Welcome, Tiny James!

I wanted to post a quick note to welcome James Oscar, my sister Erin (of the Erin and Elliots at left) and my brother-in-law's new baby. He weighed 7lbs and 110zs, was 21 inches long and has a head full of black hair. Plus, he is ridiculously cute. Elliot should be posting a few pictures on their blog, but I think you can visit his dad's blog through the link on their site and see some photos now. We're so glad he's here and the girls are excited about passing on their Razorback gear that they've outgrown so he'll have something to wear when football season rolls around.

On Call*

The job I have now is the first one where I have had to take regular emergency call. I work for a decently sized practice, so I’m only on about once every four or five weeks for a week at a time. Some of the other therapists whose practices are extremely specialized, (i.e. they only see people with eating disorders or dog phobias or something like that) don’t have to take call. Which makes perfect sense- you’d hate to call our emergency on-call number because your wife just left you and you don’t know what to do and end up talking to someone whose instinct is to ask “Are you wanting to binge eat?” So it’s not an unfair system. And before this week, I typically got about one call every other day for my week and usually only a middle of the night call about every six months; all in all ,it hasn’t been so bad. In fact, when I was on bed rest last year, I still took call, my rationale being that, hey, I was doing something besides researching things that could go wrong with the pregnancy on the internet or watching TV. It was during this time that I learned something interesting about adrenaline during pregnancy. I got paged at 4:00am one morning and woke up feeling a little panicked. The girls were asleep, too (I was about 7 months along at this point), but it took only about 45 seconds before they were up and obviously feeling panicky themselves and writhing around in there like they were trying to escape, which I thought was kind of funny. Anyway- back to my point. Basically, I’m trying to say that I don’t get paged that often and , when I do, I find that I’m usually explaining the whole “emergency” concept to whoever is calling. In case there is any doubt, let me review some situations that are not, in fact, emergencies and that I would prefer not to be paged out of bed for: your teenage daughter telling you she hates you; your child waking up one night having a night terror; your wife coming home drunk; your therapist not returning you call within 20 minutes; feeling that our office has billed you in error; and so on. I’m not trying to be insensitive; I understand that each of these events can be distressing; they do not, however constitute what I call an emergency. What I generally consider an emergency is something that most people would recognize as resulting in immediate harm or permanent damage if not dealt with this minute, like a teenagers troubling, recurring thoughts of suicide; an almost irresistible temptation to swing the sledgehammer you’re holding over your ex-spouse’s windshield in violation of your restraining order; that panicky, awful empty feeling that often goes along with depression-please pick up the phone and call the emergency on call therapist if you‘re experiencing these symptoms. Actually, if you know me, feel free to call me at home if you’re experiencing these symptoms, night or day.
But this week was different. I received an emergency call every single day and not one was a real emergency. And while I’m so glad there weren’t seven people in our practice experiencing life or marriage crises, but I am as tired as I have been since the babies were 5 months old and consistently sleeping through the night today. And it’s due in part to the fact that I was paged at 3:00 this morning for a situation that WAS NOT AN EMERGENCY. I feel empathy (but only a little) for the father of the teenage girl who called because she caught him reading her e-mail and she told him she hated him. Truly I do. But I myself was not experiencing great love for him myself when my returning his call at that hour in my formerly silent, 1200 square foot ranch style home awakened my two sleeping daughters, who mistakenly then assumed if Mommy was on the phone, it must be morning and, by golly, they were going to be forced to yell until somebody served them breakfast. While I was explaining to the caller that while, yes, it is very upsetting that your 19 year old daughter claims to hate you for invading her privacy, this is probably a matter best taken up with your therapist who knows your family dynamics in the morning, he must have noticed the background weeping and gnashing of teeth, because he asked in a irritated tone of voice “Is that a baby crying? Are you able to pay attention to my problem over all of that?” I assured him that I was, but had to reign in my desire to ask him if he thought I sat up all night in a quiet room in an office somewhere waiting for non-emergency calls all night or to assure him that I would punish the offending baby appropriately as soon as I was off the phone. As we discussed contacting his therapist, he asked me “Can you promise me she’ll call me right back tomorrow morning?” Again, I wanted to say, “Actually, I can’t, but I’ll call her at home right now and try and extract a promise that she will.” But what I said was “No, but I’ve never known her not to return a call.” So I got off the phone and went to prepare E and L’s 3:30 breakfast and help them back to sleep. But not before whispering a prayer of thanks that this is my last day of call .

