Signs and Guns and my sons.

You ever see that movie Signs with Mel Gibson and Joaquin Phoenix? I always thought of it like the story of an individual family during the movie Independence Day. Independence Day shows the big picture and the people in charge. Signs shows the struggle of one family to survive the invasion. I always feel that after a mass shooting the media is Independence Day and what is not shown are the individual struggles of every survivor.

I remember at the time of Sandy Hook I worked on an inpatient psychiatric unit in a hospital. I remember the day of the mass shooting texting my former co-workers at the children’s hospital. The worst part of that day was hearing from my friends that they were fine, that there were no survivors, so there were no hospital visits by injured children. They all died.

The months after Sandy Hook saw a decline in state psychiatric beds, a decline in state psychiatric funding, and gun legislation crafted by legislators who unfortunately know nothing about mental health.

This is a law that came out of Sandy Hook. Any one who signs in “voluntarily” for a psychiatric inpatient admission in the state of Connecticut has to give up their gun permit for a certain amount of time if they have one, and cannot apply for a pistol permit should they desire to for a certain period of time. Any person who is committed “involuntarily” as in “committed on a physicians emergency certificate” is not placed on this database and is able to apply for a pistol permit without an issue. Now those of us that work in mental health know, that people who are committed involuntarily are often more a risk to society than those who are voluntarily seeking the help. We also know how this puts up a barrier for suicidal firemen and policemen who would otherwise seek psychiatric care voluntarily. When this legislation was passed we had some meetings  to discuss it and there was not one among us who felt this law made any sense. It also was not made clear who would actually enforce it.

So that backwards piece of legislation came out of the state government that had bore witness to the death of children. Babies.

Adam Lanza’s guns were his mothers. She had no contact with mental health. So it would not have prevented Sandy Hook in any way shape or form.

When I worked inpatient psychiatry I did a project about mass shooters. I studied 28 mass shootings perpetrated in schools in the United States. I can tell you they all had one thing in common- easy and open access to guns. From what I could find they also all had at least one contact with mental health care. In one interview it is near impossible to get a teenager to open up to you. I know from experience. It takes time. It also takes a teenager who is scared of the thoughts they are having to disclose them.

Depending on mental health care providers to identify any potential mass shooter is not realistic. Often these kids do not stick in treatment, and the APA put out a statement that basically said, We suck at predicting violence.

The other common vein I found among the ones I reviewed was that they all had spoken of committing a mass shooting at school or on social media at one point before the shooting.

The conclusions I drew from my research was to limit people’s access to guns and for teachers and students to report every time they hear or see a threat of a mass shooting. I can tell you from experience mental health providers have very little power in these situations. Meaning we have no ability to report a vague threat or an instinct that we feel someone is a danger to others. Unless a specific target is identified we cannot tell any one anything. Our mental healthcare system is set up to be reactive not preventative. And every time we do an assessment we are saying in that moment the person is not a danger to self or others. We are not saying they will never be a danger to self or others.

The frequency of mass shootings and the violence our children face and the ineptitude of our legislators to pass anything of substance terrifies me.

In the year 2018 we have a president who is rolling back every advance we have made socially and environmentally. We have children still dying. Senators and members of the GOP also being shot. And I find myself googling “bulletproof vests for children” and guess what they exist. They even have bulletproof inserts for children’s backpacks. I feel like I’m being punk’d I feel like lifetimes should see progress yet all mine has seen are declines.

Legislation that is meaningless is Independence Day. Me purchasing bulletproof vests for my sons to wear to kindergarten is Signs. Footage of news anchors in tears as they report another mass shooting of children is Independence Day. Me hugging my kids and kissing them and walking out with tears in my eyes every day that I leave them at daycare worrying that this will be the last time I see them alive is Signs.

To all the people out there trying to figure out to survive each day with your children. You are not alone.

 

 

 

 

Remembering the dark days of IVF

For those of you who don’t know what Clomid is it’s a hormone. It makes eggs grow on women’s ovaries and provides a more favorable chance of pregnancy with IUI’s.

Clomid threw me into a deep depression. It was not only the third failed IUI attempt but I am very sensitive to hormones so down I went. I entered December feeling God awful. I saw my therapist who I hadn’t seen for over a year and I remember just sobbing. He was taken aback because that isn’t me. He told me to see a psychiatrist, he was worried I was actually deeply depressed and needed anti-depressants. I saw a psychiatrist. He told me I was moderate to severely depressed and needed an anti-depressant. He also talked about health care professionals not taking care of themselves, and that I may need an IOP or something. I was working on an inpatient psychiatric unit at the time, and there was no way I was going to an IOP with patients of mine.

I took one dose of Lexapro and felt even worse. It threw me into a fog for a day, and I was like Fuck this. I booked a cruise for my thirtieth birthday which was in January, and met with our fertility doctor. We decided we would proceed with IVF starting in February after my cruise.

I went on the cruise with two of my best friends. One of whom was actually working on the cruise ship. Yes we went for free. Yes knowing an officer on a cruise ship is freaking amazing. The head Chef made me grilled lobster on my birthday and sent a cake to our cabin and a bottle of very good champagne. I jumped off a pier into the Gulf of Mexico on my birthday. I drank a lot of tequila and a lot of champagne and thought I was going to die the following day. I didn’t though.

I came home refreshed. I forced myself to go the gym every day before, during, and after the cruise. I kicked myself out of my depression and put on my game face for IVF. I needed it. IVF kicked my ass.

And it all started in February that year. 2015. Started with shots. So many shots. I was allergic to the first one- and my conversation with my fertility doctor went like this, “So the Lupron gives me hives, and is extremely painful to inject.” I showed him the hives. They were big, red, and painful. He looked at them. “Okay, so we really need you to take this though. So just maybe take Benadryl or something.” I had to inject the Lupron into my hive laden body for three full weeks. After the first week I added some growth hormone which was wicked expensive and I treated like liquid gold. After that we added another one. I don’t even remember now. I just know at one point it was three shots a day, two pills, continuous hives, bruises, and hormonal craziness.

