Happy Birthday, L

I’ve said before that while many parents think the early years fly by, for us it tends to feel like each year has lasted decades.

In those first hours and days and weeks we didn’t know what L’s future would look like or if he would have one at all, IMG_6713and yet now here he is today “my precious”ing his very own piece of cake (I guess when you’re allowed to have sugar for the first time after four years without any you kind of go Gollum) and laughing raucously as he makes his new Thomas Trackmaster Sky-High Bridge Jump hit him in the junk repeatedly. #miracles

It’s only been four years, but it takes an awfully long time to come as far as he has. His first birthday was really difficult for me, but I’ve come a long way since then too, and each year that difficulty fades a little more.

Happy Birthday, baby boy. IMG_6722

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Number Two

I’ve heard a lot of special needs parents say, “I’d do it all again.”

I had a hard time believing them in some of our early months. I knew with every fiber of my being that I would go to the ends of the earth for my son, and I have never once questioned whether L is worth everything we’ve gone through for him, but if I had a choice — would I choose to do it again?

That question certainly complicates the fact that I’ve never imagined myself as the mother of an only child. For the longest time, we had our hands so full keeping our first child alive that we couldn’t even contemplate the added responsibility of a second child. As things gradually grew easier, as we learned to better navigate this medical life, a brother or sister for L began to seem more attainable – but that choice was clouded with what-ifs. In theory, we have no increased risk with a second pregnancy because gastroschisis is spontaneous and randomly occurring; but our eyes have been opened to medical realities we had never imagined before L was born, both our own and those of others, and some far more intense and all-consuming than what our family has experienced. And we know better than to expect we will never have any more bumps in the road with L.

And so, contemplating number two, we found ourselves faced with the real-life version of what has been only a hypothetical before. We knew exactly how difficult it could be if an unexpected complication arose, and we perfectly understood the potential threat to the current balance in our lives — and this time we weighed all those overwhelming negatives with the very real possibility of opting out before we ever got started.

It was never a matter of whether or not we could handle it; we have learned all too sharply over the years that you handle what you are given, because what other choice do you have? No, the real question was: Did we want to?

After much soul-searching, lengthy debate, and repeated decisions to delay just a little longer, and a little longer, and a little longer still, we ultimately decided that we did not want to let our decisions be guided by fear.

Number Two is due Nov. 3.

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‘No parent should ever have to decide if they can afford to save their child’s life.”

Jimmy Kimmel recently opened up about his newborn son’s unexpected open heart surgery, in an emotional, heartfelt monologue that touches upon the rawness and vulnerability of suddenly finding yourself in that terrifying situation as a parent. As I watched him struggle to give voice to their story so soon after it had happened, I was plunged back into the raw emotion of our own first week with L; and his takeaways resonate deeply:

“We were brought up to believe that we live in the greatest country in the world, but until a few years ago millions and millions of us had no access to health insurance at all…if you were born with congenital heart disease like my son was, there was a good chance you’d never be able to get health insurance because you had a pre-existing condition. You were born with a pre-existing condition and if your parents didn’t have medical insurance you might not live long enough to even get denied because of a pre-existing condition. If your baby is going to die and it doesn’t have to, it shouldn’t matter how much money you make.

“Whatever your party, whatever you believe, whoever you support, we need to make sure that the people who are supposed to represent us, people who are meeting about this right now in Washington, understand that very clearly.

“Let’s stop with the nonsense. This isn’t football. There are no teams. We are the team. It’s the United States. Don’t let their partisan squabbles divide us on something every decent person wants. We need to take care of each other.

I’ve said it before, but it bears repeating: the current health care debate is everyone’s debate. If you think you are safe, consider what’s at stake. If you think it doesn’t apply to you, take a minute to understand the fundamental insurance principle of herd coverage. If you think a child’s right to life shouldn’t depend on her parent’s wealth, this debate is your debate.

IMG_6138Every single day, all across the nation, families face devastating news and difficult choices. And nearly all of these families face those choices with a tiny fraction of the resources available to the Kimmel family. Implementing a new and improved health care system is far from simple, and pleasing everyone is damn near impossible – but it’s not hard to determine right from wrong when it comes to such a fundamental issue. As Jimmy so simply and poignantly stated, “No parent should ever have to decide if they can afford to save their child’s life.

The GOP’s first health care bill failed, but this battle is far from over. Keep making your voices heard.

Watch the full monologue here.

