Our First Pee-Pee on the Poddy!

We finally had a pee-pee on the poddy last night....

and wouldn't you know....

it was our little
G R A H A M !

At 21 months, Graham managed to achieve out what his stubborn three-year-old brother cannot be bothered with.

It happened when we were getting the boys ready for bath and Graham was naked on our bed. A couple of times before we let him sit on our bed naked, and he cried to get down and then prompltly peed on the hardwood as soon as his little feet hit the floor, indicated he at least knew the bed is not the place for pee-pee. Last night he was on our bed naked, and he got fussy and started grabbing his little weiner and yelled "Pee-pee! Pee-pee!" We weren't sure if he was just identifying his anatomy or what. Then he yelled out "PODDY!" So Dan picked him up and carried him into the bathroom.

A minute later I heard Dan screaming "Good boy, Graham!" over and over with proud elation.

I went running into the master bath in disbelief. "Did he pee on the poddy?"

"Yes!" grinned Dan. "He sat there for a minute. Then he did a little pee. Then as soon as he finished, he got up off the toilet."

The whole thing was too purposeful to be a lucky accident. My Graham is a little smarty pants!

So then it was time to bust out the "Pee-pee on the poddy treats" which were supposed to be for Cole. Cole and I went to the dollar store several months ago, and I let him pick out any and every toy he wanted. Then I made him tell me if he wanted each toy to be a "pee-pee treat" or a "poo-poo treat," and we created two big bags together. The bags have been sitting there just waiting for Cole to stop being so stubborn and do something in the toilet already. Last night after Graham went, I proclaimed that he earned a "pee-pee on the poddy treat" and went to get the bag.

Graham took his toy and went about his business, not realizing the significance of his accmplishment.

Cole watched Graham pick a little toy out of what was supposed to be his bag, and he suddenly became very motivated. "I'm gonna do poo-poo on the poddy so I can get a car."

We were thrilled. I whipped off his diaper only to find that he had already taken a big shit all over himself. So we cleaned him off and sat him down and encouraged him to try pee-pee like his brother so he could get a treat too. I left the room, and by the time I came back, Cole was sitting there looking all pissed off. Unable to match his little brother's accomplishment, he came to his own conclusion:

"My pee-pee doesn't work, Mama. My pee-pee doesn't work."

Goals

For months now I've been having vague thoughts about trying to train for a race to get my fat ass in shape and lose some weight. Now that the New Year is here, I just sat down and searched the web for training programs. After looking at a couple of programs for beginners, I am optimistic that around the time of my 33rd birthday in June of this year, I will be able to give myself the birthday present of finishing a 10k race.

Here's how I hope everything will work:

First of all, I have a gym membership to an awesome gym that has been ignored for several months as the busy holiday season, amongst other things, overtook my life. The gym has childcare facilities, and the boys are in desperate need of some socialization, because they now have been home with a nanny since August and are still waitlisted at the daycare of my choice. I'm going to start taking them with me and letting them socialize at the gym preschool facility for an hour or so several days each week while I work out. This is a win / win / win arrangement, because I will get to work out / the boys will get to hang out with other kids /and I will save some money since our nanny is paid hourly and the gym chilcare facilities are included with our family membership. Yes! I love my plan! (The boys just have to cooperate and not scream and fuss when I leave them there. Keep your fingers crossed!)

Now, regarding my fat ass running... I have a plan for that too:
"The Couch-to-5K Running Plan". It's a 9 week program that definitely seems doable that is supposed to have you running 3 miles when you finish. 9 weeks from tomorrow (my start day) puts me into early March, and there is a local 5k race (The Holton Elementary 5k) that I can run on March 8 if all goes well. That is goal number 1.

Then, to get to the 10k, my REAL goal, I move onto this 10k beginner training program that I found. The only pre-requisites are that I be able to run 3 miles comfortably (which I'm hoping to be able to do by March), and that I be able to run 3-4 days a week. It is a 12-week program, and if I start the 2nd week of March right after my 5k, I will finish it by June 1st, just in time to run a local 10k race on that day (The Stratford Hills 10K).

So, in theory, if all goes well, by the time I turn 33 the first week of June, I will have run a 10k and be very, very proud of myself.

That is my plan and I'm all excited. I've never enjoyed running, but I'm a goal-oriented person, and I've got both training programs printed out and will look forward to crossing off each of the 63 training work-outs one by one.

