Who says girls can't wear blue?

Last night sucked

I've been trying to fill D up on milk before we go to bed so that Luca and I can get 2 hours of uninterrupted sleep right after we go to bed. The problem is I'm not sure it really matters since my night sweats have been drenching the sheets multiple times per night.

Take last night for instance:
9:00 - Start final feed before bed
9:20 - Finish draining boob #1, Luca changes D
9:30 - D gets started on boob #2
9:50 - Turn off lights, go to bed
10:50 - Wake up in pool of own sweat. Change sheets + clothes
11:50 - Wake up in pool of own sweat again. Change sheets + clothes, feed + change D. Luca starts acting pissy because he has to get up to change the sheets.
1:00 - I finally finish feeding D, go back to bed
3:00 - D wakes up again to eat, eats for 45 min
5:00 - D wakes up again to eat, eats for 40 min
6:00 - D wakes up again to eat, eats for 20 min
7:00 - D wakes up again to eat, I feed her / pass out while feeding her. I have no idea how long she stayed latched for.
8:00 - Luca gets up, does God knows what
8:50 - I wake up, pee (with D screaming the whole time -- poor girl!!), feed D for 50 min (and actually has to do right boob, left boob, and then right boob again, sitting on the floor of the bathroom waiting for the shower to heat up so that she will stop crying long enough for me to bathe)
10:00 - Luca finally appears. Says, "Wow! She slept from 5 this morning until now? That's amazing!" Informs me that since he didn't want to wake me up, he held off on doing laundry (Screw you, honey).
10:00 - I come downstairs, pass D to Luca so I can eat my first food since 6PM last night. Luca skypes his parents for the 10th time in 10 days (I am not exaggerating), while they coo at her and cry while watching her on camera. I reflect that my own parents would never dream of showing any sort of emotion towards me or their granddaughter.
10:30 - I point out to Luca that dog has not eaten or been out to pee since 8 last night. Luca continues to skype parents. Gives me list of things to add to our baby registry on Amazon since his parents want to buy us stuff. (Not sure why he can't do this himself.)
11:00 - I go upstairs to use the bathroom. Luca decides that he too, must use the bathroom now. Ignores me when I ask him what he did with the baby. Repeatedly. Dog is going berserk. I emerge from the bathroom with my pants around my ankles, am relieved to find that he has her in the basket in the other bathroom with him.
11:20 - Luca has shit fit because D poops on his hand while he's changing her. I want to strangle him and burst into tears. It feels so unfair to me that he's allowed to lose his shit over something like that when he's had 3 more (at least) hours of sleep than I have, and hasn't even taken the dog out yet.

Meanwhile, I've found out that (as per my previous predictions) there is no computer for me to skype into for our team afternoon meeting at school. It's not *that* important that I attend, but I kind of wanted to so that I can remain somewhat in the loop over the next several weeks. It pisses me off, because it took a great deal of effort for me to get my PI's secretary to even consider bringing a computer to the meeting, and she of course did the absolute minimum, and now -- as I told her might happen -- both computers that she could use are being used by other people. I could teleconference, but my PI doesn't want to have to pay for it.

It just makes me feel like shit that nobody is willing to work WITH me here. At this point I don't think today is a great day to start doing this, but I still feel screwed over, and that if I don't insist, it's going to get even harder for me to get anyone to do anything for me while I'm out on maternity leave.

And I want to kick my husband's ass for abandoning me in the BR for 2 hours this morning, and completely neglecting the dog so that he could have a friendly chat with his parents for the 5,000,000th time this week. Of course I feel like I can't say anything at all because I feel like he thinks he's already he's already done so much to help, and besides, I'm going to have to manage all of this stuff myself when he's gone at work 14 hours per day starting next Monday.

And I know that if I say anything at all to ANYONE (in particular my parents), they will just say that I'm "hormonal" or "too demanding" and that I am really lucky to have such a wonderful helpful husband, and that I should try to suck less myself. At least that's what my internal monologue tells me. Come to think of it, that's what my father ACTUALLY told me the other day. Twice.

7

Seven.

That's how many ounces D gained between Thursday's bilirubin check and yesterday's week 1 weigh in. Only 6 oz more to go until she's back up to her birth weight.

Luca commented that if I'd gained 1/2 a lb in a week, I'd freak out. I pointed out that in fact this would be reasonable since 1/2 a lb for D is the equivalent of 7% of her body weight, which on me would be more like 10 lbs. Which would be COMPLETELY REASONABLE to freak out over.

I am really hungry a lot of the time, and I think I need to institute an overnight snack so that I don't feel so drained when I get up. Luca has nicknamed D our little vampire.

To get her to sleep a little longer, last night I tried extending the time between her 2nd to last and last feed by 40 minutes (from 90 min to 2 hrs 10 min) before we went to bed so that she'd be a little more hungry and would fill up more. Instead of immediately attaching her to my breast the minute she started fussing at 8:45, I played with her and rocked her until it was almost 9:30. And well, it seemed to work. But then when she latched she was completely voracious, and I felt really guilty for making her wait at all. I am gathering that this guilt thing is something I'm going to have to get used to....

In other news, I seem to have peed and sweat (especially at night) off 20 lbs in the past week also. And I've found that I kind of like the way my post-partum belly looks, now that it is mostly deflated. Even if it is a little saggy and wrinkly, and my belly button is completely deformed. It feels like a well earned battle scar. Add this to the list of things that I thought I thought I would mind, but don't at all.

We had night #2 of sleep x wake-up to feed x3 last night. With D in the co-sleeper doing 2-3 hours of sleep per stretch. I fully expect her to regress and cry inconsolably for at least part of the night in the near future (probably the night before Luca goes back to work... haha) but for now I am so ecstatically happy that she was able to do this.

I think I prefer her in the co-sleeper to the bed at this point, if for no other reason than that it enables me to (selfishly) sleep with the blankets pulled up to my ears wrapped up like a burrito. With her in the bed, we must dispense with the blankets so we don't accidentally smother her.

We've also been reconsidering childcare options. I think daycare is still our first choice, but realistically we probably won't get off the wait lists at two of the ones we're considering until September, or maybe even January of next year. The third, which we also really liked, told us in September of last year that May was a possibility, but who really even knows whether that is realistic or if they were just saying that to get us on the hook.

In any case, we need to figure it out, and soon, since arrangements tend to take time to get put into place. If it's going to be end of summer or perhaps even next winter, we're going to have to hire a babysitter. Then the question will become whether it would be better to hire an au pair or to pay a local person by the hour. Since we have an extra room in the house, and my schedule is pretty flexible, I'm almost leaning towards au pair, in part because it would cost less (~20K compared to ~35K for comparable hours from a local babysitter), and in part because of the flexibility. Plus, we may end up needing to hire an au pair eventually anyway to orchestrate AM drop offs and PM pick ups when I go back to med school in 14 months. We'll have to see.

I also have to admit that after spending some time at the pediatrician's office, I am kind of squiked out by all the germs there, and fear that I would have similar feelings about daycare. You can practically see the germs leaping off the fomites into Miss. D's nose while you're sitting in the waiting room. Not that my house is immaculate by any stretch, but at least those are MY germs.

It's really lovely out today. Maybe I'll even go for a walk OUTSIDE THE HOUSE. Next lunch for D, and then lunch for me.

New kinds of puzzles

Luca got a week of paid paternity leave from his job (which is now over) and is taking next week off as well unpaid. After that, he'll be back to leaving for work by 6AM and returning home (usually) by 7PM.

I am terrified. How on earth am I going to manage all the stuff that needs to be done without him around?

It's not like there's *a lot* of it, or that any of it is really all that difficult to do. I basically have to feed and change the baby 100x per day, and walk the dog once. I've even hired a dog walker to do that middle part.

The problem is all those other things that come up that require the use of both of my hands at the same time. Like having to use the bathroom, eating, and showering. Or things that I realize need to occur while I'm feeding or changing the baby. Like getting a glass of water for myself, or fetching another onesie because D's diaper leaked all over her current one and the stash we keep by the changing table is out.

Do you have any idea how difficult it is to pull down one's (sweat)pants with one hand, change one's pad, and pull up one's pants? All with a squirming and crying baby in the other hand? Avoiding this situation requires planning, since you can't just leave the baby unattended on the changing table or on the bed/co-sleeper. This means that I really need to remember to bring her basket upstairs with me *before* I decide to try taking a nap with D so that when the need to pee arises three hours later* I am prepared.

In other news, we just woke up from a GLORIOUS -- UNINTERRUPTED -- THREE HOUR NAP with D in the co-sleeper (not the bed), and me unconscious in the bed next to her. The only problem with it was that it was ONLY three hours long, and now that D has eaten (actually, she's eating right now), I want to go back to bed.

Here's hoping that this new skill of D's (sleeping not on top of me) generalizes to sleeping at night as well.



*Do you realize how amazing it is that I can once again go for three hours without peeing?

Going home from the hospital

Co-sleep

Thank you thank you THANK YOU for all your advice regarding sleeping and breastfeeding Miss D at night. Someone (I think it was Larissa) pointed out that passing out on the couch with the baby was probably at least as dangerous as sleeping with the baby in the bed, which is totally true, and I think helped sell Luca on the idea.

And I also want to apologize for snapping at Liana about already having a co-sleeper. Six months ago I didn't even know what a co-sleeper was, so if anything I should be impressed that she knows of their existence at all.

