Emily's Asthma Attack

Yesterday morning I woke up to the sound of Emily not being able to breathe.  She has had issues with nighttime cough and reacts worse to viral illnesses than her brother so her pediatrician had given her a Ventolin puffer to use if she needs it.  She usually needs it about once a day when she has a cough or cold because of her coughing.

That was not the issue yesterday morning though.  Yesterday morning she couldn't breathe.  All she could do was wheeze and spit/gag froth up.  Despite her usual gravitation to her puffer she kept pushing the mask away from her face as I only suspect she felt like she was already suffocating.  Keith convinced her to get back in the shower where she could calm down enough to get 2 puffs into her and her wheeze became more manageable.  I was minutes away from calling an ambulance.

After 13 years of marriage Keith and I have an uncanny way of not freaking out at the same time.  There are only a handful of us that have ever seen Keith freak out, like an emotional Yeti, but it has happened and during those times I usually revert into my doctor ability to stay calm.  That did not happen yesterday morning.  I do not like people not being able to breathe.  It's probably why I didn't go into Respirology or Anesthesia but I find it much easier to handle shortness of breath at work where I have access to oxygen, face masks, medications and intubation if necessary.  I have all those skills still in my back pocket if I would ever need them at work but I don't have them in the bathroom at my house when my kid is wheezing in front of me.  Also doctors have seen the worst-case scenarios and often those cases come flooding back to your mind when you are afraid and it's your own kid.

I threw on some clothes and got Em out of the shower and put some clothes on her.  It was 630-645 am and she was much better than she was but was still wheezy and her voice was different than it usually was.  Keith went to pack her stuff in her backpack including a snack but I was having none of that.  What if they had to intubate her and she had eaten that snack and aspirated it into her lungs ?  Keith just indulged me and didn't persist.  Cian was the hero just before we left as he reminded us to pack Emily's puffer and aerochamber.

We got to the hospital and Emily was sweet as can be. Both of my kids tend to get even kinder when they are really sick.  We got to Children's ER and she seemed better and I thought maybe I had freaked out too much.  The only other times we have been to Children's ER have been for Cian and once was for croup and he had needed Dexamethasone (steroid) and Receimic epinephrine (adrenaline) and I had thought he was relatively fine and didn't want to make a mistake like that again so I had brought her but sitting in triage I felt like maybe it was overkill.  The nurse assured me I should have brought her and validated our experience that it would have been scary in the morning if this is how she was post-Ventolin.  We waited a bit in the waiting room and although I am not known for my patience I did often come back to the thought that I was thankful we hadn't had to be rushed straight to the back; that waiting in the waiting room meant that was was relatively well and how lucky we were for that.

After about 45 minutes we were taken into a room and the nurse and then doctor assessed Emily.  She was still pretty wheezy on exam and they felt her signs and symptoms were consistent with an asthma attack and that she should receive the medication regimen that they usually do for that.  It's known as an asthma care map or care plan.  Patients get 8 puffs of Ventolin (the blue inhaler) and then 3 puffs of Atrovent (the white inhaler) and then 2 more rounds of that 20 minutes apart for a total of 24 puffs of Ventolin and 9 of Atrovent.  She also got an oral dose of Dexamethasone (steroid) and will need another one in 2 days and went home with a Ventolin puffer and a steroid puffer to take for the next week or so.  They explained things thoroughly and easily as I'm sure it's routine for them, as routine as me explaining labour or painful periods, but we hung on every word like it was the first time we were ever hearing instructions.

Emily loved having a piece of paper with instructions and checkboxes.  She loved checking things off and telling me how many puffs were left.  By the second round of puffers she was more like her usual self and after the third round we were back to living in our regular scheduled life musical (she sings everything all the time).  The whole ordeal took about 4 hours.  I have never been more grateful for every component of medicine.  Thankful for medical research that figured out how puffers would help reactive airway disease and the discovery of steroids.  Thankful for universal health care and that I never once had to worry about the cost in addition to all my other worry.  Thankful for the expertise of the people I work with and their calm in my fear.  Thankful for their kindness despite the uncertainties of our provincial health care system and despite protests of our health care cuts happening at the exact same time.  Manitoba doctors and nurses provide amazing care in what appears to be one of the most confining provincial budgets, even before these proposed cuts.  After a quick trip back home to shower and get ready for my hectic clinical practice I brought coffee to the Children's ER staff.  I wanted them to be reminded that something so ordinary for them was so comforting for us and how much we appreciated it.  I read something recently that a physician wrote "Your life is my life's work" and that is so very true - it seems so routine for us at work but being a patient (or a patient's parent) is a good reminder of the weight and importance of being a front line health worker.  Thank you to the doctors and nurses that cared for Emily yesterday.

