Note: Gary’s Dad was hospitalized last Thursday morning with difficulty breathing. Gary flew down to Florida to be with him and oversee his care. He wrote this on the flight down and gave me permission to share it.
It is a trip I have taken before. It is filled with dread and anxiety. It is filled with a sense of obligation and duty and a sense of purpose. Once again, my father is at a crisis point. He is hospitalized and in some significant danger. Each time, it is a bit worse than the previous episode. Each time, yet another illness has been added to the list of threats to his survival.
I travel there as his son. I am not his doctor but yet I am. Every major medical decision is really made by me at this point in time. I know too much. He has multiple diagnoses each of which carry a very limited life expectancy, starting with him being 95 years old.
Add to that lung cancer, kidney disease, about 7 decades of hypertension, atrial fibrillation that used to be paroxysmal (coming and going) but now is chronic, diabetes, a monoclonal protein that could at any time turn into myeloma or other blood cancer, nodules on his kidneys, a large nodule on his prostate. And now congestive heart failure.
I guess you could say the most surprising thing is that he is still alive. He is, if nothing else, a remarkably determined man. He is still, all these years along the road, inspiring to me. He is not the man he used to be. Time and illness have taken away much of his incredible vigor. He is physically and mentally slower than he was. But he still finds a way to love life and even to enjoy it.
He is not like me. I am probably better in math and science than he is, but in the most important ways he is stronger and more resilient than I could ever imagine being. He enjoys people. He tends not to be overly possessive. He doesn’t like to wait; patience is not his strongpoint. He is beyond courageous. He will not let terrible things make him unhappy; his will is immeasurably immense.
He trusts me and I feel like he has always trusted me. At least for as long as I can remember going back to my childhood when I got to drive his car in the parking lot when he went to check out the refrigerated warehouse that held the cold cuts he was responsible for distributing to supermarkets. He trusted me to drive the forklift at too young an age. Both of those experiences were thrilling for a youngster and I was not going to crash and betray his trust.
I will not betray that trust today either.
In a sense, the flight that I am on, this trip to Cleveland Clinic Florida hospital, is symbolic of the larger, sad journey we have been on for some time now. He will die at the end of it. If we do everything right, he will die. There will be pain and loss and sorrow. If we don’t do everything right, there will be guilt as well. There will not be guilt.
This journey is one variation of the journey most children ultimately take with their parents. It is the journey Linda took with her father. It is the way things are supposed to go. The children bury the parents. That is what happens when it goes the right way. And if you are very lucky, you get 95 years, perhaps even a bit more, of meaningful life. Of life that is by and large happy. Even when your parent, your hero is less than he was. Even when the limits of life are more and more closing in on him, when his wife, your mother, is no longer the person she had been in almost every way.
It is really the best you can hope for. It therefore ought to be good enough. It doesn’t feel like it is.
I am grateful for so many things. For the tremendous efforts my siblings have made to arrange essentially everything in my parents lives so that they could go on and live out what remains in dignity and with as much independence as possible. I am grateful for Linda’s eternal support and wisdom. And for the endless good wishes and support from my children and my lovely daughter in law.
I have friends who are kind and a work environment that is flexible and understanding. Nobody says anything more than good luck when I have to cancel patients at the last minute to take one of these emergency trips down to Florida.
But, despite this, I am still filled with the same dread.
Postscript: David was released from the hospital late Saturday afternoon. His breathing greatly improved. Hopefully with an adjustment in his medication, he will be stable and able to continue to enjoy his time in Florida. If all goes according to plan, Gary and I will visit Paula and David to share Passover with them. We are keeping our fingers crossed that there are no medical crises between now and then (during or after, for that matter).
Class ended. Mercifully, after two and a half hours of policy analysis and evaluation, it was time for lunch. A group of six of us, all full time graduate students at Columbia, had a habit of going to the diner a couple of blocks down Amsterdam Avenue after class.
I gathered up my stuff and started walking with the others to the elevator when Dan nudged me to get my attention. Dan, who wore crisp oxford shirts and chinos to class and spoke with authority, asked “Why do you always apologize before you ask a question? I don’t get it.” I looked at him blankly, “Huh?”
