Previously Published

Never How it Should Be

~ cindylw ~ 1 Comment

Also published at: https://www.kevinmd.com/blog/2019/02/when-a-baby-arrives-dead-in-your-emergency-department.html

When a baby arrives dead in your emergency department

When a baby arrives dead in your emergency department

When a baby arrives dead in your emergency department

The world stops. You stop breathing. You are gasping for air.

She is limp, she is cool, she is pulseless.

Chest compressions on the tiniest 6 month old I have ever met are done with the finger pads of my index finger and middle finger. Quick, synchronized beats. I look at her blue, blue lips. It should never be like this.

Her eyes are fixed and dilated telling me that she has been like this for quite some time.

We stop and check for a pulse. No pulse. Chest compressions resume, we work to put a tube in her mouth to help her breathe. It is how I imagine a doll’s airway must look like. Stiff, tiny, a small pink flap over the throat.

There is a cool calm, a cool horror, a cool this-is-never-how-it-should-be. We work deftly to bring her back. But she is gone. She was gone before she arrived. She is gone now. She is gone.

There is hysterical sobbing heard by the family. Our insides are gutted. Our hearts, shattered. But the emergency department keeps pulsing, and we need to keep it afloat.

I meet my nice gentleman with the irregular heart beat in the 160’s. I check on my patient with the migraine headache. I discuss at length with my patient with the extraordinary high blood pressure and horrible headache the need to do a lumbar puncture to rule out a head bleed. She ultimately leaves against medical advice despite my coaxing and persuading. I evaluate a diabetic with intractable vomiting and abdominal pain. I see a sweet woman with severe pain who is now wheelchair bound and whose 80-year-old husband can no longer care for her at home. His shoulders relax and his eyes sigh in relief when I tell him I am going to admit her to manage her pain.

Throughout all of this, the weight of a dead 6 month-old suffocates me and holds me captive. My heart is in pain, and I am devastated, and this is too catastrophic to set aside to mourn later, but I do. I do, because this is what I do. This is what we do.

I’ll never forget walking into this. That sweet purple, lifeless, limp 10 pound baby on a huge white stretcher. The tiniest of chest compressions giving her heart an external beat. For those suspended moments in time, she was all of our child. We loved her, we ached for her, we didn’t want anything to harm her. We will all weep in our own ways over the days, weeks, months to come. Not even the usual armor that we constantly garner will keep these feelings at bay. This is one that will rattle us. Keep us jarred.

Because there is nothing natural

When a baby arrives dead in your emergency department

The Man That Scares Me and The Man I Love

~ cindylw ~ 2 Comments

Republished at: https://www.kevinmd.com/blog/2018/10/the-man-that-scares-me-and-the-man-i-love.html

There is a man. He is in my house. I don’t know where he came from. But he just came into my house. And now he is living there. And I am afraid of him. I do not know who he is. There is a man in my house. I am so scared. I don’t know why he came. But he is there. And he tells people he is my husband. And he is not! He is not! And no one believes me. Do you believe me? He is not my husband. I am so scared. Do you believe me? I am a good person. I have seven children. I am an honest person. There is something wrong. I know there is. I know there is.

 My patient. Age 68. She perseverates about this man. She is insistent. She was found wandering in the hospital parking lot. No one is with her. She wants to let out her fear in screams, but her voice is thin and frail. She is so frightened.

 They told me she has early onset Alzheimer’s dementia a year and a half ago. Last week I found her standing outside in the rain. A few days ago she had walked down to the neighbor’s house three doors down at 11 o’clock at night without a coat on. Today, she had an accident in the bathroom. She hollered for me to come to the bathroom and then hurried me away because she said she was going to clean it up. I went to check on her and she was gone. She had taken the car and left. She drove herself here.

 My patient’s husband. He is soft-spoken. His left hand tremors as he stands. His face is slightly glossy and his expressions are muted. I explain that she currently is confused. She thinks he is not who he is. She may be frightened to see him.

Sometimes she gets like that. She yells at me. “Get out! Get out! You don’t love me! You don’t love me! You son of a bitch! Get out!” It hurts my feelings. It does. It really hurts my feelings. And then sometimes she tells me she loves me. She thanks me for being her husband.

He speaks with a hollow, flat voice. He stares at me with foggy, pale blue eyes. His sadness and defeat lean into me. He tells me to wait for his son. His son is arranging for her to go to a center. He’ll have the details to tell me.

We’ve been married 44 years. We have seven children. And 16 grandchildren! She is my world. Can I go in?

 We stand outside her room, and his eyes fall on the closed door handle. I tell him that she seems frightened at the moment, but he knows best. If he thinks she will be comforted by the sight of him, he is more than welcome to go into her room. If he thinks it may make matters worse, he is welcome to wait in the waiting room. Whatever he thinks would be best for her.

Well. I think I’ll try, Doc. If she shouts and hollers and shoos me away, I’ll go outside. But if I go in quietly, sometimes I can talk to her and she is okay with me staying there. And then sometimes she warms up to me. I’m going to try.

 He is soft spoken but resolute. I peer through the crack he leaves in the door as he slowly inches in. He leans over the railing of the bed. He straightens her white crisp hospital sheet. She looks at him and I can’t hear their conversation, but that is relieving. He settles into the seat next to her side.

The next time I enter the room, the husband has left with family to rest and the patient’s son sits at the bedside. He loves his parents and he tells me that they are arranging for her to go to a memory care center.

He won’t be far behind her. He can barely take care of himself, let alone her. It’s just been too much for him, you know?

 The last ten days has been draining on their family. This seems like a quicksand downhill plunge. They have been in and out of hospitals. She was at her neurologist’s three days ago and there is nothing to do. Maybe these new medications will help. They will take time. In the mean time, they are chasing her in the rain.

I come back when the work-up is finished. I am relieved. She has a urinary tract infection. I am not relieved there is something wrong with her but I am relieved there is something fixable. You see, urinary tract infections can make you more confused than normal. Confusion can be the absolute only sign that you have an infection. And there it was. The last ten days of rapidly losing this adored wife, this beloved mom, this treasured grandmother, explained with a urinary tract infection. IV antibiotics were started and I admitted her to the hospital where she would not wander into the rain and she would get better.

I am not saying this is the end of their battle, that it won’t still be a declining slope, but I am saying that maybe they haven’t completely lost her the way they had thought.

I go back into the room to tell them. She is no longer tense and tearful. She is relaxed and loved and safe next to her son. I tell them about all the things I have done. Laboratory studies, CT scan, and that she has a urinary tract infection that is very treatable. She laughs out loud and all sense of that frightened woman I had met before seem to be drowned right out. She holds her hand up high in the air to give me a high-five.

Wow! Good job, Doctor!  So thorough! Thank you!  

She laughs joyously like I have just uncovered the eighth wonder of the world for her to see. I thank her for the first high-five of my day. We all chuckle together like old friends and it feels good.

There it was. A glimpse of her real self. All the charisma, all the spunk, all the warmth. There was the woman he has loved for 44 years. There is the woman that raised seven children with all the strength in the world. I see her now. I can see why this is so hard. To see her, then lose her, then see her. It would hurt my feelings too.

Hold close to those you love. Remember all you love about them. Tell them often. Let what you love imprint itself onto you, because you never know which way life may turn.

 

.

Therapeutic Tears

~ cindylw ~ 1 Comment

Also published: https://www.kevinmd.com/blog/2018/05/a-doctor-cries-therapeutic-tears-with-her-patient.html

He wasn’t particularly likable on first encounter. He wasn’t apt to answer questions asked. He had a long pause and a long drawl and a tangential, winded story–and back story–all of which he was bound and determined to tell to its detailed completion. With an irregular heart rate in the 170’s and a respiratory rate in the 30’s, I tried to steer him in the direction of concise answers so I could obtain as much information as possible and do my job. This is an emergency. He is an emergency. An emergency who had waited until the last possible millisecond; we did not have the luxury of time.

But he was not to be rushed. My mind raced around his long pauses. My hands flitted around. Feeling his pulse, feeling his distended abdomen. Feeling the smoldering, red, hot cancer that took over his right thigh. I had never seen anything like it. It took my breath away and chilled me with impending fear of the extent of disease yet to be uncovered.

I tried to redirect him, but each interruption was met with a pause, and an indignant return to where he had left off in his storytelling.

It had been three years since he found out. Then, it was just a small bump. They told him it was cancer. It was easily covered up with clothing and easy to deny. He muffled it’s pervading presence with his stubbornness. He was indignant. This wasn’t happening. But it continued to happen. With or without his permission. It grew and grew and grew. And now, it was an undeniable monster. Growing on his thigh, in his liver, in his lungs. Filling up all his space, causing him to take staccato, labored breaths. Fighting to steal some room for oxygen every moment of his days.

