small mother

I was already a mother when I became a mother. Long before I had my son. I just didn’t know it.

I became a mother at three. My mother had tuberculosis when I was born. Luckily she coughed blood a month before, otherwise I would not be here. I was born in a tuberculosis sanatorium, the first baby there in 25 years. My mother said that the staff was hugely excited about a baby. She was drugged to the gills while reading about the French Revolution and hallucinated Marie-Antonette’s head on a pole and the guillotine. She joked that she could never read about the French Revolution again. I was born, she kissed me, and I was swept away so that I would not get tuberculosis.

I was with my father and father’s family and then with my maternal grandparents. I came home to my parents at nine months. Adults kept handing me to other adults. I concluded that they were loving but stupid and couldn’t be trusted for a moment.

My sister was born five days before I turned three. My mother said that I met guests at the door and said, “Come see my baby.” Mine, because these adults don’t understand the needs of a baby, and I want her to feel loved and safe. No one will give my baby away!

Later my mother would tell a story about my sister worrying about Kindergarten. My mother could not reassure her. Neither could my father. I spoke up: “All you learn is colors, numbers and ABC and you already know those. I taught you.” My mother claimed that my sister was instantly reassured. I don’t remember: these are my mother’s stories and she is gone. But I have collected mother daughter pictures and small statues, just a few, all my life. And I wanted to have children. I liked surgery and obstetrics, but I chose family medicine, because I want to have children and to see them and be a mother too.

Health and joy and safety and comfort to all mothers and fathers and children everywhere.

 

In the warm

In the warm

I am here in the warm.
The thumper.
Sometimes it is fast.

I am in the warm.
The thumper.
The loud swish thing.
I kick it.
Loud place, I kick.
I am running out of room.
I push.

I push.
Thumper wild.
Thumper fast.
I have no room and now it is squeezing!
Stop squeezing! Pushing me! I want room! Room!

Ahhh! Bright!
Noisy! No warm! Cold!
Things touch me! Room! But no warm!

I am warm but not wet.
Bright. Wrapped.
Here is thumper.
I cough. No wet, something else. Air.
I want. Oh, thumper. Oh, mouth on warm, milk.

Here is room.
Thumper and others.
I know others. They are fast.
They are noisy.
That one is the one that held the swish thing. I kick.
Thumper and those are big.
These two are small, I am smaller.
Noisy! I like them.
I am getting used to light and dark.
More room. Milk. Air.

I know names. I have hands like others.
I can chew my hand.
My hands don’t work like theirs.
My noise doesn’t work either.
Not like brothers. Thumper is mom.
Other big is father.
Other bigs come and go.
I want my noise and hands to work!
I keep practicing.

I keep practicing
More!

I took the photograph of my daughter in 1998. This is scanned. I may try with another scanner….

 

At what age should we talk to our kids about drugs?

I am a rural family physician and my recommendation: before age 9. Before third grade.

WHY? Your eyes are popping out of your head in horror, but my recommendation comes from surveying my patients. For years.

The biggest drug killer is tobacco. However, it takes 30 years to kill people. It is very effective at taking twenty years off someone’s life, destroying their lungs, causing lung cancer, heart disease, mouth cancer, breast cancer, uterine cancer, stomach cancer, emphysema, heart disease….

I ask older smokers what age they started smoking. This is informal. This is not scientific. But most of my male older smokers say that they first tried cigarettes at age 9. I think parents need to be talking to their children about cigarettes by age 9.

And then start talking about alcohol and illegal drugs and the terrible dangers of pills.

“My innocent child would never….” Unfortunately my daughter said that as a senior in high school in our small town, there were 4-5 kids out of the 120+ that were not trying alcohol and marijuana. But there are kids trying far worse substances. We have methamphetamines here, and heroin, and pain pills sold on the street.

The perception that pills are safe is wrong too. Heroin is made from the opium poppy and it’s rather an expensive process, not to mention illegal and has to be imported from dangerous places. But teens take oxycodone and hydrocodone, bought on the street, to get high. And now drug sellers are making FAKE oxycodone and hydrocodone and selling that on the street. It contains fentanyl, which is much much stronger. If the dealer gets the mix wrong, the buyer can overdose and die.

Talk to your children young! NEVER take a pill from a friend, never take someone else’s medicine, never take a pill to party! YOU COULD DIE! And if you have a friend that is not making sense, that you can’t wake up, DON’T LEAVE THEM! Call an ambulance. Your friend may have used something illegal, and may not want you to call an ambulance. But if you think they are too sleepy….. don’t take a chance. People can get so sleepy, so sedated, that they stop breathing.

And parents, you are the ones that have to set a good example. Don’t drink alcohol every night. Don’t use pot every night. Take as few pills as possible. Pills aren’t necessarily safe because they are “supplements” or “natural” — hey, opium and heroin are plant based! Stop using tobacco and if you have a hard time doing it, tell your children you are struggling. It takes an average of eight tries to quit smoking. Get help.

