anna in med school

In October, a residency interviewer asked me if I planned to continue this blog during residency.  Without hesitancy, I said “no.”  My confidence surprised me, and it felt like, in that moment, I made the decision with my response.

I have been dragging my feet trying to write this post, in part because we have been knee-deep in buying a house and moving down to Central Virginia (poor Ari: “What happened?  Where all the toys?!  No bed?  Animals?  All coming?  Evie comes too?”), but mostly because I don’t know how to end it.  Nearly five years and 650 posts–this blog has been a tremendous part of my life.  It achieved the primary goal of helping me appreciate med school for its own sake and not merely as a means to an end, but it also helped me connect with people (old friends, family, new acquaintances, even fellow colleagues), improve my confidence as a mother and physician-in-training, and start to develop (for me) a new style of writing and communication.  The thought of being without this outlet feels strange and scary.

But ending feels like the right decision.  For one, I’m no longer Anna in Med School (I know, total cop out…not a compelling reason).  More importantly, the thought of my blog simply petering out under the time constraints and stresses of residency (and raising a family during residency) while trying to maintain HIPAA compliance is depressing, and I’d rather rip the bandaid off (and add a few trite medical analogies in the process 🙂 ).  Mostly, however, I’m excited for what this next chapter might bring, and I’d like to make space for a new opportunity or two (writing or otherwise) without feeling like other parts of my life are being shortchanged.

John and I have been tempted to start a family blog–mostly an excuse to post an obnoxious amount of pictures of babies toddlers and maybe share a story to two of recent excursions (or mundane crap that we find hilarious during sleep-deprived moments).  Will let you know if we take the plunge!

For now, thank you for sharing med school with me.  It has been my sincere pleasure and honor.

with love and gratitude,

anna (with john, ari, & evie)

I graduated from medical school this past Saturday–surreal, to say the very least 🙂

To be honest, I was a bit of a nervous wreck during the ceremony…not that I would trip or, for some reason, not receive my diploma, but that my poor kids wouldn’t make it through the 2+-hour ceremony.  Ugh, they were troopers, as were John and my brother Stephan who were tasked with entertaining them.

And then there’s a tradition of one’s kids joining her on stage for the “hooding” and receiving of the diploma (which I love!).  Considering there are days I struggle with the walk from our house to the car with both of them, I was seriously doubting our ability to make it across the stage…especially when there are so many strangers in big black robes and scary hats along the way.

Ari and Evie rose to the occasion.  John and Steph brought them to me in line as I was waiting for my name to be called, and Evie had a little panic attack as John passed her off.  She didn’t recognize me in my cap and gown–heartbreaking!  Then Ari started excitedly clapping along with the audience for the new physicians standing in front of me, and I smiled and joined along…something about that expression reassured Evie, and she gently caressed my face to make sure it was really mine.

“Dr. Anna Jesus.”  And we were off, Evie in my arms and Ari holding my left hand.  When we got to Dr. Goldfarb, I realized I didn’t have a hand to take my diploma.  Without pause, he bent down and spoke to Ari, “Would you mind holding this for your mommy?”  And she replied, “Okay, I take it.”  My brother got it on film:

How proud Ari looks–I love it!

My family and friends have been such a huge part of my med school experience, I’m so thankful to have been able to celebrate with some of them at graduation.  The only downside to having the kids there was that it was nearly impossible to get a chance to say hi and thanks and hug and unfortunately goodbye to many loved ones.  I hope it was/is abundantly obvious how much I appreciated everyone there, in body or spirit.

How is this possible?  Almost exactly nine years ago I decided I wanted to be a doctor.  Even Saturday morning, I don’t think I fully believed that it would happen.  I’m a doctor.  (And no more letters addressed to Dr. & Mrs.–ha!)

Apparently, I am a Master of Bioethics!  Thrilled John woke up at the ass crack of dawn to fly home from San Diego just in time for the ceremony:

Fellow MD/MBEs:

Many, many thanks to Lance and Autumn for creating this unique opportunity for us:

If anyone has seen a UVA diploma, you know my Penn ones are going to be dwarfed by them!  Family comes in tonight (must mop our toddler-destroyed floors!), and tomorrow an MD!  So many exclamation points!

