Saturday, December 21, 2013

Ready, break!

I am bad at taking a break but I decided to take a full 3 days off with no studying or anything school related. It's now expanded into day 5. I may even take tomorrow off as well! Kapow!

In the meantime, things spiral ever on around here with the girls getting too big. My computer is ill and I'm giving it a winter break too so I'm sorry for not commenting. It's really hard to comment from the spouse's computer and so I'm very far behind but I am reading and thinking happy thoughts for everyone.

Here's what I've been pondering lately that might turn into whole posts if I'm willing to spend more time at the computer:

The new healthcare law: it frustrates me to no end that my county healthcare employees have no idea what's going on with it (and I live where medicaid is expanding so it isn't like this is some surprise taking employees by storm, it's been in the works for years). We've been getting the run around from them for almost 8 weeks now and I'm about ready to throw something at them. Maybe I should try cookies. I bet cookies would get better results. Bureaucratic nonsense just maddens me and that we have a huge bureaucracy built up to support the weird insurance patchwork that exists in America bugs me. Lots.

Giant leaps and bounds in Little Monster growth. She says things sometimes, including KITTY! and dada and mama and meeee! (which seems to mean MILK! or HOLD ME!). Yesterday she said "in der" in reference to a bowl she was looking into. She climbs low stairs like it's no big thing at all. She has 3 teeth and a few more should turn up soon. Standing for up to a minute with bending down to grab a thing to shake happens. Whoa.

The personhood of businesses and whether they are entitled to a faith or not. I personally avoid patronizing businesses that advertise their religious connection  because I think it's downright immoral to give businesses person-like rights to donate money to political campaigns and nonprofits. I am choosing rotations to avoid pharmacies that advertise for "crisis pregnancy centers" because I think those are a travesty and should be defunded ASAP. It's complicated but in short, no more personhood for anyone who isn't a person. Should animals be protected under the law? Sure but not as if they are people because they are not. Defining "people" and "person" more broadly than those of us living, breathing, humans is a very dangerous slippery slope.

Personhood laws are also on my hate list. My opinion is that, as there's no evidence to the contrary based in science, we cannot give the unborn the rights of a person. Note above where I pointed out that a person should be narrowly defined as a living and breathing human. Can't live or breathe on your own? Not a person and not entitled to the rights and protections of a person, therefore pregnant people ought to retain their rights and not have them superseded by "rights of the fetus." Embryos aren't people so they shouldn't get rights like a person. Should they be protected? Yes. Should they be used for any old science research? Probably not without a lot of supervision and careful ethical consideration, but it shouldn't be prevented on the grounds that "embryos are people." Definition of a person needs limiting to an actual, living, breathing person.

I am so ready to be done with school. And pumping. Maybe not nursing but pumping. Gag. I think my feelings have shifted on the subject and I have things to say but probably at length. For now I am excited that I'm not getting bitten.

Wednesday, December 4, 2013

Daycare drama

I've been pretty happy with no daycare for Little Monster the past several months. She likes being home and having personal parental attention. I like avoiding pumping as much as possible. But to everything there comes an end. It's time for daycare.

So that leaves us looking. We got really stinking lucky and found 3 places with openings in January (and we're on the wait list for the "good" center in town where there might be an opening by September). The first place was acceptable but not what I'd really like. It's an in-home daycare and it's at capacity but the space is really small. Plus every wall had 2 or 3 Jesus-related pictures or crucifixes or cutesy Biblical sayings. It made me gag. They also have the TV on to kids' programming all day. At the very least the kid is a super TV zombie. She gets mesmerized and will watch stuff for 5-15 minutes, then declare she hates it and please change the channel, then when it doesn't change (you can go do other things, we remind her), stays another half hour. I imagine Little Monster will be much the same way, just falling in to watch TV more than she would if it weren't just on.

We went to the second place yesterday and it's perfect. Double the space of the first, the provider mentions how she picks up kids' music CDs at childcare conferences she goes to because the kids like it, all that. And today she decides because of her husband's health she's not going to take any new kids right now. Bah.

Tomorrow is the third place. It's a center too but my impression is it's a place people choose out of desperation rather than because it's great. They offer 24 hour childcare and are probably one of a very few places within 50 miles that do so. Sigh. Talking with them it doesn't sound awful but I'm wary.

I feel like we have a good handle on what we're doing in choosing a daycare as we've had far too much practice at it, and yet it's so hard. Especially since I feel more and more every day how much we screwed up leaving the kid in care that has damaged her or at least switched her anxiety switch on and ramped it up to 11 I fret. The best part is we have to have a decision made so we can get quotes so I can get financial aid to cover the cost (more debt! yay!). Now I'm peeved because our best choice (probably) is out of the game which hopefully means either the next place is amazing or we get lucky again and find something else somehow. Before the end of the semester. While the spouse suddenly has more than a full-time job for the week. Yay.

One of my great wishes in life is that free or low cost, quality, public childcare was available. It's such a fiasco to find care for a baby. Or if we can't have public childcare, could we at least have 6 months of paid parental leave? Even a year? I bet it wouldn't even cost that much in taxes to do it. The level of quality varies so widely between "licensed" providers it's maddening. Someday the politicians will take what's best for families seriously. For now, it is a mess.

Sunday, December 1, 2013

Of leashes and liberties

I really enjoyed reading the different posts over at PAIL bloggers about the "big picture" approach to parenting and how your ALI background has or hasn't influenced your parenting. I enjoyed them so much you're gonna be stuck with my belated contribution! Suggested topic questions have bullets because I like lists and it's almost finals so I'm ready to think fast and get onto the next thing.
  • Does your ALI background make you feel like you need to spend more time being exclusively focused on your child?
Yes. I think secondary infertility kicked me hard and made me realize that if I meant it that children were a priority, then I needed to be there with my kid more often. This comes with the caveat that I'm the secondary parent, mostly by necessity because of the omnipresent school (only another 500ish days, but who's counting?). My goal now is to spend more time with the kids when I am with them, and when I'm not mentally with them, to actually be physically somewhere else so I can focus better on one thing (school or kids or work). Mostly this happens (ok, not in the latter half of the semester but I did pretty well the first half) but sometimes I am plopped in the living room with a screen or two glowing and ignoring the baby climbing toward me. It was interesting to me to read that so many other moms felt it hadn't influenced their parenting, and cool too. I wish I didn't feel so guilty hiding in my study cave, but it's there. Then again I get less guilty as time goes on because I know I'm using my time with the girls better when I'm not half studying during my time with them.
  • Are you more “hands off” as a parent than you thought you’d be? More of a “helicopter parent?” Are you happy with the type of parent you’ve turned out to be?
This is interesting. I'd say my instinct is helicoptering but I know it. I love to control every stinking thing, or pretend I control it, so I would love to be right there keeping the girls totally safe from all the scary and/or bad things. BUT I know myself enough that I saw this coming so I am very actively hands-off whenever I can get away with it. If I'm at the playground, I have a book and I am reading it. That said, I now have a super anxious child who is terrified of... well, most things. She demands we go with her often, even across the room to get something if we aren't at home. This makes it more of a priority to pry her off of me/us to get her to be independent. 5 year olds can and should walk around the block without needing a parent, and she does that fine, but she won't leave our sides in some situations and it's a struggle. Up until we moved and/or the bullying/playing the "I'm not your friend anymore, but now I am your best friend again, but now I won't talk to you" game that went down at daycare last year, the kid was very independent and secure most of the time about it. Now she is constantly upset about not knowing what's going on in any setting, yet she ignores anyone who explains things (especially if it's us parents) and also pays no attention to what is going on in an effort to figure it out. This leads to more of her clinging and us pushing her to be more independent and take responsibility for herself, and more tantrums on her part when anything doesn't go exactly to her (generally top secret) plan. Also me rage eating candy and glugging too much soda late at night because UGH who is this kid?

So I suppose I'm getting at that right now, I am incredibly frustrated with my parenting skills. Whatever we try fails and often with spectacularly bad results. The other week the kid refused to go to her room upstairs, and refused to stand in the corner for a time out instead, and refused to go punch the punching bag downstairs, so she got carried upstairs. This was met with much protesting and shrieking and throwing things at the spouse and me and then the spouse's glasses got chucked downstairs and a lens vanished. Then the shrieking about how "you are so mean and made me throw that stuff at you!" commenced. UGH. She spends all her time blaming others for her choices. I really hope it clicks soon that she decided to do things and nobody made her and if she stops, looks for the perfect thing to throw, and then throws it, she can absolutely control herself... Bad phase, nothing is working, I think we need to see if someone can help us figure out how to fix the anxiety because I'm going nuts trying to cope with her. And I need more skittles.
  • Does your child do well with independent play? If so, did you have to consciously encourage this or did it just happen?
Right this moment, oh no the older one does not and the younger one has discovered separation anxiety and is attaching herself to me whenever she can see me. If I'm gone, Little Monster is fine and will happily play alone or with the kid or anyone else around. If she hears me or catches a glimpse, there is a baby attack. She crawled down a long hall to find me last week, and really fast. Speedy baby, getting all huge and stuff.
  • If your child doesn’t do much independent play, do you simply focus more on group learning and activities?
Right now we are prodding for more independent play outside of our house, along with willingly interacting with kids and asking what the rules of the game are instead of being hurt nobody will play with her (but she claims she's too SHY! to ask what the rules are... hmm...). I think a group activity that she could enjoy would go a long way in helping her have friends she trusts, as would really understanding more about how friends work and that just because you decide someone cheated at a game (it's not cheating just because you lose at tag and are "it" but my kid is SURE it is, causing major life crises) it doesn't mean the person doesn't want to be friends.
  • Does the length of your “leash” change depending upon if you’re at home or in public (e.g. at the park)?
Nope. We aim for as long a leash as possible. When the kid started walking we got her a backpack with a monkey and tail, and the rule was that she had to wear it any time we were out. Eventually when she behaved and stopped when we asked and didn't run off where she couldn't see us, we gave her the tail to hold for herself and she loved that. I just wish we spent less time these days pushing her out of her dwindling comfort zone. It's typical at our faith community that the kid is off somewhere for a half hour at a time without checking in with us because she's good at taking care of herself and doesn't need us. I'm hopeful that she'll get back to where she's a bit more comfortable other places and isn't forever dragging us over to play with her instead of meeting new kids at the playground.

