The Girls From Residency

It's been awhile, but this weekend brings Natascha, Karen, Mimi, Allie and me together again.  We are just missing Abby.  These are the girls I laughed, learned, suffered, and cried with throughout our 3 years as pediatric residents.  It was over a decade ago, and none of us had children then.  Now between us, there are thirteen kids and maybe more to come.  This is a special group for me because these girls understand that being a pediatrician doesn't make it easier to be a parent.  Yesterday Mimi was worried about her youngest who was suffering from a fever.  If we had been with other friends, there might have been a comment, "Oh, you're lucky, Mimi.  You're a pediatrician.  You know exactly what to do."  Yes, we can all dose Tylenol in our sleep, but that doesn't mean we have a crystal ball into the cause of the fever or how long it will last.  And our training doesn't mean we worry less when our own children get sick.  But with this group of girls, I share a unique bond, because we know that pediatric training and the grueling years of residency are no match for the challenges of motherhood.

Separation Anxiety

On our well-child checklist at the 9 month visit, I ask parents if their baby is developing separation anxiety.  Does he cry when he's taken from your arms?  Does she get upset when she's in the care of an unfamiliar person?  I tell the parents it's all part of normal development.  The child will outgrow it like every other phase of infancy and babyhood, and someday this kid will be the one who doesn't look back when he checks into his college dorm.  Far from their college years, though, Sophia and Max are already so well-adjusted that they didn't even shed a tear when I said goodbye to them for a weekend away.  Are these the same children who once wailed and cried when their babysitter took them from me?  Sophia and Max were perfectly happy to say, "See you Monday!", while I was the one sitting on the airplane, thinking about how much I was missing them.  Who's got the separation anxiety now?  As children grow up and start making their own way into the world, it just gets harder and harder for a parent to let go.

A Baby Period

I'm on call tonight, and I got an anxious page from first-time parents of a five-day-old baby girl.  They had noticed some slight bleeding from her vaginal area, and the mom said she had broken down into tears when she saw the blood.  I quickly reassured her that this bleeding is not uncommon in newborn girls.  The baby is just responding to hormonal changes as she adapts to life outside the womb, just as mom's hormones are also fluctuating wildly in her postpartum state.  The falling levels of maternal hormones in the baby's bloodstream affects the uterus and creates the "baby period."  But at 10 PM at night, in her sleep-deprived state with her C-section wound still hurting, all the mother heard was that the bleeding was normal.  Her relief was palpable even over the phone.  I hope she can get a few hours of rest now.

Bedtime Rituals

I make it sound so easy.  Bedtime rituals for young children, as I always tell parents, should be consistent.  Toothbrushing followed by a story or two then good-night kisses and lights out.  Parents need to establish a routine and follow it.  Very simple.  Somehow, though, I can't parlay my advice into reality; in my household, bedtime has become such a long, drawn-out, often stressful process.  First, there's the cajoling to get everyone upstairs, then the pleas from us to cooperate with tooth brushing, then the kids' agonizing choices of which books to read, then our begging them to lie quietly in bed.  Getting Sophia and Max to bed takes at least an hour every night.  I tell myself this is not going to last forever; I know that someday I will want to turn back time to when my children needed me to brush their teeth and read books to them.  But right now, in my present day, I wish I could get some advice on getting MY kids to sleep.

How Old Is Too Old To Drink From A Sippy Cup?

That is a question a parent posed to me the other day, and quite frankly, I had never given that question much thought in the past.  I blurted out, "Don't get rid of your sippy cups until you can trust your kid not to make a mess when she drinks from a regular cup."  I think the parent thought she was going to get an answer based on my pediatric knowledge, but the mommy in me answered instead.  Sophia, who is entering first grade, is more than capable of drinking from a regular cup and has been for a few years now, but there is no way I would let her sit on our new couches in the family room while drinking from a regular cup.  Unless she's seated at the kitchen table, Sophia still uses the sippy cup with its ingenious valve because I am too afraid of a mess if her milk or water accidentally spills.  I told the parent that using a sippy cup isn't going to hurt her child's development in any way, so if she needs to continue the sippy cup to protect her furniture and keep her house clean, go right ahead!

