Gratuitous Pictures of my Babies

All of us (even Dan!) went to Portrait Innovations on Sunday morning. I highly recommend it.

We were lucky to get the any shots of Cole and Graham together, because Cole wanted nothing to do with his little brother during the photo shoot. Being a big brother, as far as he is concerned, means gently patting Graham on the head every once in a while, or proudly retrieving Graham's paci, burp cloth & doggy blankie from the baby swing and parading them over to me while I nurse him on the couch. But if Cole goes to crawl into my lap with one of his books and finds Graham already there he gets quite annoyed. One time Graham went so far as to kick Cole in the back when he brought a book into my lap, and Cole whined in protest and reached his little arm back and tried to push him away. And so it started...

Yesterday, at the photographer's request, we repeatedly deposited Graham into Cole's lap and Cole repeatedly screamed "No," pushed him off, got up and walked away. The one shot we have where there is actually brother-to-brother contact was snapped as quickly as possible immediately after putting them on their backs together on a bean bag, just as Cole was sliding away from Graham as fast as he could. Guess we need to practice brotherly love!

Now my count is 3 successes (with actual pictures purchased) out of 5 photo shoots attempted. The 2 failures were Cole at 6 weeks (too colicky to cooperate) and Cole at 1 year (just plain pissed-off that day).

Here are my 7 favorite shots from the latest successful shoot:

Graham's Poop Project

He did it! After greater than a week's hiatus from shitting, Graham dropped a deuce yesterday. I was the lucky recipient of The Big One.

It was an angst-ridden week waiting for the little rascal to shit (See previous post: "Drop a Deuce"). I tried prune juice, Karo syrup, rectal stimulation with a thermometer. Poor Graham took it all in stride. Then I went looking for answers on the net and found this reassuring article, and decided to leave the poor baby alone for a while. He was never uncomfortable until the night and morning before the big blow.

I, on the other hand, was very uncomfortable about the state of his bowels and spent the week neurosing. I had everyone on high poop alert - grandparents, friends, neighbors, daycare, babysitter. I even mentioned it to one of my patients who was asking me about her own baby's 3-day hiatus from shitting. She found Graham's week-long hiatus very reassuring.

All week I kept thinking something was coming because his farts kept getting worse and worse and worse. By the time anything actually happened his ass was releasing the worst Death Bombs you've ever smelled. When I walked by his nursery to Cole's room, I actually got a whiff of it emanating out from under the closed door as he slept...

Finally, yesterday morning, Graham started grunting and straining and looking like he was in pain. Dan had already encouraged me to call our pediatrician if it went longer than a week to see if he had any advice. It takes a lot to get me to call my pediatrician because it's like a sign of weakness -- I'm supposed to know this stuff. But watching him turn red-faced and cry made me pick up the phone. The recommended plan was to pump milk rather than put him on the boob, so I could add dark Karo syrup (1/2 tsp to every 2 oz, if anyone's curious) to every single feed until he pooped. Apparently more than a week without poop is concerning to the pediatrician, so if he didn't poop within 24 hours I was supposed to call back.

Graham overhead the phone call with the pediatrician, and I don't think he liked the plan to not put him on the boob. He made it a BIG project and worked it and worked it, grunting and straining for a good 3 or 4 hours... His timing is exquisite, because just as I was picking him up off the playmat to take him to the store for dark Karo syrup, I not only smelled the Death Bomb aroma, I felt like I was inhaling it. Sure enough, there it was. Now I know what a week's worth of baby shit looks like. (I had typed a description here but deleted it because it was just too gross. It suffices to say it was bad.)

Then the celebration began! "Graham, you POOPED!" You would think the child had just won a Nobel prize. He did look particularly proud, though. I called Dan and left a celebratory message on his voicemail at work. I called my parents and left a "He pooped! Yay!" cheer on their machine as well. It's amazing how parenthood changes what makes you excited. When Dan first bought me my fancy car, I was excited to roll around looking cool. Yesterday, As Graham and I left to get groceries after the Big Blow, the Benz was cruising down the street with the window down so I could scream "He Pooped!" and give the fist pump of joy to the neighbor on the front porch . What could be cooler than that?

Good job, Graham.

Ways to Annoy your ER Doctor

This post is inspired by my not-so-wonderful shift two evenings ago.