Thursday, November 21, 2013

The future state of the family

Decisions. I stink at them. A lot. I'm slow and indecisive about the big things in life. When I'm in charge and it matters though, I make quick assessments of what needs to happen and how to handle it and decide what's next fast. It's a skill I've honed because I know myself well enough to know how slowly I usually make decisions and I know my slow approach is impractical.

Anyway, family size. It's a sticky issue in PAIL land because, well, when families aren't easy to build it's hard to decide when you're done. Are you done after a miscarriage? Two? A failed adoption? After one infant loss? These are all totally fair places to say that it's enough for a lifetime and let it go and live with life as it exists then (child-free, one child, two children, fur babies, whatever it might be).

For me the worst part of infertility and recurrent miscarriages is the loss of control. It's all well and good to get pregnant but I was never convinced it would last until we had a baby in the room screaming with Little Monster's pregnancy. I was mostly convinced, yes, but not totally.

It's worse in my view to feel robbed of my choice, our choice, about when to be done building our family. I hate being cornered by a health  condition that's uncontrollable so completely. Most of health we have some control over. If you have asthma then you take your medications and avoid triggers. If you have type 2 diabetes then you can watch your diet, exercise, and take your medications. Infertile? No control. You can implement interventions or pursue adoption but there's little to control except when you step off the merry-go-round of treatment or waiting. The choices available if you're infertile are limited and unpleasant and don't feel like real choices because they don't actually offer more control of the situation. We don't have any embies on ice to consider but that sure adds another level of complexity - if you have some frozen, then what? Attempt another pregnancy if you can afford it? Give them up for adoption? And on what terms do you measure "afford" anyway? How much suffering is it worth going through in search of a child?

In my dream world we have 4 children. In this real world, there are currently two little girls frolicking and those three holes in my heart. But are we done? Is this it? Is there another baby or even two out there? Or no? I don't know. It's weird to be in a place where I'm planning the next 18 months of my life in excruciating detail and then thinking, "Wait. Does a baby fit in here somewhere? At the end? A year after that? Or... not?" It dawns on me that Little Monster will be the same age at graduation that the kid was when I started pharmacy school (within a month or two at least). That's pretty crazy to think about. Time flies, nobody is getting any younger, and the original idea was to have our third be a baby about now... so see how well that plan worked out...

Then we have been tentatively talking about adoption and because we'll almost certainly move when I get a job that adds to the wait. Is that necessarily bad? Probably not. I suppose at this point I'm in a place to get the spouse better informed on adoption and foster-to-adopt and all that jazz. Then we can figure out what we want to do once we have all our options really on the table.

Wednesday, November 13, 2013

Random snapshot part deux: electric boogaloo

Things that have made me laugh really hard this week:

My school is SO EXCITED that a woman prof got quoted in a news story about the lack of women in some professions and the lots of women in others (pharmacy being one of them). They interviewed the professor who most resembles a doll. Seriously. Of all my female profs, do they interview the most mature or the one with the most research credits or the assistant dean or the one doing the most innovative stuff or even the newest to the staff? No. They interview Bar.bie. HAH article on getting more women into STEM careers. Way to police yourself and not perpetuate stereotypes about how women should look to get good jobs...

The baby wanting desperately to be carried around by big kids. We were at the toddler gym, cruising by ourselves in the big open space and attempting standing/dancing/crawling/walking with various foam shapes. Then the 7 year old and 4 year old girls arrived and she kept crawling to the 4 year old to be carried. She grinned and laughed and loved it.

Phishing got my school's email domain blacklisted from lots of places so I can't finish emailing preceptors and I have to try to get them on the phone. Go figure, of all the things that would cause my emails to bounce, it's some fools getting phished.

Things I'm excited for:

The new baby over at Full Bed blog! BABY! YAY! Congrats to mama baba and big sister!

Loaded baked potato soup, which we will make this weekend in a large quantity and freeze so there's something to eat until after finals. (I'm less excited that we couldn't make soup yesterday because there's zero funds for it, but that's life right now... yay... you don't want to hear about the other stuff we can't afford between here and the next student loan disbursement so just imagine)

The end of this semester. Let me out! LET ME OUT OF HERE!

Sunday, November 10, 2013

Snapshot part 1

I feel like this space is getting neglected. Sorry about that. Life is wild lately. Also miserable and so forth and who needs more misery in life?

So, a series of snapshots is in order. Part 1: while tidying up

Recent conversation:
Look at me! Look at me spouse! I'm putting away all the extra medications we bought at cos.tco. Look! I'm storing medications over the toilet... but, obviously they won't fall in because they aren't C2s (controlled substances that mysteriously fall into toilets all the time... hmm...).
Spouse: uncontrollable giggling

Wednesday, November 6, 2013

Looking the part

Last week I read this really fantastic blog post about the status signifiers and how much they matter when they shouldn't in theory. Now the author is very focused on how this matters ever so much when you're a non-pasty white-ish person, and she is absolutely right that it matters ever so much more if you don't have the privilege of being a white American. Absolutely. But that power game of demonstrating by what you wear, how you wear it, subtly, that you are of the right class or smarter than average or whatever, that crosses skin color. So here's my experience with it to complement hers.

It's something I think about a lot since I come from a bi-class family. Example: my dad is a 2nd generation American, very working class, first in his family to finish a college degree (his uncle went for a couple of years on a sports scholarship until he blew out a knee and didn't finish). My mom's family is old money, much longer-term American, and a much higher class of behavior is expected in her family. Status is a thing for her (and the rest of my family) in a way it isn't for my dad's family.

This means that I have it in my head that there are situations that you need to look a certain way, that you use your big words and subtly show off, that you hold yourself differently to show your class, that you make sure your nails are clean and perfect and your hands don't show the wear and tear if you work outside (so much moisturizer when my mom worked on the farm to hide it). I have an impulse to purchase pearls, for example. It's just one of those things that since I'm a woman and need to display my status periodically, I probably should acquire. And let me add, it bugs the pants off of me. It aches to know I am socialized in such a way that I not only know about these overt and subtle status symbols but that it's so much in my head that I consider it whenever I get dressed.

Now this knowledge I need to dress the part and the budget to do so don't necessarily coexist, certainly not right now. I've selected a few wardrobe pieces very carefully and I wear them sparingly (one silk shirt, one suit, one nice pair of slacks in addition to the suit, one decent looking skirt, a couple of high end sweaters and blouses). I also have a sweatshirt with my college's name on it and my girls have a couple shirts with the name on it too. Subtle advertising. I often wear my school polo to the kid's school events when I can't spiff myself up enough so someone will ask about it and I can point out that I'm a student. My wardrobe mostly comes from second hand places but I'm very selective. I only shop at used clothes stores in ritzy suburbs or high-end neighborhoods because the selection is better and the wear is lower. I may buy exclusively used but I work hard to make sure it doesn't look like it's all used!

One very memorable occasion I got to watch a guy change statuses just with his posture. I was in line to get fabric cut, sometime shortly before Halloween, I was actually making a wrap to go to the opera of all weird things. Anyway, the gal cutting fabric was asking everyone what they were making for Halloween. A bee costume for a kid, a pirate costume for an adult, and then this guy came up to have his stuff cut. He gave his requests crisply but still slouched, wearing a plaid shirt of some type, looking like nobody important, just some old guy, not memorable at all. His fabrics were pretty outlandish and strikingly a bit odd. I bet the gal cutting fabric's guess was a hobo costume or something with the bright polka dots and strangely colored stripes. But she asked him, "And what are you going to make with all this?" in a pretty condescending way like he was a cute but confused old guy who must have had a shopping list from his wife. He drew himself up to his full height, adjusted his shoulders and his face and said, "I design for the University Theater" and he scooped up his fabric and huffed off (well he stalked off really, the huff was implied because he turned away from her very fast). Whoa was that lady shocked and put in her place! Just like that he changed his bearing and showed that even in his scrubby clothes he deserved a whole lot of respect. I saw the show with the costumes made from that weird array of fabrics and the choices he made were amazing. Everything worked just right with the tone of the show, the sets, the lights made it all look great. Boy did he ever design!

So why does the wardrobe matter? Well, I go to professional meetings. Lots of them, relatively speaking. When there's a gaggle of students at a professional meeting, the pharmacists don't chat with most students because you can spot them at 30 feet (aside from being in a gaggle) with the cheap clothes, no giant diamond rings, no nice earrings or tie clips. For me I have the advantage of not looking 16 (sometimes I am glad I went right from looking 10 to looking about 20 and stayed there for 15 years, other times it's awkward) but I also get the wardrobe thing. I have the right wardrobe and I avoid the gaggle of students (ok so that's natural antisocial behavior there) so I meet far more pharmacists than other students that way.

Why do these meetings matter? Well, it's a tight job market. It isn't super tight everywhere but it is tight enough that it's hard to get a job as a new grad, especially a full time one (unless you move somewhere super rural or otherwise unpleasant like the wilds of Alaska). I am on the hook to have a job lined up upon graduation since I will be the primary income, if not the only income. It's key for me to be seen at these meetings in a positive light so when I do meet someone, say the owner of a local small chain of pharmacies that might be hiring in a year and a half, I've already made the impression at a meeting before. Being at these meetings is hypothetically to network and get a job based on brains and/or connections, when really, it's largely about the suit, the being seen... I hate that I need to know these status symbols, that they matter so much, and yet... it's a part of our culture.