Lastly, we talk about childhood innocence, but we let kids babysit at age 11. That is the Red Cross youngest age. My daughter took a babysitting course at age 11 and babysat. If we think they are responsible enough to do CPR, call 911 and do the heimlich maneuver, shouldn’t we also be talking to them about addictive substances by that age?

Talk to your children about addiction young… so that they can avoid it.

I am submitting this to the Daily Post Prompt: calm. I am not calm about this topic, but the photograph is calm…. and if we can help more children and families…..

Adverse Childhood Experiences 8: Social cues

I am thinking about social cues for people with high Adverse Childhood Experience scores. With crisis brain wiring the response to social cues may be very different than what is considered the acceptable “norm”.

I always miss the cue when someone says “see you later”. I think “When?” Then I realize it’s a social comment and they do not in fact plan to see me later. I have a moment of disappointment. I do the same thing when someone says, “Let’s get together for dinner.” or “Let’s have coffee some time!” or “I will call you back!” or “Why don’t you come to our cabin some day?” Yes, I think, when?

And then I think “Liar.”

So I fail social cues….. or do I? Maybe I am not responding to the “correct” or “conventional” or “nice” social cues.

My father drank too much and especially while I was in high school and college. And my mother would enable and cover up and pretend nothing was happening. Children in this situation, which is way too common, develop special skills.

My sister was three years younger. As adults we discussed the stages of drinking and which one we hated most. We would both walk in the house from school with trepidation. In the door and almost feeling the air: what is happening? Am I safe? Do I need to hide? How dangerous is it? How much will it hurt?

I walked in once during high school and missed the cue. I was thinking about something. I thought my father was asleep in the kitchen. I went in to get something. I was very quiet so as not to wake him. I made a cup of tea.

He was not asleep, or else he woke up. And it was the worst stage, or the one I hated most.
Not physical violence. But he started talking. One of things he said was “You can tell me anything.” Now, he meant it. But he was crying by then and I knew I did not want to tell him anything and all I wanted was desperately to leave the room. And neither my sister or my mother was home. Finally I was crying too, because I said “I just want to go read my book.” and he was more crushed and maudlin and emotional and crying. And I tore out of the room and up to my room, as my mother walked in.

I did not cry much. Ever.

I refused to talk to my mother about it.

The next day she said to me, “Your father told me that you were talking about Lamont.” Lamont Cranston was a very beloved cat, The Shadow, who was missing now. Dead, we thought.

I said nothing. Because we had not talked about Lamont. So either my father was lying or else he’d had a blackout, didn’t remember and was making shit up. And if I told my mother the truth, she would back him and deny what I said or make it into a joke.

The stages my sister and I identified were:
1. sober
2. a little bit
3. goofy/silly/makes no sense
4. crying
5. asleep

We were ok with 2 and 5. I don’t think we saw 1 for years. We disliked 3 intensely, especially in public and especially when our mother was doing a cover up dance. And 4 we hated.
And yet I loved my parents and mostly miss them now that they are gone. Except when I remember things like this.

So, what is the point?

I miss “social cues” because that is NOT what the crisis brain, the ACE score brain, pays attention to. I am paying attention to far more intuitive things: body language. Whether what the person is saying matches what I know about them and what they have done in the past. I am looking for whether this person is telling me the truth.

I don’t trust instantly. Why would I?

I said to a counselor once that reading the “cloud” around the person was terribly useful in medicine but made me a social misfit. “I don’t know how to turn it off.” I said. She grimaced and said, “Why do you think I went into counseling?” She said, “I can’t turn it off either but I have learned to ignore it during social situations.” I was in my forties before I realized that there are people who don’t sense this cloud, who trust people until the person is dishonest, who understand that it is just fine to say “Let’s get together.” and not mean it.

Because actually, when someone says “I’ll see you later.” and they don’t mean it, they are saying an untruth. They are not planning to see me later. They don’t mean it. And my brain automatically files that under evidence that this person is not trustworthy. To them it is a social cue that is polite. To some of us, it is clearly something that is not actually true. I pick up on a cloud of social cues, but not the ones that are acceptable or conventional. And I am not the only one.

my sister on the left and me on the right, in the 1960s

Why care for addicts?

Why care for addicts?

Children. If we do addiction medicine and help and treat addicts, we are helping children and their parents and our elderly patients’ children. We are helping families, and that is why I chose Family Practice as my specialty.

Stop thinking of addiction as the evil person who chooses to buy drugs instead of paying their bills. Instead, think of it as a disease where the drug takes over. Essentially, we have trouble with addicts because they lie about using drugs. But I think of it as the drug takes over: when the addict is out of control, the drug has control. The drug is not just lying to the doctor, the spouse, the parents, the family, the police: the drug is lying to the patient too.