Looking Back on Toilet Training

We were at my in-laws' summer house for the weekend, and Max found his old floor potty to use as a stepstool.  What a relief it is to be done with toilet training.  Last summer, that potty consumed much of my time, sitting by it, praying that Max would pee in it, cleaning poop out of it, moving it from the upstairs bath to the downstairs one and back.  A year later, Max is fully trained, and I think back to the angst and pressure I felt to get him trained.  The pressure was on because he had to be trained to start preschool last fall.  Funny, parents come to me and talk about their toilet training struggles, and I always reassure them that it'll all fall into place.  Don't stress, I say, I can almost guarantee that your child will not be pooping in his pants when he graduates from high school!  But of course I stressed with my own kids, and I feel a little silly now that Max so naturally tells us he needs to go and takes himself off to the bathroom.  He's even taken to asking for privacy when I follow him in. 

That toilet training so consumed us last summer and now the old potty is being used merely as a stepstool makes me think of a quote a friend of mine posted on Facebook.  She wrote about the days going slowly and the years going quickly when you have young children.  How true.  Although it's so easy to get caught up in the day-to-day struggles of child-rearing, I think that most parents would agree that we have to make the most of these special years with our kids.

Cucumbers for Allergic Eyes?

I recently saw one of our pediatric neurologists in our office.  She had brought in her son for his swollen, irritated eyes.  In the realm of conjunctivitis, I entertain the possibilities of allergic, bacterial or viral etiologies.  With allergic conjunctivitis, the patient's eyes are usually swollen, sometimes red, with lots of watery discharge.  Usually the parents will also report sneezing and runny-nose type symptoms as well.  With cases of bacterial conjunctivitis, or classic "pink eye," the child has red eyes and thick yellow-green discharge.  Viral conjucntivitis commonly accompanies a cold, with milder symptoms of redness and discharge.  It may be difficult to distinguish a bacterial from a viral conjunctivitis.

The pediatric neurologist's child was clearly suffering from allergies, and she had been trying her own home remedy for him, applying cucumbers to his eyes at night.  We both laughed, as I jokingly told her, "I'm going to tell my patients that our esteemed pediatric neurologist treats her child with cucumbers."  But all kidding aside, I wonder if we discount home remedies too often.  It's so easy in modern medicine to place all faith in FDA-approved drugs, with their researched half-lives, dosage guidelines, and side effect profiles.  And likewise, it's easy to dismiss alternative treatments and home remedies.  Problem is, medical school training and residency teaching does not focus on such therapies.  The cucumbers probably did help, with their cooling and astringent effects.

But then, ultimately, the child needed more than the cucumbers.  I prescribed him allergy eye drops and recommended Claritin or Zyrtec, and I am glad to say that they relieved his symptoms.

A Diabetic Patient

One of my favorite moms was in the office yesterday.  She was still smiling, despite the fact that her three-year-old son was diagnosed with insulin-dependent diabetes earlier this month.  I hadn't seen her nor him since their hospitalization over the Fourth of July weekend, and thankfully, she was in good spirits.  I couldn't think of much else to say except to reassure her that she was in good hands in the care of the pediatric endocrinology group that I love.  We talked about how her son would likely live a long full life, especially with all the recent advances in diabetes care and research.  I reminded her of the million other diagnoses that would have been infinitely worse, like leukemia or lymphoma.  If I were in her place though, I'm not sure I would have found that statement all that consoling.  Diabetes does take over every aspect of a child's life, from what time he can have a snack, what the snack should be, whether he got too much insulin for the two bites of diiner he ate.  If this had been Max, and there is something about this little patient's smile and pudgy legs that remind me of Max, I don't know how I would be coping.

Waiting for the Doctor

Sophia and I waited a half hour to be seen at her eye doctor visit yesterday.  Not bad, I think, in the realm of waiting times for a doctor's office.  I wonder what most patients consider intolerable for a wait time.  45 minutes?  An hour?  People defnitely start to pace at the 45-minute mark and then begin to get very angry when it's been a hour.  What most patients don't realize is how badly a doctor wants to stay on schedule.  I absolutely abhor running behind; I hate keeping my patients waiting, but somehow, somewhere along the line, the practice of medicine has become such that it's practically impossible not to fall behind with every patient a doctor sees.  To survive, to keep our office running, to pay the malpractice insurance, the staff, their health insurance, not to mention the electric bills, we have to book patients every 15 minutes.  But can a well-visit for a child ever take just 15 minutes?  Only if the parent has no questions or if I don't engage the child in conversation.  And I refuse to do that!  And for a sick visit, it takes time to examine a screaming, crying febrile toddler.  In between these visits, there are phone calls to return, school and sports forms to fill, and consult letters to be read. 

