Of Medicine and Motherhood

Raising young children is like the residency of parenthood. I was reminiscing on my medical training experience, only to realize it’s not all unlike what I’m experiencing now. The similarities are intriguingly numerous once you think about it: the chronic sleep deprivation that comes from being awake at all hours of the night and trying to catch up on sleep at all hours of the day. The heart-sinking feeling when you get paged just after dozing off in the call room, not unlike the feeling when the baby starts crying right after you’ve settled into bed.

The unpredictability of your schedule: getting an admission just before your shift ends that wrecks dinner plans; the inevitable blow-out diaper or tantrum just before we’re ready to leave the house. The resultant difficulty of finding deep community, of trying to get to know people or attend events whilst navigating call schedules or bedtimes or being quarantined inside with sick kids. The temporally consuming nature of both, to the exclusion of all else if you’re not careful.

The wacky diets: coffee and granola bars and pilfered graham crackers and peanut butter in residency. Now it’s peas, packets of squeezable apple sauce, goldfish, string cheese. Not eating out much and sometimes not eating in much either—finishing the kids’ leftovers while standing over the sink is routine—which is perhaps why I keep losing weight.

Even the dress and accessorizing: gone are dry clean-only items, smart little purses, heels and makeup. In residency it was scrubs and clogs and white coats that accumulated patient notes, extra scripts, lenses and drops. Now it’s jeans and pajamas and diaper bags that accumulate extra socks and chew toys. Both reflecting the unending grunt work: paperwork and dressing changes and bedside consults as a resident; now, diapering and feeding and outfit changes (whoever invented onesies with buttons has obviously never tried to button up a squirming infant). In both cases, dealing with bodily fluids.

And so, it’s like I moved from one residency to another. I was just finishing the last of my medical residency years when I embarked upon what would become four kids in six years. In a way, it feels like we never got a break. I sometimes daydream about what life would be like if we had nine-to-five jobs with no kids: the fantasies usually involve a perfectly-decorated abode, pets (either an Abyssinian cat or a great dane), cultivated hobbies like oil painting and world traveling, and, between my working full-time instead of part-time and having no diapers or college funds to pay for, a hecka lot more disposable income.

But of course, catching the break isn’t the point. The point isn’t imagined comfort but forged meaning. Clearly in these seasons there is risk of burn-out, isolation, and depleted relational margins. But perhaps because we are so pushed in meeting daily demands, we are more aware than usual of how we are doing, with God and with each other. The stressors expose our inner condition and relational status, and in coming together to live the residencies of life with purpose, we become stronger. There’s really no room for narcissism or torpitude in this world of compulsory daily service. It’s a transformative period, probably in ways that only time will tell.

Primary Parent

“Most two-career families sooner or later find that one person falls into the role of lead parent. To be sure, Anne-Marie was actively involved with our boys, taking responsibility for specific chunks of their lives… But none of this is lead parenting. Lead parenting is being on the front lines of everyday life.” – Andrew Moravcsik

The reality is, there is always a primary parent. Dave and I started off extremely equitably; there were long stretches in residency when he did nearly all of the childcare during my demanding rotations. I remember once, Ellie’s daycare closed due to a blizzard. I was in the OR about to scrub in on my next case. Dave was in the ICU about to place a central line. He called out and I kept working.

But over the past six years, I’ve slowly taken on more of the everyday childcare duties. I felt more strongly about being home for the kids, so the transition happened naturally. With the addition of each kid, I worked a little less, and the demands of parenting increased a little more. Simultaneously, Dave’s career has taken off, and like they say, success begets success. The grants and speaking requests and committee invitations multiplied, leading to greater travel. He started studying for a doctorate. He was gone more; I was home more.

So I’ve been learning more and more what it’s like to be the primary parent.

It’s hard. It’s much harder being at home in some ways than being at work. I mean, it’s hard to even talk about why. If I have a hard work day, I can say “there was this refractive error after surgery” or “this patient was upset about this”—a hard day at home would be something like “well I was nursing Esme and praying she would finally sleep since I needed to get dinner cooked and she was so grumpy I had to hold her all afternoon but Elijah and Eric were downstairs bickering again and Elijah started screeching so loud Esme was being distracted and I was thinking why can’t they stop fighting for one moment!”

