Bananaman

When your toddler has a tantrum, ignore it.  They want you to give them attention, and if you do, you reinforce the behavior.  I tell this to parents in my office almost every day.  Now that I have an 18-month-old at home, I do my best to follow my own advice and appreciate how hard it is to be a textbook perfect parent.  Beyond the embarrassment and shame you feel in front of other parents, there is the genuine concern for your child—maybe he is actually suffering—and your own personal desire to end the tantrum (and everyone’s misery) by giving in.  I am not easily rattled, though, so I usually hold out and this strategy was working well until I went to Whole Foods.

N has recently become obsessed with bananas, so when he shouted “nanas” and pointed toward the produce section, I figured it was a good idea to stock up.  While the bananas sat on the check-out conveyor belt, they seemed to taunt him and he descended into a banana-frenzied fit, complete with tears, frustrated pulls of the hair, kicking, and swatting away any substitutes I offered.  I thought to myself, well, he isn’t starving and they aren’t even ripe yet, so I’m just going to ignore him and hope this passes quickly.  I could feel the stares and glares from all around me.  I willed the cashier to speed up, but I held my ground.  Then, the Whole Foods Customer Service representative came over and said, “If you just want to give him a banana we won’t charge you.”  I was mortified that it had reached this point.  “It’s on the house!” he exclaimed, proud that he had solved this problem.  Doesn’t he know that this will only make it worse in the long-run?  I wanted to say, “Oh, why didn’t I think of that!” but instead, I surrendered, peeled, and handed over my power to my toddler.  As he furiously shoved the banana in his mouth, acting as if this was the first time I had ever fed him, I scanned the faces of the other customers hoping not to recognize anyone.   No friends, no patients, no DHS workers—phew.

There are times when every mom feels like a failure and tantrums certainly highlight these moments.  The next time we were at Whole Foods, a mom standing next to me apologized for her son’s whining with “I’m sorry, he’s a little wild,” and I gave her a knowing shrug and “so is he.”  N was amazingly calm though and a Whole Foods employee actually rewarded him with a knit giraffe.  This made me feel like the many moms who have reassured me in the past but then seemed to have angelic children, making me hate them even more, and I felt guilty for being on the other side.  I still give parents the same advice about tantrums, although I know we all break the rules sometimes.  Like toddlers, we all have our moments of success and failure.  One time Whole Foods is bribing you with bananas and the next time you are celebrated with handmade toys.  Either way, this kid has learned how to score Whole Foods swag.

Preschool Prelude

First days are always tough.  I’ve had many first days of school over the years and they are always full of excitement, fear, promise, and trepidation.  Now that my schooling is behind me, I’m starting over with my son’s first days and it started yesterday with nursery school.  We’ve already mastered saying goodbye, as I went back to work when he was 6-weeks-old.  He’s also been in daycare for the past seven months, so I know he can socialize with peers and follow rules (or at least as much as a 17-month-old does).  What worried me the most about the first day of nursery school was whether or not his teachers would understand him like I do.  Once they figure out his quirks, I know they will see the amazing, sensitive, determined, and passionate little man that I know.   I just wish I could fast-forward to that point and save him the inevitable frustration that comes with not yet being able to verbally express oneself and being in a new environment.

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In discussing our children, a friend and I sheepishly admitted to each other that when asked to describe our children (as nursery school applications required), we were afraid to write down the first adjectives that came to mind.  Is “active” a positive way of saying “destructive?” she nervously laughed.  We were embarrassed and fearful that the nursery schools would reject our applications based on our own descriptions of our toddler sons.  What kind of moms are we? Of course we think they are amazing, but on a daily basis it is their wild behavior, tantrums, picky eating, and messiness that bombards our senses and sensibility.  In order to help a new teacher see past these things and instead the boy I love, I would like to offer up these tidbits of advice, proclamations of fact, and charges of encouragement.

  1. He’s a yes-man, but it is pronounced like a Swedish “Ja”
  2. When he raises an index finger toward the sky, he hears a plane or helicopter and will continue to point until you acknowledge it too
  3. He likes to hug stuffed animals with you—a plush ménage a trois
  4. He will teach you more about yourself than you will teach him
  5. He is going to tantrum and his head will find the nearest sharp corner when he throws it back
  6. When he is really happy, he scrunches his nose when he smiles
  7. His eyes sparkle, and not only because they are the blue of the Caribbean but because they are full of life
  8. He gets frustrated easily, but challenge him to persevere
  9. He can run ½ mile before pausing
  10. When in doubt, he wants milk.

