Tag Archives: children

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Adverse Childhood Experiences 15: Guidelines

I wrote Adverse Childhood Experiences 14: Hope quite a while ago.

The American Academy of Pediatrics has a guideline that physicians should introduce and screen for Adverse Childhood Experiences. The American Academy of Family Practice is skeptical, here: https://www.aafp.org/pubs/afp/issues/2014/1215/p822.html. Here are two more writeups: https://www.aafp.org/pubs/afp/issues/2020/0701/p55.html and https://www.aafp.org/pubs/fpm/blogs/inpractice/entry/screen_for_aces.html.

It is difficult to screen for ACE scores for the same reason that it is difficult to screen for domestic violence and to talk about end of life plans. These are difficult topics and everyone may be uncomfortable. Besides, what can we DO about it? If growing up in trauma wires someone’s brain differently, what do we do?

I don’t frame it as the person being “damaged”. Instead, I bring up the ACE score study and say that first I congratulate people for surviving their childhood. Good job! Congratulations! You have reached adulthood! Now what?

With a high ACE score comes increased risk of addictions (all of them), mental health diagnoses (same) and chronic disease. Is this a death sentence? Should we give up? No, I think there is a lot we can do. I frame this as having “survival” brain wiring instead of “Leave it to Beaver” brain wiring. The need to survive difficulties and untrustworthy adults during childhood can set up behavior patterns that extend into adulthood. Are there patterns that we want to change and that are not serving us as adults?

This week a person said that they blow up too easily. Ah, that is one that I had to work on for years. Medical training helps but also learning that anger often covers other feelings: grief, fear, shame. I had to work to uncover those feelings and learn to feel them instead of anger. Anger can function as a boundary in childhood homes where there are not adult role models, or where the adults behave one way when sober and an entirely different way when impaired and under the influence. There may be lip service to behave a certain way but if the adult doesn’t behave, it is pretty confusing. And then the adult may not remember or be in denial or try to blame someone else, including the child, for “causing” them to be impaired.

What if someone had a “normal” childhood but the trauma all hit as a young adult? I think adults can have trauma that changes the brain too. PTSD in non-military is most often caused by motor vehicle accidents. At least, that is what I was told in the last PTSD talk I went to. Now that overdose deaths have overtaken motor vehicle accidents as the top death by accident yearly in the US, I wonder if having a fentenyl death in the family causes PTSD. Certainly it causes trauma and grief and anger and shame.

I agree with the American Academy of Pediatrics that we should screen for Adverse Childhood Experiences. We need training in how to talk about it and how to respond. I have had people tell me that their childhood was fine and then later tell me that one or both parents were alcoholics. The “fine” childhood might not have been quite as fine as reported initially. One of the hallmarks of addiction families is denial: not happening, we don’t talk about it, everything is fine. Maybe it is not fine after all. If we can learn to talk to adults about the effects on children and help people to change even in small ways, I have hope that we will help children. We can’t prevent all trauma to children, but we can mitigate it. All the ACE scores rose during the Covid pandemic and we are still working on how to help each other and ourselves.

Here is another article: https://www.aafp.org/pubs/fpm/issues/2019/0300/p5.html.

Blessings.

For the Ragtag Daily Prompt: open wound.

The photograph is one of Elwha’s cat art installations. He would pile toys on his bowl. Two bowels because I need to keep out the little ants. Sol Duc would do it too but not as often. I fed them in separate rooms. They would pile things on the bowl whether there was food left or not.

Elwha is still missing, sigh. That is a wound. The photographs are from March 2023.

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You can have some of the things some of the time

My father’s name is Malcolm Kenyon Ottaway. He went by Mac. He died in 2013. I miss him and I still follow Mac’s Rule.

Mac’s Rule is simple: You can get one third of the things that you think you can get done in a day.

I played with this on my days off for quite a while. I would write a list of all the things I wanted or needed to get done. Once I write the full list, it looks silly. Soon it is clear that he is correct.

