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!

Black Lives Matter

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I stopped posting on social media at the end of 2019 when my best friend lost a baby in the third trimester. I would scroll through and see photo after photo of families – pregnancy announcements, newborn babies, growing babies – and think of how that must smart when you have just had a horrific pregnancy loss. And then I started thinking about how every post could be hurtful to someone – anniversary posts to the single/widowed/divorced, Mother’s and Father’s Day posts to those who have lost loved ones or never had them in their lives, and on and on. I never post now, but I do continue to follow certain platforms to access mom and professional groups, keep in touch with international family, crowdsource, etc.

Recently, there have been times when I have wanted to write something here, but it didn’t feel right to do so without first addressing racial injustice, police brutality, the senseless deaths of Black men and women in America. I don’t have anything particularly enlightening or unique to say on the topic. I am not Black and, because I look white, I have benefited from white privilege in ways that are glaringly obvious to me. So I am appreciative of people who are more knowledgeable than I – learning from their experiences, taking in information that I am privileged to have been largely oblivious to. I am making my way through recommended reading lists and curating the kids’ bookshelves to be increasingly diverse. I am becoming more involved in diversity initiatives at work and challenging my own beliefs and implicit biases. I’ve spoken up at times when I would have previously remained quiet so as not to rock the boat. I have stopped following and supporting individuals, blogs and accounts who have not explicitly stated that Black lives matter, or who have skirted the issue by speaking in vague generalities. I recognize some may label this judgmental, but if someone can continue to post on a regular basis during this time without calling out the elephant in the room, then it is clear to me that this issue is not a priority for them.

The above doesn’t feel like much, but it’s a start.

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!

Parenting after infertility

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Tuesday was my anatomy scan for my fourth child. (I know this doesn’t sound like a typical infertility post, but bear with me.) I was a nervous mess. My husband came with me but wasn’t allowed into the room because of COVID precautions. My ultrasound tech was a woman of few words, who mostly complained about having to wear her surgical mask all day (another COVID precaution).

Some women announce their pregnancies the second they know about them, with elaborate pregnancy announcements and social media posts. I’m in the other group – moms who worry every step of the way. It’s exhausting. As soon as I find out I’m pregnant I worry that I will miscarry in the first trimester (for the record: I have never had a miscarriage). I hold my breath at every ultrasound until the doctor finds the heartbeat. I worry about the results of my nuchal translucency/first trimester screen (perhaps for good reason: I have tested positive – false positive – for Trisomy 21 twice now). I hold my breath waiting for the cell-free DNA results (normal 3 of the 3 times I have had to take this test). The anatomy scan is the worst, because by 20 weeks I tend to look pretty pregnant so people know, and how would I break the news to everyone that the baby had some terrible congenital abnormality that was incompatible with life? It sounds ridiculous as I am typing this out, but this is the world inside my head. When I was pregnant with my first, I refused to wash any of the clothing we had purchased for him until late in the third trimester. I couldn’t imaging folding it all up and putting it away if something terrible happened. With each pregnancy, I have worried about the baby not moving enough. With my first I vividly recall drinking orange juice at night and jostling my belly around to get him moving. Perhaps that is why he was born a night owl! Just today I took a 5 minute break to lay on my side in bed because I hadn’t felt this baby move in some time. Last year, my best friend lost a baby at 31 weeks. It was every mom’s worst nightmare. My heart aches for her, thinking of how she waited for labor to start days after she had learned that her baby was not okay, and ultimately delivered a stillborn baby. I flew out to see her right after the birth and there were no words to remedy how unfair and cruel the world can be.

My struggles have been minimal by comparison. I had hypothalamic amenorrhea and stopped getting my period for a decade. When I got married and decided to have kids, it (surprise!) did not suddenly make an appearance. In retrospect, I can summarize the story like this: I had hypothalamic amenorrhea and started eating more, gaining weight, and working out much less in order to promote natural fertility. I eventually got pregnant with minimal assistance from a fertility clinic. My subsequent pregnancies occurred without any intervention. However, the period from May 2012 to March 2014 was so more stressful than that paragraph reflects. I had no idea why I wasn’t able to get pregnant. I knew hypothalamic amenorrhea was playing a role but what if (a) it was irreversible and (b) there was something else? What if I would never be a mom? What if I had messed up my body so much that I would never carry a baby?

