Introducing Younger Brother

Kid #2, who shall henceforth go by the pseudonym of Younger Brother, has arrived!  Eleven days early and nearly nine pounds.  He is healthy and adorable and relatively calm for a newborn.

Close-up image of a newborn baby's foot.

I like a good birth story, so I’ll write up the details of my labor for a later post.  I never went into labor with my older son (who was breech and born via C-section), so this birth was an entirely new and different experience.  Recovery has been much easier.

(Side note: You might have noticed that I’ve changed some blog things recently—like the name—to reflect my graduation and changing life.  Those updates aren’t completely finished, so please pardon the mess!)

Advertisements

Saying goodbye to my office and to grad school

I said goodbye to my office yesterday.  Literally: I closed the door for a minute, so no one could see, and gave each remaining item a small farewell.

Goodbye, chair.  You have been a good and comfortable chair.

Goodbye, computer.  Thanks for holding up as long as you did.

Goodbye, desk.  May you last forever.

(Seriously, that desk is a giant industrial metal thing.  It will last forever.)

I moved into that office three years ago, about a week before Little Boy was born, so it seemed fitting that I would be very pregnant again while moving out.  The furniture had come with me from my first office, a larger shared space in the main building.  That office switch had been quite the kerfuffle, the product of some rather poor decisions by our department chair, but it had worked out in the end.

After my little parting ritual, I turned all my keys into the department office, one of the last steps to being done.  I submitted the final version of my dissertation to the appropriate authorities last week.  My campus parking permit expired on Friday; my student health insurance ends at midnight tonight.  It’ll be another week before my transcript says I’ve finished, and then goodness knows how long before they mail out the actual diploma, but at this point, I’m not a PhD student any more.  I have a PhD.

Goodbyes to furniture are melancholic but easy.  Goodbyes to people are much harder, especially when you’re trying to communicate how important someone has been in your life.  I ended as awkward as ever, and spent the next few hours at home trying to recover from the panicky anxiety that ensued.  Watching the new grad students register for classes and the established ones settling in for another year, I also got the feeling that the department was moving on without me—which of course it is, because that’s how universities work.

I won’t miss academia, but I will miss this place, if only because it was a part of my life for so long.  I’ll miss my friends, many of whom have already gone off to various jobs in other states.  I’ll miss, for a short bit anyway, the part of my identity that revolved around being a student.

Goodbye, graduate school.

A fun office trip with Little Boy

Little Boy’s daycare is closed for a few days of teacher training, so I brought him with me to campus this morning.  My office is in a mostly-empty outbuilding, so there weren’t any major concerns about disrupting others.  (Not that there are many other people on campus at 9 AM in early August anyway.)  The plan was to try to keep him entertained with the novelty of it all while I sorted some papers and packed a few things.

It went delightfully well.  When you are almost three years old, there are many new and exciting—and sometimes scary—things to experience at a university.  Parking garages!  Elevators!  Public bathrooms with loud toilets!  And of course, Mommy’s office, with swivel chairs and a dry-erase board and stuffed animals and a vuvuzela (yes, really).  Plus a scientific calculator (he assumed this was a phone at first) and a computer with a mouse that he could click and scroll and use to make new desktop folders!

I had several dozen old pens that had accumulated over the years, and set Little Boy to checking them.  “If it works, give it back to Mommy; if it doesn’t work, put it in the trash can.”  He was quite effective at this task.

The best part of the morning was when my friend, who is also graduating and packing up her office across the hall, arrived.  Little Boy was ridiculously excited to see her, despite only knowing her by name before today.  He spent a good 20 minutes jumping up and down and running back and forth with sheer happiness.  Preschooler enthusiasm is amazing.

When I was Little Boy’s age, my dad was a PhD student.  I’m going to have to ask him if he has any stories about my visits to his office and lab.

Thanks for reminding me why I’m leaving academia

Well, the post-defense high was nice while it lasted.

I submitted my final research paper to a suitable journal about a month ago.  Last week, they sent me back the referee report, i.e., the comments from the anonymous reviewer.  I got what people in other fields call a “revise and resubmit”: they tell me what I need to fix, and then I return it to the journal for further review.  Very standard for this journal.  What’s not standard is that the reviewer—if you’ll pardon my language—was an asshole.

I don’t mean that he was critical, because reviewers are always critical, and it sucks and you feel bad and then you make the revisions and the paper is probably better for it in the end.  And I don’t mean that he didn’t read carefully or was oddly picky about some little thing, because that happens all the time too and you roll your eyes and grumble about it and move on.