*All identifying information and exact dialogue have been changed to ensure client confidentiality and to comply with all HIPAA regulations.

The First Swim

Long time, no blogging. Today, though, the pictures are too much fun to put off posting them until I can do writing of substance. I hear you all breathing a sigh of relief that this might be a reasonable length-ed post. I'll have to come up with something extra long next time to pay you back for your sarcastic attitudes toward me. Anyway, today my friend Brea and her son Skeezix* called (well, technically, Brea did the calling) and suggested that L, E and I come over and go swimming in Skeezix's new pool. Given that it was ridiculously hot here for May, we were delighted. We were even more excited to arrive and find that the girls' other good friend, Julio Eduardo* had just arrived to swim as well. It was a great time for the girls to try out their new suits. L wasn't a huge fan of the water, preferring as she does that the bodies of water in which she chooses to soak be warm. E, however really liked the whole pool idea and spent a good portion of our time there climbing in and out and attempting to drink the water face first like a puppy. You would have guessed by the way she acted that we never provided her with anything to drink. They both also got a kick out of playing with some of Skeezix's fun toys that we don't have. All and all, it was a good first swimming experience for the girls.

*As per Christy's custom, names changed to protect the innocent.

E playing with Skeezix:
















L. attempting to climb out of the pool:




















Here are the girls playing with Skeexiz's toys:















And a final shot of the most adorable Julio Eduardo and the handsome Skeezix practicing their splashing together:

Happy Birthday, Girls.

One year ago today...

