SCOTUS, Aphasic Ladies, Pot, and a Car Crash

I was planning on posting pictures of our gummy candy bonanza, but then today happened.
There was a pretty significant SCOTUS decision made today, and I had a long an eventful work day. The gummies, news, and musings are all swirling around in my head and I thought I'd spew them out to share with any insomniac friends (or 2 AM nursers) who cared...


So I think by now we all know what SCOTUS concluded:  the healthcare mandate IS constitutional, and will become the law of the land.
Healthcare coverage is a truly wonderful thing. You don't know when you're going to be jumped on the street by a few guys with baseball bats. You can run weekly marathons and eat an organic paleo diet, and it's not going to prevent you from ending up in a coma with tubes that you breathe and eat through. Your habits MIGHT help you actually survive getting your skull bashed in to get to a rehab hospital, but doing the right things and having good genes aren't going to prevent you from needing healthcare.
And preventive medicine is a wise and wonderful thing. Spending a few hundred dollars teaching people to control their or their children's diabetes can save hundreds of thousands of dollars of medical care in the future. A few thousand dollars of prenatal care can prevent many more thousands of dollars of intervention if birth defects are prevented. It's just money wisely spent.


We have amazing healthcare in our country. And lots of it. You can find a healthcare provider on just about every corner in Boston. And lots of good ones. Yes, I know that not everyone in the U.S. has top-notch specialists on their street, but if you are willing to drive a bit, you can get to one. I take great comfort from the idea that, if needed, we could fly any family member to Boston to treat any rare malady that might occur. Healthcare is easy to get. Healthcare is of high quality. Healthcare for everyone!


According to a few randomly-googled sources (CNN, MSNBC and kaiserEDU.org,) healthcare spending is currently around 17 or 18% of GDP. That's almost 1 out of every 5 dollars spent in our nation. Wow. Don't get me wrong, I think spending money to birth healthy children and keep them healthy is a good use of my money. I think spending money to keep my family members' blood pressure in check to prevent debilitating strokes is a good use of my money. But here's a question:  is there such thing as spending TOO MUCH money on healthcare? Is there a percentage of GDP that we Americans could all agree is just spending too much on our health? Would we ever hit the "outrageous" mark? Or even agree that there is such a thing?


Please don't accuse me of supporting "Death Squads". I work in geriatrics, I think preserving the health of seniors is part of the Fourth Commandment. (That's "Honor your Father and Mother" for those who didn't attend Catechism class...) An extra healthy month at the end of a 95 year life IS valuable. BestestHusband wisely stated once, "I'm happy that we live in a country that values life." We were discussing DNR orders and related topics, and the fact that it's not easy to discontinue someone's feeding tube or breathing machines. Life is valuable. We need to err on the side of preserving it, even if much money is spent to do so. This is a noble concept.


But reality sets in at some point. Doctors and nurses must be paid. Enteral feeding supplies aren't cheap.  I've never worked in a medical facility that has its own money tree. Rationing already happens at various levels.


I do it regularly.


When I evaluate a patient, I must admit that I consider multiple variables in deciding "yes, she needs therapy" vs. "no, she's fine without us." Some of these variables are patient-specific:  medical history, pt motivation and participation level, family support and discharge plan, the baseline activity level of the patient. In other words, if a 40 yr old IT manager who just got married has very mild deficits but wants desperately to get back to being 100% of her baseline self so she can get back to work and start her married life with her husband, I'm picking her up for therapy. I'm going to max out my available time with her to help her meet her goals. Conversely, if a 75 yr old man with a history of medical non-compliance has mild deficits, but at baseline sat in a recliner watching TV all day and was taken care of by his wife, I might not pick him up. Especially if he didn't seem to try very hard on his eval. Do they have the same deficit level? Yes. Do they have the same ability to significantly benefit from the services I offer? No. Does the optimist in me say that "everyone deserves a chance" and "maybe I can help him despite himself"? Well, yes. But sometimes external factors make a difference.


The factors that I also take into consideration include:  what is our current caseload; who's available to help manage a large caseload; are many people up for discharge soon; how needy are the other patients on my caseload? These are factors that some might argue are unfair to consider when looking at a patient's allocation of therapy time. Maybe. But the factors and the limits they impose are REAL.


This allocation issue came up today at work. My optimism-killing patient is off caseload. He was sucking time from the patients who really WANTED to do therapy. The other therapists have to keep him a few days longer and are grumbling about it. He's sucking their energy, their spirits, and their time from more motivated patients. One of the therapists is pretty sure his family is bringing in pot that he sneaks out to smoke. Well, they sneak him out to smoke it. He's pretty dependent and can't really get himself too far... Let's compare this guy with a sweet aphasic lady I saw today. She's so impaired that she can't communicate basic requests for toiletting, food, or going to bed. But she's SO MOTIVATED to get better! I think I could easily spend 3 hours a day with her in speech therapy. Her husband would spend another few hours helping her out with homework activities. She would benefit from the therapy. My time invested in her would yield good dividends. It's a good resource allocation. Our pot-smoking, therapy-cancelling, drug-seeking, medically-noncompliant gentleman... well, I'm arguing that he's not a great allocation of our scarce resources. Who would you give an extra 30 minutes to? The eager aphasic lady? Or the "screw you" pot-sneaking guy?


Are we allowed to decide this on a grander scale? Who decides? I like to be an optimist and give people a chance. But this guy clearly blew his chances. Right? Or did he? If all Americans get healthcare that is subsidized by all other Americans, do we get to a point that we start setting limits on what people get?


