Light and Momentary

Read this book: Raising Elijah

Back in (oh dear) March I requested and received an electronic review copy of Sandra Steingraber's Raising Elijah. I galloped through the book, taking notes for my review all along the way, but I never wrote it up. Why? Because it's about a divisive political issue, and I don't talk about divisive political issues very often.

Steingraber's previous book, Having Faith, looked at the effects of environmental toxins during pregnancy and lactation. I read it when I was six months pregnant with Joe and spent the ensuing weeks flipping out about toxin exposure. Her new book looks at risks faced by children beyond toddlerhood, and it is equally flip-out-inducing. Maybe that's the most important thing I have to say here: you should read it and see what you think. Read it and see if there's anything you want to change, because if enough of us want to make changes that will protect our kids, maybe we can do something about it together.

I'm finally writing this post today because it is [was] the feast of Christ the King and I am thinking about our obligations to "the least of these," and because there is [was] a horrifying story in today's NYT Magazine about the after-effects of fracking -- which, incidentally, is discussed in the final chapter of Raising Elijah. (And also because it's NaBloPoMo.)

Steingraber's book winds through an alarming array of topics of particular interest to parents. There is a chapter on the carcinogenic properties of pressure-treated wood (which is probably an integral part of at least one playground structure near your home), one on the relationship between toxins and asthma, one on the neurotoxic properties of environmental contaminants -- their possible role in ADD/ADHD and autism spectrum disorders.

She writes about the discovery that the kitchen floor in her home was actually a triple-decker terrine of toxicity: when she and her husband decide to replace the vinyl flooring (after you read about the explosion at the vinyl plant you'll never think about vinyl, or freight trains, in quite the same way again), they uncover asphalt tile (necessitating emergency asbestos abatement) atop lead-painted hardwood. It's a story that makes a person say, "When are we going to figure this out? When will we stop building our homes with substances that harm our children?"

In frequently lapidary prose, Steingraber urges us to protect our children. Here is the thing that deterred me from writing this post: many of the women who read here are Catholics who tend to vote Republican. On that end of the political spectrum, there's a tendency to argue about the existence of climate change and downplay the importance of environmental issues -- the issues that Steingraber labels "the great moral crisis of our day." Many of you who read here will have a very different idea about the great moral crisis of our day, and will be saddened to learn that Steingraber is open about the abortion she scheduled when she learned that her first baby had multiple anomalies. But I think there is an important truth submerged in those colliding narratives of crisis.

In this country at this time, there is a strange alliance between pro-lifers and pro-industry forces: the politicians more likely to support legislation that restricts abortion are generally less likely to support legislation that requires external regulation of industry, including the chemical industry. Does that really make sense? Environmental contaminants play an important role in fetal anomalies. Fetal anomalies play an important role in late-term abortions. What if we could protect the least of these and steward the earth more wisely at the same time? We say that we believe God knits us together in our mothers' wombs. Why, then, are we silent about the substances slashing savage steeks through his handiwork?

When I was pregnant with my oldest son, I worked with a woman from a small farming town. She was also pregnant, as were two of her neighbors. She was broken-hearted when both of their babies were diagnosed with multiple anomalies incompatible with life. "Why?" she asked her OB. "Is it something in the water?" "Oh, no," the doctor assured her. "It's just one of those random things." Given the stats I later encountered on reproductive toxicant release in that region, I am disinclined to believe it was "just one of those random things." We mothers clutch our vigilance like a totem; during pregnancy we take our folic acid and we steer clear of unpasteurized cheese. But the reality is that we need systemic changes if we are to shield our children, born and unborn, from harm.

Steingraber proposes three changes in Raising Elijah: she encourages each reader to plant a garden, to use a reel mower in lieu of a gas-powered mower, and to line-dry clothing. (I tell myself, in the immortal words of Meatloaf, that two out of three ain't bad.) She acknowledges that to some readers these suggestions will seem ludicrously difficult while to others they will seem ludicrously inadequate. Wherever you fall on that continuum, I suspect you will find her book intriguing and provocative. Read it, and tell me what you think.

Disclosure: I received a free .pdf of Steingraber's book. I was not compensated in any other way for this review.

Apples Aren't Enough

When I picked Petely up at school today he had an apple in his hand. The principal gave it to him, he said, because it was Walk To School Day.

It seems like a reasonable idea: encourage kids to be active and independent, encourage parents to cut their consumption of fossil fuels and reduce traffic around schools. But I am thinking about all the factors that prevent kids from walking to schools, and an apple is looking like a pretty lousy incentive.

In the past couple of weeks I've been driving waaaaay out on the edge of town,where I bumped into the district's newest schools. I knew their names but not their locations, and I was surprised (and disappointed) to see that they are in completely unwalkable locations. One of them is surrounded on all four sides by cornfields. It is the utter opposite of a neighborhood school -- I spotted a lone farmhouse within walking distance, and the road is busy enough to render walking imprudent.

If we want kids to walk to school, they need neighborhood schools, and sidewalks.

This has been the least stressful soccer season ever, because two of my three players can bike to practice. It's still a bit of a scramble to get everybody to the right spot with the right gear, and to figure out dinner timing, but I can't tell you how nice it is not to be piling all the kids in the car every evening at 5. One surprise for me was how much my 9yo appreciates the independence. "It feels really good to get there on my own," he said. Today my oldest said something similar about getting to school on his own: "I really like the freedom."

If we want kids to walk to school, they need room to discover the pleasures of small freedoms.

I've posted before about my neighbor issues; they have brought home forcefully the reality that the culture has changed. People have the idea that we need to protect kids by driving them around instead of letting them be alone on foot. (In other words, by increasing their exposure to the most dangerous activity the average American child engages in.) Just this week at preschool I overheard a mother talking about her grade-school child. He was having a hard time on the bus, she said. It's only two blocks, she said, so it wasn't really onerous to drive him. She didn't like that option either, but she didn't know what else to do.

If we want kids to walk to school, the adults have to be sensible about relative risk.

Still crunchy after all these years

Bearing-Erin wrote a fun post about how her former crunchy self and her current crunchy self align, and I've been thinking about it this weekend. I had very strong opinions about the right way to do things when I was expecting my first child, and I fear my 1996 self would not entirely approve of my 2011 self. My 2011 self thinks my 1996 self was perhaps a wee bit uptight.

Still Crunchy

• Long-haul breastfeeding
• No commercial baby food -- baby-friendly table food instead
• Co-sleeping. (Stella sleeps alone until she wakes up, and co-sleeps thereafter.)
• Babywearing
• NFP (ditto what Erin said)

Even Crunchier

• I've learned a lot about gentle discipline since 1996. My kids know that I expect to be listened to, and I know not to flip out if they need to be reminded. Mostly.
• Homebirth FTW. No placentophagy, though.
• I grow (some of) my own veggies and herbs.
• I have a little compost heap.
• We can afford to buy some organic food and humanely raised eggs now.

Decrunchified And Okay With It

• Farewell, homeschooling.
• Cloth:disposable diaper ratio runs about 20:1 right now.
• My 2yo goes to preschool (a lovely, lovely preschool where kindness reigns and where she loves to be, but 1996 me would have been appalled).
• The reason she goes to preschool is that I work part-time.
• I'm thinking about applying for a full-time job for next year. (1996 Jamie frantically attempts to ward off the evil eye. 1996 Jamie had drunk deeply of the Kippley Kool-Aid, which drew a straight line between maternal employment and teen suicide.)
• I use the childcare room at the gym. And on Wednesday? I went to pick up Stella and she said she'd like to stay longer. 1996 Jamie would have seen this as a certain sign of bonding failure.

