Rebirth: Healing from a C-Section

Wednesday, February 14, 2018


I wrote about Aviva's birth story here, and in it, I talk about how I had an emergency c-section. What I didn't write about was how much having a c-section affected me. For many women, having a c-section is their preferred choice, or sometimes it's just the way things end up, and they're okay with it. For whatever reason, my c-section brought up all kinds of feelings, none of them good. Before I go on, I want to say that I am not judging women who have c-sections, either by choice or by necessity. This is about me and my feelings about what happened surrounding my birth. Okay? Okay.

After a diagnosis of endometriosis and PCOS, 2 miscarriages, and infertility, I had already spent a lot of time being mad at my body. Pregnancy, once it finally happened, was one of the only things my body has ever done right. It grew a whole human! That's why, when my body stopped cooperating at 6 cm, it was like an even bigger slap in the face. I felt like my body had abandoned me. Failed me. It was just one more failure in a string of already depressing failures.

I carried that failure with me for months after the birth. For a long time, I had trouble even accepting that I had given birth. I felt like one minute, I was 40 weeks and 2 days pregnant, with a very present, kicking, little person inside of me, and the next, someone had just... handed me a baby. There was nothing in between. There was no space during which I felt us become separate people. Instead, I had been unceremoniously sliced open like a fish and now instead of skin-to-skin and immediate breast feeding, I was lying on a table with my uterus outside of my body, being stitched back together. (I've assisted in c-sections. They're kind of barbaric. Useful. Effective. But... aggressive.) I didn't get to have my doula with me, I didn't get any of the things I wanted.

Except an alive baby, which is supposed to make all of this okay. And it does. But it doesn't take away the disconnected feelings and the grief I had about how it all went down.

When I found out that I would be having a c-section, a mere 20 minutes prior to when I was on the table, I was out of it. I had been in labor for 25 hours, I had a fever, I was in pain despite my epidural. I was exhausted. Most of all, I was terrified for my baby. I made the only decision I could make at that point, and that was to consent to the surgery. I know that I made the right decision, because at the end of the day, Aviva and I were alive and healthy, and that, they say, is all that matters. And it does! It matters the most. But what also matters is how it made me feel, and women's feelings are dismissed constantly. Since c-sections are so routine now, and everyone was fine, no one seemed to understand or even care that I was hurting. I felt like a failure.

I don't mean to sound ungrateful to modern medicine, because I definitely am, but there will always be a part of me that is sad about how I brought Aviva into this world. I will never get the birth of my first child back, and instead of an empowering and moving experience, it was cold and clinical. Just another procedure in a long line of procedures my doctor had done that day. I'm also afraid. Afraid that, if I'm fortunate enough to get pregnant and have a second baby (and an opportunity to attempt a VBAC), that it will happen again. I'll labor and labor and labor and end up with a section all over again. No one can tell me whether that will be the case, so we'll have to wait and see when we get there. No one can even tell me why what happened happened, which is frustrating because without a reason, there's no prevention that can happen. I know better than most that medicine sometimes doesn't have all the answers (Lord, I wish it did!), but when your own body is the mystery, it's hard to stay objective.

There's part of me that is so angry with myself for even having any of these feelings, because women are fed so much crap about how birth and mothering should be, and I would like to say I'm better than that, but it got to me and now here we are. I'm also angry with myself because I would never be this harsh to any other mother who had a c-section. Nothing gets under my skin more than when I read a birth announcement to the tune of, "After x hours of NATURAL labor..." Unmedicated birth is birth, medicated birth is birth, having a c-section is birth. Birth is natural.

I'm not sure if I'll ever "get over" having a c-section or whether I'll stop mourning the birth I didn't get to have. And you know what? That's okay. I can hold both the joy of having a healthy, alive, wonderful child and the sorrow of not bringing her into the world the way I wanted. I contain multitudes, as they say. We all do.