After my crazy clinic day I came home and did our regular evening routine.  To decompress I watched City Slickers which is one of my favourite movies.  I was reminded of it on my drive home as I thought of my day.  It was one of my worst/best days.  It felt like the worst in the morning when we felt so helpless and scared but it was also one of the best because Em got the care she needed and none of the bad things happened.  And that is truly something to be so grateful for.

 Emily with her asthma care plan and pencil.  This girl likes lists and counting and is getting back to her regular self. 

Day at the Beach

Em had a day off school and I desperately needed a day away from the hospital. It was supposed to be 33 degrees in Winnipeg on Friday so all conditions seemed to be perfect for a trip to the beach. 

I told Emily a few days before about my plans and she was super excited.  Something special just for you is awesome at any age but especially if you are 5.  I told her not to tell Cian because he had school on Friday and she was true to her word and said nothing to him.  This is a huge deal because Cian is her favourite person and she tells him everything.  Interestingly, when we came home and he realized we went to the beach without him he was totally fine but I still think it was the right decision not to tell him beforehand.

The night before Emily said "Mom, a day of just you and me at the beach is everything I ever dreamed about" and my heart totally melted.  I know putting the time in with them is very important even though they very rarely complain about the amount I work. 

In the morning we got packed up and Emily was invested in naming all things we packed and emphatically saying "CHECK" when we had it in the bag.  Then we drove over to Stella's and she hopped out of the car and exclaimed "Are you ready to brunch mom??" Man, I love this kid.

We had breakfast at Stella's and Emily was too excited to help me with the crossword to really dive into her cinnamon bun.  She ate it on the way to the beach instead.  I got a coffee from Them Baergan  and we were off.

It was a gorgeous prairie drive.  We got the West Gate of Grand Beach and brought out all of our stuff.  Emily carried all of the toys.  I instantly set up the new sun shelter I bought from Canadian Tire.  Basically I can't believe I've ever gone to the beach without one - it's awesome.  We ate snacks from our cooler and made a "super sand castle".  Everyone told me the water would be cold but it was refreshing and we spent a tonne of time in the water having water gun fights.  Emily wanted to stay forever but was good when we had to head home.  She was a total delight to spend the day with.  She is one of my favourite humans and I am so lucky to be her mom.

The Privilege of My Job

Yesterday I had a long and gruelling day.

The Friday before a long weekend is always chaotic as everyone tries to make sure that every patient is safeguarded through inherent lower resources over the next few days.  People want to cross every "t" before being away and the on call person for the hospital often gets extra calls/jobs because of this.  That is coupled with the fact that our residents have their academic half day on Friday afternoon putting more pressure on the remaining staff.  Usually that works fine and the attending doctors pick up their pace until the residents return but on a day where everything converges it means working at a superhuman level.

That was yesterday.

Despite the exhaustion of yesterday's call shift I find waking up post-call I have overwhelming feelings of gratitude.

I am grateful that despite all the demands on me for my job that I have the resources to help people.  Say what you will about our current health care system (and there is lots to say) but if someone needs an ultrasound I can get it. If they need to be admitted for pain control we can get that for them.  If they need life-saving surgery we have the resources at our disposal.  I think of how much harder a demanding day would be if I had to look at patients knowing what they need and not being able to provide it.  For people who work in remote communities and in the Third World that part of your job must be excruciating and takes a personal fortitude I admire.