Evelyn.  Our sweet, pure-joy second born is a year old today.  Someone once called her an old soul, and that rings true to me, for reasons I can’t fully articulate—maybe because she always seems more patient, tolerant, and observant than the rest of her crazy family.

Kudos to all the moms who write out birth stories in the haze of newborn days.  I am determined to not let the story of her birth fall totally by the wayside, eclipsed by, in most ways, the more dramatic birth of her older sister.

Even in birth, her story starts with that of her sister’s.  Aurelia was born unusually quickly.  Our friend joked, “I hope you don’t like your living room carpet, because her future siblings will be born on it.”  Though I hadn’t had any complications with Ari’s birth, and John has delivered his fair share of babies, a home birth was not something I wanted to try.  I feared the worst-case scenario.  If I was going to deliver a baby, it was going to be at an institution with a level III Neonatal Intensive Care Unit. Period.  So, starting at week 37, we were on high alert.

I was also more anxious (unnecessarily so) about getting to the hospital early because I turned out to be positive for Group B Strep with this pregnancy, meaning that I would need to get IV penicillin during labor in order to minimize risk of Evie developing a serious bacterial infection as a newborn.  My midwife said that, ideally, I would get at least two doses during labor, the first of which being over four hours before delivery.  Considering that my labor with Ari was arguably less than four hours, I wasn’t optimistic that Evie would be appropriately protected.

Now jump to early May 2014…John and I are sitting on pins and needles, with our close friend Stephie staying with us for two weeks leading up to my due date so that we can make a sprint to the hospital and leave Ari with her.  I had just finished my pediatric emergency clinical rotation and had high hopes of getting some work done before #2 arrived.  I managed to dig up and wash Ari’s newborn clothes and do just about nothing else, as a constant nausea (with irregular contractions) set in that made it hard to motivate to do much beyond the bare minimum.  I LOVE to eat, so my last week of pregnancy, when I struggled to eat half a gluten-free dinner roll, was unsettling.  I was convinced that the only way I would manage through labor was if they stuck me with two large bore IVs and pummeled fluids back into me.

I did try to make it to crossfit, if only for the change in scenery and motivation to do something. But I assure you I was just showing up; there were no PRs.

Here I’m in the middle of doing of modified version of the benchmark WOD Angie, 26 hours before Evie was born:

The day before my due date, Stephie had to leave us.  Still nothing but a week of irregular contractions and nausea. John had the day off.  We drove Ari to daycare after a particularly brutal meltdown (limbs, torso, head (hers, and perhaps mine in spirit) thrashing violently on our wood floor).  I remember sitting in our living room that day with the lights off, feeling like any fight I had was just gone.  I let John control the remote and watched a movie that I had no interest in.  We strategized in bits and spurts, contacted our neighbors who might be willing to watch Ari when I went into labor.  For unknown reasons, I thought I should defrost short ribs and try out a new slow cooker recipe.  We picked up Ari from daycare, went to a playground, and I ended up having microwave popcorn for dinner (delicious in theory, disappointing in execution).

I woke up at 3am.  My contractions didn’t feel more severe, just different.  John made me promise to wake him up immediately if anything changed. (He still teases me for not waking him up until I was practically ready to push Ari out. I still gently admonish him for taking a shower while I was actively trying to suck Ari back in.)  I nudged him several times, each time more forcefully, and he reluctantly roused.  “Things just feel ‘different’?” he repeated, unimpressed.  He rolled back over and told me to time contractions (6-12 minutes apart).  A few minutes later, he thought better of it, and told me to call the midwife.  (John would later tell me that, as he tried to go back to sleep, he thought to himself, How stupid would I be if I let us wait too long to get to the hospital the second time around?)

I shared my vague symptoms with the midwife-on-call, assuring her that I wasn’t so uncomfortable and wasn’t convinced I was even in labor.  She explained, “Most other woman I would advise to wait it out.  But…I don’t trust your uterus.  Just come in.  And maybe eat something if you can.”  No way I could stomach food.  “Well, then you probably are in labor.”

This time around, we both had time to take showers, not feeling rushed yet.  I finished packing the getaway bag.  John cleaned up the kitchen and moved the short ribs from the slow cooker to the fridge.  I texted Elizabeth, our kind neighbor from across the street, and she came over around 5am.

