Monday, December 15, 2014

On deaths and dying

I've had more time to think lately and I've been reminded of the time 3 years ago when we went through that third miscarriage. I also think more about it because we so clearly have a toddler now and not a baby anymore. (Later I think I may discuss my adventure attempting to get to the airport in morning traffic in LA and the hours spent contemplating a very different world, but for now, just the grief.)

The dying part is hard too. My friend who has been dying for some time is now at the end of hospice care waiting to die. She's in so much pain and not really eating any more and it's hard. Obviously not so hard for me as it is for her and her family but it's had me pretty frozen. It's a really good thing I'm not keeping track of how many brain candy books I've read in the past few weeks. I'd say it's about 50% escaping reality and 50% trying to fill the time with more cheerful thoughts rather than the gloom and doom and death hanging around everywhere. Happy Festive Winter Holiday to me?

I guess the two events, aside from both occurring in December, really bring up a lot of survivor's guilt for me. I never feel worthy to be on this side of things with a toddler and no cancer. My friend has the most perfect spouse and four awesome children and I wonder why her and not me. I never feel like I'm enough. It matters that I get these second chances and I'm trying to seize them and do some good in the world but it's a struggle to kick the feelings of unworthiness. I haven't descended into feeling worthless but it's hard to avoid that pitfall. I suppose I might say that grief has me standing at the edge of the pit of worthlessness and I can see how it would be easy to fall but also that the way to whatever is next in life is walking along the edge of the pit and not falling in or going across.

Anyway, the most intriguing thing happened last week. I was feeling mopey about life and how many of my favorite Festive Holiday ornaments have been ruined when yanked off the tree by Little Monster (and/or Fluffinella and/or the Kid) and then I was checking FB yet again (nervous habit I suppose?) and ran into a friend posting about the Mental Illness Happy Hour. It turned out to be the day a new weekly podcast came out and it was the above linked episode... about miscarriage.

I figured that I'd better share it with you all. The guest in that episode is a fellow infertile with multiple miscarriages and she talks about her experience with a full-spectrum doula. So much of what she says is so familiar and wonderfully put. You should go listen. Then maybe if you need it, read what she wrote about the closure ceremony part here as well.

So I feel better now. Still freaked and unworthy of all the amazing things happening in my life and totally unworthy to be applying for residencies but I'm trying to psych myself up and stop putting anything off. Today has awesome parts even if the transition to whatever happens after life is circling in close. On the whole, just getting to breathe is pretty awesome, let alone getting to snuggle a grumpy toddler for 5 hours while she watches the yellow hat dude and some critter wander around a city. Bonus!

Wednesday, December 3, 2014

Baby shower blues

I still hate baby showers. They are a great kick in the guts every time, a reminder of everything that didn't work in our attempt at family building. I've kind of resolved that I will excuse myself from as many of them as possible because there's no sense in me attending and being a glum bunny. It's just a thing and I'm stuck feeling the way I feel until it gets better maybe some day. For special people I am willing to put on a happy face and stuff my feelings briefly. Some people are worth celebrating.

So here we are (I am, actually), with the most recent baby shower invite to an event happening this weekend. This one is for a family friend who's the closest thing to my spouse's sister that exists (closer than my sister-in-law, that's for sure). Based on family relation alone this is one I'm pretty obligated to attend. Then there's the infertile club membership we share. It took a couple years for her to get pregnant with her first (two)and the twins were born at 22 weeks just about a year ago. This baby happened remarkably soon after that and is expected in late January. It hasn't been an easy pregnancy as you might imagine so I feel bad there too. I get it, at least more than the perfectly fertile folks. I want to be there in solidarity.

But. Oh I hate baby showers. I'm also flying to the ASHP meeting (that giant pharmacy conference which is in California this year) that same afternoon so I get to leave the baby shower early at least. But I hate flying so much. Usually I get to the airport 4ish hours early so I have plenty of time to panic before I get on the plane. Attending the baby shower cuts my pre-flight airport loitering time down to only 90 minutes.

I'm debating the merits of skipping the thing so I can go hide at the airport. I asked weeks ago if it was ok for the girls to come so I can pawn them off on my MIL while the spouse drops me off at the airport. This week the sister of mom-to-be has been discouraging everyone else from bringing kids and their mom was doing the same. If the answer was no children, why on earth did you say they could come? I hate passive aggressive baloney. Ugh.

I don't know what to make of my selfish motivations. I suppose that means I make an appearance and pretend I hate it less than I am likely to. It's possible it might not be awful. Maybe my motivations will straighten out and I'll figure out whether I can go or whether it's better to send my regrets.

