Im(mobile) Technology

Before I had a cell phone, or a mobile as I called it while living in England, I used to call home from pay phones while on long car rides. Halfway between my parents' house and Princeton there was a McDonald's where I pulled over more than once, using a prepaid calling card to place the call, justifying the fries I would order as being a form of payment for the use of the facilities since, as Annie put it, when you gotta go, you gotta go.

Now, without my cell phone in an easily accessible pocket, I find myself nervous about pulling out of the drive, almost as if traveling without the ability to summon EMS is akin to courting certain death. I am chastised by my husband if he finds me unreachable, pointing out that the daily cost of my cell plan is wasted money if I can't remember to charge my phone or keep it with me in order to eagerly receive his calls.

Bite me, is usually my very inelegant reply. Still, it gets across my point.

Until recently, when I was lucky enough to receive a work sponsored upgrade, I lagged enormously behind the available technologies. When I was in Liberia I was surprised by many things, not least of which was that everyone seemed to have nicer and newer cell phones than I. For more on Africa's cell phone revolution, consider perusing this piece in The New Yorker or this one in USA Today. Both make interesting points, none of which I'll linger on here, because my real point in writing this post is to point out how incredibly privileged and lazy I am.

We have a big house. It may be falling apart, but it is still rather large. While in our one bedroom/one baby closet condo we never had a baby monitor, but this was one of the first things we bought when we moved in. We had to. While I was outside planting the many fabulous bulbs soon to burst forth in all their glory in our front yard, Emmaline was napping. How else were we to hear when she awoke? And how else are we to call each other down to dinner, or find out where each of us is, than by calling each other not out loud but on each other's phones?

Earlier today my father got home from a visit to the barber. He probably wanted to show of his new hairdo and was disappointed not to find any of us waiting to tell him how fetching he looked. So he called me.

"Where are you guys?" he wanted to know.

"Upstairs in Em's room," I replied.

"All of you?" he asked, meaning Emmaline my mother and me.

"All of us," I confirmed.

There was a pause.

"Are you coming down soon?"

Emmaline was busy taking things out of her toy box and I was busy putting them back in again. So we were not making a move any time soon. I told my dad this. There was yet another pause.

"Okay, then," he said. "Bye."

"Bye," I echoed.

We hung up.

I love many things about my phone. I love that I can take pictures of Em and send them to Daryl while he is at work. I love that I can make videos of Em and do the same. But still, on the whole, I find many of the ways it has impacted my life more than a little ridiculous. But I am a ridiculous person, so I guess it sort of makes sense.

Bigger and Better

One of my very favorite nurses had her last day in the ER yesterday. She has three beautiful boys at home and the hospital schedule was one she was ready to leave behind. I certainly cannot blame her. There are times I wonder myself how people sustain the necessary energy over the years and decades. There are times I wonder how people sustain the necessary energy over the course of a shift.

I feel enormously lucky to have worked with her. She kept me in line.

Hopefully she'll condescend to let her older, wiser boys play with Miss Em someday. I'm sure they would teach her many things, just as their mother did for me.

Social Media Frenzy

It was on the news this morning and in my emails from the AAP (American Academy of Pediatrics). Facebook is changing the world, but it is also opening a doorway to depression for some teens. As someone who resisted social media until my husband signed me up for Facebook and (years later) for Twitter, I am amazed at how quickly participation in these online forums has changed my perception of friendships and closeness.

On the one hand, I have been lucky enough to reconnect with certain middle school and high school friends who had babies around the same time I was expecting Emma. It may be only a form of glorified stalking, but it has given me no end of joy and of comfort to watch Tara and Dahlia grow bigger (in their online photos) and to occasionally let their moms know just how pretty I think both girls are. Doing so is a reminder to me that no matter how many times I've moved over the years or how many different groups of friends I've had to move in between, I still have some connection to the girl I once was.

On the other hand, the contact I have with Tara's and Dahlia's mothers is limited and intermittent. Still, I know that it is better than nothing. I know this because there were years we did not speak at all. There were years, in the pre-Facebook era, when our paths intersected rarely if ever. For teenagers today, who know no world but the one in which MySpace and Facebook and Twitter are ever present and pervasive, there is no such perspective. Social media is not an amusing appendage. It is an imperative.

In the ER I saw a fourteen year-old boy with carpal tunnel. "But I don't type much," he protested. I countered, "Do you text?"

I saw a sixteen year-old girl who had broken her ankle. "I can't get a signal in here," she complained, waving her cell phone. "I need to let everyone know I'm okay." More upset about being cut off from her friends than by the break at the base of her tibia, I reassured the girl she would be splinted and ready to go soon. "No, now," she whined, eerily echoing Veruca Salt. I looked at her mother, who shrugged, so I walked away.

What makes me worry is that teenagers have a hard enough time being nice to each other face to face. Online, where the shame of seeing the hurt you have caused another is attenuated to the point where it is practically nonexistent, I can only imagine that they are brutal.

Even adults, with the cloak of anonymity the internet can provide, are quickly reduced to behaving atrociously. On a blog hosted by another physician, one particular topic got the readership particularly incensed. The comments section was filled with expletives and hideous, hurtful statements. Had the physician been witness to such language in person, no doubt he or she would have felt compelled to intervene (in a professional capacity if not simply as a human being). But online, despite being more permanent in many ways than the spoken word, the conversation was condoned.

If adults are behaving this way, what horrid things must our offspring be doing while we ourselves sit at our laptops or tap away at our smart phones? We will never know unless we ask.

Hannah Montana

I was chatting recently with a woman whose six year-old daughter, Judy, behaves in many ways as if she is only four. The girl is smart, verbal, and lovely. In many ways she outperforms other children her own age. But in certain aspects of social interaction she struggles. She does not read facial cues as other children do; the negotiation over who will play with a certain toy that may be effortless for another child, for Judy becomes torture.