His heart medications had gotten mixed up, confused, or refused. It was hard to completely tease out what had happened, as he wasn’t ready to be completely forthcoming. His stories took us farther away with every follow-up question asked. Now his heart worked in an overloaded chaotic state.

Infection had found its window of opportunity and seeped its way in to make sickness sicker—his organs on the cusp of failing.

His last name ended in an “-er”, like “Tyler” or “Kramer”. I brought the consent form for the procedure, he turned his head sharply towards me; we were practically nose to nose, as I had leaned in close so he could hear me in his good ear. “That’s not me. My name has no ‘S’” he said. I looked at the name I had written a top the consent form. I had mistakenly added an “S” to the end of the “-er”, like “Tylers” or “Kramers”. “You’re right”, I said. He gave me a gruff, indignant grunt.

We did what we could to stabilize him. I prepared for a procedure. “Have you done this before, Doc?” He looked suspicious. “No.” I said resolutely. “But I just looked it up on YouTube, and it looked really easy.” He was startled and appalled. I winked and smiled. “Oh, you got me. You got me good. That was good.” He let out a bellowing laugh like a man with all of his breath and strength. It filled the room. We both needed to share that.

I spent my time in Room 7 with him. Fluids, antibiotics, labs, imaging, procedures, talking. I softened. I grew to see his heart. His light. And I grew to like him very much.

I ultimately admitted him to the hospital. He may not have too much more time.

The next day was a day off clinical work, but I was at the hospital for meetings. My mind settled time and time again on Mr. “-er” with no “s”. I wandered between meetings up to his hospital room.

It took him a second to register who I was. My hair was down, and I wore normal clothes, not scrubs. “Oh hi Doc. Well, what are you doing here?” He asked breathlessly.

“I was just thinking I wanted to see how you were doing.”

“You want an update? Well, I can’t says it’s looking good Doc.”

He recounted his last 24 hours.

“I think I waited too long, Doc. And now my wife, you know. She’s home. She needs someone to take care of her. So, you know. We have to figure out how to tell her. My son was here, you know. He slept here last night. You just missed him.”

We sat for a long time. I watched his monitor. An irregular fast heart rate still in the 140’s. I listened to the rapid jagged, sharp breaths he sucked in and out.

“This must be tough. You have to remove yourself. You can’t let yourself feel. You see terrible things. All the time. But you have to Do, not Feel. It must wear on you.” In a moment about him, he made it about me.

“Well,” I said. “I just want you to know you have touched my heart.”

We cried. That awful stifling cry where so much needs to come out of what feels like a pinhole. I gripped his forearm with its weathered, dry skin. My finger scraped the edge of the medical tape that held his IV in place. He patted my hand with his other hand until the blood pressure cycled and forced him to straighten it out.

“Oh Doc. Thank you. For your therapeutic tears. They are warming. You worked last night, and now here you are. Right next to me. What a doc you are. What a doc you are.”

He lay with his eyes closed. Tired. Silent. Just his labored breathing.

Mr. “-er”, no “-s”, you are on my mind. Know that I’ll be here. Right next to you.

How Was Your Shift?

~ cindylw ~ 2 Comments

Also published: https://www.kevinmd.com/blog/2018/03/emergency-physicians-shift-really-went.html

She is 61 and she can’t help but smack her lips together repetitively. She has no teeth and the curvature of her spine makes her a miniature version of what she once was. Her frizzy hair is a purple-gray tone, and there are dark particles of something in the knots alongside her left temple. Her clothes are too loose and there are food stains on her shirt. The ambulance arrived at her home and there were pills strewn all over her floor and scattered pill bottles. She tells me that it wasn’t her. That someone had been in her apartment. That they were putting different pills in those bottles that weren’t hers. That pills were showing up on her floor. She was being followed when she went places. Her lips smacked harder as her anxiety mounted. She had to flush all the pills down the toilet because they weren’t her pills and so she didn’t have her own to take.   I ask if there is family I may call.  She stares back at me with hollowed eyes and does not respond.  She had just been released from the hospital a week ago for paranoid thoughts, but it is clear she will need to come back in.

He is 70 and his anxiety is like a storm cloud exploding in the room. He is overwhelmed because he cannot pay the bills and someone has stolen his identity. His furnace is broken and he is afraid the pipes will explode. He is concerned there is a carbon monoxide leak in their home and they are all being poisoned. At times he cannot speak because he is so overcome with his panic. He stutters and spits and cannot get the words out. I hold his hand and rock it back and forth as if to relieve the tremors that riddle his body.  I tell him it is okay over and over as I hold on; at times he appears momentarily calmed and is again able to speak until the next wave of emotions takes prey over him. His family arrives, and there are tears of fear, pain and love filling their eyes. None of this is real. No one has stolen his identity.  There are no broken furnaces and no carbon monoxide leaks. He paces at home and cannot eat or sleep. They have even called the fire department to the house to prove to him that there is no carbon monoxide leak. But it has not helped. These delusions have become his reality.

He is 57 and drinks every day and lives on the streets. He comes in one to two times a week for pain. Sometimes, he says his pain is so bad he wants to shoot himself. He says he has guns at his son’s house. This time he said he fell and his hip hurts. I help him take his pants off and he smells of urine and stool. Where can he go to take a shower? There are no bruises, scrapes, or cuts, but I x-ray his hip and there are no fractures. He says he won’t actually shoot himself if he can have a sandwich and bus tokens to go. He asks for a sandwich and bus tokens with every visit. He says his pain is 10 out of 10 and immediately falls asleep. It is the warmest and quietest place he will sleep until he comes back next week.

He is 20 and he overdosed on heroin. He was not breathing when the ambulance arrived. They gave him medication and resuscitated him and now his heart is racing and he looks bewildered as if he is on fire with anger. He says he knows it is dangerous. He has seen his friend dead in a car from a heroin overdose with the needle still in his arm. Maybe this is his rock bottom. I ask him if he is ready for me to help him get help so he doesn’t die too. He was really close this time. He says he understands what I am saying and he appreciates it. He says he is ready to stop, but he just doesn’t need help today.

These were four people I met on my evening shift last night. There are endless more stories like theirs. I don’t know where they were before they got to here, but I know life has not handed them anything. Their days are constant, steep uphill climbs. It may be addiction. It may be mental illness. It may be violence. It may be homelessness. It clasps its grip around them and won’t let them go. Day to day it swallows them and pulls them back down deep. There is little voice that advocates for and represents them. There is endless judgment that looks down upon them.

Friends and family will ask me how my shift went. I often don’t know what to say. Sometimes I feel I can help and do great things. Sometimes it is a vat of endless hopeless stories in a system with limited resources that continually seems to fail in one way or another. We will keep showing up and keep doing what we can, but it certainly is not enough.

The MIA Parent

~ cindylw ~ Leave a comment

Also published: https://www.scarymommy.com/want-people-know-about-absent-parents/

In hushed voices, I heard them. The seven-year-old boy stood, still in full practice hockey gear, hockey helmet pressed against the window of the double doors, waiting for an adult to arrive. “His mom is never here, poor thing.” came one hushed whisper. “If I knew which bag was his, I’d help him change myself!” came the hushed response back.

This parent thing is a hustle, isn’t it? Making it on time to this hockey practice, to this football game, to gymnastics practice. Remembering to pack a cardboard cereal box for the next school project, remembering to buy Valentine’s cards for the school Valentine’s party. Remembering to sign permission slips and pay for the school party. RSVP’ing to your son’s school friend’s birthday party, then hurrying to the store the day before to buy a birthday gift. Not forgetting to pack the mid-morning school snack when packing the lunch you made last night. Buying the right dance shoes for your daughter’s dance competitions. Getting new skates for your son’s growing feet. New snow pants for your seven-year-old daughter that has been squeezing into too tight pants for an embarrassingly long amount of time. Having dinner ready. Making sure your kids have their shoes and boots for school. And a hat. And gloves. Lining up all drop-offs and pick-ups so your kids are never the late ones or the last ones to get picked up.

Maybe your hustle looks different than my hustle, but it is all in the wizadry of scheduling and mental notes floating in our minds when it all falls into place day after day after day.

Listening to those moms at that hockey practice, I felt a pang in my heart. I felt a pang in my heart for the multitude of times I was that MIA mom. When I am that mom that cannot drop off and pick up my daughter at dance practice. When I cannot stay and watch my son play football. When I cannot be the one to pick them up or drop them off at school. When I could not be there at their 1st grade winter party. That time I almost missed my 3-year-old’s first daycare program and nearly broke my back figuring out a way to make it there.