He continued, “You always start your question, in class, by apologizing for it. Like, ‘Sorry, but I was wondering…’ Why do you do that?” There was more than a trace of annoyance in his tone.
I felt defensive. I thought for a moment, as we continued walking, trying to come up with an answer. Fortunately, the others in the group were chatting amongst themselves.
“Well,” I began, “I can’t say I consciously knew that I did that….” I was thinking quickly, reviewing what had happened in class that may have triggered Dan’s observation, trying to come up with some kind of reasonable response.
“There’s no reason for it, you shouldn’t do that.” he said, emphatically. “Sorry if it annoys you,” I responded, and I sped up to join the others. I probably annoyed him again by apologizing again.
This happened over 35 years ago. I thought about it then, and I still reflect on it now. Asking questions, in class or in conversation, isn’t that simple. At least not to me.
As I thought about it, many things came into play. First, was self-consciousness and insecurity. Maybe I HAD missed something the professor said. I knew some students, as a result of those doubts, didn’t ask questions. I had enough confidence to ask, but not enough to not preface it by hedging or softening it. I realized, as Dan pointed out, that I likely did start with something like, “Sorry, maybe I missed this, but can you explain….” I wondered whether there was anything so wrong with that.
I don’t think it occurred to me at the time, but it did years later, that it also probably related to being female. I knew that as a woman there was a line to walk, of not coming across too aggressively, but not fading into the woodwork, either. I had a hard time with that. I wanted to ask questions, I wanted to express opinions, but I wanted to be feminine, too. I think I felt that asking a question could be threatening and that was the last thing I wanted to communicate.
Other things probably played into it, too. When I was in college, Merle, my roommate, and I volunteered to work at the campus hotline, called High Hopes. It was a resource for students to call if they had questions. The question could range from the ordinary, like where to get birth control, to the very serious, like what to do about feeling depressed. We went through fairly extensive training – we weren’t supposed to be counselors providing therapy, but the hotline was a first line of getting someone help if they needed it. Some of the training involved attending lectures, getting information about drugs, sexuality and other common issues of concern to college students. We also learned about non-judgmental ways of listening to people and we did role plays.
We were trained, in a basic way, to use Carl Roger’s technique of reflection, which meant listening to the caller and repeating back what you heard them say. This method was intended to help the person clarify what they felt. Sometimes a person didn’t know exactly what they felt, so by reflecting back what you hear, he or she can evaluate whether it is accurate.
In addition, in reflecting, we were trying to refrain from judgment. Sometimes just asking a person ‘why’ can insinuate judgment. If we needed to ask the caller for more information, we weren’t supposed to ask, “Why do you feel hurt (or substitute any other emotion, angry, sad)?” It was better to say, “It sounds like you feel hurt. Can you tell me more?”
This made so much sense to me. I had a number of opportunities to use that approach on my shifts at High Hopes and, generally, it worked quite well. It turned out to be useful in parenting, too.
Leah was quite an emotional child. Supporting her through the roller coaster of adolescence was a parenting challenge. I was most effective when I remembered to use reflection (full disclosure: I didn’t always remember). It validated her feelings, helped her clarify them and often led to insights. I recommend it!
While that technique doesn’t exactly apply to asking questions in a classroom, which is what my classmate Dan was calling me out on, in one respect it does. As a result of my High Hopes experience, I became conscious of not implying judgment in a broader sense – I didn’t want a professor to think I was questioning their expertise, or suggesting they were a lousy teacher. It seemed like a reasonable strategy to start by acknowledging that I could be wrong or uninformed.
Before Dan’s comment, I hadn’t thought about it consciously, much less considered that there could be a downside to doing it. But I was learning that there was. If Dan was any example, it could be annoying. It also diminished whatever came after the apology, I was devaluing my own contribution. I didn’t want to go around apologizing for my existence. As I’ve gotten older, I think I’ve done it less.