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Gutsy Surgery: Six Months Later

I think medical time moves differently than regular time. It has split personalities, perhaps. When you have young children, the weeks and months seem to fly by somehow (“Can you believe he’s going to be FOUR?! How is he almost four years old?!!!”) but in many ways, even this last big surgery already seems like a lifetime ago.

A friend asked me recently, “So, was the surgery a success?” She’d asked me something similar before surgery – how will you know if it works? – and I had fumbled through an explanation about how there may never be a clear answer to that question, in much the same way that there’s never really a finish line for us; there’s no real “cure” with L, it’s always an ongoing process of management, and varying degrees of better and worse.

Today though, just six months out, I can say without hesitation that our October surgery was a resounding success. Even to write that makes my breath catch just a little – how gutsy of me, to make such a bold proclamation, and surely perhaps a little naive? In our house, we don’t even say “at least bedtime should be easy tonight” because that’s the surest way to guarantee it will take hours; we’ve spent so much time refusing to look directly at progress for fear it will slip away that to voice the words “resounding success” feels downright dangerous. As certain as I am that this surgery was a success, I am equally certain I will live the rest of my life waiting for the other shoe to drop.

And yet – his appetite came in with a roar less than two weeks post-op, and there’s been a hungry lion living inside him ever since. He eats seven or eight times a day, and not just grazing; he’s eating full meals, and my picky eater’s short list of “L-approved” foods has expanded from roughly a dozen fruits, carbs and cheeses (but only in very particular shapes and forms) to an entire world of food groups and variety. Meats! Fish! Nuts! GREEN VEGETABLES!

He’s eating, and tolerating nearly unrestricted liquid intake, and his gut is working so incredibly much better than we ever dared to hope before. He’s having beautiful poops (Look, mama! Let’s take a picture!), and only 2-3 times each day as opposed to the so many we were seeing before. His belly is smaller – it would get horribly swollen before surgery, due to the dilated sections and bacterial overgrowth – and he very clearly just feels better all around. The cause and effect of all these things seems a bit chicken-or-egg, but they all play off each other to keep the rest moving in the right direction.

He was able to come off of TPN (IV nutrition) about six weeks after surgery, at which point we switched to overnight g-tube feeds (that means we’re running a medical version of Pediasure through the feeding tube in his belly, which goes directly into his stomach as if he were drinking it, only in a slow, steady drip that’s more easily absorbed). Over the last three months, we’ve cut the volume of that overnight Pediasure in half, and he’s been able to maintain weight, stay hydrated and stay on his growth curve; we’re hoping to keep forging ahead and sooner or later ditch the overnight feeding pumps altogether.

The biggest remaining hurdle is vitamin deficiencies, which aren’t going away anytime soon and can cause some serious health problems over time if left untreated. But even there, it’s an ongoing process of management, not a discouraging setback – and we have some exciting prospects on the horizon in the form of patches and pills.  

We’ll never be completely free and clear. L’s gut could re-dilate. He could develop a new stricture or obstruction or perforation – I still suppress a dull panic every time he complains of a stomachache. He could experience an illness that unexpectedly throws us into a long downward spiral. And as he grows, he may go through stretches where his body can’t keep up with his nutritional needs, and we may need to supplement in one form or another.

But for now, he is thriving. He is healthy. He is line-free. And we are making up for lost bathtime.

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It’s an April miracle.

Let it be known that on this day in history, L swallowed a pill.

My not-quite-4-year-old SWALLOWED a motherflipping PILL.

This is huge – not least because about a year and a half ago, he was seeing a speech therapist for feeding issues and receiving occupational therapy for suspected sensory processing disorder. (Admittedly, the driving force behind swallowing the pill was that he loathes me poking the pill and squeezing its innards into his mouth, which doesn’t exactly rule out sensory issues here. Just let me have this for now.)

The potentially bigger reason this is huge, though, is that the particular pill he swallowed is a massive dose of Vitamin D (befitting of the superhero phase we’re currently in, we call it “Super D”). One of his biggest hurdles right now is vitamin absorption; certain parts of the gut absorb certain vitamins, and it’s likely he just doesn’t have the parts of his gut that are responsible for most of his vitamin D absorption. Twice each day, he takes a double dose of a liquid multivitamin designed for kids with malabsorptive disorders, as well as a separate vitamin E, vitamin D and liquid iron supplements.

