Tuesday, March 24, 2020

Guest post: Maternal Awakenings

I always wanted to be a perfect mother and was na├»ve enough to think she existed. There was so much that I did not know when I became a mother at age thirty-four, so many things to learn as I went along. My husband and I decided to have children soon after our marriage in August 1983. David was born in October 1984, Anne in June 1987, and Laura in February 1991. During the first seven of my mothering years, we lived in a small two-story house in a quiet, mixed Houston neighborhood in the Montrose area along with other yuppie families, several gay couples, and nearby apartments which housed middle-income Hispanic families. A modest, shady park with a playground was located nearby. My husband and I were busy with work those first years, but also dealt with many unexpected childhood issues. There were breastfeeding challenges and night terrors, toilet training, early discipline and temper tantrums to manage. Later there came embarrassing, immature and impulsive behaviors in kindergarten and grade school. We tried our best to sort through all our children’s needs and issues.

We did not ask our parents what they thought; after all, we were smart, educated doctors. I did not plan to pattern my mothering after my own mother. I wanted to be involved with my children’s lives, to protect, and encourage them. I was extremely lucky to have married another pediatrician. He was always calm when things went awry but did not seem as hungry for knowledge as me. I consumed stacks of books written by experts on child behavior and child development. (Thank goodness there was no internet back then, or I would be addicted.) I needed to know if all the things I observed with my children were normal. Surprisingly, there were several childhood conditions that I had neither encountered nor learned about in my own pediatric training.

Understanding why young mothers, including me, knew so little about breastfeeding was simple. The generation before us had not breastfed, as a rule, hence they were unable to inform us of the correct ways to go about it and could not support us through our breastfeeding problems. They fed formula to their infants, so it was natural, when anything went wrong, for them to say, “Why you don’t just feed him/her some formula?” My mother had a theory that David would sleep through the night at six weeks of age once she fed him a large bottle of formula. One evening, after we returned home from a date night, she had been babysitting and happily announced “He took a full bottle.” David woke up three hours later, around 2am, as usual. Sadly, he busted her theory; moreover, he didn’t sleep through the night for three more weeks. My mother did not know that sleeping through the night is a brain-thing and not a hunger-thing. A few days later, I asked my husband to hint that my mother refrain from giving me any breastfeeding advice. I remember thinking about returning to work when my newborn son was six or eight weeks old. I distinctly remember being bored. I loved caring for him, holding, rocking, and nursing him, but there was no challenge, no thought process there. About six weeks after her daughter was born, my older daughter mentioned to me that she wanted to return to her work as a nurse in the Pediatric ICU. She wondered if that was a bad thing. I tried to reassure her as I recollected how lots of working moms would rather work than stay home full-time with babies. Maybe it’s an activity thing. Maybe it’s maternal style. Some women clearly crave satisfaction and success. Your personality type may play a role: Extroverted thinkers (as opposed to introverted feelers) tend not to stay-at-home. Some of us are just not meant to be stay-at-home mothers.

I never entered the field of medicine to work part-time. The training had been too long and arduous. Besides, I loved being a doctor. Medicine gave me a huge sense of contentment and competence. My mother had worked full-time as an elementary school librarian. In addition, she was away from home quite often doing church-related volunteer work. Back in the 1950’s, when I was growing up, mothers did not hover over their children. They certainly did not go to all their school and sporting events; at least mine didn’t. As a result, I learned independence from an early age.

Likewise, our parents had disciplined us in different ways than we planned to discipline our own children. Parents were more authoritative in the 1950s and 1960s. The other neighborhood mothers would contact your mother if you acted up in their yard or home. My parents were very strict disciplinarians. “Because I said so” was heard often, and Daddy’s rules were set without discussion. Mother went along but left the punishments to my father. My husband’s father had acted similarly in his family—he used physical punishment. Phillip and I discussed discipline, and we planned to be more lenient parents. From the outset, we both cared more about our children’s self-esteem than setting limits or strict discipline.

