Tuesday, January 31, 2017

Marching with my middle schooler

Wasn't going to make her go, but was thinking it might be the experience of a lifetime.  I wasn't sure how safe it would be, but I decided I'd ask her to think about whether she wanted to go along with me and a few of my out-of-town friends who would be coming to DC for the Woman's March on Washington.  My middle school daughter thought about it for less time than it takes to eat a spoonful of mac and cheese and said, "YES, I'm definitely coming!"

So we reviewed over the next few days a few key concepts.  
  • We learned some words.  Words for body parts.  Words of pride, and words of power.
  • We learned in one night to knit, as we readied ourselves to join in the pink parade, and we discussed the rationale for the name and shape of the hats.
  • We reviewed what choice over one's body means.
  • We discussed the notorious RBG.
  • We packed and shared assorted protein bars and water.
  • We went to stand among many of all shapes, colors, sizes to "march" and to rally (without peeing) for about 8 hours.
  • We read the cleverest signs!  And saw lots of versions of the uterus.  Having already reached the Mother in Medicine with a middle schooler milestone of syncing up our menstrual cycles (has happened once thus far in our household) and having made it through all matters of pubertal hormones thus far, we joined so many many many other women and supportive men in solidarity. 

Oh, and later that night, she said, her exact words, "It was the experience of a lifetime." 

Indeed, I hope she (and all) have a lifetime of equality and choice and freedom and diversity and democracy.

*though we eventually got separated, was wonderful to take an "MiM Metro" to the March with Gizabeth and KC!

Friday, January 27, 2017

Witness the Sickness

I am so sick. Like miserable, no energy, hacking cough, congestion, achy muscles type of sick. Who knows what it is, but does it really matter? At work the other day I desperately had one of the X-ray techs do an AP on me. No pneumonia. That would have been too easy. How did I get this? From my 14 month old daycare attending daughter. Only she's moved on and is back to her normal, playful self.

The same thing happened around Christmas, but my husband was the innocent victim. She brought something home that knocked him down with a viral malaise that turned into a raging sinus infection. The babe got better in a few days; he lingered on with "man cold" for a couple weeks. We all know how painful that is for everyone!

I hear that what my household is experiencing is a thing. People tell me, "I've never been as sick as I was my first winter with a child in daycare." I hear, "Every time they change classrooms you'll get deathly ill." I have also heard, "It gets better once they turn two." Please God, let this be the case.

So Mothers in Medicine, my question is, what are your strategies for dealing with this? Is there any preventative magic I should be invoking? Because I don't know that I can go through something like this (two plus weeks of feeling like utter crap) again. We all know how hard it is to take care of our patients (and our children) when we are the sick ones, and we as a profession are the absolute worst at staying home and nursing ourselves back to health! What do you all do?

Wednesday, January 25, 2017


March 20, 2003. I stand with other students, staring at a television in my university's student union building, watching Baghdad being bombed. Explosions light up the screen. "Shock and awe". I'd spent many hours in the preceding months organizing, marching, due to the pressing need I felt to do whatever my small part was to stop the impending attack on Iraq. In the end, not surprisingly, it went ahead. I was grateful that Canada wasn't a part of it, but still, here it was. I stand watching war on television. 

In the strange happenstance of life, I now spend my days in family practice, seeing Iraqi refugees resettled in my city, still reeling from the effects of the war. Crippling PTSD pervades some of their lives. Yes, they have built new lives in Canada and many are thriving, but the ones who aren’t take up most of my attention. Layers upon layers of trauma. And for all of them, the sense of loss remains. I think of these effects as the reverberations of those initial explosions - rippling out across the world and the Iraqi diaspora, for years. 

This is, of course, not unique — the longstanding, multi-generational effects of trauma are felt within many communities.  But it’s one that’s close at hand to me, almost every day. During the student and community campaigns that I worked with to urge non-violence, I strove to think of the individual men, women and children who would be affected on the ground in Baghdad. Today, I know some by name.


Tuesday, January 24, 2017

Women's March on Washington

When Trump was elected into office, a small movement began on Facebook, one that resulted in the largest march in history. When I texted KC, it was still in its infancy. I had the time blocked off for a conference in Vegas. I've never been to Vegas, but decided it could wait another year. "KC, do you want to march?" "Yes." I booked plane tickets to D.C.

I know KC doesn't want this blog to be political. Neither do I. I've read all the perspectives, Trump garnered many of the votes. I've read lots of essays and novels: I get why so many women and men voted for him; it's a vote to try to change a corrupt system. His presidency is a blip in history; albeit one causing a lot of anxiety. While there were many signs that were anti-Trump, there were many more that were pro-women. That's why we gathered. For Democratic principles.