What sets those limits? Age? Genetic factors? Lifestyle factors and behaviors? Financial resources? Realistically, we know that increased financial resources will always get you increased medical services. (The US has many well-respected hospitals with private-pay patients that fly in from all over the world.) Certainly at some point we as Americans need to calmly discuss that fact that our current habits of healthcare use just aren't sustainable for the long-term future. But will we? Can we get past the "I'm special, and I need all available resources.!" but still honor the Fourth Commandment and our nation's history of revering life?


So now to mention the car crash:  I was having a patient read from the newspaper to practice using clearer speech, and I noticed a picture of a strangely-familiar face to the side of the article he was reading. I eventually got the chance to look at the picture and recognized the face of a nurse I used to work with. Under the picture, it said "Tragic: Sarah E.*" She was one of those wonderful nurses who spent her career honing her calm demeanor and ability to create happiness and peace in the patients in her care. She worked with patients who had advanced dementia. She was a mother and grandmother. And she was killed in a car crash on Sunday by an illegal immigrant. Tragic. Life is sometimes just really unfair.


Can we create a "fair" healthcare system? Can we afford it?


Time to go into practice working with rich people who can afford to pay privately. Might be my best bet for job security...


*Sarah E's family could probably use some more prayers, if you're inclined to pray for strangers. God knows who you're referring to, I'm sure...

Good Gamish and Insanely Great Gummies

Today was a day of many small successes. I'm going to celebrate the small wins. Because parenting small children doesn't feel like you're "winning" all the time.


The day started out with a dog and a skunk. BestestHusband took the dogs for a long walk, and came back with a very smelly Mandy. He thinks that she didn't really CHASE the skunk this time, just accidentally stumbled into it. Regardless, we had a skunked dog. Thankfully the weather was milder than the last time, so we were able to open all of the windows in the house for the whole day to ventilate. And I discovered a great home remedy to skunk smell. No, it's not tomato juice...
1. Saturate the dog's fur in straight-up white vinegar. 
It neutralizes the odor. Quite well, actually...
2. Shampoo the dog with blue Dawn dish detergent. 
It's what they use to de-grease wildlife in oil spill zones. And you know what? It degreased the oil from the skunk spray and Mandy no longer stinks! I was able to hold her in my lap after dinner without the urge to gag.
WE WIN! It's yet another use for both vinegar and blue Dawn, and I should start stocking up...


The day also started out with 2 sore throats. So we skipped the gym. But a bit of pain reliever and we're good as new. We kept the day easy to promote actually getting better. But we're doing ok, and will go to work and preschool tomorrow. 
WE WIN!


I experimented with making a new, extra-creamy, high-fat yogurt. I started with whole milk and added a pint of heavy cream. I wanted to try it out for our favorite neighborhood twins, who are slowly expanding their diet of solid foods and eat a lot of yogurt. Also, I thought it would make yummy fro-yo, too. I tried a new water bath method. And I think it worked! So I now have 5.5 quarts of extra decadent yogurt in my fridge. 
I WIN! (Jackie, your tester quart is among that 5.5, so I can give you some tomorrow and you can win, too!)


I used 7 different containers of leftover ingredients while making dinner tonight. BestestHusband asked, "Is this a recipe, or a gamish?" (his term for a concoction of mine that's created to use up ingredients). "A gamish."
"It's pretty good. 4 forks!"
I cleaned out the fridge, prevented food waste, and got 4 forks! 
I WIN!


BestestHusband brought out his souvenirs from his recent trip to Germany - 4 flavors of insanely great gummy bears:  prosecco, strawberry-rhubarb, grapefruit, and exotic fruits. Holy cow, they were insanely great. They deserve a blog post of their own. And they don't even have to be indecent to get my attention. The Germans really know their gummies!
WE WIN!


Oh! And as a bonus, we got the girls to bed EARLY today! And they didn't even get upset about it!
WE WIN!!!!!!!!!!!!!!!


Ok, so maybe I have a boring life that these events are worth mentioning. But hey, sometimes you've got to look for joy in life.


Did you win today?

A Walking Merriam-Webster

We're in a new phase in our household. We didn't spend much time in the "Why?" phase. But we are very much in the "What does that mean?" phase.


A typical conversation might go like this:
Me:  "... and she gets emotional when she hears that song..."
HeyMama:  "What does emotional mean?"
Me:  "Well, your emotions, like happiness, sadness, frustration, can come out as tears. When that happens, it's called being emotional." 
HeyMama:  "What does frustration mean?"
Me:  "Well, frustration is when you get angry or upset because something isn't happening the way you want it to, like when you ask MeToo to stop coloring on your paper and she doesn't."
HeyMama:  "What does angry mean?"
Me:  "What does angry mean? You know what angry means, right?"
HeyMama:  "Yeah, it means 'mad'."


So we go along from one word to another until she runs out of words she doesn't know and eventually asks about a word she does know, and I call her on it. This can go on for quite some time.


Ok, so this is an example of a time when I DO actually get to use some of my undergraduate education and clinical training in my job as a parent. I was a linguistics and psychology major. I know that HeyMama is making some cognitive transitions. She's started grouping words together by sounds - rhyming and alliteration. (I haven't dared use the word "alliteration" around her yet...) She hears new words and asks for meanings. She makes connections between different situations where she's heard the same words (and MAN, can those out-of-the-blue comments seem like real non-sequitors!!!) She's entered the world of metalinguistics - not just using words, but thinking about the words she uses:  the letters they contain, what they sound like, what they mean, the associations that go along with them. She's categorizing things in her mind at a higher level. She's no longer the simple sponge that her younger sister still is. Her brain just analyzes and stores information differently. It's so interesting.