The issue with the co-sleeper is that it is located 3 feet away from me, which in D's mind is an unacceptably far distance. In fact, anything over 12-15" is too far in her mind. Thus, our problem. We've decided to try to have her spend more time in the bassinet during the day to get her used to not being in constant physical contact with us, and we suspect this will help. However this will probably take a little time.

Last night went much better. Luca and I went to bed at 11:30 after feeding D from 10-11, changing her 3x right before bed (for 3 poops spaced 15 minutes apart -- she is a machine). We put her *in the bed* next to us in her sleep sack, since she usually starts bawling inconsolably if we put her in the co-sleeper. Within about 30 minutes, she started rooting around my chest. I held out hope that maybe she'd fall asleep since she'd literally finished eating 30 minutes prior..... but then the sobbing started so I decided she probably really did need to eat and I put her back on my boob.

She remained on one boob or another, eating or sleeping (but mostly eating) from 12 last night to 6 this morning. Child loves the boob. However since we were feeding in the side-lying position, after she got a good latch I was able to snooze a little too while she ate. And since I have a giant blister on one nipple (am going to try the Lansiloh and the hydrogels this weekend), I can assure you that it was NOT a deep sleep.

Luca got up at 7 and offered to take D downstairs so I could have some real sleep, but she started crying and rooting around again, and after 30 minutes brought her back up to eat some more. We eventually got out of bed a little after 9.

I guess all of this explanation is to say that it would *actually* be impossible for me to get up out of bed to feed D at night because I'd never actually make it to the bed in the first place if we did that.

Anyway, this probably all sounds horrible to you (especially those of you sans kids), but I basically got 10 hours of light, off and on sleep last night, which is more than I've gotten for a week, and I feel completely glorious today.

I have a couple of goals for the day which include:
A) Tummy time
b) Alone time in the bassinet
c) A short walk OUTSIDE THE HOUSE (it is 50 degrees and lovely out, and I feel like I should take advantage)

In other news: I peed off 10 lbs of fluid over the past two days, and I can *almost* recognize my feet again. Also, I no longer have an outie. Yay!!

A couple of people have asked how the Boo is adapting to all of these changes. And I have to say, despite all of our concerns, she has actually been pretty awesome. I got progressively worse about giving her adequate attention and exercise over the course of my pregnancy, and I think that this has made the transition easier. Ha.

She finds D interesting, especially when she cries, but not in a bad or aggressive way. Mostly she just comes over to sniff. The "leave-it" command and the "look" command have been especially useful. She is way more interested in treats than in the baby. This morning when Luca took D downstairs, I invited Boo up on the bed. When Luca came back, she was snug under the covers, and neither of us had the heart to make her go back to her bed while I fed D, and Boo couldn't have been less interested in her.

I think the only thing that Boo really hates is that D keeps her up at night with her crying. Boo is a lady who appreciates her beauty sleep. On the plus side, a tired Boo is a well behaved Boo, so I really can't complain there either.

Peds

Little D had her first visit to the pediatrician yesterday, and it went well!

It was during this visit that I realized something: I LOVE breastfeeding.

I already knew that it made me feel close to D, and that I was still enjoying it even though she's made my nipples sore (seriously. Ouch.). But during the visit, she started to get a little fussy, and since it was time to feed her anyway.... (I mean let's face it, she's 5 days old, any time she wants it means it's time) I just whipped out a boob and popped it in her mouth.

Then the doctor came in, and we did the full history with her eating. She was quiet and content. And when we got to the physical exam, she was a little sleepy and very relaxed, and barely cried at all. Even when the doctor tested her Moro reflex.

Things were a little more awkward when she started howling again as we were waiting to get blood drawn so she could have her bilirubin checked. There were a bunch of people in the waiting room and I felt like I should at least attempt to cover up. I am not coordinated enough at the process to both get a good latch AND be discrete, but with some help from Luca we were able to pull off something that was probably just modest enough. I didn't actually care THAT much though. It's amazing what being a little tired and showing your vagina and breasts to the entire world during L&D does to a girl's sense of modesty.

Anyway, while we were there, a woman who looked to be about our age emerged from an exam room with an adorable 12 day old baby. The baby's mom was a few steps behind her and was probably about 16 or so. It made me feel so sad. I wondered whether grandma and mom felt the same way about their baby as Luca and I feel about mine. Then I felt really guilty and judgmental for thinking that at all. I mean, why wouldn't they feel the same way? On the other hand, teen motherhood is clearly not optimal for anyone. I don't know.... I'm chalking it up to the hormones, but that's mostly because I don't know what I'm supposed to say about these things. Everything that comes to mind seems condescending, judgmental, and counterproductive, so perhaps it's best if I say nothing at all.

Then we went to Chipotle, where I wanted to seriously smack the excessively perky girl who makes the burritos. She remembered Luca and me, and I guess was trying to show us that she knew "our" order. Except that I got something different than usual, and was feeling poozely from my excursion, my hemoglobin of 7.something, and my recent surgery, and I didn't feel like laughing at her comments, which are annoying even when I'm not feeling like garbage. She tends to get a little confrontational if you don't go along with her act. Suffice to say we got out of there quickly, and fortunately before I said anything offensive.

I spent most of today in the house feeling much better than yesterday, but still completely unprepared to face the real world. A walk around the block was about all I could handle. I have to keep reminding myself that I'm still only post-operative day #5, and I'm allowed to feel like crap and not want to talk to anyone.

Cartoons

I also wanted to take this opportunity to put in a plug for Dr. Fizzy's blog and recently released book. I haven't read the book myself yet, but if it's anything like her blog (and I am assured that it is), I think most people who enjoy reading MY blog would probably like it also.

Enjoy!

Ah Caverject

In honor of the talk I'll be giving at a conference in May on my research, and since I'm not my usual entertaining self these days, I thought I'd link a recent post from Dr. Grumpy's blog from a few days back.

And yes, apparently the story is completely true.

Tired

As I woke up from a 1.5 hour nap (glorious!) and feel so so much better, I recalled with amusement a conversation I had with my brother in law about 5 months ago. It was the first day that we arrived in Italy, and we were out at dinner talking about pregnancy and babies.

My sister in law primarily wanted to know if doctors in the US chastised women for wearing high heels during pregnancy in the US. I really wouldn't know.... I can't remember the last time I wore heels.... Apparently this is something that they do in Italy however, and as woman who wears 4 inch stilettos to the grocery store, is of primary concern to my sister in law.

My brother in law was hung up on how much work babies are. He said something to the effect of, "They eat every four hours! And that's from the beginning of one feed to the BEGINNING of the next one! There's no time in between to do anything else at all!"

And well, yes. This is basically true. Except four hours is for formula fed babies. For breastfed babies it's more like 2-3 hours.

And it's not like that rule gets extended if your baby is a slow eater. Nope! If your baby takes 60 minutes to eat, and she's eating every 2 hours, then you only have 60 minutes to sleep or do whatever after it's over to do other stuff.

Except that's not even really true either. Because sometimes (often) babies need you to soothe them in between feedings as well. And since you're supposed to feed on demand, often we find that our baby (who from this point forward will be called Little D) will start rooting around already hungry 15 minutes after finishing her last meal, so in effect she has been eating every hour for about 30 minutes a session.*

Don't forget that this behavior is around the clock. So... sleep? What is that again?

Also Little D does not like to sleep anywhere except for on top of me. Including in her bassinet. You can put her down, and she will start whimpering after about 5 minutes, and after 10 this will have escalated to desperate sobs. I am *hoping* that she's just been a little chilly, and tonight we're going to try an extra blanket under her sleep sack to see if that helps at all.

I am not optimistic. The middle of the night was her active time when I was pregnant, and there's no reason for that to no longer be the case now.

Brief, but important side bar: When I was in the hospital I noticed that I would often fall asleep while breastfeeding. The lactation consultant assured me that this would happen, and that as long as the baby wasn't in danger of falling or being squished, it was nothing to worry about. This made things so much easier! When it was 3AM, and little D was fussy in her bassinet, I'd just translocate her to the bed with me to feed her. We'd do a side lying hold (remarkably easy for us to master -- haha big surprise since the mom is lying down on her side for this hold!), Little D would nurse, and I would "relax."

Just so you know "relax" is code for "pass out completely for like, an hour while the baby eats." But nobody said anything about it while we were in the hospital, probably because when they saw me, I'd be awake. Probably also because D was eating off and on more or less continuously 24 hours per day and any reasonable human being knows that parents -- even parents who are doctors (to be) -- need to sleep sometimes in order to be able to do things like.... oh I don't know, remain alive?

When Luca and I figured this out, we felt like we'd figured out the secret cheat to some video game.

Why do I say that? Because while falling asleep while nursing is permitted if it's unintentional, if you do it on purpose it's called "co-sleeping." And, well, only bad parents who don't care if they roll over and squish and kill their babies would ever do something like that on purpose.

So apparently, even though my child eats more or less continuously throughout the day, since I know I will fall asleep when I nurse in the side-lying position, I am actually supposed to get up out of bed and sit in a chair to nurse -- for 60 minutes or perhaps even all night if necessary -- in order to prevent myself from falling asleep while nursing or while holding Little D.

Honestly, the thought of doing this made me a little sick to my stomach.

I immediately starting concocting ways to get around this prohibition. What if instead of going to bed, I "slept" sitting up on the couch? Then when Little D wants to feed, she could just lie on my chest like she does during the day (when I have been known to nod off as well, I might add). But, since she is *on top* of me, and because I am technically sitting and *not* lying down, it doesn't count as co-sleeping, right?