Borrowing Erin's Classification of Theoretically Committed, But No Longer Able To Figure Out How To Do It, Ergo Constant Feelings of Inadequacy

• "No TV or videos for kids under six" -- if you had told me that in 2011 my 2yo would routinely spend more time in an evening watching videos than being read to, I might have thought my future self should be shot before she could head down such a path of destruction.
• "We don't eat that much sugar or packaged food" -- I used to look upon breakfast cereal with scorn, and now my kids eat it ~4 days/week. For about a 2-year stretch my pantry contained no white flour, no white rice, no white sugar -- now, not so much. On the upside, I cook a lot more veggies than I did in 1996.

I think I am happier as a mother now that I'm not so worried about living up to somebody else's standards. I think a lot (A LOT) about the employment question. But-- I love my job. My kids are generally happy in school and at home. The house is not very tidy, but then it wasn't very tidy in 1996 either.

Discuss

The pools in town are very different from the pools of my childhood: elaborate water slides, looping "lazy rivers" where inflated tubes are propelled by a slow current, complicated fountains and slowly filling overhead buckets that tip over at regular intervals. It's a little crazy. And yet we go to these pools, so much more elaborate than the concrete rectangles with diving boards that I grew up with, and my kids tell me they're bored. We went to a water park a couple of weeks ago and they told me, "There's nothing to do here." I boggled. I thought, "Kids these days..."

Tonight we had dinner with friends who live about 45 minutes away. They have a little neighborhood pool: small, rectangular, no frills. The kids spent more than an hour swimming happily, with nary a word of complaint.

So maybe the more diversions you attempt to provide, the less effort kids put into diverting themselves. Elaborate entertainment efforts by adults seem to engender ennui on the part of the kids. Agree or disagree?

Perhaps I will throw out all of the toys and give them some nice sticks and dirt to play with in the yard instead.

Detachment

Do you remember how I made myself crazy in Advent, knitting gifts for all five of the kids? You might even remember how one gift in particular made me Crazy-with-a-capital-C-and-perhaps-an-exclamation-point, because it combined a couple of things I don't do very well, and because it took for-freaking-ever, and because I really wanted the recipient to be happy with it. I finished weaving in the ends a little after midnight on Christmas, in time to give it to a delighted boy later that day.

This morning he confessed to me that the gift disappeared last week.

My husband cannot STAND it when our kids lose things, especially game pieces. "I never lost game pieces when I was a kid," I have heard him say approximately 2,096,365 times. "Never!" Is this really true? Perhaps it was. I, however, remember clearly the pain of losing things as a kid. (And as an adult.) I hate losing things -- hates it forever, as a matter of fact -- and yet I do it anyway.

Part of giving handknits to kids is detaching from their fate. Do I want it to be used and loved, or do I want it to sit in a drawer? If the former, well then: I have to accept that it won't stay pristine. I have a sort of mental rule, though, that I want them to wear the gift for at least as many hours as I spent making it before I can consign it to its uncertain future.

I can't quite bring myself to think about the ratio of work time to wearing time for this gift. It's not a pretty ratio.

I didn't yell or rant this morning, but my disappointment was very clear. He knows enough about knitting to know that the gift required a whole lot of my time, and he cried. He apologized. I tried to respond graciously to the apology, but I wasn't very persuasive. There's a tricky balance with kids and stuff, you know? We have to teach them to be good stewards of what they've been given, to take good care of their belongings (and others' too), to be respectful of the time and money that nice things represent. At the same time, we have to teach them that the people always matter more than the things.

When my oldest was a toddler he loved to tug on my necklace. I don't wear much jewelry, just my wedding/engagement rings and a crucifix my husband gave me on our wedding day. I told Alex again and again that he needed to leave my crucifix alone, until the day he snapped the chain. He looked aghast and burst into contrite wails. It was one of those crucible moments for me: how was I going to respond? Was I going to yell that I had told him so a million times? Instead I said, "You are more important than my necklace, even though it is very special to me." He and Elwood went together to the jeweler to have it soldered. The resulting little rigid spot was a reminder to me of the kind of mother I wanted to be -- as were the other little rigid spots that came along after later repairs. I think each boy broke that chain; finally a jeweler told me I needed a new one because it couldn't be repaired again.

I didn't get to the Office of Readings until after they left for school, and it felt like a nudge from heaven to see that today was the feast of St. John Bosco. (He is best known for his work with orphaned and abandoned boys.) Here's a snippet from today's second reading:

They are our sons, and so in correcting their mistakes we must lay aside all anger and restrain it so firmly that it is extinguished entirely. There must be no hostility in our minds, no contempt in our eyes, no insult on our lips. We must use mercy for the present and have hope for the future, as is fitting for true fathers who are eager for real correction and improvement.

My initial reaction was to feel sorry for myself: all that work, and poof! -- it's gone. Then I thought about how many gifts God has given me that I have failed to appreciate or even keep track of. I think I will swing by the school with a little note for my sad boy: "You are more important than the mittens."

A Story

Once there was a boy whose teacher was giving away a pair of zebra finches.

Problems and Solutions

I am doing my best to raise children who solve their own problems. Starting in toddlerhood my children hear the word "resourceful" used frequently as a compliment and an exhortation. My children know that we will help them to resolve their conflicts if necessary, but that the expected first step is to ask for what they need from the other party. This is not to say that I delight in uncomfortable conversations myself, or that I am the queen of conflict resolution -- only that I believe it is a crucial life skill, one worth a few awkward feelings.

I have been following the comments on this post with dread and disbelief. In a nutshell: newly divorced dad with weekend custody moves from suburbs to rural area and leaves his kids inadequately supervised. The predominant response from commenters: call CPS.

Now I accept that there are limits to the solve-your-own-problems mentality. When I observe that the utility pole in my yard looks like it would fall over if I sneezed on it, I'm calling the power company to come check it out --  not heading out there with a baseball bat to conduct experiments on how much force it can withstand. I want the people with utility pole experience to offer me an informed judgment about safety in that situation.

But if you have a difference of opinion with a neighbor, should your first step really be to call a lawyer? If the friendly college kids across the street are blasting their music at bedtime, can't you ring their doorbell and say pleasantly, "Hey, my kids are trying to get to sleep," before you call the police? And if you think a neighbor is missing the boat with his or her kids, can't you say, "I was worried when I saw..." instead of jumping right to CPS involvement?

I understand that there are situations you don't want to mess around with. I'm not going to walk into a fraternity house full of drunken 20-year-olds to ask them to turn it down. There are certainly parents whom I would not cross. But in general, if the issue is good intentions coupled with bad judgment, I just can't see involving the state as a first step.

I have been slowly drafting that final post on our CPS case -- slowly because I find it painful. I have seldom felt as vulnerable as the day I invited the caseworker into my home and said, "This is the kind of mother I strive to be," only to have him say, in effect, "Well, I'll have to get back to you about whether that's adequate." I still cannot get my mind around that neighbor's choice to call the police instead of saying, "Let's walk to your house together," or, "Let's call your mom and tell her she should come get you because you're not being safe when you cross the street." And then, as if that wasn't enough, to report me to CPS -- I still can't believe she thought that was a good idea.

If these Redbook commenters are representative, though, she's far from alone. Do people not recognize that calling CPS about questionable parenting isn't like calling the power company about a questionable utility pole? Do they really think it's a harmless choice? CPS caseworkers tend to be underpaid young adults with little parenting experience, confronting some of the most evil things human beings can do. Their mandate is to decide whether parents pose an imminent danger to their children -- not, repeat NOT, to spare you three minutes of awkwardness as you muster the nerve to say to a clueless new neighbor, "You know, we don't usually leave kids alone out here until they're quite a bit older. Some of us find babysitters through the local college/NanniesRUs/etc. -- would you like the number?"

I do agree, of course, that the dad in the story used bad judgment. But parenting judgment develops over time and is shaped by the community a parent is part of. I have learned so much from friends who were willing to say, "Did you ever think about...?" I hate to think of this man's neighbors saying, "Hey, welcome to the neighborhood! We can't be bothered to talk to you, but meet your new CPS caseworker."