AND IT'S SO EXHAUSTING. I feel like a walking Merriam-Webster dictionary. I could be an OED if I didn't slip into a Texas accent so easily. 


I keep reminding myself that a verbal child is a blessing. I'm thankful to not navigate the path of Early Intervention, IEP's and weekly speech therapy. But blessings can still be exhausting. 


"What does exhausting mean?"
"You, my dear, it means YOU!"

Stewardship Sunday: VBS Edition

So today was the last day of VBS, or Vacation Bible School. It's like Sunday School on steroids, with great decorations, games, new fun music, and of course Bible lessons. Growing up, my large suburban church did this during a week. We had enough stay-at-home moms and retirees to make it work. It was always a blast. For some reason, we always had shoestring potato chips and grapes for snack. I can't see a shoestring potato chip without thinking about VBS...


Anyway, my medium-sized urban church does not have many retirees, the stay-at-home moms we do have are staying home with small children, and our congregation is too spread out to make VBS work during the week. So we do it on Sundays in June. As I mentioned previously, I agreed to help out with music. Now, if you know me from childhood, you might say something along the lines of, "Joy, you're not a singer. You were in the band." And you would be right. And you would be right to suspect there was a reason I played an instrument instead of going into choir. To be fair, I did grow up in a Lutheran church, singing from a very early age. So I can carry a tune if you give me a bucket. And I grew up with a deep well of kids church music to draw from. So, in my church, if you're willing to stand up in front of a bunch of kids, jump around a bit, and try to sing some songs you grew up with, you're qualified to teach children's music.

Here I am, jumping around and waving my hands while the real musicians play music.

The kids learned the music, had a great time, and sang their hearts out to the parents this morning in front of the WHOLE congregation! All-in-all, things were a success. I had fun, I had great musicians that actually made the whole thing sound good. Let me tell you about the musicians in our congregation. Because I'm 10th string talent.


The real musicians in my congregation:

• An internationally-acclaimed Hungarian organist who wins competitions all over the world and can make an organ sing. Listening to him, you can understand what Bach meant his music to sound like, and how music is truly one of God's gifts. He also understands that music can be a key to opening people's hearts to hear God. This is a great combination in a church musician. Oh, and he composes modern organ works.
• A professor at Berklee College of Music who is an amazing jazz pianist. His musical skills defy description. He is humble and generous and a blessing to our church.
• His wife, another musician with a lovely voice. Together, the two of them compose new music to teach the children. It is insanely fun to sing, and the words are straight from scripture. Yes, I said COMPOSE. They typically lead VBS music, and their songs are complex, yet the kids soak them in. Amazing. 
• A young woman with an MFA in writing, who works in finance by day, and plays piano for theater groups by night. We went through a period of time between organists, and she played piano for our services. She also has a very lovely voice. She is truly talented.
• A woman who also works in an office by day, but sings in and leads choral groups during evenings and on Sundays at our church. She's another example of professional-grade talent disguised as a hobbyist.
• A woman who is blind, but can play anything she hears on the piano. I sang a verse of a new song for her, and she just started playing along with beautiful harmonies and flourishes. Songs come to life at her fingertips. Our VBS music would not have happened without her.
• A woman from Brazil who can do the same thing on the guitar. She's not blind, but doesn't read sheet music to play. Again, I'd start singing, and she'd just pick up the tune and sing along. She has a better voice than mine, and I'm glad she agreed to do music with me. Again, VBS music would not have happened without her.
• We have countless other spectacular voices and musicians, including a group of almost-grown siblings who were conscripted by their mother to play for a Christmas service. They just showed up with their string instruments and PLAYED. It was just as simple as that. And lovely, as I understand (I'm still sorry I missed it!)

But I had a blast singing myself hoarse, and am thankful for the chance to step up to the plate.


So our VBS and Sunday School starts with kids 2 years old. When I was first asked to help with a 2 year old class, I was a little skeptical. Can 2 year olds REALLY learn much from Sunday School? As I soon learned, OH YES THEY CAN! Of course we keep the lessons simple, with felt figures to tell the stories, and lots of singing and play. But they absorb the information, and even if they don't sing at church, they sing the songs non-stop at home. I hear this constantly from parents, both at church and from parents at the girls' preschool where I help with music. The kids love the music, and love to sing it to their parents. This is common knowledge in our education program, but we were all still pleasantly surprised to see this:

This is MeToo after VBS is over a few weeks ago. While everyone else was milling around eating cookies, she went back into the room where the Bible lessons were held, and started re-creating the story she had heard that morning with the felt "people". Now, in her version, the Disciples were all taking a nap. But she remembered the story. It's so fun to see her learning!


Ok, so I guess it's time to report in on my resource use for the week:


Food waste: I was the leafy-green executioner again this week. A container of baby kale went bad before I could use it, as did a bunch of cilantro. But the garden lettuce is helping me if I only pick what I need that day.


Money: Ouch again. Birthday gifts, things like backseat organizers for the car, Trader Joes, etc. Ouch.


Patience:  Fair. But without enough gym time, my nerves were jangling by the evening.


M&Ms:  I was given a baggie of dark chocolate peanut M&Ms (thanks Joy!). They did not make it home. I picked up some Mama's Magic Beans (Trader Joe's chocolate covered espresso beans), and have so far showed restraint. But with BestestHusband out of the country for a few days, the chances are good that they'll disappear quickly...