Her mother, who found her daughter was happier when they were at home and she could help maintain the familiarity of routine and reassuring surroundings, has only slowly begun forays into playgroups and outings to the supermarket or the mall. They are taking things slowly, avoiding over-stimulation, but they are making progress.

It is labor intensive and while Judy's mother is rewarded by witnessing her daughter's transformation from a child who could not function at all outside the home to one who plays regularly with a 'best friend', she also admits to finding a much more selfish source of comfort.

"She doesn't know who Miley Cyrus is," she told me. "In many ways she's still a baby."

Judy is content to let her mother braid her hair and pick out her dresses. She is content to read stories at bedtime and snuggle on her mother's lap on the afternoons she is tired enough to actually nap. She enjoys picture books with charming talking animals and never demands to wear makeup or miniskirts. She is not unnervingly old before her time.

Fashion for Tween

It may be that Judy will continue to have the same sorts of difficulties as she grows older. Certainly it is tempting to diagnose her with something, anything, find a label that fits, and petition her school for an IEP. But in so many other ways she is doing beautifully, she is thriving. Might this extra time spent as a child, rather than as a pre-tween, actually benefit her? She is closer to her mother than many other children I've met. She does not yet think in sound bites, but in entire sentences. She works hard when given a task. She concentrates. She is not easily distracted. 

She is an amazing young lady and doesn't need, I shouldn't think, any other label than that.

Physics 101

My daughter learned some important lessons about momentum today. First, it can be imparted, such as by a dog thrusting her head against your chest in an effort to obtain the strange and elusive String Cheese. In cases such as this, it is entirely possible to loose one's footing on the kitchen bench and fall, crack, onto the ceramic floor.

In light of this outcome, one might be tempted to believe I am not entirely baseless in my suggestion that Emmaline sit, instead of stand on the bench. She hears me. I know this because every time she stands up she sweetly meets my eyes and says, "Sit." Then she smiles. But even with the minor head injury, I'm pretty sure she will continue to choose not to obey.

She also learned about inclined planes and took to repeatedly rolling a large blue ball up and down her slide. The ball has become one of the few toys that is never taken away from her, being impervious to Scout's jaws, and so she has adapted it for many games, including but not limited to tripping adults, knocking glasses off of tables, and throwing it tauntingly at the dog's face.

Where she was going when she left the room with such a resolute hustle, I have no idea. By the time I caught up with her, she was doing something else entirely, namely moving the dog's dinner from the food bowl to the water bowl. The ball was already long forgotten and the front of her onesie already sodden.

So Em made some progress in her ongoing quest to master the physical sciences. She is her father's daughter after all. Hopefully this will balance her less than stellar moments of being just a baby - for better or for worse.

Long Distance Relationships

Emmaline doesn't see much of her grandparents. By this I mean her paternal grandparents. My parents, of course, she sees all the time. This weekend is an exception. Nana and Papa flew the coop and headed north, dismayed to find there is still a considerable amount of snow in the Washington Valley but thrilled (I'm sure) to have a few days without diaper duty.

Daryl's parents, who live just outside of Chicago, she hasn't seen since the weekend we visited them at the beginning of last month. Before that it was October, when they were here for two weeks to help Em pick out her first pumpkin.

They had commitments elsewhere over the holidays. We stayed home to settle into the new house and keep my mother's collection of Santa's from taking over the world.

Before Emmaline was born, these gaps seemed negligible, a few months here and there or even more. Life was busy; travel is expensive and difficult. As such, phone calls seemed like enough.

But now, in life post Em, a few months bring with them enormous changes. Yes, life is even busier; travel more expensive (my daughter is not a good 'lap child') and infinitely more difficult. But are phone calls enough?

When we were in Chicago not even two months ago, Emmaline was saying words but she was not talking. There is a difference. She would babble. She would coo. She would blurt out almost recognizable monikers like dog and ball and water and even use them appropriately, but she was not talking, not in the way that if someone were to overhear her they might think she was fluent in a language that they did not know. Now she talks. She converses. She has a story to tell. This makes the moments my own parents get to spend with her all the more precious, but it also (we learned last night) opens doors for moments of deeper connection with the set of grandparents who are far away.

Walking upstairs after picking up the family room, I expected to find Emmaline hard at work brushing her teeth and practicing putting stuffed animals in the bowl of her potty. Instead I found her pacing the upstairs hall with Daryl's Blackberry cradled to her ear. She was keeping up a steady stream of conversation, the nonsense punctuated by words I would recognize, such as hi and shadow and owl. She was telling her grandparents about the things she had seen at Drumlin farm. Or else she was telling them about a dream she had where she was an owl and lived in a tree. It didn't matter. She was on the phone talking. The chatter went on and on.

We changed her. We put on her glow in the dark spaceship pajamas and Emmaline tapped her chest and opened and closed her mouth several times to let us know that she still thinks the rockets look more like fish than interplanetary missiles. Then she resumed talking.

Lights out, she waved to her shadow. She cuddled her blanket. She dove headfirst for her crib to signal I should stop cuddling and put her down. Daryl put the phone against her ear once again so she could say night night and yayoo (love you) and bye.

It's not enough. Of course it isn't. But it's something. It's something quite special.

Thanks to the Boston Globe...

for including my piece on half-truths in today's Magazine.

Dating Yourself

Because I live with my parents, there are many things in my house that I have never laid eyes on. Much of what they brought with them in the great trek from Western New York had in fact originated in Massachusetts. They were only bringing it back home. All of my books from growing up, for instance, where I had written my name in painstaking cursive on the fly leaf or used my crayons to make 'improvements' to the story's illustrations.

These now of course belong to Miss Em and she has quite enjoyed many of my old favorites, including the story of Emmy and Timothy, the girl and her lamb, which ends in spilled birthday cake and rogue purple balloons but also includes daisy chains and long walks through grassy fields. Also, the picture book of the boy who takes his goat camping. They spend warm summer nights together in a red tent eating granola bars. That always seemed to me like something I wouldn't mind doing. Unfortunately, my parents didn't love me enough to buy me either a lamb or a goat, a slight I am still trying to outgrow.