This issue is relevant in another setting. As a school board member, and as a trainer of school board members, this aspect of communication comes up often. Frequently at board meetings a staff person makes a presentation and the board is given the opportunity to ask questions. This can be a minefield. A board member can, premeditatedly or thoughtlessly, embarrass the presenter by asking a pointed question. So much transpires in this communication. There can be history or baggage – is there goodwill as a baseline between the board and the staff? A particular presenter can be overly sensitive to questions. Some people are comfortable with public presentations and thinking on their feet and welcome engagement in the form of questions; others don’t. Even educators, who spend their day teaching, get nervous when speaking in front of the school board. We spend time at our workshops talking about modes of communication in order to raise awareness of potential pitfalls. I imagine this dynamic comes into play in many office settings. Who knew asking questions could be so fraught?
So, I’m still thinking about this issue. How do you ask a question?
Note: As a reminder before picking up my story where I left off, Santa Claus had come to the daycare center. I attended and gave Leah and Dan gifts instead of allowing Santa to deliver them and the daycare center agreed to form a committee of parents and staff to look at the holiday celebration for the future.
As Amy promised, a committee was formed. The committee decided that a survey of parents would be helpful in determining what steps to take. Since I had a master’s degree in public administration and was on leave from a doctoral program in public policy, I had taken several classes on social science research methods, so I volunteered to help with the survey design and collate the results.
It’s funny but I remember very little about the survey itself – I don’t recall what questions we asked. I do remember, quite clearly, that several parents used the open-ended question to explain that this was a Christian country and if others didn’t like it, they could go back where they came from. For Gary and I that would mean going back to Queens and Brooklyn, respectively – which were (and are) still part of this country, though some might like to deny it.
I was shocked and hurt. While it was only a small number who expressed their view in such an extreme way, I hadn’t expected it. I was especially distressed that this represented views of people employed by the medical center, a group that I thought would be more enlightened.
Despite my dismay, I collated the results and prepared a summary. Frankly, I don’t recall what the survey said in terms of Santa Claus visiting, but I think it must have been inconclusive. The purpose of the meeting was to discuss the information the survey did provide and give the daycare center administrators feedback on what to do for the coming year.
Once again, I left work and got on the bus to go to the center. A stop after mine another woman got on the bus and I recognized her as a parent from the center. I believe all parents were invited to attend the meeting, even if they had not participated in the committee. We smiled at each other and she sat down near me.
“Are you going to the meeting?” I asked. She nodded and we introduced ourselves and started chatting. I explained how Santa’s visit the year before had affected my family and that I was hoping that the center would consider changing how they celebrated Christmas. She nodded sympathetically. “I can see how that would be difficult,” she said.
We continued chatting as we got off the bus and found our way to the conference room. The meeting had quite a turnout – all the seats were taken. Extra chairs were brought in, not everyone could fit at the table.
The room felt tense to me. I don’t recall why I felt that way, but I know, even before a word was spoken, that I felt defensive. I told myself to breathe and relax.
The director and assistant director led the discussion. I reported the results of the survey, including sharing some of the disagreeable (to me) comments. Perhaps not surprisingly, the conversation devolved. I made my case: Santa Claus may be considered an American symbol to many, but not to non-Christians. Also, Santa can be seen at malls, community centers, churches, on television, etc., so if a parent wanted their child to experience a visit with Santa Claus, it wasn’t difficult to arrange.
The assistant director was outraged by my comments. If looks could kill, I would be dead. “Why should the children be deprived of Santa’s visit?” she asked, leaning across the table, accusation in her eyes. This was clearly a very personal thing to her, as it was to me.
“I was there when Santa came,” I reminded her, “and several kids were crying and others didn’t seem to care.” I was thinking that this should actually be the central point.
“I saw children having fun!” she retorted.
This wasn’t going well. I was getting angrier and angrier. At that point, I stopped participating.
The meeting continued for a bit longer. The director, to sum things up, said that they (the staff) would make a final decision about Santa and inform parents within a week. I left thinking they were going to keep things as they were, given that the staff seemed so invested in it and there weren’t very many parents objecting.