No, I mean that he was actively nasty.  The whole review is full of snide, condescending commentary.  It borders on direct insults in places.  I’m not going to go back into it and try to find shareable excerpts right now, so you’re going to have to take my word for it, but this isn’t my first experience with peer review, and this one is different.

I’ll be honest: this has really knocked me back mentally.  With the passage of a few days, my response has settled from the initial “BURN IT ALL DOWN” to a slightly calmer “ugh, I really don’t want to deal with this.”  I’ve been able to reread the review and make a list of actionable items.  But I’m still, more than anything, really angry.

I’m angry that being a straight-up asshole is allowed.  (Yes, such people are everywhere, alas, and life is not fair.  Doesn’t make it less frustrating.)  I’m angry that I’ll have to take the high road and write a response that at least kind of sounds polite, when what I really want to do is yell at him to fuck off.  I’m angry that this paper is going to take so much longer than I’d (perhaps naïvely) hoped.  I’m angry that I’ll have to deal with this guy again in the next round of review, because he’ll undoubtedly come up with new jibes regardless of how thoroughly and professionally we answer in this round.

In addition to all that, I’m angry about the culture (both inside and outside of academia) that tells me to suck it up and deal with it.  Be strong.  Don’t let the bullies get under your skin.  Don’t let the bullies win.

Screw that.  Sometimes the bullies really are just assholes, and pretending otherwise doesn’t take away their power.

On the plus(?) side, I’ve had a lot of conflicting feelings in recent months about whether leaving academia is the right decision, and I think those feelings are sorted now.  I do not love science enough to put up with this kind of shit.

Dr. Crazy Mama

My dissertation defense was on Tuesday … and … I passed!

(It’s taken me a few days to sit down and blog about it, because my parents are visiting and Family Time is fun but exhausting.)

It was not surprising to pass—it’s extremely unusual in any PhD program for someone to fail after being allowed to defend—but I am so very happy and relieved to feel like I deserved it.  That was my greatest fear over the last year: that I would be passed out of kindness or pity or just to get me out of there.  I am comfortable that that’s not what happened.

Defenses in my department are a short (30-minute) public talk, followed by an hour or two of private questioning by the committee.  My extreme social anxiety doesn’t transfer into prepared public speaking situations; as long as I’ve practiced (which I definitely did here), it only takes a few sentences for me to get comfortable.  So that part went quite well.

The questions from my committee were generally relevant and reasonable.  It was all big-picture knowledge stuff, plus some questions about possible follow-up work.  No one asked me to justify any of my methodology or even any of my conclusions.  I had to write on the board a few times, but didn’t need to pull up any plots or refer to anything specific in my written dissertation.

My answers were awkward and clunky at times.  Someone once told me that the point of a PhD defense is to find out the limits of your knowledge (and decide if it’s enough)—and so to expect people to keep asking questions until they ran into those limits.  I think not all of the clunky answers were my fault, though.  Some of my committee members were just not very good at articulating what they were looking for, and it took a few rounds of clarification to get there.

There was only one point when I felt really nervous, and that was when they sent me out of the room after an hour of questions, to decide if they were done or if they needed to ask me more.  I began the wait feeling confident, but after about five minutes started to worry that it was taking too long, even though rationally I knew that it wasn’t.  (And it wasn’t: they called me in after about ten minutes to congratulate me and sign the passing paperwork.)

I passed with no revisions, meaning that I don’t have to rewrite anything or add components to my dissertation.  Each committee member pointed out a few typos and suggested a clarifying sentence here or there in my introduction, but that’s all.  This is fairly common in my department, nothing extraordinary, but it still feels good.

Officially, I will receive my PhD in mid-August, when my university confers degrees that were completed during the summer semester.  I do still have to fix those typos and formally submit my dissertation to the university.  (Submissions are electronic these days, with much less stringent margin and formatting requirements than they used to require for paper copies.)  I’m also waiting to hear back from the referee on my latest paper, and I won’t feel mentally totally done until I’ve taken care of revisions on that.

To be honest, it still feels pretty unreal.  Did this actually happen?  Am I actually (almost) done?  My brain doesn’t quite know what to do with it, I think.  But it does feel good.

The final countdown… to my PhD defense

After many years—so many it seemed like they would never end—and an enormous amount of stress, I am almost done.  In one week, I will be defending my dissertation, the final significant hurdle to being granted my PhD.