Monday, December 1, 2014

The Relocation Shuffle

It's APPLICATION SEASON!

I'm in a place where I mostly think I am totally capable of not only getting an interview but getting a residency and yet I wake up from dreams where I am counting by 5 and the phone is ringing and the printer is beeping about a paper jam and someone is yelling at my tech about something that the tech has no control over and it is 2pm and I haven't had a break and I won't get one. So I guess I could say my confidence is not high all the time but is high enough that I'm getting along with applying to residencies.

And jobs. Also applying for jobs. I have had 7 interviews so far and one "forget this, we aren't hiring you" response, so overall not bad.

In all things, we are free to relocate if my job dictates. I think we can move the kid to one new city between now and when she's grown so this is actually a very big choice. There's some consideration that I will go during the week for a job and the family will stay here so we can move after a residency. One of the local pharmacies (we had 1 in a grocery store, 3 at big box stores, 1 chain, 2 independents, 2 at the hospital) just closed and another shrank its hours so I worry that working in town won't be an option.

When I'm not debating which of the zillion residencies to focus on applying for, I'm considering how on earth we could leap and move for a job. One of the considerations is that we have a lot of great things in place for the kid now and that's hard to find. She has a tiny class (that is 25% Caucasian, a bit less than our neighborhood but not too far out from the under 12 population demographics) and a small school that supports her with all the quirky services she needs to thrive. I don't think it would be impossible to find this again but we got really lucky to live in a neighborhood that has an elementary that exactly meets her particular needs.

The other big thing on my mind is respite care. It's hard to manage a kid who is challenging all of the time. It's hard to find anyone willing to take care of her for any length of time if her label is known. We aren't stupid so we haven't told our usual respite care friends around town her diagnosis and they are still happy to have her for a few hours. She behaves like a saint at someone else's house right now so that's helpful. I don't expect it to last. Overnights we have mostly been relying on family but they live far enough away that we can only do that maybe 3 times a year. If we move farther away we lose that help. Maybe. We could move closer to a big chunk of family too. Maybe. There's some discussion that my in-laws would visit us more if we lived somewhere more interesting/near their vacation home, even if it were the same distance from their vacation home that we live at now where they come down twice a year at best.

We've also been discussing if we really want to move for good reasons or if we want to move because we just aren't used to staying put this long. This is our third year here and the longest we've lived anywhere since we got married. I really found this video over at Rage Against The Minivan an interesting discussion. Does where you live shape your life? Tremendously so, yes. In my experience it does. Are there communities around you can join or are they all closed (or nonexistent)? [By communities, I mean things like churches or book groups or scouts or community service groups or the PTA.] Are there things you want to do nearby? What about shopping and restaurants? Do you want to do either of those in town or would you rather take a weekend trip somewhere?

My criteria for a place to live is as follows:
  • Must have pizza restaurant, preferably delivery
  • Must have a community of faith I'm comfortable being a part of
  • Must have a job for me and accessibility to a job for the spouse
  • Must have schools with support for the kid or that are willing to figure out how to support her
  • Must have childcare available
  • Strongly prefer a red big box store be within 90 minutes
  • Strongly prefer it is possible to get package delivery beyond the mail
  • Strongly prefer interesting outdoor recreational opportunities be readily available
  • Prefer limited constant wind
That doesn't actually narrow things down one bit. I'm feeling like caution is warranted rather than jumping at the perfect job, but at the same time, I'd rather go somewhere and have a great job than stay here with ho-hum options and no real reason to be here aside from "we already are" and pretty good schools.

Monday, November 24, 2014

Grace under pressure

Tonight both girls are in a horrid mood. There is screaming from one, then the other, then together. Little Monster is cutting molars and the kid is... Herself? Something is wrong but she has no idea what and is a terror because she's upset. We went out to dinner because the house is a disaster and we host thanksgiving Thursday and exhaustion and long commute are winning. At dinner the kid didn't eat until we were ready to leave and she was suddenly ready to eat enough so she could have dessert. This rotation's 2.5 hour daily commute is decidedly taking its toll on me especially, but all of us at least some.

I never understood grace before this year. I mean, I'd heard the word over and over. I'd heard it defined as poise, as the free pass we get when we are forgiven for something. I'd heard about giving yourself grace as a way to cut yourself some slack. I don't know about you, but I am terribly hard on myself. In many ways it's deserved; I'm a person and therefore imperfect, and I'm a particularly ordinary person with some reasonably common flaws that run riot in my life if I don't work hard to keep them in check. Most of the time, I am too hard on myself and I attack my flaws perhaps more than I ought. It's easy to dwell on how nothing is ever right.