As I walked out of the meeting and headed back to the bus stop to go back to work, the woman I came in with stopped me. “It would’ve been much better if you could have explained it the way you did to me on the bus. You were too strident.”
I didn’t know how to respond. I wanted to cry. I told her I would’ve like to have done that, too. I kept walking.
I sat on the bus thinking about what she said. Was it me? Did I present my case poorly? I know I was wound up, and I probably did come across too strong. But, I couldn’t help myself. I felt under attack.
The daycare center kept its policy of having Santa visit. We went through the same process as the year before.
One day, as we approached Christmas, one of Dan’s teachers, who had been Leah’s the year before, asked us if we had gotten our Christmas tree yet. I said no and left it at that. What was the point of explaining it yet again? Was it willful ignorance?
Leah was to start Kindergarten the following fall. She would be attending School 16, the public elementary school a few blocks from our house. The Albany Jewish Community Center (JCC) offered an aftercare program with transportation from School 16. We looked at whether it made sense to move Dan at that point, too, so that they would continue to be in the same place.
The JCC daycare program was more expensive (Dan was three when we were considering this) – plus the medical center took the cost of day out of the Gary’s pre-tax salary. We had to considered whether we could afford to make the move.
It wasn’t much of a decision to make. We moved to Dan and Leah to the JCC that summer so they would be settled in before Leah began Kindergarten in the fall. In many ways, it was a relief. While Gary and I weren’t interested in putting our children in a Jewish setting for their education or care, it did make things easier for the time being.
It wasn’t the end of our battles over Christmas celebrations, we had a few in the public schools, but none so painful and fruitless as that first one.
When I was in college I remember having long conversations with my friends who were all psychology majors (I was the lone poli sci major in our group). We talked about all sorts of things, from our favorite Beatle to the meaning of life and everything in between. We discussed whether nature or nurture was more important. This was back in late ‘70s when it was still commonly thought that homosexuality was caused by overprotective mothering and autism was due to mothers who were cold and withheld affection. Fortunately we have come a long way in our understanding of those issues (at least most of us have).
We spent many a night in our dorm rooms puzzling over how we came to be who we were. I am still puzzling over that question, though, hopefully in a more informed way. At that time, I subscribed to the nurture side of the equation. I thought family life and surroundings were much more determinative of personality and the path that a person’s life took. I was preoccupied with how my parents shaped me. I saw myself as an uneasy combination of my mother and father – with less emphasis on the genetic aspect of that and more on their personalities and behaviors. Today I see them, genetics and behavior, as inextricably linked.
While we have a more nuanced view of the question of nurture vs. nature, I still think it is relevant to consider it. As a parent and as a society making policy choices, what we believe about this is important.
Data shows that if you are born into poverty, it is much more likely that you will remain there. So many factors play into that, but I certainly can’t accept that it is a genetic predisposition. Therefore, it behooves us to make public policy choices that can help change that cycle. If we look at a person’s health, nature may hold sway. After all obesity, addiction and all sorts of chronic illnesses have been shown to have a genetic component. Being born female or male also has a huge impact on the path a life takes.
Where does that leave us as parents and as a society?
Years ago when Gary and I were faced with some parenting challenges, we consulted with a child psychologist. He shared his belief that children were born with a certain temperament and that temperament could be thought of as a continuum – from easy going to extremely difficult. Children at either end of the spectrum faced challenges. Parenting strategies could help the child move a bit on the continuum, and help them cope, but we couldn’t change their temperament. I found that comforting (unlike the t-shirt pictured above!). Otherwise, it was scary to think we held so much power; better to understand that there were limits to our influence. While Gary and I provided the genetic material for Leah and Daniel, we certainly couldn’t control which ones! His view was consistent with what I was observing in my two children.
Leah and Daniel came into this world with very distinct preferences and personalities. Many of those characteristics were also consistent with general ideas about gender. Prior to having children, I thought most of what was considered ‘girlish’ or ‘boyish’ was learned. Again, it is nearly impossible to disentangle the various influences, and my children aren’t a representative sample! But, I was amazed how some of their behaviors seemed to be classic sex-linked attributes from the get-go. Of course, from the get-go babies are learning, absorbing their surroundings – the colors on the walls in their rooms, the toys we offer, the tone of voice we use – all of which likely play a part in forming gender identity.