The drive to the Pennsylvania Hospital this time was so different.  With Ari, I was in a near state of panic, bracing myself with each contraction, which seemed to come one on top of the other.  Strange, pained noises were coming from my throat as I desperately tried not to push.  I had my feet slammed against the floor of the car and my hands tensely pulling the seatbelt away from my body.  John was running most red lights.  He left the car in a tow-away zone at the entrance of the hospital.

During this drive I was comfortable, much more so than I had been the last several days…excited and happy even—adrenaline, man!  I remember at one point raising a finger when John asked me a question during a contraction, and that was it.  We parked in the parking garage this time, and I walked myself to labor and delivery.

In the Perinatal Evaluation and Treatment Unit (PETU), I was hooked up to monitors.  Contractions were present but irregular.  4cm dilated.  We thought we would be sent home for sure, but instead they decided to start me on penicillin and see what happened.

While John was in the cafeteria having breakfast, two nurses came to escort me to Labor and Delivery.  With Ari, I was pushing (and screaming) as they wheeled me on a gurney.  This time, waddling awkwardly but not totally uncomfortably, I was a little embarrassed that I was being admitted when I still wasn’t 100% convinced I was in labor.

John met up with us in Room 9, one of the two “birthing suites” or low-intervention rooms, and the same room where Ari was delivered.  The main attraction: a Jacuzzi!  On a white board next to the bed, our truly wonderful and ever-encouraging nurse Dina scribbled our goals of care.  Under pain management, she wrote “natural childbirth,” and I couldn’t help but cringe a little.  (Ever since an attending once corrected me on the wards [You mean “unmedicated” or “low-intervention.”], I’ve been too sensitive about the terminology.  Not to go into it too much here, but I worry about the judgment implied. Please feel free to read more here.)

John asked me what music I wanted to listen to.  I was standing around, bracing myself hunched over the bed during the (still terribly irregular) contractions, feeling antsy and wanting something to pump me up: “I don’t know…Eminem, Bastille, Black Eyed Peas?”  He rolled his eyes, “Don’t you want something relaxing?” and turned on Eric Whitacre. “Oh, you’re right,” I responded because I didn’t feel like being openly pissed at him yet.  But seriously, when you picture a woman in labor, is the soundtrack akin to yoga-esque chant-like choir music?

I was overjoyed when I saw Sandra, one of my favorites of nurse midwives, come to our door after having received sign-out from the last midwife.  I expected no cervical change, but instead Sandra looked up, “Oh I knew I loved you.  8cm.”

“Shit! I better get in the Jacuzzi while I still have time!”  Sandra and Dina glanced at each other, then agreed but reminded me that, by law, I couldn’t deliver in the tub.  No problem.

At this point, it was approaching noon, and John was texting a few of our friends who were on Ari duty.  One replied, “It’s go time!”  I scoffed, “Hardly.”

I don’t know what it is about water, but it dissolved like 90% of any pain I was feeling.  And I don’t have a high tolerance for pain (whatever that means, but I cry when I stub my toe), and I’m not great at mentally toughing things out.  I think I got a lucky break and this tub was magical.

Dina had me stand up out of the water during a contraction so she could monitor the fetal heartbeat.  As I was standing I felt a subtle pop! that was also heard over the gurgling water, and Dina and my eyes met.  I looked at John, “Now it’s go time.”

Dina said I might be able to stay in the water a bit longer, but I started violently shaking my head as a shockwave of nearly paralyzing pain swept over me.  I needed to get out now, but I couldn’t think about how I was going to move my legs and suddenly felt like a beached whale.  I saw Dina hit a button and call for Sandra.  John helped support me over to the bed while Dina walked with one hand cupped under my pelvis (I guess she feared the kid might come crashing down).

Sandra came in at a sprint, and I told her between clenched teeth that I needed to push.  She firmly instructed, “Just let me get one glove on!”

They encouraged me to bend my knees up to my chest.  I told them I couldn’t move, so Dina and John each grabbed a leg.  I seriously regretted the wait-and-see approach about getting an epidural.  Though I knew I was physically pushing our daughter out, I mentally doubted my capability to do so—a strange insecurity unlike anything I’ve felt outside of childbirth.  Her head came out within two contractions and four minutes of pushing.

