Category: pediatrics

Choking Hazards

As a pediatrician who discusses a myriad of safety concerns with parents throughout each day, I consider myself a self-appointed pseudo-expert on choking hazards. Honestly, I discuss it so many times during the day that even I want to roll my eyes at the monotony. However, the fear of a missed opportunity ending in a childhood death, motivates me to push through my talk over and over and over. Apparently when you discuss the same topics ad nauseum at work, there is some spillover at home. Once while at a restaurant, my youngest child wanted the grapes that came with his meal. I told him he needed to wait until I cut them into small pieces, because they are a choking hazard. Upping his game 40 decibels, he protested loudly “I want choking hazards.” His sister responded “It’s all fun and games, until mommy is doing the Heimlich on you.” We got some interesting looks from surrounding diners. We are used to it.

But the one thing I had not given much thought to was choking hazards in adults. That is until recently. A little over a year ago, we were having a particularly frantic morning. You know the type I am talking about. The type of morning that makes you feel as if you are herding psychotic, oppositional cats while blind-folded in a car wash? Anyway, after asking one child or another to put his shoes on for the fifth time, I turned to my oldest child, my daughter, who was complaining about not feeling well. She said she did not want to go to school. Having already determined that she was going to school no matter what, with obvious exception made for significant bleeding or other medical trauma, I turned to her and said “you need to get in the car, you’re going to school.” The “missy” was implied.

While that may have been what I said, what I was thinking was “When I was your age, I had cancer. So you’re not that sick. Now get in the car.”

Although I did not say it out loud, I managed to say some other regrettable things between the time it took us to get to the car and to drive to school, which is mercifully only seven minutes from home. I won’t digress too much here, but rest assured I will share it in its full, embarrassing glory in my book.

Despite the fact that I had stopped just short of saying those words, I could not help but feel that I had put that energy out there. It almost did not matter that I never said them, because I put that thought out into the universe in that way that invites the universe to punch you, full force, in the face. It would be several more months before I would understand why she did not feel well that day. And it would be more than a year before I would fully understand all of the reasons that made her feel sick that day….and many days thereafter. Sadly, I am embarrassed to admit that it would take a non-medical person to highlight the severity for me. Although I am no stranger to humility, I have spent the last year choking on those words that never quite escaped my mouth.

This past year has been quite the learning experience, in that euphemistic way in which a particularly brutal, painful experience accelerates personal growth that you didn’t really feel warranted the degree of turmoil associated with the lesson. Then again, I can be a slow learner. One of the most important lessons was really more of a “reminder” than it was a de novo lesson. My much needed memory-jog pertained to comparison and judgment. The reason I deem it a “reminder,” is the fact that on paper I think most of us grasp this concept. ‘Judge not, lest ye be judged.’ ‘Comparison is the thief of joy.’ Feel free to insert additional, illustrative cliches.

But in the moment, we may forget. And by “we,” I mean “I.” The thing that I failed to recognize, as I was hurriedly rushing my kids out the door, was that everybody’s journey is different. Yes, the irony of the fact that I’m editing a book about my own journey is not lost on me. But it took witnessing my daughter’s journey to remind me that we all fight battles, whether they are obvious or hidden, abrupt or insidious.  No one can assume that their journey is any more difficult than that of another, nor can anybody tell a person how to traverse his or her individual path. Truthfully, it brings tears to my eyes to think that I was so quick to assume that just because my daughter did not have cancer, that she would sail so easily through the choppy waters of middle school. Let’s be honest. Does anyone really sail through middle school anyway? Did I mention I was an overweight nerd with permed bangs?

I felt emotional as I drove her to her first day of sixth grade, mostly because I hate that she is growing up so fast. In the recent words of my 4 year old, “Mommy is hate a bad word?” Yes. Yes it is. It is also a completely accurate description, as I would definitely opt to keep my baby girl small for at least a few more years. But as I neared school, I became aware of another emotion….a twinge of envy. I thought back to my first day of sixth grade, which I missed entirely. I had my first biopsy that day, and although I returned to school that week, I would be out for much of the next month having two surgeries. So I felt simultaneously grateful and jealous that my daughter was attending her first day of sixth grade. She looked beautiful….happy….and had the notable absence of permed bangs. What could possibly go wrong? PSA-This is nearly always a terrible question to pose to the universe. Sadly her absences over the year would partially eclipse the joy of seeing her attend her first day.

For likely obvious reasons, I will not elaborate on my daughter’s health or path. It is her own personal story, to be held close to her heart or shared, should she ever choose to, in a manner she sees appropriate. But I will share that she is doing so much better and is back to school full time. My heart aches to think of her pain but melts when I see her smile, hear her laugh, or see the most recent funny meme she has texted me. And while the days of secretly regarding her as my mini-me are gone, they are replaced with endless opportunities in which to be proud of the truly amazing person…gulp…woman she is becoming. The words, upon which I choked these last months, have been replaced with a different type of lump in my throat.