That MIA mom has been me time and time again. But I do want to make one thing clear. I am not always there, but I am always there. I packed the snack in my daughter’s dance bag, I counted her shoes to make sure she had her jazz, ballet, tap shoes. I laid out those dance clothes you see her wearing. I made sure my son had his mouth guard, full water bottle, and flag football jersey and all flags accounted for and laid out on his bed before I left for work. I pre-prepare dinner for my kids, even when I cannot be there to eat with them. I laid out their boots, coats, hats, gloves in front of the garage door, I fastened their snowpants to their backpacks. I packed my daughter’s daycare pillow and blanket for naptime and hung it on the door. I hunted down the school library books in the darkness and jammed it into my son’s bookbag all before I hurried out the door for work at 6 am. You may not always see me, but I am always there.

My physical absence has no correlation with how much I care about my children. No matter where I am, my presence and heart are always with my family. All of our families look different. But the bottom line is that we cannot compare or judge one another by our outer appearances. We all have different capacities and priorities come in all different forms. They come in the form of work, in the form of aging parents, in the form of friends, in the form of spouses or single parenting, or other siblings. Everyone’s circus is made differently.

Two weeks ago, I was in Whistler, Canada with my husband. He was the chair of a conference, and I, along with friends, were along for the ski adventures that laid on those gorgeous mountains. I ran into a friend who asked me if this was the first time I had left my children behind for an extended period of time. It was not. I explained to her that while it was not without its flurry of emotions of guilt, anxiety, sadness to leave my children at home, it was also with excitement, happiness, and anticipation that I looked forward to dedicating undivided attention to my husband and friends. I explained that I felt it was healthy for my kids to realize that the world did not revolve around them. That I loved them intensely and loved spending as much time with them as possible, but I am also committed to tending to the other parts of my life that make my life full and make me a whole person. She tilted her head, mind blown, and said, “I’ve never thought about it that way.”

Sometimes it is out of our control. I have to go to work when I have to go to work. But sometimes, a night out or a weekend away is something worth prioritizing. The bottom line is my life revolves around my kids, but it also revolves around showing them the strength of who I am as an individual and reminding them that they are one part of a greater world around them.

I believe that we all want to be there for our kids, the best we can. The best we can sometimes means we are late to pick them up from hockey practice because their younger sibling has gymnastics practice across town that consistently runs late. The best we can might mean we have a baby-sitter take them to dance practice when I work predominately evenings. The best we can might mean we spend a weekend away with our spouse to care for our marriage. The best we can might mean clearing our day to volunteer at their 1st grade Valentine’s Day party. The best we can might mean saying no to a work meeting to be there for our daughter’s first dance competition.

Being the MIA mom does not mean you are not doing the best you can. I know that better than anyone. So, to that MIA hockey mom or dad. I see you and your presence in your son’s well-fitting hockey helmet, jersey, and skates. I know you are present and the best you can do with your circus is absolute perfection to me.

Beyond The Final Breath

~ cindylw ~ 3 Comments

Republished at:  https://www.washingtonpost.com/national/health-science/we-didnt-save-his-life-but-we-didnt-disrespect-him-either/2017/02/03/74612afe-d1f6-11e6-9cb0-54ab630851e8_story.html?utm_term=.9e665c02ec43

Republished at:  http://www.kevinmd.com/blog/2016/12/didnt-save-life-better.html

“Well?  Did you save him?” “No. We did better than that.”

He came in pulseless. The machine performing chest compressions with the rhythmic thud, thwack, thump. His ribs heaving under the force of the compressor, keeping his heart artificially beating. The plastic tube secured in his airway forcing puffs of air to inflate his lungs.  His skin slightly purple-gray, on that narrow brink between life and death. His eyes like speckled round pieces of glass, with fixed pupils, staring nowhere.

Our team was assembled, prepared, ready. We worked deftly with experienced hands, our focus and determination fueled by adrenaline, a synchronized team, we worked side by side; this was our life to save and we were going to do everything.

But his glassy, fixed eyes spoke to me. As we regained a heartbeat, and we halted the chest compressions, and our adrenaline settled–here he lay, not out of the woods, but heart back from a standstill. His glassy eyes told me his heart was back, but his life of living was gone. The life that laughed, that smiled, that held his wife’s hand–there was no amount of life saving measures that could bring that part of him back.  We didn’t know how long ago he had stopped breathing. But it was long enough to have robbed him of his mind, his memory, of everything that made him that man his family loved.

His wife and only daughter arrived. I left him in my able teams’ hands and sat down with them. I looked them in the eyes. I told them the story of his final hour of life, from the perspective of his fighting, beating heart.

His heart was here with us, but his  brain had gone too long without oxygen before we could reach him. He would never walk out of this hospital. They listened to my words.  Words spinning and exploding beyond comprehension. They nodded their heads, as if to ask me to keep talking.  So long as I was talking, we didn’t have to move.  Tears were inevitable. It was so sudden. How could they be asked to make a decision of whether to continue with the resuscitation or to just let life walk its final march.

Yes, this was about them, but this was ultimately about him. What would he want? It is true it was sudden. It is true it is the toughest decision anyone will make.  But with the return of his heartbeat, the decision to continue resuscitation is as big, as active a decision as it is to stop all aggressive measures and let him be comfortable. These are both big decisions with big paths for us to travel down.  I needed them to understand that this wasn’t their decision to shoulder. It was their time to respect–in the most selfless of ways–the man they loved.  To step outside themselves, slip into his shoes and honor his wishes in the greatest way possible.  What would he have wanted if he saw himself in this moment?  Representing him in this way is a responsibility no one cares to bear, but this final act is the biggest, most giving way they could love and honor him.

His daughter immediately said, “oh, he would want none of this. He would want you to stop.”

They stood by his bedside. We withdrew all aggressive cares. We turned off the beeping monitors, we stopped artificially putting oxygen in his lungs, we turned off all pumps, we covered him with warm blankets, we let him be comfortable with his wife holding his hand for his final minutes, and his daughter stroking his hair.

And that’s how he left us.

Did we save his life?  No we did not.  Not today.  We did better than that. We upheld our promise to continue to respect his wishes beyond his final breath.

Broken Oven, Glory to You

~ cindylw ~ 2 Comments

Also published at:  http://www.scarymommy.com/being-busy-not-badge-honor/

Four weeks ago, in the midst of a baking/cooking frenzy, my oven took its final breath and puttered out. With zucchini bread batter mixed and poured, I stared at it, wild eyed with that blood vessel menacingly popping out of my right temple. With flour highlights in my hair and batter splatters on my shirt and yoga pants, I had a few words with my oven.

The next day, the repair guys were out, and let us know that it was the central circuit board that needed repair. As luck always has it, they no longer made the parts to repair it; however, they said they could certainly send it to the manufacturer for a “small” gob of money to have it repaired. Or, we could spend the large gobs of money to replace the entire oven. Yep, I’d love to send it in to the manufacturer, I replied, as if there was much of a decision to be made. So they removed it, and on their way out the door, explained it would take two weeks and I would be without an oven, oh, and without my stove as well. Huh? What the what??? The nice repair guy grinned sheepishly, “well, there have got to be a lot of great take out options around here, right?” He zipped up his jacket, grabbed the signed paperwork and scrambled to his van, keeping one eye on that crazed vein in my right temple that was slowly starting to declare itself.

No stove or oven for two weeks???? Oh boy. I checked the freezer. Emergency corn dogs and dinosaur nuggets and microwaveable-bagged veggies to save the day. I wish I had some inspirational MacGyver-meets-Martha-Stewart story of how I used chicken wire to make a stove top with flint and kindle or how I made adorable tea party finger foods or how I did the sensible thing and went out and bought a temporary, portable stove-top, but God no. That never happened. The repair guy was right. There has been a lot of take out, and a lot of microwaved, processed foods these last few weeks. And you know what? I liked it. No, no. I didn’t like it, I loved it. I love my microwave. I am one with my microwave. There. I said it.

Since having children, I have felt this great responsibility to feed them healthy, well-balanced meals. Foods that make me feel good about what I am putting in their little, rapidly growing and developing little bodies. They have been hearty-vegetable-eaters, fruit-devouring-monsters, home-cooked-meal-lovers. They have a sweet tooth for home-made healthy baked goods. All this feels so good to be able to provide this for my family, some weeks I am better than others, but in these last two weeks . . . turned three weeks without a stove, I have come to a realization that I was too busy to notice before.