So yes, it’s unpredictable, and isolating, and unlike Dave’s job, it never ends. I think there’s also a cultural double standard, that women should be the ones staying home with the kids. If I go out with four kids alone, people say almost apologetically, “you’ve got your hands full,” like “I feel so bad for you; how did you get yourself into this?” If Dave goes out alone with four kids, he gets all this “you’re so amazing! Look what a great person you are! They’re all so cute!” Sometimes the double standard makes it harder to feel appreciated, and rarely do I feel understood in the context of the toll it has taken in my career. People who see me with the kids just assume I don’t work or never worked.

The rewards of being the primary parent are simultaneously less tangible and more meaningful. I call it my “every diaper counts” theory of parenting. Every thing I do for them matters. It matters in living out who I am for them, in teaching them, in showing them I love them. Let’s face it: parenting young children involves mostly tasks you could pay anyone to do. I didn’t go to school for twelve years to pour milk and draw Darth Vader and wipe poop. But all of that matters, and these years when they are uninhibited in their openness and attachment won’t last forever, and I have to believe what I do now counts. Everything, the big and the small. Like they say, with kids, quality time doesn’t come without quantity of time.

If I could given myself advice, I would say: guard against resentment towards the non-primary parent. Don’t get upset if he can’t read your mind about how things are done at home; communicate better about parenting issues and daily details so you can be together in it as deeply and smoothly as possible. Remember to schedule regular time away from home for yourself. Remember to be in community with other primary parents. Remember the good moments and write about them.

Reading Comprehension

Lately I’ve been realizing: being able to read is not the same as being able to understand what you read. Being able to understand what you read is not the same as being able to express that well, verbally or in writing.

It surprised me once when Ellie said her least favorite lesson at school that day was reading comprehension: that girl does nothing at home but sit around reading all day!

But I think reading, and reflecting on your reading—reading for meaning, not merely for fun—is an acquired skill. Probably one most of us do so automatically we’re not aware of how we do it. But research reveals that most children do not know how to check their understanding as they read. It has to be taught.

There are some basic tools that help with reading comprehension. One is acquiring good vocabulary. My favorite way of doing that with the kids is reading above their reading level and explaining words as we go. Another is teaching about genres and how they work: the elements of a story (plot, point of view, setting, theme, characters), poem (rhymed verse, free verse, literary devices like alliteration, metaphor, repetition), or non-fiction (headings, maps, index).

Then there are common reading comprehension strategies, to facilitate interaction with the text. Here is a summation of all the ones I found after some brief online research:

Connecting: what else does this remind you of? Is this like or unlike a past experience, other books?

Predicting: what do you think will happen next?

Visualizing: what picture do you have in your head as you read? Can you draw a picture after you finish reading, of how you felt, or a character or favorite scene?

Questioning: what questions do you have before, during, and after reading? What would you ask the author? What are you wondering about yourself, or about what you read?

Inferring: what do you think you can tell about something even though it wasn’t actually written? What clues can you get from the text, or from background you already know?

Fixing: if you don’t know, how do you figure out what it means? What can you tell from pictures or nearby parts?

Summarizing and retelling: how would you tell it to me in your own words? What is the main idea? What’s most important? How do you connect the main ideas? How do you put it all together into one main thing?

Critiquing: what did you like about what you read? What didn’t you like?

I try to insert questions like these as I read aloud to the kids—instead of just brainlessly flipping through each page, I pause and ask, what do you think will happen next? How do you think you’d be feeling if you were this person? Have you ever seen this happen before? What was your favorite part of the story? Etc.

My favorite moment with Ellie after we started doing this was when she said, “Mommy, I think one thing we can tell from this is that the girl is poor, even though it doesn’t say so.” We were reading my new favorite picture book, The Rag Coat by Lauren Mills, and it started a great conversation about what it means to be poor and rich, and what the main idea of the story had to do with her inference.

Here are two helpful links:

Scholastic handout on reading comprehension strategies

Reading comprehension for grades 1 and 2

Why Have Kids?

Wow, that’s a big question. And not one I actually thought about much before having kids. I just always wanted a big family; wasn’t much deeper than a gut feeling. My thoughts on this are in retrospect, though I think in some ways having kids gives you a deeper understanding of the reason for having them.

