There is no silver lining.

I don't want a hobby.

I don't want a social life.

I don't want a break.

I want to be with my children every day.

There is no silver lining.

In Which Our Heroine does not feel very heroic at all, and does not get her happy ending

Dear Reader,

Assuming there is actually still someone still out there?  If so I hope you are well.  You made it through the worst of the COVID-19 pandemic and that is no small feat.  When I last wrote - 2017, goodness -- I had no idea the world would be turned upside down and I would watch patient after patient die while I had nothing to offer except empathy (including my own Zayde who died of post-COVID pneumococcal pneumonia complicated by bacteremia and empyema).  I had no idea I would have tears in my eyes when I got to schedule and take the first dose of the vaccine -- on the eighth day of Chanukkah, what a miracle!  Or that, almost a year later, I would say a Shehecheyanu blessing when my children got theirs.  I never thought masks would be a political statement.

I didn't expect my sweet A to be diagnosed with a brilliant intellect yet struggle with ADHD.  Thank goodness for dexmethylphenidate!  (Yes, we are Pharm-free on this blog!)

I didn't expect my sweet J to be just as smart.

I never dreamed I would get to witness and love such miracles.

I also never thought I'd write the following:  Husband wants to divorce.  He feels we simply are too different and will be happier, better people and better parents apart.  He wants to remain good friends.  Thinks we could still visit his family together.  So we are trying to work out an amicable, uncontested, divorce.

I feel crushed.  Heartbroken.  Humiliated.  Sad.  Angry  Devastated.  Everything everywhere all at once.  I feel like we won't be a family anymore.  I can't bear the thought of not seeing my babies (yes, I know they aren't babies anymore) every day.  And I would still rather work this out.  We can get along and we owe it to our kids to do so.  What happened to commitment?

But once again, major aspects of my life are not mine to control - even fight to change.  I couldn't do anything to make a successful transfer happen  and I couldn't stop a virus.  And I can't stop this.

But I did do something to control infertility, right?  I kept trying until we got our miracles.  And I kept putting on that N95 and holding patients' hands until things improved.  So maybe I can get though this?  I don't believe it at all right now.  It's too fresh.  But maybe once again, after another six years, I will be in a better place?

In Which Our heroine decides

So I just made a Big Decision.
 I agonized about it afterward and was literally shaking, but I did it.

I turned down an academic position.

I only ever wanted an academic position.  Teaching nourishes my soul.  When I was almost suicidal, teaching still made me happy.  As a devotee of lifelong learning, I also wanted the chance to participate in didactics, and grand rounds, and morning report, and scholarly activity.  This particular position would also have allowed me to learn more about infection control, and get some special training, as well as training in how to teach.  I would also see clinic patients one half day per week.

Sounds like a dream job, right?  And at my beloved home institution.

It almost was, and I only barely was able to turn it down.  Because my biggest dream came true, and I have (turn the Evil Eye) two precious miracles who are finally asleep, and that job takes precedence over everything.  As that means spending at least half the year working six days per week and the other half working five days per week (probably with another few Sundays thrown in) is not the right fit for me at this point.  Especially since I am no fool, I have seen the life of an attending, and I know that the stated hours are just the tip of yhe iceberg.

But it is so incredibly frustrating.  I am forced to choose between a satisfying professional life and dedicating time to my children.  It shouldn't have to be this way.  There should be a paradigm for part-time academicians.  We who want to be part-time are just as serious.  In fact, maybe we are more intense, because we are truly trying to have it all, knowing that one can never actually have it all.

Another problem I think I grapple with is the perception - and probably even my own - that by taking this low-key, private practice position, I am being lazy.  After all, I only want to work three days a week and every fourth weekend.  Getting into and through medical school, residency, and fellowship is all about hard work and pushing onceself to excel.  My personality is also such that I don't do things by halves.  And my parents, for whom I have everything to thank, taught me to push as hard as possible to reach my full potential.  But that is exactly the opposite of what I am doing right now.  I am knowingly rejecting career advancement.  Acknowledging that someone else will make the next breakthrough.  Agreeing to watch others take over the field.  And truthfully, it makes me feel like an underachieving loser.