With that said, it seemed to me that Leah and Dan arrived defined to a larger extent than I anticipated. Leah was fascinated by people; Dan by objects. He was absorbed by the mobile over his crib, leaves shaking in the wind, cars and trucks barreling down the street. Leah was much more interested in faces. She craved interaction: singing, storytelling, cuddling. Dan liked to be read to, also, but would rarely sit still for it. Early on we wondered about his hearing because he often didn’t do the typical things that let you know he was attending to what was being said. He would appear distracted or tuned out. Over time we realized that in fact he was taking it all in. There are some amusing stories about that actually. Leah, on the other hand, made eye contact, she wanted you to know she was listening. She needed the feedback – she gave it and wanted it in return.
It is possible, of course, that these behaviors weren’t hard wired. Gary and I may have taught them to behave stereotypically, but it certainly wasn’t conscious on our part.
We didn’t offer toy guns to either Leah or Dan. When one of his uncles gave Dan a large plastic tank as a birthday present, Dan took to it immediately. He knew exactly what to do. He proceeded to use it to rumble around the house and blow things up. Dan also had his beanie babies wrestling! All of these activities were accompanied by the appropriate sound effects. Vroom! POW! In contrast, Leah would take her clothes out of her drawers, take the fabrics and rub them on her face. She loved soft textures against her cheek. Leah’s Bobbe, her paternal grandmother, had a shoebox full of fabric scraps, zippers, thread and other sewing paraphernalia (no pins, needles or scissors) that was a treasure trove to Leah. Dan showed no interest in that assortment of playthings.
We tried to baby-proof the kitchen cabinets (emphasis on the word tried). Gary installed latches that required that you insert your finger to release the mechanism. Leah pulled the door as far open as the latch would allow and studied it. After a while she put her finger in and released it. Dan took a different approach. He kept pulling on the door, harder and harder, with as much force as he could muster, until it popped open. So much for relying on the latch to keep them safe!
This isn’t to say that there weren’t exceptions. Leah and Daniel didn’t conform to all of the stereotypes associated with girls and boys. Leah enjoyed roughhousing. When she played soccer or basketball she didn’t shy away from physical play. Dan, on the other hand, didn’t relish that part of sport. While he loved basketball, he didn’t enjoy mixing it up under the boards.
I have tried to figure out if there is something inherently female or male, aside from the obvious biological traits, mostly to understand myself. How do we put ourselves together harmoniously – the feminine and the masculine? Growing up I sometimes felt I was waging an internal war (as I wrote about in another blog post – here).
Is there utility to the concepts of feminine and masculine? Do we need to categorize ourselves and others in those terms?
I admit to feeling some discomfort with abandoning those ideas. Categories help us understand and make sense of things. It seems to be a human instinct to order things by defining and categorizing them. Can we do that without putting each other or ourselves in boxes? Can we leave room to embrace the exceptions?
When I meet someone I want to understand who they are. But maybe I don’t need the categories we have always fallen back on. Is it important to know if the person is male or female? Black or white? After all when we make assumptions based on what we see, it can create problems. But it’s hard not to do it. I think, too, we are searching for common ground and those categories can help find it.
When Leah and Dan were in elementary school I stopped trying to assign their characteristics to one side of the family or the other. I accepted that they were each a unique constellation of attributes. I wish I understood that about myself all those years ago. While I have moved beyond the nature vs. nurture question, understanding that the two are inextricably linked, I am still left pondering identity and how we form it.
Note: Today is Daniel Aaron Bakst’s birthday. In celebration, I dedicate this blog entry to him. I love and treasure him and wish him many, many more happy and healthy birthdays.
about to lose a tooth!
about to graduate!