Time:  We did a lot of play dates and play time with friends this week. We had a blast. This negatively impacted my gym time, but we were outside and moving around. And it's the summer. We should be outside having fun instead of cleaning. I think we used our time very wisely this week. 


How was your week?




PS. Thanks Mary Reuning for the pictures! I love the action blur of my hands. I suppose that's typical in any action shot, even if I'm not singing to kids...

Bragging Rights

I'd like to brag about my husband for a bit. He's on a plane to Germany, so he probably won't read this for at least a day or so. After picking up some more interesting gummy candies in Heidelberg, he'll check in to see how things are going at home, and he'll probably get a bit embarrassed. 


Sorry honey.


But I have a really great husband. 


Today was one of those days that just epitomized some of the great things about BestestHusband.
He got up before the rest of us to walk the dogs.
He put away dishes, helped get breakfast for the girls, and helped us all get out the door for swim lessons.
He was, as usual, an enthusiastic and encouraging component of swim lessons.
He ironed the laundry.
He carried a mini trampoline around the corner to a birthday party*.
He hung out with a bunch of 3 and 4 year old girls and their moms for a few hours.
He held someone else's baby for part of that time.
He read nap time stories.
He then went outside and moved dirt and rocks to make more improvements to the garden and yard while the rest of us napped. 
He did bath time for the girls.
He watched YouTube videos of Kriss Kross' "Jump Jump" with the girls.
He let the girls "help" him pack his suitcase.
And all along, he was funny, affectionate, and wonderful to all 3 of his girls (yes, including me). 


Thanks to a recent column in The Atlantic titled "Why Women Still Can't Have It All", the topic of work and family has come to the forefront again in the blogosphere and in my online mommy network. I'm happy to hear some people discussing the concept of FATHERS that are also making career sacrifices in order to have a happier home life. Because BestestHusband did this years ago, and continues to do it today. After college, he was recruited to join a firm doing very lucrative investment banking work. Very. Lucrative. But he looked around at the employees and saw that they had miserable marriages and family lives and said, "No thanks." He knew even then that he wanted a family someday, and would have to make sacrifices to have a happy home life. And the company that he's with now, the one with an extremely family-friendly culture and hosts summer outings to places that have bouncy houses and entertainers for the children, pays a lot less than other companies. Companies that don't provide paid paternity leave and an understanding and flexible schedule for parents who need it.


Of course I did that too. I purposely chose a career that was family friendly. And less lucrative than others that would make being a mother more difficult. That's what the so-called "Mommy Wars" want to discuss -  my sacrifices, and my forsaking of a graduate degree that I must do to care for our young children. But let's not forget all of the wonderful husbands out there who attempt superhuman balancing acts and make sacrifices for their families. Their efforts demand our recognition, too.


So here are some updated photos of the garden that BestestHusband has sacrificed his weekends to create:

BH moved a LOT of dirt and rocks to make this garden.

He had to remove a large shrub and move another cubic yard of dirt to add this extension to the garden. (Anne, these are your seedlings in this corner!)

Didn't he plant some gorgeous lettuce?

The tomatoes look lovely, too.

The spinach is spectacular.

Lots of spinach. Yum!

He planted TWO kinds of mint!

Zucchini blossoms!

He moved a lot of boulders to build this retaining wall.

Side view of the garden, including small boulders.

BH did pretty well in creating a garden out of an infertile slope.

Thankfully, the plants are helping to hide the boulder - the one that got away...

All in all, if he likes to move heavy things to get some exercise, I'm happy with the results. But it's yet another way that he invests his time and energy into taking care of the family. He could spend his weekend mornings on a single scull on the Charles River instead of letting his daughters "help" him in the garden. But he doesn't. He gives his time to us.


Anyone at The Atlantic want to write about that?






*A, hope you don't mind that we shared the trampoline...

Summer is Here!

We spent last week with highs in the 50's, asking, "Where is summer?!?!"
Well, it came today. With bright fanfare. It was 93, brilliantly sunny, with a faint sea breeze. Gorgeous. You Houstonians out there read this and think, "Wow, that sounds cool and pleasant!" Of course Bostonians are talking about the heat, and local officials are posting "Heat Advisories".

Summer came to our family today, too. We took our new single stroller and braved public transit to have a playdate in the city. Ok, so we technically live in the city. But not the part with the tall buildings and fancy bridges. No, we went to the "real" city to meet up with friends for a playdate at a splash park on the Rose Kennedy Greenway. We packed a lunch, got in the stroller, caught the bus to the train, and took the train into the city. The girls were THRILLED! We parked ourselves under a tree, picnicked, and set the girls loose to the water fountains. We were there for 3 hours. The girls ran. They splashed. They chased pigeons. Ok, only MeToo chased pigeons. ("HI PIGEONS HI PIGEONS HI PIGEONS!!!!") They kicked a ball. They spun in circles. They ran some more. They splashed some more. We played until MeToo looked like she would fall over. She was asleep in the stroller before we got to the train station. HeyMama was overtired but still giddy from excitement the whole train ride home. We got home to the blissful air conditioning, crashed on the couch, and spent the rest of the day recovering from the first part of the day.

To me, it felt like summer. It was warm. We were with friends. There was no real schedule. We were free. We could walk wherever we pleased. We were happy.