Once you have had any degree of infertility, you never take being a parent for granted. My first wouldn’t sleep. He had a strong startle reflex and broke through every swaddle combination we tried. He would cry all day and night unless we held him. I remember being exhausted to the bone, crying on the phone to my friend, telling her how guilty I felt for not savoring every waking moment after everything I had been through to have him. This has been my thought process on repeat for every child and for every step of the way. Every decision I have made for them has been fueled by the knowledge that their lives may not have been if things had worked out differently.

I know how fortunate I am to have these children. Once you are pregnant with your fourth (and to some degree your third), people start commenting on your reproductive decisions. “Isn’t the world populated enough?”, “Yeah, probably not a good idea”, “Why would you have another child?”. Quite frankly, it’s rude. In the same way I was hurt and offended when I couldn’t get pregnant and people asked me when I was planning to have a baby, I am hurt and offended by these comments. I don’t push back though – I’m never going to convince people who say those words out loud to consider another viewpoint. I know how much my children mean to me and my husband, and that’s all that matters. Although I would have preferred not to have gone through those years of infertility, I am grateful that they provided me with this perspective.

No more cornflakes

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Today is Day 38 of no school for my kids and Day 33 of shelter-in-place. It’s 1:48am and I am up again. We’ve been battling bedtime with one of my kids for what seems like an eternity (a year perhaps?). With the extra time at home, less need to be at work first thing in the morning, and generally more exhaustion, I have started falling asleep on the floor of his room (his preferred sleeping arrangement) more often than I would like to admit. After sleeping a good 3-4 hours, I find it tough to seamlessly transition to my own bed. Thus why I am up right now – writing for the first time in ages.

The past few weeks have been an adjustment, to say the least. Before I go into details, I first have to say that we have been very fortunate. My husband and I are still employed and no one we know or love has been ill with COVID-19, despite much of our family living in New York and New Jersey.  I work at a hospital but my department has made patient, faculty and staff safety a priority, and this has helped to relieve a lot of exposure anxiety. I am also 19 weeks pregnant and my colleagues immediately volunteered to take over some of my riskier patient care responsibilities, as the evidence regarding COVID-19 and pregnancy continues to evolve (fortunately, it has been mostly reassuring, but we are learning more each day).

We are very blessed and acutely aware of this, but also affected by the monumental change that occurred in our lives these past few weeks as well as the uncertainty regarding the future. What began as a two-week hiatus from school after there was a confirmed positive in the larger school community was gradually extended, until they just recently announced that school would be out until the fall. Summer camps have started to cancel. There is talk of the 2020-2021 school year looking dramatically different.

I do feel fortunate that my children are young (1, 3 and 5). Mostly they have reacted to the news with glee. For them, it is an extended vacation and their parents are home all day on most days (I am currently going into the office one day a week for essential procedures). They say they do not miss school or their friends. We live in a warm climate where they can go outside each day – even if it is only in our backyard or a short trip around the neighborhood. But I do worry about the change in structure. This week in particular was tough became it came with some change in behavior. My 1 year old is undergoing a sleep regression – often crying before bed, waking up in the middle of the night (he woke up as I was typing this), and a few mornings waking up before 5am. My 3 year old finds his way into our bed more often than not (perhaps related to my falling asleep on his floor most nights?). My 5 year old, who is generally very well-behaved, started to act out this week. Small things, for sure, but they pile up quickly when my husband and I are home all day, trying to fit work into any snippets of time we can find, and generally exhausted/operating on fumes. Parenting 3 kids 5 and under while both working full-time was hard at baseline and then COVID happened and it seemed almost impossible. (But I remind myself daily that at the height of my struggle with infertility I would have prayed for this conundrum. No matter how many kids I’ve had, there is no way to forget that burning desire for motherhood, the disappointment that came with every negative pregnancy test, and the fear of it never coming to fruition.)

