Breathing, Being

Sometimes (OK, many times), it’s hard for me to know what to write about.Life is so extremely busy, so unending, so consuming — it keeps my husband, kids and I super busy, even though we know we are far away from loved ones in our new home. The fortunate thing about a busy life is that it gives you little opportunity to wonder what it would be like if you did not take those great leaps forward and away from familiarity. Instead, a life well lived is so consuming that you can do nothing but enjoy it, and let the adventures waft past you as you attempt to take deep breaths and drink them all in. The air passes by me much more quickly these days. It’s hard enough to let the joys of a tickle fight consume me as I think to the day’s tasks tomorrow, charts to be created, people to be managed, patients to be treated. But tonight was  one of those super fun nights. Ok, it had a little share of whining, but miraculously my little tykes ate their quesadillas, flavored with chipotles in adobo, no less, the kitchen was decidedly NOT in utter ruins this evening thanks to my cleaning lady and my lovely nanny taking charge, and the kids were bathed and dressed for bed, basking in the joy they had earlier where they went to a large sporting goods store and bowled with their nanny.  Baby steps, I think. Maybe they’re not consumed by activities yet, but we are taking it in and having fun.

So after the cleaning routine and a little cartoons for the li’l uns, L and I had a monster game of tag where he got to direct the safe zones — which alternated between the bedroom and our downstairs office — in other words, wherever he was and I wasn’t.  To join in this revelry I’d hoist my daughter R to my hip as she raised her hands upright saying, “Godhi, Godhi” (or “Pick me up and carry me, mamma!”) and go scampering past L.  Meanwhile my husband T was mystified; someone (presumably the cleaning lady) had corrected the arrangement of strings in the office tchotchke the kids had entangled upon his desk.  So up and down the stairs we all ran, round and round the house, enjoying ourselves right up until little R took her dolly — the now 40+ year old doll Clarissa who both I and my older cousin owned — and brushed her teeth, sang her lullabyes, had her wave goodnight, and climbed into bed with her. The doll is practically as big as R, so it’s a pretty funny site watching her extend her little arms to balance the giant doll and teeter her through the bathroom to the bedroom.

Now that I am in the basement, taking care of the little necessities — like cleaning out my ancient phone of excess pictures so that I can get it to function reasonably well — I find another wonderful reason for being. A dear picture from my last job, where I painted henna on a teenage boy who was dying of cancer.img_0681

It was somewhat unexpected to get the message. I had started at the hospital not long before, but I happened to get a call via a friend of a friend who knew me from my henna days way back when.  They didn’t know that I happened to now be a pediatrician at the hospital, but once I heard that there was a young boy who was terminally ill and that his dying wish was to get a henna tattoo, I was too happy to oblige.  And then began a really nice afternoon getting to know a boy, his best friends, and his parents, as they slowly said goodbye to him.

Once I painted the “survivor” design on his palm, everyone was thrilled to get in it and get matching tattoos — listing his nickname, his high school mascot, a “fight cancer” theme despite everything.  And I sat, painted, watched as he asked for more pain medication to ease his discomfort, listened as family members looked at him, spoke to nursing staff, scheduled a massage appointment to help keep them comfortable as they went through these most stressful days, and hopefully brought them some peace. It wasn’t profound, it was very plain to do my art, give my good wishes, and part ways. But I hope that it helped ease their minds and took them away, if only for a short while.

Even after working in a health care environment, I cannot imagine having to spend day in, day out in a hospital NOT of my own volition. How it must be as a family to pack up your things and to go to a place where you know your child is NOT going to leave. He’s not going to get better, and at the end of the stay you’re going to lose him. There are so many fortunes which we have in this world — which includes all that glorious time we have with one another before we, too, depart.  As you can see from this young boy’s tattoo, he may not have survived to see today, but he is a survivor, and his story and his memory is with me and with those he loves.

When I sit back and think of my kids scampering back and forth, shouting and laughing gleefully, I see the fortunes and the joys in the world, the reason for bringing joy to others in a day. Even if I’ve handed my sanity over to a crazy thing 1 and thing 2. It’s for kids that I am and because of them that I breathe.