In trying to keep up with my career-family balance, I have constantly felt over-stretched, over-tired, and overwhelmed. I remember leaving a late shift at work, and one of my beloved nurses telling me, as she realized that with my husband out of town, I still had to go home and pack lunches for my kids and had to get up early the next morning to take them to school, “You have to let it go.   Just let it go.” And I looked at her with that same bewildered“HOW DID MY OVEN JUST BREAK” look, but too tired to ask further, just nodded, smiled and kept on walking out the door.

But now. Now I get it. See, the breaking of my beloved, necessary stove and oven has shown me something I’m not quite sure I could have seen myself. That in taking this break from the often insurmountable task of meal preparation and everything that goes into it for my family, I have allowed something to go and it has allowed me to breathe. Those extra hours a day that have fallen into my lap are glorious. They are hours I can spend on something productive or spend on nothing at all but my couch, a cup of coffee and HGTV. They are hours I can call a friend and ask, “How are you?” Those extra hours have lifted a weight, a responsibility, a stress, that gifts me energy and leaves me less tired, less cranky, less irritable. I had no idea that something as simple or as tough as preparing meals was doing this to me. Because, if I think about it, I tell myself, “Come on, how hard is it to make meals?” I don’t have to explain it to you if you are this person in your family. It is hard.

So, now I am thinking what else do I feel this way about? Every task, every responsibility we pile onto our shoulders is just one more “simple” thing, and we say to ourselves, come on, how hard could this be to add this one tiny thing? Well, one thing adds time, time adds energy, energy adds stress, stress leads to irritability . . . ahh, it is all making sense!!! What a simple concept. Where have I been???

I think I’ve been where all of you have been. We have been feeling that we are working mothers and fathers taking care of our family, of our home, of our communities. Sometimes, we lose sight of the value of our own limits and really, our own self. Boundaries blur until there are no boundaries, and we keep on keeping on. We estimate our capabilities, and like the old saying, our eyes are bigger than our stomachs, our undertakings underestimate what is needed from us to accomplish every minutiae of every day—and soon we are stretched too thin doing everything, but unable to do anything with the best version of ourselves.

So, let’s give ourselves a break. What we do is enough. What we don’t do is acceptable. Give what you have to the things that matter the most, and when there is not enough of you to go around, be okay with it. There is no glory in “I am so busy!” There is value to doing things with time, with your full attention and ability, choosing wisely what is important to you and having the energy to enjoy rest, relaxation, and time for calm. Let’s chisel away at this society of “busy”, and let the glory be with broken ovens and microwaves once in awhile.

Your Last 24

~ cindylw ~ 5 Comments

Republished at: https://www.kevinmd.com/blog/2019/04/a-patients-last-24-hours.html

There are those 25 minutes before my work day begins that I either drive in silence, or blare the radio and jam out to pop hits priming myself for the unexpected hours ahead. When the music is loud and the tempo is upbeat, it transports me back to being 21 on a summer day in Chicago, before kids and bills, headed nowhere too important, definitely not too fast, stuck in traffic on Lake Shore Drive. But lately, I’ve trended more towards driving in silence. Calmed by the gentle hum of the engine, feeling the gentle pull of the turns in the road, letting my mind settle. And lately, my mind has been on you.

My heart settles into a dull ache. It pulls me in and hollows me out. I feel unjustified in feeling this way. These are not my feelings to feel. These are not my emotions to own and declare. There are people more deserving of telling this story. It is not me. But here I am. These emotions clinging onto me for the past 5 weeks now, and I don’t want it just to be in my mind. I don’t want this hollowness in my chest to go unidentified. It means too much. So, I’m going to talk about you.

I met you on a busy night in the emergency department. You were short of breath, you were sweaty, your heart rate was going too fast. I thought within seconds of meeting you, “He is sick.”

When emergency medicine providers say someone is sick, it doesn’t mean the usual sick.  We do not throw around the word “sick” haphazardly.  It does not mean you have the sniffles, or a bad cough, or fever, or appendicitis, or a broken leg. When we say “sick”, we are on high alert. Our heads turn.  Our focus shifts from everyone else in the emergency department to you. You are the one that needs us most. We will take care of everyone else, but you have taken priority over everything else that must be done. Bluntly put, when we say “sick”, we realize–perhaps before you do–that you are struggling for your life.  We are worried that you may get worse and die.

Everything had happened so suddenly, your wife told me. You had seemed fine. Maybe a little fever. Maybe a bit of body aches. Then tonight, you were suddenly short of breath. Sweating. Feeling your heart beat out of your chest.   You have no idea what suddenly changed. I don’t want to get into the medical specifics. Though I replay them over and over in my mind. I pour over your chart again and again. What more could I have done? I’ve talked to my closest colleagues. I’ve lay in bed at night and replayed everything.

I remember exactly how you looked when I walked in the room. I remember your wife sitting there on the edge of her seat.   I remember you said you have three kids. Two boys and a girl. I remember how old they are. I remember the name of your youngest. I remember the puzzled look your wife gave me, “What is going on?” I remember explaining to the both of you what was happening. How infection was taking over your body, taking over your organs, shutting down your body. You asked me how long you would be in the emergency department. I explained you needed to be admitted to the intensive care unit. You both were a bit puzzled. How could a healthy 43-year-old become sick so fast? I explained that I was worried about you.

I don’t worry about a lot in the emergency department. I can handle it. I can fix it. But you. I was worried about. I did everything my training had taught me to do.  You were getting better. I felt slight hope that maybe things would turn around. You were admitted to the intensive care unit.

The next day, I checked on your chart when I got to work. You had died.

You have a beautiful wife. You have three amazing kids. You are the nicest of people. You are hard working.

You are no longer with us.

My heart aches. My heart aches, but when it aches, it is an unworthy ache. Because the heart ache of those that love you, those that were your life: your wife, your children, your parents, your siblings, your nieces and nephews, those are the ones that are truly hurting. And this makes my heart ache more. I wish you were alive. They wish so more than my words can do justice.

I did everything I knew how to.  But it wasn’t enough to save your life.  I wish I could have done more. I am so, so sorry.

I was maybe one of the final ten people you met in your life. For you, I was only part of those last 24 hours. For me, you will be in my heart a lifetime. I can’t even say this without grimacing, because what you mean to me doesn’t even compare to those that love you most. But I just want you to know, you have affected me. You will stay with me. You will live on in every one you touched along the way. Even in your last 24 hours of life.

A Work Day That Ends in Sushi

~ cindylw ~ Leave a comment

Previously published on:  http://www.coffeeandcrumbs.net/blog/2016/4/8/a-work-day-that-ends-in-sushi

My husband and I waited seven years to get married; in those months after we became engaged, before I even picked my dress or wedding colors, I had already started planning for the family that occupied our daydreams. We’d have three kids; I was sure of it. We would have two boys and one girl. Of course, our baby girl would be the youngest so she would have two older, protective brothers. They would come on cue two years apart.

Instead, I picked my strapless A-line dress, we settled on red roses and ivory linens with gold trim, we got married, and we had six miscarriages.

I would get pregnant, and just as we would allow ourselves that hopeful glimpse of the first trimester final stretch, I would miscarry. It was crushing. Yet it became a cycle that I became all too familiar with. My emotions became a pattern of predictability: excitement, anxiety, devastation.

By my third miscarriage, the emotional strain of losing each baby I had lovingly carried  brought me to the point of buckle-at-the-knees desperation . . . followed by a sinking relief. I felt relief that I wouldn’t have to wake up another morning asking, is my baby’s heart still beating? I would let my anxiety wash away, replaced by a heaviness in my heart, and almost a strange sense of peace. It was a dark place to be, but a familiar dark place. A place that I could control.

In the midst of uncertainty, I even developed a miscarriage routine. Routine was something I could do. And something I could do well, on my terms. It was a way to say, “I got this.” Even if I didn’t.

 I would realize I was miscarrying, and continue through my day. Continue to care for other people, to smile and joke, when inside, I was hurting so much. I was thinking, “I know you are hurting, patient-in-my-emergency-department, and please be assured I will do my best to take care of you, but you see, what I can’t tell you is that my baby is dying and I am hurting too.”

My baby is dying right now as I stitch up this cut on your finger. My baby is dying while I try to figure out why you are having abdominal pain. My baby is dying while I tell your loved ones you are having a heart attack. My baby is dying and I can’t take care of her the way I can take care of you.  My baby is dying and no one knows it but me.