Camazotz

Yesterday I was thinking about writing up the story of this month and pitching it to Brain, Child or another publication. Not just as <dramatic intonation> one woman's saga </dramatic intonation>, but as a reflection on shifting societal norms.

An example: when I was a kid, I played all the time in the creek that ran behind our house. A fellow fifth-grader drowned in that creek, but nobody ever told me to stop, or to make sure I had direct parental supervision. Those were some of the most delightful hours of my tenth and eleventh years -- poking around in the mud with my dog, swinging on the branches, naming my favorite spots.

These days a much smaller creek runs through our neighborhood. Honestly, a person would have to work at it to drown in that creek. But my kids are forbidden to play there. This is our fourth year here and they've never set foot in it. When I was a kid the line was drawn in one spot: it was normal for kids to play in creeks. Now it's drawn in another. How do we balance the suffering of the one family whose child drowns against all the hours of fun to be had playing in a creek? How much room is there for individual families to make decisions that go against the norm?

I was thinking that as an illustration I might mention Camazotz, from A Wrinkle in Time. Remember the neighborhood where all the kids bounced their balls and jumped their ropes in time? One child was out of sync with neighborhood expectations and had to be reported to the authorities for inappropriate ball-bouncing. I am not willing to live in Camazotz, I was going to say in my essay. But I was talking it over with Elwood last night when it occurred to me: even in Camazotz, for heaven's sake, children played outside without their parents.

The larger reason why Camazotz isn't a great analogy is that we're not out of sync with neighborhood norms. Yesterday I was talking about this on my front porch with another neighborhood mother who used to work for CPS. Two kids came running down the middle of the street, no parents in sight. "Look! Negligent parenting!" I said, and she rolled her eyes at me. A moment later a different trio came along from the other direction. "More negligent parenting!" This is the way our neighborhood runs -- our kids have some freedom. We all keep an eye out for them. We like it that way. Or at least most of us do.

My anger toward the neighbor who reported me has waned since last week, when I ranted to one of my friends, "I just want to go over to her house and...and...and spit on her porch." (That's me all over: my wildest revenge fantasies run to reckless acts of public expectoration.) I cannot stop wondering what she was thinking, though. What good did she imagine would come out of this for Joe? Because I tell you true: her decision to report a calm and carefully reasoned mothering choice to CPS has caused more stress to my children, and will leave a more enduring mark on them, than any consequence I would ever impose.

RIP

Harriet McBryde Johnson died last week.

I had never heard of her until her 2003 NYT article on Peter Singer, which made me want to stand up and cheer. Sometime in the preceding year or so, in a short article I cannot find now in the NYT archives, the magazine had written uncritically about the practice of killing disabled babies in the Netherlands -- taking a syringe filled with poison and injecting newborns with painful congenital conditions. I sat at my kitchen table and wept, reading it. Two weeks later I wept again when I read the letters page, because not one published response -- not one -- suggested that there was anything immoral about this practice. 

I thought about writing in myself but I could not even think where to start: "News flash! There is a profound difference between alleviating suffering and poisoning a baby with the intent to kill." What kind of world do we live in where that distinction even needs to be made? I was delighted to read Johnson's account of her visit to Princeton -- it is smart, brave, ambivalent, unforgettable. It seems cliched to call her brave, but I cannot leave it out so cliched I will be.

Johnson provided a breath of fresh air in the Terry Schiavo case. The political posturing and media maelstrom made me want to hide under the bed until it was over, but I love her piece from Slate. "Florida law would not allow a husband to kill a nondisabled wife by starvation and dehydration; killing is not ordinarily considered a private family concern or a matter of choice," she wrote. Damn straight.

More than her writing on end-of-life issues, it is her views on day-to-day life with a disability that will stay with me. I have spent a sizable chunk of my professional life in long-term care facilities, trying to help people who, like Johnson, have brains and muscles that don't communicate effectively. She wrote in another 2003 NYT essay on the stripping away of small freedoms that many of her friends had faced, of the small things, like long hair and a gold bracelet, that marked her as an outsider when she visited them.

The essay made me think about my own choices in my work with with chronically disabled people. In long-term care, at least 75% of an SLP's workload is assessment and management of swallowing disorders. Can a resident keep liquids out of his airway? Can she chew well enough for adequate intake? If not, we recommend thickened liquids or pureed foods or both. Many SLPs approach these decisions conservatively, since aspiration pneumonia can be rapidly fatal. If you suspect aspiration and don't recommend thickened liquids, you could get sued in a hurry. (Oh, yeah, and also your patient could die a painful death. Much as I hate the tendency to emphasize the potential lawsuit over the human cost, it's easy to think that way.)

I will always remember Johnson's choice to decline a feeding tube, even when she weighed 70 pounds. By the time I read her essays I had moved away from the hyper-caution of my first year of practice, preferring to outline options and risks for families and encourage joint decision-making. Johnson's voice, though, is a potent reminder of the ways that we strip away patients' autonomy "for their own good." I'm not going to practice like that ever again. You want to bring your husband some homemade chicken soup? Sounds delicious. Let's talk about how we can keep it out of his airway, so you don't feel like you have to give it to him on the sly. 

I don't know how much clinical work my future holds, since I am in training to be a professor and not a clinician. But I hope I can share Johnson's wisdom with my future students: When you work with people who have disabilities, you can help to make their world a little narrower or a little broader. Go for broad.

Abhominable

All right -- I was always going to be hard to please when it came to the Narnia movies.

ZETZER

Sarah emailed to ask if I had any ideas about stemming the "tsunami of whining" that has invaded her home. In general, my response to whining is feigned deafness, with a healthy dose of goofy. "What's that? [furrowing of the brow] It... sounds... almost... like... English, but I just don't speak Whining." Or I will sing, "Oh where, oh where, has your pleasant voice gone? Oh where, oh where can it be? You can't get what you want if you whine, my friend, so try your nice voice out on me." (So, yeah, the scansion doesn't quite work. But hey, they're preschoolers.)  If the whining is tsunami-esque and you are pulling out your hair and they are whining even louder, I suggest a different strategy. I call it ZETZER.

I believe that most annoying kid behaviors are incidental -- they just go with the territory. Have you ever shaken your head at a rant from the ranks of the child-free? "Those kids! They were whining! And not listening! And-- and-- breathing to boot!" Part of the work of the early years of motherhood for me was getting it through my thick head that my child was usually not being deliberately annoying.

Occasionally, though, I found that a negative emotional reaction seemed to be weirdly appealing to my oldest son. "Hey, I can't get what I want," he seemed to be thinking, "but neither can you. Fair's fair." Out of desperation, ZETZER was born.

ZETZER stands for ZEro Tolerance, Zero Emotional Response. It started in response to hitting -- I expended so much energy trying to teach my oldest son not to hit. Say what you will about spanking in general, I think it's a bad idea for parents who are dealing with aggression. "No! We don't hit! Hitting is wrong! And to enforce that moral teaching, I'm going to...hit you!" But what to do?

In those days the consequence for hitting was time-out; now I usually require acts of kindness or service. Even a two-year-old can put away his brother's clean socks for him, and I think that right actions can nudge kids toward right thinking. The ZET- part of ZETZER is to be absolutely rock-solid consistent in following up, because the "ignore it and it will go away" approach is not your friend in a tsunami situation. To crib from Barbara Coloroso, what is a practical response to whining that leaves everybody's dignity intact? How can you best send the message that whining is a waste of time because it will never, but never, get you what you want? How can you handle it if they are whining about a need that is actually urgent, and not just a preference that you can safely ignore until they lose the awful torturous gouge-your-eyes-out voice? (It could be as simple as saying matter-of-factly, "You really need [fill in the blank] right away. Next time you need to use a nicer voice to tell me.")

