Physical Health

Our church is going through Rick Warren’s Transformed campaign, and this week we are studying physical health. It’s interesting to reflect on physical health not as some fitness regimen, but as a spiritual discipline.

If I had to make a list of what the world tells me about my body, it would look something like this: my body belongs to me. It exists to serve me: I can push it as much as I need to get what I want done. Its appetites are meant to be filled as much as I want, for the purpose of giving myself as much pleasure as I want. It exists to make me appear good so I have value before others. Aging and sickness are to be feared and dreaded. In short, the purpose of my body is self-worship in the pursuit of image, youth, pleasure, and self-achievement.

If I had to make a list of what God tells me about my body, it would look something like this: my body belongs to God (1 Cor 6:15, 19-20). It is a temple (2 Cor 6:19) and therefore its primary purpose is to allow me to worship God. I should not be dominated by any one appetite (1 Cor 6:12). Aging and sickness are not the end as one day our bodies will be restored in glory (Phil 3:21). In short, the purpose of my body is to worship God (Ro 12:1).

What does it look like to worship God with my body? I prioritize health so I have full energy to do what God wants me to do. I attentively care for my body as I would steward anything else God has given me. I do not idolize my appearance, but see that God values not the outward man but the heart. I see God’s character, image and glory in the many good things my body can enjoy. I identify with Christ when bodily suffering occurs for a moment or period of time.

I think the point is not physical abnegation or excess for our own purposes, but pursuing God in our bodies, which is quite a counter-cultural paradigm shift. And I think as we get older, whether we live out the world’s or God’s beliefs about our body becomes more obvious. As a mid-thirty-something just starting to feel my body aging, I look ahead to folks 20-30 years ahead of me and think about those who have aged well, who are fit with energy to serve God, who attract me to God because of their physical testimony. I want to be like one of those people. I want to be even better now at honoring God in my body than I ever was in my life, and I want to pass on that mindset and lifestyle habits to my children. 

My Beautiful Chaos

“Chaos: When the present determines the future, but the approximate present does not approximately determine the future.” – mathematician Edward Lorenz, of chaos theory

I don’t think anything quite prepares you for the chaos that is everyday life with four little kids. I mean, as an FP who masqueraded as a TJ most of my life, I do a reasonable job keeping a routine and general daily expectations for the kids, but really there’s an unavoidable degree of disorder. There’s the usual, sort of baseline, chaos: putting someone’s shirt on while helping another find socks; flossing for one while squeezing toothpaste out for another. Answering one question while trying to listen to a very slow and convoluted description from someone else. The usual multi-tasking of chores while trying to be simultaneously aware of various emotional needs and verbal dialogues.

Then there’s the bigger derailments, like one person having a bad mood all day, or another not napping all day, or what happened this past week: one getting sick, followed by others getting sick, followed by my getting sick. It all can just turn on a pin, and go from routine to difficult, or from expected to unexpected, in an instant.

Part of me loves the chaos that comes with a big family. I’ve always loved big, bustling holidays and family reunions; the feeling that there are lots of people who love each other, together making lots of bustle and noise. Well, we definitely have that. We have holidays every single day around here. Can’t say I particularly like the chaos involved in the minivan-gymnastics of buckling in and unbuckling out four kids every time we go anywhere, or in having to clean tons of sippy cups and do laundry all the time. But the crazy, sometimes-loud loving and bustling: I love that.

Still, it can wear on you after a while. For one, it can be draining in an oddly lonely way. I mean, when Dave asks me how the day went, what do I even say? “Well, the house looks tidy and calm now but you have no idea how crazy it was five minutes ago.. I had this really sweet moment with Elijah.. then another moment when I almost lost it at him.. the baby didn’t nap the whole day.. I felt like I was holding her the whole day, though I guess I wasn’t literally holding her every minute.. the kids discovered a puddle to bike through outside and they loved that.. I don’t even remember the other stuff we did.. here, take the baby..” I mean, the other most chaotic time of my life was probably being on the wards in medical school, but even then you had a lot to show for it: a list of scut items checked off, admissions to present, workups to review. I think we have to recognize that the chaos of staying-at-home is a lot less acknowledged and understood.

