone after day 5. Well, no one was negative even close to day 5. Myself and at least one of the kids were still positive by our respective day 10s. I finally went back to work on day 11 (no further restrictions and I was obviously masked and finally positive). The kids returned to life the following week. But, wow, that was a crazy long time of disruption in our family.

And here’s the thing: the reason COVID is going around life wildfire is that no one is keeping themselves and their kids home for 2+ weeks. It was honestly really hard, and we are fortunate to have flexible jobs that allowed us the time off. But we also lost out on thousands of dollars of childcare those 2 weeks between kid camps and in-home care. That’s a lot of money. And if your employer isn’t going to give you paid time off, what option do you have? And remember, the kids were only symptomatic for 1-2 days. 2 weeks is a lot of lost time for 1-2 days of symptoms. So I imagine there will be some changes to the rules down the line – maybe now that the under 5 vaccines are approved?

Pro tip #3: if someone in your life gets COVID, don’t ask them what they need – just send them something you think they might need or want. Prior to us having COVID, I would ask my friends who were diagnosed with COVID what I could send – a meal? toys for their kids? other? Without fail, everyone said thanks and nothing. I did the same thing when we all got sick. But the sweetest surprises were from people who didn’t take no for an answer and just sent something – a lunch delivery, a homemade dinner, a sweet treat, toys/activities for the kids. The novelty of these thoughtful tokens was enough to turn an otherwise ordinary day into something special. And the feeling of being loved was overwhelming.

So now, I’m happy to be on the other side. I spent so long being so afraid of COVID, and now that’s it gone through our family I feel a sense of freedom/peace. Although I also recognize that this is fleeting because immunity post-infection does not last forever. I also feel incredibly grateful that our children were minimally symptomatic and have no long-term symptoms. Despite the adults having a bit more symptoms, we also fully recovered. And I will be forever grateful that our pregnant nanny did not get sick.

Croissants

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Yesterday, we split up the four kids. We do this every once in awhile to give them a bit more 1:1 time (or, as it happens to work out, 1:2 time. My 4 year old had his first birthday party in over a year (actually the first for our entire family in over a year), so my husband took him and my 6 year old. It was a masked, handful of kids, outdoors at a large playground, candy and cupcake get-together. They had a blast.

In the meantime, I took my 7 month old and 2 year old downtown. We parked at the train station (my 2 year old’s favorite thing to do), watched trains go by, crossed the tracks a few times and then stopped by some stores to support local businesses. We purchased art supplies to keep the kids entertained in the afternoon and perused the bookshelves for Lion Guard books (another current fave for the 2 year old). We also stopped for croissants.

Downtown, there is a French bakery that makes the most delicious pastries. In 2020, when the shutdown began, we ate at a home for 2.5 months. This was a pretty big deal to us because we do enjoy eating out. Ever since my husband and I were dating, we would go out for coffee, ice cream, cocktails, multi-course dinners – definitely a splurge. With the kids we became less fancy in our dining options, but we still ate out quite a bit – indoors, outdoors, with or without music – so it was a big change for us. In the beginning, we didn’t know whether COVID-19 could be transmitted via food preparation, and we were all so nervous (plus I was pregnant), so we didn’t venture out at all. My husband cooked dinner every single night, as well as most breakfasts and lunches. In May, we decided to eat out for the first time and went to this very same French bakery. I stayed in the car with my pregnant belly and my 3 boys, and my husband stood on line with his mask. They were letting one person in at a time. He purchased a few croissants and we ate them at a local park before riding bikes (the playground was closed at the time and the parking lot was roped off).

Yesterday was a reminder that we are moving in the right direction when it comes to COVID-19. I stood on the line (masked, as was my 2 year old) with almost a dozen people. The outdoor seating was filled to about 50%. I felt okay bringing both kids into the bakery to order. We ate on a bench near the train and I fed my 7 month old a packed up lunch (broccoli and applesauce purees) – the first time he had ever “eaten out” with me. It felt almost normal. Older kids at a birthday party, younger kids enjoying downtown. Definitely warmed my heart.

What doesn’t feel normal is that we have yet to see the grandparents. My in-laws are older and not yet fully vaccinated (although did have COVID in January) but my parents are younger and have been vaccinated for a few months now. I wish they would just fly out to us. I imagine the thought of flying during a pandemic is anxiety-provoking, but it seems pretty safe with vaccines and appropriate masking/eye protection. There’s just no way that we’re going to fly to them with four unvaccinated kids. To be honest, I wouldn’t even want to fly with all the kids if we didn’t have a pandemic to worry about. It’s getting harder and harder to talk on the phone with my mom because she spends the whole time lamenting the pandemic and saying she’d be here in a heartbeat if it wasn’t for COVID-19. And yet I have friends with parents who are immunocompromised and unable to fly because they can’t get vaccinated or because they haven’t mounted antibodies. Friends whose parents are international and are unable to take off enough time to visit with quarantine requirements and testing feeds. And it seems so silly to me that we’re still not seeing them just because there’s a flight involved. Maybe I’m being selfish and lacking in compassion here. Who knows. All I know is that my husband and I are running on fumes right now. We miss our families and will not feel like things are back to normal until we are able to see them again.

