The Sound of Resiliency

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.

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When The Village Is Not Available

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

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

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

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

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.