The other place I occasionally use my education and snappy wardrobe is when we're waiting around for some kind of assistance. It's amazing how much faster I get seen at the WIC office if I have business casual attire on than if I have some random scrubby t-shirt or even scrubs (yes I do wear scrubs just lounging or going to class because they are comfy and I can). It pays huge dividends for me to be able to put on my Upper Class You'd Better Pay Attention To Me wardrobe and face and posture and then to get it. In my little bubble, there's nobody I know who needs that push to help them get something they need, but I like to think that given the chance I'll do it. Our faith community has a young woman member, maybe 16 or 17, who I don't think really considers college as something that she could do. I think I'll offer her my college's alumna referral coupon so she could apply for free if she wanted to, to show her that I have confidence that she could succeed at a place with a middle to high level of prestige. She could, she's smart but she doesn't care much about school since she hasn't seen it benefit anyone.

I think it matters a lot that we all recognize this bias, that we mark status and treat people showing a high status so differently. It's all well and good to pretend everyone is treated equally but it isn't true at all. Maybe if more of us realize what we are doing we can fight against the prejudiced idea that poor people are stupid and that the clothes matter so much more than the brain behind the person.

Monday, November 4, 2013


You know that game with the gophers or some little furry creature that pops up and you whack them back down with a big fluffy mallet? Whack amole! I bet they are intended to be moles, now that I look at that name. That's what baby showers feel like to me. A series of hard hits on the head or to the heart that remind me of what will never be. It stinks. I'm unsure why I go. Well, I go because it matters to me that I am part of the family and making the effort matters.

Anyway. My extended family is finally having babies (aside from the 2 cousins who have kids the same age as my kid, the last of a few for one and the only for the other, we rarely see either of those cousins). I have this feeling I mentioned my dislike of baby showers when I attended the sister-in-law of this weekend's baby shower recipient's shower in June. As it works out, Little Monster is the oldest of this round of babies (on my cousins' other side of the family they have 4 additional babies born this year) so she's the only one sitting up and eating by herself, only one yelling in delight when she pulls up on the coffee table over and over and over, and the only one on the floor because the other babies aren't crawling yet (or aren't allowed on dirty floors without sanitizing them first/putting down a giant crawling blanket/etc). It's a weird experience. I'm mostly unfamiliar with not being the only parent of a small child in the room and how that works when the other babies are calm and well behaved and captive.

I think that being in a room with people who take it so totally for granted that pregnancy is simple and easy to achieve and complete hurts. Right now I'm doubly reminded of the things this baby doesn't have because either I donated them in a fit of fury after 3 miscarriages that were each a freaking year apart or because we are spectacularly broke. I think this week is the one where we figure out how soon we will need to go to the food shelf and if we might make little enough to get food stamps (pretty sure we don't). It just hurts.

Every comment about the cute baby in my arms just stings when I know the cute baby just across the room from me has a sibling the age of a baby who's missing in our family. Every "oh isn't she just the happiest baby!" grates on my nerves because I know that upstairs with the spouse is the angry child who I am failing spectacularly many times a day. Wanted, loved, absolutely, for both girls, but that doesn't stop it from being infuriating to handle this particular phase in the 5 year old. Every frilly pink thing on the youngest baby just rubs in that she's born a year after they got married. What a luxury and they don't appreciate it at all. My eldest cousin was at this shower too, childless still but I think they have some idea of children "in the future" and she's 35 or so. Not so much future left, I want to say, and yet I don't. I just pop back up at the next baby shower and think about how much it hurts and get whacked on the head some more by well-meaning aunts and cousins. Yet I kind of feel like I don't have much choice in popping back up either since it's so expected and it shouldn't be a big deal. Maybe that's what makes it sting the most, that I'm guilty about how miserable it makes me to go. On the one hand, having the token kid for 5 years has been lonely in a big family where lots of folk were married but not having kids. On the other hand, while it's nice that there will be second cousins for Little Monster to play with, it's hard too that she won't see them much and maybe even less depending on where we wind up when we're done with school.

I think it's good that nobody else is having a baby soon because I need a much longer break than 4.5 months before the next one of these things. Oof.

Monday, October 28, 2013

Alternate life me

One thing that's kind of unusual about our wonky infertility journey is its start. Based on the spouse's health history we figured it would be hard to have a baby of our own. I don't think most people start from the premise that getting knocked up isn't so simple as it's made out to be in the media.

So we set out figuring a year trying was to be expected. Or at least six months. Then the spouse would be done with grad school and have a job and I'd be in semester 3 of 5 before that science teacher license was finished. 

Of course that crashed and burned and the fiasco that ensued was just astounding. 

But I've been thinking about Alternate Life Me who got up for that 8am chem class I dropped. Let me take a moment to point out the awful advising I got. I came in wanting to take music theory, French, and chemistry as possible majors. The person advising me first pointed out that the chem class met 5 days a week at 8am and "are you really sure that's what you want to do?"

And I went to a women's college.

I got advised only on the negative side of that chem class, not that it was a prereq for any health or science grad work, not that the 8am time was to weed out nursing majors who didn't mean it, not that if I was thinking about a science major I had to take it or gain a full year of college (the bio major sequence fit into 3 years but needed that chem class as a prereq too). I wish I knew what random prof I had as my advisor that day so I could send her an angry note. Even though I was considering 3 majors, French, music, and chemistry, the chem class was the one I was advised out of rather than the music class that was within a dying major (the last music major graduated with my class).

Anyway, I got influenced by a bad system that didn't advise me strongly into a science/tech field despite my interest.

Alternate life me, who took that 8am class, probably would have majored in chemistry because it's FUN. Perhaps not to people who aren't me or even most people, but I love it. Maybe alternate life me would have figured out the whole calling to be a pharmacist deal a bit sooner than 6 months post-graduation, but maybe not. Even if it had been that 6 months post-graduation revelation, I could have applied to start the next year with a spanking new chemistry degree. Alternate life me would have 3 or 4 years less of college. That's a lot of time I won't be working, or that I'll be working instead of retiring. Sigh.

 Of course, especially when the 5 year old is being a tornado of repressed-until-bedtime emotions at night and waking up for the day at 5:15am (seriously UGH), I think about what alternate life me would have decided about children. Knowing  what we did before we decided to try for a baby, would having a firmer grasp on school or another major so there was no giant life shift have changed what we decided, that trying young was important because we might not have much luck?

One of my high school classmates got that undergrad chemistry degree, went right to pharmacy school, did a residency, got the perfect job, and then bought a house and had a baby. Everything in the right order. Sometimes I worry that putting life in all kinds of a jumbled order has been detrimental. It would be a boatload easier to study with no screaming 5 year old stressed because she got confused and didn't get her after school snack at the program she goes to (and professes to hate after she claims she had fun right after the thing ends). We are surely much more broke because there are two girls hanging around, and we are also stuck here where the spouse's job prospects are now limited sharply. The benefit is that we can just move for my job when it exists, but that's sort of a lot of pressure to put on my fledgling career.

I wonder about all the folks around me who are delaying having children right now and if it enters their minds that children don't just turn up 9 months after you start trying. I know a friend with PCOS certainly does think about it but I'm not sure if it's good or bad that so many folks don't even consider the possibility of infertility or loss. On the one hand it is so much harder going through infertility when nobody has any idea how to react and everyone has helpful un-advice like Just Relax! On the other hand, it's kind of nice not to have everyone so knowledgeable that they keep asking about what's going on all the time. Sometimes it is nice that what you're going through isn't common knowledge. It provides at least a little privacy if you want or need it.

My high school class is having a get-together coming up soon and I'm excited or terrified. I think I'm still the only one with kids I'm parenting (one person had a baby placed for adoption not long after graduation, and yes, tiny high school...) so that's weird. I bet this time there will be less "oh how weird you have kids" and more "so how's that going? We're thinking about kids now too" than there was about 5 years ago when we got together last (maybe it wasn't that long ago but I don't remember clearly). Upside: I'm not the only person still in school! One of my classmates worked her way through community college in 6ish years and then finished a bachelor's degree in the next 2 and is working on an advanced degree now (unsure if it's just master's or masters to PhD). It mostly makes me feel old. Is this the end? The last baby? The last time I'm "young" or anything like it? Is alternate life me happier or more miserable stuck in infertility purgatory longer? I suppose it's better not to know. I do know that today is pretty all right.

Monday, October 21, 2013

Feeding the baby part 3: travelog

Continued from parts 1 and 2, here is pumping part 3: oh man I dislike pumping

I was out of town for a week (all alone) so I got to manage pumping and being away from the baby and then transport back of all the milk. Here's how it worked out.

First I attempted to replace my crappy pump that seems to be dwindling in ability to function. Due to some insurance mumbo jumbo gone wrong the pump arrived Monday when I left Saturday and since I was in a rural area with no UPS, there was no shipping me the replacement. I think the problem may be that I need to replace my squishy parts but this didn't dawn on me until it was too late to get the parts.

I attempted to pump 4 times a day while I was away but actually I hit only 3 times a day each day. It seems to have worked out all right. My supply isn't back up to pre-baby-free time levels after 3 days of nursing lots but it seems to be adequate enough for her tastes. It also helps that this week was one where her solid intake cranked up like crazy so there are many demands for more solids from Little Monster. For comparison, she had been nursing 5 minutes at a maximum and with lots of choking and howling breaks before and now she's nursing more like 7 minutes with some breaks to look around and be distracted. The choking is gone and that's great from my perspective. She's also eating about the same number of times a day as before just with that little bit longer duration.