I haven't figured out how to deal with this yet.  But one approach I think I dislike is that I am "sacrificing" my career for my children.  That approach paints children as a burden, a roadblock, and something to be resented.  I am spending two days at week with my children because I want to be with them.  It is draining and at least as exhausting as taking call.  But there are too many precious moments that I would miss if I were at work.

At any rate,  I have decided.  I hope I can find ways to enjoy private practice.

On the plus side, the enjoying-the-children part is easy.  But that's another post for when I am not typing on my phone and it isn't after midnight

If Gilmore Girls can broadcast a revival...NO SPOILERS

....as I have not even watched more than five episodes of the original Gilmore Girls.  So don't worry.

But I thought, dear readers, that I may as well update you.  It's been almost a year.

How does one measure a(n almost) year in the life?

In a miraculous baby J, a beautiful baby boy.  Born 31 August, 6 pounds, 2.4 ounces, 19 inches of pure blessing.  In Hebrew we call him י.  He has the most delicious smile and is starting to laugh.  He is apparently small percentile-wise, but his thighs are just a little zoftig :o)

In a little girl who is sweet as sugar, now almost three years old, with a sense of humor that cracks me up and a sense of empathy that makes me proud.  And yes, she has curls to die for.  (Forgive my ending the sentence with a preposition.)  She is working on toilet training and she loves Maisy books by Lucy Cousins and handing out stickers.  She just graduated from the little pool at swim class to the big pool where mama watches from a side bench.  I'm not sure I'm ready.  She uses Hebrew as easily and sometimes more easily than English.  World, I am raising a daughter whose primary language is Hebrew.  This makes my Jewish-day-school heart so proud.

In a last goodbye, at least for now, to the institution which has been my academic home since I started medical school.  Technically I will still be there, but as a private practitioner, essentially competing with the university.  I make no apologies.  I wish they had been able to offer me a position.  But they can't (and aren't interested in hiring part-time faculty), so their loss.  And yes, I intend to show up and kick butt at grand rounds.

In a new home, two blocks from my old home and only one block from my parents and grandparents and one set of aunts/uncles and across the street from my other aunt/uncle.  It was a crazy move, done within a week of returning from Israel and one week before flying out to meet baby J.  The house has tons of potential but needs more work than anticipated.  I believe that's what they call buying a house :o)

In tap dance class, and Jane the Virgin, and a wonderful novel called A Suitable Boy, and fights with Husband, and making up with Husband, and watching my sister become a kind, caring, competent young woman who makes me so very proud.

In wipes and diapers and pull ups.  Loads of them.

In highlighters and Mandell chapters.  My goal is to finish the book cover to cover at some point.

So where does this leave us?  As I write with my little one snuggling on my lap, and my sweet girl in her bed, it's almost time to go back to work.  I will start my first big-girl job next month.  If all goes well, it'll be part time, giving me a chance to enjoy this motherhood for which I worked so hard.  The physician whom I'm joining is a sweet, understanding woman committed to me being able to have a family.  I would love to do academic medicine at some point, so we will see where things lead.  A local academic program may have an opening soon, but I don't know whether part-time will be an option, and full time is just not an option.

People ask me if we will go for a third.  I would love to, and N is willing -- she brought it up, not I.  Yet it feels so greedy.  I have two beautiful children, so it's not like I am trying to make sure A has a sibling anymore, and I am asking N to risk her body.  And yet...I just don't know that I am done, and we do have good-quality frozen embryos.  Husband isn't sure yet.

So we will see.  We have several months before we have to decide.  Right now we can't afford it anyway, and I don't want to ask my family for help.

We do know that, if we have leftover embryos at any point, we will donate them to someone/s trying to make a baby.  We would love to pay it forward and it doesn't weird me out at all.

For now though, I will savor the sweet miracle sleeping in my arms and Husband and I are going to watch Monday's episode of Jane the Virgin.