And yet. Today was a hard day (also a hard night, it seems, with 2/3 of the kids already up 2 times each) and I started thinking about one of my favorite books from childhood – No More Cornflakes by Polly Horvath. I had forgotten the general plot and had a good chuckle when I read the Amazon synopsis: “Hortense seeks the advice and friendship of her eccentric Aunt Kate when her mother spends her days eating cornflakes and hopping around in public, pretending to be a rabbit”. It is about a girl growing up in a changing household – her mother is pregnant (and apparently losing her mind?  I should go back and read this now that I am an adult), her older sister is out more/becoming more independent, and she finds solace in a deepening relationship with her quirky aunt. The one thing I vividly recall, even decades later, is her aunt’s advice to find an “oasis”, a small ritual you have for yourself each day – one that is yours and only yours, one that brings joy always.

I love this concept even more now. As our world has become smaller – confined largely to the walls of our home – as our social interactions have become non-existent, as our opportunities for experiences, vacations, etc., have dissipated before our eyes, how do we find solace in our day? What can we do to bring a sense of peace, calm and fortitude into our lives? I’ll be thinking about this deeply in the next few days, as we continue to refine our daily schedules, to bring small rays of sunshine into our lives.

For now, I am trying to focus on the positives. I have had the opportunity to experience staying at home with my children (I went back to work with all 3 when they were ~4 months old). They have had the opportunity to experience a different childhood (I sometimes joke that it is my childhood) – one without planned activities, playdates, structure. We, as parents, are working on encouraging more creativity and independent play. We are trying to find small pockets of time for ourselves while the kids are awake, so that we don’t have to cling so desperately to the post-bedtime hours. My 1 year old’s language has taken off exponentially now that his brothers are home full-time. My 3 year old rode his bike for the first time today without training wheels. My 5 year old has been reading on his own and doing math. We are eating at home every night (we always ate together, but did often eat out) and I am so incredibly fortunate that my husband cooks for us every day. We are finding the time to complete random items on our to-do list that always fell to the bottom of our busy days.

One day, as long as everyone stays healthy and safe, we may look back on this time with some degree of fondness. I wonder if it is the closest we will ever be as a family. Soon, if we are still sheltering in place and socially isolating when this fourth baby arrives, we will be even closer!

This is how it often is

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We met on her second day of hospital admission. She was in her early 30s with a newly diagnosed leukemia. Her symptoms had been mild to start, and now she was here, admitted with cancer, about to begin chemotherapy. She had a six year old daughter at home. The walls were filled with artwork, family photographs, the annual Christmas card.

This is how it often is. You don’t have cancer until you do. The symptoms are mild at first – “I thought I had a terrible virus”, “I was so run down but I had been working so hard”, “My back was aching something terrible but I had just started CrossFit”. You’re living your normal life until it shatters.

I am a dermatologist who sees patients in the hospital when they experience side effects from cancer treatment, or have had a bone marrow transplant with skin complications, or have skin disease in either setting. This is not the role we usually envision for dermatologists. When I was an intern at a renowned academic teaching hospital, the ICU attending skipped over me while we were reviewing a chest X-ray on rounds. “You don’t have to know how to read this – in a few months you’ll just be doing Botox.” I was sleep-deprived, short on caffeine and the low woman on the totem pole, so I swallowed my tongue and folded it up as an anecdote I would later share with my own residents. As one of my mentors always says: you have to show skeptics your value, not tell them about it. Eventually they’ll come around.

The things I love most about medicine – the connections I have with my patients, the trust they have in me, the things I learn from them – are sometimes the hardest part of medicine. Patients often share their hopes and fears. They tell me things they have only told their closest families and friends. I had unprotected sex with someone who wasn’t my husband. I tried to kill myself. I don’t want to die. I never wanted to have children. I grew up in foster care and never had a family who loved me. It’s heavy. There is never any judgement, just a deep understanding of how complicated our world is. There is so much loss and pain, and on the flipside so much beauty and love.