After work, I would call my husband, then stop to get the sushi I had craved since learning I was pregnant. I would go home and focus on the pain of my cramps, because that was exponentially easier than acknowledging my broken heart. When everything passed, I would mentally brush my hands off and ready myself for the next time. That was my routine. My miscarriage routine.

I was riddled with guilt over everything about it.

During this two-year period, I felt like a failure. I felt like a weak woman. I felt I was doing something wrong. I felt it was my fault. I felt guilty. I felt inadequate. I felt out of control. I felt ashamed. I had never felt so vulnerable and nothing had ever felt so personal.

A year into the process, I went to an infertility specialist and received the million-dollar work-up. Nothing was wrong. How could nothing be wrong? But test after test confirmed that, “Congratulations! Nothing is wrong!” Translation: there is nothing we can fix. I was started on this medication and that medication, because “It’s worth trying.” I was hopeful, but hopeless. I was exhausted from this constant testing of my emotional strength.

And then it was our seventh pregnancy, and this time–twins!!!! Twins!!! My excitement was quickly followed by a flood of anxiety. My husband and I kept our news to ourselves. We held our breaths.   We had been through this. We tiptoed around our fears, whispering to one another, stifling the excitement we held in our glances towards one another, and we waited. And waited. And my belly grew. And I had no cramps. And I had no bleeding. And I saw their heartbeats. Time and time again.

The infertility specialist said we didn’t need him anymore. I sat still in his clean, slightly-dated office, in the same blue upholstered chair with its thin wooden arm rests, the same chair I had sat in for two years, staring at the same framed picture of him and some big fish he had caught with his nephew, and I weighed the heaviness of his words. Then I broke down in wave after wave of tears. We didn’t need our infertility specialist anymore.

We passed three months. And four months. And five, and six, and seven, and eight!!!!! And two healthy beautiful babies were born.  They are beautiful to this day. I stare at them sometimes, and marvel at how they came to be.

Sometimes when I am tucking in my five-year-old daughter at night, I tell her, “Do you know that you are more beautiful than I could have ever imagined?” What I mean to say is, everything about her existence is more beautiful than I could have ever imagined.

When we decided to have a third, I was ready for the journey. I was nervous of going through the process again, but having had our twins, I knew it was more than worth it. The day we decided we wanted to try again, I put up my defenses against my own emotions.

Five weeks later, just like that, we found out we were pregnant. I braced myself. I was fearful this would become another pregnancy that would fall victim to my routine. I went in for ultrasounds every week. Week after week, there was a heartbeat—I couldn’t believe my ears. And then our beautiful baby girl came into our lives seemingly seamlessly. It was too good to be true, but it is true.

These three beautiful babies of ours.

I realize now after eight pregnancies and three babies and innumerable dreams for our family, there is nothing to be ashamed of. There never was. There was nothing I failed at.

 These days, when I see the chief complaint of “possible miscarriage” show up in my emergency department, I want to see that patient. Not because I can provide better care than my colleagues, but because I want to share my story. Mother to mother. I want to give them hope and I want them to know they are not alone. I am unashamed of the tears that fall from my face when I share in their grief and acknowledge my own. I want them to know it is okay to grieve and natural to feel defeated, and then it is okay to hope again when you are ready.

Sushi has once again become my favorite food. When I eat it now, it doesn’t taste the way it once did. I don’t feel like I am swallowing heartache, loss, and failure. These days, when I stop for sushi at the end of a long day, I bring it home to share with my three children and husband. We talk about what was good about our days, what could have been better about our days, what we look forward to tomorrow. It has become our family favorite meal.  No words can express what these days that end with sushi mean to me now.

I am thankful for everything I have been through. It has given me what I have, it has given me who I am, and it has given me what I have to share. And most of all, it has given me and my husband our beautiful, healthy children.

A Memory of Sundresses and Heels

~ cindylw ~ 4 Comments

As previously published on:  http://www.scarymommy.com/ever-evolving-marriage/

All of our mornings begin the same. We wake up as if in mid-panic, frantically racing against the clock to brush our teeth, take a quick shower (or sometimes not—thank you, top knot, for being on trend at this season in my life), throw on some clothes and get the kids ready for school. Sometimes we tag team, sometimes one of us has been up way too late with work and one of us takes the morning duties, sometimes we both have been up way too late and we both take the morning duties, or one of us takes one for the team and let’s the other sleep a little longer.

This particular morning, I can’t remember who was up late or if we were both up late, but we both got up in a frenzy, bleary-eyed, hurriedly getting ready for the day ahead. At one point, I remember being half-ready, opening a dresser drawer to grab a shirt as my husband passed by hurriedly pulling his undershirt over his head. I thought about how we have evolved.   Six years ago, there would probably have been a pause, a flirty comment about his half-dressed wife, or a playful kiss or hug. This morning, like every morning, there was a sense of immediacy. There were demands that needed to be met before it was too late, and we were already waking up, mid-rush. Our three kids’ teeth needed to be brushed, they needed help getting this arm in this sleeve or that button buttoned, and our littlest needed her nighttime diaper changed as its bulging bottom taunted us with what would happen if we waited. There was breakfast that needed to be prepped, and hair that needed to be combed and put in braids. There was my husband that needed to be ready to go to work, and my need to at least have my teeth brushed and no remnants of yesterday’s mascara under my eyes when I dropped them off in the morning. It was our morning routine of the race against time.

Yes, today, our day-to-day routine and the way we interact in these routines have changed.

I have a vivid memory of walking with my husband through the middle of campus when we were in college. It was a gorgeous mid-morning spring day. I remember the green ivy that added so much richness and life to the brick walls of those old buildings. He was walking me to chemistry class.  I remember realizing that I had forgotten a sweater to pull over my strappy dress because though it was sunny and warm outside, chemistry class was always freezing cold. I remember the gentle, lazy click of my heels on the uneven paver stones. The thing about this memory, is that I was wearing a strappy, floral dress to chemistry class. In heels. And that was who I was when my husband met me. I was this girl that dedicated an hour every morning to blow-drying and curling her hair, to getting ready and wearing little strappy numbers. And heels. Always heels. I could do anything in heels. I could do a four-hour experiment in Physics lab in heels. I could run the entirety of campus in heels. I realize this is not everyone’s college years, but these were mine. And this is the girl my husband got to know 14 years ago.

And today, that person that my husband met is so far from the person I am today. I truly can’t remember the last time I took an hour to get ready. Maybe my best friend’s wedding over the summer? And wasn’t that because we had to figure out how to iron, pin, and drape our saris? I can’t remember the last time I wore heels for more than a short evening out. Which reminds me, I really should get new work sneakers . . . And dresses? Who can live in dresses? Are you insane? The way I am constantly bending down to pick up one kid or the other or squatting to pick up the trail of Cheerios that follows my toddler through life? How would I do this in dresses? My wardrobe of athletic wear and lounge wear run the gamut of colors and seasons and serve me very well on a daily basis . . . and sometimes a two-day-at-a-time basis . . . I think back to that person I was, and can’t imagine how horrified she would be to see me now. Putting on jeans for me on a day off is a good day. Blow-drying my hair? Wow. I MUST have a special event I am going to. It’s not that I don’t take pride in how I present myself, I do try to be healthy, dress appropriately for occasions, and try to stay fit, but today, there are too many stacked priorities to have time for those things that seemed to fill my college days. While getting ready was most certainly once a priority that floated easily in my top five essentials, it has quickly been bumped down by school drop-off, grocery and meal preparation, work meetings and obligations, juggling our schedules, picking up toys and mystery bits of dried food from the floor, days dedicated to my family, laundry, laundry, and laundry.  And laundry.

I think about how relationships and marriages grow. They are ever evolving as our lives change; it fascinates me to think how so many variables can change and one couple still find unity and consistency in one another.  I wonder, does my husband ever think about what happened to that girl he met?  Does he ever wonder if we will ever be those two people who met a decade and a half ago?

Oh. But I already know the answer. There is so much more to what we have now. Right now, we have a family. We have three children with the most beautiful souls. They are kind. They are empathetic. They are considerate. They are full of smiles and happiness and joy. They are well-fed, well-dressed, and well-loved. They love each other and their family. They are these truly wonderful little people because of us.  We have taken the two of us, and have nurtured and entwined ourselves in rich, green ivy, and made it so much better.