When I am working full time in Family Medicine and have a five year old and a new baby, I think about getting something done on the weekend. Clear my desk, organize photographs, that sort of thing. After a while I realize that the weekend was more like this: Meals. Get kids clean and dressed. Laundry for the next week. Clean the house a bit. Do some fun family things! Read to kids and put them to bed! My list changed and instead of the ambitious “organize photographs”, I would think of something very small. Perhaps take one roll of developed photographs, pick some of the duplicates, send them to the grandparents. That was it for the entire weekend.

If I apply Mac’s Rule to my life and list all the things I want to do, which third will I pick? For years I write lists for a day off and then pick the top third that I want to get done. If something is added to the list, a friend calls to go to coffee, I take something else off. I make sure that the list always has something that I need to do on it (and often don’t want to: start taxes, pay bills, clean a bathroom, whatever). And something fun.

I don’t try to do it all. It’s very satisfying to get that 1/3 done on the list. And I feel like superwoman if I get an extra thing done! I get to choose which third to do and think about it. And the stuff that I don’t want to do slowly gets done over time. It isn’t that awful to do one of those duty jobs, thank you letters, tax information, dental appointment, mammogram, every day and then it gets DONE.

I am working with someone who puts RUSH at the start of every single email subject line. I have to say that it makes me want to dig my feet in and not even read the email. What kind of rash haste are they working under and why would I pay any attention to the RUSH by the ninth email? It is annoying and ludicrous. I move those emails to the next day list and don’t read them on the day of arrival. No pressure, so there.

Blessings on my father, for Mac’s Rule.

For the Ragtag Daily Prompt: rash.

The photograph had to be taken before May 2000, because my mother died on May 15 and she is on the boat. I don’t know who took it, another group sailing. Both my kids are there, my father with the tiller, and I am tucked behind the friend facing the camera. Why haven’t we pulled the motor up? This is Sun Tui, the boat currently in my driveway on a trailer.

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Difficult?

With Cee’s Flower of the Day on hiatus, I am casting around. Here, a weekly prompt: divorce.

My ex and I did a year of couples counseling and then another year of hammering out the details. I felt like a terrible failure and did simultaneous solo counseling to figure out why I was failing. It took me two years to make the decision and I was anxious the entire time. And then once I decided, the anxiety evaporated like morning mist.

One thing that I realized is that we each had a blind spot. I love working and am a hard worker and even to the point of working until I get sick. My ex did not want to work, partly because his father seemed to hate it so much. My ex was dedicated to doing something fun every day and that was a revelation to me: were we allowed to have fun? So it was all lots of fun for a decade. He was in charge of play: bicycling, swing dance, going to music, golf (golf did not take with me), tennis. I was in charge of work and practical things. This started to fall apart with kids, because I wanted to have fun with the kids and he said, “Kids aren’t fun.” As I moved into defining fun, he refused to move into work.

At some point during the prolonged divorce process, I realized that some of it was not about me at all. He knew at some level that he had to go work, because his son was reaching his teens. My ex looked at me one day and said, “I’m going to have to thank you for this, aren’t I?” “Damn straight,” I replied. I wished he could deal with the work thing in the marriage, but he couldn’t. He went off and went to nursing school and has an RN. I talked to him yesterday on the phone. He said, “I decided when I was young that I was going to do tons outdoors until I got old and then I would work. And look how it’s working out!” A little hard on me, I think. Meanwhile the kids got bored with the whole thing so they were reassured that it was not about them.

Anyhow, I think it was the right thing to do though difficult. During one argument my ex said, “I have avoided doing anything hard.” I was annoyed and said, “What’s the hardest thing you’ve ever done?” “Marry YOU.” That made me laugh: a perfect snappy comeback and probably true.

This is The Yes Yes Boys, doing Make it Easy. I bought the CD when they played live at the Upstage here. I love this song. It’s not on You tube, but you can download the music for free here: https://hobemianrecords.com/product/why-say-no/.