Many times, my patients are soon in remission. The cancer was removed surgically, the cancer treatment worked, the bone marrow transplant gave them a new chance at life. I often don’t see these patients again, but some continue to visit me each year for a routine skin check, or because of a new rash. Those are joyful visits. I receive updates on wedding anniversaries, growing children, grandchildren, vacations – general life excitement.

Other times they never leave the hospital. Or they arrive to the hospital a different person. The complications pile on, everything goes wrong. Soon there is a planned discussion between oncology and the patient’s family. How aggressive do they want to be if new complications arise? Is it time to transition to comfort care? Whereas the first time we met they were sharing photographs of their families and explaining the artwork on the walls, they are now hooked up to machines and unable to communicate beyond a blink. I still talk to them when I enter the room. I repeat who I am and what I am doing – “I will be taking a look at your skin. Your oncologist is worried about the new blisters on your legs. Is it okay if I lift up your sleeve?” The syllables fade into the air, surrounded by assorted alarms. I finish my exam, say good-bye.

The next day we arrive to round and the family is huddled around the bedside, family members spilling into the hallway. The daughter is there. This is usually a sign that the patient has a few hours to live. It is a terrible moment for physicians. I wish I could shield my residents from it, in the same way I yearn to shield my children from the terrible things that happen in our world. We move on to the next patient but there is a heaviness in the air. A six year old is about to lose her mother, a husband is about to lose his wife, parents are about to lose their daughter. The hospitalization ends here but the repercussions of this loss will resonate for eternity. Eventually it will be explained as my mother died when I was six, but there were days and weeks and months and years leading up to that moment which were filled with all of the details that make our lives rich.

I sign into the hospital’s electronic medical record at home that evening to finish notes. I see that our patient has died. My children are sleeping in their beds and my husband is working on a deadline next to me but a mother has died. I move on to the next task, almost in slow motion. This is how it often is. You don’t have cancer until you do. You’re breathing until you’re not. You’re alive until you’ve passed.

What I’ve learned is this: there is nothing to do but to keep moving. Cherish the small things in life, keep your family close, take care of your health. Tomorrow is not a guarantee, trite as it may sound. Wealth and accolades will not shield you from disease and death. At the end of the day, we are all left with nothing. Ashes to ashes.

To my fellow physicians-I see you in the trenches, trying your best to keep your academic hats on while retaining your humanity. To patients everywhere-your doctors truly care about you. They think about you long after you’ve left their office and often long after you’ve left this earth.

I still remember my patients who have passed. I keep the trinkets they gave me, write down their quotes and life lessons, and have stored away the memories we’ve shared. Medicine is broken in so many ways – out-of-touch administrators with unreasonable demands, insurance companies refusing access to care, astronomical cost – I could go on and on. But all is not lost as long as the purity of the patient-physician relationship remains.

Maternity leave in review

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In two days I’ll return to work after my third maternity leave. That’s one job, three pregnancies, three maternity leaves and three “first days back at work”. My first post on this blog was about returning to work after my second was born (see October 2016 archives) and now here we are again! In honor of this occasion, I wanted to spend some time (kid naps allowing) to reflect on the past few weeks.

This maternity leave started earlier than planned when my contractions started the morning after my last day of work. I had been expecting at least a few days (if not weeks!) of extra time to wrap things up, but baby had other plans. I subsequently spent the first 3-4 weeks wrapping up work. I know that sounds really terrible, but it was actually okay. Everyone knows that newborns don’t sleep, so it gave me something to do in the wee hours of the night, and it was something that would definitely prevent me from dozing off with the baby. I am also fortunate to have a lot of support staff and they helped me make phone calls to patients (since that’s not something that can be done in the middle of the night!).

