Gentle Reflections on 2011.

I just baked my first loaf of bread, and the house smells amazing.  Nina is sleeping, Josh and Elena are playing in her room, my coffee is still hot.  At this moment, life is good and there is time to reflect.

Each year I choose a different one word phrase to add to my routine intention for my yoga practice.  At the start of each practice, after the Anusara invocation, I add "May I cultivate..." and then I run through each one.  Some days/weeks/months/years I need the recitation to remind me that I wanted to work towards that ideal.  Other times the ideal just begins to take shape in my life and/or my practice, which always takes me a little by surprise.  Wise teachers will always say that the physical asana practice is just practice for real life--the physical challenges are a metaphor of sorts for the challenges of our daily lives.  I suppose that is why each word of my choosing tends to have both literal and deeper impacts on my life.

I think I practiced fewer times this year than I have since medical school.  As a result, I can't really remember this year's word.  Patience, maybe?  I certainly have lost my patience *many* times this year, but in my better moments have been able to access an amazing vault of calm that I didn't know existed.  (Note to self--visit there more often!)  A couple of years ago I chose the word "gentleness", if that even is a word.  And really it's this intention that I wanted to write most about today, because I think 2011 has been a turning point in my quest to better emulate this virtue.

Things I have done in 2011 to live a more gentle life:

1. Have a second child.  She has softened my heart even further and makes me coo softly even when I want to scream.

2. Continue to nurse my older child.  My nursing relationship with Elena helps us both recenter ourselves during tantrums, and now that I've mastered the nursing two at once maneuver our post-work/daycare time is more peaceful and recharges us all.

3. Switched to Charlie's Soap.  Given our copious laundry, choosing a detergent that doesn't pump chemicals into the earth makes me feel much more environmentally responsible.  It also works great as a surface cleaner on counters and such.

4. Started to cook vegan meals.  I stopped eating meat January 1, 2010.  I can remember sitting in Corner Bistro, surrounded by the saliva-inducing aroma of grilled beef, having just ordered my Bistro Burger (beef + cheese + bacon = YUM) when Toni ordered a chicken sandwich.  "Why didn't you order a burger!?" asked Jen, echoing my thoughts.  I think I may have even said that I could never do without beef--my burger cravings were not common, but strong and in need of fulfillment when they did hit.

Nixxing beef was no big deal, especially after going out with a Swedish meatball bang on New Year's Eve.  But vegan?  NEVER.  The cheese!  I always cited as my biggest obstacle.  Really, for me, the biggest obstacle might be my two-a-day egg habit.  I just haven't found anything that offers that much satiety, and for a mom nursing two babes, keeping my appetite at bay has been really challenging.

Michael Pollan eats vegetarian until dinner.  I have been trying to eat vegetarian at breakfast, and then transition to vegan for the remainder of the day on most days.  We ate at B-Line the other night, and I ordered my usual Feta Jack Burrito.  With my first bite, I tasted meat and spit it out.  'There's chicken in here!" I told my dining compatriots.  How embarrassed was I to bring my dish up to the better-lit counter to point out the chicken to the staff, only to discover that my "chicken" was tortilla?  The salty feta and smoky beans were so flavorful, I mistook them for meat.  Woah, retrained tastebuds.

I watched Isa's video for making Mexican Hot Chocolate Snickerdoodles and she states that the chocolate, cinnamon, and cayenne flavors meld and stand strong in the absence of butter.  I know most people won't buy that, but the cookies are awesome, and my morning cold-pressed gingerbread coffee smells awesome but tastes blah with cream added.

In any event, I like the idea of minimizing animal products in my diet.  I am still eating rich and delicious foods, but no animals are suffering to make that happen, nor land ruined to raise those animals.

5. Changed out wasteful baby products.  New parents have no clue on so many levels.  We depend on other more seasoned parents to help us make decisions on what do do and buy for our babies.  With Elena, I started out with "earth-friendly" disposable diapers on the advice of an earth-friendly friend.  We both made the switch to cloth eventually, and felt much better about the absence of so much waste.  I had told numerous new moms that I felt okay using disposables since liquid-fed baby poop is so liquidy and another friend had told me that her experience with cloth early on was messy.  Elena was out of diapers and thankfully Nina was big enough to jump right into the same ones, and let me tell you, liquid baby waste is SO much easier and less gross than solid stool.  Oh well.  Live and learn, then pass along the message.

With Nina I also bought cloth wipes.  She still has disposable ones at school, but at home the cloth ones are so easy to use and then just pop in our diaper pail along with the dirty diaper.  Again, kicking myself for the waste with Elena, but glad I am moving on to the creation of less trash.

Another friend had been using the Playtex Drops Ins, which are sort of like a bottle with a female condom--sorry to be graphic, but I don't think anyone can see the inserts repeatedly and not have that thought at least once.  We bought those, as well as lots of Medela storage bags for my milk.  Now that our bottles are falling apart, I've invested in washable Medela bottles, which I can just pump into and screw on a nipple/ring/top apparatus.  Same amount of cleaning than the Playtex, less waste.  Oh well.

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So that's it for now.  Josh just eyeballed my work and said, "Holy long blog!" so I suppose I should stop before you stop reading.

If you don't have any New Year's resolutions, I would urge you to consider how you can be more gentle to yourself, your loved ones, your Earth.  I think I still need to work on being more gentle to people in my daily life, but that's the nice part about keeping these words in a regular recitation--the work is ongoing, and practice makes perfect.

In the end, it's all the same.

Yesterday I was invited to an integrative medicine meeting of minds, otherwise known as "patient conference."  Patient conference has always been a feature of the integrative medicine fellowship; a time to share a consultation case with a panel of providers specializing in various modalities to offer a wider variety of treatments.  I was in the office in the morning, and arrived at the meeting late.  When I walked in the room, I saw a group of people who have been my teachers for the past four years--what an honor to be invited to give *my* input to the current fellow!  I did have to laugh as Rubin was giving his advice regarding the patient's insomnia--he has obviously trained me well as my own treatment plans are directly informed with his advice:
--Sleep hygiene, with a big emphasis on limiting screen time of any kind
--Melatonin if sleep onset is an issue (though I think he starts lower than the 3 mg I advise)
--Retraining the body/mind associate bed with sleep rather than wakefulness (i.e. reserving the bed for only sleep and sex)
--Early morning sun (to help mood and reset circadian rhythms)
--Exercise early in the day
--Some sort of mind/body therapy if there is an anxiety/overactive mind component (is it a surprise that I always feel people out to see if they'd be up for journaling?)

Anyway--getting off track.  Two of the practitioners were from Traditional Chinese Medicine (Tucsonans--click the link to get info--their school has really cheap, but amazing, clinics for the public!) and Ayurveda.  The day before, the residency integrative medicine conference included a western-trained gastroenterologist turned energy healer.  In listening to these three practitioners make their recommendations for abdominal symptoms, I was struck with the similarity of the rationale for each practitioner's recommendations.  I just find it interesting that different traditions of healing arose simultaneously in different places, but yet are so similar.  Kind of like us, as humans.  Please excuse me as I tend to my crying baby--something moms everywhere can relate to!

P.S.   And to follow up on the Bean--Nina is now taking bottles at daycare.  It took a full 5 weeks, but she finally caught on!

The No-Bottle Bean.

Two simultaneous sleeping babes = awesome.  "Would you like another cup of coffee, Mommy?"  "Oh, yes, please, Mommy.  Thank you!"

This past week was Nina's fourth at daycare.  After a couple of days of taking a "full" bottle (my full bottles these days are 3 oz since so much milk has been wasted--Elena would suck 5 oz down 4 times in a full day at daycare) once during the day, we've come to another standstill.  No more smiley faces following the ounces consumed on her daily report.  From what I understand, she flips out the minute she feels that artificial nipple graze her lip.  On Friday it took one of the women an hour to dribble in one single ounce.

I've been a little stressed by this situation, feeling obligated to keep her with me on half days that I am not in the office, or traveling back to daycare in the middle of the day to feed her if time allows.  That being said, she's goes 6-7 hours at night not infrequently, and she certainly has the fat stores to prove her staying power.  As a result, I'm not too bothered by the situation since I know that the perceived problem of Nina not taking a bottle is really just mine and those that are caring for her.  I asked two of them yesterday what the longest learning period was that they had seen for adapting to a bottle.  They both looked at me a bit with pinched smiles and agreed: "Um, she's the longest that I've seen."  Great.

Is one month of non-bottle accepting an absolute predictor of never-bottle accepting?  I'm beginning to think it's a pretty strong one, at the very least.  My over-analytical side has taken over a bit, and I've been doing some google searches this morning.  Google searches are, after all, the best way to get the most accurate information (that was a joke, in case you missed it).  So I read Dr. Sears' suggestions for getting baby to take a bottle, which, in true Dr. Sears fashion is lovely and touchy feely.  But I think they've done all of that at daycare, and it hasn't really paid off.  I did, however, feel deeply justified for not "training" Nina at home since that would mean me giving her a bottle--it was nice that Dr. Sears has deemed this task as not the mom's job.

