ditch day

31 Aug

ditch day 1

This summer we elected to keep Ari in daycare despite the fact that I was home on maternity leave for nearly 11 weeks after Evie was born, and then another couple weeks between the culmination of my Frontiers course and my next rotation.  It’s a decision about which I felt some anxiety and guilt–sending one kid off to be looked after by other people when I, myself, was available; spending thousands of dollars on childcare that most mothers aren’t able to afford.  I acknowledge that it’s a luxury, let’s just start with that.  But here are a few of our reasons:

  1. We don’t have family in the area, and John was back at work less than 48 hours after Evie was born.  Especially in the early couple of weeks when my body was still repairing, I appreciated help with a toddler so I could focus on feeding and keeping alive our new little barracuda.
  2. After the initial period of repair, I still wasn’t sleeping consistently at night.  A nap during the day when Evie was sleeping felt necessary for maintaining my sanity, or at least my happiness.
  3. Probably the most important: Ari loves being around other kids her age, and she loves her daycare, or “school” as she calls it.  I honestly believe we would have been doing her a disservice, taking her out of a stimulating environment only to have her be bored watching me nurse Evie every 90 minutes, not to mention the harsh transition of leaving for a few months and then returning again when I resumed rotations.
  4. Tied for most important: I know Evie isn’t going to remember, but I think it’s good for her to also get some one-on-one attention.  I loved some of our tender, uninterrupted moments, just her and me.  And, if the weekends when John is working are any indication, Evie tends to feed and sleep much better if she isn’t anxiously anticipating Ari’s next onslaught of kisses or tickles or large packet of wipes…all meant in the name of love and attempts at being a helper, but distracting nonetheless.
  5. With waiting lists as they are, I’m not confident we could have gotten her (or her sister) back in daycare when I went back to school.
  6. Finally, I had responsibilities outside of family–residency applications, papers, certifications required for graduation from medical school–that required attention, and I certainly appreciated being able to spend several good, productive hours working on them during the day rather than relegating them to post-bedtime activities.

I’m not trying to defend our decision…well, maybe I am.  Bottom line: we had the option to have extra help, and we took it.  It felt like the right decision for our family, and I’m still working (a little) on not feeling lazy or like less of a mother for it.

I start back on my next rotation on Tuesday.  I really wanted to set aside some time with just Ari, which, between John’s crazy schedule and me putting last minute finishing touches of my residency application (available for submission September 15th!), proved challenging.  We found a window on Thursday this past week (I wish we had found more!) when John had the afternoon off and was available to take Evie, and I called the daycare to tell them we were playing hooky, taking a mental health day.

In the morning, with both nuggets, we took our time.  I think Ari must be going through a growth spurt, because she housed three eggs and two bowls of cereal!  Nothing felt rushed, and I sat back and watched Ari spend 20 minutes deciding whether or not she wanted to wear a shirt that day.  We went in to Crossfit for a WOD and then enjoyed a post-WOD sprinkle for a friend and fellow athlete expecting her fourth (!!).  In the spirit of Ari-day, we missed the group shot because I didn’t have the heart to tear her off the erg, but we couldn’t help documenting Evie and her matching “cousin”:


ditch day 8

Solo Ari-day officially began after lunch, books, and nap.  I fed Evie one last time, passed her off to Daddy, and Ari and I were off!  We took a second trip to the zoo.  Although the company of the last trip couldn’t be beat, I’d have to say this trip was more enjoyable, sans 94-degree heat or a febrile, diarrheal illness.  And it felt good being able to let her call the shots…like spending a disproportionate amount of time just staring at the goats, because goats really do go “BAAAHHHHH!”  And so can my daughter.  (They go “baaah” a lot when there are several male goats fighting over a female goat in heat.)

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On the way home, we stopped for froyo.  I was such a proud mama watching my baby use her spoon so well, not spilling a drop until the finale when she secured her lips around the side of cup and tried to pour the remainder down her throat (and then dark chocolatey brown yogurt got absolutely everywhere–in her shoes, in fact).  