State of the Med Student: The Road to Residency Edition

Sunday, January 14, 2018

Photo by Glenn Carstens-Peters on Unsplash

As the interview season begins to wind down for me, I find myself with a lot of thoughts rolling around in my head. There are so many things to think about, and as I prepare to make my rank list, the gravity of the entire process looms large. This is the last part of this experience over which I will have some kind of control. After this, my rank list goes into a computer, gets fed into an algorithm, and on the other end, hopefully a match pops out, and that's where I'm going for 3 years. Craziness. So, as a way to try and organize my thoughts, as well as give you all some insight into the residency matching process, here's what I'm thinking about when I'm making my mental rank list.

Size of the Program

I've interviewed at teeny programs that take 6 residents a year, and programs that take 21 residents a year, as well as everything in between. The programs always ask what about their program made you apply, and since you can't say, "I literally applied to 100 programs because for the love of God, I just want a job," you have to come up with something. I usually went for the size of the program as one of my reasons, as it's low-hanging fruit. Also, it was true. I see good and bad things to having both small and larger programs. I like the idea of the closeness of a small program, but it makes me nervous about covering all the work with just 6 people. What if someone gets sick? Or goes on maternity leave? Also, what if I really don't like one of my co-residents? With only 6 of you, there's nowhere to go to get away from someone with whom you don't really get along. I like the idea of a larger program because there's more people to spread the work between, more people for coverage, more people with whom to make friends. But it's also potentially less personal and a little more likely for cliques to form. In the end, I'm coming down on wanting a slightly larger program than a teeny one, probably in the 12-21 range.

Call Schedule and Nights

Regardless of where I go, there's going to be call and it's going to suck. With the change in duty hour restrictions, interns can now take 24 hour call, which they used to not be able to do. I have mixed feelings about it, mainly, "Ugh, working 24 hours is going to blow," and "At least I'll get used to it?" and "Continuity of patient care is really important!" (Mostly that first one, though.) I'm also going to have to work nights. Fortunately, most of my programs have switched to a night float system, where you do 3 weeks of days and 1 week of nights, as opposed to taking a night every 4 days or something. I definitely prefer the night float situation, so that's a mark in the plus column for programs that have that.

Resident Education and Teaching

Every program is going to have resident education, because let's be real, the whole point of residency is to learn as much as you can so you can pass your boards. A lot of places still do noon conferences, which is nice because then you can eat your lunch (theoretically) while listening to a lecture. The downside is that it's hard to get off the floors to go to noon conference on time, and even though the time is supposed to be protected (which means no one gets paged or called), there's still a lot of phones going off and interruptions happening. Because of this, some places have switched to an academic half-day, where for 4-5 hours once a week, the residents go to educational lectures, seminars, workshops, etc. The time is easier to protect, because it's longer, and it's easier to block off an entire afternoon where the attendings or NP's and PA's take your phone, rather than an hour every day. But.... 4-5 hours is a LONG time to sit and be lectured at, so hopefully, more places will start doing case-based learning. I prefer the academic half day, myself. Also, places that have dedicated board prep education score higher on my list. Another thing to investigate is whether the attendings actually like teaching. The residents are the best source of information for this, and so far, I've heard both the positives and the negatives about the teaching faculty. I've also been fortunate enough to see some of the teaching in action, which is nice. Residency is where you truly learn to be a physician, so having teachers who are invested in that goal is really important.

Research Opportunities

While I know I want to do mainly clinical medicine, I do want the opportunity to use my MPH and actually do some research during my residency. More importantly, I'm going to need research to apply for fellowships after residency, and I want to be in a place that has good support for that. All programs require a Quality Improvement project as part of the residency, and some require further research beyond that. There are some programs on my list that have a lot of financial support for research, like paying for you to attend conferences if your research is accepted, which is a nice bonus. Other places provide a research mentor from the start, where some programs leave it on the resident to seek out a mentor. I definitely prefer a program with more research support, so looking at how many residents have had research published or accepted at conferences, as well as what kind of financial and institutional support is already in place, is a good way for me to stratify my programs.

Fellowship Success

I'm 99% sure that I'm going to do a fellowship after residency, so I want a program that has good success matching their residents into fellowships, especially at large, academic, centers. I also look at what specialties residents have matched into for fellowship, as (at least right now), I'm interested in heme-onc. All of my programs seem to be 50/50 split with residents going into primary practice versus those going into a specialty, so that is a good sign to me that the program is well-rounded and has support for both options.