But before I go -- four years ago I was on the verge of suicidal.  I thought I would never hold a baby of my own.  I spent Thanksgiving lying on the sofa so depressed and sick I didn't even have the energy to watch television.  I can't promise that every one's happy ending will include babies.  Or that if it does include babies, it will take four years and not longer.  Or that it will be fair.  But know that if you are in a hard place right now, it might look different in a few year's time, and I hope any change is only for the better.

Welcome to Denver...whose population at this time does NOT include Mim or A

Dear readers,

I intended to greet you all from Denver.  This would have been the first time I actually attended an embryo transfer.

Apparently the travel safety authority felt otherwise.  I have that dangerous, 104-pound baby-toting mama look.  Clearly I am force with which to reckoned and a menace to society.  When provoked I could poor milk on people's heads, or magnetic fish.  I could even bore them to death by reading Goodnight Moon twenty times over.  Or worst yet, I could give them all diabetes by providing too many animal crackers.

This must have been the thought process of the TSA, since they opened every single bag, took everything out, tested every possible surface of the stroller and carseat, and - as this took half an hour -- made me miss my flight.  Which was the last flight that would have gotten me to Denver on time.

Thanks for keeping us safe, TSA.  After all, now I stand absolutely no chance of an accident or attack on a plane since I won't be getting on one.

I *may* have thrown fit at the gate.  Of course there weren't any passengers there since they'd all boarded on time and the jetway was already closed.

Also, may I just note that I asked the TSA officers MULTIPLE TIMES if I would be able to make my flight.  I also asked them if it was possible to notify the gate that I was being checked and would be delayed.

I "would be fine."  Except I wasn't.

So once again, I am not even close to the baby-making.

Whatever.  At this point -- I am used to it.  And it isn't as if I expect anything but failure anyway.  It just stinks because I really wanted A to meet her surrogate mommy, and I too really wanted to see N. Husband says maybe we will fly out to N's home state of California if this all works out, and go to an ultrasound together.  First of all, that would require a successful transfer, which has happened only one out of seven previous transfers.  Second, I cannot take any days off between January and July and I will be working each Saturday from February on.  So exactly how I am supposed to fly to California, I have no idea.  And I don't remember them doing ultrasounds routinely after the 18-20 week anatomy scan.  We could of course go just to visit, but that would likely be at the same time we want to go to Israel.

Let this not be misconstrued.  I am still quite grateful the transfer is even happening, and grateful to N for going through all this especially without me there.  And I ended up having delightful morning with my miracle baby, the sweetest most amazing little light of my life.  I may never have another baby (despite my mother's unflinching optimism), but I am beyond blessed with the one I hold now.

To adapt my usual end-of-consult line: thank you for allowing me to blog the chronicles of this very "pleasant" (ha!) journey.  Will follow.

Not updates in Internal Medicine, but updates from someone board-ceriotifed in Internal Medicine!

Hello again, dear readers!

First off -- if you had a rough Thanksgiving, I was in that same spot three and four years ago.  I can't guarantee each of you will hold a baby in your arms.  I wish I could.   But I can tell you that even when you are absolutely convinced you will never reach your happy ending, it might be just a matter of time.  My happy ending is currently sleeping tucked beneath a quilt my grandmother made for me.

Since I last wrote, some updates are probably due.

I am now officially certifiable...oops, I mean board certified by the American Board of Internal Medicine.  And yes, I am darn proud.  I may have bought myself a "pass present" in the form of a sapphire ring from Overstock.com -- which would have cost $75, except I had no idea of my ring size and consequently had to order four different sizes before getting it right.

My sweet A is now 22 months, sweet, loving, smart, funny, and generally the light of my life.  But that wasn't news.  She has her own personality.  Tonight she force-fed me cake.  She's also impressive.  We took her to her first Nutcracker last weekend and she watched the entire thing.  Actually watched, interested, enjoying herself.  This, Dear Readers, is a Very Big Deal.  The Nutcracker was my first ballet and the story goes that I thought intermission was the end and consequently threw a fit because I wanted more.  I aways dreamed of taking a little girl of my own to the ballet and now that dream came true.  Also yes, I will never stop wishing I had the talent, turnout, and arches to be a ballerina.

