I have some very intelligent, kind, thoughtful friends who are absolutely opposed to universal health coverage.  Their arguments are sound and logical.  And I disagree with them wholeheartedly.

During my training to work as a waitress at a local pub in Charlottesville, the owner told us, “In my ideal world, everyone would have to work at least one year of his/her life as a server.  What you learn about others, about yourself, about what it means to be at the service of others–it’s invaluable.”

In my ideal world, everyone would spend at least one night meeting and interviewing patients in the PEEC, the place where patients who presented to the Emergency Department with possible psychiatric problems are evaluated for admission.  In what world would it be better for society for these patients to not have health care coverage?  In which the alone schizophrenic woman who is beaten and raped, and almost smothers her infant child during a period of postpartum psychosis (like one of my patients), is denied treatment for her condition?

The drift hypothesis is an argument that mental illness causes one to have a downward shift in social class that often, in turn, exacerbates the problem and causes further drift and isolation.  A famous, albeit controversial, study by E. M. Goldberg and S. L. Morrison examined the relationship between schizophrenia and social class.  It determined that there was a strong association between schizophrenia and a lower social class.  However, the social class in which the participants were raised was found to be similar to that of the general population.  Schizophrenia led to a fall in social class, rather than the reverse.

The vast majority of my patients are either without health insurance entirely or on medicaid.  Medicaid provides some assistance, for sure, but it’s still disheartening to put these young men and women on second-line antipsychotics that are going to leave them with irreversible side affects later in life because the first-line drugs are outside their coverage.

Just a piece of the argument…a far stretch from completely thought out on my end.

I don’t know what I would do.  If I’m honest with myself, I think I would opt to have my breasts removed after I was done having children.  Ovaries are more tricky.  On my Ob/Gyn rotation last year, we met with ovarian cancer survivors, all of whom had their ovaries and uteri removed, launching them into “early menopause.”  It’s kind of gentle terminology for what happens to your body when it abruptly loses a crucial component of a delicately balanced hormone supply.  It affects your body in more ways than we understand.  I don’t know what I would do.

But, similar to Jolie, I lost my mother early (at 57 to liver cancer).  Unlike Jolie, I’m not at an increased risk of developing cancer.    I’m very, very lucky that I don’t have to choose painful surgery, months of reconstruction, a body that’s not entirely my own, and perpetual hormonal instability in order to lessen the risk of death while my children are still kids.  Jolie is confident that she made the right choice for her and her family–either way, any decision at which those with the BRCA1 mutation arrive, it is so brave, and so constantly thought-provoking.

It is reassuring that they see nothing that makes them uncomfortable. They can see my small scars and that’s it. Everything else is just Mommy, the same as she always was. And they know that I love them and will do anything to be with them as long as I can. On a personal note, I do not feel any less of a woman. I feel empowered that I made a strong choice that in no way diminishes my femininity.

For the first three weeks of my psych rotation, I’m on the dual diagnosis unit at Presbyterian, where patients are treated who have both a substance abuse issue and some other psychiatric disorder.  It’s a fantastic learning experience.  But, on a ward where you require a key to get in to a linen closet-size hallway bathroom and there is exactly one break room for all staff, you can imagine that places to pump are limited.  And Presbyterian is an old hospital.  With decade-old sugar packets and rancid peanut butter jars lining the cupboards of the break room, I would not be shocked to see a rat, or at least a cockroach, scurrying across the floor.

This is where I’m pumping between patients, crouched behind the deep dish-washer sink.  I’ve hit my head three times on the damn paper towel dispenser.  My attending has gotten a full-on view of my cattle-like breasts at least twice.  And I think I’m starting to get carpal tunnel due to awk pumping positions.

The first time my attending saw me pumping, he turned around quickly and apologized emphatically.  In an effort to make him feel not so embarrassed, I thoughtlessly stammered, “Oh!  No no, I don’t care at all!”  To which he replied, “But I dooo!!!”

Fair enough.

(Side note: I have received nothing but support and encouragement in my efforts to continue breastfeeding.  One of the therapists recently offered the use of her office on another floor, I just haven’t been able to take advantage of it due to time constraints.)

Right now, my experiences have only added a little extra comedy to my days back in clerkships.  But they have made me think about what I’ll choose if I have infants while in residency.  I’m thankful for the wealth of options I, and more women, have.

The day wasn’t perfect.  Our girl is still visibly and audibly pissed to be not quite feeling like herself and, to add insult to injury, she has seven more days of the an unappealing emulsion of amoxicillin.  But we had a few moments like the one below, the photos of which I’m letting distract me in the midst of memorizing the side effects of different anti-psychotics.

Happy Mother’s Day not only to the mothers but to all who nurture, teach, love in her/his own way.  xoxo

The last couple nights have been rough.  She responds well to Tylenol but, when it wears off at 2:30am, she lets out the most agonizing cry!  As I tried to calm her, pulling out all my Ari-specific mom tricks that normally work okay, she wailed in my ear as though in response: “Mom!  This is decidedly NOT fucking okay!”  I’m sorry, love.  We’re working on it.

Hoping to get you back to baseline in record speed:

Supermom, isn’t she?  What you don’t see is her commuting from Virginia to NYC to finish rabbinical school while writing her dissertation in her eldest’s first year of life.  Or her traversing land and sea, from Israel to the States and back, multiple times a year with two small children by herself, often while simultaneously battling a sinus infection.  Lauren runs 8 km before her kids wake up in the morning, makes homemade popcorn, sets up a new educational theme weekly, brings so much love to the world as wife, mother, daughter, sister, friend, rabbi, mentor and so, so much more.