I looked at some other sites, and was really looking for a blog or personal witness regarding this issue.  I stopped looking after reading some unhelpful piece of garbage that basically said it boils down to a "stand-off" or the baby accepting the bottle.  A little too much like cry-it-out for me, and I just don't think that provision of nourishment should be a battle or unpleasant in any way for the baby.

At the breastfeeding conference that I attended in August (with newborn Nina), Dr. Newman mentioned that the advice to exclusively breastfeed until 6 months before introducing solid foods was great as a public health policy, but neglected the needs of individual babies.  If a baby has the motor skills and the interest to safely eat solids, he argued, given him/her solids!  So that idea has been in my mind for some time, and I've been saying that perhaps this no-bottle issue might push us to start solids sooner.  But then I realized that in doing this, if Nina wasn't ready, we'd be ignoring more of her cues.  His section on feeding babies when mom isn't around really helped me with this realization, and will hopefully guide my stress levels over the next few months.  I love that he opens up the FAQ on this topic by saying in bold type, "This is no tragedy."

Basically, this bottle issue with Nina has been another lesson for me in listening to my intuition, which has always been saying, "She'll be fine.  The bottle is no big deal--she'll either learn, or she won't."  I LOVE reading about parenting and the wealth of information and experiences that are easily accessible on the internet.  I think in being raised Catholic, it has prepared me for handling this overabundance--I pick and choose what recommendations to follow as I see fit.  (Half-kidding, Mom!)  In all seriousness, the picking and choosing is really where that intuition comes into play.  What I've learned is that the easiest decisions to make are the ones that feel the most right.  It's incessant remembering of this lesson that continues to be the challenge. 

Okay, fine. It's not that bad.

I am reveling in the quiet that has enveloped my house tonight, and rejoicing in the tiny buzz that the mostly-full decanter of wine from dinner has given me.

Today we had meeting after meeting after meeting after meeting for work while the residents took their in-training exam.  "We" meaning my fellow residency "core faculty" and me.  We started the meeting with a "check in" (sorry for the overuse of quotes--I truly blame the wine), which was really nice.  It was so lovely to hear the faculty that trained me speak of their position in both their personal and professional lives.  I, of course, broke down after stating, "Well, I'm back.  And it's been hard to keep it together."  I couldn't really eek out more that that for a while, but was happy to witness the old adage of "this too will pass" through the lives of my colleagues.

A section of our meetings today focused on the mentor/mentee relationship.  I've always been attracted to the idea of having a mentor, and envied those that casually throw in the, "Well, my mentor so-and-so..."  The article we discussed was about how the onus should be on the mentee for the establishment and upkeep of the mentor/mentee relationship.  So I guess that's why I don't really have an established mentor, but rather a collection of faculty that I depend upon for professional advice and advancement prodding.  Though I lack the confidence to officially propose to a mentor, I was struck today at how so many in the room have mentored me over the past few years, and how grateful I am to their service and support.  Most of all, however, I am grateful for the gift of their friendship, and the freedom to share my tears over my current struggles knowing that when I am ready to regain the professional momentum that I had pre-second-baby, that support will still be there.

As an adolescent trying to find herself, I participated in countless retreats, turning inward again and again. Over the years, I have found great solace in my yoga practice as the same sort of introspection begins (and often ends) each asana practice.  But I am truly indebted to my professional life and the community that I have found through this residency program--including my integrative medicine fellows--for the obligatory retreats and self-evaluation that have fostered my growth not only as a physician but as a person and as a teacher.

I don't know why I'm so bad at asking for help.  When pondering the inherent nature of our daughters, I suggested that perhaps Nina would be like her Daddy--indefatigably happy.  Josh replied that he's not always happy, but rather doesn't "put my stress on other people."  That's really not my intent, and maybe this perception of my tendencies speaks more to the conversation I had with Julie a few weeks ago about the trend for women to overanalyze and underdiscuss until all sorts of shit hits the fan.  I think this scenario is where the verb "blurt" was born.

Anyway, I don't know what I'm trying to say, other than thanks for letting me vent, thanks to coming to my aide (when for instance my security door wouldn't open) and thanks to those who have let me know that I am not alone.  I appreciate all of your support because it helps me to move one foot in front of the other, and to see the light at the end of the tunnel.

Busted Up Mommy.

It's been a long three weeks since my last post.  Josh is working in the ICU at UMC (or UA Healthcare University Campus as it is now wordily known), which SUCKS.  It's always sucked, but now there are improvements, like the creation of a second ICU team and addition of a night float, which means he's working 13 hours days only every other day, and 10-11ish hour days the rest of the time.  This weekend was his first weekend off after working 12 days in a row of this nonsense in-the-hospital-by-6 am rotation.  That means Mommy has been in charge of morning time readiness for the past two weeks.  And also in charge of evening pickups.  And mid-day Nina drop off/pick ups as she's still not taking a bottle.  And breakfast/dinner preparation.  And most of the cleanup and laundry and food shopping.  And, not to mention, all the duties that go along with her job outside of the house.

When in residency, I think young physicians believe there is nothing worse than being a doctor in a training program.  Wrong.  Being a practicing physician married to a physician in a training program with two young children is WAY worse.  The only thing even worse would be to change the "married" to "separated" or "widowed".  So I guess there's a silver lining?

I feel totally and completely broken.  When I was home on maternity leave, I felt like I was able to be more nurturing to myself and my family.  Now I feel like I am barely holding on and have only the scanty support of a husband whose job doesn't leave nearly enough time to help out at home.  I was hoping to regain some of my sanity this weekend, booking a two hour yoga workshop for Saturday night.  Of course, minutes before I was walking out the door, I found Elena in the bathtub covered in conditioner that I had left in the shower after bathing her on a night Josh was late in getting home from work, Nina looking on from her car seat on the bathroom floor.  I almost lost it (again--at least this wasn't as bad as her squirting OxiClean in her mouth right before school on a morning I had to be at work), but instead hosed her down and left her dripping body for Josh to deal with.

The yoga workshop was good, and it was so nice to care for my body as opposed to having two beings incessantly hanging from it while alternatingly crying.  But it wasn't enough to mend two weeks of constantly tending to the demands of home and work.  Elena was up before 5 this morning, coming into our bed, nursing, waking Nina up, so I was turning between both girls all morning.  I snapped at my snot-covered toddler before 7 am--I just can't handle the whining and neediness that comes with a bad night's sleep.

Friday night I picked the girls up close to 6 pm after dropping them off at 7:30 in the morning.  Our plan was to swing home to pick up Josh, and then get beer and pizza.  Elena had to pee in the car, so I ran her in the house when we got home to quickly use the bathroom.  After that long of a day, she falls apart shortly after coming home... which she did Friday night.  She refused to use the toilet, but kept saying she had to pee, crying and getting increasingly snot-nosed the whole time.  Since I had been up since 4 am and at work in front of a computer screen ALL day (with the exception of staffing a circumcision over my lunch break), I lost it.  I got a glimpse of myself, my face contorted with rage, in the mirror.  It was sort of comical, but mostly just sad.  Sad that I had this reaction towards my daughter after being with her for just 20 minutes, when she was melting down after being separated from her family all day.

I know this isn't forever, that Josh's hours will get better at some point, and that our girls will eventually become more independent.  I feel sad that I am wishing away these days of our daughters' tiny innocence.  It was nice to have Sunday brunch with Josh while the girls were with his parents, but those two and a half hours alone weren't enough to keep me from feeling resentful that the girls' sheets for school were still wet in the washer, that he had made up only two bottles for Nina and didn't place the requisite labels on them, or that he had started but not completed Elena's lunch prep.  I know it's not fair--he is helping, but I still feel unevenly burdened.

I've learned that while I might be complex in some ways, what keeps me healthy and sane is rather simple: yoga, cooking, eating, sleeping, and reading.  What's depressing is that now that I have a morning to myself, I don't feel like doing any of it.  I've been trying to keep myself from looking so miserable, making use of my newly tailored pants and new tops, putting my makeup on quickly in the car while in the office parking lot.  But I've become perhaps a bit too honest when people ask me how I'm doing.  An intern innocently asked me last Friday, "How are you?" in a rhetorical way.  I looked at him, my face pale and pasty without makeup, eyebrows overdue for a wax, and said sadly, "It's been a rough week for our family."  Poor guy--he lowered his head and muttered, "Oh.  I'm sorry."  I mean, what do you really say to that?  He's an intern for crying out loud--his life sucks, too (just not as bad as mine... maybe).

Anyway, so that is me and my sorry-ass life.  Two more weeks of this crappy rotation that Josh is on, 12 more straight days of him leaving the house at 5:45, and not getting home until late most days.  The only difference between his last 12 days and the upcoming ones is that I started off in a better place.  Lord, help us all.

Got Grains?

I have a pet peeve.

*steps onto soapbox*

My pet peeve is the loose interpretation of the phrase "whole grains."  We've all heard how healthy whole grains are, and in an effort to appeal to consumers' desire to maximize health while minimizing effort, manufacturers have been adding bubbles and stars on boxes touting, "Made from whole grains!" and "XX grams of whole grains per serving!"