Last night Emmaline found another one of these treasures, an over-sized paperback entitled A Sigh of Relief: The First-Aid Handbook for Childhood Emergencies. It, like so many other items that emerged from the enormous moving truck my parents somehow managed to fill even after several rounds of merciless culling, is completely unnecessary in life. It either survived because it was packed in a box at the point at which no one was actually registering what things were anymore, having moved into the phase where everything just needs to go, or else my mother specifically saved it with the thought that I might find it interesting.

I do. But I will also be getting rid of it. Our house may be big, but it's not that big.

The book was published in 1977. I suppose it was reasonable back then, in the wake of the psychedelic sixties, that the few pages printed in color would be devoted to possible toxic ingestions of certain flora.

The pages that outline what to do if you are impaled in the leg by a metal dart from your dart board, I'm a little less clear about, especially as neither party involved appears particularly disturbed by their predicament.

Also, and here it was Daryl who asked the pertinent question, when would you ever use an ironing board as a stretcher? Or, as another page illustrates, a door? Doors are heavy. I bought a house, so I know this now.

In the end I didn't learn anything about medicine from flipping through the book. But I did come to the realization that no matter what Bradley Whitford may think, it is a very good thing indeed that mustaches have fallen out of favor.

Campfires and marshmallows, however, are understandably timeless.

Surely Shorn

Even with the sun streaming down around us it was cold today. Unseasonably so. Maybe it is a form of selective memory, but I do continue to maintain that March should at least make a good effort to hover somewhere above freezing. Despite chapped cheeks and fingers, we ventured out to Drumlin Farm for their annual sheep shearing event, appropriately titled Woolapalooza.

I do wonder though, had the Massachusetts Audubon not already widely advertised the event, if the farmers might have chosen to wait to deprive the sheep of their winter coats. Alas, the shearing must go on.

Em, a big fan of both outside and animal noises, started out strong.

Encountering her first rooster, she was joyous and unapologetic at the volume of her exclamation: "Caw-a-doo-doo-doo!"

The cold did bring with it a few fully toddler-esque meltdowns: screaming, lie-down-in-the-goat-droppings and kick your feet tantrums. Well done, Emmaline. You are very grown up indeed.

Covered up with a blanket and tucked into her stroller (very much against her will) she did recover and go on to do great things, such as alternately tell the owl "hoo hoo" and the people looking at it "shhhh" since the bird was clearly sleeping. She clapped when the border collie finally herded the sheep into the corral. And she grunted insistently at the very pregnant pig, who I'm sure would have been more appreciative had she not been mourning the loss of her mother, who recently "went to market" ostensibly to buy some Breyers mint chocolate chip and never came back.

It was touching how many families were out with their children, despite the cold. We had piled into the car on a whim, without any appreciation of how busy it would be until we rolled into the grassy field filled with parked cars and bustling with parents pushing Bugaboos and Quinnys or strapping on the Bjorn. Apparently this is what wholesome, upper middle class Americans do on the weekend.

Emmaline in tow, Daryl and I did our best to not blow our cover and to try to fit in. Next, to achieve full camouflage here on the North Shore, I suppose we'll have to buy a boat. Until then, since we had some cash left over, we made a stop at Fuddruckers with Craig, Lindsey, and Bridget and worked on learning how to share.

Cuddles and Cavities

Emmaline is due soon for her first visit to the dentist. At present we're putting it off, doubtful that it would be anything more than an opportunity for her to learn how much fun biting is. But the truth is that she has got herself a nearly full set of teeth. We won't be able to avoid it much longer.

In preparation for the inevitable, I've done a little reading online and I came across this article. Yes, it's almost a year old. Most of the news I read is about that out of date. When I keep up with current events, I find out things like Donald Trump is running for president and these are facts I'd really rather ignore.

To sum up, the article outlines how certain bacteria in our mouths, specifically Strep mutans, contribute to the formation of cavities. These bacteria can be spread from adults to their offspring by sharing cups, biting off pieces of food for your child, or kissing them on the lips. When one woman's two-year-old was diagnosed with two cavities, her dentist gave her printed recommendations on how to help her daughter prevent cavities in the future. This list included the advice to avoid kissing her daughter on the lips.

I have to admit that when Emmaline was first born, I was hesitant to kiss her on the mouth. At first because she hadn't yet had a bath and later because her mouth was just so small. Pressing my face up against it seemed the sort of thing that was appropriate only if I needed to give her rescue breaths. Otherwise, I thought, I was sure to smother her.

Then one day when I came out to the living room from taking a shower, Daryl looked up from the couch where he was sitting with the brand new baby. He looked at me sheepishly. 

"You need to kiss her on the mouth. I just did and it's freaking awesome."

Even with this resounding affirmation of the activity, I put it off for a while. I felt as if I just didn't know her well enough, I suppose. But eventually I warmed up to it.

Her lips are not the only place Emmaline receives kisses. The top of her head is in fact the most frequent site smooched, mostly because I can plant a few while she sits on my lap to read me Llama, Llama, Red Pajama. While she turns the pages and in between exclamations of, "Oh! Mama!", she is helpless to block my advances.

I read the whole anti-kissing column. I reviewed the decades of data that support the dangers of swapping spit. And at the end I concluded that I just don't care. She is just too scrumptious to resist. I fully intend to continue to give and receive any and all manner of Emmaline kisses that I can get. I know Scout certainly will be doing the same.

Dog Days

I don't want to be accused of cruelty to animals, so I will go public and say that I think my dog may be suicidal. She gives the impression of absolute contentment, eagerly licking Emmaline's face at every opportunity and then falling into a coma-like sleep, her body stretched out across the width of the whole sofa. She joyously chases balls, or sticks, or pine cones with wild abandon. She races along the boundary of our yard when neighboring dogs walk by with their owners, tongue slack and undulating in a breeze of her own creation. What else is there to define canine happiness but this?