My husband didn’t take his paternity leave right away, so it was a bit of a whirlwind. Even though we had family helping out, if I had to do it again I would ask him to take a few weeks off in the very beginning. It would have been immensely helpful to have a bit more overnight help those first few weeks and I would have probably been able to take some daytime naps without the baby! It seemed pretty stressful for him to work while so sleep-deprived and this definitely led to more bickering than usual. Fortunately, things improved with time (and sleep!).

We briefly had a night nurse helping us out…until she fell asleep holding the baby. I couldn’t believe it. As my husband always says “why are people so bad at their jobs? You have one job – learn how to do it right!” So I guess another thing I would do differently is not hire a night nanny. Yes, it was helpful to have someone hold the baby for a few hours overnight, but I did enjoy doing the bulk of evenings since so much baby bonding happens during that time. I also found that I didn’t rest easy when she was over, perhaps because I was worried about the above. Fortunately, our little guy persevered and now his sleep isn’t as atrocious (although it is definitely nowhere near ideal for having to go back to work!).

My older kiddos have done really well with their new little brother. Toddler Y (our middle child) had a tough time those first few days, but now he is sweet as pie. One of our major challenges when I return to work will be carving out individual time for all three kids. Right now, the older kiddos have independent activities on Saturday mornings, and I plan to build onto that time.

One of the highlights of maternity leave was seeing a lot of family. My mom spent a few weeks with us right before and after Baby Z was born – not quite as long as the last time, but just the right amount of time during the hardest days. We also had both of our families visit on separate occasions and I was able to visit home twice (the last time for 3 weeks!) during maternity leave. The kids have a blast around family, so it was so nice to see everyone on multiple occasions.

Another highlight was meeting an awesome group of moms with kiddos around Baby Z’s age. I have excellent mom friends whom I met shortly after my first was born. Some had second babies so I didn’t feel the need to branch out much with Toddler Y. But this time around I knew that Baby Z would need some baby buddies and went out of my way to meet people. Well, this group of moms is just awesome, and it’s been great getting to know them.

On an organizational front, I did a TON around the house. I cleaned out the whole attic, donated and threw out a bunch of items from all throughout our home (trying to get a head start on minimalism for 2019!), made headway on two home improvement projects we have been working on, had the guest room painted, reorganized the guest room/soon-to-be Baby Z nursery, cleaned out the entire shed and organized all of the kitchen drawers. I gave away a ton of baby things we no longer needed, worked on Baby Z’s scrapbook and first-year album and also researched and toured a slew of private schools in the area. I did much of this with the baby strapped to my chest, but needed a bit of assistance for the manual labor.

Of course, the highlight of maternity leave was the hours upon hours I got to spend with Baby Z. I wore him almost constantly in a sling (now carrier) during the daytime hours. He often slept in bed with me overnight (not necessarily by choice, but we made sure the bed was as safe as possible for infant sleep) and he accompanied me to appointments, a handful of work meetings and a slew of errands. He’s an excellent eater, and I will forever be grateful to my employer for allowing me to have all of this time with him.

When I return to work, he will be about 4.5 months old. I know international readers will balk at how little that is. However, having had all of my children in the US, I feel so incredibly fortunately to have had 4.5 months of paid maternity leave, as well as the assurance that my position is stable. When I return, I’ll be able to set time aside as I wish to pump and to adjust my schedule as needed to make this year as manageable as can be. In fact, I’m returning part-time this month, and I am so very grateful to be able to rev up gradually.

I will always be sad about leaving my baby. What will it be like for him to not be strapped to my chest all day? (Honestly, probably not as bad as it will be for me!) I will worry incessantly about something going wrong while he is out of my care and I will miss his little noises and tiny fingers and sweet smile. I will stress out trying to give everyone attention in the few hours we have before work and after work/before bed. But I have faith that it will all be okay. Not easy, but okay.