If you have fallen for this marketing ploy to pass off processed food as "whole", you are not alone.  But be fooled no longer!  Choose real whole grains, because they are delicious and nutritious (and use way less packaging).

Let's start with what is NOT a whole grain.  Bread, crackers, or anything else that includes grains that have been ground up is not a whole grain, even if it has bits of millet or seeds or nuts poking out at you to give the illusion of hearty.  I don't mean that a nice hearty bread doesn't have its place in a healthy diet, I just mean it's not a whole grain.  Anything puffed is not a whole grain, including cereals like Kashi which have a ton of dietary fiber (I think a lot of it comes from inulin, and just a little from its original yet now processed whole grains).  Minute Rice, Quaker Oatmeal packs, or any other grain-type product that cooks in a few minutes has been highly processed to allow for quick cooking time... and hence quick digestion time and quick blood sugar rise and insulin spike time.

And that is the problem with processed grains--their surface area is increased exponentially, aiding in their quick absorption, quick rise in blood sugar, and quick spike in insulin to compensate.  Most experts agree that keeping insulin levels steady rather than rising and crashing has a big effect on the body long term.  The concepts that go along with these ideas are glycemic index and glycemic load.  I prefer to use glycemic load, because it's a little more meaningful.  For quick reference, the guide to interpreting GL is as follows:

GL of <10 is low
GL 10-20 is medium
GL >20 is high

Low glycemic load foods help steady insulin levels, high make them rise quickly and/or to high levels.

These values are all per serving:
GL 1 slice rye/pumpernickel bread = 5
GL 1 slice white bread = 10
GL barley                  = 11
GL wheat berries      = 11
GL Cheerios             = 15
GL puffed rice cakes = 17
GL "porridge oats"   = 17 (steel cut oatmeal)
GL quinoa                = 18
GL brown rice          = 18
GL cornflakes           = 21
GL white rice            = 23
GL millet                  = 22-25
GL instant rice          = 28
GL pancake (no syrup!) = 39

Before justify choosing 3 rice cakes over a bowl of oatmeal for breakfast, stop and think about how satisfying rice cakes are compared to a bowl of steel cut oats.  What the glycemic load doesn't show, however, is what is missing from processed grains--fiber, vitamins, minerals.  Protein, even!  Before shunning millet, check out its nutrition information, including its manganese content.  In general, you cook the grains in a 1:2 ratio of grain to water.

And then make some Mexican Millet, modified from The Veganomicon:

1-2 T olive oil
1/4 tsp cumin
1 tsp salt, +/- more to taste
1 cup millet
1/2 cup canned fire roasted tomatoes with chiles
1 1/2 to 2 cups water, divided
Cilantro and lime to garnish

Add oil to heavy bottom pot on medium heat.
Add cumin, salt and millet to pot and stir, allowing millet to get toasty, about 5 minutes or until aromatic and/or golden.
Add 1 1/2 cups water and tomatoes, bring to boil.
Reduce heat and cover to simmer for 20 minutes, stirring occasionally.
After 20 minutes, check consistency--if too crunchy for you, add 1/4 to 1/2 cup more water.
Either way, turn off heat and let sit for 5-10 minutes.
Fluff millet, then serve alongside your favorite beans +/- sauce and top with cilantro and fresh lime juice if desired (I think they both make the dish!)


I promise whole grains can be fun and exciting.  What are your favorite ways to eat them?  Here are some of my favorites:


Wheat Berries with Pecans
Curried Millet, Shiitake, and Corn Salad Restey

1/2 white quinoa or millet, 1/2 red or black quinoa with fresh chopped veggies and herbs--good for cleaning out the fridge!

Etc.

Here are miscellaneous things that didn't fit with my previous post from today:

I am a total domestic goddess.  Or at least I was towards the end of my maternity leave.  I made my own brown sugar.  Did you even know brown sugar could be made?  Just whisk some molasses in with granulated sugar.  Domino, you are effed!

I have been obsessed with pumkin lately, and highly recommend making muffins and/or syrup for your coffee/espresso.  The pumpkin bread recipe (for muffins, bake for 20 minutes) comes from Isa Chandra's blog.  Isa is a goddess in the vegan cooking/baking world (worlds?  they are so different, yet so much the same), and if Isa says something tastes good, you listen, no matter what you eat or don't eat.  So check out her blog.  I've been OBSESSED with it lately.

And the Charlie's soap is working out fabulously--our Fuzzi Bunz are now residue free, and Nina fits into them, and Elena is potty trained (daytime).  The cloth diapers leaked too much, and I never mastered the technique, so on to the FBs!!  We had size 2 diapers left over--I bought in major bulk with Elena to get free shipping--but Nina sped through them so quickly that I ended up bringing 3 cases (one pack shy of 3 cases) to the diaper bank yesterday.

Total switcheroo.

I went to visit one of my patients today.  She's in inpatient hospice, which sucks, since obviously it means she'll die soon.  I'm going to call her "J".  I don't think she'll mind.  J is a New Yorker, born and raised in Brooklyn, with an accent to show for it.  The first time she opened her mouth, I felt like I was home.  I get all nostalgic when I see east coast transplants in the clinic, and then get a little self conscious about my neutral accent which features ending "g"s and "r"s.  (I can't really master the whole "or" sound in words like orange and Florida... I just don't know if I'm doing it right.)

Anyway, J has always been one of what I consider to be my VIPs.  My VIPs are patients with whom I have great continuity because we both love seeing one another.  She is the type of elderly woman I hope I become in terms of attitude--she's grounded (realizes the futility in being "full code"), loves her family (talks about her grandson all the time), and is totally engaged in the outside world.  Nina and I went to see her today, and I think we tuckered her out.  Crazy how just having a 15 minute conversation can do that--the body is both resilient and frail.

I asked J if she believed in heaven, and when she answered yes, I asked if she was excited to see her husband again, who died 27 years ago.  "Yes," she answered, "And my mother."  I got all choked up as I looked down at little Nina Bean, all snuggled up onto my chest, so secure in the blanket of her mommy's love.

I hope there is a heaven, and that J is greeted by her mother and husband.  If she doesn't make it there by Sunday, I'll go visit again.

Lunch is the New Dinner.

I started this entry last week, and it was titled, "My last day of summer vacation."  The theme is the same, thankfully.  What I had written is as follows (edited only a teensy bit):

I've really enjoyed my time off, and wish I had more of it.  I've loved being home with Nina, prepping healthy dinners before picking Elena up, and even trying my hand at baking.  Actually, I had thought to title this blog differently and discuss my emergence as the newest Domestic Goddess.  Since so much of my domestic rein has been associated with a specific food blog, that theme will have to revisited in the near future.

This postpartum time around, however, my enjoyment in being away not only stems from connecting with my baby, but also in connecting with other women, many of whom are moms as well.  The cliques of high school don't end there, but really continue through life.  By senior year of high school, deeper divides start to form: going to college vs. not going to college.  Those who attend college often see the same cliques forming as in high school, but following graduation the differences deepen with the still in school vs. working groups.  A few years down the road, friendships often fork at the married vs. single juncture.  A few years after that is the kids vs. no kids--this one is huge and deserves a book.  Divorce, widowhood, remarriage, retirement, financial hardships, and so on are all major life changes that place us in different groups.

(Okay, that is as far as I got, and I think it was a bit of a tangent, but I thought it was interesting to consider and have left it as is, but will not explore that theme further.)

Back to connecting with people.  I lived on a dead end street growing up, with lots of families with kids around the same ages.  It was idyllic in many ways, really.  Riding bikes, playing "teenagers" and "aquarium" in our backyard, playing manhunt or tag, and so on and so on.  I loved it.  And I loved being the only girl (my sister and Melanie were the other girls, both five years younger than me and not so much involved in some of the Ferncrest goings on until later).  But come late elementary/middle school, I became really sad.  Crossing Smith Street for anything other than cheap candy and waiting for the bus were forbidded for my early bike-riding years, which meant alienation from all the kids who lived along Fruit Hill.  Maybe I'm dramatizing the situation a bit, but there were girl pairs/trios who grew up together all over: Lisa and Carly, Corinne and Amy, Amy and Lauren, Becky and Val, and so on.  I didn't have a girl pair, and frankly, it sucked.  I mean, being part of the Sensational Six was great, but I missed out on the day everyone got their matching bracelets and went to the movies.  *sigh*

Anyway, moving on, the Sensational Six (I know, just let it go, but bear with me) was really my last group of girlfriends, and that was elementary school.  I've been lucky enough to have some especially fabulous female friendships in my life, but they total three.  Four if you count my sister, which I don't, because I just take that one for granted (sort of--I'm acknowledging how much I appreciate her friendship though in actuality she has no choice but to be my bestie).  I've also been horrible at keeping in touch with people over the years, which doesn't help matters.

After five years in Tucson, I finally feel like I have a little group of girlfriends, and it's lovely.  I'm so thankful that those who have moved have returned, and those that considered leaving have stayed.  I am grateful for having an amazing job in which I feel supported personally and professionally, and one that allows me time to cultivate these relatively new friendships.  And I'm also happy that some of my friends have kids around the same ages as mine--it's been so helpful to me to vent, compare notes, share stories, etc.