Ways to Annoy your ER Doctor:

1) Ask her "When is the doctor coming to see me?" immediately after she finishes doing a history and physical and explaining a work-up and treatment plan for your complaint.

I cannot tell you how many times I have to answer "I am the doctor," or the nurses have to explain to the patient, "You know that little blonde girl that was in here before? She is the doctor." You'd think people might clue in when the first thing I say upon walking into their room is "I'm Dr. So-and-so. Nice to meet you." All my scrubs are monogrammed to say "MD" and I always wear my hospital badge which clearly states my title, but what I really must need is a big bright button that says "I am the doctor!!!"

Apparently my undoctorliness became an issue two evenings ago. I returned to work yesterday evening and the nurse asked "Do you remember the little boy in Room 16 last night?"
"Yes," I answer.
"Did you examine him?"
"What?" I ask incredulously. "Of course I examined him. He was my patient."
Turns out that after I signed out his care to the overnight doc and went home, the patient's mother threw a fit and insisted that no doctor examined her child. Ironically, not only had I done a full head-to-toe exam on him and explained in depth my plan for evaluating his fever, I had then been cornered by the mother in our staff lounge while I was trying to quickly wolf down some dinner and had answered all sorts of questions about his eczema, his eczema creams, his allergies, and his allergy creams. I had even left the prescription on the chart for the new eczema cream that she wanted, even though it had nothing to do with the fever that brought him to the ER. Nonetheless, when his fever work-up came back negative and it was time to discharge him home, she was irate because no doctor had laid a hand on him. Guess I needed my button.

2) Be Agist
Another patient two evenings ago was downright hostile about how young I look. Patients love to comment on how young I look, but most of them manage to do it in a complimentary manner.. unlike this gentleman. He was an elderly gentleman with a laundry list of medicines and an utter inability to articulate his medical history or what brought him to the ER. I was probing by asking questions such as, "Have you been admitted to the hospital here before?" and "For What?"
All he could say was "I been coming here for years." Finally he looked me up and down and asked, "And how long you been here?"
"A year," I responded.
"I been comin' here since before you was born," he scorned.

I wonder, is this more insulting to me or to him?

3) Be Sexist
It turned out this same gentleman needed a rectal exam, because, from what I could ascertain from his vague history, GI bleed was on his differential diagnosis. "I ain't takin' my pants down for no damn woman," he scorned again.
"Well, I'm your doctor and you need this test, so let's get it over with."
"I HATE takin' my pants down for a woman," he complained while begrudgingly assuming the position.
Lo and Behold - he did have a GI bleed. "I told you that you needed this test," I said victoriously.

4) Never be satisfied by anything... ever!
I don't know what was in the air two nights ago. Another patient with pelvic pain was signed out to me at the beginning of my shift. She was waiting on an ultrasound to rule-out ovarian torsion. The other doc thought it was going to be normal, because he suspected she might be drug-seeking. Sure enough, it was.
I went to talk to the patient and her husband and tell them the good news. It's amazing how saying "You don't have an emergent medical condition and are okay to go home and follow-up with your obstetrician" can evoke such rage. "We want a CT scan. We want an MRI. You and the other doctor haven't done enough. I just saw him leaving in his golf clothes," complained the husband, "and my wife is in pain." I reassured him that I'd give her pain medicines for a day or two to cover her until she good follow-up with OB and explained again that there was no indication for an emergent CT. I left the room to do her discharge papers. They were unhappy, to say the least, and while I was writing I succumbed to the fear of lawsuits that plagues all emergency physicians and blurs the line between what we should do and what we actually do. I ordered the CT, rationalizing that she'd be back anyway for the same complaint, and I was doing a favor for the next ER doc who would see her. Hell, it might even be me... this way I could just pull up the CT report next time.
I went back to the room and told them that we'd to the CT so they could rest easy. I then told them explicitly that they'd be in the ER for multiple more hours to get this test. "We don't care how long it takes. We just want the test done."
Multiple hours later, I was in the middle of an acute stroke, a chest pain, a possible central cord syndrome (spinal cord injury), and (my personal favorite) a traumatic ejection from a golf-cart with altered mental status -- all of which had come in within the past hour. I look over my shoulder and guess whose husband is lurking at the nurse's station, just staring me down? Guess who is now pissed that they were in the ER for multiple hours? And guess who, even with a normal CT scan, still won't go home happily? And guess what lucky doctor is still being told "You haven't done enough"?
I had gone out of my way and they still weren't satisfied. Sometimes you just can't win.