The -ZER part is the harder element for me: I respond to infractions as if I am discussing something as remote and uninteresting as infrastructure improvements in Myanmar. If my negative reaction is feeding a behavior in a kid who enjoys a little chain-yanking, I'm going to starve it out. 

Do not underestimate the difficulty of -ZER. You cannot will yourself not to twitch internally when they do the same STUPID thing YET AGAIN. You can only choose to moderate your visible response, a practice I find exhausting when the problem behavior is at tsunami level. In advance, figure out a place to vent your frustration -- a friend, perhaps, who will not be alarmed by a Krakatoan cloud of invective. Don't try ZETZER when you've got a looming deadline, or when the weather is going to keep you stuck indoors for three days, or when you anticipate hormonal chaos. Nobody, but nobody, can push my buttons like one of my children. I wish it weren't so, but alas, it is. If it's true for you too, plan accordingly.

If you are thinking about ZETZER, I suggest a little preemptive problem-solving first. Are they whining because bedtime has been late and they're overtired? Are they hitting because they're bored watching you read blogs and negative attention is better than no attention? Are they disobeying flagrantly because things have been tense between you and your husband and they're trying to draw your fire to divert you from fighting? The fewer times you have to respond in a bland and neutral voice to this behavior that's driving you up.the.freaking.wall, the easier it will be for you.

Verb. sap.: I have found that I often see a temporary spike in the target behavior when I begin to work on it assiduously. "We do not hit." Oh, yes, we do. "We do not hit." You just watch me! "We do not hit." Tra la la, were you saying something, Mom? I'm busy smacking my brother over here.

Despite its difficulties, I have found that ZETZER can be really effective when I am caroming toward crazy and my kids seem to get a kick out of pushing the cart toward the cliff. Most of the time, patience and consistency will do the trick with annoying behaviors. But when they are creeping up (or exploding) instead of inching down, ZETZER is my secret weapon.

An Empty Space

"Are we having a new baby soon?" Joe asked us last night.

Let Them Eat Emergency Rooms

There is no problem with access to health care in this country, says GWB. Why, if you need to see a doctor you can just go to the emergency room.

Yeah.

I have been thinking all afternoon about health care, remembering when we scrounged our own pathetic high-deductible health insurance. I am remembering the night I walked the floor with my oldest child while he screamed. "Better bring him to the emergency room," said the nurse manning the 24-hour helpline. "He sounds miserable." I knew it was an ear infection; I knew he needed care. But did he have to go to the ER? Could we make it until morning with Tylenol and TLC? I paced; he screamed. I cried; he screamed. I prayed; he drifted off to sleep. We saw the doctor first thing in the morning, but I will never forget the tension in his feverish little body while we waited for the pain reliever to kick in.

I am remembering the Saturday that my second son gashed his head on an end table, and how I hated myself for thinking, "If we don't get it stitched, how much of a scar will there be? If we do get it stitched, how much of a bill will there be?" A friend had just paid a thousand dollars for an ER repair of a very similar injury. A thousand dollars -- it took my breath away.

Here in the land of opportunity we think that poor must mean lazy or irresponsible. If you would just get a better job, you could have health insurance. If you would just plan better you could afford your medical bills. But I have a different perspective on that than I used to. While my husband was working toward an academic career, I wanted children and I wanted to be with them full-time. I didn't complain about our little house in a dicey neighborhood, or about the rattly car that was entering its third decade of operation. When we decided to live without a car, I didn't complain about walking. I could cook you lentils every night for three weeks without repeating a recipe, because lentils were 44 cents a pound and I bought a lot of them. We had no debts and we had no complaints. Or almost none. You know what was hard? Health care.

Toward the end of our time without health insurance, I sold an essay about it. One of the published responses said, in essence, "Quit kvetching and get a job." I tried to shake it off, but I felt ashamed: maybe I shouldn't complain. Maybe I should have put the kids in daycare to give them health insurance.

Almost five years later I have a job (two, actually), and I have health insurance, and I have an even stronger conviction that our existing system is rotten. I reject categorically the idea that the vagaries of the health insurance industry should dictate whether people can pursue their dreams. If you want to stay home with your children (or start your own business, or try to make it in the arts, but this post is specifically about coverage for children), I think it is preposterous that health insurance premiums -- the requirement that we put more money in the coffers of for-profit agencies so they can refuse to pay it to the providers who render the actual services -- would be the thing holding you back. Anybody who has priced individual health insurance policies or faced a medical bill without any insurance discounts can tell you: this system just doesn't work very well for individuals. If you want affordable health care, you need the clout of a group behind you. Like an employer's health plan, or Medicare. Or SCHIP.

I cannot even think about President Bush's threat to veto SCHIP without gnashing my teeth in apoplectic fury. Health care for children is a social justice question. "As ye have done it unto one of the least of these, ye have done it unto me" -- would Jesus tell sick children to suck it up? would he say that their parents should just work harder and get better jobs? "Bear ye one another's burdens, and so fulfill the law of Christ" -- the burden of paying for children's health care is one I am happy to take up.

That's what I told my representative today, and I'd like to encourage you to send yours a similar message if he or she voted against the measure. Every time I get an EOB from our insurer, I say a little prayer of thanks that we have coverage now. I will never forget the feeling of dread I had in those days when a child was sick or injured. Would he be okay? And would we be able to afford the bill? I hate knowing that there are mothers going through that every day, and I hate that GWB is telling them blithely that the emergency room is the solution.

Let's tell him he needs a better fix than that.

Inequalities, Tame and Savage

For my summer class I just read Shirley Brice Heath's lovely book Ways With Words, the story of two working-class communities in the Carolinas.  She looks at the way parents raise children, and at how those children fare in school.  Her book was much on my mind as I read Elizabeth Weil's article in Sunday's NYT magazine, on holding kids out of kindergarten, or redshirting them.

Schools excel, I think, at teaching kids to be like other kids.  They pick up each other's slang; they learn each other's games; they try on each other's values.  But schools routinely fail, IMHO, at meeting the needs of kids who don't want to be, or aren't able to be, like other kids.

I read Weil's article with incoherent fury bubbling in my head.  I have been trying for a couple of days now to articulate why it made me so angry, and I think there are two related reasons from different sides of the special-needs spectrum.  The backdrop, as always, is the NCLB nonsense that drives me nigh unto apoplexy, but I'll mostly spare you that rant except to ask why (oh why oh why oh why) are we wasting so much classroom time and taxpayer money on the preparation for and the completion of standardized tests that measure mostly how successful a child will be at standardized tests?

I cannot read about kids who are either old or young for their class without lugging my own bias into the picture:  I have a summer birthday and I didn't go to kindergarten.  This meant that I graduated from high school at 16, college at 20.  It meant that junior high felt like a three-year sojourn in the sizzling cauldron of Satan's own refectory (not that I was bitter or anything).

When my oldest son was approaching kindergarten, we opted to homeschool because he was ahead of the curve academically and a bit behind it socially.  I expected that this combination in a conventional classroom would lead to his spending much of the year in trouble; homeschooling allowed us to foster the growth of both his heart and his mind.  That angle is missing from Weil's article, as far as I can see.  Yeah, the redshirted kids are confident.  Aren't they bored, some of them?  When they spend their first academic year studying things they've already figured out, doesn't that teach them that school is a snore?

I don't have personal experience with schools that prioritize gifted education.  I do have ample experience with schools that regard support for the smart kids as a frill.  Some smart kids entertain themselves.  Some try to blend in; some make trouble.  It strikes me as a staggering waste of human potential to keep kids sitting quietly in their seats for six hours a day, 180 days a year, while they are bored out of their skulls.  What happens to kids who spend years being told implicitly that they're too smart for learning?  If they're even older when they enter kindergarten, it only amplifies the boredom factor.