Haha, I'm sure that would be frowned upon as well. Still, Luca and I just woke up from a 1.5 hour nap on the couch where I did exactly that, and we feel so much better now it's not even funny.

All this is in support of my theory that -- at least where doctors are concerned -- if something tastes good, feels good, or generally makes your life easier, then it's probably dangerous or at least bad for you and probably you shouldn't do it.** And there is yet another reason I have a hard time seeing myself doing primary care.

Anyway, this phase is not going to last forever, I know. And Little D is so completely amazing in every way. We are so happy to have her and can't believe she is all ours.



*Yes my nipples are starting to get a little sore. Nothing too horrible yet, but when she starts nursing, things are a kind of ouchy until she gets going. I will say that Luca is a little jealous that he can't breastfeed too since to him she seemed very bonded to me from when she was only a few hours old, and for the first couple of days she would howl any time he held her. I'm happy to report that she now appears to enjoy falling asleep on him as much as she likes falling asleep on me, and now I am the jealous one because he doesn't have to have sore nipples.

**Haha!! It's a joke! I'm kidding!! (sort of...)

The Birth: How it went down

Sorry for the lengthy absence from the internet, dear readers. I finally had my baby on Sunday 1/22. She weighed 8.85 lbs and was 21.25 inches long. I am still mastering the art of typing while breastfeeding, so I apologize in advance if this post ends up having a lot of typos.

So on Saturday in the morning, I worked on some STATA code, and got my first loop to run. Then in the afternoon, I hung out with my friend M from med school in the afternoon. We talked about a bunch of things, some baby related, some not. She left at about 5:30, and then Luca and I had dinner and watched How I Met Your Mother reruns.

At 9:30 we decided to walk the Boo. We'd had freezing rain all day, and it being West Philly, a lot of people hadn't bothered to salt or shovel their sidewalks, so the going was a bit treacherous. Still, it felt good since I'd been cooped up inside all day. We got home at around 10, and I felt this pretty strong cramp in my lower back and abdomen. It wasn't horrible or anything, it was just different than the cramps I'd had before.

So while Luca went and did the dishes, I watched a little more tv. About 15 minutes into the show, I felt kind of a pop and a squirt. Like I'd peed on myself, only I hadn't been moving around so I was a little surprised that this had happened then. I went upstairs to the bathroom to clean up and pee, and more fluid came out, but not THAT much, so I still wasn't sure whether my water had actually broken. When I came back down to finish my episode, it happened again. And now I'd started having regular contractions, but not that strong.

So, this was all at about 10:20 Saturday night. Between 10:20 and 11:00, I kept having mini-contractions, so I alerted Luca to what was going on and decided to take a shower (best decision EVER). We'd been told to wait to come in until my contractions were 60 seconds and 3-5 min apart for at least 1 hr. Mine started off at 60 seconds each at 2:30 apart, and just kept getting stronger.

So, at 12PM we came to the hospital. And I was 100% effaced, but only 1cm. So I waited for two hours so they could see whether my contractions were actually doing anything. Wow were those a painful 2 hrs. But the baby looked great on the monitor.

2 hrs later I was 6cm, so I guess I really was in labor,

:-)

Then I got admitted, and as soon as I got back to my room, my water broke FOR REAL. I have to say though that I had enough pain that the fact that I was sitting in a giant pool of amniotic fluid didn't bother me in the least. I requested an epidural, and was told that there was a line and that it might take as long as 3 hours to get one, which at the rate I was progressing was likely going to be too long.

I did end up getting on about 90 minutes later. Holy mother of God were those a painful 90 minutes. If I'd had to deliver without one, I suppose I could have, but WHY on earth I would have wanted that is beyond me. I also discovered why they tell pregnant women to breathe a particular way: screaming does nothing and actually made me feel worse.

The anesthesia resident gave me an absolutely fantastic epidural. I still felt some pain and pressure, but the edge was taken off. I could still move my legs and feel them, but had very little pain. I was 9 cm by the time they were done and told to nap/relax. I think the labor floor was pretty busy on Sunday and they had several emergencies, so I waited relatively comfortably and took a nap sitting up trying to dilate the rest of the way to 10 cm.

At some point it was determined that it was time to push. Which I did for three hours. They tried rotating my baby in my pelvis (not fun -- I can only imagine REALLY not fun without an epidural) a couple of different ways to get her to come out, and tried having me push in several different positions, it was determined that her position was unfavorable for a vaginal delivery. She wasn't in any distress, but she just kept getting hung up on my pubic bone. So we decided to go forward with a c-section. Since both ORs were already busy with other patients and my baby wasn't in any distress, I took a 2 hour nap, and then they got me ready to go back. I needed it. At that point I'd been awake for almost 40 hours straight and was feeling a little loopy.

The c-section was a lot of pushing and pulling, and not the most comfortable thing in the world, but really not a big deal at all. I just remember feeling really cold and shaking a lot, which was also due to the anesthesia. It took 7 minutes from skin incision to having her out, and I could hear her strong cry from behind the blue curtain. Then someone called out, "It's a girl!" and I remember feeling so happy. The pediatricians worked on her (APGARS 9 and 9), and my husband got to hold her. It was a little surreal -- I kept thinking WOW I'm a mom now, but it didn't really hit me until I got back to the room.

We got to do skin to skin contact right away, and tried to get her to latch on my breasts, which she did on the third try! This girl is a champion sucker, that is all I have to say. We did the left breast and then the right, and my friend M came down from the 9th floor where she was on call that night (M is a resident where I gave birth) to visit me. She was so sweet, and it was awesome to be able to have such a close friend and my husband in the room right after delivery. Then my parents came and the nurses bathed our daughter while she was in the room with us. She HATED the bath and cried like she was being tortured. My dad took a video of it, and you can just see how furious and indignant she was.

Then my parents got to hold her, and we talked for a bit while I waited to regain feeling in my legs so they could transfer me to the post-partum floor. Luca also cried a couple of times, which was really sweet. My husband is such a cutie.

Then my parents went back to the hotel and we transferred upstairs. She roomed in with us that night, which turned out fine in the end, since she was so sleepy from just having been born, and we breastfed her a bunch of times.

I am really happy with my experience. I had the most awesome L&D nurses and the Ob/Gyn resident who took care of me was really great also, and the nurses on the post-partum floor have been really helpful as well. In fact, we've probably only met one provider we didn't like so far, and that very well could have been because we aren't sleeping all that much at this point yet and have gone through periods of tired & crankiness.

Things that have surprised me..... How much I love breastfeeding her. Luca even said that he was a little sad that he is a man and doesn't get to do this. And I agree! Maybe it's all the post-pregnancy hormones talking, but I love the way it makes me feel. I got lucky and she started off latching like a pro, so my nipples have not been that sore yet.

I was surprised at other parts of the process too. I was surprised that my labor was as chill a process as it was, even though ultimately we ended up with a c-section. I got a lot of useful coaching (though no cheering!), she was just positioned a little transverse, and so could not descend easily. I was surprised that I didn't care that Luca was the first one to hold her, or that he ate several meals in front of me and I didn't care at all even though I was NPO or ice chips only. I was surprised at how well I was still able to move my legs with the epidural, and I was surprised at how controllable my pain was with breathing only before I got it (though I would still never choose to go sans epidural -- it is truly an amazing technology!). I was surprised at how nice and helpful all of the staff were, and I have to say vis a vis being told I was fat by the outpatient people? I would TOTALLY go through this again if I got to have such a wonderful L&D experience.

I have also been surprised at how much I love taking care of my daughter, and how relaxed it makes me feel. I don't even mind when she cries, and though I'm certain I will mind at some point, it's been really satisfying to figure out different things I can do to soothe her. I love skin to skin time. I love that last night I figured out how to do the side-lying hold and could kind of doze off a bit while she ate. My little girl has a champion appetite it seems and is just as awake and alert at night as she was when she was on the inside.

My only curiosity is this: Do you ever feel this way again if you have more than one child? Or is it different with every one? Luca said today that he had started thinking, "We should have done this YEARS ago!" to which I said, "Well, we probably could have done it one year earlier, but I think it was nice to have a year or two to experience just with each other after I'd switched from MD-land to PhD-land.

So, that's where we are! Tomorrow we're likely going to get discharged home, and that's when I'm guessing the real fun will begin. Wish us luck!

Here's a picture of her right after she latched on for the first time.

(More pictures to come!)

Yes, she went into labor after all

Luca The Husband is temporarily highjacking OMDG's blog to happily announce the arrival of their brand spanking new baby daughter.

Labor was, well, laborious,but mom and baby are doing well.

High-five to the anesthesia team for a kick-ass epidural and to the L&D nurses for being awesome.

Gazillions of pictures to follow shortly.

The blog will return to regularly scheduled posting as soon as OMDG gets some R&R.

Thank you all for the well wishes!

Luca

No I am not in labor

This is what I tell my parents every time I call them these days. Because when they pick up the phone, you can just hear the anticipation on the other end.

Last night I had 3 hours of Braxton-Hicks contractions lasting 60-90 seconds each 3-4 minutes apart. Not painful at all. Just annoying. They went away after I ate some dinner and watched a little tv. I actually slept reasonably well last night.

This morning, I texted my husband at about 7:45 after I'd showered and eaten breakfast.