At least we can enjoy the simple things again – browsing the bookstore, spending time downtown, getting croissants. Very slowly moving towards normal.

End of an era

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I feel a huge sense of relief and a ton of positivity this week. Where do I even start?

Obviously there was the inauguration. I have never been a political junkie. My parents came from a country where there was a military coup during their lifetime, all books with dissenting political ideas were burned at their universities, and friends and acquaintances were taken from their homes in the middle of the night and murdered for having dissenting political opinions. Because of these reasons, my parents were always largely apolitical. We never put out yard signs, protested as a family, or watched States of the Union, inaugurations, etc. I myself have adopted some of this trepidation around openly expressing political opinions – especially in my role as doctor. We are so divided as a country that it seems so loaded to me to bring up politics or, more commonly, to respond to a patient’s comment on politics. But lately, due largely to the impact of social media, I have begun to wonder how much of my reticence to discuss politics comes from a place of privilege. I’m an immigrant who has been a citizen of this country for decades longer than I’ve lived outside of the country. I’m White passing, gender normative, heterosexual, educated, financially comfortable. So I have been trying to step outside of my comfort zone to be more vocal in order to advocate for others. And also, to be honest, because the events of the past four years have been disturbing beyond words – so, so, so much worse than anything I could have ever envisioned in November of 2016.

But now, there is hope. And yesterday, I sat with my two older kids and replayed some of the performances and speeches from the inauguration. The kids celebrated it at school. And I breathed a sigh of relief that my older children, now 4 and 6, would have memories of a President who is decent, humble, honorable and a good human being.

Second: this is my last week before heading back to work. I have a lot of mixed emotions regarding this. I think: this is the last time I will ever have an infant. The last time I will ever hold someone for every nap during the day. The last time I will ever spend so many hours per day, every day, every week, with one of my children. I feel a sense of nostalgia about this moment, but not necessarily sadness. As my husband likes to joke, we have done this four times – and that’s plenty! I am also looking forward to this next phase of my children growing into adults. I already see changes in my 6 year old – bigger worries, harder questions, the ability to read and digest actual novels (he is currently reading the second Harry Potter book). He is losing some of his child-like innocence.

To be honest, being home with four children 6 and under is a lot. As I always say: being a stay-at-home parent is MUCH harder than being a working parent. Yes, work is demanding. Yes, it adds a full-time job on top of full-time responsibility. But work allows you to tap into the essence of who you are. A lot is lost in motherhood – hobbies, memories of who we were pre-children, meaning outside of these small humans. For me, working is a way to hold onto a crucial component of who I am. I’m able to have adult conversations, use my analytical mind, help others in ways that are tangible, eat lunch, go to the bathroom alone, have uninterrupted thoughts, etc. I’m very much looking forward to that. But, in addition to missing the baby snuggles and extra quality time with my kids, there are two things I will miss dearly: (1) flexibility – the ability to make every last-minute school engagement without thinking about it, the ability to attend to a child’s needs 24/7 with no other obligations, the ability to run an errand for the home every day of the week, the ability to pick the kids up when they are not feeling well without having to cancel clinic, the ability to quarantine for 2 weeks without being disruptive and (2) mental space. I have been thinking about this one a lot. For a variety of reasons, I was feeling pretty burnt out before going on maternity leave. Not working has off-loaded work stress from my life (that sounds pretty obvious but it’s true!). I don’t have to worry about having a difficult conversation with a colleague, feeling disrespected by administrators, challenging patient cases. It’s hard for me to leave work at work – to compartmentalize it – especially when I have the ability to be connected 24/7 and also when I do split my workday to make time for pick-up, kids’ activities, etc. I see sick patients and I worry about how they do, and it is impossible for me to turn that off at 5pm. So I am going to see how to compartmentalize the things that I can – non-clinical work – while also feeling relieved that I have dissociated from the more toxic work environment I was previously in.

Third: I received the second COVID vaccine. I am so so relieved by this. I will, of course, continue to use PPE at work and masks when out in public, but I feel so much better knowing that I will be somewhat protected against COVID, especially when seeing positive patients or those who are being evaluated for active disease. My parents have both received one dose of their respective vaccines (they work in healthcare) and my brother and parents-in-law recently recovered from COVID, so I am hoping this all means that we can have some sort of reunion later this year.

Finally, I have restarted on of my favorite past times: reading. I am on my fifth novel this month and have been working to actively carve out time to read each day. Of course, this will be somewhat compromised when I start working, but I am hoping to keep at least 50% of this reading productivity. Reading brings back such great memories for me of reading during childhood and I think it’s so important for the kids to see me reading as well. It has also provided some much needed escapism during a year that has afforded such few opportunities for activities that remind us of normalcy.