As I've been sucked into mom-dom, our dinners out have become scant, and I can't remember the last time we met people out for cocktails sans kids.  Dinner and drinks were a big part of our pre-kids social life (second place = brunch and drinks, many times at our house), but now most of my socializing happens at lunch while Josh is at work (sucker).  Yes, lunch is the new dinner in my world.  So ladies, let's do lunch.

On Loss

This weekend I went to a gathering to honor the life of the husband of a coworker.  Donna is beautiful, from the inside out, and it was great to see pictures of her and her husband over the years at their home.  They built their house, and have the pictures to prove it.  Its unique architecture and location on the outskirts of town were balanced with a distinct grounding energy and decor on the inside, and I inwardly giggled as she gave me the tour of "where it all began" (a single small room in the center of the ground floor which years ago housed their family bed).

Our workplace seems to have been hit with tragedies this year--we lost a coworker early in the year who was in her 40s, and another coworker's husband also passed suddenly a couple of months ago.  It was interesting, albeit heartbreaking, to see the difference between my two coworkers' grief on Sunday.  "So now you know where I am.  Now you know the way," I overheard Donna say with a comforting smile to her fellow widow who was struggling to keep the tears from falling.  How odd that Donna was the one doing the comforting on the day of her own husband's memorial service, but I suppose fitting given her nurturing nature and the peace that she and her husband had made with his long illness.

As I was leaving her home, Donna reflected on Craig's death, which comes as her youngest child of four is preparing to move out of the house they constructed together.  "It's a shame that now at this point in our lives our time was cut short," she said.  She was wistful, deeply saddened, but accepting of the situation in a way.  Just over a week ago I watched my brother and his new wife vow to honor each other in sickness and in health.  My aunt, Neil's godmother, was also in attendance, but must have been missing her own partner who was thankfully successfully weathering a long 3-weeks that included a significant amount of time intubated in the ICU.  My cousin's husband was also absent from the wedding as his family rallied to support his mother at the end of her battle with cancer.

When thinking of all the sickness and eventual death that affects us all, I can't help but think that in vowing to stick by your partner till the bitter end, we have no idea what we're getting into.  I had no idea what it would be like to have two children with a man who is in his sixth year of training (one and maybe two more to go!), but I'm learning that it's hard.  Hopefully he will choose a path and a job that allows for flexibility enough to enjoy this healthy time in our lives.  Life is too short to spend working or being too busy to really be present with the ones you love.

So hug everyone a bit tighter tonight, and tell them you love them.  Its not always easy to appreciate what we have today, but it certainly makes life sweeter in the end.

Nina and the Butterfly.

I am in RI, alone with the girls, until Josh comes to join me tomorrow.  Night #1 was hellacious trying to get both girls down to sleep, but last night was total sweetness.  As I lay sandwiched between Elena and Nina, a deep gratitude washed over me.  Feeling Elena's deep and even breath against my back with Nina's quick and staggered baby breaths in front of me was utterly peaceful.  And then I had to ruin it by getting out of bed to wash off my Auntie El face and brush my teeth.

Last weekend our family marked Nina's entry to the world with a welcoming ceremony.  Another little being was honored, as well, and I like to think of them as being forever linked.  An old friend gave birth to a beautiful baby girl back in January of this year, a delivery whose complications left baby Sofia with irreparable brain damage.  On Valentine's Day, Sofia's parents finally took Sofia home to the room they had so lovingly prepared for her, and said goodbye to their long-awaited daughter.

I have thought of Sofia, Lori, and Mike daily since learning of Sofia's birth, concentrating my heart and mind on that little warrior, sending many prayers and healing thoughts her way.  When choosing Nina's name, I couldn't help but think of Sofia and notice how lovely her name sounded following Nina.  Thankfully, Lori gave me permission use Sofia's name.  All of Lori's friends know that 8i8 is a tiny butterfly, a sign from Sofia to all who are open that her spirit lives on.  I had thought to ask one of my nieces to bring a butterfly-themed piece of jewelry to Nina's ceremony, but that thought had gotten lost.  While my parents were out doing errands, I asked my mom to pick up a candle to light in Sofia's honor at the start of the ceremony.  In fact, I didn't really tell her what I intended to use the candle for, and certainly hadn't shared the butterfly significance.  My parents got back to our house after their errands, and I wandered out to find a white candle adorned with a simple brown butterfly.

Nina's welcoming, like Elena's, was pretty free-flowing and spontaneous.  I have recently been sharing a little pearl from a colleague with anyone who will listen--when I expressed sadness over not putting more thought into Elena's welcoming ceremony, she replied, "Well that just means it'll be spontaneous, which means it has to come from the heart."  What a great sentiment and comfort to two parents who are always flying by the seat of their pants.

I scurried to find some nugget of a wish for Nina, and came up with Izumi Shikibu's Watching the Moon.  I had heard a piece on NPR regarding the personality of second children, and how often when there are older children in the family, the younger ones either subconsciously or with awareness make their own place in the family by being "different" from the other child(ren).  My sister, in her words of wisdom, told Nina that being the little sister allows you to learn from the older one's mistakes in doing things the hard way (and also in how to "get away with things"!).  So my wish for Nina is that learn from Elena, but also have the confidence and insight to know her true self with the clarity of Shikibu's poem:

Watching the moon
at midnight,
solitary, mid-sky,
I knew myself completely,
no part left out.

Lying in bed last night between my daughters, I knew myself completely as a mother.  Again I thought of Lori.  I am pretty sure she will birth another child and I imagined her snuggling that baby, the rapid, uneven breaths of an infant.  As I felt Elena's warm little body against mine, I thought of how Lori might sense an emptiness at her back.  Just as quickly, I realized that supposition was completely incorrect.  Surely there will be a fullness at her back, warm and glowing, with the life that was and the spirit that lives on.

Woman of the Cloth.

Cloth diapers, that is.

If you are new to cloth diapering, or if you have grown children and you cloth diapered, please be aware that cloth diapers have evolved at light speed over recent years.  My go-to cloth diapering website is Green Mountain Diapers which is comprehensive in regards to discussing different types of diapers and how to care for them, as well as selling the diapers and accessories for proper care.  If you are interested, go to the site and bookmark it for safekeeping.  I found them initially when searching for a DIY explanation for a diaper sprayer after being too cheap to buy the ones sold by the cloth diaper companies.  (I probably spent just as much, maybe a little less, but oh, the *satisfaction* of a DIY sprayer!)

When pregnant with Elena, I thought cloth diapers were all about a triangular piece of cloth with those big diaper pins.  I thought of diaper services--any type of service implies speaking to someone on the phone or in person and then paying for it, and that didn't appeal to my shy nor my frugal side (Josh still teases me about my reluctance to order a pizza years ago).  A friend of mine from college, however, told me about gDiapers, which have flushable inserts.  I watched the video, which of course makes using gDiapers look as easy as wiping your own bum, and thought, "I could do this..."  I asked a colleague from the integrative medicine fellowship about gDiapers.  She was cloth diapering, and replied, "I just feel like if you're going to cloth diaper, you should go all the way."  She didn't like the flushing, I guess.  I can't remember if I asked her which diapers she used, or how the conversation got started... I think I posted a random Facebook question about cloth diapering and went from there.

One friend offered to send me her Bumkins all-in-ones, which I gladly accepted.  Someone had mentioned BumGenius, and I thought the name was clever--besides, who wouldn't prefer baby products bearing the word "genius"?  I bought one to try, and liked it, but asked the Facebook world for more guidance.  Another friend (Melissa) professed her undying love for FuzziBunz, which I'll admit I put on the back burner temporarily because I am that fastidious when it comes to spelling and grammar (though I know my grammar isn't always perfect.... as Josh reminds me every chance he gets!).  I read a bunch of reviews on either Babies R Us or Amazon, and decided to trust my friend's devotion to FuzziBunz because in the meantime I wasn't super impressed with the all-in-ones, and I could see where reviewers were coming from with the velcro on the BumGenius having the potential to deteriorate.

I also now love FuzziBunz.  These things are so easy.  They a super branch off point in the cloth diapering evolutionary tree:  The Pocket Diaper.  But I messed up.  I should have fully followed Melissa's advice, but I didn't.  Melissa advised washing the diapers only in either Charlie's Soap or Allens Soap.  To my credit, I did go downtown to The Co-op, but couldn't find either of the aforementioned soaps.  My "mommy-brain" must have been mom-i-fied in full effect, because it didn't occur to me to look online to purchase either.  Maybe I was too impatient.  Or maybe I was too offset by price because Charlie's is sold in bulk, and I couldn't wrap my brain around the fact that I would have saved a bunch by buying it in the first place.  Instead, I did the best I thought I could in the moment and purchased some biodegradable eco-friendly stuff.  I didn't really understand the importance of residues left behind by other detergents, but after our inserts got funkdified, I am well aware of the residues and the stank-havoc they wreak.

So I am awaiting my delivery of Charlie's.  I hope good old Charlie can solve all my problems, though I've been losing sleep over the fact that it doesn't work that well in hard water.  Apparently we live in a zone that has "moderately hard water".  But, hey.  Charlie has a product for that!  I'll keep you all posted as to how well it works for us--I'm waiting to see if we can get away without the booster.