“If you still can’t make it easy, get you a job and go to work
Don’t be hanging round here and there, miss your meals, wear a raggedy shirt
Cause when you’re missing your meals and you’re missing your bed
That’ll give you the pneumonia that will kill you dead
If you can’t make it easy, get you a job and go to work“

Highly recommended and very funny!

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child

some people say
they just want their children to be happy

not me
I don’t understand that
to want a child to be happy
fixed in amber
with one emotion

I want my children
to feel what they feel
to feel happy, unhappy, sad, angry
gloomy, ecstatic, joyous, jealous
snarky, sarcastic, silly, relaxed
to feel the full gamut
the full rainbow
of emotions

In my mother’s family
they pack their sorrows in their saddlebags
and ride forth singing

the trouble is
the saddlebags get heavier over time
weighted with grief and fear and anger
or whatever is unacceptable
to the family
until the horse staggers under the weight
falls over
dead

then they must try to drag the saddlebags
too heavy for the horse
through their lives

I am gifted my mother’s letters
when my mother is in the hospital
the tuberculosis sanatorium
the first letter a month
after I am born

My mother is cheerful in the letters
a little snarky about her roommate
a little lonely

But what stands out is what’s missing
She barely mentions me
in some letters not at all
her first baby
who misses her
and who she can only see outside
through a window

And what was in her saddlebags?
When she coughed blood 22 years old
and eight months pregnant
she thinks she has lung cancer
and will die

She says this without emotion
lightly
almost as a joke
a relief when it was tuberculosis
even though that meant six months
in the sanatorium
separate from her young husband
and baby
at least she was not dying

She doesn’t get to hold me again
until I am nine months
and I have no idea who she is.

The worst thing anyone can tell me
is that I should not feel the way I feel.

I shut down.
I don’t stop feeling how I feel
but that person is locked out.
I will not trust them with my feelings
for a long time
I am an expert at hiding my feelings
raised in an emotionally dangerous
household
and physician training as well.

Once on the boat
my daughter says, “Mom, I’m scared.”
My father says, “Don’t be scared or go below.”
“No.” I say, “Come here. What are you scared about?”
We have run aground.
Too impatient to wait for the tide
we are trying to winch ourselves off.
“I am scared we are trapped.” says my daughter.
“How far is shore?” I say.
We are in the marina.
“Not far.” she says.
“Could we get to shore?”
“Yes.”
“Are you still scared?”
“No.”
Soon a rowboat comes and takes the kids
to shore to play.

“Don’t be scared or go below.”
That was my childhood.
Emotions as monsters.
I went below.
I chose to make friends with the monsters.
I feel what I feel.
One friend says, “Of anyone I know,
you process your feelings in real time.”
and I laugh, but am honored,
because it took years
to reach this.

Don’t share your feelings with fools.
Don’t share your feelings with people
who want you a certain way,
or who try to control you.
You have a right to your feelings
as they are.

And this is what I want for my children.

The photograph is my mother and me in March 1963. I do not know who took it, perhaps my father. I would have been right around 2 years old and my mother was 24. I did not see these photographs from when I was first back with my parents until after they both died.

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Bucking trends

Terrible photograph, right? But look for the deer. Two can be seen, and there was a third, another fawn.

First I see the buck in my yard.

Buck eating apples in a driveway.

Then I see him across the street with two fawns. I didn’t get a good picture of all three. But he did that deer thing where they tell the fawns to stay put. I go over to that neighbor’s house for coffee and here are the fawns.

Fawn lying under an apple tree on a lawn.

This is the second year that I have seen a buck with fawns. This time two fawns. The fawns are still spotted but about twice the size of newborns.

I don’t know if the buck is babysitting for the day or if something happened to mom. The fawns don’t move when I walk past and go in the house. I only see the second one because I am looking for it. This is a busy street, but the deer are pretty safe as long as they don’t get hit by a car. We have to pay attention in the early morning and twilight. The deer do teach the fawns to cross at crosswalks too, at least, the moms with fawns are. I think the big bucks have decided they can cross where ever they want.