Here’s to the end of one era and the beginning of an even better one.

Vaccinated

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I received my COVID-19 vaccine today. The Pfizer one was offered to me and I took it. I feel a bit like I did after Election Day this year – ready for a big sigh of relief.

I still remember how we stumbled around COVID in the early days of the pandemic at my hospital. We weren’t quite sure what the precautions should be. When my first patient showed up, having just flown in from China, I went into the room alone, wearing an N95 mask and gown. But we still didn’t wear masks or eye protection in the workrooms and all other patient encounters were routine protocol. I remember the first time a COVID test was run on a patient I had seen on the inpatient service. My colleague called her daughter’s school and they asked her to pick her up. I was so worried that I had been exposed and would be exposing my whole family. Fortunately, that patient tested negative. I remember clinics shutting down completely and being converted to video. A few patients still wished to be seen in person and I would go in to see them. I brought my own Lysol wipes from home and wore scrubs every day. Hair up, N95 on, surgical mask over the N95, face shield in place. I would avoid my children when I arrived home and jump straight into the shower. I was so worried that I would contract COVID while pregnant – so worried that I stopped seeing patients at 34 weeks and took a full month of prepartum leave. At the time, all of these precautions seemed temporary and we thought we’d be up and running full throttle by the summer. And yet, here we are 9 months later.

One disclaimer here is that I am primarily an outpatient physician. I see oncology patients and do round regularly in the hospital on our consult patients, but I am not on the front line (emergency room, ICU, COVID units, etc.). I am in complete awe of the physicians, nurses and hospital staff who have been on the front line this entire time. I do not have it in me to do what they did. My patient population is primarily healthy, but there was still so much fear around pre-symptomatic patients coming to clinic, colleagues coming to work before diagnosis, etc.

All this to say that getting this vaccine was a big deal for me. It was a sign of hope – hopefully the beginning of the end. Although I plan to wear PPE the entire time I am at work, I feel reassured that I am less likely to contract COVID if I am exposed. Although we don’t have the data, I am also hoping that this means I am less likely to transmit COVID if exposed (again, this wasn’t studied, so we won’t know for some time). I am still nursing but decided that the risks to my infant of getting COVID were greater than any theoretical risks related to vaccine administration. I hope that by the time the general public has the opportunity to be vaccinated, we have more information to power the decision-making process. I am not the type of person who jumps on the bandwagon for new therapeutics, but as I always tell my patients who are interested in a new therapy or intervention – you have to weigh the risks against the alternative, not the ideal. Do I wish that we were not in the middle of a pandemic that has kept us away from our families for the past 9 months, kept my kids out of school for much of the year, led us all to wear masks and stay 6 feet apart and completely crippled our social interactions? Of course. But the fact of the matter is that we are in the middle of a pandemic and I will be working through it. It made sense to me to add a layer of protection by receiving the vaccine. And hopefully this truly is the beginning of the end and we can start moving towards relative normalcy sometime in 2021.

Phase two

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My husband is back at work this week. It feels like the end of a chapter – 3 months in, past the harried days and nights of the newborn stage. For weeks, my husband and I took turns holding the baby days and (some) nights while the other tried to “get things done”. Usually things were a shower, cooking a meal, tidying something up. In the mornings, we tag teamed to get the older kids dressed and set up for virtual school or out-the-door for in-person school. He held the baby in the car when I had an appointment. I held the baby in the car while he went into the store to get groceries. We ate lunch together (and if we got take-out, this was also eaten in the car because of COVID). One of us would stay home while the other drove to pick up the older kids. When we were less sleep-deprived, we checked off some items from our to-do list. We also watched movies, TV shoes and read books. We took walks around the neighborhood. I feel very fortunate that he was able to take 3 months off this time. We talked during the day about our kids – adult conversations, something we can’t do when 4 kids are in the house. This hasn’t been the case after every baby’s birth, and I can tell you that the toughest postpartum period for our marriage was when our third was born. He kept working because the baby arrived 2 weeks early and he had some things to wrap up at work. Then, because we had family help, he decided to save his leave for when I returned to work. But it was hard. As the only person who could help me overnight, he would stay up and then be tired for work. I leaned on him to help around the house as well and this was an added responsibility for him. In sum, I am grateful for this time we had together, and also feel a bit sad that we are closing the chapter on our newborn days. But, as my husband would say, “we’ve done it 4 times. I think that’s plenty!” And he is certainly right about that.