My friend Ramona knitted us the requisite "kitty-kat" hats. I think we looked adorable. Her daughter, age 12, got the third one and wore it better than we did Saturday night at dinner in their home.

KC and I, in front of the Air and Space Museum, Women's March, day after the inauguration.

For those of you who think we even knew where the speakers were, kudos, because we couldn't figure it out. There were so many women. At one point, we tried to get next to the Jumbotron, and regretted it when we were squashed and shoved and it took us thirty minutes to travel thirty feet to the freedom of the Washington Mall. I watched the speeches the next day on YouTube. 

Nothing lost in missing the speeches though. We saw lots of women and men with posters. We took pics. We found a high perch, relaxed and ate almonds and Cliff bars. When it was time to March at 1:15, we traveled to the marching site nearest us.

At 2:00 we still hadn't moved. A few women and men started chanting: "Forget the March on Washington, we are taking a Stand. This is the Stand on Washington." I got defensive. "I'm marching, if only in place. It's still a March. My feet are cold. It counts, right?"

At long last we eventually joined the March. It was everything my pulmonologist friend from Philly, one who I tried to meet but missed, raved about on text. "This is amazing and energizing! I'm so happy to be here. I'm sad I missed you."

There was lots of signage, but I decided to skip doing it myself so I could take lots of pics. There was one in particular, one of 50-100 that I took, that touched me the most.

And though she be but little she is fierce.

Monday, January 23, 2017

G2 P1011: life after loss and D&C

This post may be a trigger for those who have had an abortion, miscarriage, or fetal loss. I wanted to share my experiences because in the weeks following our fetal demise, I read several blogs by mothers but couldn’t find a single post written by a physician mother. This post is also part of my healing process. In it, I will share some of my challenges and also will explain my D&C*. I have found over the past months that many of my friends and colleagues have experienced pregnancy loss. Almost every single friend I shared it with have experienced their own loss. We are not alone. I hope that this post helps someone in need.

It’s been 2 weeks since my D&C, over a month since we learned that our little kidney bean sized fetus-baby had died, and 3 months after finding out we were pregnant with our second child.

Thankfully, the nausea has resolved, the fatigue has ended, and the waves of grief are less intense and less severe. But sometimes the grief washes over me and I can’t breathe. And I fall into my husband’s arms or I call him or my mother or my best friend A and I weep. And then I wipe my face and I go on.

Zo asked enough questions for us to know that we needed to tell him something. So, I recalled my time during residency with the Palliative Care Team and did my best at providing a 5-year-old appropriate explanation of miscarriage. “Mama, there is no baby anymore.” “No, there was a baby growing but it stopped growing and then it died and the doctors helped my belly feel better and now I’m feeling a lot better.” He pauses, looks around. Says “okay” with a smile and a hug and then “I’m going to go find my Wolverine so we can play.” And then we move on. Now that my belly has started to rapidly deflate, I’m not exhausted or nauseous anymore, his questions have become less frequent. He is satisfied with our answers.

One of the hardest parts of this process has been all of the changes my body underwent that feel downright wasted. Big old breasts that won’t nourish a baby and that sadly have deflated just like my belly. A big old belly that poked out immediately and still makes some strangers pause. I pray incessantly that no well meaning elder asks “are you pregnant?” because I have stopped telling friends about our miscarriage (I am allowing the message to be passed by osmosis because at this point, I’m tired of retelling it and everyone who needed to know now knows) and I’m not sure I won’t either curse them out or start crying. New stretch marks that show my body underwent a change and unlike my breasts and belly, they are permanent. They will always be with me.

The hardest places to go for me have been the gym and the Ob-Gyn office. The gym because all of the mirrors show me exactly what I look like. I tend to sit in the car for 30 minutes before going in. I usually have my worst cries there building up the courage to go inside to work out. Losing weight after having Zo was so easy. He nursed like a champ and I weighed less than my pre-pregnancy weight within 4 weeks. This time. No such luck. At the gym there is no cute baby to tell other people about. I see the eyes on my belly (folks probably thinking “this pregnant lady knows she needs to be at home). I see the bulge in my shirt. The popped out belly button. The widened hips. I know I have to work extra hard to fight the flub without the help from breastfeeding. It hurts. All of this good chunk and no cute baby to show for it.