Posted in Pediatrics, Personal Tagged with: , , , , ,

Depending on the Kindness of Strangers

Those of you who are close to me know that I have recently moved to the Heartland – relocated through my husband T’s job, I am about to start a new position at Operation Breakthrough via Children’s Mercy Hospital of Kansas City, Missouri. I recently had to give a very bittersweet goodbye to my previous employer – KidsHealth of the Nemours Foundation — through which I truly explored my creative interests and my zest for health education and writing over the past two years. And all in all I pretty much lived in my own hometown for 30+ years — 10 years consecutively, most recently, so it was a tough place to leave. T has worked his hardest to make the transition smooth for us. We have found a comfortable home, a nice neighborhood, wonderful vendors for various services related to moving, and have come across wonderful new friends.

The inevitable homesickness has pervaded each and every day for me – I hear it takes about 2 years before you feel settled in a new community. So, I go to networks like Facebook for solace and am focusing on making this new home everything I want it to be — hanging pictures, putting away belongings slowly but surely, getting a CD player to play long lost CDs and enjoy some nostalgia, finally getting the courage to start bike riding (even though cars are the norm here, very much so).  I do miss my family deeply, but all in all I can say that I lead a life of very good fortune — thanks to having had caring parents who sacrificed much to raise me, and having had many opportunities in life and now a caring husband and two wonderful kids. And I’m nervous but excited to start my new job, and am hoping I can bring to it everything I planned while I was applying.

But for every multitude of lovely interactions, I do have one here or there that is less than ideal – most recently it was being dismissed by some staff at a prominently known furniture store here, after which I was curtly directed to browse and consider the cost before looking at the items that I was considering.  I’m not sure if it is the color of my skin that directs it, but it sure feels that way sometime. And people have made assumptions about me – either what I can afford, what I should be doing, where I should be — and none of it is directly offensive, nor do I think that people are intentionally trying to make me feel bad — but these assumptions indeed do make me feel bad and very unsure, and it makes me think about the role that we all play in creating communities that are receptive to outsiders.  At that particular store — fortunately I approached another staff member, who was extremely kind and helpful, and gave me all the information I needed to inform on my decision-making.

People who are new to a community for reasons like mine may be like me in other ways — maybe they have a very strong social structure, and enough social and often intellectual capital to persevere when an off-putting event happens.

But I can only imagine what it must be like for others going through upheaval. Consider refugees, foreign guest workers, undocumented immigrants, and others who truly come to a new place because they seek opportunities and indeed may have nowhere else to go.  My interaction was simply as a customer in a furniture store, but what of more serious issues — being denied medical care, having trouble finding a good job? For example, I remember one recent immigrant I met who was working as a cab driver — he had been a registered nurse in his previous country and a good one, but needed to earn immediately and couldn’t go through needed training here in the US. My experience is nothing to those who are going through so many daily struggles just to get by — and they experience this all in a totally new place.

I think of my interactions with some of these individuals in clinic — and think of the denouement of the visit — the utter relief that a non-English-speaking patient expressed when I was able to use an interpreter with them – not only for the visit, but when I took steps to extend that to other clinicians they were seeing that day. Contrast that with other memories — the days when I knew I was not at my best, and the frustration that patients went through. I now think about the tears families may go through when learning their child is ill, or realizing they cannot afford the care they seek, not being able to advocate successfully for themselves because their new environment is so utterly foreign.

The kindness that we show others is not only intrinsically a beneficial thing — something that can turn a tear-stricken day into a good one for someone who has been through it all — but it has also been shown to improve their outcomes (google Health Outcomes from Positive Experiences — it’s too late for me to research tonight). I recently heard an NPR story documenting the experience of recent refugees in Canada — who after just a few weeks to months of schooling were already showing improved mental health and positive attitudes, speaking English, and adapting to Canadian society.  It is so important to show kindness and build trust with the people to whom we are least exposed, the people with whom we are least familiar. I am so grateful for the many in this community who are already so open to my being a new part of it and have shown me so much loving kindness. I only hope I can continue to grow from my experiences being a total newbie here and extend that kindness to others.