The Pre-Birth Story

Given that I ended up having a planned casarean, in some ways my whole pregnancy story is a little bit more drama filled than the actual birth itself. Except, you know, for the part where the babies are actually born, which is the most dramatic part of any birth story, I guess. But if thought I'd jump right there first, well, you haven't been paying attention to the length of time it takes me to tell any story on this blog. Anyway, for awhile there in the middle of my pregnancy, I felt like I was doing a tour of emergency obstetrical services here in the ATL and in my hometown. Should you for some reason need a ranking for hospital emergency care facilities, feel free to shoot me an e-mail and I’ll give you my opinions (ie Southcrest-the ultrasound tech only gets 3 stars). It was never my intention to have a surgical birth. I’m discovering in my adulthood that I’m much more crunchy granola than I’d thought I’d be, so I had decided to have an unmedicated birth if possible, although I knew I needed to be prepared for a section with twins. So we took a 12 week childbirth class geared toward that goal. I realize you don’t get points for not having an epidural- but there are some solid studies that indicate that your best bet of not requiring a surgical birth for twins means not having an epidural, so there was no question for me which I preferred. (I ended up loving my epidural and this is in no way intended as an indictment of choosing to have one. I’ll write more about this in another post.) Anyway, I was first put on modified bed rest one day after Rob left to do his dissertation research in Egypt. I was almost 18 weeks pregnant (about 10 days after we found out E and L are girls) and noticed that I was having contractions-although it took me a couple of days to recognize that the tightening sensation followed by angry baby kicks were actually Braxton-Hicks, followed by angry baby kicks. So when I wasn’t at work, I was supposed to be lying down or sitting with my feet up. Fortunately, I could not have chosen a more sedentary line of work, unless there was one where I could actually sleep sitting up, so my active therapist-ing around wasn’t putting the babies at risk. At 28 weeks, one week before Rob returned home from Egypt, my cervix, which had been progressively shortening since 22 or so weeks had become dangerously short and my doctor instructed me to go on strict bed rest. We also learned at this visit that E, who had been hanging upside down in utero since you could first see her head at our 7 week ultrasound, had turned into a position I can only describe as "crazy breech". After 28 weeks, twins don’t have much room, so we were pretty sure then that, unless E got fed up with L kicking her in the head, they would need to be delivered surgically. From that point on, I pretty much just left the couch or bed for about 20 minutes a day, about 10 of which was me showering. Because I would have hated to be a person with unattractive hair on who never left the house. But Rob was home, so that was a lot less lonely than it would have been had he still been overseas. When he left to go up to school, he would take my work pager, because what with the bed rest and all, I certainly wasn’t using it. After a few days, we’d worked out the kinks in our system- I won’t mention names here, but apparently some members of our family do not consider a need for Pepperidge Farms Double Chocolate Chunk Cookies to be worthy of a “911” page. At 32 weeks, we had another big scare. Since I was carrying twins and obviously at risk for pre-term labor, they were seeing me every week starting at week 27. On our usual Monday visit, it appeared that I was dilating a little, so they sent me to the hospital to have the big perinatology practice there take a look with their ultrasound equipment. Unfortunately, I hadn’t eaten lunch and forgotten the giant bottle of water I was always trying to drink, so when they sent me to triage at the hospital, I was having fairly regular contractions, which happened whenever I didn’t eat or drink. That and a dilating cervix will earn you an inpatient admission and a course of injectible corticosteroids to mature your babies’ lungs. And until you're admitted, that won't let you eat or drink anything. If you learn anything from my stroy, it's that you should always eat before that trap you in triage or it will be a really long wait until dinner. So by 4 that afternoon, I was sitting up in my room on the high risk obstetrical unit, and every nurse who came in talked to me like I would be staying there for the rest of my pregnancy, which they obviously thought wasn’t going to be much longer. To say that we were a little stressed out would be the world’s biggest understatement. Let me interject here that there are far worse things than having your babies at 32 weeks-anyone carrying multiples is blessed to make it that far-it’s just that having been a regular reader of the infertility blogsphere, I knew a lot of women inside the computer who had dealt with pre-term birth, a child or children in the NICU for weeks and the emotional stress that worrying about your baby that isn’t stable enough for you to hold in your arms that they dealt with-and knew it wasn’t the best thing for E and L to come so early (plus, we only had what we called our emergency auxiliary names at that point and if they wanted good names, they were just going to have to wait). Perinatology couldn’t see me until the next day and my doctor wouldn’t release me until I’d been evaluated, so we settled in for a pleasant night of worrying and having my vitals checked every four hours. The nurses encouraged me to take an Ambie*n to sleep, which I had never done before. And I would here like to offer a formal apology to Robert, who, when dealing with some jet lag issues he was having from all the international travel, took an Ambie*n one evening. Perhaps I was a little harsh when I accused him of faking the extreme sleepiness and inability to concentrate on what I was saying when I was trying to share my feelings that night. Because if I didn’t communicate them right then, there was a very real risk I would have forgotten whatever I was obsessively worrying about and then where would I have been? Anyway, I was wrong- as advertised, Ambie*n does, in fact, make you very sleepy and people who are unable to stay awake after taking it are not necessarily being dismissive of your emotions and to accuse them of being so is unfair.
To shorten what is rapidly becoming a much longer pre-birth story than I intended, I was ultimately seen by perinatology the next day, the girls looked good, I was still contracting, but my doctor agreed to let me go on my own recognizance. But I had to stay on bed rest AND take oral Brethine every 3 to 4 hours. Which was fine, because my goal all long was to make it to 37 weeks, so I was willing to do whatever it took. As I mentioned in a previous post, Brethine made my heart palpitate and my hands twitch, so I at least felt like I was getting a little bit of a work out as I lay there, although I'm not sure I ever reached my optimal aerobic heart rate. After two weeks of this, I began to notice the uncontrollable itching I was having on the palms of my hands and the soles of my feet was getting worse. Initially, I thought this might be another side effect of the medication. When Rob wasn’t around to help me scratch, I would just lie there and think about how satisfying it would be to have a rake or a fork (or any sharply pronged instrument, for that matter); I knew that I would be perfectly happy forever if I could just scratch. When I was in for my next visit, I mentioned this to the midwife who saw me and she ordered a few tests. Naturally, it was aside effect-I had developed a new and exciting, "unusual, but not rare" complication of pregnancy- obstetric choleostasis, and that the itching was caused by bile salts building up in my skin. That sounded really gross to me, but they didn’t seem too stressed, so I went on home to add scratching to the things I was doing to keep myself entertained on bed rest. (Although I didn’t enjoy it nearly as much as I did when Christy and Rhianna would come over and eat snacks with me while we watched the Peabody’s crazy Chinese produced Alia*s DVDs.) To be honest, I did also add asking Rob reapeatedly if he minded that I had bile salts building up in my skin to the list of things I was doing. He looks back on that period of time with much fondness, I am sure. Having access to the internet, I also did a little-who am I kidding-it was all I had to do-a lot of research on the issue (choleostasis, not Rob's real opinions of people with bile salt skin)and I was feeling alarmed. The condition is essentially harmless to the mother, but for whatever reason, the instance of fetal demise and stillbirth is astronomically higher for babies who are born after the 37^th week; those who are born before then seem to be fine. So- me being alarmed. This was how things stood on April 17 of last year (Happy Birthday, Mom!), when we went in for our 36 week visit-I was anxious about the health of the girls, but pretty confident that the doctor would tell us to plan our c-section for next week. Dr. N came in and looked at my chart awhile. Then she said, "we'd have to do an awful lot of bloodwork on you this week to keep an eye on your liver enzymes"(the root issue in choleostasis).“What are you guys doing tomorrow?” Because of the bed rest, I had no previous plans-and then “Well, let’s have those babies tomorrow.” And just like that, we were on.

