Nature vs. Nurture and Other Ruminations

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This is exactly what I’m afraid of!

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.

The Tooth Fairy and Other Dental Adventures

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.

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.

Two for the Price of One: Two Views

[Note: Another foray into prose/poetry]

Boundaries and Expectations

 

September 12, 1986

Partly cloudy skies.

Driving home alone, I could barely concentrate on the road.

My eyes welled up.

 

Will I be a good mother? Can I do this?

Minutes before,

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.

 

Hello, Lin?

I’m pregnant!

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.

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Just a few hours after birth – Leah looking directly at the camera, alert and bright. Gary, on the other hand, exhausted.

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.