I find moments of solitude and quiet when I can, but when the inevitable interruption comes (what? how can she be crying already? she was supposed to sleep for another hour!), I try to remind myself, it’s just part of life now, and this too shall pass, for better or worse. Sometimes, I try to tell myself I don’t have to get anything accomplished except for one thing: enjoy the kids. Enjoy the way they play, the way they think, the way they talk (“come w’you?” “I no fart! Emmy fart!”). The way Elijah’s butt sticks up in the air when he crawls into the minivan (a very slow process he insists on doing himself). The way their heads bounce up and down when they run. The way they are always running everywhere, like everything is an emergency. The way their cheeks and bellies and little limbs are so soft. The way Esme gets a double-chin when she grins. Their strange imaginations (the house is a lava lake! We must walk only on pillows or die!). That’s my life: trying to enjoy the beautiful chaos.

Surgical Complications

“There is a saying about surgeons, meant as a reproof: ‘Sometimes wrong; never in doubt.’ But this seemed to me their strength. Each day surgeons are faced with uncertainties. Information is inadequate; the science is ambiguous; one's knowledge and abilities are never perfect. Even with the simplest operation, it cannot be taken for granted that a patient will come through better off - or even alive. Standing at the table my first time, I wondered how the surgeon knew that he would do this patient good, that all the steps would go as planned, that the bleeding would be controlled and infection would not take hold and organs would not be injured. He didn't, of course. But still he cut.”

- Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science

I had a few complications today in surgery. Psychologically dealing with this is always hard for me. It used to be worse: I would keep replaying tapes of what happened in my mind. I wouldn’t be able to sleep. I’d think about what the patient was going through every day. I’d keep thinking, what if I had just done that? it would have all been so much smoother. Why don’t I have a job that doesn’t involve blinding people if I mess up?

It’s not quite as bad now, but it still weighs on me a lot. And it’s hard to talk with anyone who understands: none of my closer friends outside of work are physicians. Dave is probably the closest though he’s yet to actually see a cataract surgery. It’s an awkward thing to talk about with work colleagues—like they say in residency, having a complication is like losing your virginity: you want to get it over with, but you don’t want to get a reputation for it. I’m flying solo for the most part, and while people occasionally commiserate about difficult situations, it usually doesn’t involve admitting one’s mistakes.

It’s exacerbated by the fact that I work part-time. That was always the dilemma of my career: I want to operate. I love working with my hands. I would be really sad if I couldn’t scrub in. But I want to be home the majority of the time. And you just can’t really be the surgeon you could be working part-time: it’s hard to generate as much volume, and you’re not around to handle perioperative issues or track results over time. I picked a field where it’s as good as it could get: I cut into eye or skin one out of the two days a week I work. But it’s not the same.

And then I think: complications are a part of surgical life. I practice in a rural, relatively underserved satellite office, where people are nearly blind before they want to get surgery, so the majority of my cases are harder ones going in. Removing one brunescent cataract is harder than doing twenty nascent ones. Most of my cases are done in a local OR without highly experienced staff. Cataract surgery is the most common and probably one of the safest surgeries done in this country, but it’s still surgery. Things happen. I don’t know if everything will go as planned, or whether some sudden eye movement on the patient’s part, or slip of the hand or loss of visibility on mine, will suddenly change a five-minute case into an hour-long case. I don’t know if an infection or retinal detachment will blind the patient months or years down the line.

And I am not perfect. I’m not perfectly experienced. Sometimes I’m tired, or hungry, or needing to pump, and though I don’t think I let that affect me too much, perhaps it does. In the heat of the moment, when I stare into the scope and feel my heart racing, I don’t always know if I make the right decisions. Perhaps it’s the substrate, perhaps it’s me, perhaps it’s the staff and environment I operate in, perhaps some combination of it all.

I try now to see that complications provide a chance to learn: I suppose the truly tragic thing would be if I never learned and improved. All great surgeons I know have stories about complications to tell, many about situations worse than the ones I’ve found myself in. They are an exercise in humility. They are a keen reminder that what I do is never something to be taken cavalierly. They are evidence of the uncertain nature of medicine, and that empathetic care can sometimes be most expressed in unexpected suffering.

I know complications will happen, but I still hate it when they do. It still bothers me a lot, and I don’t know if that will ever change. But I don’t want it to paralyze me: I want to learn what I can and do my best to move on.