As far as storage and transport goes, this took some consideration. I brought 2 sets of pumping flanges,1 pair of 9 oz bottles, 1 pair of 5 oz bottles, and a box of 50 milk bags along with. I flew (a couple hour flight I think? Time zones always throw me off) and then drove another 5 hours out to the week's location. Because of cost I needed to have no checked luggage going out so I could afford to check one bag coming back and have the cooler as my other carry-on. I packed a soft-sided cooler in my suitcase's laptop pocket (this one) and bought a couple of ice packs on arrival because it was about 14 hours minimum from departure to getting home and the cooler was rated for about 10 hours' cold time with no ice. I also selected a soft-sided cooler because it was light. Hauling a bunch of milk around isn't light and I didn't want to add a couple pounds of cooler if I didn't need it. I brought home about 100 oz of milk in 5-6 oz portioned bags plus one bottle from the morning I left. It actually took us more like 18 hours to get home from the time the milk left the fridge. It was all still pretty close to fridge temp coming out of the cooler so I highly recommend that cooler (no, it isn't an affiliate link or anything and I paid for my cooler but I love it). It was large enough that my pump flanges and cover went in the bag with the milk as I was low on space, yet it was small enough to easily fit under the plane seat. The handle was really comfy for hauling it around airports too which was a great thing. I'm using this cooler for any future tailgating!

The bags were kept in the fridge during the week because fresh milk can tolerate temperature variations while frozen stuff is no good if it thaws, and because my host had very little freezer space. They got deep frozen this morning because that's when I realized I'd better do it so the oldest milk is at the high end on storage at about 9 days but is likely to be fine. I'm not opening it to check its freshness though!

The most annoying thing was to shadow in the hospital, hear that they like to support moms nursing, and then discover that the hospital doesn't rent or sell electric pumps, only single hand pumps and you have to see a doctor to get one. Um, what? I mean it is an area where not everyone has a fridge at home but for all the moms who work (most of them at that hospital) how discouraging to have to drive 3 hours to buy a pump or have one mailed and have much the same fiasco with mail order that I did, plus the extra time to use the post office. UGH. They also don't have a lactation consultant on staff either. Support? Hmm... maybe not so much.

It was also pretty funny how uncomfortable the whole thing made my female professor who was in charge of our trip. She didn't even want to say the word "pump" out loud. Hah. Having now nursed two babies for a total of 21 months, nothing phases me. On the way out after we left the airport I pumped in the car with my fellow students arguing about the radio station the entire half hour. No big deal. Big thanks to Josie for lending me a nursing cover so I could pump wherever. I am awful at using a cover and am thrilled I probably won't have to do it again (maybe ever).

Now I'm off to clean the new pump parts so I can try the thing out. Maybe. Or maybe I'll just use the new collection kit with the old pump.

Thursday, October 10, 2013

Schroedinger's baby

Gah things are wild around here lately. Just wild. Our faith community has this deal that we are supposed to spend 5 minutes a day doing faith stuff together and we just aren't able to manage that. Too many temper tantrums and emotions saved up to exploding at bedtime for us to manage 5 quiet minutes together... My personal favorite thing from the last week was trying to explain my sentence "Spouse has to jump through hoops right now so we can keep getting unemployment money since Spouse's job is only part time" to my 5 year old. It took 10 minutes and I don't think it really clicked with her, since she's never seen a dog doing tricks, barely ever seen a hula hoop, and has a very limited concept of money at all.

Anyway, I thought I'd talk about this interesting/strange thing that's helping me cope lately. I hear a lot from folks who are parents of babies (experience with baby/pregnancy loss or not) that they worry about if baby is still alive and breathing while asleep. I worried about it a lot too. Then one day I didn't any more.

This thing occurred to me and I have found it helps me sleep better. I just have decided that Little Monster in her crib asleep is Schroedinger's baby. She could be asleep, awake, or dead. If I go check, the odds go up very much that she will be awake since I smell like food. If I don't go check, I have to accept that I don't know. I've concluded though that (very morbidly) if she's dead now, she'll still be dead in the morning and if I've slept I'm much more likely to be able to cope so why rush the inevitable by checking on her now?

Probably having accepted sleeping Schroedinger's baby is healthy or weird or I have no idea what actually, but it is working. We don't have a monitor and we are clearly not getting one since her bed is within 10 feet of ours (in the next room).

And now Schroedinger's baby is howling awake. AWAKE and must be attended to.

Tuesday, October 1, 2013

Health systems

Caution: I am liable to rant because I am just fed up with healthcare lately. UGH.

So today the US government shut down because one party is grumpy that the Affordable Care Act is going to happen and be implemented. Today is the day to start shopping for healthcare plans if you are in healthcare limbo and to sign up if you are eligible for subsidies to help pay for healthcare! I hear the website is a wee bit slow, probably because a whole lot of people are excited at the prospect of healthcare. I sure am. Here's the website where you can check out your options and find your state's insurance exchange (if it has one).

It confuses me to no end why 20 years after the Republicans proposed exactly this healthcare reform it suddenly makes them super mad and in a mood to object to every little thing it might change even though most people support the changes it will make. The bulk of the changes are nice things like affordable insurance for a great many people, children can stay on their parents' insurance plans a long time, and pre-existing conditions as a reason to deny health insurance are gone. That doesn't mention all the preventative healthcare services that are free and designed to reduce costs in the long term like free annual wellness exams, free shots to prevent diseases, and free contraceptives to prevent pregnancies or acne.

But health systems. ACA also includes some money for healthcare providers to get themselves together IT-wise and it would be amazing if it included money for meaningful use by pharmacists and pharmacies, but no. In case you were curious, doctor's offices pay nothing to send electronic prescriptions but pharmacies pay to be in the network to receive them. It obviously takes a computer system to do that receiving. I've been to a pharmacy that uses a DOS-based system, now, and it receives electronic prescriptions, which is awesome on the one hand (legacy system for the win!) and depressing on the other (I used that system on our home computer back a zillion years ago before I started kindergarten!). It's a shame there's no money from the government for pharmacies to upgrade their IT systems.

ACA also encourages the formation of new things called accountable care oganizations (ACOs) and a switch from a fee-for-service model to a patient wellness payment model. That amounts to encouraging groups of providers to work together to get and keep patients well rather than for each one to bill the patient for every little test they can manage to make the most money. Pharmacists turn out to be a really key part of making ACOs work (at least that's what the pioneer ACOs are finding and the data supports it, squee!) and yet we don't have status to bill as a healthcare provider. Another complaint of mine. Soon though, maybe pharmacists will count as real healthcare providers for billing purposes so we can get paid for our work getting patients to take their medications and to take the right combination to help keep them as healthy as possible.

BUT. This "providers work together" thing has gone various degrees of well for different newborn health systems. In my region there are a few big ones, markedly different ones at that. Where we used to live we had a real health system. Here we have a bunch of providers with a matching logo that actually have next to nothing to do with each other.

Let's use an example. In system A, where we used to live, patient Z needs to see a specialist for a foot problem (that's a podiatrist). Patient Z stops at the appointments desk after the visit with the primary doc who said the specialist was needed to make the appointment. The podiatrist works for the system and is only in Little Town one day a month, so Z needs to schedule to see the podiatrist in another location. This is no problem and the appointment scheduling person either looks up the full schedule of various locations using the computer or calls another location to do the scheduling right then. Obviously, because this is a health system, the appointment scheduling person has the appropriate number to call any other location within the health system to make sure the appointment gets scheduled seamlessly within minutes. The entirety of Z's electronic medical record will travel easily to the podiatrist at any location within the health system where Z might be seen and any reports/test results/notes made by the podiatrist will be easily accessible to Z's primary doctor in return.

In system B, where we live now, when Patient Z needs to see that specialist who is at the local location one day a month, if that day doesn't work, next month is an option. Z probably didn't see a primary care provider because the Big Awesome Hospital in the area recruits new hires to the outlying clinics and then promotes them to work at BAH without filling the vacancies. BAH probably set up the health system as a way to vet new hires and not as a way to make healthcare more accessible to folks in the surrounding area. Patient Z cannot find out when the podiatrist will be at any other health system locations from the scheduling assistant in Little Town because the department doesn't keep track of things like that! The scheduling assistant certainly can't get Z the number to call BAH and try to schedule a visit in the city because why would the department have that number? Health information needs a form to be shared between BAH and Little Town clinic despite them being under the same logo and presumably part of the same health system, and even when the form gets filled out, Little Town will call just to make sure it's really necessary to send all the records (which are paper and electronic in some very dangerous hybrid). It is unlikely that information will come back to any primary care provider from BAH either, not in a timely manner.

Two ways a health system is set up, one that is patient and provider friendly, one that is not. I get that joining a health system is a new thing for clinics and hospitals that operated in isolation before but refusing the transition because it's scary and new is a mistake. New things in healthcare are hard of course, but systems are the thing of the future. Even if on the business end of things the providers stay separate, sharing patient information electronically is the thing we'll be doing soon. I'm not sure how my state's health information exchange is currently going but I think it will exist sometime soon. Lives get saved by sharing information. Lives get saved when I can query the health information exchange in the ER and find out someone is allergic to penicillin before we give a dose even though they are unconscious. Lives get saved when we find out someone carries MRSA when they arrive in the ER so we can isolate them and help prevent its spread.