Welcome To The Group…

I would like to think it was fitting that I spent the last night of my dear friend’s (all-too-short) life raising money and awareness at a JDRF fundraiser, for it was diabetes that first bonded us. Unfortunately, we were bonded by another illness, cancer. And it was that illness which caused her to breathe her last breath a handful of hours after I returned from said fundraiser. It was shortly after I emerged groggily from my bed, having perhaps overestimated my ability to stay up so late (and having slightly underestimated the appropriate food to cocktail ratio the night prior), that I learned of her passing. She had been on hospice a few short weeks, and I admit that each day I wondered if this would be the day that the world would lose an amazing woman, mother, physician, and friend.

I admit that my friend and I had what you might call an unusual friendship. It was non-traditional in the sense that our entire friendship occurred through the mediums of text, phone calls, social media, and messenger. Yes, that means we have never met in person. We live in entirely different states, 1300 miles away from one another. Yet, we led eerily similar lives, which united us in ways that likely no two people would ever hope to be aligned.

I first “met” her the day after my youngest child was diagnosed with type 1 diabetes. He had just been admitted to the hospital, and I posted in a private physicians group about what it was like to watch my then 20-month-old son get his first insulin injection. She reached out to me, and the next thing I knew we were chatting away on the phone as she helped me navigate my first few days and weeks as a MOD (mother of a diabetic). Her own son had been diagnosed many months prior, and she already had some experience under her belt with navigating medical devices, carb counting, and the other details of the day-to-day care of a diabetic toddler. She understood what it felt like to be a mother, and a pediatrician, dealing with this disease, and her advice and support were invaluable to me. As I traversed the path from a pediatrician ordering all the shots, to a mom giving the shots, she was the one that shepherded me along the way.

Quite ironically, we had both been pediatric hospitalists (pediatricians who care for patients admitted to the hospital). I had transitioned to outpatient (working solely in the clinic) about 3 years prior to my son’s diagnosis. Shortly after we became friends, she considered and ultimately made a similar transition to outpatient medicine. Sadly, her tenure in the outpatient world would be way too short.

We both had three children, including an older daughter (hers a few years younger than my own) and two younger boys (hers are twins, mine are 5 years apart). Our type 1 diabetic boys even looked a bit like one another, and we kept saying how we needed to get the boys together. My heart aches when I consider that this particular play date never occurred.

As a person who values physical presence and touch, it might seem odd to feel so close to someone whom I have never hugged, other than in a virtual fashion. But sometimes empathy forges powerful connections that transcend physical distance. Something within me recognized and connected with something…many things… within her. And because of that recognition, my life was touched by having her in it. Likewise, because of that same connection, I now feel the void left behind by her absence.

Having been first diagnosed with cancer at an early age, I have had many occasions in which to experience survivor guilt. Most would say it is a good problem to have. And it is. I am grateful to be a survivor. But survivor guilt is a very real thing and in no way diminishes the gratitude of the survivor. And today that survivor guilt weighs more heavily than in the past. It is not merely because she and I both had a similar type of cancer (hers clearly worse than my own), though I have contemplated that particular unfairness on more days than I can count since she was diagnosed. It has less to do with our uncanny similarities, and much more to do with the fact that I know how incredibly heartbreaking it had to be to leave behind three young children, including one with a medical illness of his own. It is the pain of knowing that your babies need you, and that you will not be able to be there.  While I am sure she took some solace in knowing that her children will be loved, nurtured, and cared for, that knowledge cannot erase the reality she faced in these past few weeks. While I am grateful that her suffering has ended, I wish God and the universe had granted her more time with her children (and, selfishly, with the rest of us as well).

However, despite all that cancer has robbed us of with her passing, she managed to touch so many people in such a short time. And those memories will hopefully ease the ache that we now feel without her presence, physical or virtual. One of my first memories of her was during our first conversation, as I stood in my son’s hospital room with tears in my eyes. At the time she jokingly welcomed me to the “group that no one wanted to be a part of.” It broke my heart a year later when I welcomed her to the other “group that no one wanted to be a part of” after she was diagnosed with cancer.  My sincere hope is that her children will know there was one more “group” to which she belonged as well. A “group” that defined her more than her identity as a pediatrician, mother of a diabetic, or even a woman with cancer. It is the “group” of women who support, empower, and touch the lives of others.

Rest in peace, my beautiful friend. Your time here may be done, but your work continues.