Then, a little over a week ago she started throwing herself into oncoming traffic. This is a slight exaggeration, but I don't doubt that this would have been the case entirely were she not confined to the yard. She would certainly have been creamed by one of the landscaping trucks that come barreling by, yard equipment in tow on a trolley attached to the rear. As it is, she is limited in her opportunities to flirt with certain death to those moments when we pull our cars into the drive.

This takes a brief description at least to appreciate the scene. The house, in its former glory days as a multifamily residence had a wide swath of its front yard paved for extra parking. This lot gives the property the air of a group home or rehab facility and is probably why people took the liberty to park in it during our neighbor's Halloween party last fall. It is not a narrow lane we are dealing with, but a sprawling open space that allows a dog, such as Scout, to achieve considerable speed while running across it.

You turn off the main road and onto a small, idyllic side street like Wisteria Lane, where the houses are just as beautiful but fewer of the residents have committed murder or vehicular manslaughter (at least so I'm told). But before you get to these newer residences, you turn into our drive, pulling up in front of the ramshackle old estate with the rotting wooden gutters and peeling paint, the withered gardens composed almost entirely of poison ivy. You creep forward, travelling perhaps 5 miles an hour while taking in the building in front of you, wondering if perhaps the owners are indifferent to appearances or have fallen into financial ruin.

Then, thwack. You run into a dog. Or did she, perhaps, run into you? You stop, not seeing her, panicked at the thought that she is dead beneath the wheels of your car and only slowly gain the courage to inch forward. Thump. You hit her again. Or, you are beginning to become more convinced, maybe it's she who hit you?

When in this situation you might be tempted to lean on your horn, reasoning that the noise would have some hope of scaring her off. You do honk, several times, and find yourself disappointed at the lack of any appreciable impact. The woman pushing a stroller along the sidewalk starts to stare. You reassess the situation, leaing forward to get a better look. Scout taunts you, standing just inches away from your front bumper. You are afraid to drive forward.

Thinking on to the next step, I can tell you with absolute conviction that the appropriate thing to do is not to open your window to yell, try to reason, attempt to distract. Doing this will only result in a willful leap, one almost certainly made with the intention of strangling herself on the window's edge. Her head is thrust in through the narrow opening; her tongue makes a valiant effort to reach for your face. Her legs then scamble wildly in an attempt to pull her body up and in through the portal. So whatever else you decide in that moment, please keep your window rolled up.

It saddens me, of course. We have tried to make her feel welcomed and loved. We have fed her and pet her and cuddled her to no end. That she should prefer death to her life as part of our brood reflects poorly on our family as a whole. That she should doggedly collide with one car after another in her attempt to find one rolling at a high enough speed to put her out of her misery is, I think, tragic.

Or maybe, I am forced to reconsider as she chases her own tail, this behavior is evidence not of a malingering depression but only that she is truly and deeply stupid instead.

Dead and Beaten

Recently people keep asking me why I chose to be a pediatrician. It's the question that follows quickly after: So why did you decide to write a book? While the answer to both these questions is complex and multifaceted, the nuances of which I will likely only uncover slowly as the years unfold, I do know that one reason for the first is that I get angry at people who are not taking care of their children. What better way to advocate for those kids than to help keep them healthy?

Now, there are many reasons why parents struggle with being able to provide for their offspring. When this happens I enjoy being able to advocate for the family as a whole. But there are other situations in which a parent clearly needs to get their crap together. No excuses. No questions asked. Just do it.

I'll also admit that when I hear mothers tell me that they are having difficulty negotiating life alone with her child or children, I typically have strong feelings about what those children's father should be doing, but clearly isn't. Then I heard Nina Totenberg's report on deadbeat parents while driving to work today and, curiously, I found myself having some sympathy for the deadbeat dad in question.

Here's the story. A father from South Carolina was jailed for a full year because he failed to pay his child support payments. This was only one of many sentences he was made to serve. Over the years, he went to jail repeatedly. 

If I had been only half listening, I might have been tempted to think that it serves him right. But I was actually paying attention for once and so I heard the part of the report where Miss Totenberg related that this man was poor. Not just struggling to makes ends meet. Not can't supersize my value meal financially limited. Out on the street, has nowhere to sleep poor.

The only way he can pay his child support is to get a job, which is unfortunate because he's generally unable to show up on time what with being incarcerated and all. I think that even if I had not already had my caffeine this morning, I would have realized that this is not only unjust, but also seriously counterproductive.

Even had I not been having a surge of unexpected empathy for the male species while listening to the radio, I would have felt it an affront to have illustrated for me just how broken this system is. To quote the NPR article: "...in South Carolina, 13 percent of the county jail population consists of nonpaying parents held in civil contempt, and 98 percent of them did not have lawyers."

Really? The taxpayers of South Carolina are paying for food and housing for both the fathers who cannot pay child support and the mothers and children who are forced to live in public shelters. What an amazing waste of...well, a waste of so many different things. Shame on us for not being able to create a system that is only slightly broken and bureaucratic and frustrating instead of one that is just really, really stupid. Hopefully the Supreme Court will be able to agree that we need to do better.

The Young and the Restless

They say that you remember your first love forever. Decades may pass since you were last sitting beside that person who inspired you to realize there was a part of your soul that was missing and could only be found in loving another.

It catches you by surprise. You walk beneath a flowering tree in spring and remember the afternoon you spent together, the window open, the scent of the petals drifting into the play room at the precise moment your hand first brushed his knee.

At first you were afraid. Minutes pass and the awkwardness only deepens, your sense of your possible misstep becomes all the more profound.

It seems as if you have no chance for happiness. You are destined to move only in parallel, always an arm's reach away but forever alone. Then he smiles.

All it takes is a smile. A smile changes everything.

A smile makes anything possible.

A smile makes everything that comes after seem as if it was always destined to be.