The Ob-Gyn office because there are cute waddling pregnant women. After finding about about the demise, I transferred my care from a midwife community practice to an Ob-Gyn practice recommended by one of my friends. I literally could not go back to the old practice; when the office called to follow up, I quickly thanked them and hustled them off of the phone. I had to let them go, they are the practice where I was hoping for a happy, uncomplicated pregnancy. I just can’t go back there.

And now with the new Ob, I don’t want to go for my follow up visit (but I do, on time!) because I know I’ll have to tell the Tech who gets my vitals that we had a miscarriage. And then the sad response, the averted eyes. I want to yell “I’m not a leper” but all I say with a smile to make her feel better is “we are okay! I’m feeling much better and the procedure went great!”. And I don’t want to hear the Ob tell me “you can start trying again next month.” And when I say “we are taking a break, this was a lot to handle” he says “yeah, yeah, yeah, you’ll be back soon pregnant with the next one. You two are healthy, you can have 3 or 5 more kids if you’d like” I have such complex emotions that I can’t mount a response. I just sit and nod. I literally am too scared right now to think about getting pregnant again. So I read books and I read blogs and I talk to friends who have lost babies and they tell me I am feeling exactly how I should feel right now. Confused. Scared. Hopeful. Encouraged. Sensitive. Fearful. Apprehensive. Angry. Loved.

It is 1pm and I have been putting off going to the gym since 9am. It’s time to get up and go. Hopefully writing this post means that I won’t spend any time sitting in the parking lot. Time to work on this belly bump.

G2 P1011. Gravid 2 (meaning I have been pregnant twice), Parity: 1 term infant delivered, 0 preterm infants delivered, 1 abortion/miscarriage, 1 living child.

*D&C - dilation and curettage. This is a procedure where the cervix is dilated and a curette, almost like a spoon or a scraper, is used to remove contents from the uterus.

My D&C:
  • In my D&C a small vacuum was also used.

  • I received conscious sedation during my procedure, meaning I did not require respiratory support. I was in the pre-operative area for several hours until a c-section was completed and then I was taken to the Operating Room and it was over within 15 minutes. The Anesthesiologist provided midazolam and propofol and I was awake within minutes after with no cramping. I was very hungry and ate lots of yummy snacks and a big lunch and then came home and was promptly sent to bed by my family.
  • The Obstetrician performed an ultrasound before to confirm the demise and an ultrasound after to show that the products of conception had been removed. I asked for them and have them in my files.  
  • I had light spotting for 3 days after. Then only spotting with exertion (embarrassing but this means after pooping) for 2 weeks, then it stopped.
  • I have had intermittent cramping and just like my Ob promised, I dind’t need any medication stronger than ibuprofen 600mg as needed.
  • I had a follow up appointment 10 days later and was cleared for all activities.

Thursday, January 19, 2017

How did you manage pregnancy symptoms at work? Share your stories!

Pregnancy is not an illness. It’s usually a joyful time in one’s life. But man, can it make you feel AWFUL. Morning sickness, fatigue, swelling, brain fog... Everyone experiences these things differently, but almost everyone is going to have something. Rare is the mom who can rosily exclaim “Gee, I felt WONDERFUL throughout my entire pregnancy!

Even in the same person, pregnancy can present differently. With Babyboy, I had very little nausea; rather, I had weird intense cravings for salty things (like sardines). So, when I learned I was pregnant with my second, I went out and bought cans and cans of sardines. Surprise! Not only did the mere whiff of sardines make me nauseated, that’s how I felt for the whole nine months.  

“Morning sickness”, which, in my experience, can last all day, is different for everyone. It can mean queasiness, or hurling. I have friends who required admission for hyperemesis gravidarum. All the ginger tea and Zofran on the planet doesn’t help, sometimes. 

I got through by only eating what I could tolerate: carbs. Sixty pounds later...

Swollen legs, incredible fatigue, brain fog... these are some of the other symptoms I experienced. I finagled "pregnancy parking" close by work at the end of my first pregnancy, when the summer heat made walking unbearable. I've heard of doctor-moms who managed to steal naps here and there... And for brain fog? I don't have any ideas what can help. 

What about you? Share what symptoms you had, and how you managed them. The info can help another doctor-mom!

Wednesday, January 18, 2017

MiM Mail: Neurosurgery and "accessory" mother?

Hello writers/readers of MiM,

I have been a long-time reader of this blog and I absolutely love the content — thank you for being honest about both the highs and lows of being a physician-mother. I am currently a medical student, and intent on pursuing a career in neurosurgery. I would also like a (small) family, though currently I’m very single (other than my books ;) ) so any possibility of a family is at least a couple years down the road.