Well, I got my cloth diapering world rocked by Tiffany and Michele.  We went to FuzziBunz when Elena was around 7 months--after solids were introduced and the poops weren't runny anymore.  (Yet another friend had helped me to justify disposables by saying that breastfed baby poop made cloth diapering messy.)  Tiffany and Michele cloth diapered from the get-go, using refolds.  Tiffany got me started with some Thirsties covers (and OMG--I just realized they now have an owl print cover!!!  I *need* that!) and Snappis, but I stalled on getting the cloth inserts...  Honestly, aren't you a little overwhelmed at the above information?  The thought of learning a new system with a newborn and toddler who is still in diapers was just a little prohibitive.  But I ordered the cloth prefolds, and then went buck wild and bought a lot of other stuff that the woman who runs the Green Mountain Diapers website recommended.

Let me just say, I got my cloth-diapering butt kicked.  I am a complete novice when it comes to prefolds.  I think Josh has done it twice--once with me explaining/showing him how to use the prefold/Snappi combination, and then a second time only because he couldn't find the new box of disposable diapers that was hiding in the closet.  So here I am, once again debating whether or not I've pushed things too far trying spare the landfills.  Please, cloth diapering moms, tell me prefolds get easier.  And did I get the right size?  They seem a little long for her, but not wide enough.  Am I not pushing the limits of the Snappi?  It seems like sometimes they're almost digging into the tops of Nina's thighs.

Just when I thought I had understood both infant feeding AND pooping...

Me, Me, Me!!

The past month has caught up with me.  I was in a not-so-great place this morning, which is not surprising since the past few nights and early mornings I've noticed that it's been harder and harder to open my eyes when waking.  The sensation of exhaustion precluding the opening of the eyes is simply awful since we have little trouble keeping our eyes open all day, necessary blinking excluded.

My parents are here, and fixing up "the playhouse".  Or, rather, my dad is fixing up the playhouse while my mother plays house with the girls.  I called Elena's school yesterday to let them know she wouldn't be in, and checked with my mom as I was dialing.  "No," she said matter-of-factly, "She's not going to go at all this week."  My mom wants to maximize time with the girls, which is understandable given the distance that usually separates us.  And then I realized that Elena would be out of school for two weeks total as we'll be heading east for Neil's wedding soon.  Between the intense face to face time (sometime literally as Elena loves to make everyone else's face into a "dancing face" by squeezing their lips or tugging at their cheeks) and wanting Elena to get used to her new classroom, we decided she should go tomorrow.

Back to me.  So I was in a rough place this morning, and maybe even yesterday morning as I called my mom before 8 am both days to find out when the HELL she'd be at my house to entertain Elena.  I'd like to think that if I didn't have her lined up to come over that I could better mentally prepare myself to spend time with Elena while caring for Nina, but that anticipation of having help makes the time creep by really slowly as my sense of desperation grows.

Mom got here, made me breakfast as I nursed Nina, and then I laid down with Nina for a mini-snooze.  Elena took her place around 11:30, and nursed and napped with me until it was time to switch again.  Honestly, from 6/6:30 am when Nina woke until I scrambled out of the house just before 1 pm, I felt like there was one child or another attached to my breast.  And if they weren't attached to the breast, they were attached to me.  I was able to brush my teeth before leaving the house, but didn't get to shower or even wash my face since I thought sleep was best for me given my growing headache and grumpy attitude.

I walked into the same salon that I visited last week--I had left there with sleek and shiny hair and a face that I had made up in the parking lot before my appointment.  Today I hurried in 6 minutes late with a snarly pony tail and day-old makeup half-rubbed off my face for a pedicure (yay for unused birthday gifts!).  I almost grumbled to myself about the fact that this self-care was annoying and causing me stress since I can never be anywhere on time anymore, and then told myself that it's just like speeding and cursing out other drivers on the way to yoga.  A little counterproductive, and certainly unnecessary.  So I let my harried appearance go, and didn't even feel obliged to explain myself or my lateness.  I stepped out of my light pink comfort zone and got a sparkly dark gray painted on my toes.  It looks fabulous.  Elena didn't notice them until later tonight when she asked me, "What doing, Mommy?  What toes?"  That is code for "What are you doing, Mommy?  What's that on your toes?"

From the salon, I zipped over to Hillary's for a massage, thankful for the blank check that I had in my wallet after being too ready to pay some bills one day.  I was planning to go home to nurse Nina and pick up my checkbook, but with the check and some milk leftover in the fridge, I was actually early for my appointment.  My massage was great, and I have to put a plug in for Hillary as she really understands and caters to changes in one's body throughout pregnancy and the postpartum period.  She gives a great massage, a fabulous prenatal massage, and has amazingly reasonable rates.

Josh picked up dinner for us, and my mom whisked Elena away to the playhouse for pool time and dinner, leaving Josh and I to eat, drink some port, snuggle, and sleep.  I have to say that the latter half of my day was sorely needed--to be touched in a therapeutic and indulgent way as opposed to the touch requisite of motherhood was completely refreshing.  And now off to sleep in a bed with just little Nina and me in it... time for some starfishing!

Practice Makes Better.

To get the minutia out of the way:

Yesterday was Elena's 2nd birthday, and Josh and my 4th wedding anniversary.  We are not gift people, and I am happy that the feeling is mutual.  I care about my loved ones tremendously, but my inherent lack of regard for receiving gifts translates into not really valuing giving gifts.  I'm sure there is a remedy for that--maybe children?  Josh bought Elena some Borders slashed price Play-Doh accouterment set as well as some backup sidewalk chalk... I had intended to wrap the Play-Doh thing to give to her yesterday, but it didn't happen.  Maybe for Sunday's family party?  If not, there's always Christmas!

Elena did "circle around the sun" at school with her friends, and showed me her birthday collage when I picked her up yesterday.  She was seated at a little table with three of her classmates with three animal crackers and 6 blueberries lined up, berries in a line on top of the cookies.  "I having a snack!" she told me, and made no move to get her things together to go home, so I hung with her buds.  One wanted to know my name, and then told me his mom was Angela.  Another told me that her cousin was her best friend, and the third kept pointing at me and saying, "Mommy!"  He chimed in when Elena started singing ABCs.

We had a pasta dinner at home--penne tossed with homemade pesto and butternut squash--followed by cake at Something Sweet, complete with candle which the birthday girl tried to extinguish with her fingers, and then she tried to get as close as possible to the flame before Josh blew it out.  Despite some mini-meltdowns before dinner, I'd say it was a success (and thanks to Tia Stephanie and Ibba for dropping a gift by yesterday--it kept her happily occupied for much of the evening!).  Or the birthday was, at least.  I think it'll take a few tries (or a few years more of our children growing up) to be able to fully celebrate Elena's birthday and our anniversary.  (Hey, that actually ties in to my blog title!)

On a completely different note, I got a request to know more about pork products in infant formula, something that had been alluded to in a recent talk on breastfeeding.  It appears that all formulas need some sort of enzymatic processing of the proteins (most formulas use cow's milk proteins, obviously soy and elemental formulas are different).  Since most formulas are based on cow's milk, and cow's milk is NOT advised for consumption for at least the first year of life, this enzymatic breakdown is needed to aide babies in digesting the proteins.  (That being said, formula causes micro-hemorrages in the intestines, leading to iron deficiency anemia, hence the addition of iron to formulas!  Chew on that one a bit...)  Some of those enzymes come from some yeast strain, but many (specifically trypsin from what I've read) are derived from pork.  This finding is kind of gross, but if you've ever looked at the packaging for parmesan cheese and read "animal rennet", the idea is sort of the same.  I love parmesan so much that I don't really care about rennet despite my not eating beef, pork, chicken.

So for many formula-using families, the pork enzyme thing isn't that big of a deal.  It's observant Jews and Muslims (and those who care for those babies) that really need to be aware of this if they keep Kosher and Halal.  If you are interested in reading more, here are some sites (for this last one, go to the top, click on "Food product by category", and type in "infant formula" for a nice chart).  Note, though, that this processing with pork enzymes is not heavily advertised and information from formula companies is hard to come by.  I think Nestle has been the most forthcoming.

**********************************
So, without further ado, here's what has got me posting.

I've been practicing yoga regularly (though in busy/pregnant times regularly might be once a week or every two weeks!) since 2000.  In those 11 years, I have never had a consistent home practice.  I've enjoyed zoning out, following the instruction of teachers, and floating on the energy of the others in class with me.  Yoga has allowed me to simultaneously work out the kinks from my body, mind, and spirit in a way that no other practice has done.  I've been incredibly grateful for the gift of yoga, and since moving to Tucson have enjoyed the connection to others that such an experience facilitates.

When pregnant with Elena, I was a Broga regular--that is short for Bruce yoga, a term coined by my clever husband and adopted by a few of my friends.  Having a teacher that understands the changing needs of your body is so important, be it pregnancy, an injury, a past knee replacement.  My last Broga class was on a Friday, and I delivered Elena on a Tuesday.  I was back at Broga at 2 weeks postpartum, eager to test out my new body shape and get back to my old one.  As I went back to work, my Broga-ing got less and less since evening classes interfered more and more with daycare pickup and family dinner time.  Between Josh starting fellowship last July and wanting to be home for dinner as a family, I haven't been to Broga in months.