Yes, two evening ago I went home very annoyed. Then last night, thankfully, I returned to have a great shift and today am back to loving my job. It all balances out in the end.

P.S. STILL no poop from Graham.

Escape from the ER

Last night on the 11:00 news there was a story about a prison inmate who was taken to his local ER with some kind of leg pain. Apparently, while in the ER, he got free and overpowered the prison officer with him, stole his gun, then used it to shoot and kill the poor unarmed hospital security guard who was trying to help the officer, and finally escaped from the ER. Now there is a statewide manhunt for him.

This story was particularly alarming to me because I treat prisoners in the company of prison officers all the time. I try to not think of them as inmates and treat them as I would any other patient. On numerous occasions I have had the officers unshackle these patients to facilitate a procedure or an exam. Man, am I naive!! I could easily find myself facilitating a tragedy like the one on the local news last night. I know our little old hospital security guard would be no match for any kind of killer. Hell, I think I could take him down on a good day. It really is not a safe environment where I work. On many of the night shifts it's just me and 4 or 5 female nurses manning the place. I guess the city police department has realized just how vulnerable ER staff can be, because now they send a city police officer to man the ER every night. Good... let him deal with the violent patients instead of me, because a syringe full of sedative and a soothing bedside manner really is not enough for certain situations.

Funny, just as I was typing this, CNN aired an update about the same inmate on their national news. Now there is a national manhunt because today he killed someone else.

Shiih, Suh & other profanity

Cole's gonna get me in trouble. Now he tries to imitate everything mama and dada do. He'll repeat anything we say, which isn't necessarily a good thing sometimes with the language Dan and I use. One day a couple weeks ago I was puttering around the house and blurted out "Shit" then heard Cole echo back "Shit" (actually Shiiih, in Cole-speak) from across the room. I laughed and immediately called Dan and told him "Cole said shit." Of course with all the attention bestowed on his first swear, Cole decided the word must be worth repeating. Now if we let it slip in a sentence, Cole will often echo back "shiiih" with a proud little grin.

Another word he likes is "sucks." I first heard it when he was helping me out on the deck as I tried to take down the old nasty patio umbrella from our outdoor table. The stupid thing was heavy, and I was grunting and groaning and I finally exclamined "This umbrella SUCKS!" Always on Mama's side, my empathetic son mustered up the most frustrated, fed-up voice that he could and screamed "SUCK" (more like SUH)! It was so cute and so supportive, I had to laugh and agree with him. So now he thinks that word is great.

And it's not just words... When I was pregnant we paid a lot of attention to my big pregnant belly. Now every once in a while he'll lift up my shirt to see my stomach. Last week I went to pick him up from daycare and as I got down on the floor to hug him, he lifted my shirt all the way up, exposing my belly and bra, just as one of the other kid's daddies was looking at us. Thanks, Cole.

If he's not imitating our inappropriate behavior, he's coming up with his own accidentally. He can't exactly pronounce "truck" and it just happens to come out "f*^k." This week my friend Michelle and I were enroute to the Children's Museum with Cole and her daughter. Cole was particularly fired up to have his friends in the car, so the whole way up I-95 all we heard was "f*^k, f*^k, F*^K!" coming from the back seat as he gleefully pointed out any and every truck he could see out the window.

The child is always good for a laugh.

P.S. No poop from Graham yet.

Drop a Deuce

Graham needs to "Drop a Deuce," as Dan would say. It's been 4 days since he pooped, significantly longer than Cole has ever gone without making a little present for us in his diaper.

This isn't supposed to even phase me. I'm a Yale-educated physician who knows that breast-fed infants may occasionally go without a bowel movement for 5 to 7 days and then pass a normal stool. I'm usually the one calmly trying to explain this to the nervous new mom who has brought her otherwise healthy infant to the ER for, in essence, some reassurance and a well-child check-up. I always hated these well-child checks. Partly because of my own lack of training in well-child care during emergency medicine residency. (Yes, I know this may come as a surprise, but your local ER doc does not know everything about everything.) After all, the ER is supposed to be for sick children, so most of my pediatric encounters as a resident were, appropriately, with kids needing emergent medical care. Give me a kid with a high fever, a seizure, or a traumatic injury and I'm all over it. But a mother wanting counceling on feeding behavior, stooling patterns, vaccination schedules, child development, etc., has always been on the long list of people who frustrate me and make me ask "Why would you come to the ER for... (fill in the blank)?" Save the well-care for the pediatrician.