Posted in Health, Medical Topics, Personal, Travel Tagged with: , , , , , ,

The most important investment we can make

Header 4-28-2016

Holding handsThe other night little L and I were playing Uno, his new favorite game. Imagine my surprise to see him calculating his way through the game after he had lost – counting whether he could finish all his cards if he played his current hand. And then his keeping track of the cards I played and teasing me for not playing my own cards better. Clearly he and I both knew the same rules, but he was on his way to playing a much better game than his mom.

In my profession we talk a lot about not wanting to reinvent the wheel. We don’t want to repeat something that has already been done; we want to learn from past experience and make change, make our product better, improve it, make it different.

But what if reinventing the wheel was the task at hand?

What if that precisely is our task?

With each new child comes a brand new iteration of life. While children are born with a genetic code, a child is not born with knowledge of all the lives and experiences that came beforehand. Children are born to learn to trust their parents, to love, to take risks . . . to make bad decisions when they’re teenagers (God help me when my kids reach their teen years, because their mom was so well-behaved during her teen years that she has no frame of reference there!).The progress we each make toward maturity cannot happen unless we experiences the consequences of our actions.

Similarly, with a newborn child comes the birth of a new parent.  It always amazed me to see every new mom comes into my office completely terrified of their child’s cold. That is, until it was my baby with the cold. My new little DS had never had a cold before and suddenly he was suffering, and all the skills I’d developed as a pediatrician were mush in my brain.

It didn’t help to remember what colds had been like for me, and to know that kids get over colds. It really took the experience of going through those difficult nights and coming out unscathed on the other side.

This is what made me think of how much we need to recognize the needs of all in the new parent-child dyads that form. Each needs tools to help the other, and it’s this precise need to reinvent the wheel with every child which reminds me why early childhood education is such a valuable investment for us to make in our modern world.

In the case of my kids — reinvention is part and parcel of each day, such as teaching my children how to manage their emotions — thank you Inside Out for making this experience so vivid! Or even helping them figure out how to handle a troublesome interaction with a friend at school. And my goodness are they absolute and utter sponges for the learning that happens. Their lovely, most plastic and pliable brains respond to knowledge in amazing ways – with my 5 year old son learning how to read and write and my 2 year old daughter learning how to get her shenanigans past her mommy.  They process and recall things so much better than I ever did.

When my son learns about ostriches in school he can tell me precise details about how fast they run, who they’d beat in a race, and give me examples of their “creature powers.” I struggle to keep up, myself! But thankfully, I have also been fortunate in my own education so can reinforce his knowledge, help him recognize if he needs to think differently, and acknowledge my own defeat when he has surpassed his mommy’s comparatively limited powers.

Compare this with an experience that I had visiting the natural history museum — I saw a lovely family going through the museum and stopping in front of a large diorama of several deer about to be attacked by a puma.  The young daughter exclaimed to her mother, “That’s a puma, it’s going to attack its predators.” And the elated mom shared this with another relative who was with them, and they continued on their trip to the museum, thrilled at how their daughter was learning. I bit my tongue – clearly this little girl was curious and learning good concepts in school, but her mom was so excited by her daughter’s knowledge that she missed an opportunity. Once we get past our own amazement, we can question the knowledge and say, “predator – that’s an awesome word! Did you mean predator, or prey?” — or something else to help her daughter clarify what she had already learned.

A lot of the fundamental knowledge that leads me comes from my earliest years — when I got to understand simple concepts of language, interaction, society, math, a zest and love for reading — the list goes on. Making learning enjoyable for those kids so that they get thrilled the next time they see a diorama at the Natural History Museum — and making sure that their parents had an awesome education and the tools to help their kids grow even more is paramount.

So it’s clear to me that we need to ensure that every child has access to a safe, play-filled, and learning-filled early education environment. It’s a clear way to even up their playing field and give them the foundation they need. But how do we bridge the gap that adults face, and make sure that both parents and kids are prepared for one another?