You could never get anything over on Daniel. He was always very observant. He noticed everything. One time we were pulling into the parking lot to pick up Leah from dance lessons, he was probably 4 at the time, and he looked up at the building and noted, “The curtains in that window are a different color than they were last week.” “Really?” I asked in wonderment. The window he was pointing to was several stories up from the main floor entrance where we went in. I’m quite sure I had never looked up, much less noted the color of the curtains.
Maybe it was related to his being so observant, or maybe it was part of his innate skepticism, but when he lost his first tooth and found money under his pillow, he wasn’t fooled. “It was you or Dad, right?” he asked, a knowing look in his eye. “You don’t think it was the tooth fairy, bud?” I asked. He looked at me, considering the possibilities.
I wasn’t quite sure what the value of the charade was, but I didn’t want to ruin the fun either. “I think you or Dad put it under my pillow,” he concluded. I countered with, “I’m not so sure.” I winked. He smiled.
Each time Dan lost a tooth, he just smiled in a satisfied kind of way as he pocketed the money the tooth fairy left; he knew what he knew.
Some of the Mom’s in my social circle saved their children’s baby teeth – I think there was even a specially made keepsake that you could store them in. The idea was creepy to me. Maybe Dan would’ve preferred that I saved them, based on what happened with his wisdom teeth.
After my experience getting wisdom teeth pulled as a mature adult, I was determined that my children wouldn’t go through that pain. If the dentist recommended their removal, we would get it done sooner rather than later.
When Dan was 18 the dentist said he should have them removed. I took him to the same oral surgeon that we used for Leah, whose procedure went uneventfully several years earlier. We finished the initial visit and scheduled a time for the surgery. As we left the office and walked across the parking lot, a car started to pull out. It almost hit me. Dan, who was walking on my right, instinctively crossed in front of me and hit the trunk of the car hard with the palm of his hand. The guy, it was a male driver, slammed on his brake and yelled an apology. Daniel was not satisfied. “Look where you’re going!” he screamed. The guy replied, “I said I was sorry for Christ’s sake!” Dan’s anger escalated. “You were being an asshole!” “Dan, Dan,” I said, quietly, soothingly, “It’s okay. Let’s just go to our car.” Dan had stopped walking and stood glaring at the guy. “What’s your problem?” the guy wanted to know. “That’s my mother walking here! You be careful!”
I took Dan’s arm and nudged him along. He took a breath and came with me. While I appreciated his protective instincts, I didn’t want him getting into a needless fight. I have to admit, though the incident happened about ten years ago, I still smile when I think of it. I knew then and still know now Dan has my back – literally and figuratively.
That wasn’t the end of our adventure with his wisdom teeth.
We returned for the surgery. I sat in the waiting room, anxious to have it done and have Dan get through it without complication. They finally called me in and told me all went well and Dan could go home. They gave me the aftercare instructions, and we started to leave. The dental assistant called after us, “Wait up a minute!” We stopped and she handed me an envelope. “He wanted his teeth,” she explained. “Really?” “Yes, it seemed important to him.” I took the envelope and put it in my purse. “Okay, thank you.”
Dan and I left. He was pleasantly loopy from the drugs but he could walk okay, which was fortunate. Dan was was over six feet tall and lanky; well beyond the point where I could carry him. We made it across the parking lot without incident this time and got home.
I tucked him in for a nap. He awoke a couple of hours later, less groggy. I checked in with him to see how he was feeling. I gave him the envelope with the teeth. “What’s this?” he asked. “Apparently you wanted your teeth,” I explained. “What?” he was genuinely perplexed. “They told me you kind of made a thing about wanting them.” “I have no recollection of that at all,” he said, laughing. “I don’t want them. Yuck.” I started laughing, too “I thought it was a little unusual, but are you sure?” I wanted to be certain before I disposed of them. “I’m quite sure,” he reassured me. The only explanation we could come up with were the drugs they gave him for the procedure. We were amused by the surprising side effects.
I took the envelope back and dropped it in the wastebasket. To my knowledge he never regretted his decision and he never asked about his baby teeth either, so I think I am in the clear. One less parenting decision to worry about.