Well, yesterday, after working all day then having the kids by myself all evening, I was trying desperately to comfort Graham as he screamed on my shoulder after eating, when I noticed his belly was particularly distended. Then came the glimpse of the sort of neurotic maternal panic that might bring even the most rational person to the ER: "I don't care what they said at Yale Med," I thought. "My child IS going to explode!" Even worse than your average neurotic mom, I was the neurotic mom with an MD, which is just like 'roids for illness-related neurosis, because you know too much: "Oh my God. I know it's not Hirschsprung's or Anal Stenosis because he's already been shitting for 2 months, but Jesus Christ now he's drugged from all the anti-histamines I've been taking to sleep after night shifts, or he's hypokalemic, or worse... he has intussusception or volvulus, or he might have a tumor -- Neuroblastoma? Wilms?...." Then Graham burped, stopped crying, and laughed at me, as if to say "It's gas, you idiot."

I knew being a mom would make me a better doctor. Yesterday's lesson -- A little bit of insight into why a mom would come to the ER for something as seemingly innocuous as a change in stooling pattern. In the future I'll try to suppress my frustration at having to do well-child care when I see these frazzled moms, so I don't make them feel as silly as I felt last night when Graham burped me back to my senses.

For now, I just hope Graham drops a deuce already! Until he gets rid of 4 days of poop, he's like a hot potatoe. Who's gonna get the big one?? I'll keep you posted...

You have to laugh.

It is 6:30am after an unusually slow night shift. All my patients are either discharged or admitted upstairs, and the chart rack is empty... which is always an invitation for something to happen. Into the beckoning chart rack, the triage nurse drops a chart: "Buttock Laceration." "Slipped in the shower and cut herself on the faucet," it reads. I have flashbacks to cases I've seen in the past of tumblers and other fun things lodged way too far up into the rectum after, according to the chart, someone had "cleaned the house while naked and slipped," landing on said object. I have to laugh as I reach for the chart.

To do what I do and see what I see, you have to be able to find humor in things. However, to maintain professionalism, the nurses and I suppress our laughter to giggles audible only at the nurses station, for such injuries are not, in my experience, funny to the patient in the least.

So, I grab the chart, which in and of itself was an act worthy of comment from the nursing staff: "Wow, doc. Most of your colleagues would have let that sit for the 7 am doctor." What can I say... I didn't get where I am today by being a lazy-ass. Anyway, with chart in hand I prepare to hear the dramatic saga of the morning shower and to try to calm another emotionally and physically traumatized victim.

Much to my surprise, I walk in the room and the patient is laughing as hard as I wanted to about the whole thing. "Hi, doc," she chuckles. "Crazy things always seem to happen to me." She's a very obese women laying face down on the exam table with a wadded-up paper-towel stuffed between her butt cheeks. She recounts with a grin how she actually lost her balance and felt the hard metal of the bath-tub fixtures gauge her between her butt cheeks, then turned around and noticed blood trickling down the drain. "I tried to look at it in the mirror, but it was too hard to see, so I just put a paper-towel back there and came on in."

I start by plucking out the paper-towel. It has only a quarter-sized blood stain on it, so I figure maybe she just had a small nick. But I can't see anything with her generous gluteal tissue blocking my view. So I put one hand on each buttock and spread, spread, spread and spread some more... and when I finally lay eyes on the wound, the tables are turned -- While the patient is calm and laughing about the whole thing, I'm the one being dramatic and let out a gasp as I see the extent of her injury. There, in the depths of her butt crack, just above her rectum (thankfully not involving the sphincter in any way, which would have made the injury a lot more complicated), is what looks like one of Cole's puzzles: a big triangle flap that obviously fits back into the big 2" by 3" gaping triangle wound. And, yes, from what I can tell, it looks like she actually did slip. "Wow," I tell her. "You really got yourself good." The laughing ceases. I revert to my comforting role, ideal for those patients who play the victim role ("Don't worry," followed by an explanation of how I would make it all better)... Except this lady, happy and laughing, was not supposed to be a victim. I was the one who had just gone and upset her. Laughter really would have been the better medicine here.