Many moons ago, when I was obsessing about going back to work vs not going back to work (not really an option for me at the time but an interesting hypothetical argument) and then obsessing about daycare vs nanny, the one thing that stuck with me was reading that kids will thrive with a decision as long as the parents are happy with that decision. So I always focus on the positive aspects of my job and the positive aspects of their relationships with other caregivers.

I also have this to get me through: my older kids are alright. They’re happy little clams, in preschool now. My oldest is four. If we repeat his life cycle 4 more times, he’ll be twenty – an adult! In other words: time flies. As my children have grown, I’ve had (some) opportunity to think about who I am independent on them, how my husband and I interact independent of them, what I will do once they leave. Yes, I am not very far in and they are still very, very small and very, very dependent, but there are snippets of time when these opportunities for thought arise. When they have arisen, I have always been very happy to be working. This is what has worked and been okay for me, but it may not be the best case scenario for anyone else, and that’s okay too.

So in less than 48 hours, I’ll be waking up and changing out of my pajamas first thing. I’ll put on make-up, grown-up clothes, triple check my bags to make sure I have my work things plus my pump things, and then I’ll leave my sweet little baby behind. First I’ll have to convince my older kids (who have been out of school for three weeks!) that getting dressed and leaving the house early is also a good idea. I am not sure which of those feats will be harder! And in a few weeks time, doing this will be the new normal, and these lovely (and hard) maternity leave days will be a distant memory!

The Blob Trimester: Baby’s Z’s 1st 3 months

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As my youngest (baby Z) is one week shy of 4 months, I find myself fondly reflecting on the fourth trimester haze. If you are not familiar with the term “fourth trimester”, it is common terminology for the first 3 postpartum months. Due to human anatomy and the limitations of the birth canal, human babies are born neurologically premature. Thus my rationale for (very affectionately) calling my newborn a blob.

Let’s put it this way: newborns would never survive in the wild. They can’t hold their heads up, they can’t make meaningful movements with their arms and legs, they can barely see, and they are easily surprised. They can only communicate via crying and they spend a great majority of their days sleeping, drinking milk, peeing and pooing. This is one reason why the fourth trimester is so challenging for new parents: you are suddenly in charge of keeping a small, defenseless human alive. No pressure!

Prety daunting, huh? Couple this with the fact that new parents are chronically sleep-deprived (newflash: babies don’t know the difference between day and night, so you may find yourself pulling a lot of all-nighters), moms are experiencing a hormonal hailstorm (why does everything make me cry? why am I suddenly so angry at my husband? why am I so worried about every damn thing?) and everything you previously knew about yourself has gone out the window (so long hobbies, singular focus on career, social life). Given all of the above, we might as well also call this time period the sob trimester.

Never fear, however. Between 3-4 months, everything gets easier. Yes, there are still challenges (hello 4 month sleep regression!), but your little blob has turned into a reciprocal mini-human who tracks your movements, produces wide-toothed smiles and even cackles with laughter, which makes the experience much more rewarding.

For the sake of preserving my own memories, here’s a recap of Baby Z’s first 3 months:

  • Birth: By far the best of three (third time’s the charm!). Baby X was induced and we barely made it to the hospital with Baby Y. For Baby Z, we went to the hospital as soon as contractions started and were told to walk around until they intensified. We did this for quite some time, even coming home to shower and re-pack, so by the time we returned to the hospital, it was go-time but not baby’s-about-to-fall-out time. I was able to get an epidural (thank you, modern medicine), labor peacefully and when it came time to push, he was out after basically 3 pushes with no tearing involved.
  • Sleep: We purchased a Snoo for this guy, but I wasn’t quite comfortable having him sleep in it from day one. The rocking seemed a bit intense for me and I capped it (there is a function where you can limit the motion) and have kept it as such to this day. In the beginning, he honestly mostly slept in bed with me (my husband would supervise so I didn’t roll on him) and we also lay him down in the Snoo (without turning it on) or put him in the Rock n Play (which he honestly never liked very much and also isn’t safe for unsupervised sleep). We hired a weekend night nanny for those first rough nights and she fell asleep holding the baby on the third night she worked for us! As my husband would say: WTF? YOU HAVE ONE JOB!!! That was pretty traumatic, but baby was okay and we gently told her we were no longer in need of a night nanny. I have to be honest: the sleep was pretty rough early on. He would spend a few hours up each night and I often had no idea what to do with him around 2-5am. My husband was also saving his paternity leave so I tried not to bother him since he had to work the next day. It was pretty intense. I tried to establish an early bedtime for him, but he went to sleep around 11p for a long time! Just recently (close to/when he hit 3 months), he started falling asleep around 9. Early on, he would be up cluster-feeding for quite a few hours (e.g. 8p-11p/12a) but more recently he would do a longer stretch, waking up either at 1a or 3a. So most nights he’ll wake up 1-2 times. The first nap was also the first to fall into place, as it usually does. It’s the one I can actually set him down “drowsy but awake” for! At the moment, we are traveling (good-bye Snoo!) and have him in a Pack n Play. I have to say that he’s not loving it. Last night, he was up every 2 hours, and spent the bulk of the night in bed with me. I’m not sure if this is a Snoo transition issue, a travel/change of environment issue, or the start of the 4 month sleep regression, but I don’t like it.
  • Temperament: When we first brought him home, we were a bit concerned he would be colicky like Baby X. Turns out he was just a normal newborn who wanted to be held, cuddled and carried pretty much all day. With every need attended to/preempted, he’s happy as a peach. He likes tummy time, mat time, play time (songs and the occasional book when he gets his own) and of course still loves when we tote him around all day. So far, he’s a happy, go-lucky baby who can also entertain himself independently (for now, this mostly involves staring at something in the distance).
  • Feeding: Baby Z latched pretty easily. I had one of the nurses remind me of the appropriate position when they are little blobs and can’t hold up their heads, but he quickly got the hang of it. I don’t have him on any particular schedule at the moment. He should technically be eating every 3-4 hours, but sometimes it’s less. Of all the baby things, nursing has always been fairly easy for me. Yes, it was always painful in the beginning. I enrolled in a lactation class prior to the birth of my first, worked with lactation consultants in the hospital the first two times, and also had private lactation consultant visits after the first two were born. These steps allowed me to feel more comfortable nursing. And yes, I worried ALL all of the time whether they were getting enough to eat, especially my first. Was he colicky because he was hungry? Were those tears of starvation? Did he want to nurse all of the time because he wasn’t getting enough milk? I also always pumped just enough and was worried each time about how pumping at work would turn out. Yet I was able to nurse the first two for 15 months and pumped until they were 11 months, using up my freezer stash for months 12 and 13. We’ll see what happens with this guy. I’m a bit worried because I had 187 oz and 300 oz of milk saved up for my first and second, respectively, when I went back to work, but currently have only 55 oz with only a few weeks to go (poor third child!). But I am telling myself that the freezer stash really only helped me to stop pumping a bit earlier, so it isn’t the end of the world that his is so limited. After all, every lactation consultant I’ve spoken with has said you only need enough milk for your first day back (and this is true).
  • Developmental milestones: Baby Z was quick to roll from tummy to back. I know I sound like a delusional mom saying this, but he was doing it month one and still does it to this day. He’s flailing his arms around and kicking his legs much more now. He sees well, follows you around with his eyes, smiles and laughs, has coo-ing conversations, and has started to grip things and bring them to his mouth. Actually, everything is starting to wind up in his mouth – his hands, the carrier strap, teething toys, etc. He can also reach out with his hands to swipe things hanging above him on his playmat or on one of his chairs. His neck is pretty strong and I will often place him forward-facing in the carrier (if it’s not naptime) because he likes to observe the world. He’s actually starting to show interest in food already, which seems early to me, but I’m looking forward to introducing solids.

I honestly can’t believe he’s almost 4 months and am definitely patting myself on the back for getting through those tough first few months. Work is just around the corner (a story for another day), but I feel very fortunate to have had this time with him.