Mostly, though, those kids will get by.  I'm not so sure about the kids at the other end of the spectrum.  For lower-income families, schools are a crucial source, if not the only source, of services for special-needs kids.  Federal law requires schools to provide those services starting at age 3, but [SLP horror stories typed out and deleted here] it doesn't always work out that way.  It often gets easier in kindergarten, when the teachers join with the families in saying, Hey, we've got a problem here.  Should we really be lengthening the time these families spend in limbo?

At the agency where I work, we talk every week about the school district dropping the ball with families transitioning out of early intervention services.  The middle-class families can ask their lawyer pals to write letters saying, "Actually, providing these services is a federal mandate and not a serving suggestion.  Are you going to get it in gear or pay for this kid to receive services privately?"  The lower-income families are a lot less likely to have lawyer pals, a lot less likely to navigate the appeal process successfully if services are denied.  Lower-income families with preschool-aged special-needs children are seriously underserved, and delaying school entry for their children will only exacerbate the problem.

Here's the thing:  maturation helps in a lot of areas, but sometimes kids need intervention and not just time.  Symptomatic lead poisoning is not a self-limiting problem.  A genetic predisposition to language problems does not resolve spontaneously in an impoverished* environment.  And kids who struggle with spoken language may well struggle with reading, in ways that simply will not improve on their own.  It compounds the harms these kids face if we use arbitrary timelines to keep them out of school.

*"impoverished" meaning "not providing adequate language stimulation," as distinct from "poor"

This is too long already and I haven't even touched on the biggest question:  what about family culture?  That's why I kept thinking about Shirley Brice Heath's book, with its careful descriptions of working-class families and their parenting practices.  I have been sitting here for ten minutes trying to condense a hundred pages of her book into a couple of sentences, and I guess it boils down to this commonsense observation:  if you grow up in a community where dropping out is the norm, you are far less likely to succeed in school.  You can spend another year at home, but it won't teach you that "I see Emma and Ella sitting quietly with their hands in their laps" is code for "So sit down and quit fidgeting before I yell at you."  Another year might provide you with the brain development to map phonemes to letters a little less effortfully, but you probably won't have any more books in your apartment and your mother probably won't have any more time to sit down and read to you.

And that, my friends, raises a host of thorny questions which I am not even going to attempt to enumerate tonight.  Please do discuss if you're so inclined.  I will leave you with one last thought, which is that for five- and six-year-olds, twelve months will always be a significant chunk of time.  As long as kindergarten eligibility spans a calendar year, the Day 1 kids will always be more mature, on average, than the Day 365 kids -- it matters not a whit whether those days are January 1 and December 31, or July 1 and June 30.

To be a kindergarten teacher is to confront every day the breadth of the range of children's development.  It troubles me that schools seem to view that range as something to be compressed, and not something to be celebrated.

In Which I Pull Plato Off The Shelf To See What Socrates Said About Roth IRAs

I haven't paid much attention to Linda Hirshman.  Her name conjured up vague images of incensed bloggers burning through bandwidth in their outrage over her errors, but there are lots of incensed bloggers and lots of scorched bandwidth out there.

Yesterday I happened to read her piece from Wednesday's NYT (hey, Jody, if you see this, how do you do that cool linky thing with the non-expiring RSS feed of NYT articles?) and I had to wonder what I'd been missing.  Why, exactly, should mothers Get To Work?  Is it so we can boost the GDP? so we can find true fulfillment, far away from the annoying barracuda children we are foolish enough to enjoy? so we can retire in comfort, unafraid of our husbands' possible foibles and faithlessness?

I googled around a little, but I have to say, a person who compares herself to the persecuted Socrates sends my Self-Aggrandizo-Meter right into the red zone.  It's been a long time since I read Socrates, but I seem to recall that he encouraged the pursuit of truth, not money.

Hirshman, conversely, says, "Money is the marker of success in a market economy."  She says feminism has failed to be adequately radical, lamenting the decline of views like Betty Friedan's:  "Vacuuming the living room floor...is not work that takes enough thought or energy to challenge any woman's full capacity."  Nowhere, in anything I read before my S-A-M klaxons started going ah-ooo-gah, does she acknowledge the pleasures of time spent with small children, the delights of slow-paced days spent grinding the lenses through which another human being will one day see the world.

How do I reject this? Let me count the ways.

At bottom, Hirshman and I are measuring success with different yardsticks:  I will consider it success when I can say with St. Paul, "I have learned, in whatever circumstances I find myself, to be content."  We have lived on significantly less and on significantly more money than we have right now.  Our goal is not to make the most money possible, but to be responsible and at peace in our situation today.  For what it's worth, I like the middle ground, with less money and more time together.

I have posted before, coincidentally, about how much I enjoy vacuuming.  Does it challenge my full capacity?  Of course not.  But doing it cheerfully is another facet of striving for contentment.  The floor needs to be vacuumed.  I can do it gladly or I can think bitter and useless thoughts about how my husband never vacuums.  (Which he doesn't.  But in the time available to him now that he doesn't work 80 hours a week at a high-paying consulting job, he cooks, tidies, does his own laundry, and takes the kids to soccer on Saturday mornings.)  For me the choice is clear.

Lately I have been thinking a lot about mothers and employment because of my own job -- partly because I am spending a little time away from Pete each day, partly because my job takes me into homes and daycare centers and I talk with mothers, at least superficially as we are scheduling sessions, about their decisions.  I despise the polarization, the pro-employment voices, like Hirshman's, that assume at-home motherhood equals cortical atrophy, and the anti-employment voices that equate any non-maternal childcare arrangements with Brave New World-style creches.  Because (a) my cortex is just fine after those years at home, thankyouverymuch, and (b) there is tremendous variation in childcare arrangements. 

I am using my non-atrophied cortex right now to offer an observation about all childcare and it is this:  caring for small children is not an ergonomically sound undertaking.  The inertia, the entropy, the chaos -- it is a highly inefficient enterprise.  For women with average earning power, employment usually requires an attempt to make childcare efficient -- in other words, reliance on group daycare.  As I mentioned recently, I just don't think it's an optimal setting for toddlers, with the hubbub, the constant competition for toys and attention, the stretched-thin caregivers doing exhausting jobs for little more than minimum wage.  I would like to silence the S-A-M long enough to see whether Hirshman addresses the happiness of young children in between her edicts to their mothers. 

And what about the happiness of those mothers?  Hirshman wants changes to tax law, assuming wrongly that all couples are focused on the bottom line.  What about workplace changes, to increase access to meaningful and consistent part-time work?  I am extraordinarily lucky to have landed in a field in which I can find flexible, fulfilling work that pays me well.  It shouldn't be so unusual. 

What about the needs of women outside the top income quintile?  What about untethering health insurance from employment, so that their children's need for health care isn't driving the job choices of so many mothers?  What about subsidizing childcare workers' salaries, so that the work is more attractive and women can choose it because they genuinely want to do it?  Hirshman would probably reject that idea out of hand, though, because she seems to think that caring for children is work for women who can't manage anything better.

Perhaps that's what irks me most about her writing: its echoes of dated second-wave feminism.  Free to be you and me, as long as you don't want to do anything crazy like spending time with your children.  Girls can too do anything boys can do, biological differences notwithstanding.  But what about those biological differences?  I think about all the oxytocin my posterior pituitary has pumped into my bloodstream over the past decade -- is pumping now, as Pete nurses in my lap.  Oxytocin increases one's capacity for repetitive work, decreases stress responses, facilitates bonding.  I am wired, biochemically, to do the work of mothering my children.  Hirshman's insistence that I should short-circuit the wiring to do work she finds more important is myopic and intrusive.