Before heading in, Evie joined us visiting our neighbors and Ari’s most favorite canine named Dex, a bowlegged bulldog with quite possibly the largest head and tongue you’ll ever see.  Walking back up to the porch, John snapped the photo at the very top–I love it.  I seriously stare at it while nursing Evie in the middle of the night.  Our girls!  We just look so calmly content, rested, and well fed–a great moment at the end of a summer I’ll never be able to repeat.


cry-it-out epic fail

18 Aug

It isn’t right for everyone (like my friends in a one-bedroom Manhattan apartment, neighbors on the other side of three walls), but the cry-it-out technique of sleep training worked wonders for us.  After three months of spending every night pacing the downstairs, gently bouncing the constantly swaddled Aurelia (facing in, facing out, football hold, side/stomach position, you name it), and another two months of total dependence on this godsend, John and I sat down (per our friend’s suggestion) to some of our favorite movies and a bottle of malbec, and we gutted it out.  It took about three days and a lot of tears (Ari’s and mine) and stress eating (me), but then our nighttime terror became a (knock-on-wood) good sleeper, reliably going to bed by 7:30pm and sleeping a solid 10-12 hours.

When Ari was about six months old, sleep trained for a few weeks at that point, she woke up crying in the middle of the night.  Instead of rushing to her, I waited about 5-10 minutes, and the crying subsided.  When I went to get her the next morning, I opened the door and was immediately hit by the stench of vomit.  Vomit all over her crib, all over her.  She was cheerful enough.  I, of course, felt a huge pang of guilt.  It took a fair amount of lysol and oxyclean and open windows to get the smell of partially digested food and stomach acids out of the room, but we all survived.

We’ve been lucky to have gone nearly a year and a half without similar incident.  Much, much more frequently than not, if we do go in to rescue her in the middle of the night, we do more harm than good and just rile her up.  Most of the time when she cries she’s not even conscious, and there’s very little we can do to console her.  So we wait, and it normally works.

Yesterday morning was our first Sunday in a long time in our own bed without John having to work.  I was just putting Evie back down after a feeding at 5:45-ish when I heard Ari start to stir and cry.  By 6am, there was quiet.

At 7am, Ari started crying again, this time more insistently, calling, “Mommydaddy!!  Daddy!!!  Mom-mEEEE!  DADDYMOMMY!!!!”  John took one for the team and rolled out of bed.  I rolled the opposite direction and closed my eyes.

But the cries didn’t quiet; if anything, they intensified.  After a minute I heard John turn on the faucet to the bathtub and high-pitched screaming followed, loud enough to rouse Evie (she can normally sleep through the noise of a jackhammer), who looked at me perplexed.

Poop.  I suspected poop or vomit.  Or both.

John confirmed the former.  It was everywhere–her crib, her stuffed animals and lovey tiger Neville, her books (the poor cat in the hat had it caked all over every page), the floor.  She had it matted into her hair and her pajamas, under her fingernails and IN HER MOUTH.  My poor daughter was literally eating her own feces.  When John discovered her, she was holding out her hands and crying, pathetically begging for someone to FIX THIS SITUATION.

She was bathed and changed.  Teeth were brushed.  As soon as we got 2 bowls of Multigrain cheerios and a couple eggs in her belly (I suspect a growth spurt, therefore increased food consumption leading to high poop volumes), spirits were raised, and she seemed to have forgotten most of the trauma from the morning.  Still, we tried to make the day extra special.  All was forgiven after our family outing to Melodie’s–iced coffee for us, a fresh croissant for her–followed by please touch.  We’ll also be treating her to some new books, because some, I’m afraid were poop-i-fied beyond repair–I didn’t even bother recycling them…can you recycle poop-covered literature?

Because it’s just been too long since we had a post about bodily fluids…

Will write more about our recent trip and epic wedding (so much happier than CIO epic fail), but just a few pictures of one of our favorite Philly families, transported to Virginia for the celebration.

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And a choo-choo…

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16 Aug

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Guh!  She tries so hard now when you encourage her: “Cheese!”  Makes me think of these first attempts…

At the old duPont garden home:

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It felt right to spend my mother’s birthday surrounded by orchids.


definitely the best part

7 Aug

The single greatest impediment to error prevention in the medical industry is that we punish people for making mistakes.  (Lucian Leape, MD, “Error in Medicine,” JAMA 1994)

The last two weeks have been a helpful crash course in patient safety.  I’ve enjoyed nearly all of it, but I admit that I’m sensitive to what I perceive as busywork.  I’m giving a presentation with a classmate tomorrow on one possible intervention for improving the current method for incorporating a patient’s outside imaging into his hospital record.  What has been, I think, a productive thought exercise and possible tangible product, has also been tangled in a mesh of unnecessary, frustrating, fruitless efforts, which have taken up more than just my own time.

You could argue that the frustration, the perhaps unnecessary efforts are all part of it, helpful tools and experiences in their own right.  But this afternoon I just couldn’t wait to come home to this:

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It broke my heart this morning to have to rush her and Evie out the door this morning, while she tried to crawl into her backpack, desperate to go for a walk.  God, Ari makes me laugh the way she insists “Hah!  Hah!” (Hat), while tapping the top of her head.  And our sweet, docile second child…not quite sure where she came from.  She likes having her fontanelle stroked, her soft forehead caressed.  One of her caretakers at daycare said that she will be our family’s peacekeeper, and that we’re gonna need it!