This first day went well, but there will be so many other firsts to follow.   I will continue to let him introduce himself to his teachers and allow them their own opinions, keeping my adjectives to myself.

Nursery School

It wasn’t until I was on the other side of the healthcare system that I allowed myself to be vulnerable in front of a nurse.  Typically as a resident, I strove to earn nurses’ respect with my clinical competency and polite manners, peppered with a little deference.  Most nurses have been doing their jobs for years when I walked onto their units for a few weeks and tried to pretend that I knew what I was doing.   Regardless, I would never have admitted to any of these nurses that I was insecure with my own station, until N was in the NICU.  For the first 10 days of his life, the day and night shift nurses of the NICU were his second moms.  They not only helped change, feed, burp, and bathe him, but they taught me these basics of infant care, at which most teenage girls who babysit are proficient.  They didn’t ask or care if I already knew how to do these things because, although they knew I was a resident, they also knew thatImage I was a first-time mom.  They assumed that I either had no clue or that their way was better and they were right on both accounts.

While the Neonatologists that took care of N were amazing and still inspire awe in me, the nurses were the ones who cared for my spirit.  When I cried, they put up a privacy screen.  When I looked frightened, they gave me reassurance.  When I needed sleep, they insisted upon it.  And when I needed the wisdom of someone who had gone through this a million times before, they gave it.  Those 10 days were the most intensive parenting class my husband and I could have asked for and at the end of it we wondered how other parents were able to be discharged after only 2-3 days in the hospital.  When one of our favorite nurses walked us to the front door of the hospital on Day 11, we felt well equipped with all of the tools she had given us.

Months later at a NICU reunion, we eagerly ran around looking for each of N’s nurses.  The few we found seemed excited to see him, but likely didn’t actually remember his short and relatively uneventful 10 day stay despite the enormous impression it made on us.  As a physician, this experience taught me much about the impact that a good nurse makes on a family.  The skills these nurses taught us were as vital as the medical treatment he was prescribed.  As a mom, I am grateful that his nurses allowed me to be vulnerable and to be that first-time mom and not a pediatric resident.

Red Eye

I always knew that as a pediatrician, I would bring home a few germs.  Kids are crawling with them and crawling all over me.  I’m currently in the middle of an antibiotic course after a Pertussis exposure at work last week, and I’m sure it won’t be the last one.  Occupational Health and I became friends years ago when I got HIV in my eye.  Yes, I said HIV in my eye.  Let me start from the beginning.

It was October of my intern year and I was feverishly trying to prove myself as a legitimate doctor.  I felt especially confident with a bisexual teenager who came in for his yearly physical, as I had experience working and doing research at the Mazzoni Center, a Philadelphia LGBT health and wellness center.  After this teen confided that he had unprotected oral sex with men and had recently been bothered by a persistent cough and sore throat, I decided to culture him for gonococcal pharyngitis, in addition to a number of other sexually transmitted infections.  My supervising attending witnessed as the throat swab gagged him and he coughed a large wad of mucus into my eye.  Eww.  My attending though seemed unimpressed, as if teens were coughing mucus into the eyes of pediatricians everywhere, and being an eager and naive intern I wiped away the mucus with a wet paper towel and continued on.

By the next morning, I had forgotten about the grossness of this event and almost completely put it out of my mind with the exception that my eye was bright red.  I, along with my coworkers, believed that I must have picked up pink eye, until four days later when I was on call and received a page from the Virology Lab technician.  He reported that Patient X had a viral load so high he needed me to order additional tests.  Wait, Patient X.  He’s the one who coughed in my eye.  “Do you remember this patient?” he asked me.  I was weak with the news and all I could say back was, “my eye.”

An infectious disease doctor, who has known me since I was a medical student, tried to reassure me between my sobs by quoting the medical literature’s risk of HIV transmission from this type of exposure.  He informed me in an upbeat tone, it was 1 in 100,000.  WHAT?!  I had hoped the denominator would be more like a zillion, because I can’t imagine what a zillion looks like, but I can picture 100,000.  That’s the number of seats in a large football stadium, the population of Erie, Pennsylvania, or the number of people at a U2 concert.