Resident Wellness

No one is ever going to lie and say that residency is easy. I'm sure I'm not prepared for how hard it's going to be. (Maybe I am, because I'm convinced it's going to be the worst experience of my life, so anything that doesn't make me want to die every day will be a pleasant surprise...? This might not be the best approach here.) Anyway, knowing my own mental health journey, I know that I need a program that takes resident wellness seriously. This isn't just knowing that a program has random yoga classes, but that the administration is committed to combating resident burnout and that there is mental health support available through the health insurance. I'm pleased to say that most programs I've seen do take this seriously, which is definitely a tick in the plus column.

Benefits 

This is pretty straight-forward. Salary and insurance are pretty standard, but things like daycare on campus, money for books and technology, a moving allowance, and free parking are highly variable between programs. For some of my programs, I like one just as much as another, so the little "creature comforts" like those can make a real difference.

Location

This is admittedly not very high on my priority list, which is kind of nice in a way because I'm not beholden to stay in one area or another. It's becoming increasingly evident that regardless of where I match, we're going to be moving to a place where Ken will need to find a new job. (There is one program that is local, but I am not in love with it thus far.) Even if I did match locally, we want to move houses, so we're going to be packing up and going somewhere. There's a part of me that wants to stay in NJ, even if that means moving to northern NJ, because it means Ken can stay in the state pension system. There's also part of me that wants to go somewhere new, though. I've lived in NJ for my entire life (except for a few months here and there in college and then in med school the first time), and I feel like my "new family" and I need a new start somewhere else. Maybe now is the time to do that? It's so hard to tell!

Intangibles

There's a culture and a feeling to every program, and there's no way to quantify it. At least for me, there's always been an initial vibe for each place and it begins when I get into the town or city where the program is located. From the minute you meet the residents, you can get a sense for how happy they are. Even if they're exhausted, you can tell whether they're run into the ground or just regular residency tired. There was one program where I interviewed where it was 100% obvious that the residents were beaten down and were barely keeping it together. That, among many other reasons, is why I'm choosing not to rank that particular program. There have definitely been programs where I've fit in with the residents a lot more easily than others, and that definitely matters. The programs where I felt like I had known the residents for awhile within the first few minutes of meeting them score higher on my list than those where that didn't happen.

At the end of the day, all of the ACGME accredited programs have to have certain things. The training will essentially be the same. What will vary is how diverse the patient population is, how much pathology you see and how varied that pathology is, and perhaps most importantly, the people. The best advice I've gotten so far is to think about who you want to be in the trenches with when everything goes sideways. That is definitely something I've been able to get a feel for, and it's the hardest attribute to try and explain to other people. 

So, that's just a few of the things in my head as I mentally make and re-make my rank list. It certainly isn't all of them, and in fact, I have a spreadsheet that details everything. Of course, every time I look at it, I get slightly nauseated and close the file, so I'm not sure how much the spreadsheet is actually helping. My AP English teacher used to joke that she would take our papers and throw them down the stairs, and the ones that went the farthest got the A's. I'm thinking of doing that with all of the folders full of information from all of my interviews.

There are 38 days until the rank list is due, and 61 days until Match Day, so I guess I'll be freaking out about this until then. At least after the rank list is due, there's nothing to do but wait 23 days for my fate to be handed to me.

Until then, I'll be here, clutching my spreadsheet and probably throwing folders down the stairs. You know, normal things.

Coffee Date: December 2017

Thursday, December 28, 2017



Hi, hello, it's me, your favorite wayward blogger who shows up here every few months to randomly babble into the void in the hopes that the three people who read this thing enjoy it. I would love to tell you that I've been off doing all kinds of exciting things, but in reality, I've just been plugging along on my rotations, keeping a tiny human alive, and generally trying to keep my life from collapsing into a shambles.

So far, so good.

I can't believe that I can even call myself a blogger and that I haven't done one of these coffee date posts ever in the history of my blog. So, meet me at the nearest Starbucks, because yes, I actually do love their coffee, grab a beverage, and settle in. If we were out for coffee, I would tell you...