Before it has ended, you may walk all over each other.

There will be times when you do not always see eye to eye. You will forget his birthday. He will spend too much time talking with his friends.

But ultimately, you will never be able to forget him. The light will catch the puddles on the sidewalk at a certain time of day, the wagon wheels rattling across the pavement, the birds calling overhead, and his face will come back to you unbidden. Your heart will race and your lips will form his name.

My Matriarchy

For those of you wondering what Emmaline did today, I can tell you that she got up and had breakfast with Daryl. I slept in to prepare for a late night shift and also because I really, enormously love to sleep. Daryl taught her about donuts, including the Boston Creme, because why would you not put pudding in the middle of every food possible? She had a bath. She went outside. She had a tantrum. Standard eighteen-month-old stuff.

I can write about the glorious Miss Em ad infinitum, and certainly have, but want to take a moment to say, in a more serious note, just how much I love her. She brings me joy in ways that my husband, my work, my writing, and my friends never could. I'm not saying anything that every other mother out there hasn't thought at one time or another. But I write it today because I want to talk about an interview I just listened to on Radio Boston with Susanne Venker, the author of The Flipside of Feminism.

I need to admit right from the start that I haven't read the book and I'm actually not sure that I will read the book, as interesting as I find it to think about women's place in our society and the ultimate question of whether we are happier in our roles as providers and mothers then we were (collectively) when we were barefoot in the kitchen. I also need to admit that I am having difficulty bringing any attention at all to a book reviewed as "A gutsy and profound book.  Flipside is a must-read.” by Ann Coulter because Ann Coulter is, inarguably, a right wing nut job. I know this because Al Franken told me it was so and also, because any time I have heard her speak, I vomit a little bit in the back of my throat.

Nevertheless, I will perservere and ask the hard questions. Am I happier juggling the many different parts of my life than I would be if I didn't have the opportunity to do anything more than to decorate cookies for the church bake sale? No. Would I be happier without the shackles of Emmaline's schedule keeping me from writing or sleeping in as I so luxuriously was allowed to do today? An equally resounding no. Is life harder because I am pulled in so many directions? Do I sometimes feel bruised and battered, stretched and kneaded like toffee until I'm wafer thin? Yes.

Now in the interview it became clear that while Miss Venker and I might not be likely to agree on such things as politics, healthcare reform, or gun policies (or maybe we do, I'm only guessing), we are both reasonable people, or we at least strive to be. I'm sure she would agree that my sole goal in life should not have been, from a very early age, to marry and have children. She would instead argue that feminism has made it impossible for me to feel as if these are valid goals to include amongst the other things that interest and drive me. Fine.

I would argue, however, that these are adult goals to have. When I was seventeen and starting college, it would not have been appropriate to choose which school I wanted to go to based upon the relationship I had been in for several months. I hope that Miss Venker would not disagree. So I went to Princeton, an institution that has a not insignificant price tag. I worked hard. I decided I wanted to be a doctor. I was not in love. I was not married. Why would I not continue to do what I enjoyed, which then was learning and studying, just because I was born a girl instead of a boy?

So I went to medical school. I became a doctor. Maybe Miss Venker would even applaude me for the two years I took to study in Oxford, time off of medical school I ostensibly took to write and get a degree in medical anthropology but a divergence from the traditional track of 'start a task and finish it in record time' inspired in no small part by the fact that I felt ready to meet someone, fall in love, get married and I didn't think that was going to happen in the medical school library. Or maybe she, like my mother, would simply say I was crazy.  Two years passed. I returned to med school and residency no longer as merely an individual but rather as part of a pair. The long hours and stress were mine and Daryl's to go through together. We got a little cranky at times, but we made it.

Enter Emmaline.

Now it seems that one underlying tenet of Miss Venker's argument is that it is incredibly difficult to work outside the home and parent your children. I feel comfortable saying this not having read her book because she has also written another book entitled 7 Myths of Working Mothers: Why Children and (Most) Careers Just Don't Mix. That seems clear enough. I do not deny that this is true. It is hard. But, like baseball, maybe it's the hard that makes it great.

Also, and I think this is not only relevent but also unfortunately the most important consideration for most of us whether we fall to the right or left of center, children are expensive. I cannot afford not to work because I took out student loans of gargantuan proportion in order to train for the job I have today. Should I have not gone to medical school? Should I, single at age 21, have not pursued a career that interested me and inspired me because I might someday want to be a stay at home mom? Should I have believed so little in myself that I stood aside while my life was passing me by and patiently waited for a husband? I think not.

Certainly I think that raising children is one of the most important jobs in the world. I think it is important for women and I think it is important for men. I believe, given the opportunity and the financial freedom, both Daryl and I would choose to work less and play with Emmaline more. But I also believe, that Emmaline will be a stronger, more self assured young lady because I not only tell her, but also show her by example, that if she works hard then she can be anything she dreams she can be.

Debtors Prison

It was so beautiful yesterday that Emmaline and I were playing in the swing when it was time for me to go to work. Complimenting my stylish blue scrubs and yellow and pink striped socks, I was debuting the rain jacket I had bought from the Land's End overstock catalog in the deepest darkest part of winter. It is a lovely magenta with white polka dots and was offset by a magenta and navy striped Harry Potter scarf. I felt energetic and ready for my twelve hour shift.

When I got to work, however, I mostly felt hungry. I saw a few patients. I tried not to be distracted by the rumbling of my belly. I pushed the feeling aside. When I was pregnant with Emmaline there were times I would be consumed by hunger in a way I had never experienced before. Everything was amplified. Having to pee, for instance, is something everyone talks about. But I also went from satiated to famished in record time. When I was thirsty it was as if I had crawled my way across a dry and arid plain to reach the coveted bottle of Gatorade. When I was tired it was as if I had not slept in thirty hours...well, I suppose there was a reason for that one.