I am so grateful for my colleagues. There were countless times yesterday where I was humbled by the sheer caring of the people I work with; for the patients, but also for me.  One of our senior obstetricians stayed all afternoon on the Friday before a long weekend because he knew I had a difficult delivery awaiting me and wanted to be around 'just in case'.  This same person comes to the labour floor every morning and is the exact person I want to recount my adventures and decisions to.  He patiently sits and offers reassurance and advice.  One of the patients last night innocently thought he was my dad and sometimes in my job he is certainly paternal in his support of me.  The other obstetrician on call came to help when I was getting so slammed and couldn't physically do everything at once.  She came without hesitation and helped me weather the relentless waves of responsibility.  She then went above and beyond and helped me with planning the mountain of inductions (a job for the on call obstetrician and arduous at the best of times) so that I didn't have to do it in the morning.  "Let's do this together" is one of the nicest things to say to someone.  The labour floor nurses met me with countless hugs and tried to shove some food into me on the fly like the mamas that they are. The antepartum nurses are amazing often having to hold down the fort when we can't leave the onslaught of the labour floor.  I cannot say enough to convey the unbelievable kindness of the nurses I work with.  They always remind me to change my pants when I have blood on them (which is almost always).  They wipe blood off my arms and face.  They constantly worry about bothering me when I know they are working just as hard with whatever task they are assigned.  The hugs they give me when I have to do or have done something incredibly hard sustain me and help me to keep going.  Their funny antics and laughter make coming to work a joy - even on the hard days.  The person coming on call this morning texted me 15 minutes before arriving "Do you want a latte?" Little thoughtful gestures are what make life wonderful.

In conclusion I am so grateful to the patients.  They knew we were busy and trying our best and they acknowledged that.  The thankfulness from women and families was so true and honest I felt myself trying to wiggle out from underneath it.  I wanted to give each patient more attention than I could but I am going to try to practice good self-care and remind myself that everyone did well and that is all that matters.  I was constantly reminded yesterday of the strength of the women I serve.  My voice half-broke acknowledging the unbelievable power of a woman that did everything I asked of her and used everything within her to deliver her baby.   My favourite phrase of the book "The Red Tent" rang true "She was mighty to behold".  There were many mighty women last night.

I woke up this afternoon with rested fatigue in my body and thankfulness in my heart.  I don't think that more could be asked of a job - to work your body, mind and heart all at once.  What a tremendous privilege.

Mother's Day

Mother's Day is often a reflective time for me. Usually that is because I think of all the people who find Mother's Day difficult.  Today I find myself reflecting on a different aspect of this unusual day.

I had the wonderful 0700 am wake-up with a showering of hugs and kisses and presents dropped on my sleeping face.  I had excited kids wanting to show me the crafts they made at school.  This year's selections were especially wonderful and heartwarming.

I struggle to be honoured on Mother's Day as I find the rhetoric around motherhood and womanhood in today's political climate very limiting.  In a world that has such an incredible diversity of amazing women I feel that the ideas around motherhood more confining than celebrating.

Mothers are a diverse group of people with a variety of circumstances and interests most of which cannot be held within the confines of a Hallmark greeting card. My children are small and their love is pure and innocent.  My hope is as they grow that they will see Mother's Day as a call to examine how they view mothers in the world and how they can ultimately support them whether they choose to be parents or not.

Speaking from my own experience of being a doctor mom I am often confronted by people's misguided ideas that my children and I are always mourning the fact that I work.  That could not be further from the truth.  My children have no other frame of reference for their experience and are therefore happy they have a mother that loves them and has a cool job full of "operations and delivering babies".  I know from my friends who are stay-at-home moms that they also have people say insensitive things about the choices they have made that works for their families.

Truly supporting mothers is what I would like to see Mother's Day be about.  I think it's completely reasonable to shower mothers with hugs, kisses, cards and flowers.  But is there also the possibility of widening that love of mothers to include a stronger network of support? My mother and her mother before her and the community of mothers that raised me (my aunts, my mother's friends, my teachers, my community mothers) had similar hopes and fears to what I think a lot of us feel now. They wanted us as their children to have safety and security, health, autonomy, access to education and to grow and flourish as people.

In the current global political landscape I think we have lost sight of some of the above values that mothers often think about as they watch their children grow.