The Progesterone was an intramuscular injection- it was really thick and kind of a lot of liquid, and could only be injected into my butt. I was on that daily for a full three months and I stopped it early because my butt could not take it anymore. It got to the point where I cried every day when it was given to me. Not full on sobs, but tears coming out of my eyes.

This is an aside- I administer Vivitrol as a psychiatric nurse practitioner. It’s usually to young guys who are drug addicts to prevent relapse. It’s a big needle, thick, only can go into the butt, and is once a month. They all bitch about it, they all say I have no idea how much it hurts, and many of them have literal panic attacks and insist on laying down to have it injected and literally whine the whole time. In my head every single time I’m like, “Dude. You don’t even know.”

I literally have tears in my eyes typing this because I remember so much pain during that time period and so much hope but so much fear. I remember feeling so fortunate but also so scared working in a hospital. I had to let people in on my secret. They knew I was gone a lot in the mornings (at appointments), one resident walked in on a nurse giving me my injections one day when it got to the point that I couldn’t self inject anymore. He was super awkward but super nice but I also felt the need to explain I wasn’t getting shot up with anything illegal. People knew. They were all supportive and friendly, but it was still scary.

As a society we don’t encourage women, especially lesbians, to talk about their fertility journey. Because of fear. Fear of discrimination, fear of miscarriage, fear of so many things. This time of year for the last two years has been hard but also empowering because I remember the fear, the pain, but then I see my two sons and I’m like fuck yeah. I made you both.

My last digression and comment to this blabber is after the pain and after the hives went away and the bruises on my belly and butt went away I was seven weeks pregnant. I started bleeding. I thought I was having a miscarriage. We already knew it was twins. We went for an ultrasound on a Sunday morning with my fertility doctor. He turned the camera toward me, and I saw them there, two little beating hearts. He showed us the big dark thing on the right side of them both- there was a large blood clot. He told me almost under his breath, “One wouldn’t have been enough, the blood clot is so big, it would have taken one out, you needed two.”

One year before I saw a psychic. She did a medium reading. She told me my Grandpa kept saying, “One’s not enough.” She literally said that phrase about ten times. So when we had to decide if “One egg will be enough or if you want to do two…” I immediately said two. We had to do two. Then, at seven weeks, I knew why.

I don’t regret the pain. I don’t regret the depression. I certainly don’t regret having two. I remember that ultrasound vividly because it was like all the pain and all the shit from the last year came full circle. Came back to a chance meeting with a psychic that changed the course of my life.

To anyone going through their own infertility journey- stay strong. Go on a cruise. See a psychic. Put on your game face. It’s not easy and it’s the opposite of feeling good. But that moment when it all comes together in the end is worth it.

Co-sleeping, Vaccines, Circumcision, Formula…and every other Mom Shame.

Back in those glorious pre-baby days I thought I knew a lot about kids. I worked as a pediatric nurse. I was asked parenting advice almost daily in my job. I listened to other nurses I worked with who were moms and I learned and I gave the best advice I could at the time.

I certainly recall having some of my own thoughts about parenting though. Including being sort of judgmental about co-sleeping families, very judgmental about families who were anti-vaccines, and having zero opinion about breastfeeding other than I didn’t need to see it happening as frequently as I did working in pediatrics.

I joined a few mom groups on Facebook after I had the boys. I had a lot of time sitting on the couch or bed with two babies breastfeeding and then sleeping on me. I spent a lot of time on my phone. They also didn’t sleep, ever, other than on us, so I was looking for some magical answer online for this horrible period of time with no sleep and aching nipples. What I found were sometimes caustic and judgmental mom’s/women who would literally tear each other down for asking a simple question about whether they should co-sleep or which formula to use or when to give baby cereal or should I do a delayed vaccination schedule…etc. I quickly exited these horrible spaces. I have to say the only group where I didn’t get disgusted by drama was a lesbian mom’s group that I am still a member of.

Somewhere in my sleep deprived brain I thought, women have been doing this Mom thing with less than my wife and I have for centuries. We got this.

That’s not to say I didn’t want support. I did. But I got it from my friends and family who were not going to judge our decisions. And sure enough we have two healthy and happy two years who could give two flying fucks about when we started them on cereals and if it was rice or oatmeal.

So here’s what I learned.

Co-sleeping- didn’t work for us. Works for some people. If we had one baby it may have worked. But two was too many. They also LOVED to nurse. If my boobs were around they wanted to be on them. Being in my own bed was sometimes the only break I got from nursing in those first eighteen weeks. I’ve had some clients over time ask me abashedly about their child usually between ages 5-10 who is still co-sleeping. They can barely make eye contact as they wait for me to pass judgement. I ask three questions- Are you sleeping? Is your kid sleeping? Is it affecting your marriage? If the answers are yes, yes, and no, then I smile and say carry on. Then they worry that their kid is too old to be co-sleeping, and I’ve come to reply “Do you hear of any twenty year olds who still co-sleep?” They usually laugh. “No you don’t. Look it’s your bed, if you’re ready to make the transition the start working toward it. If not, just do what’s best for your family.” They all visibly relax. Who am I to tell someone how to be attached to their kid? Who are we as a society to tell a family how to create warmth and an emotionally secure attachment between parent and child?

Next topic. Vaccines. I’m not going to get into a debate on here. Your body, your decisions. I’m going to talk about one vaccine in particular. Tdap. Also known as Tetanus, Diphtheria, and Pertussis. Most of the vaccinations sound like something foreign and distant because we haven’t seen them in my generation. Perhaps chickenpox will be like that for my kids (because of the vaccine for it…). But I’ve seen pertussis up close and personal and it’s not pretty. I’ve never seen measles, mumps, rubella, (probably because of the vaccine) I have seen patients with hepatitis and meningitis and pertussis. All three of these illnesses are ones that I would literally do anything to have my child avoid.

Here’s the story- I worked in the pediatric emergency department for roughly 6-7 years. In that time I took care of maybe 5 babies under the age of 12 weeks who ended up with a positive pertussis. One died. Now that’s not a lot. But I can tell you I wouldn’t want to be the mom of that one. Because the illness and the death is horrendous.