Last night, though I was able to stave off hunger for a time (like any other organism not being doggedly drained of all things oxygen and glucose related by a small parasite) I knew I would not make it to the end of my twelve hours without some form of sustenance. During a quiet moment I took the opportunity to tell Teri, the nurse I was working with, that I might run up to the cafeteria to grab some food. I had just sent a few patients home and there were no more, for once, waiting in triage. I asked if she wanted me to get her anything, but she was leaving in a few hours and would eat when she got home.

Then I realized I didn't have my credit card. There was no cash in my bag. In my excitement at being able to model my new coat I had not moved my wallet from my winter coat. Instantly, realizing that I might not be able to eat for another eight hours, I was just as hungry as I had ever been while pregnant. A trick of the mind, I'm sure, but I felt my belly rumbling with ever increasing intensity and thought desperately about what I might do.

Now a normal person would have asked Teri to borrow five dollars, or one of the other lovely people working that night. But I am not normal. I am horrendously embarrassed by asking kindness of folks I don't know that well. I once borrowed  fifty cents from a classmate of mine in residency who, graciously, told me it was not at all necessary that I pay him back. But I had to. I felt uncontrollably compelled to not be a mooch. And when I could not find him to repay the debt in person, I left the fifty cents taped to his binder on the oncology floor.

So what did I do last night? Did I starve? No. I called my mother.

The baby asleep, she was doing grocery shopping about fifteen minutes away from the hospital. I talked in my most pathetic voice, the one that made her quit her job to move in with us and help with Emmaline, and put in an order for some sushi.

A half an hour later, walking back into the ER from the hand off, Teri shook her head at me. Of course when I told her what happened it became clear just how silly I was for not asking her to borrow some money.

"Yes," I said, "everyone in triage just saw my mom bring me dinner and hand me five dollars."

For the rest of the night I was teased without reprieve. I didn't care. Market Basket actually makes surprisingly good sushi and, since my mother had said she brought more than any one person would be able to eat in one sitting, I had made sure to prove her wrong.

Spring Awakening

Yesterday was too beautiful to write anything. Emmaline, with the methodical bluntness of an eighteen month old continued to insist upon "outside" at every opportunity. There was no way to deny her. It was a relief to do nothing but watch her walk back and forth, pushing or pulling the wagon, or stand behind her on the swing as Scout bounced up and down and nibbled her legs with just a little bit too much excitement.

The truth is that I needed the respite. Life is busy, but good and happy busy. But work has been busy as well. That's always true to some extent and that's fine. It's the way Emergency Rooms work. I fully understand that. But I've had a couple of shifts lately that have been a strange clash of the extremes in weather related symptoms that have left me feeling drained.

Let me explain. In the summer, one fully expects to see kids with vomiting and diarrhea come in for IV hydration. There happens to also have been an outbreak of gastroenteritis this winter. You add this to the usual wheezing and coughing and flu symtpoms and yes, it's been a little bit busy, but that's just the way it is. I'm rolling with it.

("It's been a day and a half. Why does he still have a fever of 101?" Because that's what flu DOES, it's main purpose in life is to make you miserable enough to cough and sputter its virions onto another susceptible human being who did not get the flu shot because he or she is seven and does not like needles and happen to have parents who forgot that they - as parents - are actually the ones in charge.)

Then it got warm. And this is where I got stretched rather thin. There were still kids throwing up and having diarrhea. There were still kids wheezing. There were still kids who skipped their flu shots coming in with fevers and wondering if they needed to be tested for flu. There was also the little measles index case rides the T thing, which wasn't super helpful but actually much less trouble than I thought it would be.

But then kids got on their bikes, which they hadn't ridden in four or five months, and they went outside. There were still patches of ice and piles of snow along the sidewalks, but they figured they would ride around them. They got out their bats and balls. They dug the frisbees and roller skates from the behind the ski parkas in the back hall closet. They did all of those things that they had dreamt about all winter, when the snow plows were rumbling by at 5am. And then they fell flat on their faces. They hit each other in the head with hard objects. They went, as my grandfather would have said, ass over teakettle and landed on the hard still mostly frozen ground.

So the ER was not only filled with listless dehydrated four-year-olds, feverish and cranky toddlers, and hyperactive kids puffing on their albuterol. Now we had broken wrists and collar bones, scalp lacerations, and potential skull fractures hiding beneath the grapefruit sized egg on the back of that nine-year-old's head.

A certain amount of crazy is what some people thrive on, but this for some reason just made me jealous. I wanted to be outside breaking my collar bone, not reading x-rays in my darkened office or handing out percocet.

So yesterday I walked the street with Em coasting along behind me in her stylish Radio Flyer. And I was reminded that there are children in our neighborhood, more than a few, and they were riding their bikes and waving to the baby and I felt happier than I have in a long time with the promise of long warm afternoons doing the just same all the summer long.

Oh the Places

"Outside" is Emmaline's most frequently uttered word over the past several days. Even this morning, with rain pouring down and puddles forming on the slate walkway out back, she persisted.

"Water," she said. "Splash, splash....Outside."

I was not feeling particularly accommodating, not only because of the wet but also because the temperature was hovering in the low forties, and so despite her incredible verbalization of the request Emmaline stayed cooped up and dry.

Yesterday she had gotten plenty of sun, distant and wan though it was, and so I did not feel overly guilty about denying her wish. It was a landmark occasion, the little red wagon that had been buried beneath ten feet of snow for the last several months had finally emerged, rising like dry land after the flood waters recede. It was dirty and covered in rotting leaves, it is true, but it was functional. The plows had not torqued the wheels or the handle so much that it was unusable, as I had feared would turn out to be the case.

It took Em several tries to get the hang of maneuvering the vehicle around the driveway and yard. But she kept at it. Her concentration for certain tasks is astounding, in large part because I often find it so hard to focus myself. This morning, for instance, sticking together over-sized legos while music played in the background and the dog chewed on a knotted bit of rope and I poured myself more Diet Coke, the chaos in the house was enough that I lost track of my train of thought several times merely in the process of getting ice and opening the two-liter soda bottle. But when I turned back to Emmaline she was intent, completely absorbed in the fitting together of one nubby block to the next.