“White-tailed deer mate in the fall (October – December). The male deer (buck) plays no role in raising fawns.” from here: https://dnr.maryland.gov/wildlife/Pages/plants_wildlife/Deer_Fawn_FAQ.aspx. That is a different species. Ok, try information on Washington deer: “Adult bucks take no part in raising fawns, and generally remain solitary or form bachelor groups throughout the summer.” from here: https://wdfw.wa.gov/species-habitats/living/species-facts/deer#. Apparently our deer have not read the manual. Or maybe those two spotted ones are males, but I can’t really tell yet.

Our deer are bucking the trend, aren’t they? Deershines instead of monkeyshines?

For the Ragtag Daily Prompt: monkeyshines.

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Child memories

This photograph is from a box sent by my cousin. My sister Chris and my mother Helen. On the back it says “pear tree”. My mother would try to assemble the parts of the Twelve Days of Christmas. When I was in my teens, she would hang glittery pears on her avocado tree that she had grown from a seed. One partridge, two calling birds. She had seven tiny glass swans that she would set swimming on a mirror lake, with white fluff around it for snow. I don’t think she got past seven. My mother had wonderful traditions that she developed for Christmas. She loved the old carols and wouldn’t sing the modern ones at all.

I think my grandfather or grandmother took this photograph. I thought, why isn’t it square? But it isn’t: it was cut from a page and is a bit of a trapezoid.

My sister is about four, so this would be from around 1968.

For the Ragtag Daily Prompt: children.

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The happiest day of his life

When I was a preteen, I got my first Spiderman comic book. I was enthralled. A hero who had powers, but had a grandmother, responsibilities, made mistakes, felt guilt and confusion. I wanted this, not the princess crap. I did not want a prince to ride in and carry me off. I did not and don’t trust princes. The wedding being the happiest day of a woman’s life: what the hell? Is it the happiest day of the man’s life? If not why not? It’s important to the woman to be married to her love but not the man?

And anyhow, the Disney movies were very consistent. There were no good Disney Queens. The good ones died in childbirth, or were absent, or their ship went down. The stepmothers were evil. The princess career ended with marriage. Pregnancy either kills you or turns you evil. Actually, sex turns you evil if you are a female. That was the very clear Disney message judging by the animated features. Virgin girls are pure princesses but there are no adult female role models for years and years and years. By my preteens I wanted to drive my own wagon: I was not going to be taken care of, controlled, or left poor and with small children through divorce. I would have a career and children.

What IS the happiest day of a man’s life? Do we have any map of that? When they are promoted? When they buy twitter? When they are elected President? When they get married? Why do we have a happiest day for women (and is it the marriage or the sex?) but not for men?

In the romance novels, the man is usually older, β€œexperienced”, rich, and has a reputation for seducing women. The woman is often a virgin, or she has a child because there was an evil man who she thought loved her, or the older man got her pregnant and she never told him. She knows it is true love because she is pure and yet is overcome by lust, so it must be true love. Snort. I have always thought this is stupid and silly. So men in the novels are experienced, have sex with lots of women, and then are carried away by lust that turns out to be true love with this woman? What about all the others? Did they think it was true love too? Or were they β€œbad” women, who had lust without true love? Impure, not virgins, not a β€œgood” girl. Seems pretty confusing to me. Often the virgin gets pregnant because, hey, she is carried away by uncontrollable love, so of course she would not think about birth control. What is the experienced man thinking? Hey, let’s get this one pregnant, I’d like to pay child support? Oh, he’s carried away by uncontrollable love, but really now, you’d think after all that experience that he would use birth control. Apparently the rich experienced older seducer males are all morons when struck in the heart by true love. These books should be burned, really.

