The Big Chair

I miss when you both were little. The three of us with room to spare in the big chair.  That precious time before you would sleep, wearing soft PJ’s dotted in animal shapes. I preferred the ones without “footsies”, so I could feel those small, cold feet brush against my legs as you both wiggled and wriggled. We all stretched out in that oversized chair; your bodies lay against mine in the evening hours. Your skin smelled so sweet, like innocence. You were so small, I guess in the same way I must have been so tall. Giggles and laughs. I wanted to sleep. You wanted to play. You both insisted on reading again and again. Silly words, silly times. I needed to rest my eyes. Eventually words became mumbled, vision became blurred. Finally, we all succumbed to sleep.

I watched you play and practice. On baseball and softball fields. In the swimming pool or dance studio. Racing through to the end of my work day with an invisible clock in the back of my head, always present. Always ticking. Counting down the time left to get a glimpse. A chance to see you swing or pitch. Flying starts off the block and into the pool, or an aerial that tooky our feet off the ground and upside down.

We ate pancake breakfasts at home. Hands and mouths sticky from syrup with bits of melted chocolate chip on your lips. Or Saturday morning trips into town to Georgie V’s or Egg Harbor, with the promise of an endless cup of black coffee for me and a soon-to-be spilled hot chocolate for you.  We laughed and giggled. Drew pictures on paper placemats with blunt tipped crayons. Played with words. Spelling them, putting them in haikus or rearranging their letters. There were no iPhones to distract.

When I write these words now, I stop and pause. I lose track of time. I leave the present and go back to the past. The time between then and now keeps getting longer, marching on in unrelenting fashion. Just like the two of you. You grow. In age. In height. In independence. In defining yourselves.

That oversized chair is gone. One of your rooms empty for over a year. The other soon to be. Those too infrequent times when you both are home, sleep usually lasts through breakfast and well beyond. My time outside the hospital is no longer spent racing to watch you participate in life, but waiting for you both to share with me what it has become. I check my IPhone, hoping to catch a static glimpse of dynamic moments in your life. Through Instagram, snapchat or a text.

My perception of self is that I am still youthful and young.In body and soul. Until I wake up in the morning with pain in my back and knee. Or I see the gray in my hair and the lines on the face that looks back at me in the mirror. But most of all, I feel an ache in my core, over the passage of time when I think back to those days. The big chair. Chocolate chip pancakes.Running out a grounder on a dry, dusty field.

The ache turns to loss. And when loss turns to angst, I want to cling to you both. Grab you. Weave my world even more with yours. But that is selfish, thinking I can slow the pace of change by not letting you freely move forward in this world. I know that it is now time for both of you to begin creating your own. That chair has become too small for us all.

A Thanksgiving 2000 Miles Apart

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For me, holidays such as Thanksgiving, evoke memories more than emotions. Reflection on traditions more than generating a visceral response. The ritual of a 4am wake up alarm followed by a moonlit drive on barren roads to an empty hospital parking lot has been repeated multiple times over the last few years. Racing through the workday, fueled by bitter black hospital coffee, in order to get home in time for dinner with extended family. Binging on turkey and stuffing before passing out on the couch. These are my core Thanksgiving memories. The demands of the hospital and a plateful of side dishes have overshadowed emotion and family connection.

2017 turned many things on their head. My family’s trajectory, as a whole and as individuals, abruptly changed. Among many things I have taken for granted over the years was my family’s ability to be under a single roof for Thanksgiving and other big holidays. Last year challenged that presumption. Through somewhat Herculean efforts, Becky, Maya and I were able to travel to Oregon so we could share the day with Madison. And it was there that emotions became front and center while the traditional meal faded into background noise.  The four of us dealt with emotions of a family separated but temporarily reunited, appreciating a little more the connection we share with each other.

Pages on the calendar have turned and this year’s turkey day appeared on the horizon. We assumed another reunion, this time home in Illinois. But neither Madison’s nor my schedule allowed us to travel. And with that came a growing realization that for the first time, our family was not going to celebrate together.

Families, both as a collective group and as individuals, handle stress in different ways. A few weeks ago, each of us as individuals struggled with our own unique uncertain futures. We are all at the moment working on creating and finding new paths. Each of us hope soon to be able to stride confidently down the road of our own making and choosing. But as a connected family, our struggles affect each other. Our individual orbits are not without their gravitational pulls. They may be invisible, but they are impactful on each other nonetheless. But we continue forward coping in the best way possible.