.... that I had actually thought about not blogging ever again, because I hadn't blogged in so long and I felt like I didn't have anything useful to say. Then, one of my favorite bloggers, Nicole of Just the Elevator Pitch, updated her blog after a long time, and I said to myself, "Self, if Nicole can do it, you can totally do it!" So here I am. But I'm glad I took a break to have coffee with you, of course.

... that my life has been mainly consumed by residency interviews, thinking about residency, and freaking out about THE MATCH. THE MATCH (yes, it necessitates all caps), for the uninitiated, is how applicants get matched to residency positions. Basically, the applicant makes a rank list, the programs make a rank list, it all goes into a giant computer algorithm, you pray to all the gods that it works, and a match gets spit out at the end. Then on March 16th, everyone who matched gets an envelope and everyone finds out where they're going. (The unmatched people scramble for positions, but I'm not even entertaining the thought of that happening because if I do, my brain will melt and I'll spend the next 78 days until Match Day huddled in a ball under my kitchen table. I have very healthy coping mechanisms.) The uncertainty of this part of my life is going to be the death of me, I swear.

... that thanks to winter break, I have no idea what day it is or how time even works anymore. I'm so thankful to have this time off because it's probably the last time I'll ever have 2 weeks off for... a long time. Last week, I went back to sleep every morning after getting Ken and Aviva off to school at 6:15 and it was glorious. I can't even remember what I did, other than rest, which I'm pretty okay with. This past week has been nuts since Saturday because we had family visiting and then we were traveling to NY for Christmas, so I am really glad to be home for the last few days of my break. Even though I have an interview tomorrow, I have a low key weekend planned (or not planned, rather), so hopefully by the time my feet hit the floor on Monday morning, I'm ready to go back to rotations.

... that this year, I totally ignored most of the "holiday traditions" I usually try to accomplish. I didn't decorate indoors, I didn't bake cookies, I didn't send photo cards, even though we had photos taken. Ooh, do you want to see them? I thought you might.




I'm pretty obsessed with them. But anyway, yeah. I totally shirked my holiday responsibilities and I'm not gonna lie, it felt pretty great. On one hand, I was really bummed that I didn't get my Hanukkah lights and decor up, and I missed making gingerbread, but on the other hand, it was great to do... nothing. Being an adult is weird.

... that Aviva is getting so big and I am constantly looking forward to the next milestone but also wishing she were still a squishy potato. She's pretty amazing, and I'm always ready to talk about her. In fact, I could spend the rest of this coffee date talking about her, but I won't, because that would probably be boring for you. She's 18 months old now, and she is really embracing her toddlerhood. That makes it sound like she's a hard kid, but she really isn't. She likes to push our buttons and see where the limits are, but she is so sweet and funny. She makes me laugh every day, and I am so excited to see her grow into her own little person. She is saying things now! I was so concerned that her speech would be delayed because her hearing was off due to fluid in her ears for awhile, but since she got her ear tubes, things seemed to pick up. She makes a ton of animal sounds (my favorite is for "What does a fish say?" and she responds by puckering and smacking her lips), can ask for "more" without using sign language now, and says "stuck" when she can't figure out how to do something (or when something is actually stuck, like her arm in a sleeve, or a toy). Her receptive speech is fantastic, and she understands so much of what we say and mostly listens when we tell her to do something. She's just the best.

... that I'm working on some goals for 2018. I'm not sure what they all are yet, other than, "Match, for the love of God and all that is holy," but I always like the start of a new year and a chance to make some new goals. I also just love a good list. Stay tuned.

So what's new with you?

Do the Thing

Saturday, October 7, 2017




"You're such a badass!"

"You're amazing."

"I wish I could do everything you're doing."

"You make it look so easy."

"I don't know how you do it."

Here's the thing: Neither do I.

All of these statements have been said to me at one time or another in the last 18 months or so, usually with regard to the fact that I was either pregnant and in med school or that I had a baby and was in med school. I know I should probably just take the compliment, say thank you, and move on, but it actually kind of makes me uncomfortable, like I'm some kind of imposter. Because seriously, I have no idea how I'm doing it. I barely know what day it is most days. For real.