Health systems help patients get better care by facilitating data exchange. It tempts me pretty often to drive a couple hours to see a provider in our previous system just to avoid the headache of the dual paper/electronic chart and the wrestling match it takes to get a timely appointment to see a specialist for anything. The part that really bothers me is that it's so hard for me, someone who knows an awful lot about how healthcare works and how it should and can work. It took me hours to get in to see a specialist. How many people who are actually sick (I'm just getting continuing care, it's boring really) give up or get confused and quit bothering to try to get appointments they need? Why are we growing health systems that don't work like a system to help patients manage it all? It's important to focus on what we do when health systems grow and to make sure we fill primary care positions (and that's another issue entirely) and to make sure training is even across the system so things work like it's a system and not a bunch of discombobulated locations with a matching logo. Electronic health records really help that information sharing happen seamlessly (we hope) and it's high time to embrace them. Health systems need to grow because the payment model is shifting to ACOs, maybe not to gigantic proportions like Kaiser in California/the western US, but also pharmacists need to get in on building ACOs so patients get good care from the moment they walk in the door to the moment they head home with any new prescriptions from the pharmacy.

Saturday, September 28, 2013


Here's what's running through my head lately. Things tend to get stuck there and run around, chasing each other for days/weeks/months, and I intend to write about them but then I'm not really sure what they're doing wandering around anyway and all that jazz. So here's the short list. I really liked when Mrs. T over at A Plus Effort wrote her "I'd blog about" list a bit ago so you get subjected to mine.

HeLa cell deal reached after years of yucky theft and invasion of privacy
You've heard of Henrietta Lacks whose cancer has been so good at growing that they are the basis for almost all of the cellular research that's happened? African American gal who had a cell sample taken and used without her permission whose family is finally getting some recognition of all the bad stuff that was done and some say in how her genetic material can be used by science. A little bit of justice.

The Things They Carried
This book is one that resounds through my life, probably because I am often packing and unpacking bags and boxes and trying to order the far-too-many things around the house. Or because it's good. Or because it has totally changed how I think about reality. In case you haven't read it, just go read the first of the short stories. It's about soldiers in Vietnam and the first story lists the things they carry, physical and emotional and why for a few things. I find it echoing around in my head pretty often, just a line here or there.

Baby Veronica
Oh the awfulness of this. On the one hand, I'm not so sure that if you can't communicate exactly what he's signing to the father of your unborn child, you get to have any say in what happens to her because it isn't cool to deceive people even if they haven't been supporting you/the pregnancy/anything and that father ought to get another shot. On the other hand, I dislike hijacking Native kids from their families and culture because of whatever. On the third hand I'm heartbroken for the adoptive parents who had this little girl and then didn't and then have her again and what a mess. And beyond that there's the issue of identity and when are you a part of a group and when aren't you and all that complexity.

I think when it comes down to it, I think birth mothers are the boss and that often it should be mostly ok to cut non-supportive birth fathers out of the decision-making process.

Whiteclay NE
We watched the movie The Battle for Whiteclay in one of my classes and I have nightmares about it (the town, not the movie so much itself). It's a really awful and kind of intractable situation. Dry reservation borders Nebraska and this "town" has a couple grocery stores and 4 places that sell beer. Nebraska is afraid to create laws to deal with the problem because it might become a slippery slope and the rest of the state could get over-regulated. Pine Ridge reservation has trouble deciding what to do and has few to no resources to do anything anyway. People die and nothing changes and who knows what is next? The intersection between the colonized and the colonizers who continue to take advantage of those they elbowed into a disadvantage is a really hard place, but it's also good to recognize. It makes me think a lot about a class I took where we read literature written in English from outside the US (India, Jamaica, Africa) and especially Ngugi wa Thiongo from Kenya who writes about the colonization of the mind. In other words, when the colonized get told they are less than the colonizers for generations, the mind gets colonized too and even with nobody around to oppress them, the colonized can't help but react in those ingrained ways of thinking of themselves as not worthy of good things or power over their own lives.

I am done. I hate school so much and I am ready to be done right now. Most of the time. Actually at times I'm really enjoying this semester, just not the setting up rotations part of it. Blech. I'm also getting fed up with things so much faster, like vague questions on exams that we are supposed to read the prof's minds and know were actually more specific (if you mean to ask a specific question, fine, but actually write the specific question then...).

Wednesday, September 18, 2013

Weekly update: a big ole summary post

Reminder: email me at mizfuturepharmd at g mail (dot) com if you want the password. I really do mean to move the blog eventually. I do.

Thursday, September 12, 2013

Emotional regulation

I think this concept of keeping your emotions in check is interesting. I'm not sold that it's actually an ideal thing but it is what has been known as "proper manners" for some years now, possibly as long as people have stayed put. Maybe it's just me but when I walk all day, I don't hold back with those around me at all.

Anywho, I read this interesting article about how private schools refer children who don't sit still to OTs to learn how to sit and how it's awful we demand our children conform so tightly to school rather than school meeting kids where they are and adapting our teaching to their development. The public school counterpart to this "there's something wrong if your kid can't do super sitting still structure" is sending boys and especially boys who aren't white to special ed to get a diagnosis. 

I get why it is helpful to learn emotional regulation. Absolutely it is helpful for kids to be able to keep a lid on their tempers. But it's hard to see the other extreme of emotional regulation at school in my kid. She is so successful at boxing in her emotions outside the house that she hides them almost completely. After a day of no emotions expressed, she is a lit stick of dynamite most nights just waiting to blow up without warning. 

I worry about the kid, honestly. If she can never tell the other kids when she's upset or hurt or mad about something, how can she manage in the world? Yes there are times to contain your emotions but being an emotionless Vulcan is too far. Expressing emotions in the moment is a big part of being human. To a point. I get so mad when people can't have a rational discussion without bringing their entire emotional baggage to the table. It is hard to work when emotions about the past totally inform every single sentence of the conversation. There I'd say it is fine to have emotions but you have to contain them when they impede the discussion at hand. Have a good bedside manner and use it when needed. 

I guess that developing an appropriate level of emotional regulation is going to come later. I really hope it does. The other big problem our kid has is being super shy. Shy doesn't matter at daycare obviously and she got over it or around it in preschool because the group was small enough. In a classroom of nearly 30 kids with hundreds on the playground, it is hard for her. She has no willingness to ask to play or to start a game herself. None. We keep explaining it to her and she keeps not getting it or is too scared to try and also afraid she will "get in trouble" if she admits she's scared. She has some bizarre personal definition of what constitutes "in trouble" that includes anything we talk about that she doesn't want to talk about or worries about. 

So for now I think we will attempt to manage and hope that in time she will find a niche or at least a place she is safe enough to stop being so completely defensive. I just wish we could be done with being read the "I hate you and I hate it here and can't we just live at our old house again?" pre-riot act biweekly (followed by some rioting and sobbing). So if you think you could just move with a 4 year old, know that it will be miserable and try not to do it. Ugh. I hate that it's likely we may move after I graduate, just in time for her to have settled in here. Sigh. 

Tuesday, September 10, 2013

Being broke is complicated

We just found out today, 3 weeks after the spouse's last paycheck, that there will be unemployment. Phew! And now, a month or two later, the spouse has a job! That pays exactly what unemployment did! Wait...

That said, we are right broke. My MIL and her sister offered to take the kid school clothes shopping so we of course said yes. The trick to this is, of course, that my kid now has a wardrobe that shows she belongs to one class (the one where brand new clothes from designer shops are possible). Does this matter much to the other kids in kindergarten? Probably not. To the parents though, it might. It is hard for me to see a weeks' worth of groceries get spent on clothes for a 5 year old. It was in the back of my mind to return most of it to see if we could get cash to spend on something else. Obviously that's a pipe dream but the thought is there. This fancy clothes shopping also means that she got 3 or 4 outfits, not the 10 or more I could have gotten at the thrift store for less money, so we will have to find some money for a few more things to be properly outfitted. 

I have never really understood the point of not wearing any "new school" things before the start of school. Today we had an overtired kid meltdown for a half hour about wearing the brand new tennis shoes to t-ball and I caved, mostly because I think waiting is silly. Her other shoes don't really fit anymore and the new ones are rainbow-y and her very favorite and it was my MIL who forbade wearing them to t-ball and she won't see the t-ball dust on them anyway. 

The spouse pointed out that it's about first impressions, the shiny new awesome clothes. Sigh. 

Then there's the bind where you take what you can get. We put a child bike trailer on our festive holiday list a few years ago and a fancy one, a double that you could get an infant deal for and that had a roll bar (so if the bike falls, the trailer doesn't roll with it). A family member was gung ho about getting us one, but not the one we wanted. Eventually we determined that it did have the roll bar, and the kid was almost 3 and after miscarriage 2 the infant adapter deal seemed less important, so we accepted it graciously. And now we have a bike trailer we can't use for Little Monster so we can't bike to the grocery store and we wind up driving instead.

And the clothes. A helpful family member got the kid a pink plaid dress with a tiered ruffle skirt and a corset bodice. It isn't like you could say, "Why thank you for getting my child a sex worker outfit! I'm sure it will be... fun for role-playing or something?" or even "No thanks, I prefer my small child look like one and not a sex worker." I wish I had taken a picture before I gave the thing away, but I didn't. Here's my sketch because it is just that amazing. But remember, black and pink plaid, pink spaghetti straps, pink ribbon corset-style back, more flounces than I drew (like 5ish).
And of course, food. If you were wondering what teetering on the edge of food insecurity looks like, it is us right now. We eat lots of pasta (that I only ever buy on sale and stockpile) and lots of rice and whatever else we can scrounge on our little budget. I think black bean burgers and rice are going to be a multiple times a week thing for the foreseeable future. The kid has to eat at school because there's no way we could afford to feed her 2 more meals a day. She gets free breakfast and lunch. The upside of this is that she eats more things with peers to influence her into it. The downside is that she sometimes eats PB & J every day all week. We are wrestling with a potential new food problem but it's really hard to identify because she eats whatever she wants at school and we don't get a good report from her, nor do we have any idea what ingredients were in whatever she ate. So far we haven't tried super hard to figure it out but mostly that's because of the risk of needing to send her lunches if school lunch (and breakfast) really is causing all the new problems.