If I get really into it and can find the time, I'll do other cross-training at the gym on my non-running days (weights, biking, aerobic classes, etc). Or if it's not feasible to get to the gym, there's always my collection of Taebo tapes or our eliptical machine in our basement. But all that would be gravy... I'm not going to hold myself to anything beyond the three running days each week, since there are so many other demands for my time right now.

I'm pumped and motivated for my plan!
Go me!!

Smack Talk in the ER

Smack talking is not just for athletes and sports fans.

The other night this patient in respiratory distress rolled into the ER around 11pm. This is during the three glorious hours when my 9p-7a shift overlaps with the 2p-12 midnight doctor and there is actually double coverage with two docs in the ER. I grabbed the chart and went into his room listen to his lungs and find the paperwork sent form the nursing home to try to figure out which meds he needed acutely to fix his breathing. I decided he was probably a mixed clinical picture with both CHF (congestive heart failure) and COPD (chronic obstructive pulmonary disease) contributing to his breathing problem, and I barked out a slew of orders to treat both.

I walked out of the room to chart all of my orders, and I saw my newest colleague and Gill the charge nurse standing there smirking.

"What?"

Dr. H was egging me on. "I was just telling Gill that I've never seen you intubate," he said with excited anticipation regarding what he thought was about to happen to my patient.

Gill was quick to get my back. "Oh she's good. She's good."

I just sat there and charted and said "No sweat."

I went and checked on the patient's breathing again, and Dr. H was still watching with baited breath. I couldn't resist... "Intubating's easy. You haven't seen me intubate because a good doctor can save a patient from intubation by fixing him."

"Oooooh. Touche." He feigned a slap across his cheek. The nurses laughed.

Nothing like a verbal bitch-slap to relieve a little tension. And damned if the patient didn't get better, and, yes, avoid a tube down his throat, shortly thereafter. Maybe I should talk a little smack more often.

'Tis the Season

December Already!!

It's that time of year again! I'm so excited because this is the first year Cole has any real understanding of who Santa Claus is. Between all the Christmas episodes of his favorite shows, all the Christmas books, and a lot of talking about how Santa will be coming to "White House," Cole seems to really get it.

As we prepare for Cole's 3rd and Graham's 2nd Christmas, we've already had some priceless memories:

Cole knows exactly what he wants Santa to bring him. It warmed my heart to hear his answer the first time I asked him the most popular question posed to little kids this time of year "What do you want Santa to bring you?"

Cole thought for a second and got a big smile on his face and excitedly proclaimed, "A SUPER BOUNCY BALL!!!" And he has consistently responded the same way every subsequent time he's been asked.

The child is going to end up with hundreds, maybe thousands of dollars worth of toys, and all he really needs to be happy is a $0.50 rubber ball. Nothing like the simple joys of childhood. I could have killed the Santa at the mall when he heard Cole tell him he wanted a super bouncy ball and, looking at him in disbelief, said "What else?"

"That's it," I quickly cut in. "He wants a super bouncy ball and that's what Santa is going to bring him." Santa probably thought I was a cheap bitch. The reality is that he'll get dozens of super bouncy balls plus the boat-load of gifts you'd expect me to spoil my little baby with, but if all he expects is one rubber ball, he'll be that much more astounded by Santa's generosity. I can't wait!

Graham is also appreciating Santa. He's a little young to grasp the concept of Christmas presents, but he loves to "Ho-ho-ho." I read him a few Christmas books and did the characteristic deep and bellowing "Ho-ho-ho," and he instantly picked it up. Imagine the sweet little 18-month-old "G" rounding his little mouth and making his deepest "Ho-ho-ho" whenever he sees any picture of Santa. It is priceless. He does it for Santa pictures in books, Santa characters on TV, and the real life Santas we've encountered at the mall and the Christmas tree farm. Apparently one day while out with Dan he saw a man in plain clothes who happened to have a big white beard and gave him a "H0-ho-ho" too. It's his new favorite word and it really gets us in the Christmas spirit.

A lot of joy this time of year definitely comes from anticipation. With Cole and Graham, the magic of childhood will make December very special.

Our Family's First ER Visit

It finally happened. Frankly, I'm surprised we made it as long as we did without having to take my little wild ones to the ER. Unfortunately, Sunday night was the night.

Graham had one of his typical little accidents... lost his balance, bumped his head. I didn't actually see it. Cole and Graham and I were all in the hallway upstairs and they were doing their "super speedy" nightly race up and down the hall before winding down for bed. There was an empty pampers box in the hallway, and Graham kept climbing into it between races and then tottering over. The last thing I saw was him pushing his Pampers box into his bedroom. About thirty seconds later I heard a wail and found him on the floor with his feet in the pampers box and his head up against his changing table.