We settled upon a least worst option. Becky would fly to Oregon and share the day with Madison. Maya, with a friend visiting from out of town, would stay home. I would navigate a turkey day squeezed between two busy shifts at the hospital. Not a solution, but a response to a problem that stretched, twisted and turned all our emotions, straining our invisible bands of connection.

Separate and in silence we absorbed this.  There was no specific conversation or group discussion on our family text chain. But internally I felt isolated. Disconnected. The emotional equilibrium I struggle to maintain felt off. Our orbits disparate. Our family separated by more than the geography of 2000 miles. With no other options and out of necessity, I put one in front of the other. Outwardly moving forward. Inside, my heart ached.

Change can be triggered by events big and small. Transformation can come from within or due to outside forces. And sometimes the most trivial of events can reveal what is already present.

My daughter’s friend from out of town was no longer able to travel and visit.

Almost immediately, simultaneous texts occur. One sibling offering to pay the airfare for the other. One sibling laments that they are now not able to visit.

And the emotional disequilibrium shifts.

From separate to shared. From fractured to connected.

Again, despite the gravitational pulls that affect each individual member of my family, there is more that binds us together than pulls us apart. The power of family continues to trump individual struggles and crisis. Strain and stress may hurt our family, but like fractured bone, we remodel and mold our connection into something even stronger than before.

Our family of four will not physically be in the same place this Thanksgiving.  But for the moment, we are together in this shared space of emotional connection.

So, turkey will be eaten. Gluten free stuffing will be enjoyed. Crumbs will be the only evidence left of  pumpkin pie. But the meal, no longer center stage, will be relegated to its appropriate minor supporting role as my family moves forward on our collective and individual journeys. And despite being the one left here in the Midwest, when I look back and remember this thanksgiving, it won’t be about us being apart. But it will be of the invisible emotional threads, that despite the tension and distance of 2000 miles, continue to bind and hold this family together.  And for that, my heart aches, but now full of thanks.

Happy Thanksgiving to my family, friends and to those whose journey at least briefly brought you here to Balance.

Jeremy

A Journey From Burnout to Balance

I wanted to share a sincere thank you to Elizabeth Metraux at Primary Care Progress, for the opportunity to be interviewed on her Podcast, Relational Rounds. Becky and I were able to share our story from medical school and residency training to fellowship and private practice, navigating challenges along the way.  Elizabeth has a strong interest on the topic of physician burnout and has written about it at STAT:  I experienced trauma working in Iraq. I see it now among America’s doctors

After reading my post on How Do You Know When Someone Is Broken?  Elizabeth reached out to talk. She then asked to interview both Becky and I for what turned out to be a pretty interesting experience.  Attached below is a player linked to the podcast for those interested in hearing a little of what has gone into almost twenty five years of medical training and practice while trying to balance the needs of work, family and myself.

 

Guest Post: Control

It is my pleasure to introduce to the readers of Balance, Dr. Rebecca MacDonell-Yilmaz. Becky is a pediatrician out on the East coast who has not only just completed a fellowship in hospice and palliative care medicine, but has just embarked on her third board certification, this time in pediatric hematology and oncology. We connected through social media and over shared themes in our writing. I have read many of her posts on her blog The Growth Curve and wanted to share her work with all of you. I am honored that Becky has offered to post a piece she has written and publish it first on Balance. I could spend some time describing to you all how her story resonates with me, but instead I will let the beauty of her writing speak for itself.  You can follow her on her blog or via Twitter @BeckyMacYil 

Control

By Rebecca MacDonell-Yilmaz

In the afternoon I’m asked to attend an urgent family meeting. I press the resident who has consulted me for details – a middle-aged woman with ailing heart and lungs – and scour the chart to fill in the rest. When she came into the hospital, they asked, inelegantly, “If your heart stops, do you want us to do everything or nothing?” and she chose everything. Never mind that her organs will fail soon, that putting a breathing tube down her throat and hooking her up to a machine is unlikely to lead to any sort of improvement and she will eventually die with the tube in her throat or when her family members make the decision to remove it. She’s deteriorating, and the prospect of intubation is becoming more and more real. Yet she seems to grow less and less sure of what she wants.