"Good job," I told her.

She gave me a look of derision, as if to say, "No kidding. I've been rocking this fine motor thing for a while, lady."

So outside, she kept her head down and eyes straight ahead. The dog sniffed at the wagon and knocked her about but Em remained undeterred. She walked on. She swiveled and turned and headed off in a different direction, the wagon bumping inexorably along behind her, bent wheels and all, rattling in time with her soft sing song as she told the birds and the trees about all the wonderful places she was soon to go.

Denver Developmental

Emmaline had her eighteen month appointment yesterday. It was her first visit to our new pediatrician and it went remarkably well. The room was decorated with lithographs from Lion King, Snow White, and Monsters, Inc. This not only distracted her during the lead up to the moment when needles were stuck into her legs, but also provided a backdrop against which to display some of her more remarkable verbal skills.

"Ah, ah, ah," declared Emmaline, pointing at Rafiki.

"Roar!" she said later, gesturing to Simba.

Finally, and this was the culmination of having watched the Monsters, Inc. trailer only yesterday to celebrate her brand new word, "Monstah!"

Later, to make sure that Dr. Matthews fully appreciated her prowess in the random noun category, she pointed to Sully and said it again.

Emmaline excelled in all arenas. Her height and weight and her freaking big noggin. Her ability to throw play dough. Her propensity for walking up and down the stairs holding onto the banister with only one hand. Her newly acquired talent of drawing with crayons more than eating them. Her ability to reach that last sock at the back of washing machine and hand it to you when you ask.

That's the good stuff.

Of course I already knew she was doing great, but somehow having her perform so well for her new pediatrician (and that's what it was, a play in which I was cast as the really kick ass mom) meant something to me. I especially enjoyed the part where she paraded out of the office in her fabulous pink dress with a bicycle on it and light green ruffled collar peeking out from underneath and all of the staff stopped to wave and say how adorable she was.

I do the same thing when I am at work. And to be honest, I do it even when the child is only kind of adorable and not even super adorable. So I knew the accolades might be empty, but at the same time I was completely taken in by them, my chest was puffed up and I must have been beaming one of those smug mommy smiles.

She has six months before she has to go back to the office again. If the last six months have been any indications, she will be an entirely different person by then. And hopefully we will have fully conquered geometry and moved on to multivariable calc.

Abstract Expression

Congratulations Emmaline, for learning not to eat crayons...for the most part. The first sweeping strokes applied, she inspects the canvas, mind working furiously to see her way forward to the finished product.

She reaches forward again, with her right hand (as is becoming her habit). I say, "Red." She says, "Reh." I say, "Yellow." She says, "Wewow." I say, "Purple." She looks at me blankly and picks up the blue crayon.

It was not long before Daryl ruined her creation, writing her name in large block letters across the top of the sheet. She continued in her scribbling for a little while. She even humored Daryl by echoing E, M, M, A as he tried to teach her to spell. Eventually, though, she objected to the artistic infringement and insisted on turning over the piece of paper and starting again.

Things she only did rarely during this particular studio session:

• Throw crayons to the dog
• Purposely rip the corners off the paper
• Put the crayons in her mouth
• Scream

I choose to consider this a resounding success and real progress.

Let's hope she gets it out of her system. Daryl doesn't approve of such flighty pursuits. He remains intent on Em growing up to be a plumber and supporting him in his cranky old age.

TMI

I talk about my daughter a lot at work. When a child has a fever and cough and there is nothing I can do to make him get better faster, doesn't it help to be able to tell his parents that I have been through the same thing too? Yes, it is hard. Yes, it is heartbreaking to sit up in the middle of the night and rock a fussy toddler or infant, but you do get through it.

There are times I worry I am over sharing, but also times when I know that telling stories about Emmaline (who doesn't want to hear stories about Emmaline??) is exactly the right thing to do. One father, in particular, stopped me on my way out the room to say, "Thank you so much. You don't know what it means to have a doctor who has children. It makes all the difference."

Well, thank you in return for providing me an audience. I love nothing more than talking about my beautiful and brilliant daughter.

But last night I think I may have stepped over the line. I have never been particularly adept at telling where the line is, that division between doctor and patient where everything that is real and private flows in only one direction, from them to you. That has always struck me as a little bit disingenuous. How can we expect people to share the most intimate details of their lives with us if we are not willing to do at least a little bit of the same?

We should be able to say to someone who is trying to quit smoking, I get it. I hear what you're saying and I know that it's a struggle sometimes to make good decisions that keep you healthy and stick to those decisions when it might be easier to do just the opposite. That doesn't mean I pick up a cigarette in order to see first hand what it is like to try to fight to a nicotine addition. But I do admit to patients that I find it hard as well to always do what I think is right.

Or I tell a parent whose child is screaming and throwing things across the exam room that Emmaline has temper tantrums as well. They are frustrating and embarrassing when they happen in public, but they are also entirely age appropriate. It's hard, but sometimes ignoring them (especially when a child is tired and sick and in a frightening place) is the best thing you can do.

Last night, though, was different. There was no particular benefit to the patient from sharing a little bit about my life. It happened that on a particularly busy night one of my favorite patients, Maddy, came through the ER. I had taken care of her in another hospital when she needed IV antibiotics for an infection. She had, in fact, been in the hospital quite a lot during her life because of infections such as that one, to which she was for some reason particularly prone. Despite being trapped for months on end in a small hospital room, not allowed to leave it because of the resistant bacteria she carried on her skin, she was an effusive and truly lovely young lady. Her mother, stretched thin with work and with other children and with wanting to be with her daughter in the hospital as much as possible, was also remarkably kind and gracious.