Him: Did you get my note?
Me: What note?
Him: That I took your cellphone charger to work with me. My battery was low and I needed to charge my phone. I wanted to make sure I didn't miss your text if you end up needing to go to the hospital today.
Me: Aw you're so considerate, honey! Just so you know, this means I will definitely NOT be going into labor today. Thanks A LOT!
Him: Well, you know if I hadn't brought the charger then you definitely WOULD have gone into labor, and I would have missed your call.

We both agreed that the probability that I will go into labor tomorrow is higher than today because Philadelphia is scheduled to receive snow.

I swear we are both scientists and we never ever engage in magical thinking.

*****

Yesterday I found out that my abstract had been accepted for an oral presentation at my May conference.

On the plus side: Yay! Oral presentation > Poster only!
On the minus side: F-ME! More work to do before May!
On the plus side: Maybe having to do this extra little bit of work will mean that I'll actually be motivated enough to get this paper out.

The reality of what I have to accomplish between now and this time next year has recently hit me. In order for me to graduate by 5/2014, I need to defend my dissertation by 3/2013. Since my biostatistician will be out of the country on sabbatical starting 3/7/2013, I officially have my oh-shit date.

Between now and then I have to:
1. Complete Aim 2 of my dissertation (which I only just started working on last week)
2. Do above oral presentation for other project, write manuscript, and submit
3. Design from scratch Aim 3 of my dissertation
4. DO Aim 3
5. Write up my dissertation

I love it when people tell me that I really should just be relaxing right now. That now is the time to be taking it easy, and relishing the unencumbered life of a not-yet-parent. But I can't afford to -- I have too much to do!

Because really? #1-3 need to happen before 6/1/2012 in order for me to realistically have a shot of completing everything by 3/7/2013. Ok, Aim 2 doesn't have to be completely done and submitted, but it needs to be pretty close. Subtract out 8 weeks of maternity leave, and that doesn't leave much time at all for getting this stuff done.

All this with the little booger refusing to be expelled from my uterus. My concentration levels are not at their finest right now. Today, I'm trying to make myself learn how to write loops in STATA. It's coming along, but OF COURSE not as fast as I'd like it to.

Now the painless contractions have started up again. No, no, they're not distracting at all! Maybe at next week's appointment they'll strip my membranes and I will go into labor, and we can at LAST get this show on the road.

It's not about the cheesecake

I have a neighbor who I like, but rarely see since it's winter and neither of us spend much time outside these days. She's great. She has a big dog that the Boo gets along with and we used to have her and her boyfriend over from time to time under the pretext of a doggy playdate. Then they got a second dog who does NOT get along with the Boo, so we stopped having the playdates. Now we don't see much of each other at all.

It's really a bummer! She's such a sweetie, and I always enjoy talking to her about the house, the dogs, school, the garden, the boys, etc. And every time we see each other we say we really ought to do this more often.

So on Tuesday, since I was working from home that day, and since I thought she might be home not working, I texted her to find out whether she wanted to come over for a slice of cheesecake.

She replied that she did not want any cheesecake since she hadn't exercised in two weeks. But thanks for offering!

I didn't really know what to say. After all, I wasn't *really* asking her over to force cheesecake down her throat, I was asking her over just to chat for a little while.

So I assured her that she had nothing to worry about vis a vis eating too much cheesecake, and suggested that after I give birth perhaps we can start exercising together (we've been on a couple of runs in the past, and it's been fun), and I still got rebuffed!

Sigh.

Should I just have told her that actually I was just texting her to find out if she wanted to hang out for a little while, and that the cheesecake was just a pretext? Gah! I don't know. It just makes things awkward since now I don't know if she didn't want to hang out at all, or if she really just didn't want to be force fed cheesecake.

This "making friends" thing can be so confusing sometimes!

The real reason

I've blogged before about not wanting med students in the room when I give birth. And a lot of people have said, "Of course you wouldn't! I wouldn't want my classmates looking at my vagina either!"

And yes, that is part of it. Especially my vagina while in the process of giving birth.

But the real reason has nothing to do with modesty as much as it has to do with decorum. See, I don't expect to be especially composed while I'm in labor (unless I get the best epidural of all time -- which, hey! A girl can hope, right?). And I just don't want my classmates saying, "Wow, OMDG was CRAZY when she was in labor! You should have heard the things she said! And the way she screamed at her husband? It's a miracle that he doesn't divorce her."

Ok, perhaps I'm being paranoid, but that's the the real reason. And.... not sure what else there is to say about that!

Things I am Looking Forward to About No Longer Being Pregnant

- This bullshit! I've been lying awake in bed for 1.5 hours now for NO REASON.
- Being able to sleep without my hands going numb
- Sore PIP joints due to edema
- Being able to roll over in bed without completely waking up and having to readjust everything
- Sleeping for more than 60 minutes consecutively
- Putting on my shoes without having to sit down
- Not having to plan my day around how many times I have to change my socks
- Being able to stand the entire time I'm showering without feeling at some point that I might pass out
- Being able to walk for more than 1.5 miles without developing a sore back and having to sit
- Not feeling my knees ache every time I stand up
- Having my feet no longer be swollen -- I've had to loosen the laces on my sneakers twice in the past two weeks. Scratch that. LUCA had to loosen them because I couldn't reach my own feet.
- Being able to find a comfortable position while sitting on the couch
- Being able to eat sushi, cold cuts, stinky cheese, and have a glass of wine
- Being able to pick things up off the floor without doing a plie
- Hugging my husband without having to twist sideways to do it

I'm sure I'll think of some other things, but right now the insomnia is what is pissing me off the most. And yes, I know when we have our little bundle of joy I won't get as much sleep as I want. However at least then I will be up FOR A REASON.

OMG cheesecake

As a side note, Luca and I made our first cheesecake yesterday afternoon. It was lemon flavored with a graham cracker crust (the one from the Bittman cookbook). And OMG, it was... no IS, A.M.A.Z.I.N.G.

So light and fluffy! I was worried about the step where I had to fold the beaten egg whites into the rest of the batter, that I would end up deflating the whites, but this didn't end up being a problem at all.

We decided not to go with the sour cream topping. We made that when we did a key lime pie recipe a few months back, and it was really good, but this time laziness prevailed. And the long and the short of it was: it wasn't necessary.

We'll definitely have to repeat this experiment. Who knew cheesecake would be so easy?




Recipe -- The brief version
- Preheat oven to 325 degrees (my oven runs cool, so we preheated to 340) -
1. Separate 4 eggs -- put the whites in one bowl and the yolks in another.
2. In the bowl with the yolks, use an electric mixer to make the yolks creamy.
3. Then to the yolks add 24 oz. plain Philadelphia cream cheese (3 bricks), the juice from 1 lemon, 1 cup of white sugar, and the zest of 1 lemon.
4. When the mixture is smooth, mix in 1 Tb of white flour.
5. Use the electric mixer to beat the egg whites to the point where they stand up in peaks by themselves.
6. Fold the egg whites gently into the egg yolk - cream cheese mixture.
7. Pour the contents into a pre-made graham cracker crust shell (you could always be fancy and make this yourself if you wanted to).
8. Pop in the oven for ~1 hr, until it starts to brown slightly.
9. Cool on counter top, and then after 30-60 minutes, cover with plastic wrap and pop in the fridge until it's fridge temperature (we let it sit overnight).
10. Eat for breakfast the next morning.

Interrupting

A few weeks back I did an information session with a prospective MD-PhD student in my department. It wasn't an interview, and the session was purely provided so that he could meet current students in his prospective department and ask us questions.

Long story short, it was fine. My department provided doughnuts (woo!), and it only took up about 30 minutes of my time.

But you know? I thought the kid was kind of a douche. First of all, he approached the sessions like he was just interested in selling himself. Every phrase he uttered seemed like it was designed to convey, "I am awesome," to us. Which, I mean, ok it's an interview. But it was so fake! It came across more as, "I am smarter than everyone including you," than as, "I have so much to offer this place, including you." Plus, it's pretty irritating to have a conversation with someone that consists of them essentially repeating to you how smart they think they are.

Second he had a list of questions that were germane to basically nothing about how the department actually operated, and served to primarily allow us to talk about how great [my school] is. A bunch of softballs. As a result, he got no useful information whatsoever. We never got to tell him about the coursework, or the mentorship, or the funding, how medical school was integrated with the PhD work, the fact that he'd have to write a grant to pay for himself if he came here, or what it was like to be a student in this department at all.

Finally, and possibly most annoying of all, every time I (or any other woman he was speaking to) opened her mouth, he would interrupt after we'd been talking for, oh.... about 5 seconds. Before it was even possible to answer his question or to provide any nuance. I thought it was just me, but then I saw him do this to another woman 5-6 times in a 3 minute conversation. After he did this to me a couple of times, I stopped caring whether I ended up giving him useful information, and started counting down the minutes to when the session would be over. And I'm sorry, if you do this to people, it conveys -- whether you mean it or not -- that you don't actually value the information you're being given, or the person who is providing that information to you.

Ah well, as I said it wasn't an interview, so my opinion does not matter at all to the admissions process. But I guess for those of you who are interviewing for anything in the future, make sure you listen as well as you talk about yourself. Being smart isn't enough. You have to be able to show people that you can play well with others, and that you don't think the world revolves around you. And especially, nobody likes an egotistical med student.

Ok.

Well, I think I can say now that I am officially tired of being pregnant. Even though I'm having regular contractions (which are only mildly uncomfortable if at all), they are doing nothing. Cervix is still closed.*

Luca and I have this three day weekend and we can't do anything! All of our baby-related errands have been run, and we really don't want to go shopping just so I can spend some money on stuff I don't need, or to a museum where I'd have to stand all day. I can't stand for very long without getting dizzy and short of breath, so those kinds of activities sound like torture to me.