I picked him up and loved on him, but he didn't stop screaming, which is really uncharacteristic since usually he's so tough. So I tried laying him down in bed with some blankies and he STILL didn't stop. By this time Dan had made his way upstairs to see what all the raucous was. When he picked up Graham and held him, I saw the back of his head for the first time and noticed a spot in his hair that looked wet.

I did what any trained ER physician would do... I totally freaked out. "Oh my God!! Is that BLOOD!!!" Let me tell you, it is an entirely different ballgame when it's your baby who's bleeding. I was definitely not the doctor who can take care of mangled trauma patients. I was just a frightened mom, and I couldn't even approach his head to inspect the injury without feeling overwhelmingly nauseated. I was so paralyzed by my fear of how bad it could be that Dan had to step up and take the first look.

Fortunately, it was just a simple linear laceration, about 2 cm long. It was gaping open so much that there was no way that sucker was going to heal on it's own. So we threw some sneakers on him and a coat over his PJ's and I took him into my ER for some staples (yes, that is the standard of care for scalp lacs).

I called ahead to tell them I was on my way and even though the ER was SLAM busy with people waiting for hours on end, Graham and I waltzed in and were whisked to a room that they had reserved for us. Aaahhh, one of the few perks of my job. We were in and out in about an hour.

At first he thought his ER visit was great. He was making friends and running around like a little wild man. At one point we were playing peek-a-boo through the exam room curtain and he ran full-force into the curtain thinking he was going to run into me on the other side; Instead he slammed head-on and full-speed into the metal stretcher with his forehead. That made another big hematoma (goose-egg) smack dab in the middle of his forehead, and it was the beginning of the end of his good times in the ER.

Then came the lidocaine shot (right in the cut) to numb it up. I pinned him against me in a head lock, and he squirmed and screamed and struggled and squealed. He fought so much that for the actual laceration repair, he had to be pinned face down on his stomach. I never thought sweet little Graham had it in him to be so bad. I had to lay on his torso and control his arms and legs, and the paramedic had use two hands to control his head... just so my colleague could put the staples in. It was very stressful for all parties involved. I was all sweaty and tired from the exertion, and Graham was bright red in the face, furious and covered with tears. This is the "after" shot:




















4 staples total.


















The good news is the cut is healing well, and Graham has forgotten the staples are even there. He only seemed to notice the morning after when I put him on his back on the changing table. I could see him rolling his head around like he felt something weird on the back of it, but now he doesn't even seem to care. And his hair is even long enough to hide the row of staples, so all is well.

Maybe he'll have a little "tough-guy" scar. We'll see!

Book Nazi

"Agaih! Agaih!" (That would be "Again, Again!" without the "n.") That is what Graham screams at the TOP of his lungs in his vibrant little one-year-old voice as soon as you finish reading one of his books to him, close the cover, and say "the end."

The child is relentless. There are books everywhere in this house, because I wanted to encourage a love of reading, but I never anticipated this overwhelming response. No matter what I'm doing Graham is always chasing me down, book-in-hand with a little persistent scream. "Abuh! Abuh!" (translation = "A book! A book!") He'll follow me and whine until he gets to sit in my lap and I finally open the book for him.

If I'm reading Cole one book and Graham has a different selection in mind, he will come over and try to slam Cole's book closed, throw it on the floor and hand me HIS book in it's place. You can imagine that goes over REALLY well with Cole.

He has his favorites and he'll demand the same book over and over and over again. "Agaih! Agaih!"

At one point his demands continued so persistently despite Dan's attempts to engage him in a nice game of catch with his brother, that Dan finally laughed and said, "Son, put down the book and pick up a football already!"

Someone is definitely his Mama's child. I couldn't be prouder!

Tough Love

The art of medicine is really about getting people to do what you want them to do, which (if you are a decent doc) is what will make them better and maybe even save their life. Ideally this is accomplished without too much of a fight, but unfortunately it's not always that easy.

The other night a 70ish year old woman who had spent her career working for our local cardiologist's office came in with a really good story for chest pain of cardiac orgigin. She knew all of the cardiologists that cover our ER, and I assumed (stupidly) that she knew the ins and outs of a chest pain work-up. The history (what a patient tells you) is key in deciding how to proceed with a chest pain complaint, and this woman told me all the classic symptoms of cardiac chest pain, probably unstable angina. So I told her I was going to proceed with a high level of urgency, talk to the cardiologist on call, and probably plan on admitting her. She seemed sophisticated enough to comprehend all of this.