I recognize now that there is no such thing as a “supermom” even though we were told that she existed in the 1980’s and 1990’s. Working mothers were expected to do it all. Even TV commercials told us to “bring home the bacon and fry it up in a pan.” In fact, most of us young working mothers voluntarily chose to “do it all.” What they did not tell us was that both work and mothering were daunting, and each in different ways. They did not tell us that our children would need things from us at the most inopportune times, usually the same time that work did. I spent the first ten years of my own motherhood experience learning that there is no such thing as a “supermom.” I came to understand that I was a typical working mother—constantly trying to balance full-time work and motherhood. Sometimes things were manageable, but plenty of times everything felt totally off balance and out of whack.

There is just no way on earth that one person can be in two places at once. Maybe if you are Hermione Granger in the Prisoner of Azkaban of the Harry Potter series, but not if you are me. My favorite, yet horrible, early memory of this lesson was David’s first Mother’s Day tea held at the church preschool. He was three years old, and I was held up leaving the hospital because one of my babies took a turn for the worse. That baby needed attention. Ultimately, she needed intubation (a tube inserted into her airway), and because of my work ethic, I felt that I could not leave the situation to someone else. I paged my husband and begged him to attend the tea for me while I stayed to oversee the care and stabilization of that baby. I have the cutest picture of my husband receiving David’s hand-made Mother’s Day artwork in my stead. The art was a small, purple, left handprint inked onto cloth and Phillip is sitting in a little chair at a low, round table next to David, both drinking milk and eating a cookie. David was contented; he didn’t notice that my husband was the only father there. On the other hand, I felt miserable for days.

So, I learned early on that working mothers carry guilt. My friends all had it too. And as we compared notes on child rearing, we began to understand just how much of a trade-off working full-time actually was. I was fortunate enough to afford a stay-at-home nanny and housekeeper. We never employed a live-in helper, but lots of my doctor friends did. Without a nanny and housekeeper, I would not have been successful in practicing medicine. (The same caveat goes for my husband. When I was absent, he did everything for our children.) Mable, my elder first nanny, fussed at me when I came home around 6pm several evenings in a row. She scolded me with, “He needs you more than this.” She was probably correct, but I was busy building my academic career then. An older neonatologist, a good friend and mentor, had told me that she and her physician husband had struggled like “ships passing in the night” raising their three girls. She described one of them heading home in response to something going wrong or a sick child. And then the other one would drive home later to relieve the first one, followed by the first one returning to work. My husband and I did a pretty good rendition of “ships passing in the night” ourselves those first years.

I remember vividly one morning that David was sick with some childhood virus or ear infection. He was around two years old and had awakened with a high fever. After treating his fever and dressing for work, I called the pediatrician’s on-call service to set up an appointment. When I observed my husband straightening his tie, putting on his white coat, and heading out the front door, I said, “Wait a minute, where are you going?” He said, “I’m going to work.” I asked him “What about David, what about me?” He said, “You’ll take care of it. You always do.” He turned and walked out the door, seemingly without a care. He apparently had no guilt; he was not worried. He fully expected me to take care of everything, like I always did. This instance was my first recognition of my inability to ask for help from my husband when needed. I would continue to struggle with this and many new issues as a working mother.



Susan is a retired neonatologist, living in Austin,TX. After thirty-six years of full-time practice (fourteen in academic, and twenty-two in private practice) she is actively remembering essential moments from her medicine and mothering career, and she hopes to publish a memoir.

Thursday, March 19, 2020

Should I be enjoying my bubble?


As a daughter and granddaughter of high risk loved ones, this pandemic hits close.
As a mom of elementary school kids, the homeschooling vortex hits even closer.
As a mom of a 5 week old, the unknown is just very scary.
But,
As an Emergency Medicine resident, the COVID-19 pandemic hits really hard too. Maybe even the hardest.

But yet, I'm not there. I'm not in the trenches. I'm not wearing a bandana because there are no more masks. I'm not donning and doffing. Sure, I listen to the podcasts, attend the ZOOM meetings and conferences, but with audio and video off, in pajamas, while also nursing and now virtual homeschooling, in the comfort of my home.

Friends and family reached out with different sentiments that range from " you are so lucky you are still on maternity leave" to " do you feel bad that you are missing out?" I don't know how to answer, other than "please just do your part and stay home."