So tomorrow I’m channeling her…her strength, thoughtfulness, and immense capability.  Our babe is in bed.  Clothes are washed.  Bags are packed.  Breasts are pumped.  And I even managed to review something about anti-epileptic drugs.  I am hoping that, despite studying painfully little these last couple weeks, I manage to not completely embarrass myself on the neuro shelf tomorrow.  Please wish me luck!

But the day was long and the ending was a rather rough awakening.  We had a review session with the director of the neurology clerkship, an adorably, brilliant, slightly eccentric woman who reminds me fiercely of Professor McGonagall.  (To present a small sliver of her personality, she always keeps a huge bowl filled with chocolate candies in her office and, with it, displays a graph showing the correlation between chocolate consumption per capita per country and the number of nobel prizes won by country.  She apparently always buys her candy from the same place, and always many, many bags at a time.  As they rung her up recently, looking at her skeptically, it occurred to her, “They must think I’m crazy.”  Adorable.)  Considering that most (all?) nights I come home, hang with my daughter, eat dinner with our family, put her to bed, then pass out before I’ve gotten through one clinical vignette, I shouldn’t be surprised by how poorly prepared I am.

The brain.  It’s pretty vital.  I should learn more about it.

Feeling defeated, I got on the train, which smelled like cigarettes, to go home.  John texted me asking for an ETA since I was cutting it close to dinner time.  I gave him a better estimate when my second train departed.  Only after I handed the driver my transfer ticket and stumbled off the train did I see them waiting for me on the platform.

I’m sure you’re bored with all the recent baby pictures and videos, but try to make it to second 19.  Best homecoming!

I know it’s a rare thing, but that gives me little peace (not that I am the one who should be comforted) when I’m standing four feet from an exhausted mother, holding her whimpering toddler, who is neurologically destroyed.  It’s such a contrast from my happy, well daughter who greets me when I get home.  I’ve never struggled so much to keep it together.

One of our patients suffered a stroke as a result of a disease I didn’t think I would see in this context during my training.  Haemophilus influenza (h. flu) used to be one of the greatest causes of bacterial sepsis/meningitis in young children.  Since the vaccine came on the scene in the 1990s, we’re taught that it’s been virtually eradicated as threat of invasive disease.  Vaccines aren’t 100% affective, which is one of the reasons we rely on herd immunity.  I think I’m pretty granola, but it baffles me when parents choose to not vaccinate their children out of fear of some erroneous association with cognitive difficulties, when they’re essentially putting their children (and those of others) at risk for potentially much more devastating neurological sequelae.

Article on the physician who started this controversy…

I escaped for a few hours this afternoon to try to pound out some practice questions.  When I returned I could hear Ari crying from outside the house.  As I approached from the walkway, I heard Vovi say through the screen door, “Look!  Mommy’s here!”  And I bellowed back, “I’m coming, love!”  And there was silence.

When I got to the door and saw her through the screen, she looked at me with her saucer eyes, and immediately the corners of her mouth turned upward, and she sighed happily.  She rocked back and forth excitedly in my arms once I got a hold of her.  She cupped my cheeks with her little hands.

I think she genuinely loves her time at daycare and with Vovi.  I don’t think she misses me when I’m gone.  But I love that she still remembers me when I come back.

Little did I know how lucky we would be.  After several reassuring tests and examinations, John’s grandmother seemed to be in the clear, for the most part!  And then she insisted on coming to stay with us.  We were hesitant, but thought we would try things out.  Not wanting to overwhelm her, we compromised: they would come to stay with us temporarily, but we would put Ari in daycare three times a week.

It has been an adjustment for all of us.  We’re four adults and a little one with exploding diapers living all together in a duplex with one small bathroom.  John’s grandparents are living far from everyone they know except us, and they don’t drive.  And our daycare, though wonderful (as I’m appreciating more and more after speaking with residents with kids), has hours (7am-6pm) that are not always conducive to the schedule of a physician and a med student.

Yesterday, for example: John was moonlighting out of town, so I was responsible for drop-off and pick-up.  I cleared it with my residents that I would arrive a bit late and leave a bit early.  Ari was one of two kids in the entire daycare when I dropped her off, and I was still 30 minutes behind even my predicted arrival time to clinic.  Then, on the way home, traffic was so congested, I frantically called my friend and neighbor Steffi, who piled her three-year-old daughter, her parents, and their two dogs (they were at the park at the time) in a car to go pick up a tuckered out Ari.  (It takes a village, right?)  How do residents do it?  Thank God I’m on neuro.

All that said, I honestly cannot remember a time I’ve been this happy.  I still cry most mornings as I walk to the train (Vovi says I have a heart “de pollo”), but I love being back in the hospital (at a children’s hospital no less!), and I look forward to the hour and a half I get with Ari when I get home.  And Vovi insists on making dinner for all of us–we are SO spoiled.  So today I got home at 6:30, immediately snatched up my daughter, threw on my pajamas, made myself a coffee, and enjoyed the last of the sunlight.  It’s heaven, albeit one in which the inhabiters are not-so-photogenic (at some point I’ll do something about her impending bowl cut).

Then again, as long as I have my boo and my babe, the site of Armageddon is also not such a bad place (more on Israel soon-ish!):