What our culture would say is: have kids because it makes you feel good, or look good, or gives you purpose, or saves your marriage, or lets you live out your dreams through them. Otherwise, they’re a major inconvenience.

What does the Bible say about this?

The first command God ever gave in the Bible is to have kids (Gen 1:28; later to Noah in Gen 9:7). It’s the sixth day of creation, God makes man, then the first four words he speaks to them are, “Be fruitful and multiply.” Other than that, I don’t think God overtly says anywhere else, “you must have kids!” And certainly not everyone in the Bible had kids. But I think it’s clear that somehow, having kids is part of God’s design for marriage, of God’s intent for us and how we are to reflect Him—the verse right before Gen 1:28 says we are created in his image. It’s not a leap to imagine how the fellowship God enjoys in the trinity, and relationship of God as father and son, are reflected in parenting.

Ultimately, the desire to have kids should come from an understanding of who God is, of his purpose and desire for us to reflect him in that way. And we should do this regarding children as a blessing (Psalm 127), a gift, not as a burden: our lives aren’t about us in the end, anyway. The moments of greatest beauty, joy, and transcendence come often in the most difficult times of laying aside ourselves, and parenting is one of the best examples of that. I mean, the cuteness is all great, but the real reward is my sanctification. No other situation in life calls for me to give of myself and put aside my own needs so completely or constantly.

I’m not saying everyone ought to have kids, and many can’t for good reason, but I think the point is to be submitted to God in your introspection. To examine your motives either way and ask yourself, God, is this glorifying to you, or are my motives selfish? Because if you don’t want kids for selfish reasons, you may be missing out on the greatest chance to live out Christ and become more like Christ you will ever have. And if you want kids for selfish reasons, that will all fall to pieces pretty soon once you actually have kids and realize how much you can’t do it on your own or for yourself.

If I had to describe what having kids is like, I’d say it’s like living in a broader realm of emotional and physical experience. The highs are higher; the lows are tougher. There is the altered travel and social lifestyle, the dealing with bodily emissions, the chores, the periods of savage exhaustion: but then there are the moments of heart-turning joy and sweetness. The look in their faces when you know they’ve understood something. The times you realize they are revealing something deep about yourself. Finding them dearer because you are caring for them, because of the lows. And there is no purer opportunity to share the gospel: to take these little beings, unfiltered in their sin and their wonder, and live out the gospel. That is a reward all on its own.

Parenting As The Parented

Parenting is unique in that it is something we all experience before we set out to do it ourselves. It's impossible to go into it with a blank slate: maybe we had a bad experience and vow to do it differently. Maybe we had great ones and try to do it all the same. Or more often, it's a mix of the two. And really, our concept of how well or poorly we were parented is a nuanced, changing thing, changing as we ourselves change. Changing as we ourselves parent.

You only have to look as far as siblings to see this. While we had the same general experience growing up, something my parents did that affected my sister deeply may be something I barely remember. Every time I hang out with Dave’s sister, I’m similarly impressed by how the same things their parents did imprinted in differing ways or extents in her life compared with Dave’s.

Our own valuation of how we were parented is hardly linear. We start off not knowing anything different; then most of start to evaluate our parents in our teens to early twenties. We see their fallibility, compare them with our friends’ parents, place their worldviews and values in the context of larger culture or our own evolving beliefs. We try to perceive what has been ingrained; we accept some parts and reject others. This happens more deeply and exhaustively after marriage, as assumptions from our upbringing come to light, and as we decide together what to incorporate into our own parenting. Then we become parents ourselves, maybe seeing how difficult all that theory can be to put into practice.

Probably the most important thing I’ve learned is that it’s not all black-and-white. When I was younger, I thought my parents could do no wrong, and his parents rarely did it right. I see now that there are some values my parents prioritized that I may not push as exclusively for my kids, and that his parents have strengths and legacies that will bless our family for generations. Wrapped up in that is realizing that I can’t see anything clearly until I choose to forgive and let go of any accumulated bitterness. Anger towards my parents or in-laws cripples my ability to parent my own children in a healthy way. It only passes toxic baggage down to another generation, and prevents me from receiving whatever blessing they may have to offer despite the brokenness. And part of seeing the nuances is realizing I can’t judge them, that I almost certainly don’t understand their circumstances, or even what they carried from their own parents.