If you're playing the home game, you've realized that it's been a minute (ahem, a month and a half) since I last posted. Since then, much has changed. Much has stayed the same. I finished my ER rotation and I'm still really bad at putting in IV's. (Shout out to all the nurses out there who put in IV's like, 900 times a day. You're all heroes in my book.) I started and finished my Osteopathic Manipulative Medicine/Pain rotation, and it was truly painful. There were 18 students on a rotation where we barely had enough doctors to support half that many, and so it was a lot of standing around NOT leaning on walls, lest we get yelled at for smudging them. (Not kidding.) I am 2 weeks into a Medical Genetics rotation that is proving to be far less interesting than I originally had hoped, but at least I'm learning something and my attending is nice and no one cares if I lean on a wall every once in awhile. Oh, I also applied to residency, then promptly threw up and passed out from anxiety. (Okay, maybe not that last part.)

The tiny human is still alive and being a tiny human. She's really amazing, and most days, I still can't believe that I'm her mom. Sometimes, that's because she is so sweet and adorable, I can't even believe she's real. After all the heartache it took to get here, this miracle rainbow of mine just seems too good to be true. Then there are days that I can't believe I'm her mom because I put my keys in the fridge, I lost my brand new prescription sunglasses, and I can't find my phone because I'm holding it in my hand. Like, who let me procreate here? Who rubber-stamped that decision? Oh, me? It was me? Well, that explains a few things. (What it doesn't explain is why my keys are in the fridge.)

Usually my answer to, "I don't know how you do it," is to quickly stop myself from saying, "Shhhhh, don't tell anyone, I'm totally making this up as I go along," and instead I say something to the effect of, "Well, I'm just... doing it!" and then I laugh nervously and change the subject. I also tend to bring up Ken, and blame (attribute?) the entire success of this operation to him. To a certain extent, that's actually true. I literally (and I mean that in the actual definition of the word, not that messed up new way that people use it) could not do this without him. Ken is the reason I have clean clothes and the reason the house is vacuumed. He is the reason dinner is made most nights and the reason we have food in our pantry. He's the reason I'm not curled up under our kitchen table in the fetal position, rocking back and forth, crying about how life is uncertain and how I am unsure whether I can go on like this. (Okay, that's actually never happened, but it is a real possibility, people.

It's especially been a real possibility as of late. I don't know why, but my anxiety has been terrible. Okay, that's a lie, I have a pretty good idea why it's been so bad, and that reason is fourth year of medical school. They say that 4th year is supposed to be the FUN year, but they (Who are they? We may never know.) must be talking about after March, once you have that letter in your hand that says where you've matched for residency. Until then, it's constant flux. I'm in 4 different places over the next 4 months on 4 different peds specialties, which is great and I should learn a ton, but it means constant transitions. Learning a new hospital, figuring out how to use a new EMR, learning how to present to a new attending, all while trying to impress whoever you're in front of because these are audition rotations and with any luck, they're supposed to help get you interviews. On top of that, I'm now obsessively stalking my own email and ERAS, waiting for interview invitations, so I basically have a psychotic break every time my phone vibrates. I'm really fun to be around now, you guys! 

And I know that I am not alone in my plight and that every 4th year med student out there is probably feeling similarly, but my anxiety is having a field day. I'm not even anxious just about residency and matching; it's actual, honest-to-goodness generalized anxiety. As I explained it to a friend the other day, "You know how sometimes, you get a rush of adrenaline like you're about to go into fight-or-flight mode? Well, it's like that. Only all the time. I'm about to go into fight-or-flight mode, but there's no bear that's about to eat me. All day, every day, from the minute I open my eyes to the minute I fall asleep, I'm on that edge."And don't get me wrong, I'm glad there isn't an actual bear who is about to eat me. I'd just like to reserve this feeling for such a time where it makes sense, like if I were about to be eaten by a bear, and not because I have to drive my car or leave the house. Like I said, super fun over here! ::confetti::

So, how do I do it? I get up every day, no matter how reluctantly, and I do the thing. Sometimes I have to bribe myself with chocolate chips. Or coffee. Or whatever the thing is that will get me out the door to do the thing. But I do it. I do it because I'm paying a lot of money for the privilege of standing around, not leaning on walls, theoretically learning how to be a doctor. I do it because I'm so far into this, I can't quit because I have too much debt and nothing else I do will pay me enough to eventually someday maybe pay it off. I do it because my family is depending on me to finish this damn thing. I do it because my daughter needs to know that she can do the hard things. I do it because it's all I've wanted since I was 9. I do it because I don't really have a choice; it's in my blood.