So this week, I am adjusting to our new normal. He’s working from home and I’m in charge of getting the kids ready in the morning, driving them to school, tidying up, planning meals and spending time with our littlest one during the day. I, again, feel incredibly fortunate to have this extra time with my baby. I also have to admit that this is the hardest part of maternity leave for me, because I do think there is an imbalance in our marriage when my husband works and I do not. It is especially exacerbated during COVID since I have no alternative social outlet at the moment. I take great pride in my career. I love working with and helping my patients. I respect the trust they have in me and think about them when I’m not at work. I also have amazing colleagues and feel so indebted to them for keeping me safe during my pregnancy and covering my patients while I am out.

As I start planning for my own return, I am having a hard time deciding what to do. I am worried about going back to work during the winter COVID surge, but also feel that it is my duty to do so since I have “sat out” the past few months. I am concerned about committing to a schedule since the kids’ schedule is so up in the air. There are potential quarantines if any of the children or teachers in the classes test positive, and the kids have also had to stay home for a myriad of “symptoms”. Once, my 4 y/o had a temperature of 99 and “was not acting like himself”. Another time, my 6 y/o thought he might have felt a sore throat but it was gone by the time my husband went to pick him up. He still had to come home and get a COVID test (it was negative). Yet another time we quarantined at home for 14 days because our 2 year old was exposed outdoors to someone who later tested positive for COVID. I very much appreciate how cautious the school is – so far they have had no COVID cases – but it also throws quite a wrench in any plans to work as I so hate having to cancel patient appointments. So, basically, I am now having to deal with COVID reality for working parents. I have had a reprieve during leave and it was immensely helpful during the start of this crazy school year, but now I find myself incapable of being decisive on what 2021 should look like.

For now, I am trying my best to set up some sort of schedule for my remaining days at home while mulling over the return-to-work possibilities in my mind. I am enjoying these last few weeks of snuggles because this is our last baby. Maternity leave seems like a slow uncoupling, in preparation of returning to work. First, there is the full immersion in your newborn – he is held in arms all night, worn in slings or carriers all day, nose to sweet-smelling newborn head. I am there for every minute of his day – obsessing over details like wet diapers, hours of sleep, when he last nursed and on and on. Slowly, there is a move towards (relative) independence. Trying to get him to sleep on his own at night. Working on a morning schedule – now so that he can join me on the car ride to drop off his brothers and later so that I can feed him before heading into work. Soon I will have our nanny hold him for longer stretches so that he can get used to her and her to him. We’ll try a bottle while I pump (we have never followed the “introduce a bottle early” rule with our infants. I know it’s not recommended but so far we have not had issues and it honestly just seems like more work). Maybe I’ll run an errand without him, leaving him home with my husband. And that’s how we’ll transition from spending almost 24 hours joined together to my being away during the day. Again, I am fortunate: I work full-time, but my hours aren’t terribly long. I don’t have to be separated from him at night. I have the option of doing some of my work from home. Despite this, it is clear that this next phase is bringing me closer, day-by-day, to being away from him for longer stretches of time. And even though it is a choice, it is still hard.

Gratitude

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If you had asked me this time last year what 2020 would bring, I would have never predicted any of this. A global pandemic, working from home, our children out of school for months, wearing an N95 and face shield to see each and every patient, Zoom classes for a 4 and a 5 year old, walking around downtown wearing a mask, a scarcity of paper towels and hand sanitizer, not seeing our families for months…it seems surreal reading those words back, even though they are things that actually happened (and are happening) this year.

Someone shared this image with me today and it seemed so fitting to read on Thanksgiving Eve. As an adult, I recognize that this holiday is not the idyllic pilgrim/Native American bonding fest that I learned about in school. It also wasn’t a huge holiday in our home. We were immigrants, my parents disliked turkey and I was a vegetarian, so we only really started celebrating when my younger brother was in school because he found out that all of his friends were eating turkey! But through the years we have come to define this holiday on our own terms. At the very beginning of our relationship, my husband and I celebrated at his aunt’s home, a family tradition for them and my first introduction to the extended family. We would drive or take a bus to see our families. Once we moved out West, we enjoyed a number of Friendsgiving festivities, since the holiday break always seemed too short to fly out East.

This year, we will be celebrating alone as a new family of 6. We are ordering a traditional Thanksgiving meal, because the thought of cooking with four little ones running around and no one to entertain them is too much. We’ll surprise the kids with gratitude lists – a compilation of why their parents and siblings are grateful for them. We’ll watch the Macy’s Day Parade, run our own Turkey Trot (a 1 or 2 mile loop around the neighborhood) and choose toys to donate to a local school district. I feel more fortunate than ever to have created this sweet full nuclear family during this incredibly tumultuous year.