Anyhow, I was suspicious of the princess story and I wanted my own horse and armor and sword and I’ll fight my own dragons, thank you! I was much more interested in the super hero story, even though the superheroines were still pretty lame and likely to get killed off. Oh, and girlfriends get killed off. Gwen dying from fear during a fall: give me a break. Yuk. Made me glad she was dead if she was that much of a weakling. At least she couldn’t reproduce. I liked Mary Jane a whole lot more: feisty.

I wanted to be a superhero and still human, not a princess.

So what is the happiest day of a man’s life?

_____

The cat is Boa, not Sol Duc. Boa died at age 17 right before Covid-19 started.

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Vaccination talk

My cousin asks me once, why do doctors say, “This will only hurt a little?’ when they give a shot.

I thought about it. “It’s a matter of scale. Picture this: in room one, I have a woman who thinks her lung cancer is back and it is. In room two I have a mother and daughter crying because the daughter is pregnant and frightened. In room three, I have a well adult who needs a vaccination. Scale their levels of pain.”

Room one is very high, room two is very high, room three barely registers on my pain scale.

Poll: 1 in 7 parents have not talked about vaccines with their child’s doctor

I would give out a health department vaccination information booklet by 24 weeks to my pregnant patients, especially the first pregnancy. I previously had given it later, but then I had a woman who refused the child’s vaccines at visit after visit after visit, saying that they were still doing research. The child still had no vaccinations at 9 months.

Remember the woman who refused vaccinations for her children? She had more than four children. They all got whooping cough, pertussis. They whooped for months and were on quarantine. They were not allowed out of the household, any of them, until they were no longer infectious. The mother said she now was for vaccines and got them vaccinated.

I have seen adults with pertussis. Adults do not whoop but they cough. They can cough until they throw up or until they break a rib. For months. It is not fun at all. The adult Tdap stands for tetnus, diptheria, and acellular pertussis. I have never seen a case of diptheria and I don’t want to. It sounds horrible and can kill.

Have I seen a complication of a vaccination? One in 30 years of practice. And I know a person who had a complication, but they were not my patient.

The illnesses cause way more damage and disability than the vaccine. In residency I care for a young man in a group home. He can’t talk and has an odd skull shape. His mother got measles during the pregnancy. Measles is one of the infections that can cause severe birth defects. Get vaccinated before getting pregnant, though half the pregnancies in the US are “unintended”. That usually means “unbirthcontrolled”. I do not really understand that, since the risk of pregnancy in a fertile woman is one in four every time. Twenty five percent seems a pretty high risk to me.

I’ve written about my response to my last Covid-19 vaccination. It’s not a complication. It is an antibody response and it means that my immune system is WORKING, though admittedly it is weird and annoying. I don’t like the muscle dysfunction, but I will get the vaccinations anyhow.

I have a very alternative young woman in for prenatal care once. I give her the vaccination booklet. “Oh, my child is getting every vaccine there is,” she says.

“May I ask why? I was not expecting you to say that.”

“I was in the Peace Corps in Africa. I have seen kids die from every single one of the diseases we vaccinate for. My kid will get ALL the vaccinations.”

I said, “Please would you talk to my other moms?”

She smiled at that. “Maybe.”

I hope she did and does.

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growing

My son and daughter-in-law got married April 30th in Black Diamond, Washington. The young man in the photograph was the youngest in the house I rented. We had my two aunts: 81 and 86 years old, and my uncle, 85 years old. Me, my daughter, my two friends and their son. This young man and I took photographs. He taught me new things about my camera and on the last day ran a slide show from my laptop to the television. He helped all of us folks with technology and we really enjoyed having him there.

And I am delighted to hear that he told his parent that he wished we had one more day, all of us. Eight people in a household from Thursday to Monday and it went very well. Weddings always have some interesting glitches, but after putting off the wedding for two years due to covid, the bride and groom did not seem rattled by anything! My daughter-in-law is truly a delight.

Here is to the next generation, surviving this pandemic, sweeping up the pieces and growing, and thriving anyhow.

For the Ragtag Daily Prompt: children.