The Inner Voice of Love

“Over the years, I have come to realize that the greatest trap in our life is not success, popularity, power, but self-rejection. Success, popularity, and power can, indeed, present a great temptation, but their seductive quality often comes from the way they are part of the much larger temptation to self-rejection.

"We are the Beloved. We are intimately loved long before our parents, teachers, spouses, children and friends loved or wounded us. That’s the truth I want you to claim for yourself. I hear at my center words that say: ‘I have called you by name, from the very beginning. You are mine and I am yours. You are my Beloved, on you my favor rests. I have molded you in the depths of the earth and knitted you together in your mother’s womb. I have carved you in the palms of my hands and hidden you in the shadow of my embrace.. I will give you food that will satisfy all your hunger and drink that will quench all your thirst.. I am your father, your mother, your brother, your sister, your lover, your spouse.. yes, even your child.. Wherever you are I will be.’

"Everytime you listen with great attentiveness to the voice that calls you the Beloved, you will discover within yourself a desire to hear that voice longer and more deeply.”

- Life of the Beloved, Henri Nouwen

“You must believe in the yes that comes back when you ask, ‘Do you love me?’ You must choose this yes even when you do not experience it. .. You have to trust the place that is solid, the place where you can say yes to God’s love even when you do not feel it. .. But keep saying, ‘God loves me, and God’s love is enough.’ You have to choose the solid place over and over again and return to it after every failure.”

- The Inner Voice of Love, Henri Nouwen

I have been thinking about Ellie’s insecurity and desire for love and approval, how in her it runs so close to the surface. I have been thinking about how a deep grasp of God’s love transforms that, and not suppresses, but transforms the experience of emotions and suffering and criticism.

I came across these Nouwen quotes I wrote down years ago: I bought his book The Inner Voice of Love in South Africa, and it remains a favorite, easy to pick up and reread. But it reminded me how shallow and inconsistent my comprehension and experience of God’s love for me can be. I think when I was more alone in the past, when I confronted insecurities more acutely, I thought about this more, but now my life is surrounded by people. I live with my best friend, and I’m swarmed by little people who need love but give so much of it too—all that obscures the fact that my need to rest in God’s love is not any less. No one, not my husband or kids or friends, can give me that love. And I cannot love any of them fully unless I am replete with God’s love. I certainly cannot teach Ellie about God’s deep answers to her insecurities, or show her the way, unless I am walking in it too.

Raising A Sensitive Child

“… it is primarily parenting that decides whether the expression of sensitivity will be an advantage or a source of anxiety.” – Elain Aron, PhD

During breakfast this morning, Ellie spilled her milk while attempting to pour milk from her cup into her cereal bowl. I sighed in frustration, and asked her to be more careful as I was cleaning up. I noticed a while later that she wasn’t eating; she was sitting there pouting and tearing up. I asked her what was going on, but she refused to say anything. I got more and more frustrated at her silence and at one point snapped, “why do you have to be so sensitive?”

I apologized afterwards, but it made me think about what it means to parent a sensitive child. I’m not a sensitive person, and in fact, tend to have little patience with people who are overly emotional. A lot of this came to a head when I started teaching Ellie math and piano this year: we’d get a point where she’d make a mistake, but instead of discussing why or problem-solving, she’d just shut down. I’d keep gently asking, “what is this note? we just played the same one last measure” or “do you remember which column you add first?” and she’d just sit there, mute. It was hard for me not to get frustrated.

What I gradually realized is that while I am task-focused, Ellie is relationally-driven. While I tend to rebut when criticized, she becomes paralyzed. She is so sensitive to my disapproval that she is unable to move forward or function if she thinks she messed up, especially if she thinks I might be upset about it. I have to forget about the task until she feels relationally restored and emotionally stabilized.

I did some reading about sensitive children: typically they are wired to be very responsive to their environment, whether physically, emotionally, spiritually, or socially. They may be overwhelmed by too much stimuli or changes in the environment, are highly aware, may seem to overreact.

I don’t think Ellie fits all the criteria by far—she has no problems adapting to change; she doesn’t mind busy, stimulating environments—but I do think she’s sensitive in a few major ways. She is very tuned in to people’s moods. She can be overly empathetic, especially when she was younger—one time, she was so upset after seeing a polar bear eat a seal on a nature documentary that she kept crying and couldn’t sleep (there was also a phase where Eric would step on bugs and that devastated her). She is perhaps more easily distracted; sometimes it can take her a long time to finish a lesson at school. Finally, she is easily crushed by criticism, and can take anything negative very personally, even when I don’t mean it that way.