Reflecting on this experience now raises many mixed emotions.  I am relieved that after 1 month of antiretroviral therapy, 6 months of testing, and 180 days of worrying, I am HIV negative.  Phew.  I feel angry that my attending didn’t guide me more appropriately and guilty that I didn’t advocate for myself.  I am grateful that I was on call with a senior resident who made one of the worst nights of my life more bearable and that my co-interns surrounded me with love and support.  I am proud that the first diagnosis I made as a real doctor was one that may have saved a teen’s life.

So even though I received my Tdap booster and I should be immune to Pertussis, I’m still dutifully taking my Z-pak because I have learned not to take chances that would compromise my and my family’s health and this is the example that I want to set for the interns I teach and the son I am raising.

A Baby Story

Oh F*@#!  That was the first thing I said when my son was born.  Not quite the birth story I would have written or that my birthing class had us rehearse.  This language is so atypical for me, that my husband felt the need to discuss it afterwards.  “Did you know you said that?” he said meaning why did you say that?  Well, when you haven’t slept because your water broke at 2:30 AM and you’re 5 and 1/2 weeks early and you’re a pediatrician who knows what the worst case scenario for a 34-weeker is and you’ve been pushing for an hour and there is a Neonatologist pacing in the corner and you’re in the worst pain of your life and the OB resident yells “Oh my God,” the appropriate response is “Oh F*@#.”  A better question is, what makes an OB resident think that it is ever appropriate to say “Oh my God” in the delivery room?

Whenever I’ve been called to deliveries, my favorite part is the few seconds that I get to introduce the mothers to their new babies.  After we have finished drying, stimulating, examining, banding, and foot printing, I eagerly swaddled each baby and presented him or her to the anxious mom.  What a magical moment in one’s life and I get to be a guest in it.  I always pitied the C-section moms who often couldn’t manage to hold their babies and had to awkwardly glance over their shoulders to watch dad hold the baby, while OB residents put their abdomens back together like a jigsaw puzzle.  Even sadder though were the NICU moms, who merely got to peer at their babies through the isolette windows.  I did not want to be one of those moms.

I held myself together fairly well, given the circumstances, until the Neonatologist got to the part of his antepartum counseling where he explained that there was a likely chance that I wouldn’t get to hold him.  Despite the fact that he was making an unwanted early entrance, I was eager to get my arms around him and couldn’t bear the thought of him being torn away from me, in addition to the implication that that meant he was too sick for me to hold him.

My roommate in the postpartum unit was a NICU mom too, but with 3 days more experience than me.  Although our babies were roughly the same gestational age, hers was intubated and when I met her, she still hadn’t been allowed to hold him.  We hoped together each morning that today would be the day and we celebrated when it finally happened.  I felt guilty that I was able to go to the NICU and hold, rock, and breastfeed N whenever I wanted.  So proud of my little 5-pounder I was that I breezed into the breastfeeding class being held on our floor feeling like the luckiest mom alive.  And then I saw all of the other moms, comfortably holding their plump babies who latched easily and didn’t have to be positioned carefully so as not to disturb their monitor connections or IV tubing.  I was the only mom sitting there, learning breastfeeding techniques without a baby and wishing to be invisible, when the teacher further humiliated me by giving me a doll with which to practice.  Not soon enough I was back in my room, trying to muffle the sound of my sobs when I heard my roommate from the other side of the inappropriately named privacy curtain, say, “are you ok?  Breastfeeding class isn’t meant for us.  I cried for like an hour afterwards.”  We were a different breed of moms- struggling to attach while separated, breastfeeding dolls, praying to hold our babies and cherishing each minute we are granted this privilege.

I hadn’t liked that resident much anyway, but when she yelled what she did, I couldn’t help but panic that something was terribly wrong.  What she didn’t know was that once N decides he’s going to do something, he just does it.  He may make you wait months before he decides to talk and then he’ll just blurt out a bunch of words.  Or he may wait an hour for you to push him out and then decide he’s just going to shoot out and catch an OB resident by surprise.  The way he entered this world has been quite similar to the way he lives in it: determined, on his own terms, and with lots of commotion.

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