And I am NOT doing work today. I already spent a good part of Saturday working on my models. I've gotten all the school work done that I wanted to before I gave birth. Any work I'm doing now is on new projects. Which is fine. It's just a good stopping point's all.

Pre-pregnancy on days like this, we'd go for a run, go out to a pub and get a burger and a beer, go climbing or swimming. We did go for a 2 mile walk this AM with the dog (which really was lovely), but now what? I'm tired of watching movies on Netflix. I don't feel like reading. And I have an Ob appt. at 2PM where I'm sure nothing will happen.

I think maybe we'll bake something when we get home from the appt. Of course, I won't be able to eat any of what we make.... haha**. Maybe we'll order in Indian food tonight or something.

It seriously feels like we're never going to have this baby.



*Update -- Just kidding. Now I'm at 1cm, 50% effaced, soft. Progress from Saturday, for sure. And yes, I know it's no indication that labor is imminent or anything like that.
**Of course I will eat it. The Ob/gyn can go right ahead and bite me.

Oh yeah

I passed my oral candidacy exam. One more hurdle behind me on this long, LONG, road.

Trying to be Salman Rushdie

Yesterday evening I fell walking the Boo, and got to spend the evening in the ED being monitored. Woo!

While I was there, I read some more Cutting For Stone. And I have to say I'm having a really hard time getting into it.

It sort of feels like it's trying to be this big epic involving a health clinic, the coming of age of two boys, with the backdrop of Ethiopia. Kind of like Salman Rushdie did with Midnight's Children (except there was no health clinic pretext, and Midnight's Children took place in India).

Only Cutting For Stone is just not as good as Midnight's Children. I find myself not giving a crap about any of the characters, or what happens to the health clinic or to Ethiopia. Pretty much the only parts I've found interesting have been the medicine and surgical references. Kind of like, "Ooh! I know what that is." And then we move back to the twins or Hema and I find myself not giving a shit again.

The only issue is that a number of people have told me that this book is The Best Book They Have Ever Read(TM) and I feel somewhat obliged to at least try and finish it (I'm at 37% now).

Not sure why I care.... after all I think I'm basically the only person alive who liked "Look at Me" by Jennifer Egan or "Cat's Eye" by Margaret Atwood, and that doesn't make me like those books any less.

So this morning I downloaded a bunch of books off of Project Gutenberg, which at very least, even if I don't like a single one, at least were free. And I bought "Confessions of a Shopaholic" which, hey -- I know it's not high literature -- but at least it isn't trying to be.

Hopefully I'll find at least one of these books to be enjoyable.

More pregnancy pictures.... and the Boo

Luca has been experimenting with his new camera, and last weekend we took a bunch of pregnancy/Boo pictures.

This one is a little cheesy since I'm standing on the bed. But, the light was the best in this room, so we did what we could with the space. Check out the eye contact from the Boo! If only she could always be this obedient!

The classic "Look at my bump" pose.

And another.

Believe it or not, the Boo does this on command (treats help!).

For Christmas this year, Luca got one of his photographs of the Boo and me printed on canvas. Here I am holding it. (Again, check out the eye contact from the Boo. Such an obedient doggy!)

And finally, one of the Boo on her bed, which is located practically underneath the chair I sit at when I work from home. Just because she's so cute!

As a side note, I recently realized that if I go past 41 weeks and need to be induced, my induction date will be on 2/3. Which means that I could conceivably have this baby on 2/4, which is my ex-bf's birthday. And that SIMPLY WILL NOT DO. Ok kiddo? Are you listening? You need to come out (preferably) before that, or if you absolutely must wait that long, after that. Deal?

Switching Gears

I submitted my revisions on Tuesday, and my paper was officially accepted by 12PM on Wednesday! Woo!

And now I get to switch gears and start working on my myriad of other projects.

Earlier this week I created a new dataset for my Aim 2, and now I'm in the process of running a bunch of models. This morning I set up a bunch of batch jobs to run on the grid, and I'm basically going to ignore them and work on other stuff until they finish running, sometime in the next week(?) or so.

Unfortunately, I think I got one of the slow processors, so I may have to run my jobs individually on my school PC sequentially instead of simultaneously on the grid.... (not that any of you all really care here -- just thinking out loud, folks!)

Then our data programmer returns on 1/20 (from a TWO MONTH VACATION.... bastard), and I'll need to give him a list of variables to create for me that I'll need to run as well. It won't take him long, I'm sure, but he'll probably also have requests from other people who have ALSO been waiting for two months.

And then there is the other paper that I've been sitting on (again) for months. There are a couple of things that I need to fix from my old analyses, and then I have to think about a better way to spin this paper to make a more compelling story when I submit it. I have some ideas, but of course all are somewhat time consuming. Something to mess around with using one hand after I've gotten the hang of breastfeeding maybe?

We'll see.

Learning by doing

I was talking with a friend who recently returned to clinics after a year out about an elective he was doing. He said the elective was ok, but that they didn't let him do anything, and at this point he felt ready to move on. To actually be part of the team. To have a job.

And this, friends, is one of the things I disliked most about being a medical student, and in particular about being a clerkship student. You didn't really have a job. Nobody would tell you what they expected you to do, but yet perfection was demanded from the outset. On rounds, you were expected to stand there, looking like you were completely enthralled by whatever the attending was saying even though 25% of the time you couldn't hear. And in the moments when someone actually spoke to you (which were few and far between) you were expected to come up with something brilliant / fascinating to reply with, which would impress on them that you were the best and smartest medical student ever, and deserved honors. Oh and my favorite part was when residents and attendings would address you as they would a small child.

I think one of the reasons I loved my sub-i (and my neurology externship) was that I was actually permitted to see patients on my own, write notes, and you know, use my brain. I really like having a job. And occasionally, someone would actually listen to something I had to say about a patient. When that happened, it was AMAZING.

But now I hear that they're going to get rid of the sub-i???

Let me clarify a bit. So, one of the things that was special about my med school was that when you did a sub-i you actually replaced an intern on the team. You carried the same patient load as an intern, and you did everything that an intern does. At many schools they have an externship instead of a sub-i where you are an extra person on the team, rather than a replacement. It's considerably less intense. At least though, you still have your own patients.

I guess they're getting rid of it because of a) scheduling issues that came with work hours reform, and b) liability reasons.

But still I see it as kind of a bummer.

I guess with the new arrangement, you'll still be able to "do," you just won't be doing as much as before. Ergo, learning will be slower and there will be more downtime.

Sometimes I find myself really looking forward to getting back to the hospital. To seeing patients, and checking off boxes on (endless) to do lists. To running around all day and feeling like I'm actually getting stuff done. But then I hear stories like this and it sounds like it's actually just going to be a huge letdown.

Other interesting tidbits from the Failure Panel

Everyone agreed that having a manuscript rejected, or not getting a grant, remained disappointing even as they got farther along in their careers.

Most of them had been scooped at one time or another. At the time it seemed like an insurmountable setback, but in the long run it hadn't mattered so much.

They said that it was ok if a field/line of research had more than one expert, and that sometimes it was good to have competition and conflicting points of view on one topic.

They encouraged everyone to have multiple lines of research/projects cooking at the same time in order to spread the risk in the event one didn't work out. One panelist remarked that not all PIs are good at providing this for their mentees, and it was up to the mentee to seek out other lines of research. Still not sure how to go about doing this....

Many of them had kids during training. Some of them experienced guilt. Three of them remarked that the guilt actually got worse as their kids got older and could verbally express disappointment at various things their mommies couldn't attend. The same three said that while it was hard for *them* to hand off their babies during training, their kids didn't remember this at all, and had seemed to suffer no ill effects from it.

One expressed that it was annoying that women got extra time added to their tenure clocks when they reproduced as junior faculty members. They'd had their kids during training and couldn't benefit from that perk, and their kids were still a big time commitment even though they were no longer babies. This made me feel better, as I will be in that situation when I am a junior faculty member. I realized that I wouldn't be alone!!

Two remarked that even if you have a spouse who is completely dedicated to doing his share of the house/kid work, during the first year it is basically impossible to have a 50/50 split because men do not lactate. After that it gets easier. Both commented that they felt like wet nurses during the first year of their children's lives.

Not all had experienced discrimination / unattractive commentary from their coworkers / program directors for having kids, though they knew women who had. Those women tended to be in smaller residency programs where coverage was harder to come by, or in procedurally oriented programs where there were similar issues. It's worth noting that among the five panelists, three were in peds, one was in neurology, and the fifth was in derm. (I thought the neuro lady was awesome as usual.... maybe I should hold off on crossing that specialty off? *Sigh*!)

They said that everyone makes a big thing out of publishing in Nature, Science, and Cell, but that there are very good papers that come out in "lesser" journals as well, and you shouldn't rake yourself over the coals too much if you don't have as many Science papers as the next person. Just focus on doing good science.

They all said that if they had to do things over again, they'd freak out less. Freaking out accomplished very little, and everything has turned out ok in the end.

They said that even the most confident appearing people probably have at least moments where they doubt themselves, and that you shouldn't look at other people's confidence as a sign that you're doing worse than they are.

Ouch!

Yesterday I mostly studied at home. After a while I couldn't take it anymore, and went to school to attend this year's Failure Panel, where female faculty members talk about their successes and failures throughout their careers, and give us advice about what they'd do differently (perhaps "Failure" panel is the wrong term....). Last year I organized the same event, and it went really well.