I enter the room and heavy conversation is already underway. The resident is explaining that no, she wouldn’t feel pain with the tube because she wouldn’t be awake. But we would also ensure that she wouldn’t feel pain if she chose to forego the tube, to “die a natural death,” as we put it when trying to convey to patients that even our most heroic-appearing interventions – in fact, especially those – are unlikely to bring them back.

She says that she doesn’t want the tube. “I’m tired.” We repeat back to her what we understand her choice to be; she confirms. Her son arrives. He is large – in habitus, tone, voice. He starts yelling immediately. This is the third time (fingers held up for emphasis) that he has been called in to discuss this. And she keeps giving the same answer every time. She wants the tube. She should get the tube.

Two days ago, though, she said she didn’t want it. She decided on comfort only, no more treating, no more fighting. Home with hospice and hopes for a peaceful end. Then he visited and she wanted the tube again, or said she did. And now this conversation that has begun ripping apart the moment he barreled into the room.

We don’t know that she won’t recover, he says – no one can say that for sure. I can say it with high likelihood, I say, with medical experience and knowledge. But anything short of certainty holds no clout. In fact, he points out, we must be asking these questions repeatedly because we don’t like the answers we get. From this point forward, he notes, waving his phone,  he is recording our conversation.

The thing is, if she wants the tube, I want her to have it. It’s not what I would choose, or what I would wish for her – I know what that looks like, that ICU stay, that death. But it’s not my choice to make, it is hers. And whatever she chooses, I want to honor it. But I want it to be truly hers.

More yelling. He knows she’s sick, knows she might not get out of here. But it’s her right to have the tube if she wants it. (And her right, I add – if I can finish, sir – to change her mind.) He doesn’t disagree with this last but wants us to stop asking; she’s tired. We all are. I thank everyone for their time.

Back in my office, it’s dark. I make tea, sigh, stretch, and sit to document my work from the day, my work listening, speaking, trying to hear and to help others be heard.

My pager alarms. She has changed her mind, the resident reports; the whole family has. She is tired. She does not want the tube. She wants a natural death, when death comes. This time they all agree.

On the drive home, with little warning, I begin to scream. It rips up my throat, tearing at my vocal cords. The silence afterwards reverberates, hums, and my muscles relax. I inhale and scream again, the deep breath before it like a silent meditation, the eruption a vehement release. Next comes more tearing. And again the relief.

*                      *                      *

I’m late getting home. My boys need to eat – the youngest to nurse, or to spit pureed foods at me; the oldest demanding waffles and syrup. My husband is on a conference call already so can I please distract them, feed, them, try to keep their voices down?

Attempting to head off the toddler’s impatience, I request his help: can he pull open the frozen packaging? Can he put the waffles on the pan? No, don’t touch the oven – for this part, please just watch.

I’m feeling accomplished with waffles ready, baby happy in highchair, toddler climbing hungrily into his seat. The special fork (the one with rainbow stripes) is ready, syrup is on hand, the prognosis for the evening favorable. I pour generous pools of syrup, slice the waffles into bite-sized pieces, and sink into my seat.

“Move waffles,” my toddler says. Move them? Move them where? “Move waffles.” I don’t understand. Show me; help me; can’t you do it?

The fork is suddenly waving in the air, cutting frustrated arcs. “MOVE! WAFFLES!” I hear the tears welling, the wail erupting, as arms and legs start to fly. Baby is whining, upset at the commotion, and also wanting more puree. The conference call is only a room away and voices continue to rise.

“This is not how we act.” I am seething, though I don’t want to be. I pick him up, move us into the next room where there is space to explode and calm down. I know it’s not the waffles. It’s the communication, the struggle to make his needs and wants known with language that has only just begun to blossom. It’s the control, the need to exert any scrap of ownership and direction over his life. And he’s tired. I’m home late, dinner took too long to even start, his brother needs me as well. And he needs food, sleep, reassurance.

Limbs fly through the air, crashing again and again onto the carpet. He yells and yells, face red, cries lashing out at us all. I sigh, grab the baby from the highchair and pull him onto my lap in the living room, latching him to my breast. It consoles him and he eats hungrily, fussing only when I reach away to pull his brother, who is now simmering, whimpering, to my side. I feel the tension seep out of him as I nestle him close, the molecules of my being reaching out to soak up his unhappiness. The cries die down: his, his brother’s, my own. The three of us exhale as one.

 

Rebecca MacDonnel-Yilmaz can be followed at: The Growth Curve and @BeckyMacYil