“Anna, I need you to not push now.”  I heard John and Dina mumble something about a nuchal cord.  Maybe I was too consumed by pain that I didn’t have it in me to panic, but I remember looking at their faces and no one looked particularly worried, so I decided to try to do what I was told and nothing more.

Sandra clipped/loosened (I don’t remember) the cord quickly.  (I would later find out it was a double nuchal—the umbilical cord was wrapped around Evie’s neck twice—so the tension of the cord had to be relieved before I could push again in order to make sure it didn’t tighten further around her neck.  Sandra said, “A double nuchal doesn’t worry me.  A triple makes me sweat a little.”)  Evie’s shoulders slid out shortly thereafter.  She pinked up, squirmed, and wailed.

Evelyn Adelina was born at 12:41pm, May 14, 2014.  7 pounds, 6 ounces.  Someone put her on my belly immediately. Her body on my body felt so much heavier than her weight as it momentarily relaxed.

But I couldn’t stop shaking.  My legs, that only a minute ago felt incapable of motion, now trembled so violently that the bed shook.  As much as I wanted to hold her, it was too much, so John took her to his chest. She was clearly so ready to be born, as she immediately began routing on John’s chest and tried repeatedly to latch, so John encouraged me gently to hurry the hell up and get it together!

We opted for a small dose of Demerol, which John thought was too little to have any effect, but I swear by it, and my body relaxed into the bed. Remembering how effective it was at post-delivery contraction pains, I also demanded Motrin and lots of it!  (So, that’s Penicillin, Demerol, Motrin, and then Lidocaine injections for the repair—“natural” childbirth my ass!)  And I got Evie back.  Even in those early moments, it felt like her sweet, calm, measured temperament came through.

So a rather happily mundane childbirth punctuated by a few moments of excitement…and it still took me over 2000 words (over-sharer much?). I saw another friendly face on the postpartum maternity unit: one of my NICU mentors was on Well Baby and supervised Evie’s care. After 36 hours and a few extra tests due to the CMV I contracted during pregnancy (silly, paranoid med student), we brought her home to a surprisingly welcoming big sister.

We could not be more thankful. For the tremendous care we received during and surrounding Evie’s birth. For the help of many good friends who made sure Ari was safe and happy, brought meals and company, even stayed with us (Stephie!—who took care of us all while continuing remotely with her fulltime job!). For the outpouring of love by family and friends our daughters have felt everyday.

Happy birthday, Evie!!!

John’s shift ended at 4pm today, but I wasn’t surprised when he didn’t get home until 6.  It’s the name of the game when you’re an ER doc; as much as I gripe about it, I get it.  I also get it when he doesn’t have time to return my comparatively trivial texts: “When you get home, may I go for a run?  I need time.”

But my patience was wearing thin.  The girls and I had a beautiful day together, including a fabulously messy brunch in the park with some friends and a ton of outdoor time.  Getting them in the car to go home was an exercise of wills.  Though I got them both napping for 20-30 minutes at the same time, I had hardly made a dent picking up after the tornado of our morning routine.  I had just poured a cup of coffee when I heard Ari’s bedroom door slam open.

They were charming as hell during our excursion to Trader Joe’s, especially appreciated since I ran into one of my professors.  (The promise of scratch-n-sniff stickers at the cashier’s is a strong incentive when you’re two-and-a-half.)  But as soon as we got to the car, Evie was inconsolable, and Ari refused to leave the “castle” she was building with mulch chips on the street curb.  And I was hot, sticky, and tired.

John got home, encouraged me to go for a run, but Ari needed a snack since dinner was going to be pushed back until after bedtime in order to facilitate such run (I know, I know…not excellent or selfless decision-making).  Ari wanted a yogurt squisher and assured me that she would eat the whole thing.  I opened one for her.  She took two sips, then “all done!” and went to throw the rest in the trash.

“Stop.”  She paused but kept going and opened the trash can.

“Ari, stop please.”  She persisted this time without hesitation and threw the rest of the yogurt package in the trash.

And I lost it.  I grabbed the yogurt out of the trash and proceeded to give her a lecture about wasting food that I’m sure mostly confused her.  I threw it back in the trash, stormed upstairs, and face-planted on our bed.  I closed my eyes.  Not my finest hour.