While compiling photos for our 2020 photo book, I began to see our adventures this year in a different light. So many photos of the local park, where we went for days upon days upon days, because it was close to home and had bike trails and few people – the place where our then 1 year old learned to ride his strider bike like a champ. Photos of us walking, biking and scooting around the neighborhood – devising different routes to spice things up. The countless workbooks and crafts we coordinated for the kids to do – so many pictures of them gathered around the dining room table working on one thing or another. The forts and pillow creations and countless games of “lava”. The bounce house we finally caved and bought, and how when the wildfires were raging we set it up in our living room to get the wiggles out. The summer weekends spent in an isolated area of the beach, the kids first venturing timidly to the water and then donning wetsuits and bodyboards so confidently that we had to move them to a beach that was safer for little ones to swim in. Reimagining birthdays – photos of home decor, cakes, presents. The time we celebrated the birthday of two stuffed animals in our home just to have an activity for the weekend (also learning that stuffed animals are now called “stuffies”). The boys spending most of the day half-naked in the backyard, doing all sorts of water play and venturing over to the “hot side” of the house to have their picnic lunch. A first day of school photo in front of a laptop and a white board when our oldest child’s school launched a virtual curriculum at the start of the year. So many great memories that warm my heart.

Like most hard things, the photos show only the good times. Missing from them is the fear as COVID-19 spread to our community. The uncertainty at the hospital – when do we wear masks? How do we screen patients? Will we run out of PPE? Seeing patients while pregnant, hoping I wouldn’t get sick. Coming home and showering immediately before allowing the kids to come close to me. The disappointment as we canceled trip after trip – wiping away tears when our children cried to see their grandparents. The fear of having to go to the ED postpartum and worrying about exposing my 3 day old to COVID. My oldest saying “I’m so sick of coronavirus. I’m tired of hand sanitizer and wearing masks. I wish things could go back to normal.” The weight of trying to make everything okay for your kids, when things in the world were so far from okay.

But we have been lucky. We have not gotten sick. Our parents have not gotten sick. My husband and I still have our jobs. We have not suffered financially. Two of our children are able to attend school in person. I am immensely grateful for all of that and more.

So this Thanksgiving, I am choosing to reflect on the positive notes in those photos. Years from now, that is ultimately what I will remember the most. A special time when all 5 (and then 6) of us were able to be safe at home together. No school, working from home, then maternity and paternity leave. A special time to bond while our children were young and wanted to spend time with us. My goal for the next few weeks, in anticipation of returning to work, is to enjoy these moments as much as possible. As difficult as they can be sometimes, I know that I will miss them immensely when they are gone.

6 years, 10 weeks, 4 days

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This weekend, my oldest turned 6.

This week marked 10 weeks since our youngest was born. I need a name for him on here, maybe Baby A? We have already exhausted X, Y and Z!

Today is 4 days after the election was called for Biden/Harris.

So many milestones. So much change. All within a week.

  1. Our oldest, Baby X, now Child X I guess, has crossed over into a new era. He has lost his baby features. He is aware and cognizant of the world. He is losing some of his innocence – has questions about death and dying, understands that people are not always nice, rolls his eyes when annoyed, has started to notice that there are topics out there that we have not yet touched on as parents, topics that he will need to figure out these next few years. He is independent. He can shower alone, get dressed on his own, read – in fact, he is an avid reader, gobbling up books left and right. He is in kindergarten and, according to his teacher, a “model student” and a “model child”. He received a compassion award at his E-ssembly a few weeks ago. He is responsible, athletic, energetic, loving. We are so proud of him for being himself. Having a 6 year old makes me realize more than ever that the writing is on the wall – the years are short is not just a cliche. In the span of one more 6 year run he’ll be on the brink of adolescence, and more of his world will be a secret to us. Whereas now he tells us every thought that he has, once day he will hide some of those thoughts from us. In 6 more years he will be about to graduate high school, likely off to college. He is our rule follower, our anxious one, the most mature. I hope he always knows how much he was wanted – how his dad and I weren’t sure if he would ever be born, and how excited we were when he came to be. He taught us everything about parenting. Our lives are definitively divided up into before his birth and after his birth. After his birth, we were never the same again – in a good way.
  2. As time races on, our littlest one, Baby A, is growing by leaps and bounds. I am holding on tightly to these days, especially in light of my oldest becoming a child. He lives in the sling. We are always holding him close and at night we alternate holding him close (I am typing this while he sleeps on me while my husband sleeps in the bedroom). One day I will write out his birth story, but the important message here is that he was born healthy and I did well also, without complications. We made it to the hospital. No one got COVID. It always amazes me how small and defenseless newborns are. They can’t hold their heads up, they can’t do anything but cry and try to find a boob. His brothers love him to pieces – always trying to hold him and kiss him and “cawwy” him. I am always so nervous that he will get sick – breathing a sigh of relief after month one and exhaling more fully after we cross the 3 month mark (we are at 2 months now, 10 weeks to be precise). Like most of our children, he is a terrible sleeper. He prefers to sleep being held, on someone’s chest or, interestingly with this one – snuggled up in my armpit. We hired a night nurse for the first 8 weeks. After her last day we asked her to help us out 2 additional weekends but now we are on our own. It felt like it was time to move on. She was incredibly helpful but also wasn’t working towards trying to get him to sleep in a bassinet (she held him all night long) and we thought it was best to try to figure things out on our own. He pretty early on started doing a longer stretch first thing at night (usually 3-4 hours, something like 9pm-1am) and then a bit of a shorter stretch before morning. Now, the nights are a blur of him being in and out of bed with me. Sometimes my husband stays up a few hours in a row and watches us sleep while he plays video games, or brings him into the playroom to watch TV. Other nights, I’m on my own, trying to get him into the Snoo throughout the night, or sleeping as safely as possible with him in bed. He started smiling early, and by month 2 was definitely smiling at everyone. He outgrew his newborn clothes in ~6 wks. He rolled over from tummy to back a few times in month 2. At 9 weeks, he started trying to use his arms and hands. He has an adorable asymmetric smile, which I love. I wonder what his personality is like, how he will fit into our family.
  3. Finally, the election. I have to be honest, though I started this on 11/11, it is now 11/16. Where do the days go!? I am so relieved about the results of this election. I was devastated when DJT won in 2016. I couldn’t sleep, was up most of the night with a huge sense of dread. But I remember thinking (and writing) that maybe it wouldn’t be so bad. Maybe he would rise to the occasion, maybe the people I knew who voted for him knew something that I did not. Well, I was wrong. The past 4 years have been a nightmare. When Joe Biden and Kamala Harris won, I was finally able to breathe a sigh of relief. We sadly now have this whole “unwilling to concede” situation, but I am looking forward to the day when we have an actual leader who will take COVID-19 seriously, who will respect women as well as Black and Brown communities, who will not promote violence and white supremacy, who is not merely a charlatan.