We want our children to be safe and secure and yet there are still people and more importantly public policies that don't support the FACTS of climate change and the small changes that we could make to vastly decrease our effects on the earth that sustains us.

There are thousands of missing and murdered indigenous women in this country and as I sit here with my coffee, homemade crafts and cuddles I am keenly aware that there are children that long to hug their moms and moms that long to hug their daughters.

To our fellow mothers in the United States I read about what is happening to your country and I ache for you as a woman and as a mother.  How policies can be made (by groups of overwhelmingly white men) that consider rape a pre-existing condition, that constantly battle easy access to contraception and the work of Planned Parenthood.  That an overwhelmingly more qualified candidate who won the popular vote lost the election because she is a woman and how that secretly sits in the dark places of every woman.  I think of the mothers watching the president make thoughtless choices that may culminate in war.  War that will be decided by affluent white men.  War, which disproportionately will take the lives of poor people of colour and permanently separate mothers from their children.

If you love a mother perhaps instead of (or in addition to) platitudes and cards you can examine your own inherent entrenched ideas of motherhood.  Learn what the mothers in your life worry about or hope for and learn how you can rise up and help them.  Perhaps you call out a colleague for a misogynistic statement about a working mom.  Or you listen to someone's experience of sexual harassment or assault before brushing them off as "too sensitive".  Could you take a minute to open your mind and heart when you look at a mother in a hijab before you support stereotypical thoughts on what she is teaching her children?  Or a mother who is poor who feeds her children something that you wouldn't.  Rally for easy access to contraception so that girls don't have to be mothers before they are ready. Rally for equal and universal access to education so that our future generations can make better decisions for the world.  Rally for everyone's right to health care and for the rights of the poor because it's right and because there is no one who wants a mother to be taken from her children too soon or for children to be lost because of preventable diseases.  Take the love you have for your own mother, the mother of your children, another mother you love or perhaps the love you wished you had for your mother if your relationship is strained, and work to make the world a better place for mothers, for women, for all of us.  Let us mother the world this Mother's Day.

GROOT!

Just before Christmas last year we met the newest member of our family.  We (mostly me and then surprisingly Keith agreed) have been thinking about a service dog for Cian for quite some time.  Cian's first word was dog and as a baby all walks were "dog safaris".  When we finally got a diagnosis for Cian and realized his cerebral palsy would have lifelong challenges we, of course, wanted to support him the best way we could.  Our son doesn't have obvious physical assistance needs - he is able to walk and run and paddle (he has an excellent low brace!) but he does have some physical needs once you get to know him.  Balance is challenging - he hasn't mastered a bike without training wheels and he has been known to fall off a chair when sitting completely still.  The biggest physical issue is his constant need for physical touch so after much research and soul-searching it seemed that Cian's love of dogs could serve a real medical need for him.  We contacted MSAR and met George.  George is a very interesting character.  He has a military background and also trains dogs for military and police purposes so it's so neat to see him with this special place in his heart for kids with special needs.  It was also heartwarming to see how much both Cian and George love dogs. Most of my daily interactions are within a medical capacity with either colleagues or patients and there are always. time constraints; not so with George.  He always seems like he has all the time in the world to hang out and really get to know you, your background, your interests, how you got to where you are and how a dog could help your family.  I really admired that about him and despite what I suspect are vastly different world views (the Army guy and the Menno feminist) it has always been nice to sit and have a chat without judgements.  

After multiple meetings and the alleviation of our fears that neither Keith or I have EVER had a dog and know NOTHING about them we decided to take the plunge.  Despite Cian's immense love of dogs he never pressured us for one - maybe that's just another one of his cool idiosyncrasies - his inherent knowledge that his parents would get there in their own time. 

We talked a lot about dog names while Janet from MSAR was trying to find the perfect puppy.  All of the options were nerdy and interestingly the short list were all superhero/comic characters that didn't talk very much.  Cian often tends to gravitate to characters that don't talk which I always think is interesting since he would love to not talk if he could figure out a different way to communicate.  His love of these characters remind me to not pressure him to talk when he doesn't need to.  Han Solo doesn't ask Chewbacca to speak unless absolutely necessary and he loves him just the same. 