So I desperately try to stay on schedule but invariably fall behind.  Sometimes I can sense the ire of the waiting room as I patiently coax a child to open her mouth in an exam room, but I've learned to stay calm, proceed as efficiently as I can, and hope that everyone will understand. 

A Work Day

Busy day at work today.  Lots of school and sports physicals, and sometimes it feels like my head is spinning.  But I have to say that as the years have gone by here, I've gotten attached to a lot of my families.  It's very gratifying to watch my patients grow up, and I love this time of year when the soon-to-be college freshman come in and tell us where they'll be going in the fall.  So exciting for them.  Sometimes I think I would love to be seventeen again, bright-eyed, so eager, with it all ahead of me.  But it's six o'clock now, and time to go home.  Maybe I don't want to be seventeen again, because then I wouldn't have Sophia and Max running to the door when I get home; I do love that moment of the day when I walk in and they come hurling themselves at me.

Visiting Night at Camp

I'm so looking forward to Sophia's visiting night at her day camp this evening.  It's her first year there, and finally I get to meet her counselors and her group leader.  She doesn't tell us much about her days at camp, although I'm always trying to eke info out of her.  What did you do today?  How was lunch?  Who did you sit next to at lunch?  Who are you playing with?  If she doesn't say much, does that mean she's happy?

I scan the daily photos the camp posts on the Internet, and in a few, I've noticed Soph standing on the side of the group.  Am I overreading them?  Don't overreact, I tell myself.  Her group leader has left two messages for us in the last three weeks, saying Sophia has been having a good summer.  I've resisted the urge to call back, not wanting to look like the anxious parent I am, but today I called, just to check in.  Apparently, Sophia is quiet but participates in everything.  I briefly mentioned that I noticed Sophia on the fringe of the photos without trying to sound too neurotic, but the group leader reassured me that all the girls play nicely together.  Can't wait to see my baby girl (can I still call her that now that she's going to 1st grade?) tonight amongst her friends.

It's so hard being a mommy, and it's so hard not to be an anxious one!  I feel like I'm always telling parents not to be anxious because anxious parents make kids anxious.  I am determined to try and follow my advice on this one.

Check Out The August Issue Of Parents Magazine!

Very touched that a friend from residency sent out an email telling mutual friends to look out for my essay on discipline in the August issue of Parents magazine.  Thanks, Karen!

I Think He's Got A Cold

Well, Max, you are sound asleep, thankfully resting comfortably but still a little stuffy and congested.  So much for my hopes for Claritin.  I hate the idea of you coming down with a cold!  I hope that it'll last just for a few days; I'm going to hold back from checking your ears and throat myself.  I'm going to go through the proper channels and just bring you to see my partners if this lingers for more than a few days or if you get a fever.

Sophia, I took a great picture of you today to commemorate the 18th of the month.  I take a picture of you every month on the 18th and one of Max on the 26th. (Yes, that's right, Soph was born on October 18 and Max on June 26).  I paste these photos in my journal, and I love looking back to see the progression of the photos over the months and the years.  I remember laughing at one of the moms in the practice who wanted us to rewrite the slip of paper detailing her son's height and weight at his 15-year well visit.  Why?  So that she could paste it into his baby book!  But now I understand.  I wonder how long I'll be able to keep up with this monthly photo archiving.  I guess time will tell.

Could This Be Allergy?

Max, my baby Max, yesterday you seemed stuffy, kind of congested.  This morning you came to our bed, sneezing away.  Allergy?  Beginning of a summer cold?  Hope it's allergy.  Now I understand why all the parents want to think their child has allergies and not some sort of acute illness.  Allergies are somehow more benign, less threatening - then there's no fear of impending fever, dehydration, a week of misery, etc.  So I made you take a Claritin, Max, and I'm hoping for the best.