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.