  • Find books – even children’s books – about what kids are reading – and read them together with your child. I certainly don’t remember all the details about ostriches I learned as a child but it is not as much about the details as it is about the dyad and the foundation for a love of learning. Enjoy your children’s learning and grow with them.
  • Find easy ways to incorporate their learning at home – when they are learning about plants and photosynthesis, find a few seeds and grab a little dirt from the yard, and plant a little seedling in the house.
  • Involve kids in all the things that you know – for me it could be I how I bake their favorite chocolate chip cookies and what happens if I change the recipe a little or alter the baking times. But if it’s your awesome soccer technique, how you use the bow on your violin, how you tend your garden, how you beat someone at chess (or Uno!) – whatever – remember your strengths and use them to help your child to grow! You may find the wheel reimagined completely.

What tip do you want to share with me and other parents to encourage your family’s learning? Please share!

Posted in Communication, Daycare, Development, Education, Pediatrics, Personal Tagged with: , , , , , ,

The story they don’t want you to hear

OK guys, I have to tell you something. You’re probably not going to like it. And I’m telling you, they don’t want you to know. They don’t want to hear it. They don’t want to have a discussion about the facts.

It’s about vaccines. I have given all routine vaccines to my children and things really were going as expected up until now.  My daughter is 2 and is speaking in full sentences, very active and playful, cracking jokes and making mischief.  My 5 year old had been a superstar – speaks like a little old man he is so coherent, loved his letters and doing Montessori math, and . . .well. .  after the most recent dose they got at their last well visit, the most UNEXPECTING THING happened.


Absolutely NOTHING. Not even a stinkin’ tear afterward (though they did cry a bit before). They didn’t whine or say they couldn’t use their arm. Not even a fever. The little nutcases were up and running and active right away.  They were just as communicative as ever, though I’d have to say that the worst thing about the entire experience was actually the band-aid. It took nearly a week to come off. When it did it still peeled a bit and didn’t fall off easily the way I would have liked. Every mom knows there is nothing worse than removing an ultra-sticky band-aid to make a kid distrust his mommy.  (OK maybe combing tangly hair is a close second).

Stinkin’ band-aids.

So getting back to those vaccines, they really must be a menace. I mean geez, the number of shots that kids have had to get to prevent diseases that could harm them or children whose immune systems cannot fight these diseases. With the hundreds of thousands of species of bacteria and viruses in our world, maybe it is too much to ask for the scientific community to recommend children get vaccines for 16 of them?

But here’s the crazy thing. Since getting his 5 year old vaccines, my son has learned to read extremely well. He went from reading Bob’s books to reading simple storybooks and the “Mr. Men” and “Little Miss” books he prizes. I wonder if vaccines caused him to be such a strong reader?

But here’s a bigger question. Why the meandering rant?

There’s nothing like a new celebrity wagging his finger at the medical establishment to make a doctor-mom want to vomit. A lot. The most recent iteration: Dr. (okay, not a doctor) Robert DeNiro stating that physicians and researchers have not been paying sufficient attention to the conversation about whether vaccines are related to autism (Antique Spoiler alert: they’re not.)  Doctors deal with this issue every day – thanks to the work of charlatans like Andrew Wakefield – and millions of dollars have been spent trying to see if there is a relationship. No relationship has been found. Mr. DeNiro says that “nobody wants to talk about it.” Not true. We talk about it often with patients and we all do our reading and our homework and I have personally read that horrific Wakefield study enough times to know that it’s plainly a bad study, and warrants no documentary, no expose, and certainly no recognition at an internationally renowned film festival. Interesting that DeNiro pulled “Vaxxed” because filmmakers were backing out.

Now my disappointment. Ah the disappointment. I LOVE Robert DeNiro – at least until I saw this ridiculous interview.  I remember learning that his son had autism and seeing that he blocked the “Vaxxed” film from Tribeca and me thinking, finally a celebrity who can look at this with a clear eye and not let false views prevail. And then he comes out with his interview. Where I learn that he cares about his finances more than his personal ideals — and that his personal ideals and beliefs themselves are misguided.

We physicians do (and so very much do) want to find out the cause of autism. Having a child diagnosed with autism can be a devastating experience for families, but it does a disservice to the autistic community to argue that vaccines are the cause.  All of us want our children and our patients to be healthy physically, mentally, and emotionally. But — Evidence shows more and more that autism is present in the brain before birth.