Here are a few random tidbits from our day:

• MeToo was totally the life of the party today. She was the embodiment of summer joy. I hope I never forget that grin.
• My friend Kathy brought me a Diet Coke. It was wonderful.
• Maneuvering a single stroller in Boston is way easier than maneuvering a double. 
• MBTA train stations are not built for strollers. Or for kids who need to use the bathroom frequently. (Ok, so it was ME that needed the bathroom. But still.)
• I slathered the girls with sunscreen, made them wear hats and short-sleeved rash guard swimwear. They handled the sun well.
• I did not apply my own sunscreen so well. I now have a patchy sunburn on my arms and shoulders. But I did wear a hat, so my face is ok. 
• Unfortunately, the brim of the hat was not large enough to shade the deep v-shaped neckline of my sundress. I have a funny sunburn there. Funny in a painful way.
• HeyMama fell asleep on top of me on the couch as soon as we got home.
• MeToo decided she was done with napping.
• While we were asleep, she climbed up on the counter, started the coffee maker, and ate the contents of the sugar bowl. 
• She shared some with the floor.
• I eventually finished my Diet Coke with a healthy splash of rum.

We're all ready to do it again! Yay for summer!

MeToo running at the splash park

The Donated Stroller

I recently groused to my friends on Facebook about someone donating a stroller for Ruth House that was in gross and grimy condition. Shannon asked the question, "How bad could it be?" Well, I took a good look at the stroller tonight. Shannon, I'll let you see for yourself.

Here's the stroller in my kitchen.

Here's some of the fabric. That's mildew. And holes.

Yes, that's a hole where the fabric is rotting.

There's mildew in the seat.

Lots of mildew and dirt.

Now, the miser in me says, "Oh, you could just bleach that mildew right out." And maybe that's true. We bought our patio set second-hand, and I successfully brought some pretty gnarly cushions back to life. But given the already-rotting fabric, I don't think that bleach would make this stroller any better. 

So lady, thanks for your generous donation, but I think we'll have the local trash guys drive this to the dump instead of me driving it down to Ruth House.

Upset Tummy

Poor MeToo has an upset tummy. I went into her room this morning to find a mess in her bed. The remnants of the yellow peppers, tomatoes, and carrots she ate for dinner last night were colorful. But they certainly didn't belong on her sheets. "Look Mama!" She pointed to them when she saw me. Then laid back down on her mercifully-clean pillow. 


BestestHusband was raised in a family that wasn't allowed to get sick. If you weren't actively bleeding to death, you went to school. So, since MeToo didn't look too bad, we sent her to the breakfast table to get ready for preschool. I was scheduled to work. Perhaps she'd be just fine. We gave her dry cereal, just in case. The cereal went down just fine. The watered-down juice was immediately puked back up. This wouldn't play well at preschool. I called my boss to break the bad news. 


My first thought was, "WAH-HOO!!! I can stay home and get caught up on laundry!!!" 


Is that bad? I mean, it's just an upset tummy. She's not miserable, her color is good, she'll take a long nap and watch PBS. We'll go to the store and get some applesauce and jello. She'll be fine. She was actually happy to be staying home with me. So that means I can be happy too, right? I mean, as long as we get some good snuggle time, it's still a good day, right? We laid on the couch and watched Sesame Street together. I rubbed her tummy, and she was happy. Certainly I can appreciate the silver lining of a sick day? Right?


Ok, so I'm feeling a bit guilty about my first reaction to our sick day. I promise that I'd feel sorrier for her if she seemed sicker... She hasn't thrown up since breakfast. Other than lethargy and audible tummy gurgling, she's been fine. No crying, no whimpering. Maybe I should make myself worry more. Maybe I should be more sympathetic?


Is it ok to feel happy about a sick day? At least it's better than grumbling about the pay I'm foregoing by not working today...


Yeesh, we moms really can find anything to feel guilty about! But wait, I don't really feel very guilty. Maybe I should feel more guilty...


Ok, I'll do penance by cleaning all of the floors while she's napping, too. (Yippeee!!!)

Slacking Off

I've always struggled with slacker tendencies.
In fact, since I typed the first line, I've gotten up to eat dessert, watch The Bachelorette, read email, and snuggle with the dogs. I'm easily distracted. And can easily justify it all.


Summer is making this worse. We're out having fun and are home less, so I'm less likely to sit at the computer writing blog entries. I'm less likely to heat up the kitchen by cooking. And I'm more likely to blow off a trip to the gym to stay home and enjoy other things. 


Today, I dressed in gym clothes, with the plan to go later this afternoon. I knew it would be a busy day, and I didn't want to have to do multiple costume changes. We met up with friends and played at a playground for a few hours. We came home. I was tired, and wasn't really motivated to clean. So I joined MeToo for a nap. It's a rare opportunity, and I wanted to capitalize on it. And I needed the sleep. So when I woke up, it was close to gym time, but I hadn't started laundry or pre-prepped dinner. So I started working on laundry, and HeyMama helped me. So we hung out wet laundry out on the deck. MeToo woke up and joined us. It was SO NICE outside! I decided that we needed a salad for dinner, and the girls and I went to the garden to pick some greens. We puttered around in the back yard for a while. HeyMama was captivated by the concept of picking and eating mint leaves straight from the garden. We played outside. We dug in the sand pile that will eventually be moved into our new sand box. Everyone was happy, no one was rushed, and it really was a lovely afternoon. Going to the gym really would have ruined all of that. I made a salad and grilled the chicken. We were able to eat shortly after BestestHusband got home from work. We had time to enjoy a relaxing dinner out on the patio. Going to the gym would have ruined all of that. 