Driving home alone, I could barely concentrate on the road.
My eyes welled up.
Will I be a good mother? Can I do this?
what I suspected was confirmed.
This was planned, yet I was overwhelmed.
I took a deep breath,
focused on the road and the sky, made my way home.
Into our little brick house.
I rush to the phone to call Gary.
He is still on rounds at the VA.
I have him paged.
It takes many minutes, seemingly forever.
Wow! This is such great news!
When do you think you’ll be home?
The usual time.
You can’t get out early?
Linda, you know I can’t.
I sighed and exhaled, resigned to this reality.
Okay, we’ll talk later.
I was left to my thoughts.
Eight months crawl by.
I was not glowing with new life.
Queasy, tired, morning, noon and night.
Ear infection, bronchitis, heartburn
I didn’t enjoy sharing my body.
So many rules:
No caffeine, no alcohol, drink milk
I don’t like milk.
Vitamins the size of Pluto.
Alcohol was no loss, caffeine another story.
I’m responsible for this new life!
I don’t want to screw it up!
The due date kept changing.
First May 2, then May 11, finally May 16
That day comes and goes.
The longest gestation in history.
I am ready! Nature has its way, though.
May 20 Gary travels to Long Island to take part 4 of his medical boards.
My parents come up from Brooklyn to keep me company.
At 5 pm they leave me with friends and
head back home, Gary is on his way.
I feel some contractions: Braxton-Hicks or the real thing?
Gary gets home by 9pm.
My water sort of breaks after midnight.
We call the doctor.
He tells us to come to the hospital.
It is before dawn on Thursday morning.
We put the garbage cans by the curb before going to Albany Med.
27 hours, the last 7 hard labor,
an apt description.
First, no progress, then Pitocin – a brutal treatment.
Finally, I push!
Such a relief! My body is almost my own again.
4:39 am, Friday, May 22, I look at my baby.
Labor was hard on me, but she is perfectly formed.
She is part of me and yet, she might well be an alien.
We are one and we are separate.
I understand her; I feel her joy, her hunger, her frustration.
But I am clueless, she is a mystery.
I fall in love over those first few weeks.
Her wondrous eyes, sparking with light.
Her pink, smooth skin.
She emerges into herself.
Curious, demanding, loving.
30 years later and
it is all still true.
[Note: Gary’s remembrance of that same time]
September 12, 1986. I was on rounds when I heard my name over the VA hospital intercom for the first (and only) time in my life. The operator put me through. Linda tells me that we are going to be parents. You could have knocked me down with a feather. I was elated and scared and excited. She asked me if I could get home early that day. But the patients cannot wait. I work as fast and furiously as I can to get out early but 10PM is the best I can do. I remember not being able to concentrate during rounds that day which is the one and only time that ever happened.
That VA rotation was in many ways horrible. Perhaps it was also an experience in growing up. The VA is an underfunded, second rate health care system and, in my mind, a poor excuse to offer people who fought for our country and now are down on their luck. And, to be sure, if you are a veteran and have other health care available to you, you are not going to the VA. So these are the guys who things have not gone well for after they came back home.
I was an intern along with two others on that rotation. Claude Scialdone was another intern with me and he was amazing. I can’t remember who the third intern was but it was not someone who did all that much. Worse than that, our resident who was supposed to guide and support us was an empty suit (perhaps an empty white coat is the better medical term?). And the attending physician came by in the morning to round, as he was supposed to do, but did nothing else. So Claude and I were basically two guys just out of med school trying to keep 40 very sick veterans alive with basically no help.
It was frightening and it was exhausting. On a normal day, when I was not on call, I would get there before 7AM and get home anywhere from 8PM to midnight. When I was on call I wouldn’t get home at all.
One particular patient still sticks in my mind. He had been there since well before I started my 6 week rotation and he was often times confused, weak and kept running fevers. I worked him up for sources of infection again and again. I ordered chest x-rays to look for pneumonia, urine cultures and blood cultures but they repeatedly came back negative. I asked my resident about the guy – I told him I was certain we were missing something. There was something going on and we were failing to identify it. The patient was treading water at best and sooner or later we were going to lose him.