The coughing, the tiring out, the skin color, the suffering. It’s a horrible illness to witness. I have memories of caring for babies with it for only 3-5 hours who were then admitted. I can’t imagine being parent to a child with pertussis and watching them suffer for days, and potentially die. I got a TdAP shot when I was pregnant, even though I was up to date on it, and I did not let anyone in my home while the boys were under 12 weeks if they had not been vaccinated. Yes I was that crazy mom. But it’s because I literally saw a baby die from it. The risk is very real to me and I would never wish it on anyone. So yes, live and let live, and if you don’t “believe” in vaccines fine, whatever. But know the vaccinations are protecting us from real and deadly illnesses- well I’ll vouch for the Tdap vaccine at the very least. My last side note about this is that most private colleges will not admit kids without a full vaccination history. I went to Yale for my masters and they said either provide proof or don’t come. So eventually, if your kid wants to go to a private college, they may end up needing them down the road anyway because with a private university there is no religious waiver.

Circumcision- ugh. So tough. Permanently altering a child’s body. Again this is a personal decision and one we made based off my wife’s and my background in healthcare and bad cases we had witnessed. That’s all I’m going to say about it because I don’t feel strongly one way or the other.

Formula- it’s not going to kill your baby if you can’t breastfeed. Let go of the mom shame and the mom guilt and if you don’t want to breastfeed or you just can’t physically do it, just give them formula. Seriously. I did breastfeed twins for a year and honestly my first year would have been much happier and less stressful if I hadn’t.

These are all hot button issues. I feel very strongly since becoming a mom that I DO NOT have the “right” answers. But I have the answers that worked for my family which may not work for other families. I think my biggest issue would be with anti-vaxxer’s if they haven’t given their kid the Tdap. But otherwise do what’s right for you. Don’t let anyone shame you into a decision that doesn’t feel right for you. Struggling with these decisions is not a bad thing, it means you care about your kids and you want to do what’s best. I would suggest all Mom’s just keep your mouths shut about your decisions in these areas because if you say what you are going to do you are going to hear about a hundred differences of opinions and some of them will be shaming and judgmental. That shouldn’t be the way but it is right now. Instead seek out your own tribe of non-judgmental women. They exist, I promise, but you may not find them on Facebook. Go to Mom support groups in your community, don’t isolate yourself, and know that being a Mom is hard but if you are reading this and remembering or experiencing the struggle of difficult life or medical decisions for your child then you are doing the right thing. Decisions for our children shouldn’t be made lightly or without serious thought. But once made, they also shouldn’t be shamed by others for not being the decisions they would have made.

Religious Freedom in an Emergency Department

I worked as a staff nurse in a pediatric emergency department from the time I graduated nursing school through when I received my master’s degree in nursing, in total between 6-7 years. I started at age twenty-two.

I enjoyed being twenty-two. I lived in a left wing land with Obama soon to be entering office and even though I attended school in very conservative upstate New York I never really internalized the level of conservatism that abounds in most of the country. I was working in an inner city hospital in the Northeast happily back in my liberal bubble.

The Emergency department was a hodgepodge of characters. Attendings, residents, nurses, techs, EMTs, police, security, administration, social workers, psychiatrists, surgeons, pharmacists…you name it and we had them at some point working in the emergency department. At that age and in that geographical area I basically assumed every one was pro-choice, pro-LGBT rights, and pro-healthcare for all.

I was wrong.

One day I was taking care of a patient who was raped. She was young (children’s hospital being under 18), and scared, and traumatized. The physician spoke to her mom and her about all the options available to her. Rape kit, medications, etc. One of the options was the morning after pill which prevents pregnancy from occurring. The mom and the patient wanted to discuss it and they agreed to certain things but initially did not want the morning after pill. No one pushed it, as that’s not our role.

Later, after all the tests and interviews and near time for discharge the mom approached me and said they decided she would take the morning after pill. I said sure, and went to the desk where the physicians were sitting. The Attending and the resident were sitting next to each other making my life easier. I told them the patient changed her mind and wanted the morning after pill.

The Attending looked awkward and said, “Okay, but I can’t order it,” and he looked at the resident, and she looked awkward and said, “Yeah I can’t order it either,” I stared at both of them like they had two heads and genuinely asked, “Is there something wrong with your computers?” They both shook their heads and avoided eye contact with me. I stood there staring at both of them and said, “Well some one has to order it because this kid was raped and she doesn’t want to get pregnant. So what’s the freaking problem?”

It still had not penetrated my head that they couldn’t order it because their religious beliefs prevented them from ordering it. I literally was still thinking there was a technical issue and for some reason the system was not allowing them to order it. I know it sounds so stupid, but I was young and naive and hopelessly liberal.

Another Attending overheard our exchange and likely heard my statement, and saw me standing there with my hands on my hips glaring at the computers and the doctors, and quietly said, “I’ll do it.”

That’s when I got it.

I remember walking away silently to the medication room. Later I was with the Attending who ordered it and I asked what would have happened if it was night shift and they were the only two doctors in the ED? He told me they would have ordered it. But I wasn’t so sure. I’m still not. I’m thinking if it was night shift and they were the only ones in the ED I’d be trekking up to the ICU and finding one of their Attendings to place the freaking order.

This happened eleven years ago. I still remember it vividly. For many reasons.

For starters I never envisioned patient care being affected by some one’s religious beliefs. I remember we had a travel nurse from North Carolina. She told me they don’t even offer it to rape victims where she worked down south. I thought that was shitty. Still do.

If birth control is against your religious belief I would hope that murder, rape, pedophilia, burglary, tax evasion, etc. are also against your religious beliefs. Do physicians regularly screen their patients for committing tax fraud? Because let’s be real, everyone in America who owns a business probably has kept cash for themselves and not reported it as income. Do you not treat them because they are stealing and committing tax evasion? Do you not treat men who’ve committed rape when they arrive in the ED for a heart attack? Do you not treat the man who arrives in the ED after having a heart attack while he is screwing a prostitute who also arrives with him, but quickly exits when she hears the wife is on the way (Yes that’s happened)? Why is it that you can pick and choose what religious beliefs you follow at work and which you don’t?