The drug says: just a little. You feel so sick. You will feel so much better. Just a tiny bit and you can stop then. No one will know. You are smart. You can do it. You have control. You can just use a tiny bit, just today and then you can stop. They say they are helping you, but they aren’t. Look how horrible you feel! And you need to get the shopping done and you can’t because you are so sick…. just a little. I won’t hurt you. I am your best friend.

I think of drug and alcohol addiction as a loss of boundaries and a loss of control. I treat opiate overuse patients and I explain: you are here to be treated because you have lost your boundaries with this drug. Therefore it is my job to help you rebuild those boundaries. We both know that if the drug takes control, it will lie. So I have to do urine drug tests and hold you to your appointments and refuse to alter MY boundaries to help keep you safe. If the drug is taking over, I will have you come for more frequent visits. You have to keep your part of the contract: going to AA, to NA, to your treatment group, giving urine specimens. These things rebuild your internal boundaries. Meanwhile you and I and drug treatment are the external boundaries. If that fails, I will offer to help you go to inpatient treatment. Some people refuse and go back to the drug. I feel sad but I hope that they will have another chance. Some people die from the drug and are lost.

Addiction is a family illness. The loved one is controlled by the drug and lies. The family WANTS to believe their loved one and often the family “enables” by helping the loved one cover up the illness. Telling the boss that the loved one is sick, procuring them alcohol or giving them their pills, telling the children and the grandparents that everything is ok. Everything is NOT ok and the children are frightened. One parent behaves horribly when they are high or drunk and the other parent is anxious, distracted, stressed and denies the problem. Or BOTH are using and imagine if you are a child in that. Terror and confusion.

Children from addiction homes are more likely to be addicts themselves or marry addicts. They have grown up in confusing lonely dysfunction and exactly how are they supposed to learn to act “normally” or to heal themselves? The parents may have covered well enough that the community tells them how wonderful their father was or how charming their mother was at the funeral. What does the adult child say to that, if they have memories of terror and horror? The children learn to numb the feelings in order to survive the household and they learn to keep their mouths shut: it’s safer. It is very hard to unlearn as an adult.

I have people with opiate overuse syndrome who come to see me with their children. I have drawings by children that have a doctor and a nurse and the words “heroes” underneath and “thank you”. I  have had a young pregnant patient thank me for doing a urine drug screen as routine early in pregnancy. “My friend used meth the whole pregnancy and they never checked,” she said, “Now her baby is messed up.”

Addiction medicine is complicated because we think people should tell the truth. But it is a disease precisely because it’s the loss of control and loss of boundaries that cause the lying. We should be angry at the drug, not the person: love the person and help them change their behavior. We need to stop stigmatizing and demeaning addiction and help people. For them, for their families, for their children and for ourselves.

I took the photo of my daughter on Easter years ago.

my love is so sweet

my love is so sweet
my heart sees him and skips a beat
my heart feels like it trips
how many beats do you think I’ll miss?

(all count the skips out loud)

you’ve got it really bad
it’s pathetic, you’re so sad
all day long I hear your sighs
guess how many times I roll my eyes

(all count the skips out loud)

 

The photo is mine from the 2015 Wooden Boat Festival

small pirate

In September at the Wooden Boat Festival I went down to look at the boats. There was a square rigger with a pirate. A 22 foot square rigger with the largest sail about the size of a baby blanket. After we had exchanged introductions, Captain Jack explained that his grandfather had built the square rigger to play with his grandchildren and he has restored it. It has an outboard in the middle, well, an inboard outboard so to speak. I asked how it sailed and he said, “Downwind.” I asked about hull speed and currents and he replied “AAARRRR, don’t talk to me about current.” A small child came by towing parents and he handed a pirate toy over from a big gold chest.
Then another small child came up. Very small with red hair. He gave her a pirate flag, which she waved. But she still looked at the boat. “You can come aboard,” he said. He told dad to bring her. Dad stepped aboard with her and Captain Jack put a black bandanna hat with a skull and crossbones on her. Then she saw the swords. Cutlasses made of foam! She reached for one. “Go ahead, you can have a sword fight with your father!” IMG_20150913_131056
She did, with me and mom laughing. “Would you like to take the wheel, matey?” said Captain Jack. She nodded. She and dad went back in the very small wheelhouse and she practiced steering the squarerigger. “Me boat has been shanghied, I’d better escape!” said Captain Jack, stepping ashore and leaving her and dad in full possession. The small pirate was very serious the whole time. This seemed to be new territory and she was concentrating on all of it.
Captain jack told me that he came to the festival last year and got invited back. He was very pleased and towed his boat from the inland lake. Hooray for Captain Jack and for all of the boat owners and contributors to the Wooden Boat Festival that encourage the children to be involved and Joey Pipia and all of the play pirates….