I really was motivated to work out today. Seriously. I'm not even trying to be funny. But sometimes opportunities arise that are more important than accomplishing my daily goals. I know that when I'm 80, I won't care much about getting to the gym 3 days a week. I will remember trying to teach MeToo how to use a clothes pin, and how helpful HeyMama wanted to be. I will remember the feel of the evening air and the joy of sharing a meal on the patio with my family. I know that I'm making good choices for my family. But it doesn't help my slacker tendencies at all. And it only reinforces my tendency to justify things...


Happy Monday!

Bedtime Prayers

One of my favorite parts of the day is bedtime. The girls' bedtime. My bedtime is good too, but I'm usually way too tired to truly revel in it. But the girls' bedtime is something that I look forward to. Not just for the sudden calm that descends upon our household. Although that is a truly wonderful thing... 


I enjoy our nightly routine of bedtime prayers. Every night, we gather as a family to say the traditional, "Now I lay me down to sleep, I pray the Lord my soul to keep...". Then we take turns saying special prayers to thank God for specific things in our day or ask for something we want. It's fun to see what's rattling around in the girls' heads at bedtime - this is what usually comes out during their prayers. 


MeToo has been stuck in a rut lately. She's adopted some of my typical prayer themes:  thank you for a good job, please help us all sleep through the night. But the way she blended them makes me sound like a madam. "Dear Desus, tank oo for Mommy go to work in da nigh. Please hep her stay safe trough the nigh. Amen."


HeyMama's have been a bit more colorful. Last night she thanked God for keeping us safe from raccoons, then asked Him to help her keep her undies dry. Tonight, apparently also thankful for my job, we heard, "Dear Jesus, Thank you for letting Mommy go to work in a hospital... and thank you for letting her help people... and thank you for letting her make lots of MONEY! Amen."


Well, I'm not sure if I made LOTS of money today, but I am thankful for the other stuff. And I'm thankful HeyMama doesn't think I work in whorehouse.

I Hope I Never Forget

Life with young children can be a blur of activity. But every now and then, time slows down for a few minutes, and I become aware of moments that I hope I never forget.


Now, I work with the elderly, and know that dementia does not differentiate between good and bad memories. It doesn't take the sad and leave the happy. It doesn't take the inconsequential and leave the precious. It just takes whatever memories it wants, good or bad. I wish there was a way to flag "keepers", the way you can flag important emails in your inbox. 


Tonight would be a "keeper." 


I hope I never forget the satisfaction of picking salad greens from my own garden. Setting a dinner table out on the patio. Breathing mild early-summer air. Watching the sun set through the trees. Listening to the birds chirp. Watching the girls play together while we grownups finish a glass of wine. The sound of MeToo when I tickle her. Over and over and over. The feeling of satisfaction of a long day drawing to a close. 


I'm thankful for the presence of mind to appreciate such small things. To know that I have something wonderful going on and say "I won't take this for granted." I wish there was a way to make sure I never forget this moment.


The moment where HeyMama sassed me and I sent her to timeout and she screamed for 15 minutes? I'm happy to forget that one.

Lettuce, spinach, basil, and rosemary fresh from the garden! Yum!

TGIF!!!

Gifts New Parents REALLY Need

I was able to briefly stop in at the joint baby shower for two of my coworkers today and was reminded of how fun giving baby gifts can be. The board books! The cute onesies! Baby gifts are so fun to shop for! And so fun to get!


But after having a few babies, I've come to realize that no one gives the gifts that new parents really NEED. So I'm trying to compile a list of gifts to ask for that will really be useful. By the way, you might not want to give these at a baby shower. People might stare...


1. A waterproof mattress protector for the parents' bed. Mom and Dad may not wet the bed anymore, but baby sure will. At some point, baby will end up in the bed. And so will her spit-up. Or vomit. Or pee. Or poop. Or all of the above. Don't underestimate the projectile powers of small humans. You don't want your bed to smell like a bad night with your baby when you're trying to have a good night with your spouse.


2. Baby washcloths. There are thousands of uses for baby washcloths: wiping bums, wiping faces, wiping noses, wiping spit-up, wiping hands, wiping grimy feet, etc, etc. Buy them by the dozens. Even if you're not a pseudo-hippie who cloth diapers and makes homemade diaper wipe solution, you'll get years of functionality out of your washcloths.


3. A nice pair of yoga pants. The chances are good that you'll spend stretches of time not showering, and sleeping in your clothes. Do this in pajamas? You look like a redneck. Do this in nice yoga pants? You look athletic. Do this while toting a newborn? You look like a super mom. Who do you want to look like?


4. Tank tops. If you decide to nurse, you need nursing tanks. They're lifesavers. If you don't nurse, you need long tanks to cover the muffin tops that your baby will bring you on his birthday. They're lifesavers. Either way, you need new tank tops.


5. Some source of repetitive motion for your baby. Newborns like motion. If you're a hippie, tie your baby to your body with a long strip of fabric and get moving. Pray your baby sleeps at night so you can too. Only a pseudo-hippie? Get an exercise ball and a Baby Bjorn and start bouncing while you check email and watch TV. Again, pray you have a good sleeper. Want your baby moving while you lie comatose? Get a swing/sway/vibrate contraption. Or better yet, borrow one from a friend. You really don't want to take up valuable basement space when you're done with it.