I come to you wonderful ladies asking for advice/encouragement/hard truth —whichever you feel is most appropriate. I was talking to one of my attendings today about my interest in neurosurgery and consideration of various residency programs/sub-i rotations. He gave me a lot of good advice about preparing for residency applications; however, he also brought up the lifestyle of neurosurgery and the difficulties being a female in neurosurgery entails.

I have long realized that having a career in any medical specialty, yet alone neurosurgery, will make the experience for my (future) children different than what I experienced growing up — I had a stay-at-home mom. I had (almost) completely accepted that, but today one of my attending’s choice of words really hit me — he said that I would be an “accessory” to whatever family I have, rather than playing an integral role. This has been quite distressing emotionally as I try to process both 1) if this is truly the case, and 2) if so, if I’m okay with that. I really cannot see myself doing anything other than neurosurgery and so it’s hard to reconcile both my love of this field and my desire for a family.

I appreciate any thoughts you take the time to share. Best wishes for 2017!

Perplexed Med Student

Thursday, January 12, 2017

Have you encountered assumptions/ prejudice/ racism/ sexism/ intolerance/ harassment/ discrimination at work?

Genmedmom here.

Let's talk about sex, sexual orientation, race, religion, and disability, and being judged by those things, in the workplace. Have you encountered assumptions/ prejudice/ racism/ sexism/ intolerance/ harassment/ discrimination at work? 

It's definitely an appropriate political climate to be discussing this issues. Even aside from the blistering rhetoric of the past year, let's face it, for many folks, a "real" doctor looks like Marcus Welby, M.D. You know, a white, gray-haired, suited man who exudes experience and wisdom. Not that there's anything WRONG with that...

These negative attitudes can manifest differently, and span a wide range of experiences. 

The way I see it, assumptions can be innocent. These can be sort of insulting things said by well-intentioned people. They may be based in inherent bias and unconscious attitudes. Like, for example...

How many times during residency training did I walk into a patient's room, and they assumed I was anyone BUT the doctor? I was asked to clear the cafeteria tray more than once. Even after introducing myself, I was often referred to as [insert non-M.D. staff title here] and asked to fetch things: a glass of water, blankets, a urinal.

Sometimes, those assumptions annoyed me, and I acted annoyed. Other times, I tried to be cheerful and helpful regardless. I have also been guilty of making assumptions about others, and have had to retrieve my Dansko-clad foot from my mouth...

Then, there are more obviously negative/ hurtful/ damaging experiences.

During residency, a senior physician (a Marcus Welby type) whom I respected greatly and had been working with for some time chose a younger, more inexperienced, pretty unreliable male trainee to lead an endeavor that I had been interested in leading. Oh, that hurt. I wondered and fretted, Why didn't he choose me? What secret glee I felt when the young lad never followed through, and the project collapsed! Karma, man. Karma.

A woman I trained with had a miscarriage, and the supervising physicians would not allow her any time off. It was a first trimester loss. "Think of it like a heavy period," they said. "Would you call out for that?"

What I observed throughout all of my medical training was that women received very little understanding, consideration, or flexibility during pregnancy, maternity leave, or breastfeeding. The prevailing attitude was "suck it up, buttercup."

Then, I remember as a fellow, when I was interviewing everywhere for jobs. I was singled out by a senior physician (Yup, Welby again) for being half Latina. I was asked to take on a faculty position in part "because then we'll be closer to meeting the requirements for minority recruits. You can really help the department to look more inclusive. That'll be such a bonus."

That felt weird. I did not take the position.

In that job search almost ten years ago, I sought out a flexible position in a positive environment at a progressive institution, and I am satisfied that I found all of that and then some. The few negative experiences I had prior definitely informed my decision, and helped me to recognize what I didn't want as an attending.

I'm aware that many of you have had much worse and many more negative experiences than I did, and I'm wondering:

What did you encounter?

How did you manage, supercede, overcome?

What did you learn from the experience?

Do you see things getting better, or worse?

Monday, January 9, 2017

I Want To Hear Your Voice

I had a dream when you were only six months old that your first words were the complete sentence, "You can't tell me what to do!" You babbled so early and so prolifically that I figured you'd be talking by the time you turned one year. But now here we are two months past that, and I'm still in the dark. At least you've started pointing, but many times I still don't know what you want.