You shouldn’t, hence why religious beliefs should not affect the delivery of healthcare.

Here’s one that will totally trip you up- would you refuse to treat a pregnant transgender man who wants to have the baby? What about all that pro-life chatter? Or does pro-life mean you’re only going to treat the lives that matter to you? 

The Health and Human Services Department recently formed a committee to explore religious freedom within healthcare. Per LamdaLegal article the aim of the committee is to protect from consequences health care providers who refuse services to patients due to religious beliefs. It makes me sick that in the United States we have one of the highest Maternal mortality rates in the Western world, but no we aren’t going to form a committee to save women’s lives during childbirth.

In 2009 a study out of Harvard wrote that about 45,000 deaths in one year were attributed to people not having health insurance. But we are focused on decreasing access to care instead of increasing it. Psychiatric hospitals are losing funding, states are shutting down facilities, families with severely autistic individuals have no long term plans for placement. The United States has one of the highest infant mortality rates in the Western world. But we can’t focus on that. Our current administration is instead focusing on restricting care.

But I digress. My patient got her medication preventing pregnancy. Thanks to an Attending who was not conflicted about ordering it.

My heart aches for the number of people within the LGBT community, who if this committee actually makes progress, will hesitate to receive healthcare services because they are fearful of being refused services.

Religious freedom is a beautiful component to American society and the foundation on which our country was built. But religious beliefs do not belong in healthcare delivery. Science, education, and clinical experience should be the basis of medical decision making.

 

LGBTQ in the Days of #45

The FBI published data last year that hate crimes were on the rise. According to their report entitled, 2016 Hate Crime Statistics, there were roughly 1400 hate crimes directed toward the LGBTQ community defined as crimes perpetrated due to sexual orientation or gender identification. Now in the grand scheme of our population 1400 may not sound like a lot. But those are 1400 individuals who were attacked and/or assaulted and/or murdered due to their sexual orientation or gender identification. That is 1400 too many.

That is also a 5% increase from 2015.

When this was published in 2017 the rate of murder of transgender individuals was already increased from the previous year.

I believe the actual number of hate crimes is higher, but many are not reported.

I personally don’t think it’s a coincidence that there is an increase in hate crimes toward the LGBT community after we elected officials who are openly anti-LGBT.

In my clinical practice I’ve heard many individual’s stories of discrimination and being victim to assaults due to sexual orientation or gender identification. I’ve heard from clients and in my own personal life that they have been spit on, punched, thrown against walls, jeered, followed, etc. I’ve yet to meet some one who has reported any of these experiences to the authorities.

I’ve met people who have come away with black eyes and broken bones or dislocated joints, and they have not reported these crimes. I’ve actually never met someone who has pressed charges. This is why I think this is a gross underestimation of actual hate crimes.

The saddest stories are those where the perpetrator is a family member who reacts with violence when their child comes out to them. I have spoken to individuals who have walked away with broken bones after coming out to their parents.

This happens in the United States. Not just in the South. But also in the Northeast. It happens in towns and homes right next door to you.

I’ve been questioned by transgender clients in the past year about what my medical record will say and who it could be released to. They have said they live in fear of our new administration and they don’t want to be put on a list somewhere by the government.

I thought it was cool when my medical record system added gender identification as an option. But to my clients it is a vulnerability.

The Queer community feels unsafe. I see and hear it daily.

Nothing will change this uncertainty and fear unless we vote. Vote in the 2018 elections. Vote in the 2020 elections.

Don’t turn a blind eye to the hatred fostered by this administration. It is real, we are feeling it, and it hurts.

Holding Hands with my Wife

Before I dated my wife I dated men. I went on dates in public places with men including places like the beach and the movies. At all of these places I engaged in public displays of affection otherwise known as PDA. This could be as simple as holding hands or as much as kissing, or cuddling. I never thought twice about it.

I have been with my wife for ten years. A full decade. In that time I can probably count on both hands the number of times I’ve held hands in public or engaged in any type of PDA.

I am by nature private and am not one to be extremely affectionate in public. But being married to a woman has made me even more cautious.

Recently a friend who I hadn’t spoken to in awhile messaged me on facebook and told me how much they were enjoying my blog and how much they really had no idea what my wife and I went through to be together. That’s not the first heterosexual friend to tell me that since I started this blog. Many have told me they had not idea that I didn’t dance at their wedding because it was a heterosexual wedding full of heterosexual people, or that they didn’t know about the decisions we made when selling our home in terms of our family pictures, or about the decision to be an “out” provider. That’s basically the point of my writing. Heterosexual individuals including some of my dearest friends and beloved family members, take for granted the hetero-normative culture we live in.

I vividly remember my wife and my first date. It was at a restaurant. I felt like we had a big neon red sign flashing over our table, “Lesbian Date Here” and I was terrified. I had witnessed too much discrimination with my friends and sister who were gay to be relaxed. I waited for someone to peg us as being on a date and start making comments.

We didn’t go on another date for a long time. I mean, we went out places, but I kept it very neutral in public. I still do to some degree.

In a decade we’ve been on countless dates to the movies, the beach, vineyards, hikes, etc. As I’m sure any couple who has been together a decade can attest to, we’ve spent a lot of time together privately and in public spaces. I can say that unless we were in a gay bar though, we were not holding hands, we were not putting our arms around one another, we were not pecking on the cheek if she dropped me off a coffee at work, or any other hundreds of reasons why we interact on a daily basis in public.

Not all lesbian couples are this way. Many don’t give a shit and more power to them. I personally am generally hyperaware of other people and I just don’t want to deal with discrimination. If we are with another lesbian couple we are more likely to feel comfortable holding hands, and definitely if we are in a gay space.

Something that has brought this to the forefront for me lately is our sons. We are a very affectionate family in general. Our sons are all over us and we are all over them. Since we had them and since we started venturing out in public with toddler twins I’ve realized that I still care about facing discrimination as a result of PDA, but I also don’t want my sons to see me acting differently than they are used to. They’ve sort of turned our world upside down in every possible way.