How has my parents’ parenting influenced how I parent my kids? Pretty enormously, I guess. First and foremost, they took parenting seriously. They never put ministry or career above their kids. They approached it with a sort of intellectual earnestness, a commitment to quality, despite not having the best examples themselves or having similarly-minded parents in their immediate community. They read books, discussed issues. I remember lots of ideas, some that panned out better than others, but there was always something they were trying: a date-night reward system, playing character-focused games, structuring annual vacations. I never question the value of the time I spend with the kids, which comes in large part from them.

Secondly, they passed along a lot principles we try to keep: the best gift you can give your children is a healthy marriage. If something bothers you about your child, look at yourself first. Always stay one step ahead of your kids. Never fight in front of your kids (arguably healthy fighting can be okay). Always stay united in front of your kids. Never criticize your child in public. Never negatively compare your child with their siblings. Read often to your kids. Supplement their education at home. Never criticize your child’s teacher in the child’s presence. I could go on.

Besides the aphorisms, they did practical things we try to follow: dinner was always a time we sat around the table together, without distraction. I remember similar tea-times we’d have. We had family devotions (not that I was always into them), and I remember going on dates (eating out then was a big deal). My dad was there to pick me up after school activities every day (I now appreciate the work flexibility that involved). He tutored me on physics and math often until midnight. My mom never missed a piano recital or competition. Most of all, I had an absolute sense of unconditional love: I never questioned that I was worthy of love, or needed to find it elsewhere.

But I’ve also come to see some things I’d do differently. My parents didn’t focus as outwardly on community; they were wary of bad influences, or friends taking up too much of our energy. I hope we can emphasize community to our kids, even at the cost of our comfort. I hope our home is a place all their friends will want to gather. We hope to go on missions trips with the kids. My parents didn’t always discipline me to the point of teaching me that my self-centeredness is not okay if it hurts others, even if it’s related to a drive for excellence—I can’t blame them for that; I was pretty strong-willed. But that’s something we’ve made an effort to try to teach our kids early on. We didn’t handle conflict very openly growing up: I hope our kids have the skills for and habit of discussing issues openly. And there are certain things we didn’t do—we didn’t travel a ton, discuss current news or world issues—that are simply reflections of my dad’s personality or our own inclinations, but that I look forward to developing more with our kids, mostly because Dave enjoys those things.

And there are things from my in-laws I hope to pass on to the kids: a love for the arts, a talent for evangelism and networking, how to handle wealth healthily.

I’m sure one day the kids will be processing the same things about us. There are things we’ll do great, and blind spots we’ll have. I hope they’ll have the same grace and discernment about it that I try to have about our parents. And I hope it’ll be something we can walk through together, just like we still are meeting with and learning from my parents today.

Honey For A Child's Heart

“Kids don’t stumble on good books by themselves. They read the titles they’re given.” –Gladys Hunt

I’ve been somewhat convicted that I should be more intentional about what our kids read. Because our kids do read. A lot. We go through upwards of thirty books from the library, as often as once a week. Ellie’s favorite thing to do is sit at the table with a snack and read through books non-stop: it’s a miraculous act of self-parenting. I can’t imagine what it’ll be like when all the kids do that!

Ellie’s at the stage where Easy-To-Read books are too boring, but it takes a lot of concentration for her to make it through a regular chapter book; what she likes are chapter books with illustrations. E.B. White, Junie B. Jones (though my sister brought up there are some questionable behaviors in those books), Roald Dahl, and now she’s going through the Magic Treehouse books by Osbourne. Eric, in typical stubborn fashion, refuses to do any reading lessons with me; I’ve no idea how close he is to reading, but he certainly enjoys flipping through books as if he can. Still picture books, especially ones about pirates, dinosaurs, or star wars. Elijah is loving the Martin books illustrated by Eric Carle.

Lately when we go to the library, I haven’t been too active about picking out books for them; I’ll generally direct Ellie to where the books of a few prolific authors reside, and let her pick them out. In the picture book section, we head towards Bill Peet, Stephen Kellogg, Jan and Stan Berenstien, Jan Brett, Mercer Mayer, Max Lucado, London for Froggy books.