Why are other babies your age using words when you're not? Aren't you the child of a doctor and a lawyer who speak to you constantly in both English and Baby-ese? Who read you books every night? I Google the milestones, and you're definitely lagging in the language department. Have I done all the right things? What did I miss? Is this how it's going to be, you giving the overachiever but unsure parent in me an anxiety attack at every developmental step? I know comparison is futile, but I still fall prey to it sometimes. It's going to be a long parenthood if I don't learn how to stop now.

My thoughts of worry really are just fleeting; all I want is to hear your voice. Your real voice. Not just "mamama", "dadada" and "uh oh". As your mother, I keenly know your cry and your coo, but I want to know what you sound like when you express yourself with words. The lilt in your voice when you're delighted. How the words come out when you're angry. The tones you release when you're sad. I want to talk to you, to hear your thoughts and feelings and desires. Right now all I can do is wonder, but I'll bet it's going to be a beautiful voice.

Wednesday, January 4, 2017

Mandatory meeting...CHILDCARE PROVIDED

I have posted before about how much I love my job.  I am honored to work with so many amazing people.  Quite recently a revolutionary change has occurred for our late departmental meetings…childcare is provided (as well as dinner).  Such a simple offering means SO much. These special surgeon kid playtimes are now one of the highlights of my daughter’s social calendar!

Below I have posted (with permission) the beautiful and inspiring blog post of our amazing Clerkship Coordinator after the first childcare night. I am so proud of us.  I am so proud of who my daughter (the 6 year old described below) is becoming.  I am proud of this department, of my profession and the future that we are creating for our girls as Mothers in Medicine…


From the blog of JP -

When I was a kid, about 25 years ago, I overheard my mother repeating a riddle that had been told to her. In short, a young boy and his father were in a car accident. The father died immediately upon impact. The boy was rushed to the hospital. Once in the OR, the surgeon stands over the boy and simply declares, "I cannot operate on this child. He is my son." So the riddle goes, if the father was killed in the accident, how on Earth is this possible? Keep in mind, the riddle is at least 25 years old.

I listened as folks stumbled over themselves with the most absurd answers, "The dad hadn’t really died." "The surgeon was the boy’s step-father!" "The father was not his biological one and the surgeon must have been the boy’s sperm donor." The answers came and went and when the person finally threw their hands up in defeat, the person telling the riddle simply replied, "It was the Mom! The boy's mother was the surgeon!" Gasped responses immediately followed; these gasps were made as if to imply extreme bewilderment that a woman, A MOTHER, could be a surgeon. Nonetheless, the folks on the receiving end of the riddle felt embarrassed for not offering the most overlooked obvious answer even if they could not fathom a female with a scalpel.

Fast forward 25 years, I just spent my evening at work doing arts and crafts with two children of surgeon faculty members so that said parents could engage in an after-hours faculty meeting.  I brought all of my craft items from home so the young girls could make various winter holiday crafts. At one point I noticed one of the girls (6 in age) was making a gingerbread man. I quickly praised her on her great artistry, "Hey! That’s a great gingerbread man!" I pointed out. "That's not a gingerbread man!" she quickly declared. I was caught completely off guard. Y'all. I'm telling you. It was a gingerbread man!  Before I could ask her what it was (since I was so offensively incorrect), she proudly exclaimed, "It’s a gingerbread GIRL!" Immediately, a grin washed over my face. I'd only met this child within the hour. Our time was consumed with learning each other's nicknames, teacher's names and favorite colors. Feminism 101 had yet to make it to our arts and crafts agenda. I wanted to high five her. I wanted to spin around in circles and dance giddily in only the way excited 6 year old girls do. But instead, I nodded, and told her it was the most amazing gingerbread girl I'd ever seen.

Within the next hour, the other little girl (8 in age) casually announced that she was creating a top hat for her snow woman. SNOW WOMAN! Did I hear her correctly? Snow woman!! Yes! And she'd said so, so nonchalantly. It's as if Frosty the Snowman wasn't the first... the only...the standard! “Every snowwoman needs a top hat!” I replied.

If I'd told that 25 year old riddle, now, to both of these young girls, they would have quickly and without hesitation answered that the boy's surgeon was obviously his mother. I am confident of this.