I'm not sure how I feel right now. Not sure how I want to feel, honestly.  I know I want to protect my nuclear family, stay safe, and keep everyone- from husband to big kids to infant- safe and exposure free. But I'm conflicted about my residency family, my colleagues on the front line. I know I need my time to rest, recover, and take care of myself and my own family right now, but my heart is torn. I'm also scared to go back.

As a physician, we dedicate our lives to helping others, hopefully saving some lives and making a difference. Throughout our training, we sacrifice time with our families, missing out on events, celebrations, quality time. Our priorities are constantly challenged; being a mother makes those challenges at times more acute.

So many thanks, and prayers of strength to all of you out there, fighting this on the daily. Please stay safe. Please know you are appreciated.

Monday, March 9, 2020

Coronavirus and being a mother

I have a confession to make.

I don't know how stressed out to be about COVID19. I'm a chief resident, so my job is to make contingency plans and sit in on big, hospital-wide policy meetings, and field questions from residents via phone all day long, but I don't know how stressed out to be about this.

In medicine: One of my doctor friends' husband works for the CDC, and she is constantly sharing tidbits with me, such as "we should cancel noon conference, or ideally space people 6' apart from each other as social distancing. And no one should eat the food." States are cancelling international work-related travel, then international personal travel (goodbye, husband + my planned trip to Portugal to go cycling while my mother watched the kids for a few days...), and now, domestic professional travel is cancelled, while domestic personal travel is recommended to be cancelled/postponed as well.

In the world, there are two perspectives:

1) Buy more bleach. "But I already have 3 jugs of bleach at home!" Nonsense, they say - the best treatment for infection hysteria is more bleach, and $50 bottles of hand sanitizer, and flats of 16 cans of black beans from Costco. This weekend at the grocery store, they were running low on tomatoes, beans, broth... and lines were out the door.

Have you ever tried to prevent two toddlers from putting their fingers in their mouths? "Wash your hands" they say, "sing happy birthday twice," they say. I say "TAKE THAT USED GUM FROM THE PLAYGROUND SLIDE OUT OF YOUR MOUTH RIGHT NOW." My daughter licked her fingers and smiled at me the whole. way. home.

I felt like I was weighing every choice this weekend when home with the toddlers. Go to the library? The children's museum? Church? Everywhere felt like a hotbed of infection, where I'm not only risking their lives (note: COVID19 is thought to be particularly less-severe in children) but risking become a vector for those around me, and almost as importantly, risking a 2 week quarantine from my job.

2) Just go anyway. At church yesterday, I asked a bunch of mothers whether they considered not coming to church. Everyone I asked said no, and I was surprised. "Really?" I asked them, not believing, "I almost made us all stay home... even as we walked out the door." (Not to mention, I emailed the pastor mid-week and asked if we could change our communion practice to minimize multiple unwashed hands touching the same loaf of bread and risking becoming "that church where everyone got Coronavirus.").

I'm trying to balance fear and risk, anxiety and trust in the world of parenting, where all choices affect them, too. Not just if they get sick, but if I get sick, but if their school is closed, but if my job changes such that the hospital can't run. And what do we do, if there are no residents to come in, and the patients balloon? No one is talking about what it's like to work in these hospitals in China, South Korea, Italy, where patients are in lines out the doors, in courtyards getting IV fluids from bags hung up in trees.

In so many parts of parenting, you weigh risks and benefits, you try to choose trust and hope over being stressed out and anxious. You pull the used gum out of their hands, the rocks out of their mouth, and prevent them from petting a strange dog and then licking their hands (toddlers = so much licking). But when it feels like the world wants you to be anxious, when the meetings all day long fuel the anxiety, then what?

It was beautiful out tonight, sunny and gold, the last flecks of yellow hitting me through the office window over the building tops as my husband put the kids to bed (#win). And I felt this sense of hope, of possibility. Of belief that sometimes you do the thing, before you believe the thing. So maybe just going to the park, just reading them a story, just telling them how much we love them - maybe that's doing the thing, before believing the hope that we will all be okay.