You know the story that nobody wants to hear? That vaccines work and that all of us benefit from vaccines being around and that the use of vaccines has saved hundreds of thousands of lives and has contributed to our longevity and our health.  And children who have autism have a medical condition and they are children who have needs, wants, talents, beliefs and aspiration. They are themselves and are a part of our community.

As a medical community we need to figure out how to continue to be empathic with patients and deal with their concerns while also taking on those who support bad science and fake stories. And we need to figure out how to make the true stories prevail.

Posted in Health, Medical Topics, Pediatrics Tagged with: , , , ,

The screen time that’s worth sharing with the next generation

Being a working mama means that the hours between getting home and bedtime are short and concentrated. Face-to-face interactions are maximized and concentrated, dinner is cooked and eaten, books read, and several laps around the kitchen are all in order to fill that narrow space. So those rare Friday nights when we all relaxed are coveted by all.  The kids’ birthdays are coming up in a week and we anticipated having several family visitors this weekend – but unfortunately the warm winter’s joy (i.e. illness) prevented our meeting. But the flipside was less preparation for all of us and a phone call to the local pizzeria for some nice pie!

After a tiny but decadent dose of pre-dinner chocolate we all dove in on the pizza, with a side of salad for good measure, sat, chatted, giggled, and ate cheese and crackers, while little L and his Naniji played several games of “pop-up” — a generic version of the game “Trouble” (Parcheesi).  Naniji got all the sixes and L none, so the victories were a bit one-sided to say the least.  Little R was true to form — refusing to sit in her booster seat and instead getting into daddy’s dinner chair with the handles. In that chair, up and down she climbed, asking “Yes?” as she stood up. . .  No, R. Then came the singing of Jingle Bells. She sang one line, I the next, and on we went as we traded the strangest facial expressions. Sigh and love and joy.

The piece de resistance prior to R’s bedtime brought into play T and my family’s movie pastime of childhood, which also happens to dovetail with our daughter’s obsession with the song “So Long, Farewell,” to which she affectionately refers as “Cuckoo.”

Yes, we watched The Sound of Music.

There are some screens that are totally worth it, that not only take you back but also bring your family together into new versions of that history and take your kids into your childhood. Then when they’re the Sound of Music they take you even further back into history and remind you that history happened not so long ago and so many things from then still resonate now.

I still remember the coo of my little brother singing “Edelweiss” with a lilt and a squeak (only to hear my daughter singing it similarly just a few months ago).  Our utter joy watching the Lonely Goatherd.  The way my family members have adopted the songs, sung them together, gone on pilgrimage to Salzburg, sat in utter silence as we watched Christopher Plummer and Julie Andrews work their magic. Ah the lighting, the glorious lighting, camera angles, beauty of the faces, frames. So familiar and loved.

We started the movie experience tonight with a jump ahead to “So Long, Farewell” — I wanted R to see it before I took her up to sleep. She was bouncing the whole time. Oh the glory of seeing my daughter see the kids sing “cuckoo” in person — she watched gleefully and started to join into the music, moving her hands and waving goodbye along with them. I simply can’t believe she’s going to be 2 in just a few days.

After that, Little L, my husband, and our au pair (who had never before seen The Sound of Music) went back to start the beginning of the movie. I spent this time upstairs singing “So Long, Farewell” to Little R and reading “Brown Bear” and falling asleep myself. L came up after intermission, intent to see the rest of the movie, but immediately fell asleep.

When I was growing up I never made it past the wedding scene. I just watched till then and thought the movie ended there. Didn’t quite get the bit about them wandering through the mountains.  I’m wondering how far we’ll go with the movie with Little L and if we’ll make it through all the historical parts we can teach him.  But I can’t wait to bring other parts of my musical theatre-obsessed childhood into the picture. We’ve watched Mary Poppins but in the pre-comprehension state. Interested in reintroducing it.  And My Fair Lady. Hello Dolly. Oh my, so many fun times lay ahead of us!

Posted in Personal Tagged with: , , , , , , , , , ,