One time last year, when Daryl had brought Emmaline by the hospital on their way home from visiting friends, we stopped by Maddy's room to say hi from the hall just outside her door. Em was the only visitor she had had for weeks. Every time I have seen Maddy since, she and her mother have asked how Em is doing. So last night, when I heard about what had been going on with Maddy and realized that there was nothing I could do to keep her out of the hospital, I felt awful. She looked great. She barely had a fever. But we all knew that the bacteria that tend to cause her infections don't respond to antibiotics that can be given by mouth.

We made plans for her admission. Both Maddy and her mother smiled, despite the bad news. They were lovely. They asked how many words Em had learned since the last time that we spoke. And then I stepped over the line. I took out my phone and showed them a video of Emmaline running gleefully through our upstairs hallway. She had just finished a bath and I knew, watching her giggle and cavort, that she smelled like sweet baby soap and all things pure and good. But she was naked. She looked back at the camera and screamed and ran away, chasing a cat. Maddy and her mother laughed.

Watching the video would not take away the days Maddy would lose this time, barricaded in a single room so small she is unable to get up to move around. And someday Emmaline will be a teenager and realize some of these things that I have done with her image, the pictures of her adorable baby bum, and she will hate me. Still, Maddy had laughed. It was not much, but it was the most that I could give her. I hugged her and I told her I was so sorry she couldn't go home. She smiled and seemed to think she needed to make me feel better, not the other way around. She said she understood and that everything would be okay.

Older and Wiser

It has been suggested in several individual reviews of Between Expectations that the book might be better, my narrative (and my role of narrator) more sympathetic, had I written it ten years from now, or maybe even twenty. I would have had a more mellow and less jarring quality to my observations had I aged them or let them breathe like a left bank Bordeaux.

Maybe I'll write that book as well. I hope that I get to.

But reading the pages of my own book, one I wrote only a few years ago and continued to edit until the middle of last year, it is like reading about things that happened to a stranger. I am already a wholly different person. I have already left that small, frightened intern far, far behind.

So I hope you'll forgive me for having written this book, one that takes place at the beginning and not the end of my learning, and appreciate that it contains much that I would have lost had I waited, had I tried first to make sense of each experience instead of capturing the confusion and uncertainty that permeated those years.

So stay tuned. When I become a sage and a savant, I'll let you know. Until then, I'll continue to do the best that I can.

Come a lily, come a lilac

One of the first things that happened after we moved into the house last summer is that Daryl got poison ivy. Then my mother got poison ivy. Then we realized that almost everything that was green in the garden was poison ivy.

The people who lived in the first floor apartment left behind twelve years of dirt on the floors of the kitchen and their bathrooms. They also left behind a note congratulating us on our new home and letting us know just how special the garden was, with many unique plants brought over from England when the house was built in 1902. But aside from the poison ivy (it covered the ground and climbed up the walls of the house and up the trunk of one tree practically killing it) there was not much else alive in the gardens.

We didn't make much progress. We had the trees cut down that we were informed were about to fall over and then we ran out of money. Then, in November, when it was unseasonably warm, I planted some bulbs. I planted two-hundred-twelve bulbs to be precise. My back has still not recovered. Now the snow has melted and I was able to walk through the front yard for the first time in three months only to discover several bulbs, right there on the surface, rotting in the wet earth.

I have to confess to feeling more than a little bit frustrated. Then I looked closer.

Granted, it's not very impressive, but there are green shoots there pushing their way up amidst the rotting leaves from last fall. I'll take it. It may not be the blankets of crocuses and daffodils I had hoped for, but it will be better than it was before I staked my claim, one bulb at a time.

There is much more to be done. For now, though, it is enough to simply be able to spend time outside.

Doctor Em

I'm not sure why this isn't the cover of Between Expectations.  Perhaps because parents wouldn't feel comfortable bringing home a book with a picture of such a remarkably beautiful child on it. It would only lead to jealousy and bitterness in their own offspring. And therapy is expensive.

Nastia Liukin

When it was suggested to me that blogging might not be a bad idea in the interests of trying to sell more books, I was more than happy to comply. After all, being handed a book deal for Between Expectations felt like a gift. It was the least I could do to try to prove I deserved it. The more I thought about it, the more it seemed like a good idea. Writing every day is something I should strive for anyway. Writing every day during residency was impossible, but now I am a grown up (I reasoned) and need to take control of my life. Also, and this I think was the more compelling reason, Emmaline is beautiful. She is a mess of sweet baby cheeks framing a look of perpetual awe. How could I not embrace a forum that would allow me - in fact demand that I force feed pictures of said offspring to my unsuspecting readership?

Blog started: check. Pictures of Emmaline...well, you've seen more than a few. But lately it's gotten so much more difficult.

Let me explain. A picture to illustrate perhaps?

Do you see the problem? I have many more pictures from this week and not all of them are blurry, but the majority of those are of the back of her head.

The other overwhelming difficulty is in being able to step far enough away to capture the shot. This, again, is becoming increasingly impossible to do. Another picture you say? How about a montage?

Picture 1: Preparation

Picture 2: The Summit

Picture 3: The Head Injury

OK. I did not actually take this picture. I'm sure you understand why. There was screaming. There was a look of complete shock at the existence of gravity and the absence of exemptions for toddlers with a determination to climb. Did she land on a pillow? Yes. Did she actually require a head CT or even a bandaid? No. But she was down when she had only a moment before been up. And that was the biggest tragedy she had known in the seventeen months of her life up until then. Thus the tears.

She got over it. She moved on. She lived to climb again.

For a while, she was not terribly good at it. But in the last week she's become increasingly adept at wiggling her way up on top of things and then back down again. In the family room there are three identical storage cubes, each two or three feet high. Is it wrong to let her crawl from cube to cube, I wondered, or even to stand on top? In the mall there is an enormous room parents pay to gain admission to where she would be encouraged to climb on structures not entirely dissimilar from our own furniture. So why not let her climb for free?

And when she learns to get down using a stag handstand with half twist we can talk about upgrading to a gym, but until then I think the storage cubes are just fine.