I may no longer be that girl in a sundress and heels, but I am so much more. I am the reason we have groceries in our fridge. I am the reason we have healthy prepared meals at dinner time. I am the reason our home is furnished and there is a place for every toy. I am the person that knows where my son left his Batman watch last week. I am the reason that fruit I bought and the leftovers from yesterday will get used in tonight’s meal. I am the reason my daughter will make it to dance class on Thursday on time with her jazz and tap shoes and water bottle. I am the reason my son will start soccer in April. I am the reason our kids have a five-year check-up with their pediatrician tomorrow and the reason their school knows I will be picking them up early to get to that appointment. I am the reason our kids have clothes that fit them and bows that match. I am the reason my kids think women are strong.  I do it far from perfectly, but I am the core of our family. I am the strength, the love, the force.

Do I wonder if he ever truly wonders what happened to that girl he met 14 years ago? No. Not deep down. Because I am still that girl, but I am so much more.  We are so much more.  So, if he passes me again tomorrow morning, and there is no coy, flirty comment made, I know that it is not because anything has changed. It is just that life has evolved. Today, we show our affection in different ways. Did I tell you that last week he let me sleep in and took the kids to school and came back with my usual Starbucks drink order before heading to work? The sheer joy and melt-my-heart ode to our love that hot, steamy caffeinated beverage brought me in my five-hours-of-sleep haze just proved that nothing had truly changed. It just looked different.

My husband and I, we are far from being those college kids we were when we met. We have become an unrelenting team under a mound of responsibilities. This is the season of our lives. And we are the right people for the job. Because underneath it all, we are still two people who love each other deeply and are unwavering in our commitment to our family. We can do this, one day at a time, with a couple short cuts here and there and a couple frantic moments . . .  or daily frantic moments . . . But we will get by, and we will do it with as much respect and love for one another as ever.

 

The Sound of Resiliency

~ cindylw ~ Leave a comment

As Previously Published:  http://www.kevinmd.com/blog/2016/08/laughter-thats-sound-resiliency-hear.html

Sometimes, the loudest sounds I hear in the emergency department are laughter. It may seem irresponsible. It may seem discordant. It may seem callous. To me, it is the sound of survival. It is the sound of resiliency. It is the sound of making it through the day.

My father was at work when he suddenly became cold, clammy, and collapsed to the ground unresponsive. His staff did the right thing and called 9-1-1. He was rushed by ambulance to the Emergency Department. He had vital signs taken, an EKG done, and blood work drawn. It was an experience that shook my family. My dad on the other hand, was exasperated. He minimizes his health and upon arriving to the Emergency Department, was already scheming ways to get himself discharged. He had no such luck, and was ultimately admitted for further monitoring and testing. Today, he is back to his healthy self, and doing well.

I remember speaking with my father while he was in the Emergency Department. He commented, “All these people. Bunch of jokesters. Everything is a joke!” I could tell he appreciated it. He is not one for dramatics, and their sense of humor helped him get through that visit. It helped me too. It made me feel he was in familiar territory, that culture of humor that pervades all emergency departments across the nation.

It may seem like a strange place to hear laughter. But here is the thing. Working in the Emergency Department is more emotionally draining than I could ever have fathomed. No matter how high of spirits you are in when you walk in the door, the day will wear you down. You keep up your coat of armor, you navigate the fires, but inside, you feel yourself being broken down. It comes from all directions. It comes from the deepest sadness of sharing bad news with your patients. It comes from the confrontational situations you never wish you were in to begin with. It comes from the stress of hoping that everything is going to turn out okay in a way that will comfort your patients and their loved ones. It comes from the pressure of working fast, the responsibility of not missing any one thing, juggling too many tasks to count at one time. My words could never give that heavy pit in the stomach that follows us through the day true justice.

And so how do we cope? We laugh. We joke. We check in with one another through everyday banter to ensure that we are all still okay. It is the only lighthearted part of our days, and I assure you, we need it to get through. No day for us is a typical day. We are sharing in some of our patients’ lowest moments. We are here to provide support, to provide comfort, we are here to absorb it all, and ultimately, we find our own ways to release what we put on our shoulders. If we allowed ourselves to be consumed by our stress and our sadness from each moment, we just couldn’t come back and do what we do tomorrow.

So. I ask you. Please forgive us if our loud voices and laughter seem callous. Please know it is the opposite of that. It fuels our resiliency, it allows us to take care of the revolving door of patients coming in and out of our emergency department. It allows us to bounce back, it is our way to decompress and de-stress and face the next challenge of our days with the renewed energy and compassion that we need to get through today in the healthiest way possible.

When The Village Is Not Available

~ cindylw ~ 2 Comments

As Previously Published:  http://www.scarymommy.com/parenting-without-village-worst-days/

Last night was parenting misery at its finest. My husband was out of town, our part-time nanny and our back-up part-time nanny have both recently had changes in their schedules and are no longer available, my in-laws wouldn’t have been able to make it to our house in time, my close friend emergency contact was at an event and unavailable. So there I was. My village unavailable. Three kids. Hit with the worst migraine I can recall having in the last four years. The last time I had a migraine this awful, our previous full-time nanny had changed her dinner plans, come over for the last hour of the kids’ day, to just tuck them in because I was too debilitated to make it another hour. I awoke from that haze of a migraine to see the dishes in the sink washed, the house picked up, the kids in bed, and blissfully clean quietness. If I wasn’t already in love with our nanny before, I certainly fell hard for her at that minute, right then and there.

Well. Now the love of my life has moved to North Dakota (my former nanny—not to be confused with my husband), and there I was. Sharp, stabbing pain coursing through my left eye to the back of my neck, the nausea warning me as to what was to come, the dimmest light making me feel as if I was staring into the core of the freaking sun, barely able to keep my eyes open. I profusely thanked my type A self for pre-prepping dinner for the kids. I plated their food and poured them their drinks, then curled my throbbing, pounding, close-to-vomiting self up on the couch. I called out orders from the couch to my newly promoted baby-sitting five-year-olds. “Is your baby sister done with her food? Is she eating? Can you get her some fruit? Can you make sure she doesn’t stand up in her high chair? Can you make sure she doesn’t stick her fork up her nose?  Can you get her milk?” I had been so proud of my aspiring Martha Stewart self for making the most adorable fruit skewers with peaches, blackberries, grapes, and strawberries. Now I was cursing myself for making those damn fruit skewers, imagining my 21-month-old stabbing her unsupervised eye with a skewer. Thank goodness for my doting son that plucked each piece of fruit off the skewer for her and put them on her high chair tabletop.

It was five o’clock and I was on the verge of breaking down wondering how I was going to shuffle my kids to take a bath, brush their teeth, get in pajamas, and make it to the end of the night. I could barely move. The voices of my boisterous five-year-olds had never sounded so LOUD; they were like splitting daggers hitting me in my left eye. If I moved, I might throw up. If I spoke, this intolerable pain was going to become worse. I could feel her adorable, piercing brown eyes staring quizzically in my direction, wondering why her mama was curled up in the dark on the couch and not eating with her. She just kept saying, “Mama. Mama. Mama.” To which I answered sparingly. My five-year-old baby-sitters finally told me my 21-month-old was done eating. I took a deep breath (mostly to pep talk my stomach contents to stay within the confines of my stomach), mustered up the last drop of energy and cleaned her off. She kept saying, “Nose. Nose, Mama. Nose.” I looked at her nose. Sure enough, she had stuck a corn kernel up her nose. Had she ever done that before? No. Did I have any energy to react? No. I took some tweezers and pulled it out. “Nose. Nose, Mama. Nose.” I looked up further. Ah yes. Another corn kernel jammed up the crevices deep into her left nostril. I thanked myself for choosing to go through the years of schooling and the years of training that made me a master of foreign object removal from toddler noses. If this was the pinnacle of my MD degree, it had made it all worth it. I removed it. Checked one more time. No more corn kernels. I reminded myself that next time I asked my five-year-olds to babysit, to add to the list of sub-standard expectations, “Can you  make sure she doesn’t stick food up her nose?”  I gave her a meek talking to, using half my energy to speak to her and half my energy to keep my nausea at bay. It was 6 o’clock, and she usually goes to bed at 7. But hey, what’s an hour. So she went to bed at 6:15 because I had no more left in me to make it another hour. I was lucky to be able to put her into pajamas, a night-time diaper, and to remove one of her pigtails.

I called down to my five-year-olds to come upstairs, get their pajamas on, and we would reconvene in my bedroom. I announced it was a bath and tooth-brushing national holiday and no one was getting proper hygiene that night. They lounged in bed with me, and watched indulgent amounts of cartoons—My teacher says TV is really bad for your brain. Duly noted, my dear daughter. Thank you for the public service announcement—while I curled up under the covers, and made a cameo appearance only to expel my stomach contents in the bathroom. In never before recorded history, I asked them to please tuck themselves into bed. They rolled with the punches. My son hugged me, kissed me, “tucked me in”, and turned off all the lights, and hushed his sister, “Be quiet. Mommy is sleeping. Stop talking to her.” And without much more fanfare, I heard their doors click closed and silence. I felt so, so thankful that the day was over, even more thankful for the best kids I could ask for, and laid in the dark willing this fierce pain in my head to subside.