I guess I'd say that right now, I have coped adequately and it isn't so stressful to know how close we are to financial wreck and ruin. We (well, mostly I) have been hoarding food for a few years now because of the last time we were this broke and wandered into the land of "adults get 1-2 meals a day" level of food insecurity. We have enough food stockpiled that we could eat just what we have for at least 3 weeks, maybe up to 5 or 6 weeks. It wouldn't be things the kid likes very much but it would be edible. It's just a habit now to ensure I feel a little bit more secure. This summer we didn't buy any groceries besides milk for 3 weeks and we did fine. Now we're back up to stockpile levels and I like knowing that we have a cushion before we have to worry about what to eat.

When you're thinking about food stamps and food assistance and why people need help, remember it isn't much we're talking about. It's the difference between eating 1 or 2 meals a day and 3. It's the difference between the extra stress of cooking only cheap food instead of healthy food (have you seen how much organic food costs? $5 for a single green pepper? Yipes!). It's the difference between getting the car fixed when it isn't yet broken and when it is suddenly un-drive-able. Isn't it helpful to support people when they most need it? Isn't it nice to know the security net is there to catch you if you fall because of an illness or a lost job?

Monday, September 9, 2013

Pumping part 2: on the road again

Building up a stash
My strategy was to pump on the other side when the baby had slept for more than 4 hours while she nursed on the other side, starting at about 3 weeks old. We didn't know for sure when she'd start daycare (or that it would only last 6 weeks) so that's why we started then. If we'd had longer until childcare, I probably would have waited until closer to 6 weeks to get serious about pumping (If I'd known I had 12 weeks of leave or something). My other strategy for stockpiling milk is to note any time I leaked and pump then (that's how I picked that time in the first place) and no skipping weekend pumping. I have an attack let-down so pumping with nursing means I get more than I would just pumping, but I think the same is true for most folks. For me it was crucial/helpful to stick to an approximate schedule so I can train my body when to produce more.

One thing to note is the shape of a lactation curve. I know, I know, we don't like to think about dairy animals and moms producing milk together, but I think it's useful here. On the bottom it's weeks since giving birth, and this is a cow curve because she's done at 10 months to have her next calf at a year from the first one's birth (poor livestock).
 Here's the thing: it's wicked hard to increase your supply after about 2-4 months (this curve is a bit sharper than I think most people curves are so stretch that top bump to about the 10-12 week mark). In those early days you can convince your body to feed twins (or come close) if you pump enough or nurse the baby enough. Afterwards your body just isn't responsive nearly so much no matter what you do. So if you are going back to work and going to pump, start early not only to build a stash but to be sure to build your supply enough that when you pump less than baby nurses you still get enough.

I've heard lots of women say "I had low supply" based on pumping, and I'd say that's untrue. Pumping doesn't actually reflect how much milk you're making. Left alone with a baby, I produce more milk than she needs. If I'm pumping, I don't get the same amount she drinks from a bottle unless I pump one time more than she eats which is miserable. MISERABLE. On her normal daycare day/day with the spouse, she eats 4 times so I should really pump 5 times to hit the same volume... for a half hour each time... UGH. Still doesn't mean I have low supply, just that I am bad at pumping. It takes a lot of very specific manipulation to clear my cloggy ducts. Compared to the tech that's available for livestock I feel like our pumps are terribly lame and technologically pathetic. That's why I think there's no reason to declare low supply based on what you pump. If your baby isn't growing, you have low supply. That happens, absolutely, but don't get too judgy based on pumping alone. Also note if you are taking a thyroid med, doses too high of it can stall your milk production so be sure it's carefully monitored. ::end soapbox::

Car tactics
The car adapter for the pump is awesome. I really liked the quiet of my car as opposed to a study cube in a hallway indoors. With my pump, electric or car worked equally well while batteries worked less well. When it was cold out, I assembled as much of the pump set up as possible indoors. I'd then set things out on the dashboard, get the heat running if needed, and get on with pumping. A cardigan or a zip-up sweatshirt is really handy for sneaking around if someone walks by while I pump. I don't own a cover so I never used one and those things are so obvious that everyone knows exactly what you're up to, but if I'm just sitting in my car, nobody really gives you a second glance. Garish nursing cover? Makes people stare (or it makes me stare because whoa are those bright/ugly/tent-ish and distracting).

Indoor sneaky tactics
My college has two places to pump (officially), each a 20 minute walk from where my classes are, so they are non-options for me (20 minute walk, 30 minutes to pump + 5 minutes set up and clean up 20 minutes back = more than the hour between classes). Usually I am parked much closer (3-5 minute walk) but sometimes it is cold/windy/raining so I find somewhere indoors to pump. I make good use of the sweatshirt to hide the sides/hands holding things (nope, no hands-free fanciness for me... alas). I also set my drip towel under my pump. It makes a terrible racket left to its own devices because it doesn't sit level (or no surface I've ever found is level enough) so this cuts the huge noise down to what might be a noisy laptop. There are study cubes with sides that work well enough. My personal preference is to get a study room in the library. Some college libraries have group study rooms you can rent for just one person, others you actually need a group so you could bring a friend to sign into the thing with you. Currently we have "media viewing rooms" that you can check out for just one person and it works well enough. I wind up sitting on the floor because the main outlet is behind the TV console and the other one is hard to access and get my power cord to reach from a chair (and the chairs are terribly uncomfortable). These are sound proof so no worries about being loud or a noisy audio book. If I have time I set up my laptop to run its screen saver where I can watch all the pictures of the baby scroll by. She's getting so big! Sheesh!

Airplane management 
Coming soon after my fabulous week-long field trip. Field trip! Wahoo! Also terrifying! I will say that keeping milk fresh rather than my usual freezing strategy was the way to go because I had stuff thaw on the one flight with pumping I've taken so far (and there was a delay in flight too so my pitiful ice supply wasn't enough to keep it all frozen). Also since that was a time we traveled with the baby it was very confusing for the security guys as to why there was bottled milk and a baby, but after a few minutes they decided it was innocent enough even if it didn't make sense to them. Sigh.

Thursday, September 5, 2013

Feeding the baby

I thought I'd quick touch on how Little Monster is doing at eating things. 

She's still nursing 7-11 times a day (at least 2 are comfort since she spits up like crazy afterward) and is now eating at least one meal of solid food a day. We are doing baby-led weaning, which amounts to "feed the baby whatever you adults are eating."

She started seriously grabbing for every bite we took at about 5.5 months (so almost 6 weeks ago) and we decided it was time to let her have solids. We gave her some bread crusts to start with and she was thrilled. The next day she got a peach and ate about a third of one. Actually gnawed it and swallowed it. She'd have gone for more but we ran out since we thought she'd stop after only a couple slices. Whoops!

Since then, Little Monster has had green beans, apples, oranges, pasta with a bit of butter and cheese, and a trip to the local Chinese buffet where she ate very well. She got a chicken drummy, half a spring roll, a good bite of egg roll filling, some celery (not a hit), hard boiled egg, green beans again but fried, and an ice cream cone. So far she had a kind of scary reaction the second time she tried oranges she turned red, got some hives, and had some trouble breathing but it was solved by some bena.dryl. Otherwise things are going well!

Just feeding the baby is so much simpler than fancy mushes for just the baby. I am a big fan. 

Friday, August 23, 2013


Trigger warning: here's a discussion of pregnancy loss and probably rape. Feel free to skip this post if you aren't in the right headspace for it.

See? Lime Cat (who is more accurately wearing a pumelo) is not amused. Trigger warnings are serious stuff yo.

So in the realm of "awful things we get to do as the pharmacist," there are two or three that come to mind. One is telling someone how much their life-saving medicine will cost and then watching their face fall because it is too much. This one doesn't happen too often, and when it happens and the patient gets super mad but has a carton of cigarettes with them, I get a wee bit cynical.

Two is talking to a hospice caregiver who is just starting out with hospice. The caregiver is stoic but has a deer in the headlights look the entire time. It is a lot to switch mindsets from "s/he will get better" to "s/he will die soon but comfortably."

Three is a rape victim who hopefully is getting the full rape STI prevention cocktail and not just looking at the Plan B shelf in a terrified manner. The only part of having it sitting out on a shelf that worries me is these ladies, who really need a referral to the victim support system in the area (and yes, probably the Plan B as well). If they can just cower and grab the thing off the shelf, how will they get that referral to get a rape kit so the bad guy gets caught? That cocktail of meds has a number of serious side effects and it's a lot to keep track of it all (some are taken four times a day for quite a long time).

And fourth is the woman getting medicines for dealing with a miscarriage. I haven't had this one happen while I was working yet but I would totally cry while explaining the medications. I will. I suppose that makes me more personable or human and not healthcare mystic than anything I could say.

So, dear readers, what would you want to hear from your pharmacist if you were in one of these positions? If you have been there, what insensitive thing did someone say that could be avoided? Today one of my classmates is curious but I am too. I can share my experience with loss a tiny bit and my experience with hospice and affording meds as well, but the rest? Maybe you all have some ideas. Maybe my brain is just too tied up in dosing vanco right now to think this through.

What do you wish you had heard from your pharmacist? What would you like to hear in the future? About any sensitive and icky topic, IVF meds included for sure.