I haven't watched Grey's Anatomy in a really long time. Like, not since season 3 or something. This quote always sticks with me though, 

"I mean if life's so hard already, why do we bring so much trouble on ourselves. What's up with the need to hit the self-destruct button? Maybe we like the pain. Maybe we're wired that way because without it... I don't know. Maybe we just wouldn't feel real. What's that saying... Why do I keep hitting myself with a hammer? Because it feels so good when I stop."


Here's to doing the thing. 

Unrelated PS: Should I go back and rewatch all of Grey's Anatomy? Someone make this decision for me. I have no brain cells left to do it myself.



Up to Speed

Tuesday, August 15, 2017


| JUNE |

Finished third year of medical school! (Whaaaaaat?)
Aviva turned 1! (Whaaaaaaaaaaaaaaaaat?)
Studied for boards
Family photos




All photos by Jessica Piva Photography
| JULY |




Aviva's 1st Birthday Party & Baby Naming
Studied for boards
Took boards
Applied for some residency programs (!!!)

| AUGUST | 

Trip to Orlando
Stuck in the Philadelphia airport for 6.5 hours with a baby




Aviva's first time in a pool



Floated down a lazy river at Rock Spring Run in Apopka, FL
Started my Emergency Med rotation
Stapled a guy's head
Sutured a stab wound
Worked a week of night shift
Put in some IV's

To be continued...





Mothermorphosis

Sunday, May 7, 2017



When I was getting married, I was determined to "not lose myself," in this new role as "wife".

The same thing happened when I got pregnant. I said I would never lose myself to my new role as a mom.

Well, here's the thing.

Caterpillars.

Yes, caterpillars.

We all know that caterpillars, at some point, go hang themselves up as chrysalises and when they wiggle out, a beautiful butterfly emerges. Or maybe a beautiful moth. Or a plain moth. Whatever. Regardless, a squirmy, wiggly, thing with a lot of legs goes into a tube, and when it comes out, it's an insect with 3 body sections, 2 wings, and a lot fewer legs and a proboscis that lets it drink nectar emerges. If you're like me, you've often thought WHAT HAPPENS IN THERE? Well, it's kind of amazing and completely insane. Here's a cool video:




Basically, the caterpillar releases a bunch of enzymes that turn it into a soup with a bunch of chunky bits, and then the entire thing rearranges itself into an entirely new organism that is made up of all the exact same DNA that was there when it was a caterpillar. NATURE IS WEIRD, YO.

ANYWAY.

So, how is this related to anything I was talking about at the beginning of this post? It turns out that I was wrong. It's impossible to not lose yourself, at least a little bit, to your new role. I noticed it less as a new wife than I have as a new mom, but it was still present, even then. My priorities shifted. I was no longer a single unit, operating with only my own goals in mind. I was part of a team, and the team's goals became my own goals. I still had goals that were just mine, of course, but most of the time, they were superseded by those of the team. That is how I wanted it. How we wanted it.

It wasn't always the case. Going back to medical school was a time when my own personal goal superseded what was probably "best" for the team, but any good team sometimes requires compromise. Ken fully supported my dream then and continues to support me now as we come slowly (ever so slowly) towards the end of this wild ride called medical school. (1 year to go, basically! Whaaaaaaaaaaaaat.) So now I'm a wife who also happens to be a med student, and even underneath those layers, I'm Alison, the woman who loves reading, cheese, and sleeping in on Saturdays. What I'm saying is that there's a definite give and take to marriage, and I haven't lost my old self. It's just there in a different form.

Motherhood has been even more of a trip. I refused to become the stereotypical caricature of a mother that we all know. Haggard, can't remember the last time she showered, slowly martyring herself every day and giving all of her energy to her children. Am I tired? Sure. We're all tired. Granted, this is a different kind of tired than I've ever felt before, but it's nothing exciting or earth shattering. I refused to give up what gives me personal satisfaction and meaning to have it replaced by being a mother. And yes, I love being Aviva's mama, and knowing what I know now, I wouldn't give it up for anything in the entire world. But being Aviva's mama is not my sole identity. It is but a part of the wife-med student-reading-late sleeping-cheese eating woman that I am (and then some).