Anyway THIS year I feel I came to it with different perspective than last year, perhaps for obvious reasons. Haha.

There were a number of things that struck me. This post I will tell you all the first one (because I am in a hurry and need to walk the dog and get to a meeting!!).

So, there was a cardiology attending, and she told us stories about how she had her first baby during 4th year of med school, and her second during her second year of fellowship (she fast-tracked*). Cards is a pretty procedure intensive fellowship, and is HARD. You spend a lot of time on your feet. She was proud of the fact that she took all her required call THEN (rather than the following year), and worked hard all through her pregnancy.

When she went into labor, she was on a CCU rotation, and it was the middle of the night. And she continued to receive pages after she'd been admitted to L&D. (More than the L&D people, she noted with some pride.)

Anyway, the point is, a lot of female doctors really want to be hard core. To be seen as superhuman. To show no weakness. I will admit that part of me wants a similar dramatic story about how I worked my butt off until I went into labor (and I WILL, only the work I'm doing now doesn't require physical exertion, call, or all nighters). But the truth is, it's all a bunch of BS. Physically, I don't think I could do what she did, and you know what? I don't think that makes me a worse / less dedicated person or physician-to-be. And people shouldn't HAVE to have the dramatic story in order to be taken seriously. Your work, and how you are to work with, should speak for itself.

I can tell you from my own experience that the first two trimesters were not a big deal (though probably could be if you have especially bad morning sickness or something). But the third trimester REALLY knocked me on my ass. This is probably in part because I've had a cold for the past 5 weeks or so, and before that (when I had contractions at 30 weeks) was under the weather with something else. Before I would hear stories about how women would go into labor while in the OR -- while they were OPERATING -- I'd be really impressed. Now I hear those same stories and it makes me feel ill to even contemplate. This is because I cannot stand in one place for more than 30 seconds without getting sick and dizzy. My legs hurt (sciatica, shin splints, and tendonitis). I really WANT to be that hard core woman who is able to run a marathon up until I drop the baby, but the truth is, I am not, and can never be that person. I have come to accept this. If you can do this, more power to you, but I don't think that working like that until you deliver should be the expectation for everyone.

She commented later that some people have praised her for working as hard as she did until she delivered. But other people have told her that she shouldn't brag about how hard she pushed herself because it just sets the bar that much higher for other women who come after her. As in, "So and so did XYZ, you should be able to do that too." But for what? You're incubating another human, it's natural to feel like crap sometimes, and sometimes you really need to take it a little easier for the sake of your health and the health of your baby. That shouldn't be viewed as slacking off!

My attitude about all of this is the following: Sometimes you really do HAVE to work that hard, and sacrifice your body and your health a bit for your career. But when you don't, why do it to yourself anyway? It's like when my classmates in med school would brag (yes, that's what it was) about how little sleep they got. WHY??? I slept very well on my clerkships and it paid off big time. I'm sure I'll have to work hard later and sleep a lot less, so why torture myself now if I don't have to??

And also, for those of you who've never been pregnant, or who've been blessed with incredibly easy (and somewhat unusual) pregnancies, remember that it's not easy for everyone. It can be incredibly physically challenging. Have a heart. And I suppose that goes for other medical/family crises too. Be kind to your colleagues. The world is a much happier/better place when people try to accommodate one another than if they are constantly worried about being taken advantage of.

As a side note, now my contractions hurt more often. And they are on the top of my uterus, rather than just on the sides. Still not so bad, but maybe things are starting to cook? Or.... maybe not.




*If you want an explanation of this, let me know.... like I said I'm in a hurry this AM.

Stroke Surgery

About halfway through the class I was TAing last semester, a study came out showing that vascular surgery to prevent subsequent strokes had similar mortality* as medical therapy in patients who had suffered a single ischemic stroke. The student's report of the study was fine, and it was a great study to present to the class, but I was disturbed by commentary she made at the end of her presentation.

In particular:

1. That is was a *good* thing that this study showed no difference between medical and surgical+medical treatment, because she is sick of studies that find that more costly treatments (rather than the current standards of care) are better for patients. That this null finding was a point scored for non-interventionism.

2. That the authors of the study most likely had ulterior motives (like being able to make money off of performing more surgeries), and she was glad that this null result meant that they wouldn't be able to do that.

Gosh, where to start.

So first off, if you have one stroke, you have a 20% risk of having another shortly after the first one. And furthermore, strokes -- especially second strokes -- can lead to permanent disability and death. I think it would have been great news to hear that the surgery reduced stroke recurrence because I think in general, reducing disability and death are positive things, even if doing so costs money (that's why we do cost-effectiveness rather than cost-saving research in general -- because often to get better health you have to spend more $). Maybe she was suffering from the misconception that only old people have strokes and they're gonna die anyway, so why bother? In any case, I found it troubling that she couldn't see this other important side of the issue.

And second, sure, neurosurgeons or vascular surgeons might end up with more patients had this study shown that the surgery worked... but so what? If a surgeon ends up with more cases because we discover a procedure that helps a lot of people, I'm not sure how this is a bad thing. I was bothered by her idea that this research exists solely for the purposes of enriching doctors, and not for the purposes of helping people, and also the idea that doctors should not be compensated for performing services that benefit patients.

Anyway, her commentary highlighted the bizzaro thinking that a lot of apparently well educated people have. I tried to explain why I didn't see the null result as a resounding victory for medicine, but I don't think she wanted to hear it. She probably assumed that as a future doctor I was biased as well.

:-P




*It could also have been incidence of second stroke, I can't remember at this point.

Practice

Today I had yet ANOTHER Ob appointment, because all the slots for later in the week were full, and not only had the baby grown 1.5cm since last Friday, but I had also put on 4 lbs. If you want to get all technical about it, that's 6 lbs. since 12/30. My feet were really swollen a few days ago, but not so much today, so I really have no idea where all that weight is going, but I didn't get a lecture on dietary indiscretion, so I am just not going to worry about it. It's not like I can do anything about it anyway.

However, that and a report that the baby had been moving less that AM bought me a non-stress test. Which I have to say, wasn't nearly as bad as I thought it was going to be. I was in and out in less than 40 minutes, and still had time to make it to the weekly Critical Care research meeting where one of the fellows on our team was presenting his ideas.

So, the baby is fine. And it turns out I am having contractions every, oh..... 6 minutes or so. Mostly I'm not feeling them, but sometimes I get this achy sensation in my upper abdomen and lower back. Kind of like mild menstrual cramps. So, now I know what *that* is. It's definitely less uncomfortable than the contractions I was having at 30 weeks though, and they're pretty easy to ignore.

Everyone at the drs office keeps saying to me, "You're ready to go! Any day now," and Luca keeps asking me, "Do they mean, like THIS WEEK?" I keep telling him that their definition of "any day now" means between today and three weeks or so from now, and NOT that he should be expecting me to go into labor imminently. I'll admit that part of me wonders this also though.

I also ran into my PI who promised me that he'd take a look at my manuscript today. I thanked him and said that indeed, it was my preference that I submit it before I have this baby. He thought that was a swell idea.

Cleaner

As a Christmas present for Luca, I told him that I'd hire a housecleaner to do a deep clean before the offspring arrives. And then, as per the recommendation of a friend of mine, I decided to use a particular company. I hired them SPECIFICALLY because she said that they came when she wanted them to.

So, regular readers may remember the various barriers to having a housecleaner that I have cited in the past, and which prevent me from hiring them. Ever.

1) You have to pick up before they arrive.
2) Luca usually "forgets" to help, and therefore I have to scramble around in the 2-3 hours before they get here doing this myself (especially not fun when 9 months pregnant).
3) Oftentimes they will only come during regular business hours.
4) I have to tend the dog while they're here.
5) They don't come when they say they will, so every single time they come, I have to waste a whole day running around picking up, and hanging around the house waiting for them.
6) Often they won't commit to coming at a particular time until the day before they arrive, so you have to block out your entire day to accommodate their schedule.

This time, I was assured by my friend that #6 would not be a problem and that they would come when I wanted. Score! So I called to set up the appointment after receiving an estimate.

I told them Tuesday would work. And then, I ASKED them what time they'd be coming.

"Oh, we don't set up the schedule until the day before, so we'll let you know when on Monday."

Hi. Unacceptable.

You'll "Let me know?????" In other words, you will tell me what time is convenient for you when it is convenient for you to do so, and I will have forgo planning anything else that day until you get around to making your schedule. And then I will have to wait for you to show up so that you can do your thing. If you show up on time, which I will be very very surprised at.

And now I'm left in this position where I am confined to my house all day Tuesday. Fantastic.

We will therefore not be hiring this company again either. I am willing to make this accommodation just this once because I promised Luca I would get the house cleaned as a Christmas present. However, this is NEVER happening again. Ever.

Who has the time to just sit at home all day waiting for housecleaners to show up? Because my schedule's about as flexible as they come, and *I* don't have the time. No wonder the cleaners think we're all "kept" women who don't work, and treat us accordingly. Because that's the only kind of person who's actually able to do this.

Vaccines

About a week ago, I shared an article on facebook from the New York Times about herd immunity and why you should vaccinate your children. It was written by a woman with CLL, and I felt it was pretty non-controversial, as far as this sort of thing goes. And I got a number of "likes" and a couple of comments from some people that led me to believe that they didn't agree.... but whatever.