A few minutes later I heard her little, not-so-subtle feet (how someone less than 30 pounds can make so much noise walking barefoot is impressive) climbing the stairs with John behind her.  She cautiously walked into our bedroom, climbed on the bed and rested her head on my chest: “I’m sorry, Mommy.  I love you.”  John told me that she got the rest of the yogurt package out of the trash herself and finished what was remaining.  Ugh!–I’m the bitch who made my daughter feel like she needed to eat out of the trash.

I love that I have two healthy daughters who, to the best of my knowledge, seem to be developing into decent human beings, and I am lucky that (at least for now) they are quick to forgive my many imperfections (and tantrums of my own).  And I love that I have a partner who helps me work toward being a better parent, never chastises me when I fall short, and encourages me to be kind to myself in the process.

I went for a run at 6:30 this evening–35 minutes of uninterrupted alone time in an arboretum.  We didn’t eat until 7:45, and the kids were in bed potentially by 9.  Could be worse.

I have mixed feelings about this “holiday.”  My sister and I always text each other when we get one of those random “call your mother” comments from strangers.  I think it will always be hard, and my heart goes out to the many for whom I’m sure this day is much, much harder.  I’m grateful for all the loved ones who reached out to me today.  This one was the best of the last 15 for me.

It’s hard to imagine that we will move out of our sweet duplex in less than three weeks.  It has been our home for nearly four years, the home to which we brought our newborn daughters on their second day of life.  We love Philadelphia and its suburbs.  We love the friends and neighbors and mentors we have here.  This move, though entirely what we want, is bittersweet.

On Thursday, John and I went on our last date in Philly (while living here, at least).  We chose outside seating at Audrey Claire.  When in Philadelphia, enjoy your own wine at a small cash-only BYOB.  We brought a Nebbiolo from Barboursville, where we got married.  Then we had the bartender’s choice at the Ranstead Room, a dimly lit speakeasy tucked away behind another restaurant.  The weather was perfect.  I wore a black dress and make-up.  We held hands without being encumbered (though happily so) by strollers, carriers, and diaper bags.

Yesterday we took advantage of our Longwood Gardens membership for the last time before becoming Virginians (does one ever stop being a Virginian?).  I personally have a lot more fun being a parent in the Spring (when I can just get us all outside and keep us there), so I’m pretty psyched to be moving to a place where Spring starts a little sooner.  The draped Wisteria was so inviting, but lately I’ve been, stereotypically, drawn to the friendly shade of the Virginia Dogwood (ugh, I know, saccharine!).

Check out that catfish mouth staring back at Ari!

Physically worn out, well fed, and caked with all sorts of mulch, leaves, bananas, and mac and cheese…still singing about head and shoulders and magical eggs:

We received our schedule for next year!  June 22nd I start my first block–on the WARDS!  I feel like I got thrown into the deep end of the pool…with the big kids (all the smart doctors who have so much more experience, efficiency, and gestalt) and the sharks (weird analogy I’m making to the tiny humans admitted to the main inpatient service).  I’m a little terrified, but also happy to start off with a bang!

In the mean time, John and I are checking off all the many little boxes necessary for a move and making sure our butts are covered (like health insurance).  And soaking up more of this, so much more of this:

The Broad Street Run is the nation’s largest 10-mile race, with over 40,000 runners.  It starts in North Philly, goes around City Hall (it used to go straight through the building!), then ends at Navy Yard.  I’ve wanted to run it since moving to Philly.  My first year I didn’t register in time (before the lottery, it filled up in hours!).  Then pregnant year 2, travel year 3, hella pregnant year 4.  This was our last (practical) chance before moving to Virginia.

And we had another motivation: our friend and fellow crossfitter Lisa.  A little less than a year ago, she was diagnosed with Hodgkin’s Lymphoma.  With a lot of strength, grace, bravery, and humor, Lisa underwent chemotherapy and other treatment while continuing to thrive in her many invaluable roles, including being a loving mother of two small children.  To celebrate the end of chemo and 80+ days cancer free, she decided to run Broad Street.  80+ family and friends (incidentally one for everyday cancer free) surprised her by running alongside her.