After working myself to my absolute limit to get the writing done, I now have a brief period to breathe.  My dissertation has been sent around to my committee.  I just need to prepare my slides for the formal talk part, and practice the talk, and remind myself of a couple of little details that I think might come up in questioning.

I waver between serene confidence and absolute terror—so, completely normal for someone at this stage.  In the last few months alone, I have had multiple panicky crises about whether I would ever get the research and the writing finished, but having reached this point, there is no real doubt that I will pass the defense.  My work is solid; my advisor had some extremely complimentary things to say about my last research chapter.  But the question remains: how hard will the committee make it, and how foolish will I feel by the end?

Wish me luck, readers!  I will let you know when it is over.

Survey vent, part 2: do gender better

For the last few years, all the official student surveys coming from my university have offered three options for gender: male, female, and transgender.  I appreciate that they’re trying—it’s better than only listing male and female—but arg, no, that’s not how it works.

By itself, “transgender” isn’t a gender; rather, it’s a descriptor meaning that your gender identity doesn’t match up with the gender you were assumed to have at birth.  Transgender people are male and female and non-binary, not an extra separate gender.

I’ve seen other surveys that attempt to do better by offering four options: male, female, transgender male, and transgender female.  However, that kind of setup implies that trans people aren’t “real” members of their gender.  It would be somewhat less problematic if the first two were specifically listed as “cisgender male” and “cisgender female”—but if you really need to know whether your survey respondents are cis or trans, consider breaking that into another question.  The Human Rights Campaign has a good example of a survey approach that separates “What is your gender?” from “Do you identify as transgender?”

Of course, as alluded to above, gender is not binary, and your survey also needs an option for people who are non-binary / genderfluid / genderqueer / agender / etc.  (Not to imply that these terms are interchangeable, because they are not, just that at bare minimum there needs to be some kind of “outside the gender binary” selection available.)  If your survey design allows it, an additional option with an open text field will help you avoid unintentionally excluding anyone.  And personally, I’d also like to see a “prefer not to say” choice for gender, as is common on some of the other demographic questions.

Survey vent, part 1: married students exist

When designing a survey to be taken by university students, please remember: Some students are married or live with long-term partners—and some students have children.  These things are true for any college-student population, but they are especially relevant when your survey specifically targets graduate and professional students.

This little vent was brought to you by a graduate housing survey from my university’s Residence Life department.  “Lives with family” can mean very different things depending on whether you mean “lives with parents” (which was the implied meaning in this case) or “lives with spouse/partner/children” (for which there wasn’t another, more applicable choice).  And don’t frame your rent, roommate, and bathroom-sharing questions in a way that assumes people are single.

Oh, and while we’re at it, don’t ask me for my “hometown.”  Be more specific about what you’re looking for here.  Where I grew up, where my parents live now, and where I consider “home” are three different things.

Taking medication while pregnant: what to consider

For me, spring means allergy season: constant sneezing, itchy eyes, the works.  Basically, my sinuses go into full freak-out mode and decide that protecting me from some as-yet-unidentified pollen is more important than actually functioning.

Fortunately, medications exist that can calm down my widely overactive immune response.

However, I’m pregnant, and our culture is filled with messages about how the smallest dose of anything is dangerous and scary and really you just shouldn’t risk it.  And most meds aren’t well-studied during pregnancy, so it can be hard to figure out what’s worth worrying about.

So what’s an expectant mother to do?

1.  Talk to your doctor.

Or your nurse practitioner.  Pharmacists can also be helpful, although I’ve found their advice tends to be more generic.

When it comes to anything concerning pregnancy, this is the #1 rule: talk to a medical professional.  Call up your OB/GYN’s office, or bring it up during an appointment, or whatever is applicable for your situation.

My OB/GYN helpfully provides all her prenatal patients with a one-page list of common medications that are considered safe to take as directed during pregnancy.  Happily for me and my allergies, diphenhydramine (Benadryl) and loratadine (regular Claritin) are on her approved list.

Relatedly, you should also talk to a doctor before abruptly stopping medication during pregnancy.  Even if the drug in question is widely considered dangerous to fetal development, you might be risking worse effects by doing a sudden withdrawal instead of a controlled taper.

2.  Be skeptical of online information.

This is a universally true rule for life, but it is especially true when it comes to medical information.  Health info on the web has always been questionable, and it seems to have gotten worse in recent years with the proliferation of “healthy living” websites.