And then yesterday, some crazy girl that I knew from undergrad posted on my wall challenging me about the veracity herd immunity (she called it a myth). She said that because some vaccines don't last for an entire lifetime, herd immunity didn't exist.

It saddened me. She has a PhD in biology (NOT immunology or microbiology, it's worth pointing out), and she's been on the SAHM track for about 5 years now. It turns out she recently started this Natural Medicine company too. Well, more power to her. But frankly I wasn't interested in getting into a big debate on facebook with someone I barely know anymore about an issue that I consider mostly settled. Though I could in theory do this, I don't have time to wade through the literature for the purposes of finding the 1,000 most compelling articles supporting my case, especially when she has the memoir of Andrew Wakefield enshrined on her mantle.

So not worth getting into it with someone like that.

It's like talking about abortion with someone who's views are different from yours. I'm not going to change my views because of anything you say, and you're not going to change yours because of anything I say. The entire conversation is a waste of time and serves no purpose other than to make everybody mad, and fuel pointless righteous indignation.

So anyway, I told her I didn't want to debate her. That I had neither the time or interest to engage in a public debate. But guess what -- she wouldn't let it go and kept posting incendiary messages on my wall. So I called her a quack and unfriended her.

Jesus. THEN she started sending me messages saying that she obviously knew the vaccination literature better than I do, and that she was obviously right (and had SCIENCE to back her up), as evidenced by my refusal to engage her in a facebook wall debate.

I asked her how she could possibly make the claim that I knew nothing about the vaccine literature* since she has no idea what I do for a living, and set about figuring our how to block messages from non-friends. I finally figured it out, but not before she sent me FIVE more messages calling me a small person, immature, uneducated, etc..

What a freaking waste of time.

Dude. What is with some people? I suppose on the positive side, I know not to let my infant anywhere near her unvaccinated kids. Too bad not everyone tatoos their beliefs on their forehead like this. It would make protecting my family a whole lot easier.

And I did figure out how to block messages from non-friends, unfriend someone, AND block someone from friending me in the future. Thanks Mark Zuckerberg for constantly moving these functions around so I have to relearn them every time I want to change my security settings.





*Which is patently hysterical. I am an epidemiologist and have almost completed med school, and my husband is a virologist who is heavily involved with vaccines.

Writing Things Down

At my last Ob appointment, after I told the NP I saw that day about my oral exam and my manuscript submission, and all the other things I wanted to get done before the arrival of the offspring, she said to me, "You really ought to write some of this stuff down so you can show it to your kid when he grows up."

Haha, indeed.

If only she knew.

:-)

To do...

Manuscript revision: Completed (for now) and circulated to co-authors.

Next: Lunch.

And after that perhaps I'll start creating my datasets for Aim 2 of my dissertation? It's so cool to think I'm finally starting a new project. Of course there still is that other paper hanging over my head.... which really needs to be completed at some point in time. But since the models for Aim 2 are likely to take a month or so to run, I was hoping to get that all set up before I went on maternity leave.....

Over the weekend we'll be doing a lot of house related tasks:
- Fire up the chest freezer in the basement
- Do big grocery shop for staples to eat right after the kiddo is born
- Pick up house in preparation for house cleaners next Tuesday
- Wash the dog
- Set up the co-sleeper
- Finish packing hospital bag (it's almost done, I just need to put everything into a bigger bag since the glorious bathrobe my friend M gave me does not fit in the current bag)

I'm sure there's other stuff to do too that I'm blanking on at the moment.

Baby is really pressing down on my cervix today = ouch. Hold tight, honey! Mommy really needs to submit this manuscript before you arrive....

Summary to Ob Visit

No lecture about my weight -- Woo!

Had an ultrasound to confirm that the baby's head is down. It is. (No wonder it feels as though I am carrying a bowling ball around in my pelvis.)

She remembered to ask about my oral candidacy exam! I was really impressed.

(My statistician told me this morning that in her opinion I'd passed, and that the exam wasn't supposed to be about having my Aims perfectly developed and planned. It was supposed to be about my ability to think on my feet and answer their questions, which she felt I'd done. So, though it's still not official -- yay!)

I told her that NOW as long as I don't give birth before I can do the final submission of my accepted manuscript (which I should be able to complete in the next day or two), I should be ok. Maybe I could even get started on Aim 2..... but that would require remaining pregnant for a couple more weeks.

She laughed and said that wasn't what people usually said.

Anyway, they were all booked up next week except for Monday, so I guess I'm going in after 4 days. Oh well. Maybe I'll even give birth before then.

Poll

This morning I weighed 151.7.

Last Friday I weighed 149.

I'm pretty puffy this morning. For me.

Anyone want to vote on whether I'm going to be lectured about my obesity today at my Ob appointment?

As a side note, I got permission to take Tylenol Cold & Flu last week at my appointment to help me sleep (Tylenol Cold was recommended). I didn't ask for permission (Ha. I know better than to do that.) it was volunteered.

Except.... Tylenol cold uses phenylephrine, which doesn't work. Oh.... perhaps it makes me a little less likely to get dizzy when standing for long periods of time. Because it's a freaking PRESSOR. But it does literally nothing to relieve nasal congestion.

Don't you think if I were going to expose my baby to a medicine that is potentially harmful, I'd only want to do it if the medicine were actually effective?

Anyway, Luca's not going to be there, so I think the odds of getting a lecture are range from 60-80%.

Anyone want to vote?

Oral Candidacy Exam

So I had this oral candidacy exam yesterday? And.... I have no idea how it went. It didn't feel like a slam dunk, but I'm not sure it was supposed to.

And then there was the issue with my Aim 3.

As you may recall, sometime during the first week of December, my entire Aim 2 got scrapped. Not because it's not a good / necessary project to advance my field, but because there is no freaking way the project is going to get completed over the next year.

So, my aim 3 became my aim 2, and I had to think of a new aim 3.

This posed some problems. My PI and I had some ideas about what we should do for the new aim 3, but none were fleshed out fully, and the idea he liked the best has some pretty major flaws, though on the surface the idea seems like it could be really really cool. I proposed another idea at a meeting we had on 12/14, but he wasn't familiar with the method, and while I still think it could be a really cool paper, it's one of those things where we're going to have to chew on it for a while before we decide we want to go with it.

Which left me with the problem of how the heck to write up aim 3 in my proposal: 1) As the severely flawed but superficially cool sounding study, or 2) as the new but unfamiliar study.

Bear in mind this was due on 12/19, so it's not as though I had oodles of time to work on it. Also, I didn't want to make my PI angry by cutting his cool-but-flawed project completely... and I also didn't want to present something completely novel that he'd never seen before. So I ended up writing a compromise.... which had problems, but it is what it is.

So anyway, I feel like the exam was going ok until we got to Aim 3. At that point we'd almost run out of time, and my committee agreed to stay for an extra 30 minutes so we could go over it, which I was really grateful for.

I got some EXCELLENT feedback on it. Of course, they completely trashed the flawed study, which was... awkward. One member proposed an alternative study, which might be really cool, but I have to think about it some more before I'll be willing to commit to it. They liked the unfamiliar study, but again I think everyone needs more time to mull that one over (including me).

So the upshot is, I have no idea whether or not I passed. In retrospect, it was probably too early to have this exam, but on the other hand there was no way for me to know that until about two weeks ago, at which point it seemed too late to postpone it. And I got some great feedback on my Aims. I kind of wish I had more opportunities to meet with my other committee members because I always learn so much when I do.

So, if I were them, I'd make me re-write my Aim 3. Who knows if that's what they'll decide though. Hopefully they'll let me know soon.

At the end of the meeting, I got an email saying that my paper (project #1 of my dissertation) had been conditionally accepted at Very-Important-Journal pending minor revisions. Which is AWESOME. Now I'm working like a mad-woman trying to get the revision out before I give birth and my life gets even more crazy.

Jury Duty

As if life couldn't get any more fun and exciting, I just received a summons for Jury Duty on 1/31/2012.

As you may recall, I am scheduled to give birth on 1/21/2012 (or 1/24/2012), and could very well be in the actual process of giving birth on 1/31/2012 -- who knows!!

I did note that there is a place where I have to mark whether I can mentally or physically perform the functions of a juror, and I believe that the answer to that question is no. Not sure how the state feels about that though.

Has anyone else been in this situation before? Could I get a letter from my Ob stating that I am due to give birth then and can't serve?

Oh also, what about pumping while I am serving. Is that going to be a problem if I end up serving later on in the year? This isn't a contingency I'd ever really given much thought to before...

Any thoughts would be most appreciated.

Why won't people listen?

Yesterday, Luca and I were out walking the Boo, when we passed by our friends' house. We really like them, and they just had a baby a few months ago, so talking with them is also additionally highly instructive. Usually.

Anyway, they invited us in to say hi.

We hesitated big time.

In addition to a baby, they also have a dog. And while he is a very placid calm dog, the Boo is not. Particularly when inside a house or other confined space with another dog. And we really didn't want the Boo to attack their dog. Especially when they were trying to tend their infant. It's never been a problem in the past, but we recognize that it could happen, and we'd really like to avoid that situation.

They insisted it wouldn't be a problem though. Repeatedly. As we insisted that it wasn't a good idea. Repeatedly.

Why couldn't they have listened to us????

And so the Boo cried and whimpered, and repeatedly tried to lunge at the other dog who just stood there 5 feet away. And she made the horrible gagging/choking noise that comes with wearing the gentle leader that sounds like a growl to pretty much everyone who doesn't know her.