I am honored to be part of Team Lisa.  In fact, though I had always wanted to run Broad Street, being part of this team was the only real reason I didn’t sell my bib.  A series of minor but annoying injuries have kept me from distance running (that and difficulty finding the opportunity with the kids), and I hadn’t run more than a couple hundred meters since January.  But one of our beloved babysitters was willing to come over at 6am on a Sunday, and a two-mile test run last week proved uncomfortable but manageable, so I didn’t have an excuse not to give it a whirl.

I just needed to finish.  And I did, but it most definitely wasn’t pretty.  Was very thankful for my friend Vanessa who similarly trained little and agreed to share two hours of pain with me.  One of my favorite moments was when a little old lady whizzed past us and, as she patted me on the shoulder, earnestly quoted the text on the back of our shirts, “This is a good pace for you!”  (The mantra used by Lisa and her crossfit BFF.)  Don’t we look fabulous(ly terrified) before the race:

So I was a little stupid.  John, however, was completely insane.  He had to work the overnight shift, which ended at 7am.  The race started at 8am, over an hour away from his place of work and with no available parking.  His colleague was kind enough to show up to relieve him at 6:30.  John then raced (in his car…bad joke) home, had our babysitter pack up the kids (groggy, still in their PJs, utterly confused but game for adventure) and drive him to the starting line (way beyond the babysitter call of duty).  Amid the over 40,000 runners, I spotted John bouncing along at a nice clip shortly after crossing the starting line, and I felt my heart leap.  I used all my energy to catch up with him briefly (which is, of course, why the last 9.5 miles were so painful :/) and give him the most awkward mid-run smooch.  I wouldn’t find him again until the bus ride home.  He crushed it!

I admit, though I recognize the feat of actually running (as opposed to my variation of jog-walk-trot-saunter) a ten-miler after working all night, I was feverishly envious when, immediately after kissing the kids “hello,” John marched up the stairs, took a shower and went to bed.  Jealous.

You know what helps dissipate envy?  A toddler in nothing more than socks with a metal around her neck.

This weekend I served as a discussant for an 80-minute symposium, “Gendered Experiences in Science, Technology, Engineering, and Math (STEM): Understanding Drivers of Staying and Leaving,” at the annual conference for the Society for Industrial and Organizational Psychology.  Four research studies were presented that examined the work-family issues experienced by women in STEM and their impact on career success, advancement, and turnover from STEM.  As a woman in STEM, I was tasked with reflecting on the presentations, and discussing how their findings could be translated into meaningful insight and change for women pursuing and striving for success in STEM careers.

The experience was awesome!  Though I definitely did that thing where you get up to the podium and all your thoughts fly out of your head, the notes you’ve scribbled down during the presentations look like a jumbled mess, and you end some sentences with “so, um, yeah,” I appreciated the opportunity to publicly think through some of these results that feel so close to home.  Why are more college women leaving STEM majors (or, in my case, being too fearful to enter them at all).  How does gender play a roll in the confidence of post-docs or the possibilities to be hired for academic jobs?  How does family impact women’s decisions in STEM fields at the higher echelons, for better or worse?

I couldn’t help but think about some fundamental structural aspects of medicine that make being a woman who chooses to have a baby a somewhat awful experience, especially during residency.  As seen recently on the Student Doctor Network:

Resident in a surgical specialty here.  I’m single.  My program has more children than residents.  Yet another resident is pregnant, this time it’s one of my classmates.  The schedule for next year came out the other day…I’m the one who gets screwed.  I have to take an extended period of night float, plus I’m the back-up for if she delivers early…I can already tell I’m going to get stuck covering a couple of weekends for her while she’s on her 6 weeks of free vacation.  I’m sick of covering for people so they can sit on their ass and not work. It’s a small program, so when there’s constantly someone gone, the rest of us get screwed.  I’m never going to get free time off like this, so why am I the one getting shafted again?  Should the folks who had a baby have to bear the brunt of this?

Although this resident’s general attitude and tact are uninviting, she brings up valid points: the structure of residency forces a great deal of additional work on those who don’t have children.  My impression is that it leads to a considerable hostility within these communities that are, to many, supposed to act like a second family.  I wonder if this component affects women’s choices to stay or leave more competitive specialties, not only in medicine but other STEM fields.