So I left her and ordered all the necessary medications, lab work and x-rays, and then, because it was already 12:30am, I decided to call the cardiologist and have her admitted to the hospital based on history and risk-factors alone, since I knew the cardiologist wouldn't want to hear from me at 1:30 or 2am when all of the test results come back. It was a slam-dunk admission, especially when I mentioned that the patient is the woman who worked in their office for years and years. So I filled out the admission paperwork and went back to give the patient a prompt update, assuming she'd be pleased at how expeditiously everything was handled.

"Mrs. H, I talked to Dr. B and he is going to admit you to the hospital because of how concerning your chest pain is tonight."

Well, damned if Mrs. H didn't go postal on me. She couldn't stay.... She had to go home and take care of her husband.... She didn't understand what about her chest pain was so concerning... Why couldn't it be done as an out-patient?.... blah-blah-blah. It was the same initial response most people have when they think they're just coming to the ER to get told there's nothing wrong with them and get discharged, but then their doctor tells them they have to stay.

Problem was, Mrs. H apparently thought her career as a cardiologist's secretary made her more qualified than me to decide what she needed. "I'm not staying." Then she proceeded to drill me about why her chest pain was so urgent. I tried to play along and re-hash all the eliments in her history that were concerning, and she fought me tooth-and-nail on every miniscule point... even denying some of her initial history. "I never said I was nauseated!" she snapped at me. Why the hell do people come to the ER when they're not going to listen to what the ER doc has to say?

Finally, she wore out my patience. When someone is threatening to leave AMA (against medical advice) and they have an emergent and potentially lethal medical condition, you do what you have to do and say what you have to say to try to get them to stay. I could have said "Whatever you want," and given up and walked out of the room. But, no, I fought for her well-being and I fought to get her to stay. And, yes, I was stern and, yes, I was threatening, i.e., you could DIE if you leave here tonight! I can count on one hand the times I've played the Yale card with patients, but she was so incredulous of my decision-making that I finally said, "Look, based on my education and experience, you need to stay. I know I look young, but I have a degree from Yale Medical School and I'm residency-trained in emergency medicine. I know what I'm talking about."

And damned if the stubborn old bag STILL would not consent to stay. So I just told her I wasn't going to argue with her and left the room, leaving her family members in there with her to hopefully convince her not to leave AMA.

It was a busy night and I had plenty of other patients to keep me busy. I optimistically kept the orders for Mrs. H's care active and went about my work. About an hour or so later I looked up and saw Mrs. H's daughter at the desk and I dashed over to get the scoop. "Is she going to stay?"

Well, according to the daughter, Mrs. H was, in fact, going to stay, but she thought I was very rude. Rude? RUDE? Excuse me for trying to save her life! I told the daughter, "Whether or not she thinks I'm rude, the important thing is that she's going to stay, and as long as she IS staying, I was effective."

But it really bothered me that this woman who, as my luck would have it, knows every cardiologist in town, thought I was rude, because normally patients love me. I'm not used to getting that kind of feedback.

I went about my work again but it kept eating at me and eating at me.

Finally I went back to Mrs. H's room and said "I've come to make nice. I'm sorry if you thought I was rude, but I was concerned about you and I didn't want you to leave here and die."

The stupid old bitch STILL wouldn't come around. She gave me this pouty nasty face and said in a condescending way "I accept your apology," in a way that was all too clear that she was going to hold a grudge to her grave.

Great, she hates me. This is what I get for trying to get her to do what was in her best interest. Sometimes you really can't win. Tough love is hard.

Son of Spaz

I have many talents. Athleticism, unfortunately, is not one of them. However, as the mom of two potential jocks-to-be, I try my best to be sports friendly, and I just hope that my boys will overcome my severe sports deficiencies.

The other day I thought I was doing a great job of working with Cole on the football pass. We were throwing the ball back-and-forth and I kept coaching him to "keep your eye on the ball." Well, be careful what you tell a two-year-old...

Next thing I know Cole catches the ball and proudly exclaims, "Mama, I'm keeping my football on my eye!" Then he puts the football LITERALLY right on his eye like an eye-patch or a telescope, and he flashes me his proudest smile before he tosses it back to me, like that's how the game is supposed to be played.

Yup, that's definitely MY son.