Here's Hirshman's take on the tasks of at-home motherhood:  "They do not require a great intellect, they are not honored and they do not involve risks and the rewards that risk brings."  Really, I could write another thousand words fisking that, but in the interest of time I'll forbear.  I will point out, though, that last Saturday when I skipped off to the computer lab to  do homogeneity-of-slopes testing and ANCOVAs, it was with a keen sense that I was getting the easy job.  Not that my husband would be doing the drudge work, but that he would be the one thinking about juggling our boys' many needs.

Full-time motherhood stretched me:  sharpened my thinking, shaped my character, satisfied my soul. Hirshman, predictably, disputes the idea that God might have designed the default child-rearing system, but for me the presence of the divine is palpable, when I permit it to be, in the mundane tasks of motherhood.  Which leads me, of course, back to Socrates -- to the Euthyphro, which considers the nature of holiness (in brief: mysterious, but unrelated to masterful money management).  I believe there is an essential and enduring rightness, a quiet sacredness, in the messy work of mothering. Does it pad the CV? Does it beef up the bank account? Does it confer status?  Obviously not.  But a person who compares herself to Socrates might pause to consider what he had to say about such things:  He is richest who is content with the least.

Hirshman excoriates the relativists who say this argument is exclusively about women's choices; she insists that she's a philosopher and philosophy is about what's fundamentally true. And hey, I'm all in favor of public acknowledgment that fundamental truths exist and should shape our decisions. But my observations lead me to believe it is fundamentally true that happiness and fulfillment are unpredictable.  Women's preferences vary; children's needs vary.  What mothers need is flexible options to accommodate those variations -- and not, if you please, any more condescending demands that we disregard what we want and Get To Work.  We've been working.

Ethics and Family Size

I like Randy Cohen's column, usually.  He writes "The Ethicist" for the NYT Magazine on Sundays, if his name doesn't ring a bell, and he strikes me as smart, funny, and frequently on target.  Recently he responded to a woman who wrote in saying, "I want to have three children, instead of the optimal one or two, because I am intelligent and from a desirable class stratum.  May I?" (Paraphrased, of course, and unfortunately while this was hanging out in my drafts folder the Feb.12 column got old enough that now you have to pay to read it.) 

Cohen provided the jocose smackdown that this woman had coming, but he didn't stop there.  He went on to list ethical family size choices: zero children, one child, two children, or occasionally three children.

Ahem, says this mother of four.

Let me be frank about the limits of my knowledge of population issues:  I am not an ecologist, not a sociologist, not a populologist (or whatever one would call a person who studies the impact of population change).  I have found the population debate to be so polarized along political lines that it's difficult to find accurate information.  But I do not think I am unusually ignorant; I think most people are in the same boat.

I do know that Malthus was not a prophet. There is an upper bound for sustainable population somewhere, but it is far higher than he estimated.  The UN is now saying that underpopulation is a serious concern.  Why can't we leave the 70s ZPG rhetoric in the 70s and have a real conversation about what's at stake?

One piece of information usually missing from the debate is this: resource consumption matters more than straight numbers in determining population's impact.  A family of three living in the exurbs in a 3400 square-foot house, with two Yukons in the garage and a pantry full of foods from far-flung places, will have a far larger ecological footprint than a family of ten in rural Namibia.  And yet when the NYT wrote about a struggling large family in Malawi, the first batch of responses said unanimously:  Get those people some contraceptives.  That's the problem here -- all those kids.

If we see kids as a drain on the planet's limited resources, if we deny the truth that children enrich the world, ugliness ensues.  When I used to think that we were in imminent danger from overpopulation, I would feel a secret surge of relief at news of terrible natural disasters.  At least that earthquake means 40,000 fewer people sucking up our natural resources!

Yikes.

Catholic teaching on family size is often misconstrued as a not-so-secret bid for heedless global hegemony.  But Catholic couples are not instructed to crank out as many babies as possible; they are called to balance generosity and prudence, to say Yes to the chance of another baby unless good reasons ("iustis causis," CCC 2368) lead them to say Probably Not.  Even before they have children, this teaching can help couples make a positive difference in the world.

NFPing women are not excreting synthetic hormones into the water supply. Couples may be willing to live more simply if they are challenged to focus on generosity as well as prudence.  For my own part, I would never have thought about having a baby while my husband was a grad student without the example of other Catholic couples; I know I would not have studied Amy Dacyczyn's books with such alacrity, nor would I have learned so many ways with lentils.  Most of the time, a frugal lifestyle is an environmentally friendly lifestyle.

Often large families are more efficient than small families.  If you have one boy and one girl and their clothing and gear are all purchased new, your family's footprint just got a lot bigger. If you're buying secondhand and passing down, your resource consumption in that area is smaller even though the number of consumers is larger. Large families may also be more likely to make choices like home-laundering cloth diapers, because they expect the up-front cost to be amortized over many more months of use.

Large families may also be more efficient when it comes to food: less waste, more beans.  I know I throw out a lot less food than I used to -- in part because I have more practice using it up, but also because I have more mouths eating it.  We ate low on the food chain out of necessity for a while, and necessity became habit.

There are also intangible benefits to living in a larger family.  In most large families, it's obvious that the pie can only be cut into so many slices.  Kids see that selfishness has consequences.  I am doing my best to raise generous children, who see the importance of sharing the pie even though it means smaller slices for them.  I am doing my best to caution them against a feeling of entitlement, an attitude that says, "Maybe air conditioning is bad for the environment, but I'm far too hot to keep the thermostat at 82.  Let someone else sweat instead."

I am raising four sons who think it is normal for 6 people to share 1750 square feet, who prefer not to hop in the car for every outing. One day last year when I told them we were going to drive the half-mile to the library, they said, "Are you crazy?"  "Mom has lost her mind," one said to another, "she's driving to the library."

In writing this post I have wondered about the long-term effects of our choices.  Will they grow up to think McMansions seem lonely and odd?  Will they be eager for more space?  I expect they will grow up to disagree with me about many things.  I hope we can always agree on this:  an unexamined conviction is not worth holding.

And yet it is a given in many circles that large families are environmentally irresponsible.  Despite the fact that environmental impact does not increase in a linear fashion with increasing family size, despite the buzz about the many (and costly) needs of the aging Boomers, despite the consequences of underpopulation -- it's aphoristic for many Americans that having fewer kids is the optimal choice.

I'm not telling anyone else to have a large family.  I'm only asking that those who prefer small families bear in mind that the questions are complex, and that their idea of "supporting reproductive choice" ought to mean leaving room for women who want to continue having babies.

Before I end, may I encourage you to be charitable in your comments?  There are women with six and seven children who read this blog; there are women with one child or no children.  There are lots of different political convictions rattling around.  We all agree that children consume resources and that some resources are non-renewable.  But here's the thing:  I would have more money in the bank, probably, if I had fewer children.  I would also be immeasurably poorer.

The Making of a Three-Eyed Werebear

This is a post I began ages ago, when I wrote about my oldest son's nearly catastrophic birth.  Near the end of that post I said I'd write more about learning to be a mama bear instead of a mama sheep, and I started this right afterward.  But it had been languishing in my drafts folder ever since. 

Then Jane L., whose recent comment about the doctor who delivered her first baby has made me laugh over and over, left another comment that inspired me to dust this post off.  I hope that many of you find it unnecessary, that many of you already have such comfortable relationships with doctors that you say, "Duh, Jamie," and go skipping elsewhere in the blogosphere.  But I suspect that some of you, like me, have occasional trouble feeling like you're on equal footing with your children's HCPs.

The truth is I am not usually very bear-like.  Most of the time I am soft-spoken and conflict-averse.  Nobody messes with my kids, though, and perceived attempts at same can induce a surprising metamorphosis.

The three-eyed-ness came about because I have looked at the issue of parents talking with HCPs through three different lenses.  First I was a health care worker myself, and then I became a mother, and then I became a breastfeeding counselor helping frustrated mothers.  In reverse order, here are some of the things I have seen through those lenses.

