Therapeutic Tears

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.

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How Was Your Shift?

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

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

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

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.

A Work Day That Ends in Sushi

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

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.