There are a few ways I can help parent a more sensitive child like Ellie better. First, I need to not respond in frustration, but see her sensitivity as a gift: it’s how she sees the world, and the sooner I accept and appreciate it, the sooner I can help her take advantage of the strengths it gives her: she has empathy that can turn into compassion. She naturally seeks to please which makes her responsive to gentle forms of discipline, not to mention naturally well-behaved at school. She is perceptive, which is a gift socially and spiritually. Sensitive people tend to be creative and imaginative, and she is certainly that! Her spontaneous drawings, brilliant imagination, and creative ideas are really wonderful.

Secondly, I need to remember that she needs, and really soaks up, positive affirmation. I need to be mindful of building up her self-confidence, both through positive comments and also applying the gospel so she deeply internalizes her worth in Christ. One study discussed in the Harvard Business Review found that the ideal praise-to-criticism ratio was 5.6 for the highest-performing teams—nearly six positive comments for every negative one. For Ellie, that ratio may be even higher.

Articles also mention things like aiding focus by providing a quiet environment, or partnering with her to achieve goals rather than applying harsh discipline—I think we already do most of that with her, but good to keep in mind.

Most importantly, when Ellie has an emotional response or is shutting down, I need in my heart to be completely and consistently accepting of how she is, because she can sense even small hints of disapproval or can be driven by fear based on my past responses. I need to remember that she may take something personally even when it doesn’t seem remotely offensive to me. I need to ask God to change my heart, and give me a spirit of compassion and insight. I need to listen and understand rather than judge or denigrate her feelings.

And as she opens up, I can teach her more about how to handle her emotions, how to react when people may seem harsh to her. And I can naturally build on the strengths her sensitivity brings, and learn from her when I’m not being as aware as she is of what’s going on with others.

Adjusting Expectations

I think what’s been sinking in the last few days is that expectation really is everything. I mean, I know this—disappointment is a function of unmet expectations—but knowing it and experiencing it are two different things. Over the past few weeks it’s come to light that I need to adjust my expectations, and the result is feeling freed to be grateful, to enjoy where I am, to basically made headway in dying to bad attitudes.

I’ve adjusted my expectations for what I expect from Dave: I don’t expect him to get back by a certain time from work. I know I will take care of the kids alone much more than he will. I will be involved in their schooling and lessons much more than him. I see that God created me to desire being home with the kids, that God gifted me with a flexible job (what kind of surgeon can work two half-days a week?), that God gave me a gift for teaching and creative arts. I see that Dave carries a lot of the responsibility of leading our family in the bigger picture, of taking care of the finances, of growing his career so he will have good job options. I can see and know all of this with joyful acceptance and not resentment, which makes a big difference.

And I adjust my expectations for the kids: I try to approach my agendas and time-tables for the day with considerable flexibility. I expect them to need some of my undistracted attention each day.

I adjust my expectations for myself: I can’t expect myself to function without eating or drinking, so I make more of an effort to actually cook and eat (definitely lost too much weight after this last pregnancy). Amazing how much that helps. I expect myself to need breaks and don’t feel guilty asking for them. I try to connect weekly with at least one friend.

All to say, when I’ve adjusted my expectations, I’m not as clouded by frustration. I can see and hear God more: I experience greater thankfulness and delight. I laugh a lot more. I can be present a lot more. It’s not thinking less of my circumstances or of people: it’s just thinking more appropriately about them in a way that frees me to think more for them, instead of being tangled up in my own grumpiness.

I Love His Post-Nap Face

Journal Excerpt

It’s late, but I do want to say that I feel thankful for the kids. That in itself is a work of God: that I look at my days and feel that. Well, maybe it’s also getting sleep at night.

Don’t have much time to write, but here is what I’m thankful for from today: Elijah singing loudly at the top of his lungs (“TRUCK AND OBEY / FOR DERE’S NO UDDER WAAAY…”). The kids racing around the hall butt-naked before getting a bath. Ellie obligingly doing all the errands I regularly send her on (closing all the blinds, getting me a wipe, clearing the table). Elijah’s squeals of laughter when he sees the others laughing, even though he doesn’t really know what’s going on and just wants to tag along. Esme’s red, plump cheeks right after waking up from a nap. Eric asking sweetly, “Mommy, can you hold me?”