And of course then we had to endure the, "You should really take her to obedience class,"* comments as well as the, "You must be really worried about what she's going to be like with the baby."**

Gah! Drives me crazy, I'm telling you.

You know what, people? Next time maybe you should listen to us when we tell you our dog is not good with other dogs. I'm tired of having to fall all over myself in an effort not to be rude in situations like these, and then feeling powerless as the Boo gets needlessly worked up and agitated. (And she HAS improved -- she calmed down *immediately* after we left. Before she would have continued acting crazy for at least 15 minutes.)

I honestly don't know what to say when this happens. I've tried explaining that a) dog aggression is not the same thing as people aggression, and b) that she's not actually growling (she's snorting and crying), but I can tell that they just think I'm making excuses for her behavior, and that they are judging me. Which makes me want to tell them to go fuck themselves (of course I don't). Maybe I just need to be more assertive and just walk away when presented with these situations... but then I'm afraid they'll think I'm rude then also.

Would it be so horrible for them to have said, "Oh, it's not a good time? Let's get together later then!"

No. No it would not have been. And this whole situation could have been avoided.

Why can't people just listen???

At least I've gotten better at saying no firmly to strangers (who want me to let their toddlers pet the Boo) -- rudely even, if necessary (and it is often necessary). It's a lot harder when it's someone you like though.



*Has YOUR dog attended a year's worth of class? I didn't think so.
**If you must know, we are somewhat worried about this. However since there isn't much we can do about it at this point, hand wringing incessantly isn't something we're interested in starting. Plus, I always find it ironic that the people who ask me these things have DOGS THAT HAVE ACTUALLY BITTEN THEM IN THE PAST, but yet seem to get off on making patronizing comments about my dog's behavior and how awful it is, as well as my apparently shitty skills as a dog owner.

New Year's Resolution: Clean the House

With the help of Miss Boo! Maybe.



As adorable and highly trainable Miss Boo is, I think we may have to hire a cleaning person instead. Sorry sweetie! Though as Luca points out, she is already excellent at cleaning the kitchen floor, and bringing all of her toys to her bed.

Just 5 days (by LMP) or 8 days (by ultrasound) until I'm 38 weeks! Luca's parents said to him last night on skype that they didn't think I had three more weeks to go. Haha.

We'll see. I'm still in denial about this whole "having a baby" in a couple of days-weeks thing.

2011 in review

Ana posted a year in review over at her blog and I liked the idea so I decided to do the same here.

January -- Return from Christmas at my parents' house in CT. Find out I'm pregnant. Enjoy extra attention and affection showered on me from Luca. Get period a week later, and while I'm disappointed, see how devastated he is, which makes me feel worse. Start my final semester of full time class for my PhD, including a class on Outcomes Research which I love. Decide I want to focus my career on policy research. Put thesis project aside to start side project that my PI (temporarily) finds interesting.

February -- Get pregnant again! Finish side project, which PI no longer finds interesting, wondering out loud why I haven't made more progress on my thesis project. Grrr..... Luca is happy about the pregnancy news, but not as optimistic this time.

March -- Lose 2nd pregnancy. Really start hating class. Take Control Unleashed with the Boo, whose behavior improves immeasurably, at least in the class setting. Work on class, which takes up way more time than it should.

April -- Finish semester. Finally. Manage not to fail Operations research class and actually get an A, which in retrospect, it's an MBA class, why in heck was I worried, again?? Get pregnant again at the very end of the month, only this time I don't realize it.

May -- 34th birthday. Go to Outer Banks NC for "vacation" where I finish off my final projects for the semester and prepare a poster for the ATS conference I'm going to. Take pregnancy test which I swear is negative, but Luca thinks may be positive. I overrule him and have a margarita and raw oysters that night, and get my "period" the next day. I feel vindicated. I go to ATS the next week in Denver which goes swimmingly, but I feel like I've been knocked on my ass and retreat back to the hotel for a nap every day at 3PM. I attribute this exhaustion to jet lag and a cold I am getting over.

June -- I have my third positive pregnancy test, and then get my "period" three days later during the Department of Medicine Research Day. I take and finish the last class I hope to ever take for my PhD (crossing my fingers!) and start studying for my qualifying exams. And for real, get officially cracking on the first manuscript of my thesis, now that I've set aside the other "interesting" project that is no longer interesting. Luca and I start doing rock climbing on the weekends because we're bored with our exercise routines and I decide if I can't have a baby, then at least I'll get strong again.

July -- Almost finish manuscript but have to put it on hold to study for my qualifying exams. Study constantly for 4 weeks or so, and relearn a bunch of stuff that I never get tested on but which actually turns out to be quite useful. Go to see reproductive endocrinology because of 3 consecutive pregnancy losses. Wait for period so I can do day 3 labs. Period never arrives, and I conclude that I must be pregnant. It turns out I'm 13.5 weeks. Feel like the stupidest medical student ever. I call Luca to tell him the news. He is ecstatic, but never is as affectionate to me as he was after the first positive pregnancy test, and refuses to tell his parents because it could be bad luck.

August -- Studying for quals, prenatal labs and appointments out the wazoo, take qualifying exams (10 days of my life that I will never get back, and I don't think they even read the grant I had to write when they graded it -- we certainly didn't get any feedback on it if they did....). Go to St. Louis for my swim buddy's wedding, and have my first manicure and pedicure ever. Go to Italy for "vacation" while Luca has job crisis #2 on the year, and is a total basket case for the entire vacation. I hide in the bedroom and read 5 books.

September -- I return from vacation, finish my manuscript for thesis project #1 and submit it! I start TAing a class, which initially annoys me, but it turns out that I really like teaching undergrads. I start preparing my protocols for my oral candidacy exam.

October -- Revise and resubmit received for manuscript, which I am ecstatic about because all of the points are addressable. PI is more pessimistic. Keep working on my orals protocol. Belly really starts to pop at the beginning of the month and I feel fantastic. Things start going well with my PI and the rest of the project team, and at long last I feel I'm getting somewhere.

November -- Committee meeting goes well. Try to finish up analysis for previously abandoned paper, but then have to do revise and resubmit instead, and re-abandon previously abandoned paper. Submit IRB amendments for projects I ultimately will never do. I feel like I was working all the time that month but for the life of me I can't remember on what! Start and finish a bunch of projects on the house.

December -- Scrap third aim in the week before my oral candidacy exam protocol is due. Whip together other aim. Complete revise and resubmit. Submit continuing review documentation for grant with brand new aims and hope nobody at the NHLBI minds. Finish TAing. Catch two colds. Feel really enormous, and amazed at the same time how quickly time has flown since I found out I was pregnant. Think more about what I really want my life to be like and procrastinate by looking at real estate prices in various areas of the country on zillow.

Overall, I'd say the year improved steadily as it went along. Hopefully this trend will continue next year. I can't believe I only have 14 months of PhD-dom left, and then I'll return to med school. It's just crazy!

New Years Eve

This year, Luca and I are planning on extending our 6 year long tradition of cooking a nice dinner (minus the wine this year) and going to bed by 10:30. Do you all have anything fun planned?

I woke up this morning and puked my guts out! It was mostly water. Otherwise I feel like my cold is finally going away. The baby's head is lower in my pelvis this morning and I can feel it when I'm sitting now, as well as when I stand up and walk around. Not comfy!

Luca immediately googled vomiting at 37 weeks and freaked out. "Oh my God you might be about to go into labor!!!" he said.

Yeah, right. At yesterday's appointment, my cervix was thinner, but still closed. In any case, the baby *better* not arrive until after my candidacy exam on Tuesday. I don't want to have to prepare for that all over again.

Which, incidentally, I have no idea what I need to be doing to prepare for this. I wrote my protocol, and of course will not receive any feedback on it before the exam. I literally have no idea what people are going to say or ask me, and frankly most of them have never administered a candidacy exam before, so in fact THEY probably don't really know either. I'm really only afraid of what my statistician will ask me since a) she is a statistician, and b) she has done this before.

I'm kind of anticipating a committee meeting on steroids.... and if this meeting goes as well as my last committee meeting in November went then I should be ok. But then again, most of them have never seem my third aim before. Add to the fact that my PI didn't want me to do it the way that I think it needs to be done based on what a more experienced investigator told me a few weeks back. So of course I had to write it up the way my PI wanted it. I'm anticipating that my other committee members may pounce on it as wrong. Good times.

So to prepare, I'm reviewing my protocol. Again. Going over my slide deck. Again. Reading through the literature (some more). Making sure that I've read all the papers my PI has forwarded to me over the past several months.

Convalescing.

It's been hard to get really motivated or stressed out about this exam. I mean, what would happen if I failed? I suppose I'd have a better idea of what to expect next time.... It's not as though my progress on any of these projects would stop. I'd simply give birth, re-prepare, and then re-present in 4-5 months, with (in theory) more completed work behind me, and more opportunities to receive guidance on what they think I should be doing differently. I have to have another committee meeting in 6 months ANYWAY, so would it really be that much more of a pain? I don't know. Of course I'd like to avoid that scenario....

As for New Year's Resolutions, I'm not so into them, but I'm hoping to strive for the following:

1. Continue trend of eating more salad and vegetables, which I started during pregnancy.
2. Keep up better with the literature in my field.
3. Sleep as much as possible.

Other than that, who knows what the next few months will even bring, so it seems silly to give myself a bunch of resolutions that may end up being completely unreasonable.