Wednesday, August 21, 2013

PAIL monthly theme: feeding babies

  • How did you feed your baby?
    • Primarily breast milk at the breast with the first one and even moreso (so far) with the second. Bottles while at daycare as one might imagine, except that time my pump got stolen and we couldn't afford one for a week when I snuck over to daycare instead of eating lunch myself to feed the baby. It was miserable.
  • If you exclusively breastfed your child, how long did you do it? Did you have a “goal” for length of time, or did you just wing it?
    • The goal with the kid was a year and she was sick when we got to a year so we plugged along at it until 13 months when I was done. So done. I needed the 2.5 hours a day back to study for finals. I think she would have been happy to continue, as would I except for the horrid pumping. Ugh pumping. Now? My goal is next week and maybe as long as October and then we'll see.
  • If you formula fed, how did you choose the formula brand? What are your suggestions for finding the best brand for your child?
    • In my dream world, we could switch to formula whenever it suited us so I am super curious about this. In the real world, I have to fight to continue nursing until at least a year or close to it so Little Monster can then transition to other sorts of milk.
  • Did you research breastfeeding prior to your child(ren)’s birth?
    • Yes. I took a class that was me and the educator and mostly weird, I read the La Leche League book and was tempted to throw it at someone who wrote it for the minimal information on how to pump and still nurse and the shaming of non-stay at home moms. Ugh.
  • Did your method of feeding your child(ren) differ from what you had hoped/planned to do? How did that make you feel?
    • That is a complicated question. I'd hoped that nursing would go well. It did eventually for the kid (we hit our stride at 4 months or so) and immediately with Little Monster, but I really don't like nursing. It is just uncomfortable for me. I would have loved to nurse for 6 months and then try to transition to formula this time (and it could be the thrush talking, but probably not completely). Yep I am selfish but I just don't like adding to my discomfort level all the time. We've had our latch checked and it's great, it's just me and presumably that awful Raynault's. I guess it makes me feel super ambivalent about the whole thing. Maybe if nursing felt like a choice rather than a desperate grab for a way to keep the baby fed without bankrupting the family it would feel different.
  • If you worked outside the home during the first year, how did that affect your decision?
    • Most of the time I was in school after the kid turned 6 months old I really wanted to be done pumping. Every day I wanted to be done. I was so glad to have a group of ladies with teens who had nursed their babies who cheered me on, visited with me while I washed pump stuff in the bathroom, and were just awesome. This time, no cheering section but I've been home much more. We'll see how things go in January when I'm back in school full time.
  • What would you tell an expectant mom about the realities of breastfeeding & formula feeding? Is there something you wish you’d have been told?
    • I never know how to react to the non-rude but turn and walk away because I'm nursing people. Mostly I ignore them because it's about them and not me. The other thing I wish I'd known about nursing was just seeing more women actually holding babies who were eating. Positioning is something people can tell you about and diagram, but until you actually see the baby in action, it's hard to figure out properly. That's why I nurse Little Monster everywhere we get the chance without a cover. Someone is watching and needs to learn what's going on. I suppose now that YouTube is a thing, you could find some good videos to remedy this. Our internet before the kid was born was a dirt track to the internet super highway so videos weren't really an option.
  • Do you feel your “preferred” method to feed your child was affected by how those around you feed their babies?
    • No because we still know very few people with babies. Also yes a little bit because my in-laws get up and walk out of the room if the baby is nursing. Being supportive in word is fine but it's weird to be talking, the baby starts yelling, and then suddenly she and I are alone because she's eating. I often strategically fed the kid before we'd visit so we didn't get walked out on too often. My extended family is totally unimpressed and ignores nursing because it's a normal part of life and totally not worth commenting on.
  • How much (in your estimation) did you spend on feeding your child for his/her first year of life? (pumping supplies / formula cost / lactation consultants / etc)
    • First pump: about $65 as insurance co-pay
    • Second pump: $250
    • Nursing bras: $140
    • Spare pump parts: about $60 (across both kids)
    • Bottles: about $50 with the kid, about the same with Little Monster because in the 4 moves in between their births the bottles all vanished. Arg.
    • Lactation consultant: Free and paid for by a grant the first time, free and paid for by the hospital the second.
    • Milk storage box: $8
    • Milk storage bags: about $20 for 120 of them
    • Total so far: $643
  • How did the transition to solids go?
    • Well... not so awesome. We made purees for the kid and she was never that into solids after the purees. Even things she loved as purees she loathed 6 months later as solids. It coincided with us being broke and not having the healthiest options available to us, so the kid doesn't eat all that many veggies or fruits or meats or anything besides her favorite selection of about 10 things. She refuses to try new things.
    •  Since we are trying again with the second baby, we are just doing baby led weaning. It's easier for everyone and it is making the kid nominally more interested in trying new foods to either set a good example for the baby or because it looks appealing once the baby has it. This is going wonderfully well and we will keep it up.
    • I have also decided not to panic about allergies because... well, why? All of mine were adult onset anyway so there's limited risk of the baby having any at all. Plus we are savvy and can easily assess if there's been an allergic reaction as we are seasoned parents of an allergic kid (please FSM no really scary reactions. Hives I can handle but more? Eeeep).
    • We are about a month into baby led weaning and everyone is happy with it, aside from the baby who gets thirsty with her meals and then has to wait to nurse. We also don't have a proper high chair and Little Monster doesn't sit up on her own just yet so the booster means a lot of tipping over and fussing.

Monday, August 19, 2013

The proper time to panic

I am starting to be concerned about this semester. Or, I have considered that now might be the time to panic. Granted, this is the hardest material in all of pharmacy school but my brain hurts a great deal after every lecture and I am less coherent in non-school related conversations than usual. Example: typically by the end of the semester, unless you are asking me something about a specific drug or treatment regimen, I have trouble putting together a sentence that includes all the words. I often lose one or more and then have to explain it. In the last few days though I have moved up to calling the girls by the wrong name about 30% of the time, lost the word for lunch and pizza (and probably more things, but it's really amusing to try to talk around those two. Me to spouse: "You know the food that happens about this time of day and it usually isn't the same for me and you because you eat nasty lunch meat and I eat something else and now I am hungry but the baby is eating and I can't think of the word for this? Could you help?"), and just felt overwhelmed by everything. Usually it takes a few weeks or even until after midterms to get to this level of absolute brain redistribution (that is, all brain for pharmacy school and zero for everything non-essential, and what is essential dwindles as finals approach toward sleep, study, caffeine).

Some of it is that we got a new learning management system so all of my class materials are hidden in new places in an interface that looks funny and doesn't organize things the same way at all. It triples the time it takes me to prepare for a lecture because I can't find the files to read and the textbook assignment is in page numbers and my e-book seems to have forgotten page numbers exist and soforth. It amuses me that while I like new tech, I hate having to adapt to it and it frustrates me until I've gotten to play with it enough that I know what I'm doing. I hate it doubly much when it is misbehaving and I know it but I can't make it stop.

I'll also add that I keep coming home and looking at the living room and thinking, "At any moment Little Monster will be mobile. She rolls but hasn't realized she could roll more than once, she bounces in crawling position and spins but doesn't quite crawl. Yet. At any moment..." and wondering how to keep the kid's tiny toys away from her and how we will ever barricade the TV and other cords and it overwhelms me very quickly. I just don't even know where to start. Probably with toy removal.

To boot, I have had what I suspect is a lingering very angry cyst for the past 2 months and I got fed up and saw my OB. Who is leaving. Just like every other doc I've seen in the past 10 months who had been with the clinic less than a year (so about 5 in a practice of around 35). Sigh. Anyway, it's the usual round of tests and trying to fix things. I am pleased that my doc was all "and let's check your thyroid because your hair is dwindling" without me pointing it out and asking "so... do we check my thyroid too?" Which means I am somewhat seriously considering getting a wig made with what's left of my hair for when it is all gone because it must be that noticeable to everyone else. Today's exam included a student (resident? I wasn't really paying attention) so I got double manual inspections and it hurts triple much as a result. OW. Hopefully it is a cyst and not scar tissue or some other ugliness. Endo folks, how did you get a diagnosis? I'm very pleased to know that it's PCOS but if it's also something else, I wanna know now so I can get this as fixed as possible.

And I suppose at this point, I am just trying to stay as close to caught up as possible at everything while still putting the computer away from 4:30pm until after bedtime. I think I may suddenly lose even more sleep this semester than the average person with a baby and professional school (and really, does that person exist? Doubt it.)...

Of course, there's the bonus stress of the spouse's career crash and current unemployment. It mostly looms beneath the surface at this point. I hate uncertainty and mystery and indecision and that is where we are. When you crash your career with one wrong move (since that's all it takes in this industry and that also makes me nuts... but it isn't my industry so I should just let it go...) it is hard to think of what is next and what should be next and what you'd like to be next. Hates-moving-so-much kid adds to the stress. Before we would just have moved for work and gotten over it, but now? Now we will try to move just once more, possibly ever, probably to at most one more community. That probably means following my job and that means a holding pattern until I have one. In 2 years or a bit less. Sigh.

For family movie night, I'm going to demand we watch Hitchhiker's Guide to the Galaxy this week because I need a 100 minute reminder not to panic. Assuming I have a hundred minutes to spare from studying. Sigh.

Friday, August 9, 2013

Everybody's baby

One of the weirdest and most unexpected things I've discovered about being a parent is how willing I am to let other people into the baby's space. I'm pretty introverted, but the kind of introvert who likes to interface with people well enough to be willing to do it all day. I find my solitude in brief moments in a wild space where everyone is chattering and that's fine with me.

But as an introvert, if I'm just out in public, I want to be left alone for the most part. Saying hi is fine as we pass, but absolutely no mini-conversations. When I lived briefly in the South, there was this "How yall doing today?" conversation that just made me want to hide (and move back north where no chatting was required) that went like this:

"Howdy. How yall doing today?"
"Good and you?"
"Just fine, thanks."