1 Aug

This week was my first back at school since Evie was born.  It’s been okay.  I’m taking a frontiers course (a 2-week course led by faculty experts) on patient safety and quality improvement.  The schedule is so reasonable (like 8:30-4), and I’m still struggling.  The one morning this week I was totally solo with the girls, I actually called the daycare from the train in order to make sure I had dropped both of them off, fearing the worst systems error (like what we dissecting in this class).

But it feels good to be learning around adults.  As we studied Toyota’s method for creating quality, I found its mission statement particularly encouraging.  It’s not to make best-selling cars; it’s to make the world a better place:

Toyota will lead the way to the future of mobility, enriching lives around the world with the safest and most responsible ways of moving people.

Through our commitment to quality, constant innovation and respect for the planet, we aim to exceed expectations and be rewarded with a smile.

We will meet our challenging goals by engaging the talent and passion of people, who believe there is always a better way.

This weekend we have a toddler who is very excited to go back to the beach!!  Have a wonderful weekend!

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avascular necrosis

28 Jul

2011 was not my year, and it started with breaking my shoulder.  Happily, the surgery was a success, I healed quickly, and enjoyed full use of my shoulder until last summer.

I started noticing some discomfort in my right shoulder joint while I was doing kettlebell clean and jerks (sub-par description: snap the kettlebell up to the front rack position with one arm, then quickly press it overhead with the same arm).  I took it easy and backed off, things seemed to improve, but the discomfort would always come back…kind of had an eery quality about it, if that makes sense.  It just felt like something was wrong.  I stopped doing any movement that caused pain, including any weightlifting overhead.

About a month later, I got pregnant.  I knew that no surgeon would touch me in my status, so I used the pregnancy as a practice in patience (if it wasn’t that already), I listened to my body and tried not to be overly frustrated.

The last two months have been the worst for my shoulder, as it’s a pretty much constant annoyance.  I can’t hang from a pull-up bar without feeling pain; I can no longer sleep on my right side.  Carrying two children at once has likely been an exacerbation.

John made the good point that, since we had met our deductible this year with Evie’s birth, I should try to figure out the problem sooner rather than later.  If it was just a question of a screw being out of place, going in for surgery before the new year would be financially beneficial, not to mention easier on my daily comfort.

I was, frankly, shocked  by what the x-ray of my shoulder revealed: “There is extensive subchondral lucency and patchy sclerosis involving the humeral head suggesting avascular necrosis.”  Layman’s terms: my bone is dying due to interruption of blood supply, a rare complication from the kind of bone break I had.

Tomorrow I go in for an MRI to determine how quickly the necrosis is evolving, if I’m in danger of bone collapse, or if it is relatively stable.  Bottom line is that I will need a joint replacement, but the question is when.

Although this news isn’t terrific, I’m encouraged by the options available to me and my surgeon’s optimism–his goal for me is full use of the joint.  First screws, now a brand new joint!  I’m becoming more and more bionic with every procedure!  At the end of whatever road we go down–pain management, watchful waiting, surgery, recovery and rehab–I’ll be very happy when I’m able to carry my daughters on my shoulders again.  It’s the best (“dah baest!” as Ari declares).

This weekend I dragged a febrile 21-month-old, her sister, and friends to the zoo (“ztou!”) in the 94-degree heat.  I liked the giraffes.  Ari preferred the cold ice cream.  (I’ve noticed that on weekends in which John works, I don’t shower.)

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don’t get sick on a plane

25 Jul

We learned from firsthand experience that there isn’t much on a flight that will help save your life from a medical standpoint: a small automatic defibrillator, like 500mL of normal saline, an injection of epinephrine, a couple bandaids.  Here’s another reason you should try to avoid cardiac arrest on a flight that I’m on: as of 10:30 this morning, according to the American Health Association, I am a qualified Advanced Cardiovascular Life Support (ACLS) provider, and therefore deemed fit to come to your rescue.  While I feel comfortable cycling through the algorithm (shock, two minutes of CPR, 1mg epi, etc.), I would rather not be the one calling the shocks on your poor fibrillating ventricles.

So maybe I should just not get on an airplane without John.  He will always be seven years ahead in medical training and is, as an ER doc, uniquely qualified for this sort of thing.  He can be the rescuer and I’ll stay with the kids.  How bad could the latter be?

Happy Friday!

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