Pregnancy-related Google queries are particularly unreliable.  Most of the results you’ll get for something like “is it safe to take Benadryl while pregnant?” are mommy forums where other women have asked the same thing—and gotten a bunch of responses from women who also don’t know the answer.

I understand the desire to scour the internet, hoping that someone somewhere knows something that can give you a definitive yes or no on medication safety.  I’ll be honest, I’ve done some serious Googling on this stuff myself.  But with a lot of drugs, we just don’t have that much data about safety during pregnancy, and you’re far better off going with someone who’s qualified to interpret the data that do exist.

If you must ask the internet, go directly to a reliable source.  I’ve found these resources to be valuable:

  • The medication fact sheets at MotherToBaby, which are put together by experts in teratology (the study of birth defects).
  • The InfantRisk Forums, part of the InfantRisk Center at the Texas Tech University Health Sciences Center.  Forum questions about medication safety are answered by administrators, who are qualified medical professionals.  The InfantRisk Center also has an app, although I haven’t tried it myself.
  • The Massachusetts General Hospital Center for Women’s Mental Health has a ton of info about mental health and psychiatric medications during pregnancy, although you sometimes have to dig around a bit in their archives.

3.  Consider the risks of not taking medication.

The discourse around taking medication while pregnant (or indeed, doing anything while pregnant) revolves around minimizing risk.  There is a general tendency for people to focus on the risk of doing something, as in, “if there’s even the tiniest risk of taking this medication, I won’t do it.”  But what about the risks of not doing?

For example, imagine you’re pregnant and thinking about taking some acetaminophen (Tylenol).  Tylenol is on my OB/GYN’s “OK to take” list, and is broadly considered safe for pregnancy at appropriate doses.  But maybe you saw that study recently about there being a possible association between Tylenol during pregnancy and children’s later behavior problems, and you’re nervous.  You’re worried that you might be taking an unnecessary risk.

What are the risks of not taking that Tylenol?  It depends on your situation.

If you’re just a little sore, maybe you stretched a muscle the wrong way, or you’ve got a bit of a tension headache, there’s probably not much risk to skipping the Tylenol.

But if you’re running a fever, there are documented risks to not taking a fever-reducer like Tylenol: high fevers, particularly during the first trimester, are associated with birth defects.

If you’re in serious pain—let’s say it’s not something directly dangerous, just really uncomfortable—the risks are somewhere in the middle.  Pain stresses your body, making it pump out cortisol and other stress hormones.  Pain might make it hard for you to sleep, or to otherwise care for yourself.  We don’t know that much about how stress affects developing babies.  I wouldn’t want to imply that it has dire effects, because everyone deals with some amount of stress during pregnancy, but lessening the stress on your body is probably a good thing.

(This last one is where allergy medication falls for me: the risk of not taking it is that I will feel like absolute crap.)

With other medications, especially those that haven’t been well-studied, the risk calculation is even more complicated and specific to individual situations.  I am currently taking the antidepressant escitalopram (Lexapro), after a great deal of thought and consultation with a psychiatrist who specializes in pregnant and postpartum women.  I’m aware of what we know and don’t know about the risks of taking Lexapro during pregnancy.  I’m also aware of the risks of untreated depression in pregnant women in general, and the risks of untreated depression in me in particular.

4.  Understand how drugs are classified during pregnancy.

Whenever someone asks a med question on a mommy forum, there’s always that one person who shows up to announce that the drug in question is Category B and therefore obviously dangerous and clearly the rest of you are dolts for even considering otherwise.

That person is a pompous twit, and also wrong.

For a number of years, the U.S. Food and Drug Administration (FDA) sorted medications into five pregnancy categories, A, B, C, D, and X.  Other countries use different systems, often based on similar principles.  As of mid-2015, the FDA officially stopped using the five-category system, but it’s still widely in common use for discussing drug risks, and it’s useful to know what the categories mean.  (It’s also not clear to me that the new labeling rules, which supposedly provide more information, are actually in use yet.)

Here’s what the categories mean:

Category A:  There have been controlled human studies showing no risk to taking this drug in the first trimester, and there is no evidence of risk in other trimesters.

Very few meds are in Category A.  It’s actually pretty hard to find examples.  Folic acid (you know, the stuff in your prenatal vitamin that helps spinal development) is Category A.  Many thyroid replacement hormones are Category A.