Letter to Esme

Dear Jemmy,

You are nine months old today. You are doing a fantastic, fantastic job of sitting upright with only minimal wobbliness (my friend told me today her child was walking at nine months, but we still love you). You are doing an equally impressive job growing rolls of fat on your extremities and a nice little Cushing’s-like hump of fat on the back of your neck. Your soft little mini-mullet brushes against the hump of fat in the cutest way. Your arms are so chubby you look oddly buff, until of course one realizes it’s all squishy fats.

The best gift you gave us on turning nine months was suddenly sleeping through the night! Real twelve-hour stretches. Your mom feels like she has a new lease on life.

After refusing to touch food for the longest time, sometimes to the point of repeated vomiting if we tried to force some down, you’ve finally started to eat. Turns out what you didn’t like was anything pureed. You’ll pretty much eat anything as long as it’s in huge, choke-worthy, solid form.

The whole food thing, plus your waking up at crazedly-random hours of the night until suddenly deciding to sleep it through, has made us wonder whether you have a stubborn streak, but for the most part you’re pretty congenial. I wouldn’t say placid—none of our kids were placid—but you’re happy to be entertained by your older siblings, and are used to going along with whatever we’re doing. You get a lot of love, Emmy, a lot of love: in-your-face-yelling love, pulling-at-your-feets-while-mommy’s-holding-you love, stuffing-food-in-your-mouth love, suffocating-hugs love, tickling-your-fat-folds love. When younger, this caused you to have a wary look on your face often, but now I think you love it. You smile a lot.

One of the most special things about you is how well you nurse. Mommy’s never nursed a baby out this far. You nurse patiently even when the milk doesn’t come in right away; you’re always willing to feed right before I need to leave for work; you don’t bite with your now-eight teeth. You’re good at telling me when you want to feed, and truly seem to enjoy it even now. I love how your little hand kneads into my chest or reaches up to play with my hair while you feed (or sometimes reaches back to swat my kindle or iPhone if you sense I’m doing something else. You actually nearly prank-called someone once).

You’re so cute! Daddy likes to say. He squeezes and kisses you a lot. You’re our last baby. We love you lots.

Mommy

Being In The Moment With The Kids

I’ve been thinking lately how I need to make undistracted time to enjoy the kids, to be in the moment with them. It’s ironic, how I’m staying at home to do just that, yet either get so caught up doing other stuff I’m not really focusing on them, or get so taken over by tired grumpiness that I’m counting down the hours until naptime. I’m around them, but I’m not really with them.

My friend described this as “getting down on the ground” with her toddlers: stopping whatever she was doing, lying down on the ground and focusing her sole attention on them for a bit. That’s what I need to do: mentally stop myself from running down my to-do list, thinking ahead about what to make for dinner, analyzing the shortest route to put away the assortment of toys on the counter—and instead just be with my kids. When was the last time I took time to simply observe them? Asked them a question without any kind of agenda? Sat down beside them just to be present? Did something with them for no other purpose than having fun?

I mean, sure, I do some of that, but usually only if it can be fit in after I do all my other tasks. But as usual, the most important things aren’t the most urgent things. I think my kids sense when my attention is fully on them, and when I’m distracted. And with four of them around, I think each child senses when I’m focused only on them, or when I’m distracted by their siblings, and that “mommy has time just for me” feeling is important.

There are a few ways to make this kind of time. I think one is just to be attentive and open for unexpected opportunities of undistracted connection with each child—sometimes the best moments are the spontaneous ones. Or the ones that happen after discipline. This involves having a mindset of mindfulness, of being present and tuned in to your kids, so you can catch those moments when they arise. It involves not being so externally committed that you are unavailable or unaware.

Another way is to schedule these times in. Dave and I try to take each of the kids out alone for a date about once a month. We have the regular luxury of dropping off one or two of them with my parents to have more undivided attention for the others. We took Ellie on a trip by herself to D.C. before she started kindergarten, which would be a nice tradition to continue with the others. We make bedtime routines a priority. Other times for undistracted attention might be during dinner, a daily walk, or ten minutes set aside during the evening.

Sometimes I think: God has given me these children to delight in, and how much better would my days be if I did that, if I enjoyed the moment with them. These days won’t last forever.