6. A source of constant white noise. Some babies don't need them. Our first child required it to sleep through the night. And as I was working full time after she was born, I required it to sleep through the night. We were able to borrow a specific baby sound machine from a fancy gadget store. You could program it to fade out after a specific amount of time, or just keep going all night long. Both settings were helpful. We discovered that an iPod with a downloaded waterfall track will stand in for the white noise machine. But you need something.


7. Boob supplies. Planning on nursing? You need supplies for that: lanolin, nursing pads, soothies, APNO, etc. They're pricey and add up fast. Not planning on nursing? You might want a little something to help dry up all that milk. There are herbs and teas to help. And there's plain old Sudafed, which will do the trick.  Whatever your view on your baby and your boobs, you will need supplies.


8. A bottle and some formula. Whether or not you decide to nurse, you can benefit from a bottle and some formula. Now, don't call the La Leche League on me. I KNOW that your baby doesn't need formula and a bottle, because "Breast is Best." Of course it is. Your darling will do just fine on a never-ending, every-two-hour, 24/7, on-demand supply of breast milk. YOU on the other hand might want someone else to do a feeding. Or maybe just a 9 hour stretch of sleep. That's when you need a bottle and some formula. So that you can sleep without your baby starving or screaming for 9 hours. And you might want to start that bottle early on and keep it up on a regular basis. We waited too long for our second kid, and she refused to take anything but the boob until she was 6 months old. That was a very LLOOONNNGGG 6 months!


Ok, that's all I've got for now. Hey, experienced moms out there, what would YOU add to the list?

The Death of Optimism

I think therapists tend to be optimists. I'm sure that other careers, like teaching, attract optimists as well. If you spend your days pouring all of your time and energy into helping someone get better at something, you have to have a deep belief that people CAN get better.


I would lump myself into the Optimist category. But every now and then, I encounter a patient that overwhelms and defeats my optimism.


I worked with such a patient again yesterday. It was our second or third session together. Joe* is in his 40's, and had a significant stroke on the right side of his brain. (MCA CVA for those who like medical jargon.) The left side of his body is paralyzed, and his brain tends to ignore that it's there. (left neglect for you jargonists out there) So he'll start swearing about how much his left shoulder hurts. And you have to point out to him again that it's because he's sitting on his left arm. Now, most people can learn how to pay attention to their left side again, and they get much better. But his stroke has significantly affected his overall self-monitoring and error-detection. How do you fix a problem that you don't think you have? Why would you exert maximum effort in a therapy session to fix something that isn't broken? This definitely affects someone's rehab prognosis.


Joe doesn't understand how cognitively impaired he is. His mind jumps from idea to idea, seemingly uncontrollably. Sessions with him are exhausting. You can spend 30 minutes just trying to get him to read through his medication list. He won't do structured memory tasks, but I tried to work on his memory by helping him learn his lengthy list of medications. We didn't get very far.


My favorite moment from yesterday's session was a conversation that went something like this:
Joe: "I think I might need to fire my doctor and get a new one."
Me: "Why's that?"
Joe: "I was taking tons of pills at home, but he couldn't keep me from havin' a stroke. Shouldn't he have known I was goin' to have a stroke?"
Me: "Didn't you just tell me that you smoke all day long, eat nothing but greasy food, never exercise, do drugs, are diabetic, and until recently weighed almost 400 pounds?"
Joe: "Well, yeah."
Me: "I think your doctor's done a great job of holding off your stroke as long as he did."
Joe: "yeah, maybe you're right..."
And then he changed the topic again.


The part that makes all of this most difficult is his baseline pre-stroke personality. My co-worker describes his life as "chaotic." She's stating it nicely. Here are a list of things he's told me about his life:

• While he was in the hospital after his stroke, his mom had his new van towed and "crushed".
• She evicted him from the apartment he was renting from her because he didn't pay rent while he was in the hospital.
• He's taking her to court.
• His 17 year old son is in trouble with the law, and is wearing an ankle monitoring bracelet. 
• He recently paid $1000 bail to keep his son out of jail. He's afraid his son will miss his court appearance and he'll lose that money.
• His 17 year old son told his teenaged girlfriend to get an abortion.
• He wants to "bust him in the mouth" for doing that. That's not what their family does, even if it was going to be a "mixed-race kid."
• Joe lives with his girlfriend and her 3 teenaged kids.
• She helps him with his medications and doctors appointments.
• They want to have a baby together.
• They just got a pit bull puppy.
• When Joe gets home, he's going to start running, playing basketball, and lifting weights every day.
• He's going to have a 6 pack and a body like you see on TV.
• He's going to go back to school and become an RN.
• He'll support his son and keep him out of trouble. 

(Nevermind that he never does his homework exercises and can't support his own weight, and left the previous rehab hospital against medical advice, one of the best in the nation, because he just wanted to go home. Oh, and he didn't finish high school, and isn't really very literate...)


His personality is one that does not take constructive criticism well. This makes providing feedback in therapy sessions quite challenging. He "fires" therapists regularly. He yells and swears at the staff regularly. He yells at me for "cutting [him] off all the time." I consider it "redirecting him to task." Especially in the context of needing 30 minutes to read through his list of medications...