Yet this culture is also prevalent (albeit to a lesser extent) outside of the more competitive, demanding specialties.  I am entering pediatrics, arguably one of the most family-friendly specialties.  This year, my husband and I briefly entertained the idea of having a third child while I was a junior resident.  In part based on his own residency training experiences, he kept coming back to this point: “You really don’t want to be the resident for whom other residents have to pick up call in the Pediatric Intensive Care Unit.”

Of course there were other considerations, first and foremost being the overall well-being and happiness of the family as a whole and as individuals.  Having two daughters has infused our lives with so much joy.  I think we would fall in love with a third child, as much as we did with our two daughters.  Once again, our hearts would expand beyond what we thought possible.  Ari and Evie would be in awe.  The child would be safe, secure, and well loved.

What would be the cost?  Our children have stretched us a little thin, worn our patience, exhausted us, and strained our marriage.  Though I think Ari and Evie would adore a younger sibling, it would be hard on them too, as they would see me so little as a resident, and my time outside of work would mostly be tied to a newborn.  He/She wouldn’t know any different, but it might suck to have mom replaced by a bottle at 4 weeks of age.

Though there are many interns and junior residents who choose to have a baby and balance family and career beautifully, I would have serious concerns about my work suffering.  Interns already sleep little.  I can’t imagine returning to 60- to 80-hour weeks with a 4-week-old at home.  I want to be able to do more than merely function on the job; I want to be able to learn, absorb, and retain as much as possible.  This thought is only with regards to me personally (NOT other interns/residents): I don’t think it would be responsible for the work I’m doing, for the pediatrician I hope to become, to try to juggle a newborn, in addition to the family I already have, as an intern.

As I pack away the 6-12-month baby clothes and we see other families sign on for a third child, it feels a little like inertia drawing us in.  Then there’s the question of capability–I can absolutely handle another kid, bring it on!–not a great reason to have another baby, but one us type-As tend to consider.  But I think our decision is sound.  Not now, hopefully later.  Focus on loving the children we already have, loving each other and ourselves, preserving our sanity, and giving ourselves the opportunity to thrive in our careers.

Evie fell asleep at a barbecue last weekend.  The toddlers couldn’t decide if she would be more comfortable with her hood on or off.  Ari’s friend then covered Evie’s legs with her jacket.

We could not be happier to welcome Jéssica to our family in less than two months!  Since Match Day, we had been searching au pairs through Au Pair Care (chosen mostly because it is the agency one of my mentors uses).  There were many people who looked kind, responsible, and capable.  But when Jéssica’s profile popped up in my search, something clicked.  Her photographs looked not just friendly but genuine.  Her profile description didn’t seem canned.

Jéssica is from Santa Catarina, a state in southern Brazil.  I have vague memories of my girl scout troop representing Brazil for World Thinking Day when I was in second or third grade.  I think I attempted to make a mosaic out of poster board; we might have cooked good food.  Clearly we know not nearly enough about Brazilian culture and stand to learn a huge amount from Jéssica.  Although she would like to practice her English (which, we learned from our interviews with her, is already excellent), it will be wonderful for John’s grandparents to be able to speak Portuguese with her.

There are certain details about her personality–her likes include cooking, hiking, dogs (she has one named Marley), and of course children–that resonate with the jive of our family.  Per her own admission, she talks a lot (she will fit right in!).  She has a degree in nursing and experience driving in New York City!  She has two older sisters.  And her family is very important to her.

“On paper” she looked awesome.  But it was our interview with her that did it.  We skyped with her twice, but I think John and I both knew it was her (if she would have us) within a few minutes.  She is warm, playful, thoughtful, and sincere.  And she won several smiles and giggles out of both girls–rare feats when so close to nap time.

We received her travel itinerary today–it all feels very real!  I admit, a little bittersweet.  While there is nothing wrong with more people loving on my daughters (thanks for the reminder, Mama Mills!), and I am sure she’ll quickly become part of the family…my transition from being full-time mom to working 60-80 hours a week will take some adjustment.  I want my girls to love Jéssica (I’m sure they will), and I hope she loves them.  But it’s gonna sting the first time I see Ari run to her after she falls down, or Evie reach for her when she’s hungry.

And, again, 80 degrees but insists on a wool cap.  Oh, my heart.