So many milestones these days. These days are passing us by.

Waiting

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Well, we somehow made it to mid-August and I will be 37 weeks tomorrow. 37 weeks is technically term and I finally feel like I can take a deep sigh of relief. We’ve made it to this point!

I have checked most of my nesting tasks off of the to-do list. My hospital bag is packed, newborn clothes are washed, two bassinets set up (one in nursery and one in our room). The car seat and base are the in the garage for my husband to install last minute.Our 3 boys have been sharing a room for a month or more and it’s going surprisingly well. The nursery closets have been rearranged and our bedroom has been reorganized to double as a nap station. Postpartum supplies are stocked for me, newborn diapers and wipes are stocked for the baby. We have hand sanitizer and hand soap galore. Tomorrow I’ll have help with the kids and plan to review my list to see if there are any last-minute items to tackle.

I feel ready. I’m anxious about going into labor, of course. As an obsessive planner, it’s difficult for me to NOT know when something will happen or how exactly it will happen. This time around we’ll have the added stress of needing to coordinate childcare quickly. Our families ultimately decided not to fly out. I totally understand their rationale. They are being incredibly cautious – not socializing at all, working from home for the most part. The idea of being on an airplane doesn’t jive with me either. At the same time, it’s difficult not to have family around for this. I’m super pregnant and my husband is working frantically to wrap things up before paternity leave. The kids are also a handful at the moment. It would be nice to have family in town to spend quality time with them and to offload some of our exhaustion. The situation is sad but I can’t perseverate over it – there’s literally nothing I can do. Our plan is to have our amazing nanny (who has saved us over and over again these past few months) “on call” to come over when I go into labor and we are very fortunate that she moved closer to our home earlier this year. I had originally planned to drive myself to the hospital while my husband coordinated childcare, but my ob vetoed that idea. So now, if things seem to be happening quickly, we’ll load all of the kids into the car and have her meet us at the hospital. I am hoping that my contractions start during the day or that I make it to my induction (39+3). I REALLY do not want to have a baby at home or in the car!

So there’s the unknown component to contend with now. But there is also the fear component – what is something goes wrong? What if I have a postpartum hemorrhage? What if baby has some unknown birth defect or there is another complication? Obviously, I have no control over these things and am trying not to fret about them. I am mostly at peace – trying to enjoy these last few days/weeks with my three little boys, with our family of five – loud, crazy, chaotic – but at least it is our normal and well-known. The first few weeks with our newest addition will be a period of constant adjustment.

We have tried our best to prepare for the postpartum period/fourth trimester. We will both be taking parental leave. Our nanny will help out during the day. We hired a night doula for the baby as well. I am still a bit torn on this. Some of my favorite memories are the sleepless newborn nights. I have usually slept alone with the newborn, nursing all night, watching the clock tick towards morning, waiting for the sun to rise, snoozing on the bed or couch whenever I am able to set the baby down. But, in truth, it has always been exhausting. Some nights my husband would have to watch me sleep w/ the baby cradled by my breast because we were unable to get him into his bassinet. Mornings I would be so exhausted. And the truth is, we are going to need all of the energy we can get to parent 4 kiddos through a pandemic. So we hired a night doula five nights per week. I think it will be great to have the help and two nights out of the week I can enjoy solo evening parenting! I am also hoping that working with a night doula will instill good sleep habits early on, because we have always struggled with this and only just sleep trained my youngest at 18 months!