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And these doses are large. To put it in perspective: a typical dose of adult vitamin D drops (and remember we’re talking about a 36lb child here) is 4,000 units. His regimen included those 4,000 unit drops twice each day, plus a 50,000 unit “Super D” once a week – and he was still deficient. We bumped up to 50,000 unit Super D twice per week — still deficient. We did recently add in these neat patch vitamins that claim to absorb directly into the bloodstream through the skin, which we’re hopeful might be a turning point for us, and our initial trial in the week before his last round of labs did show his Vitamin D levels moving upward – but by a whopping one point, while still taking his biweekly Super D, so the jury’s still out on whether or not we can switch to more regular-sized doses of patch vitamins (full review to follow after May labs!)

Currently, we put all these vitamins through his g-tube. After his last big surgery, we were able to drop the twice-daily 90 ml of green bean puree that had been part of his vitamin regimen for years (green beans are great for thickening up short gut poop!), and we had started squeezing the Super D into his mouth, which he hated, but it would be a miserable, hopeless battle right now to try to get him to take all the rest of these supplements orally, twice each day. (Have you ever tasted liquid iron?!)

Swallowing a pill, though — that’s new territory. He’ll still need alarmingly large doses of anything that goes through his gut, but we’re slowly weaning off of his overnight tube feeds; vitamins are the last big hurdle. And swallowing pills could open up new doors. Tube-free doors.

To be continued….

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Dear Jason Chaffetz: My iPhone isn’t going anywhere.

Dear Mr. Chaffetz,

Yesterday, while the nation was talking about the proposed replacement for the ACA and I was busy writing about the importance of “herd coverage” in health insurance, you thought it timely to tell low-income Americans that they’d be able to afford healthcare if they would only give up their beloved iPhones.

Now, the complete tone-deafness of that remark was quickly and thoroughly denounced by the DNC Chairman and the interwebs alike, Forbes has outlined exactly how many iPhones it would take to cover the cost of healthcare, and you’ve already eaten your words. So it seems less than necessary for me to point out that my family’s health insurance premiums cost 3.5 times the cost of our phone bill each month, or that we pay approximately another ten brand new iPhone 7s toward our maximum out-of-pocket costs every single year; that my son cost nearly 5,000 brand new iPhones before he ever came home from the hospital; or that I actually received my iPhone more or less for free when we enrolled in our service plan, which also happened to come with a couple hundred dollars in Costco gift cards that we used to buy grocery staples, since we were stretched kind of thin by our medical bills at the time.

No, I think it’s more useful to consider exactly why my iPhone actually is a necessity. Here are some of the many ways it’s essential to the health and well being of my family:

  • It’s my primary, and in some cases sole, means of communication with a small army of healthcare professionals.

In the year after my son came home from the hospital, we did not have a coordinated care team; I was responsible for communicating with a pediatrician, a medical specialist, a surgeon, a dietician, a physical therapist, a drugstore pharmacy, a home infusion pharmacy, medical supply delivery drivers, home health nurses, endless insurance reps, medical billing services and a NICU follow-up team, none of whom communicated with each other. I spent a lot of time on my phone that year.

Now that we’ve switched to a more integrated team, I still depend on my phone for regular check-ins to manage my son’s care, to make and manage an endless string of appointments, to receive results from frequent bloodwork, to access help negotiating difficulties or unusual symptoms, to dispute improperly-processed claims, to pay bills, and to notify his team if it turns out we’re heading to the ER yet again. In fact, I don’t even have to identify myself when I call his specialist’s office, because I speak so frequently with the administrator who answers their phones that she recognizes my voice.

  • It’s an immediate and ever-present font of information.

When we brought my son to the ER presenting with alarming neurological symptoms that are apparently common among kids with his rare disease, none of the staff in the entire emergency department were familiar with what was happening to him. You know who was? The parents in my diagnosis-specific Facebook group, and Dr. Google.

  • Some of my best friends live in my phone.

When my son was in the NICU, I essentially lived at the hospital for 4.5 months; my phone became my lifeline to the outside world, and my primary means of keeping friends and family updated.

During that time, I also solidified enduring online friendships with some amazing women who became an around-the-clock refuge during some of the lowest points in my life; when I was struggling mentally and emotionally, when I felt like I was drowning, when even a trip to a therapist had failed miserably – the friends in my phone kept me sane and gave me the strength to persevere.

  • It’s the best way to keep a squirmy toddler still during uncomfortable procedures.

Side-eye all you want — if you had to try performing a sterile dressing change in your living room on a small child who hates medical tape and doesn’t like to be held down, you’d be rushing off to download the YouTube Kids app too. Ryan’s Toy Review has saved us from contamination on more than one occasion (and how many iPhones do you think it costs to treat sepsis?).