Nina's pregnancy was very different from Elena's, which allowed for introspection and pampering--two of my favorite things!  I don't want to think about my cortisol levels during this last pregnancy, and what their potential effect could be, so let's not even go there.  With Nina, I was lucky to get a practice in once every week or every two weeks, and even then it was for hour-long classes here and there which tend to whip through poses quickly in an effort to give the mostly college-aged group the biggest caloric bang for their 4 bucks.  These classes are very unlike the leisurely 90 minute "intro" Broga classes that I am partial to, but they did the job in helping me clear the muck.

These mini-classes have also opened a door for me to start developing a home practice (finally!!).  Yesterday I practiced for the first time since the week before Nina's birth, using a 30-minute playlist (love i-Tunes and Apple TV).  I acknowledged tight rectus abdominus, hip, quad, and calf muscles along with a restricted ability for backbends.  All in good time.  Today I made another 30 minute play list, and was happy that my abdominal muscles were more stretched and less restrictive, and happily focused on my hips and legs.

Yesterday my intention was easy given all of our reasons to celebrate.  Today I had to sit for a bit longer before deciding on one that felt fitting for the weeks to come, but I feel that if I continue to mini-practice daily, my actions will align more with this intention.  Yesterday, through the mini-meltdowns of my birthday girl, I felt better able to exercise patience and am hoping that that trend will continue.  Of course, if I continue to go to bed at midnight (damned Hunger Games!) and be awoken at 4 am by a baby who doesn't fall back asleep until 9, it might be a different story.  But for now, my practicing is making things infinitely better.

Nina at 4 weeks.

P.S.

Nina is 4 weeks old today, fully chunky cheeked though still thin thighed.  Not to belabor the point of my last post, I feel guilty for not writing much about her except for the fact that she nurses a bunch--hence this post.  On second thought, that's really all she does aside from sleep, but I did want to mention the following:

She started smiling (I accidentally typed "smoking"!) some time between 2 and 3 weeks, though I still only get 1-2 smiles per day.  Today she seemed really content to have Elena sneak up during her nap and cover her with a burp cloth.  Maybe she was pleased that the cloth was the perfect size for her little body from the neck down when oriented the long way.  (Ordinarily Elena entirely covers her dolls and stuffed animals and once Nina.)

Also around 3 weeks she started being awake more during the day... and more fussy during that time.  Most of the time these periods are during the day or between 10-12 at night, so my sleep has still been decent if I can turn off the computer before then.

Her hair is super soft, but very thin in the front, kind of like a man who has just begun to go bald.  I tried to put a bow in her hair last week after she was mistaken for a boy twice in the same day, but due to the thin front and top, it just slid out.  Note to self: red onesies = general association with boys.  We went to lunch with Maya and GiGi (who looks fabulous with head bling), and our waiter said, "Oh, they'll grow up together and get married some day!"  I said, "I... uh... MAYbe, though probably not in Arizona..."  On the way home, I stopped to drop off Josh's dry cleaning and the woman there just went off about boys boys boys everyone is having boys (she is pregnant with a boy).  Since I was just dropping off and was worn out from lunch, I just went along with it.  Until she held the door open for me on the way out and asked "his" name.  "Um, Nina.  She's a girl.  Okay, bye!"

Hope that's a decent enough update for Ellen and my mom.

Steeped.

That's me--totally steeped in motherhood.  I don't think you can have an infant and not be completely absorbed in the world of parenting.  I didn't feel "in it" to this degree when I was working--there simply wasn't enough time.

Now I spend most of my days googling things like cloth diapering (more on that later!), "milk teeth", and pork byproducts in infant formula (more on that later, too!).  Okay, so that's what I googled today, but you get the picture.  I think about (but don't usually) making plans with other moms with kids that are either one of my kids' ages, comment on Facebook posts by those same types of moms, join The Mom Challenge, and nurse and nurse and nurse.

With Elena, I had such mixed emotions about the end of my maternity leave.  Our postpartum family bonding was so wonderful.  Josh and I both had cushy years--Josh was a chief resident (think mostly admin with little clinical responsibility--an actual 9-5 job!) and I was in my integrative fellowship year (with a M-W structured time schedule--I did stuff the other time, but at my own pace).  Josh was home for FOUR weeks.  Four!!  And none of it was vacation time, leaving those four precious weeks of vacation untouched.  Four weeks of adjusting as a family, reading the Twilight series (Josh skimmed the last two books, I bagged out mid-way through the second one), snuggling and napping and mastering the baby swaddle.  It was great.  And the book that played such a role in savoring that time was Aviva Romm's Natural Health after Birth--if you know someone who is pregnant and even a teensy bit crunchy, this book makes a GREAT shower gift.

I'm rereading the book this time, but it's not the same.  The magic is just not the same this time around.  Josh had two weeks off, one of which was Elena's vacation week.  (BOTH weeks had to be counted as two of his four vacation weeks this year.)  We were busy busy busy that week, trying to fill the time and Elena's energy/exploration needs for the day.  I feel like I've been sleep deprived since... maybe 2002 when I started med school?  Late night studying, 30 hour calls, working 2 weeks straight without a day off, being on pager for 3 months at a time for pregnant patients--all of these things did not prepare me for being a mom and the sleep deprivation that comes with it.  In fact, it probably put me at a disadvantage for coping with Elena's persistent nighttime wakenings (she still wakes up nightly at age 2, though now she falls back to sleep with Josh easily in her own bed).

My point in bringing up the sleep deprivation thing is to say that when you are chronically sleep deprived and working long hours, your priorities shift... or stay the same, in my case.  I've never been neat around the house, and I've never liked cleaning even a fraction of how my sister feels about it.  That has remained the same.  Tomorrow is another day for doing things that need to be done, and the day after that, and the day after that... We've been living in shifting stacks of medical journals, unopened mail (including bills!), opened and sorted mail, things to put in Elena's baby books, a few patient lists that came home with us, etc.  I've finally made some good progress with de-crapping the house, and the piles are starting to disappear.  The trouble is that my to-do list has also disappeared.  *Sigh*  That list plus some coffee in the morning made me a super-charged mommy!  Of course, I'd spend the next day in bed until 11 or 12 in the afternoon, but isn't that what I'm supposed to be doing with my maternity leave?

The change in character of this postpartum experience is not unexpected or shocking in any way given that Elena is an active 2 year old.  I guess what is still the same is the presence of feeling guilty.

Guilt is a part of being a mother.  That's what I've read in Camille Perl and Kate Moses' books Because I Said So and Mothers Who Think that offer a variety of issues over which to be guilt-ridden.  That's the whole point of The Mom Challenge on Facebook which challenges moms to do something of the creators' choosing (crap, I was supposed to take a bubble bath or something tonight!) for themselves daily.  That was a heavily discussed subject during a recent panel discussion about child care on NPR's All Things Considered.

Last time, I felt guilty about going back to work so early (6 weeks), despite the fact that any additional time would have to have been unpaid.  We managed piecemeal coverage until Elena was 4 months old, which eased my guilt a bit, but kept me up at night trying to keep the schedule straight and creating more guilt in asking our families for help.  Watching Elena thrive at her school makes me happy, and hearing about the purported value of preschool makes me wonder if we're getting some added benefit to all the socialization she's been exposed to since starting there.

This time I am feeling like I can't spend enough time with either child without compromising one or both of their mommy-time needs, or without compromising my own mommy-time needs.  Since making the realization that I am selfish (if my own needs--which are many!--aren't met then I am not a good mommy or wife), I've really tried to prioritize my interests more.  My brief but intense foray into Angry Birds caused me guilt in not being more present while nursing Nina, but really, what else are you going to do when your sleeping child isn't yet finished at the breast and you're all caught up on Facebook posts, email, bills/bank accounts and The Weather Channel?  I did delete the app (which Josh downloaded!!) after being so obsessed with trying to beat a level that Elena whined, "Turn it off, Mommy, turn it off!"  Yikes.  Talk about guilt!

Also, if you've ever had kids or cared for them at length, you may have had fleeting to full-fledged feelings of guilt about waste.  Living in the desert I think has made me more aware of the imbalance of things that are scarce and the abundance of waste that we create.  So I'm using the disposable diapers that we had leftover from Elena (I bought in major bulk!), but today I started using cloth prefolds with Thirsty covers for Nina.  (Thank you, Tiffany!!!)  I've bought additional Medela storage bottles to increase my non-bag capacity during work pumping sessions (I was using about a bag to two bags daily since I only had three bottles... so that's about 4 days a week average x 1.5 bags average x 40 weeks Elena's first year = 240 little plastic bags...wasted!).  But now I'm wrought with guilt over the fact that we bought the Playtex Drop-Ins for Elena, and they waste a sleeve with every bottle (4 bottles per day x 4 days a week x 40 weeks = 640 sleeves!).  I was so tired and researched-out when making that decision that I just went with what one of our acquaintances was using.  Hell, I even feel guilty for posting a link to the website!