The other huge thing happening during this waiting period is that school is finally starting for my older two. My oldest is entering kindergarten and the first trimester will be all virtual for now. I am torn on this. I don’t feel any emotional need to have him attend in person. He has been in a preschool-like environment since age 2, so I don’t feel like entering kindergarten is a huge momentous occasion. That being said, I worry that he will have a long, intense virtual schedule. The draft they sent show kids “in school” from 8-3. I am hoping this is modified for the younger kiddos because that is a LONG time to be in front of a screen. He’s also a social kid and I worry that he’s going to miss out on that aspect of school this year. And, finally, because we transferred him to a private school, I’m not thrilled to be paying tuition to have him at home! But, alas, this is the situation we are in at the moment and the most important thing is obviously keeping him, our family, his teachers, the school community and our general community healthy and COVID-free.

My second oldest is entering pre-K at this school and, because they are under different state regulations, he will be able to attend in person. I am also a bit torn on this. On one hand, he is harder to teach at home than his brother was and he is also more shy and introverted, so a place where he has rules to follow and friends to play with would be beneficial for him, I think. I also worry that he will get lost in the shuffle at home. Even with our nanny here, if one person is directing online learning all day and one person is trying to make sure our (almost) 2 year-old doesn’t crack his head open jumping off of furniture and one person is tending to a newborn, what happens to our second oldest? Will he get enough attention? Will he learn anything? These worries are counterbalanced by the very real concern that he might get or be exposed to COVID. So ultimately I can’t say that I am entirely at peace with our decision, but for the reasons listed above and some more, we have decided to start his year in-person and continually re-evaluate.

So this is the world we are bringing this baby into. Fortunately, I was able to stop seeing patients in person early on (34 weeks). I completed 2 weeks of telemedicine and then took my earliest maternity leave to date at 36 weeks. I was fortunate to not get COVID and to not be exposed to any COVID + patients during this time. Despite having just started leave – and the baby not even being here! –  I am already stressing out about going back to work. In normal times, it would be sad but doable. In pandemic times, it seems impossible. Who’s going to sit with our oldest to do distance learning if that is still happening in the new year (I believe that the whole school year will likely be remote)? How will we balance that with my second child’s pick up/drop off schedule? There is a very real possibility that I will have to scale back or modify my hours to work around these schedules.

But, for now,  I am going to try to remove worries and outstanding questions from my mind. I am going to try to enjoy one more night of sleeping through (I hope – the kids do still get up sometimes for one reason or another!) without having a newborn to feed. I am going to enjoy this next week of productivity, nesting and time with my three boys. The next time I write anything, I anticipate that our new addition will be here!

Distance

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Today, while I was tidying up our bedroom, my 20 month old reached into a bathroom drawer and pulled out a bag my mom keeps at our house filled with essential toiletries. My parents (and in-laws) live across the country, but my mom used to (pre-COVID) visit frequently. To avoid buying new toiletries whenever she arrived, we started keeping a bag for her so that it would always be ready for the next trip.

My heart was heavy when I saw that bag. Who knows when the next trip will be? We canceled our trip last month as well as the upcoming one in July. She canceled her trip in June. The big unknown is August. Will she come out for this baby’s birth? She has been such an integral part of each child’s early days that I have no idea how we will handle it alone. And if school doesn’t open in the fall, how will we handle a newborn and a 2 year old while homeschooling a preschooler and kindergartener?

There are so many things to worry about. If she travels, are we putting her at risk for getting COVID? Would she need to quarantine for two weeks upon arrival? Would she be stuck here for the second surge of this pandemic? What if my father gets sick and she is unable to be there right away (and would she need to quarantine upon arrival)? Is she at higher risk of getting COVID around my kids than she would be at home?

Of course I want her to be here, but I also feel that it would be a selfish request. We’ll talk more about it as the date draws closer, but I’m going to prepare for the newborn days without her.

This pandemic has highlighted the distance between us. My husband and I have lived away from our families throughout the entirety of our 13 year relationship. We moved to California a decade ago. There have been times when it felt farther than others, but we always knew we were a (relatively) short flight away from home and our families. COVID-19 has changed everything. Flying feels so risky and it seems silly to endeavor it when we are so carefully sheltering in place in every other respect. I don’t see this changing any time soon, and the prediction is that this is going to last months to years. My hope is that our families stay healthy during this time, but I also recognize that we don’t have limitless years left with our parents and it is such a shame to missing out on time when they are well and able to enjoy their grandchildren.

So much to be sad about during this unprecedented time. For now, I’m going to keep my mom’s toiletry bag tucked in the bathroom drawer, hoping that her next trip is not too far away.