All things considered, I’d say the $57.49 per month I pay for my phone service seems like a pretty damn good investment. Tell me, Mr. Chaffetz, when will you be making the choice between your taxpayer subsidized healthcare coverage and your taxpayer-funded iPhone?

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America, Let’s Talk: Mandated Healthcare Coverage and the AHCA

House Republican have just unveiled the long-awaited “replace” part of their promise to repeal and replace the Affordable Care Act. And, huzzah! – they’ve retained some modicum of sense and decided to keep some popular and very necessary components like guaranteed coverage for people with pre-existing conditions. But there are also a lot of less favorable components to unpack and discuss, so let’s start by focusing on one basic component of the ACA that’s been a point of tension for many of those opposed to it: mandated healthcare coverage.

Nobody wants to pay a penalty for not having health insurance. I get that. It’s not exactly unprecedented – I mean, in most states, if you’re caught driving without auto insurance, you can face penalties of several hundred dollars and some jail time, and may be ineligible to make injury claims against a driver who causes a damaging accident, even if the other driver is 100% at fault (so if you’re driving uninsured, let’s hope you have health insurance!). But if you felt you could afford to pay for health insurance, you probably would; and paying a penalty for not having that insurance seems to hit you when you’re already down.

The disconnect between the motivations behind mandated coverage and the mindset that paying penalties is unfair lies in the scope: mandated coverage is intended for the good of the group, and objections to it operate at the level of the individual.  

Since I’m already diving into controversy here, we might analogize it to vaccines: some may view mandated vaccination as an infringement on individual rights, but the effectiveness of vaccines depends on herd immunity. There are any number of individual liberties that end where they begin to pose a threat to the life and liberties of others (the choice to drive while intoxicated, for example), and the choice to leave your children unvaccinated poses life-threatening danger to those too young or ill to be able to receive vaccines. If a single person chooses not to vaccinate, they have decent odds of being covered by the immunity of the herd; odds are pretty high, in fact, that that person will not get sick. That’s how newborns, people with compromised immune systems and others who are ineligible for routine vaccinations remain relatively safe from vaccine-preventable illnesses. However, if lots of people choose not to vaccinate, we begin to see the resurgence of preventable diseases that had become almost nonexistent in the United States. If lots of people choose not to vaccinate, herd immunity weakens; those who need it most are no longer safe; people die.

Similarly, functional health insurance depends on herd coverage. Many of us pay for healthcare coverage; many of us don’t use it beyond a well visit here and there, and maybe treatment for the occasional respiratory bug that won’t go away on its own. And, others of us could never pay enough in premiums to make up for the exorbitant amounts our insurance companies have paid out for our very expensive healthcare. If a single young, healthy person opts out of healthcare coverage, they have fairly decent odds of not having a medical catastrophe or suddenly developing a chronic illness, relatively low odds of either drowning in medical debt or dying from lack of treatment, and the group is not hurt much by the absence of that one member. But if more and more healthy people choose to opt out, well — you have to have a lot of healthy people paying for insurance in order for the insurer to be able to afford to pay the healthcare costs of those who actually need to use the insurance.

This is not Obamacare theory; this is not socialism; this is Insurance 101. If lots of people choose to opt out of healthcare coverage, you begin to approach a point where there’s not a big enough pool of healthy people paying for coverage to cover the expenses the insurer is paying out for those who need more extensive care. Herd coverage weakens; insurers begin to cover less, and pay less for the things they are covering; those who need it most are no longer able to access the care they need; people die.

The Republicans’ proposed plan would remove the mandate on coverage. This may seem like a good thing – freedom of choice! But their plan also:

  • Revises the financial assistance available to help pay for healthcare coverage. The proposed tax credits will be lower, in many cases, than the current subsidies made available by the ACA. Fewer people will be able to afford coverage.
  • Proposes to put caps on Medicaid expansion, to an extent that even some GOP senators are saying will be damaging to those currently covered by state Medicaid policies. Fewer people will have access to the coverage and care they need.
  • Allows insurance companies to charge people a 30% penalty upon purchasing a new plan, if they have let their insurance lapse – effectively continuing a penalty against the uninsured, but one that the uninsured can only avoid if they remain uninsured.

Early analyses have concluded that the proposed bill would lead to millions of people losing coverage. And without herd coverage, healthcare suffers, and people die.

I recognize that the importance of mandated coverage can be a hard pill to swallow if you’re scraping by financially, are already unable to afford health insurance, and now you suddenly have to pay a penalty on top of not being able to afford health insurance. I can sympathize. But the alternative could quite literally be the death of you.

