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An intern recently presented to me a premature baby discharged from a two-month NICU stay to her 15-year-old mom.  The intern’s eyes were wide as she read the pages and pages of NICU jargon that she was expected to synthesize into a plan for this baby.  After we discussed the primary care of a premature baby in general terms, I held up the discharge summary and said, “If this overwhelms you, imagine how this mom feels bringing home this baby.”  This pile of papers translates into a very tiny baby, who has already had an eventful life, and his young mother who has to learn how to meet his needs while maintaining her own identity.  “You need to go back in there and give this mom some encouragement and support.  That is the most important thing you can do today.”  This is how I feel about most newborn well visits.  After making sure the baby is healthy and safe, much of what I do is partnering with the mothers (and fathers) about how difficult, and yet amazing, their job is.  There is so much about those first few weeks that makes you barely able to recognize yourself or your former life and while you love your new baby more than anything, you dream about a full night of sleep and the freedom you once knew.  It helps to hear someone who has survived it all tell you that you will too.

I recently read another blog post about moms allowing themselves to be photographed with their children, despite their insecurities and lapses in hygiene.   I wrote earlier about how to dress your post-baby body, but I’ll admit that there aren’t a plethora of photos of me and my son to choose from for exactly the reasons that Allison Tate mentions, including putting my son’s grooming and fashion before my own.   However, I was asked for work to submit a photo of myself and my son for a newsletter and while scrolling through thousands of photos on my iPhone, I scarcely found any featuring myself.  I imagined that someday my presence in my son’s life would be undocumented (besides this blog!) and since then have tried to hand off the camera more often so that we can capture these moments.   I want my son to see the joy on my face when I am holding him, the bags under my eyes because we were up together all night, the pucker of my kisses all over his head, and the body that gave him life.

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Every so often, a family asks if they can take a photograph of me with their baby– usually to document their first exam.  I love these requests because it reminds me how special my work is when it starts to feel routine.  Lately though I have been the one asking families if I can photograph them.  One mother of nine had seven of her children in my office and while we were talking they had all managed to climb onto the exam table, sitting there with legs dangling like the photo of the men atop the skyscraper, so I asked if I could capture this on her camera.  How often could this mom possibly get photographed with her children?

For all the moms I see in my clinic who don’t have the ability to hand off their camera to others, or don’t have the mommy friends that I have to share their feelings, and can’t imagine that one day things will get easier and that the sleep and freedom they once knew will return, albeit in a different way, I try to offer them small pieces of that in 15-minute increments.  As mothers, we need to support each other and create a community that highlights the important work we do every day.  And while sometimes I am not sure what pearls I have to offer the brilliant residents with whom I work, my experiences from the trenches of motherhood are always freely shared because I think these are some of the most important things a young pediatrician can learn.

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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.

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