In the past little while, I've been practicing forgiving myself for being human. It works sometimes and others it doesn't. Grace is there if I want or need it. Well, when I want and need it. All I can ever do is my best.

But then there is life. Everything crowds my little tiny bubble of "I don't have to be right, I don't have to have all the control, it will be fine probably so stick to the next right thing" affirmations. I yell. I curse a great deal. I lose my temper after the first test of my boundaries instead of the tenth (my goal). It is so hard to find grace in the screaming (usually not me for too long) that I lose faith in the whole exercise of allowing myself to be imperfect. In an awful lot of messy situations, I have been collected and said and done sane things, the right things even. I know that I have access to that grace within myself. I just don't know how to operate day after day with children prodding at my weak points constantly and still find that place where I can think and act from a place that allows them grace too.

Little Monster is sure she is 2 and yells and tantrums to demand things. For the most part, that I cope with all right. I get so frustrated with myself when I can't cope with the kid doing much the same thing. After all, we have had the best part of 5 years to adapt to her tantrums and screaming... and yet it is impossible lately for me to cope. That makes me think I totally missed the mark learning about grace and that I have a very long way to go before I can hang onto any semblance of grace under child-inspired pressure. 

The best part is that I have tomorrow to try again to be a smidgen better than I was today. And please, all that is holy, let there be less screaming tomorrow.

Thursday, October 23, 2014

There and back again

It's strange to go home after a month away.

I can tell you I have learned the value of having a pharmacist in your healthcare team. From chatting with patients in this clinic pharmacy, I know it takes an hour or more sometimes to check in to see a doctor and that they only see walk-in appointments for a few hours a day. It takes at least 2 hours and sometimes much longer to get a call back if you leave a message for the nurse of a provider. If a patient called the pharmacy, they spoke to a pharmacist within 3 minutes. Sometimes we could triage what was wrong (go to the hospital if you take a blood thinner and fell and now you have a headache, go to the ER if you are throwing up blood after taking a new medication, try taking your medicine with food or on an empty stomach if it makes you sick or isn't working, you are supposed to take 3 every day and not just one so see if that works, etc) sometimes we couldn't (make an appointment if you need a refill on that medication that was stolen... again...) but at least people got their questions answered rather than waiting hours. That accessibility of pharmacists is sure valuable. Then again we are often too accessible. No other healthcare provider is as likely to work overnights as a pharmacist. Doctors take turns covering nights but not regularly working them, we have a regular rotation of night pharmacists in hospitals and community pharmacies. It's really easy for people to demand to see us too, and they sure do, often to ask silly questions like:
  • "I want a flu shot. Where do I sign up?" while standing under a sign that points to "Check in for your flu shot here!"
  • "Where are the paper towels?"
  • "I need a refill of my medication." "OK, you can talk to my technician over there." SuperTech: "Which medication would you like refilled?" Patient: "The little green one." ST: "What do you take it for?" Patient: "Because my doctor says I need to take it."
  • "Why won't you vulcanize my tires while I wait?" 
So maybe that last one is a Clerks reference, but you get the gist. Because you can see the pharmacist in a community pharmacy and because we answer our own phones in the hospital, people make demands on a pharmacist that they would never dream of making on a doctor and yet we have similar educational backgrounds. Somehow pharmacists let themselves be used by everyone else, helping out people and getting nothing in return to the point that we make ourselves miserable.

Anyway, home. I've learned a lot and I'm really glad I had this experience, but it is so hard to be home. While I was gone, Little Monster learned to say "I love you." She wouldn't say it to me when we video chatted for the first few days after she learned it, but then she did it with no coaching or prompting at all, for like 3 minutes straight. She's so big. It boggles my mind.

Sunday, October 19, 2014

Compromised values

I'm getting ready to apply to residencies and this brings to the forefront a few things.

First, I really don't want to work for a religious institution. I think. Probably. Or at least not a particularly prevalent one that runs an awful lot of health care establishments. Think hospitals named after saints and you've got the right idea. I'm too lazy to disguise the name of this particular religion and I don't want to invite a legion of angry commenters here by using its name.

My major reason for not wanting to work for one of these institutions is the disservice done to women in the face of obstetric problems. Nobody with pPROM who wants labor induced should have to wait until signs of infection to do so. Nobody with an ectopic should have her tube removed because using the standard of care medication amounts to an "indirect ab.orti.on." I'm perfectly content to let anyone think whatever they want and use their own thoughts to decide on appropriate obstetric treatments for themselves, but I absolutely don't want a hospital to prevent a woman from getting appropriate care for any reason.