But we’ve ran out of new books to try, and I’ve gotten lax about what the kids check out. I’m always trying to talk Eric out of some violent graphic star wars spin-off novel. I’ve also gotten lax about actually sitting down to read to the kids: I was fanatical about doing that with Ellie, but I haven’t been nearly as conscientious with the others.

One BSF home lesson referenced Gladys Hunt’s book Honey for a Child’s Heart, which has a lot of book suggestions. I found a few websites that had lists distilled from that book, or other helpful lists in general:

Exodus Books

Classical Homeschooling resource

Various booklists someone assembled

I came up with a huge list of books and authors for various levels, which I printed out and stashed in the library bag. Tons of new authors and titles, which I’m just as excited to read as they hopefully will be. Read on!

An Ode To Breastfeeding

Today I was looking down at Esme while she nursed to sleep, nestled up against me with her chubby fist next to her mouth. I’m less than one month away from making it out to a year. For the first and last time. Never managed to make it out this far with the others.

I started thinking back on it all. I remember the sinking feeling I had after Ellie was born when I realized I could never leave her or a pump for more than three hours without serious discomfort. No one had told me about that. I remember how painful nursing through mastitis was, and the gymnastics of all the crazy holds so she could vary her latching position to prevent clogged ducts. I remember walking across the hospital to use a hospital-grade pump; eventually even that couldn’t contend with the work hours and stress and I gave it up by around four months.

Eric was memorable: scared of running out of milk, I pumped so much extra milk before going back to work that we couldn’t fit any more in our freezer. Then after I went back at three months, he refused to take the bottle, going on hunger strikes for days. My dad drove him in to the office every three hours and I’d run out to nurse him in the car. Pretty sure he screamed his lungs out the whole way there and back. I think we made it to about six months that way.

Elijah made it to about eight or ten months nursing: around then, he just lost interest. Started biting, and that was the end.

So this is something special Esme and I have going here. She’s just about the most compliant nurser I’ve ever had: always willing to nurse if I ask her to, which makes timing leaving for work much easier. Willing to patiently suck for a long time for a letdown, which helps with production. I’ve also been home most for her, which probably makes a difference.

And watching her, it’s easy to remember all the things I really love about nursing. The secret smiles they give with the nipple still in their mouth. The way their hands wave around like little birds, or reach up to rub my shirt or twirl a strand of my hair. The drunk little happy grins afterwards, the burps. It really is some kind of connection, some kind of miracle. I’ll be happy having more independence, but I think part of me will be sad too when it ends for good.

Arriving

One of the things I have the hardest time not believing is life will better when _______. Some of the things I have subconsciously filled in the blank with in the past include: I get married. I lose weight. I have kids. I have the right number of kids. I find the perfect house. I remodel my house. I get this outfit. I get this bag. I get a full nights’ sleep. I have this kind of sex life. I have these kinds of friends. I earn this much money. I acquire this reputation at work.

Obviously it’s okay to look forward to things, but I can get to a point where I hinge a certain portion of my thought life on arriving at a certain material or circumstantial place that has nothing to do with godliness. And it’s subtle, so subtle it’s nearly subconscious.

It probably has to do with the fact that so much of earlier life is about arriving somewhere: passing a test, getting into a school, passing another test, getting into another school, etc. And it probably relates to the world of constant advertising we indwell, in which it’s easy for a healthy material anticipation to edge into obsession or relative discontent.

It’s the world’s paradigm, that we should always be looking for more, looking for what’s next, to be happier. But the gospel shifts that paradigm completely. It says both that we can be completely content in our current circumstances, and that we ultimately anticipate and work towards eternity, which could come at any point. Nowhere does it say, life will be so much better when you design the perfect house. In fact, from an external perspective, Jesus didn’t “arrive” much of anywhere: he was never married, never had kids. Never got a degree. Probably didn’t own a house or earn much of a salary.

Part of this is reminding myself that my life should reflect what is most important now, and not put off working on things until I arrive at this or that landmark—for example, waiting to work on marriage until we have more time. Part of it is enjoying where I am now, not looking to the grass being always greener in the next stage of life or parenting. I think God created us to anticipate—and we’ll probably always anticipate and hunger to some degree until we get to heaven—but this is a good reminder to me to not base too much on the future.