Pandemic Pregnancy

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When I became pregnant, COVID-19 wasn’t even a thing. It was mid-December and I don’t recall hearing anything about what was happening in Wuhan until January at the earliest. So it was probably a thing, and there were cases, but the thought of closed schools, clinical work on hold and shelter-in-place were not on my radar. I was honestly mostly focused on the application process for private school for my two oldest kids. They were (and I recognize how ridiculous this sounds) applying for entry to pre-K and K, and my biggest worry was where they would be going to school the following year. Now I’m doubtful that they will even get to attend said school in person, but that’s a topic for another day.

On February 25th I screened positive for Trisomy 21 and perseverated over that for a week until my normal cell-free DNA results.

We slowly began to take precautions at work to screen for COVID-19. It began with questioning patients prior to their visit to see whether they had recently traveled from Wuhan (this eventually expanded to all of China, and as everyone knows that question soon became obsolete). We also asked about cough and fever. Carts with PPE were positioned outside of these patient rooms.

I developed a cough on March 6th, which was terribly awkward to have while everyone was on high alert regarding COVID (for the records, I have had a negative COVID-19 PCR and also negative IgG and IgM antibodies). One of my patients even sent me a personal note saying that he was worried about me because I had been coughing (I wore a mask in every patient room during this time) and seemed short of breath. I had to, with some embarrassment, tell him that I was short of breath due to climbing 3 sets of stairs while pregnant. Fortunately he was a patient I knew quite well.

I had an ob appointment March 10th and my ob was pretty close to 0% concerned about COVID. She told me the reports out of China were reassuring. Pregnant women seemed to fare well and there were no cases of vertical transmission. She also told me to drink a glass of wine, which was interesting because she usually errs on the conservative side (also for the record, I did not drink a glass of wine).

My close colleagues, however, were more concerned and ended up encouraging me to drop one of my higher-risk duties – seeing patients in the hospital. I stopped doing that the week of March 2nd. The week of March 9th I made a huge pivot in my career and left one of the clinics I had worked at for 6 years. Too many things weren’t working out. I was losing staff, knew I wouldn’t have any when I returned from maternity leave again (it was a drawn-out nightmare the last time) and was so exhausted from pregnancy and turning 37 that I knew it was finally time to call it quits.

March was a month of major upheaval. Our world paused in March – with school canceled starting March 12th (initially only for two weeks but that eventually progressed to no school for the rest of the school year) and shelter-in-place coming 5 days later. Everything was being canceled. It was such a crazy time.

We largely stopped seeing patients in person, with my last real clinic held on March 16th. Everything has been virtual since. To be honest, it’s been challenging. Some conditions in dermatology are easy to treat virtually (acne, for example). Other things, like checking over someone’s skin to look for skin cancer, are impossible. I have been seeing 1-2 patients a week for skin biopsy and evaluation of more serious rashes, but always wearing ample PPE (I have my own that I cycle through). We have just started talking about opening up clinic more robustly, and I am concerned about the plan (or lack thereof). It doesn’t sound like anything is changing, other than spacing out clinics and appointments to encourage social distancing. Of course, we are asked to wear PPE, although it is unclear whether this is readily available.

Normally, I wouldn’t be too concerned. But last week, at my follow-up ob visit, my doctor was suddenly very concerned. She told me there had been new reports of COVID-19 found in placentas, IgM antibodies in newborns, vertical transmission (from mom to body), second trimester miscarriages, stillbirths and premature births. The numbers of reports were small, but there was definitely more alarm. Moms are tested at the time of delivery at our hospital and COVID-19+ moms are recommended to separate from their newborns. Having had three kids, I can’t imagine how heartbreaking that would be.

In sum, I’m starting to worry about ramping up capacity to see more patients. I’m not reassured by the plan currently in place and now I’m much more anxious about doctoring while pregnant. At the same time, I feel a bit silly, because I don’t work in an emergency room or ICU, and certainly don’t do any high-risk procedures (any biopsies I do near the face are usually relatively quick and nothing compared to an intubation). I also feel a strong obligation to my patients. I know how scary it can be to have a spot that you are worried could be a skin cancer, or a rash that keeps spreading. Our patients have been so wonderful these past few weeks, understanding that we are taking every precaution to keep them safe, but I certainly don’t want anyone waiting months to be seen. Since I am taking maternity leave, I would be gone until early 2021. Finally, I care deeply about my colleagues. Although they might not be pregnant, they could have co-morbidities or take medications that make them immunosuppressed, live with elderly parents or in-laws or immunosuppressed children and spouses. I don’t want to burden anyone else with having to see my patients because it seems to imply that my pregnancy is more important than their personal circumstances.

It’s an uncertain time for all and I don’t envy our management who has to make some tough decisions moving forward. For now, I’ve reached out to my ob to see if she can give me some clarity on making a decision. If need be, I’ll reach out to my colleagues to see how to best mitigate risk. I’m taking leave at 35 weeks so essentially only 13 more weeks to go. Hoping those 13 weeks are as smooth and uneventful as possible!