When I talk with mothers who are saying, "My doctor says I have to..." or "My doctor is making me..." I encourage them to consider a different perspective.  (I would like to tell them to reject such thinking out of hand, but it would be a mite inconsistent for me to counter inappropriate bossiness by being inappropriately bossy.)  I pay my HCPs for their opinions.  I do not give them money so they can strip me of my autonomy, or leave me feeling incompetent as a mother.  If a mother is feeling backed into a corner or pressured to do something that makes her uncomfortable, I suggest that she reframe the discussion with a phrase like this:  "So your recommendation for my baby is that I consider..."

I do not say it with an adversarial or unpleasant tone.  It is simply intended as a reminder -- to both of us -- that there's more than one way to skin a cat.  May I deconstruct? 

So your [not God's, not even the entire medical community's]
recommendation [not ukase]
for my [let's remember who has to consent here before we proceed]
baby [small vulnerable person for whom I will walk through fire]
is that I consider [because I am a competent person and you can be certain that I will weigh my options in this situation]...

Part of my job as a breastfeeding counselor is providing mothers with references they can take to HCPs.  Many doctors are pleased to learn about Tom Hale and his work on medication use in lactation; they welcome an informed alternative to the PDR (guiding principle:  "If we tell you not to take it when you're nursing, you can't sue us after the fact").  Any doctor worth his salt knows that things change in medicine and few (if any) of them have time to keep up with all the journals they might like to.  A mother can say, "Hey, I found this article from the British Medical Journal that suggests an alternative."  It doesn't have to be a big hairy "you-are-out-of-date" confrontation because a low-key exchange will do the trick in many cases.

When stressed mothers call me about difficult doctors, I encourage them to remember this:  you are the expert on your child.  Other people can be experts on teeth or ears or lungs or whatever, but they can't see the whole child as clearly as you can .  Once I was told by a dentist that my 2yo son needed to wean before we came back.  I wish I had said what I was thinking:  "He is more than teeth.  I'll have to see if he's ready for that.  What else can we do about the decay in the interim?"  Instead I nodded and seethed and never returned.  (The end of that story, since there are many many similar stories out there, is that I subsequently found the world's kindest dentist and at age 4 my son had two fillings, painless for all concerned.  He weaned not long before his fifth birthday and has perfectly normal teeth today.)

As a new mother dealing with HCPs, my biggest problem was fear of conflict.  It was hard for me to see a middle ground between meek compliance and teeth-baring hostility.  Of course there is an enormous middle ground, and I have grown more comfortable inhabiting it.  I was surprised to learn that I could say, very pleasantly, "What's the rationale for that?" or "What are our other options?" or "You know, I don't feel comfortable with that recommendation," and send a conversation in a much less stressful direction.  (Maybe you all grew up in homes where healthy conflict was the norm, but I emphatically did not.)

I also had to learn not to be afraid of other people's opinions.  While I was working in the hospital where my oldest son was born, I went to NICU rounds and heard the irritated gossip about quirky and demanding parents.  As the mother of a NICU baby I did not want to seem quirky or demanding because I did not want to provide amusing stories at NICU rounds.  Afterward I was so angry with myself when I thought about the times I had quietly given in.  Never again, I vowed, would I let anxiety about what someone else might think or say keep me from doing what was right for my child.  I can't say I have always stuck to my resolution (and I hate those muttered "that kid needs a good spanking" comments as much as anyone does), but I do my best. 

One other thing I wish I had known earlier:  if you can't get what you need from your HCP, go elsewhere.  When my first son was born, my husband was a graduate student and money was very tight.  I took Alex to public health for well-baby exams and immunizations, but the public health nurse practitioner and I had a -- what's the opposite of a harmonious relationship?  Can people have cacophonous relationships?  Because the bad vibes between us were abundant, and amplitudinous too.  (Dictionary.com says amplitudinous is not a word but I say puh.  It ought to be a word.  If you are part of the OED staff and you are looking for a citation for amplitudinous because how else can one describe the intensity of some kinds of dissonance, go right ahead and cite me.  You heard it here from yours humbly.)  I never left there without feeling like I was a bad mother overlooking serious health problems in my child. 

Once in particular, my son had had been fussy and had a cold.  When we went in for his well-baby check, he was much less drippy and much more happy but he had some fluid behind his eardrum.  The NP said he needed a ten-day course of amoxicillin; I asked what would happen if we waited a day or two to see if he continued to improve since he had no fever and seemed to be so much better.  "Oh, you don't want to do that," she said imperiously.  "He could get meningitis."  Yeah, and we could get hit by a bus on the way home, too.  From that encounter comes one of my firmest convictions about health-related decision-making:  I don't do scare tactics.  If you have incidence data, if you have solid information on risks and benefits, then let's talk.  If you can only offer me arm-twisting and improbable bogeymen, I'll take my children elsewhere.

After too many public health well-baby visits that left me feeling like my child was an agglomeration of inadequacies waiting to be identified, I opted to shell out the money to see our pediatrician instead.  This was a big deal, given our financial straits at the time and my own frugal tendencies, but I quickly decided it was money well spent.  That pediatrician told me something I will always remember:  he said, "In medicine there's almost always more than one way to do things.  Anyone who tells you otherwise probably just doesn't want to take the trouble to learn something new."

Do not think that I am in a hurry to bash HCPs here, because I have also been the one in the white coat.  I have sat across the table from angry, frustrated patients; I have had that sinking feeling when the receptionist whispers, about the family I am scheduled to see in ten minutes, "She's not a very nice mom."  One of the reasons it is important to me to keep my interactions with HCPs pleasant is that I know just how it can feel from the other side.

When I started my last job I walked right into a nasty situation:  nursing staff complained that a patient's daughters were adamantly rejecting my predecessor's recommendations.  "They just don't care if he dies," said one angry nurse.  "They're very unhappy," said the social worker.  "They're not the only ones," I thought to myself.  But I took a deep breath as the social worker called them to introduce me, and I asked them to tell me more about what was going on.

It turns out that a two-part regimen had been recommended, and they thought part B was adversely affecting their father's quality of life.  They didn't object to part A in the slightest.  "Oooohh," I said (that's me, ever articulate).  "I don't see a need for B at all.  I was very concerned about A, but I certainly see why you wouldn't want B."  I kid you not:  three minutes, problem solved.  Keep A, scrap B; everyone's happy.  Their father died quietly in his sleep a few weeks later of an unrelated condition.  I hope his last days were peaceful.

What I want to remember from his situation (aside from Don't Borrow Trouble -- I was pretty stressed about that phone call beforehand) is the fruitlessness of hostility.  The nursing staff saw it unequivocally:  the daughters were heartlessly disregarding recommendations that could save their father's life.  The daughters saw it unequivocally:  the nurses were heartlessly covering their butts without noticing how unhappy their father had become.  I am a little saddened to think about how often similar scenarios play out.  No matter which foot the shoe is on, I want to be willing to listen. 

I had thought these three points of view would be more separate, but they seem to have interwoven quite a bit.  Maybe that's as it should be, since the outcome should be trinocular vision and not triple vision.  The principles that guide me in the roles of Christian woman and mother and occasional allied health professional mesh nicely, I think:  Do unto others.  As you do it unto the least of these.  First do no harm.

I am reading back over this with a critical eye and thinking, Honestly, Jamie, didn't you know this stuff before?  But I didn't, and the learning was painful, and so I am going to go ahead and post it in hopes that it may prove useful to another mother somewhere.  Reluctant werebears, unite!

Easier

So after my high-drama post about the arrival of my second son, I felt compelled to post again in case I frightened anybody considering another baby.  I have muffins in the oven (if you do not have Amy Dacyczyn's universal muffin recipe, go right now to your library's website and reserve The Complete Tightwad Gazette (or volume two as originally published) so that you too can use leftovers profitably in eclectic muffin combos like apple-pecan-butternut squash), and a cup of coffee at my elbow, and...a toddler reportedly lying across the dining room table.  Back in a flash.

