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.

Summer Lovin’

Back Camera

Our family spent the past week in my and my husband’s hometowns and it made me consider how vastly different our childhood environs were from what N’s is in Philadelphia.  With the help of Wikipedia, I made these comparisons between my childhood home in the “fertile land sloping toward the sea” and N’s “city of brotherly love.”

My hometown

N’s hometown

Area

54.8 square miles

(15% water)

142.6 square miles

(5% water)

People

22,532 people

(23.8% < 18y)

1.5 million people

(22.5% < 18y)

Race

96% White, 0.74% Black, 0.96% Asian, 2% Hispanic

41% White, 43% Black, 6% Asian, 12% Hispanic

Median Income

$52,269

$36,669

Philadelphia obviously has many advantages, as it is the 5th largest U.S. city, known for its arts and culture.  However, what my hometown lacked in culture and diversity, it made up for in nature, specifically the Pine Barrens and beaches.  I grew up in a vacation destination, but was oblivious to its pearls until I had some distance from it.

When I first left home to live in New York City, I wondered how city kids would have the childhood experiences I treasured: riding bikes, swimming, and playing in the woods.  I doubted that they could have these “normal” experiences in a big city.  After babysitting for two different NYC families, I quickly learned that not only did these kids have those experiences, but they had so many other amazing opportunities.  I would take them to gymnastics, karate, ballet, and piano lessons and they rode bikes and played in the park—all things I could have done in my hometown.  However, easily accessible to them were the ballet, opera, and museums.  When I told one of the girls that I was taking an Anthropology course, she told me that her 6th grade class just toured the Natural History Museum and taught me about Margaret Mead, who I didn’t know anything about until I reached college.   These young girls, now amazing women, changed the way I think about city kids and are why I am now excited to raise one.

Seeing N crunching sand beneath his feet and splashing in the ocean made me sad that these wouldn’t be everyday experiences for him, like they were for my childhood summers.  There were so many fun things about growing up at the beach.  Fortunately, he has two grandmas who still live there though, who he can visit anytime.  Now that we are back at home in the city, we are looking forward to swimming at the Y, splashing in the public fountain, and going to the Farmer’s Market—just a few of our favorite weekend activities that aren’t so far off from what I grew up doing.  However, this Philly kid also has options like the Please Touch Museum, Smith Playhouse, Longwood Gardens, and Franklin Square in his backyard.   Between these and his weekend escapes to the shore, I think he has some fun summers ahead of him.

Book Nook

One of my favorite things about well child exams is giving out a new Reach Out and Read book.  It seems like a small token, but I love seeing the look on children’s faces as I give them a brand new book and encourage reading together as a family.  So when my own son went for his 6-month-old check-up, I eagerly anticipated what book his pediatrician would select for him.  We had plenty of books for him at home already and had been reading with him since birth, but the message that a book as a prescription from the pediatrician sends is one that I think is important and special.

Imagine my disappointment then when my son showed no interest in books for the first year of his life.  My husband and I have a combined 18 years of higher education, an entire wall of books (literally) in our living room, and a hobby of reading at our local bookstore on Saturday mornings.  How can we have a child who doesn’t like books?

ImageThen, he finally showed an interest in books and started doing the cutest thing.  One at a time, he pulls each book off his bookshelf until he finds one of his 5 favorite books.  That’s not the cute part though, that’s the frustrating part that I have to clean up.  The cute part is that he then takes that book, walks over holding it horizontally and attempts to insert it into your mouth.  I can only imagine that this is because that’s where words come from.  This technique is then reinforced by us reading the book.  He might be a genius.

I am thrilled that N is finally showing the passion for books that his father and I share and I know that this will only grow as he does.  His early favorites are diverse, a little comedy, a little counting, and include one of his pediatrician’s Reach Out and Read selections.  I can only hope that my patients enjoy the books I give them as much as N enjoys his, and I hope their parents find the same happiness that I do in watching him make his selection, feeding me the book, and then sitting in my lap to embark on a literary adventure.

Here are N’s Top 5:                                  Image

1.  Max’s Bedtime by Rosemary Wells

2.  Happy Baby Colors by Roger Priddy

3.  123 Philadelphia by Puck

4.  Brown Bear, Brown Bear, What Do you See? by Martin and Carle

5.  Harry the Dirty Dog by Zion and Graham

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