When Cian and Emily thought to put Groot on the dog name list they were pretty decided on that as the name.  They both love Guardians of the Galaxy and Cian LOVES Groot.  What is not to love about a tall tree superhero that only says one thing, saves his "family" and is loved by all.  That would certainly resonate in his heart.  It was Groot from that moment on.

Cian was pretty specific that his heart was set on a "brown boy dog".  Service dogs are typically labs, golden retrievers, poodles, labradoodles, and goldendoodles.  I LOVE golden retrievers but Keith, ever the practical one, thought a golden doodle would be better since we have a small house and they shed a lot less and we don't love to clean.  Very practical and ultimately the complete right decision. 

Janet found what Cian was looking for.  She said it was the first time she had seen a puppy so relaxed that he was lying on his back.  She sent pictures of him and we completely fell in love with this mix of standard poodle and red golden retriever.  This was Cian's match and we couldn't wait to meet him.

We met Groot on Christmas Eve.  We had told Cian that Janet had found him a puppy and he didn't react with surprise - it was like he knew that this was how his life was supposed to unfold.  Meeting Groot did however bring an unmatched happiness reaction.  I was worried for a little puppy to be confronted with so much touching and love but Groot was made for Cian and even as a brand-new puppy he wasn't afraid of Cian's "aggressive friendliness".  It was a perfect match and everyone could feel it. 

Groot won't live with our family until at least 12-14 months after we met him for the first time.  The person who has the hardest time with this fact is me.  Cian is far more practical and realizes that Groot has to "go to school".  He lives with Sam and Kaylee and Sam's service dog Molly.  Molly is a gorgeous Golden Retriever and is the perfect role model for Groot.  Sam and Kaylee are doing a wonderful job with Groot and send us regular updates and pictures via text and social media.  He has a large social media following which is an unexpected joy of this journey. (You can follow him on Instagram @wannebeservicedogs)  It's wonderful to have strangers encouraging and loving our dog.  Our neighbours and family follow his journey too.  One of my young patients follows MSAR on Facebook and said she saw our pictures with Groot and is following along too.  It takes a village and our village is full of dog-lovers.

At the beginning of April we were allowed to have another visit with Groot.  There are a lot of rules when it comes to service dogs and we are learning as we go.  For example, we asked if we could get him a toy and they said we could and suggested that Cian sleep with it for a while so that it would smell like him and then Groot would get used to that for future bonding.  When I told that to Cian he really took that to heart.  We decided on getting him a Rocket the Raccoon toy (aka Groot's best friend in Guardians of the Galaxy) and Cian took it everywhere around the house and slept with it and also occassionally rubbed it on his sister as they are always together.  On our way out the door to meet Groot he put it in his coat and exclaimed "I have a Rocket in my pocket!"  

We met Groot at the Neighbourhood Cafe which is literally our Neighbourhood cafe that has bookshelves for walls.  The cafe was awesome and all the patrons loved Groot (it's hard not to stare at a cute furry puppy on the floor that's climbing on an ecstatic little boy).  Cian and Groot were inseperable from the moment they saw each other.  Groot was practicing his compressive therapy and immediately laid down on top of Cian.  They were relaxed with each other like they were old friends. Cian seemed to relax within himself too - he was way more engaged with Sam and Kaylee than I expected (as we had never met them in person before) asking questions and telling them about our neighbourhood when we went for our walk.  If I had any doubts about the choice to move forward with getting a service dog (which I didn't) this afternoon together would have quenched them. 

Some people have difficulty trying to figure out labels for people that are different.  We like to put things into lists, preferably hierarchical ones.  Even I am guilty of this despite all the things that being Cian's mom has taught me.  I know that Cian isn't the typical person that people think of when they think of "service dog".  Because he doesn't have the same physical disabilities people associate with service dogs I sometimes feel people think he isn't "bad enough" to need one.  I have chosen to remind myself that the responses to Cian getting a service dog have been overwhelmingly positive from the MSAR staff, our friends, family and neighbours and anyone that knows Cian.  It's my own thinking that has slowly become less reductive.  Supporting the needs of my own kid needs to be my focus and his brain injury has manifested how it's manifested and Groot supports his needs. Groot, we  truly feel blessed to have you in Cian's life and thank you for working so hard to be what Cian needs. Thanks to Sam, Kaylee and Groot for their tireless work - clearly it comes with great heart and we are humbled by the love and kindness put into helping our son.