I’m not going to turn into a PDA slut, and the point of me writing this is not to be some major transformative moment for me. It is to bring awareness to my hetero-audience.

You take for granted your freedoms.

If you know a lesbian couple who has been together a long time you should take stock of what you’ve witnessed in terms of PDA and recognize if there’s a general lack of PDA that it’s not because they are not or do not want to be affectionate.

It’s because they don’t feel safe being affectionate. 

Straight people have privilege to be natural all the time. If you want to reach out and touch your spouse’s hand as they walk by you in a crowded room, out of reflex, you can. I have been with my wife for ten years. I have literally held her hand in public less than ten times. If I really sit here and think about that it brings tears to my eyes. Next time you hold someone you love in public think about the freedom that gives you the opportunity to do so and don’t take it for granted.

 

Why Strong Women are B*#%&’s and how I was compared to a woman stabbing a head.

My cousin and I often send each other interesting cards or postcards randomly through the year. One I got from her this Fall took me some time to process. If you don’t know the story of Judith and Holofernes allow me to give a short version. Holofernes invades the city Judith resides in. He decides he wants Judith’s body. She enters his tent, he gets drunk, and she beheads him. It’s kind of awesome. I mean she takes on an Assyrian General who is literally laying siege to a city.

This story has been portrayed in numerous paintings over the ages including one by Francesco del Cairo. It was during the Baroque period, and since I took Humanities in high school I have a minimal idea what that means. The only lighting is to draw the viewer into Judith’s face. The rest is very dark. It takes a minute or two to look away from her bad-ass expression to realize she’s holding a dagger in a head. Holofernes’ head. There is also a servant girl who is trying to whisk her away from the scene.

Now my own back-story. If you’ve read the blog you know I’m feisty. I stand my ground, and I’ve been described as a bitch, hard-headed, stubborn, and most recently like a “gnat that will just keep coming and coming until she figures out what the hell is going on,”. The gnat comparison was actually positive because it was some one who was telling a client I would be relentless in trying to find an answer.

My cousin wrote, “Her face just says ‘are you going to piss me off too.’ You are also a glorious bad-ass who doesn’t take shit from anybody and you’ll do whatever it takes to protect your people.” The stamp was a Disney villain- Maleficent.

I called my cousin.

“You compared me to a woman stabbing a head.”

We laughed and she reiterated her original point. I ended with, “There’s a blog post here somewhere, fair warning.”

All of the qualities I have been criticized for over the years would be praised in a man. If I had a penis I would be called  a “go-getter” or my favorite, “Boys will be boys.” Standing my ground and holding to ethics when others waver and bend is looked down on in me because I’m a woman.

 

I also work in a female dominated field (nursing) and have had to go toe to toe with male physicians and psychiatrists. For voicing my opinions in healthcare I have been told to “Smile more” “take the weekend off because you may not be thinking clearly” “I know this is because you’re pregnant” “Is this because you are still breastfeeding?” “You just seem sensitive to this right now” “I’m not saying this because you’re a woman.” “You didn’t do anything wrong, but” “So I need to talk to the real person in charge now.”

What I have had to say because I’m a woman, “My face is up here.” “So me bringing up the fact that the resident made a bad call and this was done under the Attending is now translating to me not thinking clearly?” Message received. “That patient grabbed my ass, and you laughed, I don’t think I’m being overly sensitive, I think I was sexually groped and the staff present, a physician laughed.” “MY FACE IS UP HERE!!!!”

Healthcare is hard. Corporate structures are hard. Being a female in any field is hard. Being a lesbian pregnant or nursing female is even harder. Some days the fight doesn’t seem worth it. I did take that weekend off several years ago, and I came to some very important conclusions. I could not change that system unfortunately. I had to work there, bide my time, and leave. Sometimes we have to work in places we don’t like to get to the light on the other side. Without my time in the darkness fighting and learning to not fight, and learning about “old boys clubs” and bureaucracy I would not be where I am today. Some of my hardest lessons personally and professionally have been learning that I can’t fight every battle even when every atom in my being wants to. Staying silent takes more strength and more inner turmoil sometimes than speaking up.

I worked in the hospital settings for ten years as a staff nurse and an advanced practice nurse. I experienced sexism in almost every possible way. It’s hard to not come through healthcare and have some sort of resentment build toward men. There are also constant power struggles that are hard to not engage in especially as a younger less experienced provider. I came through the last decade less naive, more cynical, but if anything I am now more passionate about my patients and providing quality care and that’s I think what is important for me to hold onto.

The thing that really gets me is if I were a man all of the traits that have been admonished in me by previous bosses in healthcare would have been praised if I were male. The bitch in me would be seen as authoritative and somewhat attractive in a male. But because I’m female and have been pregnant or worse menstruating I am just a bitch.

I used to bristle at male qualities being pointed out in me as negative. Now I’m like fuck it. I’ll stab the head and hold it up and roar. I’m direct, I have a dry sense of humor, I smile only when it’s truly warranted, but that doesn’t mean I don’t care. Our country and our youth have gotten into a situation where by being nice we have allowed monsters into power. We allow our LGBT youth to die from suicide and homelessness and drugs and hatred. If standing up demanding for the tenth time you look at my face and not my tits makes me a bitch, so be it. If standing up and demanding action and pointing out the negatives in our society without a pretty smile on my face makes me a bitch, so be it.

If putting females into a villain role is the only way we as a society are comfortable with them being strong, fierce, loyal, fighters, then so be it. I’d rather be Maleficent spewing fire than laying back with my eyes closed living in a fairy tale.

Psychostimulants…the Good the Bad and the Ugly.

Stimulants first arrived on the market back in the 1950’s. Prior to that they were given to soldiers in World War II in order to keep them awake and focused. There’s a great novel- ADHD Nation- that outlines the history of stimulants so I will not go into that here. What I do want to talk about is my clinical experience in prescribing stimulants.

I have a lot of thoughts about ADHD as outlined here. For this blog post I’m going to try and stay off my soap box and stick to clinical experience only.

The Good. 