It gets a bit more complex though. I live in an area where the closest non-this-faith-based hospital is an hour and a half away across state lines. I don't think the hospitals nearer are doing any terrible things most of the time. They're just the only hospitals around and they happen to be run by some extension of this particular faith. The level to which they subscribe to the official doctrine varies but it isn't one of those things it's easy to ask before you work somewhere.

My personal job acceptance line has been "absolutely no job is worth having at a certain big blue box store" and "if at all possible, a job at a giant red pharmacy chain should be avoided." Beyond that I'd consider myself open but I continue to have mixed feelings about even considering such a religious institution while finding that an awful lot of the places that are otherwise appealing are also religiously affiliated... I'm continuing to consider the merits of maintaining my line as previously defined or to change my values to allow for working for a health system that has a faith-based sponsor.

Then I wonder if I'm compromising too much. There are lots of places similar to this one that we could move to that have secular health systems where I could work.

Second is that I am more likely to get a really satisfying job in a community pharmacy if I take a job offer sooner rather than later. Specifically the job interviewing season is starting in November and my classmates who work for a big chain are starting to be offered jobs there already. I really feel like we live in a decent place now and it would be nice to stay put if we can manage it, but that means working for a faith-based hospital system or getting a job with a chain community pharmacy.

Third is that I'm trying to avoid just going with the flow, or seeming to just go with the flow. My plan is to cultivate a few possible paths, to explore even the ones that are scary and that I'm likely to fail at, and to be on the look out for the ideal opportunity that is the right fit. I'm sure that I will know it when it arrives but I am impatient as ever. I want the certainty of saying, "Here are my career goals and I really want to meet them and I clearly see how I can accomplish that" instead of the liminal space that exists now where I have some pretty good ideas for what I'd like to do but I am unsure which direction is the right one for me, for us. If things go perfectly smoothly, I would love to work in a hospital doing clinical and technical pharmacy. If things go in another direction, I'd be very happy working in a community pharmacy. If things go in a third direction, I'd really enjoy working in an ambulatory setting.

So I guess I know what I'd like most but I'm not sure how to articulate the "I don't commit to one way yet because I don't trust my certainty of my own judgment" place that I'm in. I stick with the next right thing and I do that and then I do the next right thing after that. If I try to plan for years ahead I usually am wrong because I skipped that next right thing in favor of dreaming.

Thursday, October 16, 2014

To scale or not to scale?

I have never personally owned a scale. Not in a great many years now have I even had regular access to a scale. None of my roommates had scales so I haven't had access to one at all since I moved out of my parents' house better than a decade ago.

Lately I've been pondering if a scale would be a useful thing or a detrimental one. Obviously I'm attempting to get into proper shape which should eventually come with a good deal of weight loss. I'm also healthier now than I have been in a long time so I'm not visiting the doctor all too often so I have no accidental/coincidental scale access either.

My memory of having access to a scale is not friendly. The scale was a source of stress and a way to control something in a world that was spiraling out of my grasp. My weight became the only thing I even attempted to control and I did that through very damaging eating patterns.

So on the one hand, I think it would be motivating and helpful for me to know how I am doing in attempting to lose weight. On the other hand, I never want that disordered eating in my life again and I'm afraid of what having a chart of my weight would do to me.

On the third hand, I like to think I'm overall much healthier now than I have been before. Most days I think my mental health is pretty well taken care of and my physical health is improving with exercise. Maybe I'm giving the scale control of my life without it even being present to impact it at all. Maybe it would be no big deal to weigh in once a week or once a day.

But there again, I don't know. I want to make sure my girls develop some kind of healthy relationship with eating and their bodies. The kid eats so little and at most meals, Little Monster eats at least as much if not more (sometimes by double or more) what her older sister eats that I worry their approaches to food are going to set them apart as they get old enough to notice how different they are. We are probably already ruining them by pointing out the good things Little Monster does when presented with a new food ("Look, she's picking it up and smelling it up close! You could try that too! Why don't you just touch the fish stick? Oooh and now she's taking a bite! What a brave Little Monster! See? She likes it! That fish stick might be your favorite food and you are missing it, Kid!") and how great it is that she eats her food instead of ignoring it at meals and demanding 5 desserts afterward (and I'm sure Little Monster will also do that when she has words for it but since nobody ever gets 5 desserts, no matter how much they whine and tantrum, she hasn't tried to develop words for it yet).

I remember times when my mom spent days and weeks weighing herself a couple times a day before giving up or before giving up dessert and then dinner in favor of some fad diet snack she'd eat before we all did. I bet that stuff influenced me more than I realize. It isn't something I consider often but I know my body image is very skewed.

So where do you stand? Scale or no scale? Should I get one? How long of a trial do I give it? How would I even recognize if the scale were a problem?