I often joke that life with a baby is the same as it was before, just... with a baby. But it's not. Sure, our activities are largely the same. We go out to dinner, we do housework, we binge-watch Parks and Rec, and we do it all with Aviva in tow (usually). But something feels different. I can't put my finger on it, but I am feeling like that caterpillar that has turned into a butterfly. I was doing fine as a caterpillar. Life was pretty good most of the time, and I liked it. Then, for 40 weeks, I was in this cocoon of pregnancy, and then I gave birth.  When a butterfly is emerging from a cocoon, it is really hard work and it can take a long time! The 12 weeks after Aviva arrived were my emergence from the cocoon. Our little bubble of a new family was perfect to me, and managing it was also the hardest thing I've done yet. (Yes, even more difficult than boards.)

So, to continue this grossly extended metaphor that is bordering on conceit, now I'm a butterfly (or, maybe a moth, because let's face it, ain't nobody got time to be butterfly beautiful every day), Some days, I feel like I'm still emerging from that cocoon. Drying my wings and learning that not only am I completely different, I am also completely the same as I was before Aviva was even an idea. I'm not going to lie and tell you that it's not hard. It is. It's hard and it's amazing and it's weird, and I'm still not entirely sure who I am or how being a mom fits into the rest of my life. That's the thing about life that I'm (reluctantly) learning; you kind of have to live it to figure it out.

Unlike a butterfly, I think that throughout Aviva's life, I'm going to keep going back into the cocoon, remaking myself. After all, she's not a static force, so I have to change in order to best support and care for her. What she needs from me now is not what she will need from me in 2 weeks, 2 months, 2 years, or 2 decades. I think that any time our identity is threatened by change, even amazingly great change, we have a tendency to back away from it and to fear it. I know I do. But I'm trying to remind myself that it's okay to take all the time I need to get out of that cocoon, and it's okay for you to take your time, too. We don't have to know everything right now. And every time we go back into our cocoon, we have a new opportunity to learn about ourselves and change how we want to see ourselves in the world. It's scary, but hey, at least we don't have to completely liquefy ourselves to do it.




13 Reasons Why

Wednesday, April 26, 2017


If you have a pulse and an internet connection, then you've probably heard of "13 Reasons Why". Spoiler alert: It's about a girl who died by suicide after... a bunch of stuff happens. And she leaves a bunch of cassette tapes (who even has those anymore?), detailing how each person in her life contributed to her death. It was a book before it was a series directed by Selena Gomez. Apparently, it's pretty popular and addictive. I watched it. Well, most of it. I watched the first 9 episodes and then skipped to the end and watched pieces of the last episode. I'll tell you why.

You shouldn't watch it. No one should. Here are a few reasons (not thirteen, because who needs that many?) you shouldn't watch 13 Reasons Why. And, uh, spoiler alert, I guess.

No one is responsible for anyone's suicide.

Period. End of story. Suicide is a horrible cause of death, often following a protracted battle with depression or other mental illness. The people left after the suicide always, always, always, need to know why. They want a reason why their loved one chose to end their life. They want to know if there was anything they could have done. Or if they did something to cause it. The rest of their lives, some of these people will probably blame themselves in one way or another. The last thing we need is for mainstream media to purport the idea that one or many people can cause someone to kill themselves. Or perhaps more dangerously, the idea that if we're all just really kind to one another and we just love one another better that we can prevent suicide. Depression that ends in suicide cannot be prevented by simple kindness. Full stop.

Getting help is essentially not discussed.