My resident responded by asking me if any of the cultures had grown anything and the answer was no. He then explained that this means he’s fine. He wasn’t fine. He wasn’t close to fine and I knew that in my marrow, but I was out of ideas and had no help.
At that time, the VA closely controlled the use of the newer, broad spectrum antibiotics. If you ordered any of them, you automatically got an infectious disease consult. Normally that might not seem like a problem, but in the Albany VA at that time, it meant you got Dr. Aldonna Baltsch on your floor. Dr. Baltsch was as feared as any doctor I have ever known. She was a phenomenal, dedicated, passionate physician but she was also a perfectionist with a temper. She would come in and yell at you for all the errors she determined you were making. I think she just wanted to make us better doctors but perhaps didn’t exactly know how to go about doing it. In any case, nobody ever wanted to see Dr. Baltsch around.
For that reason, nobody ever called for an infectious disease consult. And the interns and residents became experts at using combinations of older antibiotics to avoid the newer ones that came with a dreaded visit from Dr. Baltsch. But in this moment, I realized I feared the prospect of failing and losing this patient more than I feared Dr. Baltsch.
So I ordered a new wave, broad spectrum, expensive antibiotic when my resident wasn’t looking. I did so because I knew that, while it would bring the holy wrath of Dr. Baltsch, it would also bring her expertise. She came up and was really, really angry. It was as if Mount Vesuvius was going to erupt and the lava would scorch us all. However, as it turned out, her anger was entirely directed at my resident. She never even spoke to me – which was fine with me.
And she ordered exactly the same tests I had ordered. But this time, after they yet again came back negative, she ordered an LP (spinal tap). That came back negative too but she told the lab to hold onto the spinal fluid sample longer for viral cultures and they eventually came back positive for Varicella (the virus that causes Chicken Pox). Turned out he had Varicella encephalitis, an infection of his brain caused by that virus. This is still the only case of Varicella encephalitis I have ever seen.
He was placed on antiviral antibiotics. His fevers ceased after a few days and he finally started to get better. Dr. Baltsch called for a special meeting of everyone in the entire department of medicine basically to humiliate my resident. It looked like vultures picking at a carcass as the entire faculty went after the guy. I almost felt sorry for him.
That rotation eventually gave way to others, some nearly as hard and some not quite as tough.
But fall turned to winter and winter to spring and then I took my boards exam on Long Island. Knowing Linda was past her due date and could go into labor at any minute, I rushed through the exam. It was the only time in my life that I was the first person out of the room on such an exam. That night, Linda had spontaneous rupture of membranes (her water broke). We took out the garbage and drove reasonably calmly to Albany Medical Center where she gave birth after 27 long hours of labor.
She was an amazing trooper. No anesthesia. One single dose of one pain killer. Hour after hour. I spent much of the time with her but also left to do rounds and see patients during parts of the process. At the end, on May 22nd, Leah emerged, perfect, beautiful, alert and brilliant. A miracle in our lives who has been such a great joy ever since.
Leah was a force of nature. It is hard to explain how even in those earliest days she had a spirit and a liveliness and a curiosity. I felt like she saw and understood the world around her in ways that most babies could not and her smile melted my heart. Life had taken on new meaning and I fell in love with her.
Still I was torn. I could not devote less time to my patients than what I felt I needed to. And yet I wanted to be home; to be with Leah; to help Linda who was in some ways almost a single parent. She was exhausted and I was exhausted. And I could not do all I wished I could do. I could not do all Linda needed me to do.
Having already completed all of the hardest rotations in May of 1987, my last rotation of internship was scheduled to be an easy one in a community hospital very near our house. It was going to be perfect. I would be working a short walk from our house, the hours would be reasonable. A long, hard winter was about to give way to a beautiful spring and hours with Leah and Linda. It didn’t work out that way. On the day Leah was born, an intern quit the program and the department of medicine met to determine who should cover that intern’s rotation. They decided I should cover it. I was back in the VA hospital.