The pain did subside, and today, I am back to myself. I remember a colleague saying that a sick child was no excuse for not coming to work. That everyone should have a back-up to their back-up to their back-up. Well, some people are not so blessed with a village to take care of their kids. And while I am that fortunate, sometimes, the stars just do not align. I am so lucky that for me, these moments are fairly rare. I don’t know how you do it, parents out there without a village. But I am in absolute awe of how you make your family work, whatever your family looks like. Keep it up, all you parent warriors. It isn’t easy, but man, if your children are fed, their teeth are brushed most of the time, they take a bath some of the time, then hey, from where I stand, you are killing it.

My Mistake: Imperfections are Real

~ cindylw ~ 1 Comment

Previously Published:  http://www.scarymommy.com/parenting-open-about-imperfections/

Since having children, I’ve started living my life in unexpected ways. I’ve changed my attitude and daily life in ways I never imagined I would or could. I’ve done these things to be the example I want to be for my children.  I’ve dug into my inner confidence and shown them that I am confident in who I am, I am confident in the body I was given and take care of, and I am confident in what I do. I’ve tried to show them I will put forth my strongest, best efforts, and that I will never shy away from responsibility. I try to show them I am passionate about what I do.  I try to show them the importance of a work ethic. I try to show them the importance of resiliency.   I try to show them that nothing matters more than love and your family.

Today, I realized that in all my efforts, what I’ve failed to show them is that imperfection is part of who we are and that it is okay. Please don’t get me wrong.  I am far from perfect, and I am the first to acknowledge that. I have insecurities, I am more likely to win the “most improved” award on any given day than “most likely to succeed”, and there are a million things I wish I could learn to do. But, in the eyes of my five year olds and 1 ½ year old, their mommy can do anything. They know that there are some things that mommy is better at, that daddy is better at, but they truly believe, we can do anything. And what I came to think about today is perhaps I am doing them a disservice by nurturing this impression.

This past week, our nanny that had been with us for four years before she moved, came to visit for a week. Today, she left to go home. Minutes after she left, we were driving away in the van. I looked back at my five-year-old son, and saw him biting his lip, blinking his eyelids rapidly, red circles forming around his eyes. My sweet, sensitive boy was sad and missing our nanny. When the van stopped, I crawled into the back seat, and wrapped my arms around my sweet boy. His tears brought tears to my eyes. I was just as sad as he was that our nanny had left. “I know buddy. We all miss her right now.  Look what you’ve done. You’ve made mommy cry.” I chuckled lightly. I saw my son look at me, wide-eyed, startled at what was happening. I realized then that my son had never seen me cry. Me. Sap that cries at every “Extreme Makeover Home Edition” episode. Me. Sap that cries at every Ellen DeGeneres give-away clip. My son, searched my teary eyes in panic, to make sure that everything was still right, that I was still me, and this was going to be okay. I smiled at him, “You know, buddy. It’s okay to cry. Mom cries too.” He looked at me unsure, and continued to stare, slightly bewildered, but slowly became reassured as I smiled through my tears and joked with him.

I realize that in trying to be an example to my kids, I have ignored a huge part of life and living and success: failure and imperfection.

I haven’t set my new year’s resolution yet, but I suppose my new year’s resolution, and maybe my new parenting resolution is to show my kids real life.  Show them the bad with the good. Show them the challenges I face, the failures I confront on a daily basis whether they are big or small. Show them that tears happen. That disappointment is part of life.

Without showing them I’m not always the best, I can’t show them how I regain my confidence. Without showing them my mistakes, I can’t truly show them strength. Without showing them my imperfections, I can’t show them how I try my best. Without admitting that I have to do things I don’t like to do, I can’t show them how I own my responsibilities and pursue my passions. Without telling them about the challenges I face, I can’t show them the importance of a work ethic.  Without telling them about my failures, I can’t show them the importance of resiliency. Without all these things, I can’t show them that no matter what, there is still love and there is still our family.

I guess what I want to say to my kids is, sorry. My bad. Let’s try this again tomorrow. And that’s okay.

This is the Time of Our Lives

~ cindylw ~ Leave a comment

Previously published: http://www.scarymommy.com/family-life-time-of-our-lives/

My baseline default mode for the last five years has been “frantic.” I gave birth to my amazing twins, and if I thought I was “busy” before, I was sorely mistaken. The kind of acrobatics I came to accept as normal with juggling life and these “darling” newborns of mine was nothing short of chain-my-right-arm-to-a-40-pound-weight-and-ask-me-to-balance-a-stack-of-fine-china-on-my-forehead kind of acrobatics.

I remember a conversation I had with a colleague who confessed that he was not yet ready to have kids. “I’m not ready to give up my freedom,” he said. I didn’t think twice about what he said, really. Not ready? My ovaries have been rioting with their readiness for years! This conversation faded over my pre-baby months, and resurfaced with a vengeful vigor post-babies as I began to understand exactly what “give up my freedom” truly meant.

Giving up my freedom meant holding onto my full-three-hours-ago bladder just 10 more minutes (or 15 or 60 more minutes) while I finished changing my daughter’s dirty diaper, got their snack ready, and wiped up that weird stain on the carpet, and—is that another dirty diaper I smell? Dear lord, children! This is not a race to fill up the diaper pail!

Giving up my freedom meant forgoing brushing my teeth today because I had just finished breastfeeding the twins, and my daughter was already asleep, but my son was bright-eyed and ready to goo-goo and da-da-da, until of course, my daughter started to stir and wake up again.

Giving up my freedom meant staving off the surfacing panic as I came to the realization we were out of diapers in 3, 2, 1…and I needed to go to the store with both my infant babies.

Giving up my freedom meant date nights with my husband—wait, I can’t stop rolling with laughter. What are date nights with my husband?

I never knew what “I’m not ready to give up my freedom” meant. I could have smacked my colleague. Why hadn’t he shaken me ferociously and waved his hands frantically in my face while shouting and knocking some insight into my head so I truly knew what he meant? And by the way, was he some kind of secret sensei for figuring this out without ever having experienced it himself? Or was I just blinded by my ovaries?

“I’m not ready to give up my freedom” is an ever-changing phrase these days. As my infants grew into little toddling an-injury-is-a-step-away cuties, it was a game of chase and keep track and forgo finishing that sandwich you have been craving for the last six hours. As they became so smart and so verbal, it was a game of respond to their every demand for blueberries, milk, their favorite stuffed dinosaur and clap vigorously at their potty-training-in-training achievements. Today, it is a game of “why?” and congratulatory compliments over their new family portrait with house and tree and sun.

I think back to before I had kids and how much that is all I longed for—to have a family. These idealistic daydreams I had of family life, of Janie and Jack-clad children playing sweetly with their not chipped or half missing set of wooden Pottery Barn Kids blocks. I think about the things that kept me busy before kids, that I still try to accomplish with a fraction of the attention and energy I paid it in the past. I think about my constant struggle between enjoying my kids and maintaining this person in this life I lead before them. And then, it all came together. I came to realize that maintaining this pre-children life was no life to be maintaining, because it wasn’t my life.

This is my life. This is our life.

This is the time of our lives—this life that my husband and I have nourished and that is the center of our world. These three kids of ours, that are constantly in tow, like our very own pack of three little ducks clipping at our feet. And it is a full life and an amazing life. And this is what I yearned for and am so, so lucky to have in all its imperfections and all its fullness.

When life changes, let your expectations change. This is the time of our lives. This is the time of our lives when the dishes can wait in the sink after dinner, because it is the holidays and Rudolph the Red-Nosed Reindeer is on TV, and you are so excited to share this part of your childhood with your children.

This is the time of our lives, when my hair might (will) still be wet when I pull it back, because there are kids filled with joy who want to be a part of my day right now. There is my daughter who wants to show me her latest dance-twirl-robot move in her pink tutu with stars and flower-print leggings and princess slippers. There is my son who has 20—make that 40—questions during a football game as he discovers his love of the sport, and I discover the unexpected love I have for witnessing his flourishing passion for something.

There are their questions and commentary and the way they process and regurgitate information and memories when we engage in undistracted conversations that make me marvel at how their brilliant minds are growing.