So I'm just trying to let it go.  All of it.  Things like Angry Birds help, but they generally create a numb covering up as opposed to really just letting it go.  Or it creates the mental space to make up really ridiculous scenarios in my own head, which isn't constructive either.  Good thing I deleted the app.

Really, I am enjoying my time off with Nina, and on a day-to-day basis I don't feel horribly guilty about any one thing.  But I know that there are a lot of FWKs (friends with kids), expectant moms, wishing-for-babies moms, not-yet moms, and never! moms out there who read my blog.  And I will tell you that you are not alone in these feelings of guilt.  But they don't have to suck the joy out of your experience.  It's all in the 'tude.  Guess now I need to take my own advice and restore a bit more magic to this postpartum experience!

Everything In Its Right Place.

I was just overcome by a flurry of activity--maybe my lack of movement earlier on in the day just built up to the tornado of straightening up.  Who knows.  At least our bedroom doesn't look like a total disaster anymore.  And really, while Elena is a (physical) home wrecker, its our lack of imagination and willingness to divert her that allows disaster to strike every room she has access to.  I blame the heat, keeping us prisoner in our own humid house, but in actuality Josh and I are lazy.  Made lazier by heat, that is.

Elena goes back to school tomorrow.  We are SO excited, and I feel awful saying that though my guilt does not diminish my feelings of freedom.  Freedom to nap without keeping one eye open to see that she's spread her clean but unpackaged diaper/insert pairs around the room.  Freedom to cook a decent meal without her world collapsing because she can't have milk at that moment.  Freedom to take a shower without feeling hurried by cries from the other side of the door.

This afternoon I left a bed of sleeping girls and daddy to take my first shower in a disgusting number of days.  I had just about washed my hair and face when I heard Nina's chirping cry, followed a minute later by Elena's wailing.  Did that stop me from shaving both my underarms and my legs?  Nope.  How about filing my heels?  Did that, too!  Josh's last week of vacation/paternity leave is this week, and I am anticipating some rough mornings getting Elena to daycare so Nina and I can relax a bit.  Of course, Nina will be more awake then and therefore more demanding of my attention, so I'm getting my personal time in now.

I still have 5 outstanding notes to finish, and probably some patient tasks to tend to.  That is all for tomorrow, and I think that chore deserves a fully caffeinated espresso drink.  I've (mostly) been avoiding caffeine since Nina's birth on the off chance that it really would affect my milk supply.  Plus I had gotten way hooked on caffeine late in my pregnancy.  Nothing beyond the moderate caffeine that ACOG okay'ed, but enough to give me terrible withdrawal headaches (or maybe that was withdrawal from the 800 mg of ibuprofen I was prescribed on discharge?).  Anyway, Allscripts tasks, laundry, and processing dirty diapers are on the list for tomorrow.  And making sure that Nina is on our insurance so her hospital care will be covered--oops, we should have taken care of that before this weekend.  Oh well.  See what Elena's vacation did?

In case you were wondering, Nina's thrush got way worse, covering her tongue with a thick white coat with patches extending to the sides of her tongue, her palate, and her lip.  After just a few days on nystatin (administered with an aggressive Qtip painting by Daddy), it is gone.  Elena was treated as well, and I got some antifungal ointment in a base that is safe for both to eat.  Since we delayed the whole insurance sign up thing, we (foolishly since Elena was being treated with the same medication and dose) paid out of pocket for Nina's medicine.  Since mine was special order through the compounding pharmacy, it was $43 out of pocket.  All in all, we spent about $80 treating this damned thrush, when really only Nina was affected.  I guess better safe than sorry, but still... 80 bucks?

The bottom line is that I'm looking forward to organizing my life a bit more with Elena hanging out with her friends.  Nina's crib is a holding area for clothes that need to be packed up for a later date, and there is a nest of papers that need sorting and shredding that has been in "the cage" (the area between our front doors--sadly, I've been locked in the cage a few times but that's another story) for way too long.  You know, things like that--things that likely will not get done for another couple of weeks as I catch up on sleep with Nina while someone else watches my spirited toddler....

Learning Off The Job.

On my pediatrics rotation in med school I heard the phrase, "Being a parent makes you a better doctor, but being a doctor does not make you a better parent."  True!

Nina has already had two common infant rashes--she was born with pustular melanosis, most of which resolved in the first 24 hours after birth save the "freckles" left behind by the pustules.  I don't think I've seen this in the pustular phase before, or at least to this severity.  Shortly thereafter (as in day of life #2) she developed quite the case of erythema toxicum which is fading fast as well.  She also had some tongue tie that I didn't want to wait on becoming problematic.  I've become a little like the tongue tie police in the nursery and in the clinic--early intervention on problematic ankyloglossia is so satisfying.  That being said, I think I would have advised me to wait since Nina wasn't having issues nor was I.  That being said, once I snipped her frenulum (in the office, not at home! and only because her provider that day hadn't done one before!) it did seem to me that her latched changed for the better.  Who knows.  I just didn't want to have to worry, go back for a weight check, potentially watch my kid turn into a pumpkin from jaundice, and so on and so on...

And now Nina has quite the case of thrush.  I guess it's not that bad--it's just over her tongue (I think), but she's such a little rooter that I see her tongue and the little white patches ALL the time.  Here's where the intro statement is totally true, and even reeks of physicians sometimes having their parental decision-making impaired (er, maybe the tongue tie thing fits in there, too).  Instead of e-mailing or calling my colleague who is the girl's doctor, I re-research what I think I've read about thrush.  Common in newborns, doesn't have to necessarily be treated unless baby or mom is having symptoms.  So I sprinkled some Culturelle (Lactobacillus GG) probiotic on my nipple before nursing to help it clear up faster and minimize the chance of me catching it as well.  Hey, Dr. Sears says that's okay, so I'm doing it.  I've also guilted myself into e-mailing Colleen.

And poor Elena's little cold now has a cough to go along with her raspy voice, and she has a fever.  I might check her ears tomorrow, just to make sure there's no infection brewing.  Is this too much DIY?  We roll our eyes in ERs, urgent cares, and the office when parents come in with a 10 year old who has a cold and a mild fever that has resolved--hasn't this happened tons of times before to your kid?  They'll be fine!  I just don't know if I'm striking the right balance between trying to minimize unnecessary medical care and treating my kids beyond what a normal mom would do.  Medical people with kids, speak up.  Am I alone, or are you struggling, too?

Cha-cha-cha-changes!

Okay, so this two kids as opposed to one thing is a lot harder than I thought it would be.  That being said, I didn't really give it that much thought to begin with--half because I was too busy and half because what's the use in worrying about the future if you can't do much to influence it?

Both girls have been relatively great.  Nina is a happy baby who loves to nurse and sleep--she is more of a sipper, though, meaning she snacks more than she feeds right now.  Lots of snacks.  And she loves to be held.  Funny how babies sense that--she sleeps the most solidly and for the longest periods of time snuggled next to me or on me.  Put her in the bassinet sound asleep and she is up 10 minutes later.

Elena has been... okay?  I suppose.  Not the picture of perfect big sister, but certainly adapting nicely in that she shows love to Nina and has been doing really well adjusting to having much more Daddy time and less Mommy time.  But she's not sleeping well, which makes her cranky, and she is still learning to share.  We've also seen a new side to her in the past couple of days--more a new pattern of speech in which she expresses her frustration.  The overall pattern is (with furrowed brow and stuck out bottom lip), "I. don't. like. SOMETHING."  Very staccato with an emphasis of distain on the last word which she purports not liking.  My favorite from yesterday was, "I. don't. like BIDEOS."  She has the whole Spanish "v" pronounced as a "b" thing going on.  She also expressed dislike for both Josh and myself yesterday at various points.  Oh well, I guess that is to be expected.  At least she hasn't said that about Nina (yet).

Like Nina, Elena has also been a snuggler from day 1, which was further ingrained through co-sleeping.  Since getting her new room and new bed, she's been doing okay.  She doesn't like sleeping alone, and will toddle into our room in the middle of the night holding her puppy and sometimes a blanket.  Depending on how we felt in the past, we'd either lead her back to bed or just let her stay with us.  Now with Nina in our bed, Josh has been taking her back to her room, but then passing out with her until they both toddle back to the family bed around 5:30.  So Nina and I are solo in the big bed, which has been working out okay because she's so easy to put back to sleep after nursing (provided that we are touching).  Maybe that's why I struggled so much with Elena?  Because I'd try to put her back to sleep in the bassinet?  Who knows.  Practice makes perfect, I suppose, so maybe we should have a third and hope to get things right.

As for me, the naps have been winning out big time.  One of my main goals was to make quiche for dinner last night, and that didn't happen.  My other goal was to drop off a gift in a given time frame.  Another fail. I had showered and gotten dressed in real clothes and everything.  Oh well.  It's a good thing I have low expectations of myself in some regards.