...Okay, so while my older two are playing Attila, Scourge of God (always fun until somebody loses an eye), let me tell you that I spent a lot of time when I first became an at-home mother wondering when things would get easier.  I thought, "It will be easier when he can hold up his head and isn't so floppy."  Or it will be easier when he can stand up so I don't have to hold him on my hip in a dirty restroom stall while I refasten my jeans one-handed.  Or it will be easier when he can talk and I will know what he wants.

Oops, someone lost an eye.  (Figuratively.)  Back after the re-insertion.  You know, if I kept track of how many sittings it takes me to write these posts, it would be a depressingly large number.  But I digress.

Here's the reality:  whenever -- whenever -- babies take a developmental step forward that ought to make life easier, something else arises to make it more complicated at the same time.  As soon as they can talk they say things you don't want to hear. When they're big enough to stand up while you use the toilet, they're also big enough to crawl across the filthy floor and into the next stall.  I think it's a zero-sum game and mostly you have to roll with what you've got at the moment.

Part of my frustration with those first months at home was the way nothing stayed done.  At work I could make lists and check things off.  They stayed checked off.  At home I would finally get the laundry put away and my baby would blow out his diaper all over both of us.  I would get all the dishes washed and suddenly it was time to cook dinner.  A Woman's Work Is Never Done, up close and personal.  I decided to adopt a slightly more cheerful mantra:  Everything Is Temporary.  The lintless toy-free carpet is temporary, but so is the sink of dirty dishes.  The annoying noise Alex made for his entire tenth month was temporary; so were those sweet round cheeks and the hair that was just the color of mine.  Enjoy what you can and don't sweat the rest.  If you can't not sweat it, figure out what needs to change.

Just as things got easier and harder at the same time with one child, they also get both easier and harder as our family grows.  I tell you, I was afraid of having a third child after our experience with the second.  One day in June of 2001 I was talking with a friend who was expecting her third.  "I am not ready," I said flatly.  "It is too hard right now."

But one day in August of 2001 I was feeling more ready and Alex said, "Mom, why don't we have any baby sisters at our house?"  Absently I answered, "God hasn't given us any baby sisters yet.  You could ask him for a baby sister."  "Okay.  God, please give us a baby sister."  That night my husband decided maybe he was feeling more ready too.  Nine months later our Joe was born.  (Alex was fine with the explanation that sometimes God answers prayers in unexpected ways, and that maybe there's a baby sister somewhere in the future.)   I was braced for a rough transition.  I was in for a surprise.

As Marty's big brother, Alex was a terror.  If he was not ignoring Marty, something bad was happening -- as in bloodshed bad.  But he turned around completely when Joe arrived.  One day when Marty went down for his nap and Joe was content I said, "What would you like to do?  Read a book?  Get out the Play-Doh?  I am at your disposal."  He said, "I just want to be with Joe."  He got down on the floor and stroked the baby gently, singing, "Joe, Joe, your brother's here and your brother loves you." 

These days I am never lonely quite like I was when I had one toddler to occupy:  my children can be a lot of work, but they are almost always good company.  I do a lot more laundry these days, but I have a lot more help with it.  Even the youngest pitches in because his older brothers make it look like fun.  (Having a 2yo put away laundry is sometimes a way to create additional work, both in refolding clothes this afternoon and in searching for them on Sunday morning, but we'll keep trying.)  In our family you're expected to do your chores cheerfully; if you grumble, you get to do extra work so you can practice your good cheer.  Slowly, it's paying off.  Small things that plagued me when I had two, like getting the 4yo's shoes on when the toddler was running outside alone, or wrestling a double stroller into a restaurant through two sets of doors, are a snap these days.  The oldest can watch the toddler for the minute it takes to get the 4yo's shoes tied, and he holds doors open without being asked so I can push the stroller right through. 

After many many repetitions of "what is a better way to let him know you're frustrated?" the older two have a reasonable relationship.  They play together harmoniously (if Attila, Scourge of God can be considered harmonious) long enough for me to write posts like this one.  There are dishes to be washed and clothes to be folded (not to mention the Legos dumped all over the dining room floor), but today I am going to enjoy the 2yo who carries a small blue tractor everywhere he goes (including to bed, where it finds its way under my scapula reliably around 2am), and the 4yo who pretends to be Theseus slaying the minotaur when he is not asking to hear Bread and Jam for Frances, and the 7yo who wants to know if the resurrection of the body means he will have opposable big toes in heaven.  Because I have learned something I won't forget:  Everything Is Temporary.

Elegy for a Fricative

Joe learned early on that if you can't combine sounds very easily it's wise to have a big repertoire of individual sounds to get your point across.  We joked that he sounded like a little Xhosa speaker with his tongue clicks.  He used two different kinds of raspberries and a combination of lip smackings to communicate with us.  If you smack your lips three times in my house, I'll expect you to mean sandals, keys, or penis because that's the Joe lexicon. 

All of those sounds I could label and classify.  One of his favorites had me stumped, though:  a fricative I couldn't duplicate and couldn't even find a name for in the International Phonetic Alphabet (yeah, language geek that I am, I looked).  Fricatives are the hissing sounds in a language.  We have nine of them in English* but lots more exist -- the soft b used in Spanish, the two ch sounds in German (one in "ich" and a slightly more posterior one in "buch"), the French r sound (which, if memory serves, is a uvular fricative.  Isn't it nice to know you can talk with your uvula?).  Children with cleft palates sometimes rely on pharyngeal fricatives (sort of a deep gargly sound) because they can't muster enough intra-oral pressure to make sounds like /s/.

In all this panoply of fricatives, though, there's nothing like Joe's sound.  He seemed to take the whole back half of his vocal tract, squeeze it tight and let 'er rip.  It sounded like a combination of a jacked-up guard cat and an angry pressure cooker on the edge of geyserhood.  He used it to mean anything related to "spray" or "squirt":  Windex, shower, catsup, hose.  Last night, though, we passed a sprinkler on the way home and he said "Spray!" (rendered "bay" but close enough for me).  I was curious.  I asked him, "How does it go?" 

He couldn't make his sound.  He tried and came out with a half-hearted Spanish x.

The thing I wasn't prepared for about childhood seen from the other side was its evanescence.  Everything changes so quickly.  I knew the schlocky songs ("Sunrise, Sunset," "Turn Around") but nothing could prepare me for the reality:  in roughly the time it takes to floss, my firstborn has grown from a pink inscrutable infant into a person with permanent teeth, favorite kinds of sushi, and a voracious appetite for science fiction.  Today he lifted me up off the ground.  (And then he promptly fell over.  But he did it.)  I mean, whoa (she says articulately).  How did that happen?

From my children's mutability arises my parenting mantra, This Too Shall Pass, and its corollary, Enjoy It While It Lasts.  The things that annoy me, the things over which I've wrung my hands and gnashed my teeth -- they've faded away like those first teething pains.  (When Alex was cutting his first tooth, I was sure something was seriously wrong with him.  Cancer.  Undiagnosed genetic disease.  Something Really Bad.  I was so embarrassed when his tooth popped.)  Conversely, the things I've loved and reveled in, like Marty saying "No like it very all" to express displeasure as a not-quite 2yo, or Alex's trilling "happy noise" from the same age -- those are gone too.

There is a prayer I often pray:  Oh, God, make of my life a lovely thing.  Sometimes it's on bad days, when "non-hideous thing" seems like a more manageable goal.  But tonight I am thinking hopefully, envisioning the ephemera of my children's lives as jewels on a delicate chain.  The reality fades, but I hold the memories like something precious, something sparkling and beautiful and many-faceted.

Goodbye, Mystery Fricative.  It was nice knowing you.

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*f, v, th, TH, s, z, sh, zh, and h