I don’t prescribe Adderall. I will limit my discussion to Ritalin LA, Ritalin (methylphenidate), Focalin XR, Focalin, Vyvanse, and Concerta. There are short acting stimulants (Methylphenidate and Focalin are the ones I prescribe most, however I have also prescribed Dexedrine) and long acting stimulants (Concerta, Vyvanse, Focalin XR, Ritalin LA). There is also a patch called Daytrana- I have never prescribed it. I know prescribers who have and they report mixed results. The good about Concerta is that it’s cheap and usually covered by insurance. The good about Vyvanse is it is less addicting and has a slower onset as well as less of a crash. Focalin XR I’ve had mixed results with, it doesn’t last as long as Vyvanse or Concerta but when it works it does really work for people. Some people who couldn’t tolerate Vyvanse or Concerta were able to tolerate Focalin XR. Ritalin LA same results, doesn’t last as long but generally well tolerated when it works. The benefits of stimulants for teenagers with ADHD can be quite astounding. They report feeling like they can focus better, having improved short term memory, improved organizational skills, and many of my clients report feeling better and more confident socially. To be clear, these are all subjective reports from my clients and what I have observed in my practice. None of the above should be substituted for your own practitioner’s recommendations and clinical experience.

The Bad.

They all reduce appetite and I’ve had to stop them or not even be able to start them in teenagers who are already underweight. There often is a crash of some sort. People report feeling very tired when it wears off or having onset of significant headaches. Some people just don’t tolerate long acting stimulants in general and feel crappy and in a fog when they take any of them. They can cause hypertension, and yes I’ve seen that happen in multiple cases hence why I check blood pressure. They can cause increase in irritability and anger. They can interfere with sleep. The worst is when a teenager is taking a stimulant and doing much better in school, and then they start to not be able to sleep. They come in for a medication visit with their parent and they both ask for a sleep aide. This is something I don’t do. I’m not going to prescribe an “upper” during the day and a “downer” at night to mitigate the side effects of the “upper”. If there are adverse effects such as poor sleep then we need to take a break from the stimulant. Many people do not like this answer.

The Ugly. 

Stimulants (and non-stimulant Strattera) can cause auditory and tactile hallucinations. I have seen this in clinical practice and it’s very scary for the client and their family. Stimulants can stunt growth. I’ve had clients on stimulants throughout their adolescence who grow to be over six feet. I’ve also had clients in their adolescence who stop growing and who need to be off stimulants and obtain growth hormone injections in order to reverse these effects. The growth stunting is very rare, but I’ve only been prescribing for four years and I’ve seen it happen. There is no predicting who will be in which category. Stimulants are absolutely addictive and they have a street value and you can snort them. I’ve even had clients who injected them.

The ugliest part of stimulants to me as a prescriber are instances when they are sought for the wrong reasons. I’ve done intakes on kids who are absolutely brilliant. They are referred by teachers for being “too fidgety” or “off in space” but they are getting straight A’s. These kids are bored. They need more challenging work at school, but in a class of 25-30 kids the teacher teaches to the average or below average so the kid only has to pay attention for the first five minutes to understand the lesson. I don’t prescribe to these kids, but their parents can easily take them to some one who will. Or the kids who are angry all the time and acting out at home so they must have ADHD. Then you talk to the kid and find out about a trauma history. These kids don’t need stimulants they need trauma therapy. The worst are the drug addicts who seek them to abuse or to sell or both. The addiction to psychostimulants is rampant and it’s something that no one talks about because drug companies are making billions of dollars.

Fun fact- the volume of Adderall that can be produced in a single year is regulated by congress. Guess who endorses the continued increase in the volume of Adderall that can be produced yearly? Our representatives and senators in congress. In one breath our politicians are speaking out against opiate addiction while in the next they are advocating for increase in production of stimulants. As a prescriber who sees the abuse of these medications daily I feel this is a problem.

My take home message is there can be vast benefits for people who truly suffer from ADHD and for who it is impairing their functioning socially and academically. But there are also adverse effects, long term effects, and addiction which all need to be considered carefully before writing out a prescription.

When I was told to breastfeed on a toilet.

Pre-babies I had a lot of thoughts about breastfeeding. Some of them still hold true. I don’t need to see other people breastfeed. I am a very modest person in terms of nudity and seeing other people’s boobs is not something I’m into. However, I would never put another mom down for breastfeeding wherever and however they need to do it. It’s my issue so I look away. If I ever heard any one give a mom a hard time for breastfeeding in public I would immediately come to their defense.

Some stuff I learned about breastfeeding twins for twelve months is important. As a society we don’t talk about breastfeeding because it has to do with boobs and we as a society are extremely closed to these discussions because apparently we only like talking about boobs if they are sexualized.

There is a lot of pressure on new mom’s to do things certain ways. And the right way varies depending on who you talk to. People become very judgmental and invalidating. I’m writing this blog post to hopefully provide some encouragement and validation to new mom’s.

I decided to breastfeed my kids because I work in healthcare and I knew it was the healthy choice to make. I was not going to put a lot of pressure on myself to “make” it work though. Because I knew my mental health was more important when starting a journey as a twin mom. So here’s my breastfeeding story.

Immediately after being cut open and having two babies taken from my uterus and while I was still intermittently puking I had two beautiful little beings put onto my boobs. One of them took it to it right away, the other was not very interested.

They were born at 36 weeks, they were both 5 lbs. Having been a pediatric nurse I knew they were at high risk for weight loss and feeding issues. That is what would keep them in the hospital. So I was determined to make this breastfeeding thing work. I also agreed to supplement with formula until my milk came in. I wanted to bring them home.

Enter in pre-eclampsia. I had high blood pressure which is why we did the emergent C-section. The next morning I lost all peripheral vision in both eyes. I was put into maternal special care and started on a magnesium drip as they thought I was having full blown eclampsia. The next twenty-four hours sucked ass. I got no sleep. They check vitals every hour on a Magnesium drip. I was on bed rest, so I had the freaking catheter still in. My incision freaking hurt, and they would still come in every two hours and throw the boys onto my boobs. They also encouraged me to pump between feedings to help bring in milk supply.