I've been less of an ugly mommy in the past few days than I had been some days in the preceding months.  I'm trying my best to be patient with Elena and give her the special time she needs to know that my love for her hasn't changed.  It's hard, though.  Josh has been doing the majority of Elena entertaining, and he's been a little.... snippy.  Quick to hand out the time outs.  It's kind of nice to have him dealing with the frustrations that I've had on all those weekends with him on call, just to see that my reactions weren't unusual.  I try to intervene if Nina is at a pausing point for nursing, but like I said before, she loves to be held.  So if anyone wants to do something fun and air conditioned this week, let us know--Elena is on vacation from school and is quickly getting bored in the house.  In the meantime, it's been a nice change to have Elena whining for Daddy, and to see her cling to his neck to be carried to the kitchen to make breakfast.

On a more superficial note, I'm hoping that my after birth cramping has stopped--apparently these pains get worse with subsequent pregnancies as the uterus becomes more and more distended.  I didn't have any with Elena, so when pains so severe that I considered again taking my hands and knees butt-sway position hit, it was a little bit of a surprise.  My postpartum bible said they "rarely" last beyond 72 hours, so when I was still feeling them yesterday evening and last night, I was annoyed.  They're lessening, though.  Patience!

Also in the change department, I could be a triple X model with the size of my chest right now.  *Sigh*  I know many women welcome the boost that pregnancy and lactation offer, but not me.  That's all I'll say about that, except that if you see me in the next few months, try not to stare.  It's just not polite.

Today was Nina's big photo shoot with my yoga pal Dan.  Hopefully some of her cross-eyed photos came out well.  We were thrilled with the pregnancy batch, so these should be a nice compliment.  Since I am discussing changes, I will take this opportunity to say that I wore a pair of pre-pregnancy jeans for the shoot this morning.  Don't hate me--they were snug with a tiny rim of muffin top, and I really just wanted to see if they'd fit, thinking more that it would be seeing how far I needed to go to fit back into them.  Given my ridiculous top heavy look, I'm glad that this time around I was blessed with a rapidly shrinking waistline as consolation.

So that is the story from Sunny Drive.  We are hanging in there, but need to be hanging out of the house a bit more to keep Elena happy and from smothering Nina with too much love.  Ideas?

Endorphins vs. Naps.

After coming home with Elena, all I wanted to do was look at her when she slept, and then run and get something to eat and try to "do" something.  I remember making a chicken soup from scratch after we had eaten a farmer's market chicken the night before--I made the stock and then prepared all of the stuff to go in it.  That particular morning stands out in my mind as a particular waste of my postpartum time.  Lucky for me, Josh had a nice chunk of time free of work duties and though those weeks went fast we did enjoy that time.

A friend sent me a message this week via Facebook, which saves all of your past correspondence with others--the last time we had messaged was after Elena's birth, and I remember the morning that I told him about.  I had trouble sleeping in that first week, and would wake before Elena and Josh and make some lactation tea and breakfast and enjoy the quiet.  I had my tea in the early morning sun, enjoying the heat on my legs.  I don't really think that was a waste of time, because I remember feeling perfectly peaceful and deeply happy, and those moments should be savored.

Again I feel this pull between the rush of endorphins post-delivery and the impending overwhelming sleep deprivation.  Today was busy--I finished off the batch of butt balm that I had started a couple of weeks ago, shattering a glass in the process.  Elena had her first doctor's appointment with Tia Liz, and Mommy snipped her frenulum there (maybe more on that later).  Then we went to lunch, got Tia Liz some caffeine as a thank you for seeing us during her lunch hour, and headed home for a quick nap before Elena got home.  Elena was her usual energetic self, aligning Nina's diapers in lines around our room, and then placing Josh's loose socks neatly over diapers while we Skyped with my parents.  Josh's parents brought us dinner, and Uncle Tio and Isabelle came over after their dinner.  I'm beat.  And yet blogging as Nina sleeps peacefully next to me.

It's a battle.  Endorphins vs. naps.  I wish I could say that I will try to help naps win out in the next few days, but there is just so much I want to write about and read about (plus some outstanding patient charts from Monday that need to get finished) that I know I will end up burning nap time in favor of blogs and google searches.  Oh well.  I'm taking 8 weeks instead of 6 this time, so at least I have that in my favor!

Nina Sofia Malo.

She's here!  Nina is a mini-Josh face and a total delight--I am so in love with our growing family.

Elena and I read (or started to at least) Angelina's Baby Sister the night before the delivery.  Angelina throws a temper tantrum and trashes her room when she feels she's not getting any attention, and then her mom pours on the love after her parents and grandparents witness her poor behavior.  It was about that point in the book where Elena said to me, "I don't like that book.  No, Mommy," and made me close it.  I guess that explains her initial reluctance to even acknowledge Elena in the first few minutes of their meeting, choosing instead to hang her head over the side of the bed and look at the floor, kicking her feet.

She warmed up pretty fast, however, and was soon hugging Nina incessantly and now can't keep her hands off of her.  There were many "I want my baby sister" whines tonight after she came home from daycare.  The two nursed simultaneously a few times, and she'd reach out and stroke Nina's hair, or toes, or hands (depending on how they were both positioned).  Very sweet.

After Elena's birth, I detailed her birth story in my journal.  I guess I'll go electronic with Nina's.

As I mentioned, I had my doctor strip my membranes at my 1:00 appointment on Tuesday.  After the appointment I had irregular contractions that evening going on into the night, waking me up some.  Elena must have known something was up because she kept waking up as well--a real restful night for all of us!  Around 5 am they started to get more regular, and I needed to breathe through them a bit more, but nothing a little yogic breathing couldn't handle.  I had a half-schedule of patients that morning, with the remainder of the morning to be spent fielding lab results and calls from the practice's patients.  By 6 am, I was still thinking that I could go in and finish my morning session.  By 6:30, I thought that wasn't going to be possible, but I could still swing by and sign some prescriptions I had printed the night before.  And by 7:30, I let that ship sail as well.

I had called Josh's mom around 6:30, and she was planning to be at our house by 8.  By the time she got to our house, I couldn't stand to be in any position but on my hands and knees during contractions.  Luckily Josh got there a few minutes after Lynn did, and we were soon off to the hospital.  I told Josh in the car that if they checked me and I was 6 cm, then I would try the tub, but if I was 7 cm, "I'm just getting the f---ing epidural."  I went on to say, "Yeah, I know the body produces endorphins and all that crap, but come on."  I guess rational brain handily won the battle against romantic vision brain.

I was 7 cm when they checked me in triage, and shortly thereafter I was wheeled (on hands and knees) to my room.  IV placement, labs, calling anesthesia (and waiting for labs) all took a little bit of time, and my epidural was in some time after 9:45.  Just before the anesthesiologist arrived, I was starting to panic with contractions, annoyed at all the tethering (BP cuff, IV, etc) and feeling nauseated and hot.  I just don't know how people tolerate even more intensity coupled with actually having to do something during contractions.  Post-epidual I was relaxed, nice and cool, and insanely thirsty (and still answering questions from the triage nurse, not even the L&D nurse).  In triage I had learned that someone else was covering my doctor's patients (such as myself), and was sort of disappointed, but in too much pain to care.  Right around epidural time, my nurse told me that Dr. H was going to come in just for my delivery, which she did, straight from her step aerobics class, headband and all.

Once I had a chance to collect my thoughts post-epidural, I put in my requests to my L&D nurse about skin-to-skin time and nursing during the vitamin K administration.  Dr. H was on board with the same mode of delivery with her delivering Nina's top shoulder and me reaching down to pull the rest of her out and onto my chest.  She also offered to keep silent if I wanted to claim an unmedicated delivery, which was sweet of her.  I do have to say that my epidural wasn't as heavy as my last one (my last one left me unable to control or feel my legs for hours after my delivery), so at least I could claim a 75% medicated delivery?  Not that it matters, I'm kidding.

Everything went great--I got to watch Nina's progress in a mirror, deliver her onto my chest at 10:57 am, assist in wiping away her cheesy vernix, and get to have her hot sausage body against my bare skin for nearly an hour.  Josh declined the offer to deliver her, but he did cut her cord.  She was a pro with latching on to nurse, and even ventured to open her left eye a bit to check out the scene (the right one stayed closed for a bit).  That skin-to-skin time was pure magic.  Hot, sticky, melty magic.  After about 45 minutes we were both satisfied, so I okay'ed the start of her torture.  She yipped a bit with the vitamin K, but then went back to nursing.  Eye gooped, weighed (7 lbs 7.73 oz), measured (20 in), she then got diapered and given back to us.  There was a nursing student there who followed me from triage through trans, and she seemed very appreciative to have been allowed to observe--apparently I was a model patient as my seasoned labor nurse (who I knew from UMC and have seen in my office as a patient) said to her, "They don't all do this well."

I can't explain how nice skin-to-skin is.  We did some post-bath skin-to-skin last night, and even Josh got some STS action.  She's such a soft little toaster.  I'm sad that I didn't do that much with Elena, but so grateful to have experienced its glory now.  It totally rivals the awesomeness of the epidural.

She's been great, nursing like a pro (though I think my technique and well-conditioned equipment help), and even had a nice 4 hour stretch of sleep last night.  I'm hoping for the same tonight, but we'll see.  Who knows, this post got interrupted by Elena waking, needing a splinter removal, demanding a bandaid, going back to sleep, and then waking up again.  This should be interesting!