I went to a Mom's Night Out from A's nursery school class last night.  It went better than I thought, considering my social awkwardness.  I made it through the usual birth stories and interestingly, when it came out that we used a surrogate, I got a universally positive response.  When I told them I was a physician, I was also met with unexpected admiration.  It was a good feeling.  Coming from a family of physicians, spending time with friends who are almost all physicians, it seems so normal to be a doctor.  I am incredibly honoured by the privilege it is to practice medicine, but it never occurred to me that it is impressive.  Yet think about all those people who wish they could get into medical school, or residency.  I am pretty lucky.

As for Operation Sibling: we have six chromosomally-normal embryos "on ice" at CCRM and transfer date is approaching.  This will actually be my first time attending a transfer.  Yes, out of seven transfers, I have attended zero.  We already had plans to be in Israel for the first transfer, and after that it was just too painful to be at Northwestern.  Now I'm excited to see it from a medical perspective.  I'm thrilled to see N again.  I'll bring A, so I'm especially looking forward to N getting to see how much she's grown (although I send pictures all the time).  Have any of you attended an embryo transfer?  What was it like?

We have also decided to do a single embryo transfer.  I'm a little worried.  They quoted me a 75% take-home baby rate with our embryo quality (5AA), which is amazing, but still leaves a significant failure rate.  But they also quoted a 60-70% risk of twins, with all the associated complications.  I would love twins if you could guarantee they'd be born normal.  But with a 20% prematurity rate, and a 15% gestational DM rate, and increased preeclampsia, my first priority has to be N's and Baby's safety.  We probably won't have additional children after this one.  It feels wrong to me to keep risking other people's health, and it feels greedy.  before I knew about Turner's Syndrome I always wanted four children.  But some women don't get any children, and I already have one.  So I am pretty lucky, don't you think?  But I do wish we could get to Beta day already.  Positive or negative, I would just like to know.

Lastly...I suppose...career.  it has recently come to my attention that this July I will graduate.  I could be done with training forever.

Let me rephrase that.  After twenty-seven years of formal education, I could be done.  A real adult, looking for a job.

The last time I applied for a job it was a cashier position at Borders.  This was in no way motivated by the 30% employee discount, of course.

Interestingly, there aren't exactly a plethora of jobs in academic infectious diseases.  I don't want to go into private practice.  I want to teach students and residents and fellows.  I want to be a part of grand rounds and morning reports.  But a highly-placed person at our medical school just told me there are no part-time jobs in academic medicine.  I can either have a job that makes me happy, or I can be the mama I want to be.

If you know me at all, you know this decision isn't actually hard to make.  A wins, every single time.  But maybe I don't have to give up on academic medicine?  Mama thinks Highly-Placed Person may be wrong.  It remains to be seen.  But another questions is whether I should take up Highly-Place Person on his offer of a two-year PhD in molecular micro (exact field TBD) which would provide me the research skills I need to continue in academia as well as the funding to do so.  No need to find a grant.

Mama thinks perhaps with a PhD in hand, I could convince somebody to hire me part time.  Anyone out there with experience?  A doctor doctor?

Anyway, my eyes are closing as I write.  Shabbat shalom everyone, and I will try to update again soon.

Another update -- also known as procrastination -- Change of place, change of luck

But not too much procrastination.  I do need actually to pass my Internal Medicine boards, after all, and study time is scant.

But in brief: we have decided to change IVD clinics.  I had no great love for our previous clinic, and as it turns out, their rates are below average and overall poor.  I'll not get into specifics but basically we've noted serious detail problems and are ready to move on.  We're considering two clinics.  One is CCRM and one is on the west coast.

A Hebrew phrase goes, משנה מקום, משנה מזל, meaning "change your place, change your luck."  In some ways I feel odd writing that as our darling A is a true miracle.  But I think you all know what I mean.

I won't mention here the name of the centre which I just "divorced."  I don't want to slander or speak ill and I can't remember if I mentioned it previously or not.  I will simply say that I now know a much better centre in Chicago, and if anyone needs the recommendation, feel free to contact me.

Now -- practice exam questions and hopefully a new entry in my journal to A.

Goodnight!