So I had no vision, I was on a drip that made me feel shitty, and I was fresh post-op. People were texting us wanting to come to see the boys. I wanted everyone to go away and leave me to die. It sounds so dramatic but it was totally awful.

So that was my introduction to breastfeeding.

Luckily after some force-feeding of the boys with medicine droppers and the 24 hours of Magnesium we were all cleared for discharge. One of my boys was breastfeeding like a champ, the other one not so much. Every two hours it was an ordeal. One boy on each boob, and extra attention to the one boy who needed it.

About five days in my nipples felt like they were going to fall off every time they nursed. I’m not exaggerating. I actually had nightmares where they fell off. Because they didn’t get a break. There was no switching boobs, it was one baby on each boob every time they nursed. No breaks. Around this time we realized both my sons could not tolerate formula. We tried milk based, soy based, anti-allergy etc. The only thing they could keep down and sleep after having was my breast milk. No pressure.

After the first two weeks of me crying through every feeding because my nipples hurt I wanted it to be over. Now. But we literally tried every formula and it was not happening. They were both in pain afterward, up for twelve to twenty-four hours sometimes just miserable. So onward we went with breastfeeding. I did get my lazy feeder to start nursing well, so by about five weeks in they both were at least nursing easily but I was living life as a milk machine. I was always crazy about my supply. If I took six hours to sleep at night, I would wake up in the middle and pump. We were building up a freezer supply which thank God we did because we needed every last drop to get us through to a year.

Enter blocked ducts. I was making milk for two babies. My boobs were overloaded so I continuously would get blocked ducts. It feels like a hard lump in your boob. It’s extremely painful. The solution- nursing. One of my sons was a very vigorous nurser so he’d have to nurse on that side until the duct cleared. He did clear it every time. But it took a few tries sometimes.

Then we had family and friends over and they were sad they couldn’t give the boys bottles. They wanted to know why I couldn’t just not breastfeed them one time. It made me want to scream. I was working so hard physically and emotionally to keep up with twin supply. Every time they had a growth spurt my supply had to keep up with them. I also knew I was going back to work at eighteen weeks and we needed a freezer supply. I was working all the time on making breast milk to feed my sons. I didn’t want to hear it from anyone about giving them a damn bottle.

Breastfeeding twins who are not on the same schedule meant I was breastfeeding upward of eighteen hours a day. Mostly they were on the same schedule. But they never had growth spurts at the same time which meant those weeks were rough. Then one of my sons cut his first tooth at ten weeks. Yes that is rare. Yes it totally sucked. They didn’t use pacifiers at that time, and instead he was gnawing on my boob.

I couldn’t leave the house because if we left the house one of them needed to nurse. They weren’t the quiet nursers. They made a lot of slurping noises, they looked around all the time, and unless we were sitting alone on the couch at home it was not relaxing for me or them. Thus it was an incredibly isolating eleven months. The twelfth month we made it through on all frozen milk.

Had I not had two babies who were extremely sensitive to formula would I have stopped breastfeeding? Yes. Did I receive many opinions about my breastfeeding journey from many different individuals? Yes. Did this want to make me isolate even more? Yes.

Around the tenth month I was back at work already and had been sharing a double office with another new mom. We would both hook up our boobs to our pumps and do our notes while we pumped. It was a nice set-up because we could lock the door and we were both going through the same thing. But then there were some major office changes and we were told we would be put into a group room with three other employees, some males. When I asked my boss and the woman in charge of office space where I would pump they said well we don’t have a space. I said you have to provide me a space, and they said, “Well you can use a bathroom.” I said, “You want me to pump milk, food for children, sitting on an open toilet in a nasty public bathroom?” They both said “yes.” I informed them that this was against our state and federal labor laws to suggest I pump on a toilet. I ended the meeting, waited until I walked out and burst into tears. I was still pumping three times a day at work at that point.

I worked for a hospital, and both of those individuals were women one a mother. I could not believe I was being treated this way and I felt violated. I had come so far in this breastfeeding journey and put so much work into it and it literally was how we fed our children. I was angry and stressed and hormonal and I also knew it was illegal. So then I had to set up meetings with human resources and our executive director. I couldn’t believe that the three men I spoke to (while crying) about my whole experience were more understanding and more willing to help me than the two women.

The psychiatrist I worked with at the time and our chief resident immediately came up with a solution for me to use in the interim until the hospital got it’s shit together. I remember feeling so angry though that I had to even involve them. That my breast-feeding journey became this spectacle and source of gossip at work.

The whole experience was incredibly eye-opening for me. The more I talked to other women at work and online and in my life the more stories I was told about women being told there would be no accommodations made for them to pump at work. Teachers and nurses had it the worst or maybe that’s just who I was surrounded by. Women came forward having been told they could not take pump breaks or there was nowhere for them to pump, or use their car, the bathroom, etc. It was shocking to me.

Why do women not make a stink about this? Why are women treated this way by employers? Why as a society do we not empower women to feed their children in any way they want instead of making it impossible for them to do so without it being a battle? My place of employment should not dictate how I feed my kids. I should.

By the time the boys were eleven months they were big, healthy, eating solid food, and the last time I nursed them one of them bit me (he had a full mouth of teeth by twelve months) hard, and I was done. One of them was clearly ready to be done, one of them would probably still be nursing if I let it go on, but it was time. They went from 5 pounds at birth to over twenty pounds each by one year. My boobs will probably never look the same but it was worth it. There were moments when we would be nursing and they would cling their little hands together or hold onto my fingers. They would sigh and fall asleep on my chest. They would look at me and really see me with their big blue eyes. There were beautiful moments I wouldn’t trade for anything.

When a friend became pregnant with twins they asked me for advice. I said the number one thing I’d do is not stress about nursing. If it works it works, if it doesn’t and they tolerate formula just move on, the first year will be happier and easier and less isolating. Do I regret nursing? Never. Do I wish I was less isolated for the first eleven months? Yes. Do I wish I never had that experience at my job? Absolutely. It was horrible. But it also made me more aware of a problem our society has.