The only time Hannah Baker tries to access the mental health system, it is through her guidance counselor at school, which turns into an unmitigated disaster. She can't and won't tell him who assaulted her, and without that information, he glibly says that she other option is to "move on". She leaves the office in a huff, saying that she "needs to get over it", finishes recording her 13th tape, and then goes home to kill herself. Not once was this girl referred to any kind of actual health professional. Despite the fact that she displayed multiple signs of needing help, including saying things like she wanted life to stop and that she thought she was a burden, her school performance dropping, withdrawing from friendships, feeling worthless, and withdrawing from hobbies and activities. No one hauled that girl into a doctor's office, no one sat her down and made her talk. No one tried to find out why she was in so much pain. No one. There are so many options. 1-800-CONTACT and 1-800-273-8255 are both 24 hour hotlines that anyone can call and talk to a real human about something going on in their lives. You can call 911. Your job probably has an Employee Assistance Program. Your college has a counseling center. Hell, leave me a comment here and I will personally help you find someone to talk to. You are not alone. 

It glorifies and glamorizes suicide.

When someone dies by suicide, there are things that you and others SHOULD. NOT. DO. One of those things is don't glamorize or sensationalize the suicide. This entire show violates this and makes it the centerpiece of many classroom discussions. Furthermore, in death, Hannah Baker received everything she hoped would happen when people listened to her tapes: sympathy, anger, regret, guilt, and lastly, most importantly, love. She was vindicated in these tapes. People realized how awful they had been to her, they all felt bad, things HAPPENED. Will things change? Probably not, because people, teenagers especially, are terrible. But in the show, Clay Jensen decides to be nice to that weird girl, and her parents get closure (???), and there's a court case in process. (Sure, there's also that lingering, terrifying, idea that there's a kid planning a school shooting, and that yet another kid has tried to die by suicide, but let's leave that for the moment.) Overall, the entire thing is just handled incorrectly, and really the exact opposite of how any suicide death should be handled.

The suicide scene is gratuitous.

It reads like a how-to on slitting your wrists. Not only does it depict the entirety of the act, it does so gruesomely and painfully. I have a strong stomach and an equally strong mental fortitude for things, and it made me nauseated. It chilled me. Maybe that was the point. But I'm also 30 years old and I know better than to try and die by suicide because I understand that death is FINAL and there is no coming back. In the novel, Hannah's suicide is vague, but it can be inferred that she dies by taking an overdose of pills. In an interview with Seventeen, Jay Asher, author of the book, was quoted as saying, "We worked very hard not to be gratuitous, but we did want it to be painful to watch because we wanted it to be very clear that there is nothing, in any way, worthwhile about suicide."

Welp, Jay and Selena, it was gratuitous. And you skipped the middle part. You know, the actual dying. You went from bleeding in a bathtub to totally dead. You didn't talk about how when your blood pressure plummets, your heart rate goes up to try and correct it, and you become starved of oxygen because there isn't enough blood in your body to get it to your brain, even though you're breathing just fine. In fact, you're probably hyperventilating. Feeling panicky because at this point, yeah, you're going to die, probably and now you can feel it. You forgot that part.

So no. There is nothing, in any way, worthwhile about suicide. You just certainly wouldn't get that idea from watching 13 Reasons Why.

So, why should we listen to you?

I mean, go ahead, don't listen to me. You're a grown-up. I'm only one person, shouting into the void of the internet along with millions of other people. But I can tell you this. When I was 16, I was suicidal. I spent 10 days in an intensive, outpatient program. It was hell. I was contemplating suicide a second time at 27. That time, I spent 4 days as an inpatient on a psychiatric ward of a hospital. It was also hell, in case you were wondering. For 14 years, I self-injured. For 4 years, I have been a recovering self-injurer. When my depression gets bad, it is a conscious choice I have to make to not hurt myself. It is not always easy. Depression is hard. It lies. Constantly.

While I can't say how I would have felt if I had read this book or seen this series when I was 16, I can pretty much guarantee that the answer wouldn't be, "Way better and way less likely to hurt myself,". What did help me wasn't books or shows about other teenagers dying by suicide and the dramatics that followed. What helped were my friends and teachers who weren't afraid to tell my mom they were worried about me, even after I "swore them to secrecy". Therapists I saw on a regular basis. Oh, and drugs. SSRI's are a huge part of why I'm here today. Better living through chemistry.

If you have already watched the show, or you're still going to watch it, then I want you to remember this. Suicide is not meant to be consumed as mass entertainment. 13 Reasons Why wants you to think it is.

If you've watched the show, how did you feel about it? Did you read the book beforehand? Let's chat.





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