I love it when patients have big plans, with big goals. I'll never forget the 54 year old hand surgeon that had a cerebellar/brainstem stroke. Let's call him Larry*. His mind was intact. But he had severe ataxia - a lack of motor control. He had difficulties speaking, eating, walking, bathing, etc etc etc. Returning to vascular surgery was out of the question. And he knew it. But he specialized in reattaching fingers. Working on hand transplants. He successfully amputated a guy's big toe and used it to replace a mangled thumb so a patient could have a useable hand. And he and a friend had been playing around with a new hand prosthetic design. So he set reasonable goals for himself. He and his friend turned their attention to the prosthetic. He decided that he could continue his love of hand surgery via teaching. He just needed to improve his speech to be able to do it. AND HE DID. If I told him to do 20 repetitions of an exercise, he did 50. When friends came to visit, he told them to grab his therapy notebook and do exercises with him. He toughed it out through the most intense electronic stimulation treatments I've ever administered. He set goals for himself, and he just worked his backside off to reach those goals. 


Larry fostered optimism, even in pessimists. And when he gave an intelligible lecture (with Powerpoint images of severed fingers!) to our medical and rehab staff, I KNEW he'd be fine.


But Joe... he's not a do-er. He doesn't set reasonable goals and work hard to achieve them. So even if he did wake up one day and realize that he had problems, I have no evidence that he'd set out to solve those problems. He doesn't have a history of being a fighter. Of being someone who doesn't take "no" for an answer. Someone who will sacrifice towards a bigger goal. Because he does drugs all day long. He creates drama wherever he goes. He doesn't play by the rules. He lives in a different world than I do. One of drugs, prison time, welfare checks, baby mamas, and street cred. And I"m having a hard time seeing it as an environment that will help him recover and regain his own life, much less start a better one. He's ready to discharge himself from the rehab hospital so he can sue his mother. Can you imagine a guy like him in court? It's going to be a nightmare. 


So I need help being optimistic on this one. I've never had a patient's situation upset me so much. I know that miracles can happen. There is still room for a miracle in his life. And he needs a miracle more than anyone I've ever met. No, I take that back. His son needs a miracle. His girlfriend's kids need a miracle. Because the sins of the father will be visited upon those kids and direct their future more than they can even imagine. He's going to be a handful to take care of... 


Pray for Joe. And pray for my optimism. Thanks!




*Of course I"m not using their real names. The HIPAA police would come after me.

Downsizing. And a Miracle or Two...

Today was an exciting day. We did some serious downsizing. We sold our double stroller to a woman with a single stroller of the same brand. It was newer, less-used, and significantly SMALLER! I'm SO EXCITED!!!

Now an observant person might ask, "But don't you have 2 kids? Where does the second one go?" 

Well, some of the additional money that changed hands helped buy the glider board for HeyMama to stand on. It folds up when not in use. It's pretty amazing. The girls are excited, and I can't wait for them to see it in the morning. I sold the double and got the single this morning, and bought the glider after the girls were in bed. That's why I have the stroller parked in the kitchen. I want them to see it first thing in the morning. It's like Christmas. For me, at least...

Here's a look back at our old stroller. It's an awesome stroller if you need a double. Walks and trips to the Arb were a dream. Especially with smaller kids. And it folds so quickly and easily. And it's light for a double. But it's not great for getting on busses. Or the T. Or into tiny stores in the Square. And it's not great for getting your preschoolers to get a bit of incidental exercise getting from Point A to Point B.

So I'm really excited about the prospects of using public transportation this summer. Have I mentioned that I'm excited about the new stroller?

Ok, so I did mention that we had a miracle or two today. I truly believe that we don't recognize the small miracles that occur in our modern life. Does a miracle really have to require raising someone from the dead or feeding thousands of people with just a few fish and loaves of bread for us to recognize it as a miracle? Here are the miracles that I saw today:

1. I made it to my PT appointment on time. This requires a bit of back story... I went to bed late. MeToo climbed into our bed at some point in the middle of the night. She proceeded to twiddle my hair and generally keep me from sleeping. So I didn't wake up at 6:00 when BestestHusband did. No, I regained semi-consciousness at 7:25. My PT appointment was at 8:00. I had 35 minutes to get myself ready, get the girls up and dressed, pack a breakfast for everyone, drop the girls off at daycare, and drive myself to  the office during the morning commute time. Anyone with small children knows that this would require a miracle to actually happen as planned. Well folks, a miracle happened today. BestestHusband and I made it happen. And no doubt there was a big dose of the grace of God. Because how often do things go WRONG when we're in a hurry that keep us from actually leaving on time? I think it's more the rule than the exception in our household. Except for this morning. I can only attribute that to a miracle.

2. Everything else happened today, as well. After the PT appointment, I picked up the girls from daycare. We went to the gym. I did a real workout. Then showered. Then we drove towards our stroller rendezvous point. The meeting time had been pushed back an hour, so we went to Target to pick up a few things. Then we got the stroller. Then we dropped a bag of stuff off at Ruth House. Then we came home. Then the plumber came over. Then I cleaned the floors downstairs. Then we went outside. Then someone came over to buy the carseat adaptor from our old stroller. I started folding the laundry on the spare bed. BestestHusband came home. We ate dinner. I drove out to pick up the gliding board. It was quick. So I stopped by DSW to see if the red patent flats I'd been eyeing were finally on clearance. They were. I was able to replace the scuzzy and smelly brown flats I wear to work in the summer. I came home and finished folding the laundry. I'm writing a blog post. I'm about to go weed out the winter clothes from my closet. THAT IS A LOT OF STUFF FOR ONE DAY! I can't help but think that this is yet another miracle. Everything fell into place perfectly. How often does this happen? If I were the gambling type, I'd play the lottery. But instead, I'll just be thankful that miracles don't restrict themselves to the lame walking and lepers being instantly healed. 

What minor miracles have you experienced lately?