Breastfeeding is an incredibly vulnerable act. It exposes our bodies, it exposes our babies. It puts us into the position of not being able to defend ourselves if needed. It also makes us vulnerable to people’s judgements. Any mom who breastfeeds for any length of time deserves a medal. She deserves encouragement, pride, support, and NO judgement.

It’s taken me a long time to write this blog post. I stopped breastfeeding one year ago. But it still causes me to feel raw when I think about those eleven months. It was so hard for so many reasons. I could not have made it through without the support of my wife. I also would not have made it through if my son’s hadn’t absolutely loved nursing. That’s what kept me going. But I’m not going to lie. I’m very happy it’s over.

Bigotry down the street buying a Christmas Tree. 2017.

This holiday season brought a lot of decisions for us. We always celebrate Christmas. We were both raised Christian though our religious experiences left us with different tastes in our mouths for sure. We agreed on Santa Claus from the start. We sort of agreed on Advent breakfasts. That’s just a thing my family does every Sunday in Advent we have a nice breakfast at the dining room table and light an additional candle each week until we have five on Christmas day. I grew up reading certain passages from the Christmas story in the bible, so we do that too. However we also have the “Yule” book at the table, written by a Wiccan, and flip through that to find blessings and legends outside the Christian tradition.

Our advent breakfast sounds so austere when I read what I wrote above, but in reality it was me flipping pancakes, the boys screaming because they don’t do well without eating first thing upon opening their eyes. Waiting the ten minutes for pancakes is torture. But they do love pancakes. Then we served them their pancakes in their highchairs at the dining room table, we brought out the coffee, placemats, then by the time my wife and I sat down the boys were basically done. I read the passage from Luke and the boys babbled the entire way through with my wife “shh-ing” them, and telling them to be quiet, and me telling my wife to be quiet. Then they got down and wanted to help us eat our pancakes and one of my son’s knocked over my water bottle…the chaos just goes on. So in reality our peaceful advent breakfast was a clusterfuck but we don’t regret it. Traditions start out as clusterfucks I’ve decided, or maybe that’s just in my family.

The one tradition my wife and I never disagree about is the Christmas tree. We get one every year. We cut it down fresh, drag it to the parking lot, watch them wrap it in twine, struggle and swear at each other as we lift it onto the car, tie it down. Then the ENTIRE way home I ride the breaks and make my wife practically hang out the window to make sure it’s not going to fall off (it never has. I’m just a freak). My wife meanwhile bitches about hanging out the window and tells me to drive faster and the tree is fine.

This year is the first year the boys had any clue what was going on. All four of us went out into the field, the boys frequently falling and tripping over all the stumps and holes. We finally found “the tree” thinking it wasn’t too big, when in fact it was the biggest freaking tree we’ve ever gotten and literally would not have fit in our living room if there was furniture in there. Which there isn’t because we just moved in, thank God, so it’s still unfurnished. Well except the big ass tree.

So we are out in the field, I’m chasing the boys around, we are all getting trapped in prickers, my wife is sawing down the tree yelling at me to push it, I’m yelling at her that I have to watch the two boys. It finally comes down. We try and get it onto the cart. We fail miserably. It’s not going on the cart. Then she’s yelling at me that we picked a tree that’s too freaking big, and I’m like I wanted the little one back near the car. And we are losing the boys.

So I take the empty cart, and yell to the boys who follow me like little ducklings, still tripping over every hole in the freaking field. My wife drags the tree that’s literally five times her size, and then a very nice gentleman sees our struggle, and probably hears me scream at her “I hate doing this with you every year!” And she screamed back “I hate doing this with you too!” then we both are cracking up, and one of the boys is stuck in a hole.

Anyway the nice man helps my wife carry the tree to the twine thing. The boys and I and the empty cart make it out alive. Covered in scratches from the prickers. The lady by the twine says the tree is too big for their twine machine and has to be brought to the “main farm” for their “industrial twiner”. I’m like Motherfucker. At least they transported it there in a pick-up.

We put the boys in the car, we drive up to the main farm, and see the ginormous twiner. Now back at the tiny twiner we put a tag on the tree with our last name. Pretend our last name is Smith. We are hanging out at the big twiner. The boys are drinking “cider” (it was warm apple juice, gross, but it was free), and sucking on candy canes, watching the trucks and dogs and everything. The four of us are standing together watching our tree go through the big twiner, it’s kind of a kodak moment. It’s bitter cold and we are all snuggled together loving life.

There were three middle-aged white guys working the twiner. And one woman supervising the “cider”. They put the Smith tree through then looked around and only saw the four of us. The guy in charge looked at us, and said “Are you the…uh…” and he looked back and forth between my wife and I, pointed at me directly, “Are you Smith?” he says. Kodak moment broken. Stupid bigot alert. It wasn’t what he said, it was the hesitation, the understanding that flickered in his eyes as he was putting it together, and the downturn in his expression when he did.

I gestured toward my whole family, and smiled and said, “Yes, we are the Smith’s” (in my head it continued with some profanities). He took us all in. The boys had on fleece hats. I mean come on. Cutest thing ever. And one had a cut on his cheek from the prickers. Battle wound. We just survived a family bonding outing from hell. And we wanted our damn tree twined up and put on our car. It was an awkward moment, and the other men  there were clearly sizing us up and deciding whether they would help us or not. I think because we were the only people there and they had literally no escape and my eyes did not leave them for a second, they gave in.

They helped us put it on the car. But they weren’t nice. They didn’t interact with our sons and barely with us. They essentially acted like we had lesbian germs and they wanted to throw the tree at us and run. Which of course made me want to slobber all over them, but now that I have kids I can’t be that annoying lesbian calling every person out on discrimination.

Takes family bonding to a whole new level. Because all of the sudden we were not safe, and we were only a mile from our home. Suddenly I didn’t give a shit about the tree. I wanted to protect my sons. Because those guys could have spit on us, could have thrown the tree at us, could have destroyed our car. They could have followed us home and realized we were practically neighbors.

Some day the boys will be old enough to notice. Some day they might have a mouth like mine. Some day I hope middle aged white guys who live on farms will be nice to us.

And some day I’d like to actually estimate the size of the tree correctly.