There is the time when I step on another Cheerio and resist the urge to run for the vacuum and Swiffer WetJet, because my 18-month-old squeals in delight when she sees me break for the vacuum, thinking instead that I am coming to chase her, and she takes off in the cutest diaper-butt shaking baby sprint, clapping her sticky hands with pure glee. Why would I want to do anything but chase her? There are still the occasional 3 a.m. wake-ups when I pick up this sweet, sweet baby of mine and indulge in her warm tired body, snuggling on my chest as she falls back to sleep, burying her head deeper into my shoulder.

“I’m not ready to give up my freedom” these days means that I will never go back to those pre-kid days and I wouldn’t want it any other way. This is the time of our lives. The time I always daydreamed about, and now it is life and it is reality. This life is bursting at the seams. It is love. It is full. It is joy. It is tiring, exhausting, unrelenting. But it has never been better.

My Childhood for Their Childhoods

~ cindylw ~ Leave a comment

Republished at http://www.scarymommy.com/club-mid/happy-childhood-peer-acceptance/

I was an awkward kid to say the least. I wasn’t good at sports. I wasn’t good at being social. I wasn’t good at knowing what was the hip thing to wear. I had red glasses. I had a perm.

I was no novice to rejection. I once mustered up the courage to ask the boy that I liked in seventh grade if he would go out with me. Or, let’s be honest, I mustered up the courage to ask my friend to ask the boy I liked if he would go out with me. The answer was no, and so I pushed my glasses back up the bridge of my nose and continued to admire him from afar, counting small victories like the time he walked by my table at lunch and glanced at what I was eating.

I can hear your “awwww’s” and your “poor awkard kid!” remarks now. But, this is no pity party. I am comfortable with my childhood. I own it. It is part of why I am who I am today. But now with kids of my own, childhood takes on a whole new meaning. My heart is full of anxiety for what my children’s childhood will be like. Will they be accepted? Will they be good at sports? Will they be picked last at gym to be on the dodgeball team? Will they have an easy time making friends? Will my daughter’s “Justin Kinley” say yes in the seventh grade when her best friend asks him if he will ‘go out with’ her?  (I imagine by that time, I will get an eye-roll–“Mom!  Who says ‘go out with’?  What does that even mean??”)  Oh, I am riddled with trepidation of how this childhood journey of my three children I love so deeply will affect them.

My daughter was telling me about which friend she picked to do work with at school the other day. My ears perked up. Friends? She has friends? She has friends!!!!! I went to pick my son up from pre-school and one of his friends asked me if my son could sleep over. I had to control myself from breaking into somersaults right there, right then, in front of 20 preschoolers. Another mom was telling me how her daughter is obsessed with my son and how she won’t stop talking about him at home. Does someone like my sweet, sensitive son???? Oh, stop my bursting heart!!!!

Here is the thing. I accept my childhood and acknowledge how it has helped me become me. But I won’t lie. It wasn’t easy. There may even have been tears. Maybe even lots of tears at lots of times. But as my children enter into this new phase of starting school and being around their peers, I have new found respect for the experience of childhood. I lurk in the sidelines and wring my fingers together hoping and silently rooting for them to be accepted and not teased. I vigorously hope this will be a joyful time that will help build their growing confidence.

I know there is still a lot to experience and I am definitely getting ahead of myself; my three kids are all four and under for crying out loud. But I would relive my childhood, the tears, the awkwardness, even the teasing on the bus, if I could trade it for acceptance for my children among their peers and a childhood filled with positive experiences. Oh, I would just give anything for that. So, if you see me perched in the bushes at my children’s preschool, please don’t judge me, I am just rooting for their success from the sidelines, or, I mean, from the bushes.

My Parade and Me

~ cindylw ~ 2 Comments

Republished at http://www.kevinmd.com/blog/2015/12/physicians-jaded-keeps-medicine.html

Republished at http://www.scarymommy.com/life-as-a-doctor-and-mother/

I am constantly coming across articles written by physicians with strong voices.  Physicians that are jaded. Physicians that didn’t go into medicine to be dictated by patient satisfaction surveys. Physicians that didn’t go into medicine expecting that people wouldn’t trust in their training because “WebMD” begs to differ. Physicians that cringe at the drive-through mentality that patients can present with diagnoses in hand and demands for tests to be done. Physicians that want out.

As I read these articles, their sentiments resonate with my own experiences. But what we don’t talk about is what pulls us back in.

My patient in room 7 is 10 weeks pregnant, terrified she might be miscarrying. She hides her thoughts by pre-occupying herself with her blonde, curly-haired 2-year-old daughter. Ultrasound and blood tests confirm that she is in fact miscarrying. She busies herself with readjusting her daughter’s perfectly buttoned shirt while I confirm her worst fears are true. Willing away eyes welled with tears, she nods and smiles, keeping a brave face for her daughter. I sit by her side and hold her hand. I try to give her hope. Before I leave, she squeezes my hand.

My patient in room 1 is dying. She is 92 years old and her daughter is at her bedside. She celebrated Thanksgiving with her family, including her 17 great grandchildren. But her disease is progressing, and she has declined further intervention, because if this is her time, she wants to enjoy her remaining days at home with her family. And today, during my shift, is her time. Her son comes later, and asks me to please let his mom die with dignity. So we turn off all the monitors, dim the fluorescent lights, and remove her from all the wires, and let her be a mother, grandmother, great grandmother enjoying her last breaths flooded by memories of all the love of her family. Her daughter holds onto the necklace we had removed from her neck in our initial attempts. She sits at her mom’s side, this 57-year-old daughter and mother of four. She cries with her eyes clamped shut, and she rocks back and forth and murmurs repeatedly between sucked in breaths of air, “Mommy, Mommy, Mommy. Oh, Mommy, Mommy, Mommy.” I rub her back. I am sure she has forgotten I am there until she turns to me and asks me to put her mother’s necklace with a small angel charm around her neck. I take the necklace and drop it through my fumbling fingers. I pick it up and drop it again. She just has one simple request. Can’t I just do this one thing for her?  The fast pace of the emergency department slows, every beep of a monitor, every hurried set of footsteps, every ring of the ambulance phone seems to muffle and all I want is to put this necklace around a grieving daughter’s neck. One month later, I receive a holiday card from the patient’s son. It has evergreens with snow and glitter and a cardinal on the front. It reminds me the holidays for this family are forever changed. “Thank you for allowing my mother to die with dignity.”   Three years later, this card lies in my box of cherished cards and pictures from close friends, my husband, and my kids.

In room 11, first-time parents bring in their son. He is 3 months old and he won’t stop crying. He cries during the day, he cries through the night, he won’t stop crying. Why won’t he stop crying? They have been to their pediatrician innumerable times. But right now, it is 2 in the morning, and there is nowhere to bring him but to the emergency department, and we have found nothing wrong. How could there be nothing wrong? The three of us hold a quiet conference as to not wake the semi-sleeping baby. We talk, not about medicine, but about my own experience with my son who was 3-years-old at the time. We talk about how he cried too, and he wouldn’t stop unless we held him all the time. And we were so exhausted. My husband was so sleep deprived he was having visual hallucinations. We took turns on which day we would brush our teeth and shower. The three of us laugh (cackle quietly) at what absurd things sleep deprivation can do to a person. We talk about how I never thought it would end. But it did end. One day, he just started sleeping. We were so exhausted that we didn’t even notice until we had slept for four consecutive hours and woke up in a frantic panic. They listen intently. They sigh a tired kind of relief. There is someone that knows what they are going through. They are not alone. They leave with the same son they love deeply that still won’t stop crying, but feeling some sense of peace–or maybe even hope–they hadn’t had before. I didn’t figure anything out for them, but it was worth the visit.

Here is the truth. I went into medicine because I believed that if I put hard work into learning about illness and treatments, I could help people at their greatest times of need. What I know now is that medicine is about caring for people. But it is also about confrontation and conflict. It is about taking things in stride. It is about leaving your work at work so you can come home and be a mother or daughter or wife so you can preserve balance and your sanity.

Except for those moments that hit me in the gut, the heart, the soul. I hold onto those moments. Correction: they hold onto me. They roll over and over in my mind. They replay in my mind when there are quiet gaps in time. They are the parade growing and marching behind me five months later, 3 years later, 8 years later. They keep me going.

I acknowledge that those creeping feelings of wanting out are there. I sometimes hold my breath anticipating my cracking point. But then something happens. I get a squeeze of the hand. A card with evergreens and glitter snow. A couple that just needs to know they are not alone. And it is a big red reset button. And it is worth it. And I keep going, parade and all.