Category B:  There have not been controlled human studies, but the existing evidence (including animal studies) indicates there are no serious risks.

Pretty much everything that’s basically fine is in Category B.  The meds on my OB/GYN’s “OK to take” list are Category B.  Tylenol is Category B, as are some antibiotics, some allergy medications, and a variety of other things.

There is, I think, a tendency for laypeople to assume that drugs end up in Category B because they’re inherently not as safe as drugs in Category A, and that isn’t true.  A lot of meds end up stuck in Category B because it’s really, really difficult—not to mention frequently ethically problematic—to run controlled trials, the kind where you assign people to treatment and non-treatment (control) groups in advance, in pregnant women.  You can ask women about their med usage and compare outcomes, as they did in the Tylenol study mentioned above, but a lot more confounding factors can creep in that way.

(Somewhat weirdly, Category B does include drugs that have had controlled human studies with good outcomes—if there are also animal studies that show possible risk.  As always, talk to your doctor for details on your particular drug.)

Category C:  There are limited data in humans, and maybe some animal data showing risk.

There are a bunch of different combinations of data (or lack thereof) that can put something in Category C.  There’s “we don’t have formal studies on this, but women have been taking it for a while and it doesn’t seem to cause anything dramatically bad.”  There’s “we can poison animals with really high doses of this, but we don’t have human data.”  There’s “we’ve seen this cause withdrawal symptoms in newborns but it doesn’t seem to have any long-term effects on their development.”  In short, Category C meds are not known to be safe, but they are also not known to be unsafe.

General pregnancy references often lump Category C meds in the “don’t take this” group, but what they mean is “don’t take this without consulting your doctor about your own personal situation.”  Any source that tries to tell you Category C drugs are absolutely unsafe should be treated with great suspicion.

Examples of Category C medications include my Lexapro and several other antidepressants, some types of antibiotics, and the antiviral Tamiflu.

Category D:  Human data show that this drug can have negative effects on developing babies, but the benefits might still outweigh the risks in certain situations.

If you’re dealing with a serious health situation—epilepsy, cancer, etc.—and less risky drugs are not available or appropriate, a doctor may consider giving you something from Category D.

Interesting fact: the common painkiller ibuprofen (Advil) is in Category D in the third trimester.

Category X:  Human data show that this drug is dangerous and should not be taken during pregnancy.

Category X includes things like thalidomide (infamously prescribed for morning sickness in the late 1950s), methotrexate (used, among other things, to treat ectopic pregnancies), and isotretinoin (the prescription acne medication Accutane).

5.  Don’t panic.

And carry a towel.  (Because if I can’t make Hitchhiker’s Guide to the Galaxy jokes on my own blog, where can I?)

Do I worry, sometimes, that taking Lexapro and allergy medications and the occasional Tylenol will hurt my growing baby?  Yes.  But I’ve talked about my worries with my doctors, and I trust them, and I trust myself.

Be thoughtful and be cautious—but take care of yourself.

Should I answer the phone? A flow chart

My cell phone is ringing. Should I answer it? (A flow chart.)As a parent, I’ve become much more vigilant about carrying my phone around with me, even into meetings and places where I can’t easily step out to take a call.  Thank goodness for caller ID, is all I can say.

In practice, my “should I answer it?” thought process has a few more qualifications than the above chart, although not many.  Which of my contacts is calling is relevant.  For instance, if I got a call from my brother, I would drop whatever I was doing to answer it, because my brother has literally not called me since the year 2010 and I can’t imagine what would prompt him to do it now.  (We communicate by text.)  And yes, I do have Little Boy’s daycare in my contacts, but only their main line; the teachers usually call from the classroom phones and I don’t have those all saved.

Also, when I say local number, I mean local as in “where I live,” not local as in “same area code as me.”  Like many folks my age, I’ve moved since I was first assigned this number, and no one who’s not already in my contact list is going to be calling me from my original area code.  I still get mystery calls from that region, though.  They never leave a message, so they’re either genuine wrong numbers or scammers trying to spoof a number they think I’ll pick up.

On rare occasions, I still get calls for the guy who had this number before me, even though I’ve had it for more than a decade.  Usually, it’s just automated spam with his name inserted, but once it was a real person.  A collection agency, I think.  I assured the lady on the other end that I had no idea where the guy was or how to contact him, and she never called back.

How do you decide whether or not to answer the phone?