It was in that moment, and for the rest of the evening, I stood proud; proud of the progress women had made in the last 25-30 years. Proud to have been able to witness, in my lifetime, such dramatic change, albeit long overdue and with still so much progress yet to be had. I was proud to be a female working in surgery education. I was proud to work for a team with so many female surgeons. I was proud to work under the leadership of a successful woman, whom not only was a General Surgeon, but also the Program Director of the General Surgery Residency program.  I was proud to work for and with a group of smart and successful women who greatly value their profession and equally, their role as a mother. I was proud that these young girls were exemplifying everything I’d known to be true as a child, but always felt so disconnected with. Perception was no longer reality. The reality had finally become perception! These mothers, these brilliant successful female surgeons, they are paving the way for the next generation of gingerbread girls and snow women to achieve greatness.

This is how we lift each other up. We create an environment in which we welcome one another's children so that we and they grow enlightened, encouraged, educated, inspired and excited by possibilities. We embrace the difficult balance. My God, the balance is difficult. We dispose of the box that which we were placed in and we become assertive in our ideas of becoming both brilliant and successful professionals as well as invested mothers. And it doesn't just begin and end with women, my friends. We must embrace our professional fathers as well! We are only as good as our counterparts. Our strengths are magnified when we surround ourselves with other strong, confident and supportive human beings.

I am grateful to be able to contribute to their (our) mission.

Monday, January 2, 2017

Happy 4th Birthday C!

Little C is turning 4 tomorrow. I am not quite sure how that happened but I just wanted to share a letter I wrote for her.

Dearest C,

I seriously cannot believe you are now 4! There are times it feels that these past 4 years flew by but it also seems like you've been with us forever and what was life before you?

If there was one word to describe you, it would be that you are a fighter. I knew from the very beginning when you were in my tummy. Being my first pregnancy and all, I wasn't sure if what I was feeling were your kicks in my second trimester. However, when I went into the ER at 26 weeks for abdominal pain and you went in with me to get a MRI, you let me know you hated it! I didn't blame you as it was so incredibly loud for an entire 60 minutes and the images were being taken right where you were! But you definitely let me know that you were pissed off. You kicked me the entire 60 minutes and it was then I knew what they meant by fetal kicks.

At the time, I was so worried about what would happen to you while I went under general anesthesia but you nailed it. You were literally there when I had my appendix removed and you did exactly what you were suppose to do. You stayed inside and cooked for another 14 weeks.

When you were born, you were perfect. I was not. Tears still come to my eyes when I think back on that period of your life and I feel this insurmountable amount of guilt of what I put you through. I had no idea what I was doing. Instead of focusing on my perfect and healthy child, my mind kept going on how the heck I was going to balance motherhood and my career, which was in its infancy as I was only a PGY2 in my 6 years of training.

You nailed it again. You were the most perfect baby. You went from 7 pounds to 17 pounds by the end of my 7 week maternity leave! By the time, I had to go back to work, you were basically sleeping through the night except waking up once to eat and would right back to sleep. You thrived under the care of grandma. As I watched you grow into a happy healthy baby and eventual toddler that guilt started to lessen but never completely. You let me know in your way that you were doing well even though, I wasn't your primary caregiver and I knew my decision to keep you with grandma was the right one.

Fast forward to June 2015 and your move home. We only had about 4 weeks as a family of 3 until daddy had to go away to the east coast for fellowship. It was our first year as just the 2 of us. Once again, you were beyond patient with me. I struggled with balancing my last year of residency with being your primary caregiver. It wasn't easy for you to go from being the center of the world at grandma's house to going to pre-school full time and having a full-time plus working mom. But once again, you nailed it. You shut down all my fears in 2 months. You thrived at pre school. You learned English in a matter of weeks. You made friends. You formed bonds with your teachers. It was one of the most hardest years of my life but it was beyond gratifying to finally be your "favorite" and the one you wanted in your times of need.

And here we are today on your 4th birthday. We survived the first half of mommy's fellowship. Daddy is finally back on the west coast but he's still 2 hours away. (On a side note, we are so incredibly proud of him!) It's still just the two of us but we have so much to look forward to as in 6 months, we'll be joining daddy and mommy will be starting her first attending job. We have a lot of firsts to look forward to this summer as we start a new chapter in our lives. But until then, I'm going to enjoy these next 6 months of just you and me. I will always look back at these times and the difficult memories will fade but the memories of picking you up from school while you run to me, the memories of eating dinner just the two of us and the memories of all the mommy-daughter dates after school will always remain be in my heart.

I know I say this all the time. But I had it all wrong. You continue to teach me something new every single day. You show me a love that I didn't I know I was capable of and you show me that love is not finite. My heart grows in places that I didn't know existed. Life has never been the same since you entered 4 years ago and I am beyond blessed to be your mama.

It is truly an honor, C. Thank you and happiest birthday to my firstborn!

Love, mama