I walk out of the exam room and, since there's nothing else going on in the ER, all the nurses are eagerly waiting to hear the juicy details. "Well," I explain to the nurse assigned to her room, "It's gonna take some sewing, so I need you to glove up and stand there and hold her butt cheeks open for me so I can fix it." More suppressed chortles and snickers from the nursing staff. "Don't worry. This lady's cool. She was laughing at herself too."

So we go in and the patient lays with her jigsaw puzzle ass in the air, the nurse retracts her cheeks, and I stand sewing with my face right in her butt. The three of us get through the procedure by just laughing at the ridiculousness of it all. I ask her if she needs a tetanus, and she starts laughing harder. Turns out she got her tetanus 6 months ago when she came to the ER after sticking her curling iron in her eye. "Crazy things always seem to happen to me." Despite the pain in my back after 20 minutes of contorting myself to get the optimal view of her butt crack, it was refreshing to be reminded that patients also appreciate the humor that can come through those ER doors and that they, too, have to laugh.

"No"

Cole had a little milestone this past weekend...
I went to work Sunday and left Dan with a sweet 19-month-old who only shook his head when he didn't want something, and I came home to vocal little protestor who had learned to say "NO." I'm not exactly pleased at this milestone. There was a reason he could say three-syllable words like blueberry and applesauce (even if they sound like "Boo-bay-ee" and "Ah-Sau") but not a simple one-syllable "no"... I was purposely trying to keep him from learning it. But yesterday my plans were foiled. Now he uses it indiscriminately, even after questions like "Cole, Do you want to sit with Dada?" and "Cole, Do you want to take a bath?" -- two of his favorite activities. Fortunately, for now, it's a short-lived protest, because 2 minutes later he'll happily jump into Dada's lap or the bathtub. Really, what is he supposed to say to "yes / no" questions when he hasn't learned "yes" yet? That will be our next project...

I'd like to note for posterity that I still think his little "no"s are very cute. We'll see how long that lasts...

Night Shifts

Last night was a milestone --
Graham slept through the night for the first time, at 11 weeks old. He went to bed at 10p and woke up at 5:30a. FINALLY -- 7 glorious hours of uninterrupted sleep for mom.

I've been bitching and moaning about the disproportionate number of night shifts I was given within my first weeks back from maternity leave, compared with the other full time ER docs at my hospital (except for the full time night guy, of course)... yes, I count. So much for cutting the new mom (and baby, and dad) some slack! The first day back to work was hard enough, but the first night back was heartbreaking. All I could think about was my little newborn baby waking up in the night and looking for the comfort of my boob, only to find a silicone nipple... Not to mention my concern for Dad, who doesn't handle sleep deprivation as well as I do, having to be up throughout the night and then work the next day.

Well, we all made it through my night shifts on Wednesday and Thursday. Then, wouldn't you know, after all my stressing and worrying about the deleterious effects of night shifts on Graham, he goes and gets his best night of sleep ever on Friday! After two nights of waking up to silicone, I guess he decided he'd be better off to just sleep. I never read about working nights as a way to make your baby sleep in any of the "How to be the perfect mom and do everything just right" reference books (usually written by men); but if I have to work these damn night shifts, at least there are small victories like this to help get me through.

Hopefully he'll do it again tonight, since I'm scheduled for work tomorrow at 7a. Go Graham!

P.S. It just occurred to me to make this blog anonymous so I don't run into patient confidentiality issues. And that way if I complain about work a little like I just did, (hey, everyone has a few complaints, right?) I won't have to worry.

Me and My Blog

Okay - I did it. Ever since my friend Wendy created her blog, I've been wondering if I should start my own, and today I finally decided to try it out.

I had never even heard of blogging until Wendy sent me the link to hers. I would not say I'm a technically savvy person and am not going to have a fancy "souped-up" blog, but it's not the packaging I'm interested in... I'm doing this to record the rich and wonderful contents of my everyday life.

Every day I bring home so many memorable ER stories from work. With the success of shows like "Trauma Life in the ER," "Untold Stories of the ER," etc., I figure it's worth recording some of my own stories for posterity. And then, of course, my three boys (sons Cole & Graham, and husband Dan) also fill my life with many more memorable moments -- precious memories that I want to preserve, because babies grow up too fast.

By juggling both a full-time medical career and motherhood, I am privileged to so many unique insights and experiences. My hope is that this blog will be the perfect vehicle to document and share them all. Stay-tuned and enjoy!

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