(picture of L and E on our front lawn last week)

L. and E.'s First Easter

I've got several posts that I've been working on, but I wanted to put some pictures of the girls' first Easter up for their grandparents and aunts and uncles. I included pictures of E. having her bow put in her hair-she's doing a new thing where she squinches her eyes closed when she smiles for the camera. The past couple of weeks, I've noticed that she's been pulling the bow or barrette we have to put in L.'s hair to keep it from getting in her eyes (and her oatmeal, for that matter). She then tries to put it in her own hair. It occurred to me that maybe she really wants to wear something in her hair. It's so crazy, but today, while she and L. engaged in their ritual of removing their own and one another's shoes and hair accessories, E. never tried to take her own bow out. If it makes her happy, we'll try it again. Notice the look of contentment on her face in the shot on the bottom, post-bow placement. I just picked the photos of L. (the top two)because I thought she looked so pretty.
We had a nice Easter, but I had a question for all of the mom's out there. Today, for the second Sunday in a row, we were paged out of church to come get E. from the nursery. Poor E. She had been crying since we left. Since she's always home with Rob and me, she's not used to being places alone without one of us and, starting about nine months, she has developed stranger anxiety. It took me five minutes to get her calmed down, but she started crying again whenever I made any move to even set her down to cuddle L. Eventually, I just had them page Robert and we went home early. I'd love any advice on making the transition easier for her or stories about how you made it through this phase with your kids. If you don't have children, I'd love to hear your opinions anyway. Happy Easter, everyone.

Yesterday at Work

I haven’t posted about my job, mainly because I’d like to keep it and it’s not considered terribly ethical to publish information about the marital difficulties of one’s clients, even if they do things like have shouting matches in the parking lot and key each other’s cars before the drive off. So when I talk about anything on here related to my job, I’d like to state before the record that I obscure all identifying details and alter the stories so even if they were to stumble onto this blog, they wouldn’t recognize themselves. Except maybe the couple I referenced before. Anyway, I work on Saturdays and the occasional Tuesday and Rob stays home with the girls. He’s writing his dissertation right now, so he can work from home during naptimes. (Here’s a picture of how he gets sooo much work done when he’s home-that’s L., who enjoys chewing on the hair of family members).
I love what I do-I feel like marital counseling is what I’m best at, but I love the individual counseling, too. About one-third of my client population is under 18 and I consider the work I do with children to be among the most difficult, primarily because no one brings their child to see a therapist for insight-oriented therapy-something bad is always happening in their lives to bring them in to see me. And that makes me sad, because while you can make a case that the adults who are coming to see me have at least limited control over the circumstances in their lives and can act dramatically to change things, with children, they are rarely responsible or able to change what’s going on that necessitates the counseling. They’re usually in a fair amount of pain, because their parents are divorcing, because they’ve been abused by an adult, because they’ve just lost someone they loved and emotionally, it’s hard to be the person who hears it all and is responsible for helping them heal because I find it so profoundly painful as well. Yesterday, I saw one of those kids. She was talking about how she was uncomfortable coming to see me. And I told her that was okay, that some things are just uncomfortable to talk about, that I wouldn’t want to come see me, either, if I was always having to discuss bad things that had happened. She then said the saddest, funniest thing “It’s not you-I like you. I just that I wish I had broken both of my legs.” It’s been my experience that it’s always better to ask what your client means when they say something like that- so I asked the obvious question “why do wish you’d broken your legs?” Because I didn’t really see how broken legs would have improved her situation any. And she said “then you could be my, you know, that other kind of therapist-like the one my friend sees to help her move her arm after she broke it.”

“Oh, a physical therapist.”

“Yes, that’s right. I wish you were just my physical therapist.” I really wished I was, too.