Musings on the Front Porch

Sitting on the front porch watching the sun come up on my post-post call day I am enjoying the porch swing that Keith hung up for me.  It's probably the most romantic gift that I bought myself.  That's because the romance isn't in the purchasing (as in most things) - the romance was in the hours of figuring out how to support it and hang it properly to be enjoyed by our family as we sit out front smiling and waving at our neighbours.  The porch really is the best in the shade of the early morning and to enjoy leisurely sun-kissed naps in the afternoon. Keith's love language is most certainly in the little things and sometimes I can miss all the little things until I realize sitting on this front porch that this beautiful swing that I love so much would still be sitting in a box if it wasn't for him.

Last evening I was again reminded of all the little ways he improves my life.  I was doing my typical post-call mania which goes something like this....

Me: I feel amazing!!! (on 3 hours sleep) I am going to do all the things.  I'm going to get everything on my to-do list done.  I can do anything and everything cause I feel great.  I have never felt this good.

Keith: Maybe you should just relax a bit...

Me: NO I CAN DO ALL THE THINGS

1 hour later

Me: I am tired.  I don't want to be tired.  I want to do stuff.  The sun is shining...waaaaahhhhh.....

Keith: Why don't you just go to sleep - you will be fine tomorrow. 

Me: I don't want to go to bed.  This sucks.  Bedtime is stupid. zzzzzzzzzzzzzzzz.........


Anyway who thinks being married to a doctor would be awesome doesn't realize that at times it's like having a bigger and whinier child.  It's not for the faint of heart.

Thankfulness

Thanksgiving if my favourite holiday.

This year we were missing our regular partners in fall festivities - the Schaapshers.  We are so lucky to have friends that regularly make the 14 hour trip to see us as the leaves change across this country. It was not in the cards this year and their absence was felt but hopefully our love for them was felt from provinces away.

Because we have finally finished our deck and the renovations are (mostly) done and because the back deck seemed to lend itself so splendidly to a giant dining table we were hoping for an outside feast and the weather didn't disappoint.  Despite the snowy temperatures for our friends back in Alberta we made it to our projected high of 12 degrees and with a rented patio heater and a roaring fire (and knitted layers) we were all able to enjoy Thanksgiving under the prairie sky.

There was of course WAY too much delicious food and drink.  I went overboard on stuffing because it's my favourite and I only make it once a year.  Jen's dad made my favourite cabbage rolls.  Andrea brought delicious vegetarian goodness.  The turkey literally fell off the bone which was a good thing since usually Paul carves it.  I, in fact, became keenly aware of all the things that Paul silently does to help me on Thanksgiving day.  I had to do an awful lot more chopping this year.

The kids were a great help this year too.  Emily cut intricate fall decorations for the front windows and they made 15 tea light lanterns to put along the banister of the back deck.  They were excited to see their loved ones too.

Keith, of course, did all the thankless jobs. He dutifully put up the lights to make the backyard an autumn evening wonderland.  He got all the supplies and cleaned all the bathrooms.  He doesn't begrudge me my ridiculous over-the-topness.

Our house started embracing it's visitors around 4pm.  There is nothing better than people coming to the door that generally want to come and spend the evening with you - no agenda and no expectations.  I love that everyone rolled up their sleeves and helped put the last minute touches on everything.  Lighting the lights, making sure there were enough chairs, cutlery, the "always last-minute" gravy.

There was tonnes of belly laughter, honest conversation and hugs between friends new and old.  Older kids playing with younger ones and "cousin friends" literally sweating with excitement and video game enthusiasm.  We enjoyed the pink sunset as day turned to night and the lights started to twinkle and the fire warmed our bodies and friendship warmed our hearts.

I spent Thanksgiving with people I love in my favourite place and for that I am truly thankful.

"Hear blessings dropping their blossoms around you"  - Rumi