It happened maybe 15 times a day, just as you passed someone around in the world in any old place, with any old stranger. Loathed it.

The entertaining thing is that now the person doing this annoying chatting thing is my spouse. Sigh.

Anyway, I had figured that as a very private person who is pretty ordinary looking (aside from my awesome eyebrow) nobody would be interested in my baby and now baby and kid. I had expected I'd keep people away from any baby because babies were private property, right?


We have adorable, giant eyed babies and the one with hair has curls that are too cute (and seem to be going away now that she's 5 and has had her hair cut). Everyone wants to look at them. Everyone has to stop us and coo and remark on how adorable and all that jazz. It is amazing to me how interested people get in this baby particularly, although that's probably because she is out and about much more than the kid was as a baby born in a harsher winter. I will say the repeated comments are a bit demoralizing and overly Aryan (would you be complimenting my non-pale baby for being so cute? Hmmm...) but otherwise, I don't mind.

Our faith community regularly passes Little Monster around. I'd say on any given meeting day, at least 5 and often 10 people have held her. She is a popular baby (by virtue of being the only baby around) and a social baby who likes to smile at everyone, especially if they have glasses or gray hair like Grandma. We walk in the mall sometimes and every time we run into someone wanting to peek at the baby and exclaim at how cute she is and how we've made hir day.

The surprising thing to me is that it doesn't bug me at all. I am totally willing and happy to pass the baby off to whomever, whenever. I had no idea that I'd be fine toting around everybody's baby.

Example: at the playground, some girl, maybe 7 years old? 8? comes over and asks if she can hold the baby and with zero hesitation, I pass her off. Yes, I stayed fairly close by but I let a total stranger hold the baby for 20 minutes or more. Honestly I stayed close because the baby was fussing if she couldn't see me (this may be a hard phase).

A friend's mom died not too long ago, so we took the baby to the funeral on the premise that babies make funerals easier for everyone, especially if the person who died was old. She acted as a sort of therapy baby and was hugged and cried on by several people and enjoyed by all.

I am so glad that I have this chance to let every random stranger paw at my baby. That 5K we did last weekend? It supported a local organization that helps families dealing with the NICU, baby loss, or extended antepartum hospitalization. It's a great group that's doing lots of cool things. It was very moving to spend the morning with families who have survived the NICU, and with the full range of outcomes. Several kids had trach holes and g-tubes. One of the various bits of swag we got was a bottle of hand sanitizer on a clip that you could attach to your stroller or diaper bag, and I saw that a great many of the strollers and diaper bags were already outfitted with them.

I get to be grateful and enjoy having everybody's baby. It's humbling to remember that not everyone has a baby who can be passed around with ease and to remember to parent the baby you get, not the one you expect to have. This extroverted baby? Clearly accessing some recessive genes in her parents, and being stinking cute flirting with the old folks.

Thursday, August 8, 2013


So I have mentioned my goal of getting into shape. I have probably mentioned that for me, the scale isn't the goal. I'm setting "doing things" goals to stave off scale obsessions. So far, that means being comfortable walking a 5K without dying or being in agony. It's a huge accomplishment for me even though I'm sure it's small potatoes for city people and athlete types. 

Today was my first non-scale and non-athletic victory. I fit into a beloved clothing item again! It's just a sweater type deal but it fits properly again! Squee! It's also a really good thing it fits as currently the spouse and I are experiencing seasonal imbalance  issues where I am cold and zie is overheating, cranking up the fan or AC or both. I've concluded the only thing to do is to move somewhere very cold so I can wear fabulous sweaters all the time and the spouse can keep wearing shorts but never again need an accursed fan. Or at least that will work until either the glaciers all melt or new ones form en masse, which I'm hopeful will take a few years. 

Baby steps! Tiny victory! Now I had better get back to reviewing everything I've ever learned for this semester's ├╝ber class, reading 2 books and 10 articles for the first class of the semester, and that new exercise regimen. Plus feeding Little Monster solid food twice a day and helping her practice scooting and sitting up, and preventing cat attacks on the girls. 

Sunday, August 4, 2013

Oh the torture: pumping part 1

I don't think many people talk about the nasty part of working/going to school and nursing a baby: pumping. It is unpleasant at best and just awful at worst. (and hey, this has been lounging in my drafts for weeks and weeks so it's an amalgam of pumping with full time daycare and pumping with just long-term stockpile in mind).

So let's talk logistics of pumping, since that isn't super widely discussed. For me it means that I have about 3 dozen 2.5 oz bottles in rotation with about a dozen at daycare, a dozen clean or in the wash, and a dozen in my deep freeze. This puts me an average of 3-5 days ahead of need (at 4 months it did, anyway) so everything gets deep frozen before going to the freezer at daycare.

I pump when the baby wakes up and eats in the morning (one side, about 30-40 minutes depending on everyone's patience). Then I pump both sides about 2 hours after they leave for daycare (9am), 2 hours after that, and then about 3 hours after that but for 20-25 minutes instead of the typical 30ish minutes (2-ish) when we picked the girls up from daycare at 4pm-4:30. On the weekends I just pumped that first time in the morning, and post-daycare, I am (after a pumping break because I loathe it) back to this as well.

I have heard that keeping a set of pump attachments in the fridge all day works well to reduce the amount of dishes you wind up with, but because of what's presumably Raynaud's, it isn't an option for me. The cold added to the pain in a big way. 

As far as storage goes, here's a picture of my freezing prep.

I keep 2-3 days' worth of milk in the fridge in whatever volume it was pumped (bottle with no sticker since I group each day's bottles together, oldest on the left) and freeze it only in the 2.5 oz bottles or 5-6oz bags. This makes the math simpler for me since the baby eats either 2 bottles or 1 bag of milk per feeding & eats 3-4 times a day at daycare. 

We use the Total Baby app at home and we also used it at daycare to track what Little Monster was up to. Not having a paper report helped us immensely because we'd never find the thing in the bags of cloth diapers & 5 year old debris plus it meant we could match up milk inventory easily. The app syncs across an infinite number of iDevices and can be backed up to the computer. I don't add milk to the inventory in the app until it gets frozen because I never know how dates will get combined and it keeps me from obsessing about how long I'm pumping and if I'm getting enough and all that jazz. We arranged that all milk listed as in the freezer was at daycare and in the deep freeze was at home so if our daycare provider wanted to time a thawed bottle it was easy to find on the list. 

For labeling bottles I use garage sale stickers and put just the date since daycare didn't require a name as well. I keep a pen with the stickers in my milk pail above the fridge. The pail gets used for setting a bag in as I pour a measured 5 or 6 oz into it so if I spill it's easy to clean up. The Lansinosh bags have worked well for us so far although we haven't thawed many. I like the label space above the body of the bag. They also fit into a playing card box with some dividers out (you'd buy one from a comic/games shop, it holds 3200 cards, and we took out 2 dividers. Think the thing cost about $8 but it's priceless for saving on freezer space and potential messes.) and that makes storage really nice. Here's a picture of it, for your reference.
Notice the real sized card and the comically large card. The label folds above the zipper part so I don't worry about the box causing leaks. Bags are frozen flat elsewhere in the freezer then added to a box.

I have 3 full sets of pumping stuff so I only wash one side's worth during the day by hand & dishwasher the rest. To pump into I have 9 bottles that are 5 oz (plus another few that advertise Medela) and 3 that are 9 oz for use only in the morning when I occasionally get over 6 oz of milk. Also the big bottles are easier to maneuver when pumping while nursing. None of these came with lids so I bought some of these. I've also pitched the 4 oz BPA laden bottles that came with my pump (5 years ago) so I gained some 2 part lids there too. I don't freeze bottles with the 2 piece lid because they are big and don't store well (plus I suspect they leak). Did you know so many bottles had standard necks so you can pump into almost any old regular bottle?

I should add that I have an Ameda pump (in style, no less). It's slick to go from batteries (less suction than plugged in or using a car adapter) to car to electric outlet and back, plus it has a closed system. Maybe it's just me, but I sometimes pump too much into a bottle and milk backs up into stuff and with this pump, unlike the Medela single electric I had (same parts as the common ones, I think this thing doesn't exist anymore) no milk gets into the pump itself. That's what a "closed system" means. PLUS the Medela custom size flanges fit into the horns that come with it (while the custom size flanges made by Ameda don't fit tightly at all) so you can get a wide range of custom sizes to fit you exactly. I have two different sizes so it is great to get a tight fit and be more comfortable pumping. Also if you buy the Ameda pump and need a non-25mm size, don't waste your money on their custom size sets. The inserts don't stick tightly enough to pump successfully. They do make decent funnels for mixing up powdered drinks that need to go into a bottle with a narrow neck (hey... or formula would work too... hmm...).

While I pump I usually listen to an audio book or watch TV. I almost always can set up my computer nearby so I play a slideshow of baby pictures to help with let-down. If it's an awful day pumping I watch videos of the baby too so I can hear her chattering. In the realm of TMI, I have one side that produces more milk and yet is really hard to pump from, so if I'm pumping and nursing, baby gets the bad side. It's where I've had mastitis all three times too. I also have a milk duct that randomly empties an inch from where it should so that's part of the problem and ensures I get wet every time I pump. I actually keep a cloth diaper in my pump bag that I wedge in the bottom of my bra to protect the rest of me from sogginess. 

Now that we aren't doing daycare I pump only the one side after a long sleep (4+ hours) and try to get 5 oz to freeze in keeping with the system. This means after she eats, the spouse puts the baby back to bed. Usually she sleeps a bit longer but it can be 20 minutes of rocking to get her settled so that gives me the chance to finish pumping and everyone is back asleep at about the same time.

Anyone have any questions about pumping that I might answer? Part 2 is going to be travel logistics and stuff I accidentally forgot to mention.