You can find more information on the proposed AHCA here and here – and mandated coverage is just the tip of the iceberg, so look for more from me to come.  

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Giving Voice to the Absences

img_6268Each non-Leap Year, Rare Disease Day is observed on February 28. I say it’s observed on February 28 rather than it is on February 28, because RDD is actually February 29. Like Leap Year babies, RDD chooses February 28 as its backup day of observance in all years that cannot be evenly divided by 4 (and also in years that can be divided by both 4 and 100, but not also 400 – have you ever read the actual rules for Leap Day?!).

It’s fitting that February 29 should serve as Rare Disease Day; it is, after all, a rare day. Perhaps even more fitting is its absence, its silence, in three out of every four years. Most years, for most people, February 28 slides on into March 1 as though February 29 were never even a thing. Unless you are one of the rare people born on Leap Day (at around 4 million worldwide, they are a group only 1% the size of the rare disease population), you probably don’t give a second thought to that non-second of time at midnight in which February 29 doesn’t really exist.

Rare diseases often exist in silence, too. They live in the absences: the friend who stops coming to gatherings because the exhaustion from a late night might incapacitate her for days; the coworker who stops coming to the office because the pain is too much; the mother who doesn’t explain why her child is still in the hospital because she doesn’t know where to begin.

Unless you have been directly affected by one of them, it’s likely you’ve never heard of most or all of the nearly 7,000 rare diseases recognized by NORD. I had certainly never heard of gastroschisis or short bowel syndrome until they were quite literally thrust into my lap four years ago. But if you know even a handful of people, odds are high you know someone who has been affected by rare disease. By definition, each rare disease affects fewer than 200,000 people in the United States at any one time, but collectively there are more than 30 million people living with rare disease in the U.S. – that’s about 1 in 10 – and an estimated 350 million people worldwide.

This year’s RDD theme is research, and research is certainly a fundamental necessity for the rare disease community. Fewer than 5% of rare diseases currently have a treatment, and lack of knowledge and quality information can result in devastating delays in diagnosis. Many people remain undiagnosed, sometimes for entire lifetimes. And the need for treatments and cures is pressing; rare diseases are responsible for 35% of deaths in the first year of life, and 30% of children with rare diseases will not live to see their fifth birthday.

Last year’s theme, however, will always resonate most deeply with me: Patient Voice. On a true Leap Day in 2016, RDD made those 350 million voices heard. Research is brought about by advocacy and awareness, and advocacy and awareness begins with voices. The patient voice is the best advocate in a world where even most doctors don’t understand rare diseases, and it is the best avenue for placing faces next to scary, unpronounceable words. It’s voices that fill the absence; voices that inspire more voices; voices that make sure someday, somewhere, a mother will never feel as completely and utterly lost and alone as I felt in 2013.

To hear more voices or to learn more about rare disease, visit rarediseaseday.org or Rare Disease on The Mighty.

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Raphael the Girl Tiger: L’s Healing Helper

When we were plunged into our health journey, we had never heard of gastroschisis or short bowel syndrome or TPN or a Broviac or a Mic-Key button or any number of other things. Our world suddenly became very narrow, and very deep. Among those things we had never heard of, however, were a number of organizations and resources available to help families who find themselves in our shoes, which I’ve recently gathered on a shiny new resources page linked in the black bar at the top of each page on this site.

One of these is Avery’s Angels, a foundation dedicated to gastroschisis research, awareness and family support. One of the many amazing things they do is a “Warrior’s Christmas” program, through which they provide Healing Helpers to kids who face ongoing medical challenges due to gastroschisis. And this year, L was chosen as one of their Warriors.

Meet Raphael the Girl Tiger:

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(Cousin C, I think we may be inadvertently channeling Hank the Girl Cat.)

With all the boxes of medical supplies that show up on our doorstep (see those boxes of Pediasure stacked over there?), you’d think L’s enthusiasm for opening packages would have been tempered by this point. But he is continually elated to open each box to find out what’s inside, and this time the contents did not disappoint.

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Raphael the Girl Tiger has had intestinal surgery that left a scar just like L’s, and she also has a g-button and scars where her line and her ostomy used to be.

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Here, L is performing primary closure:

L has never been attached to any one lovey or blanket, but Raphael the Girl Tiger has quickly become a bedtime staple. And, in true short gut fashion, she’s already proven admirably resilient when it comes to being puked on (I’ll spare you the photos on that one).

L, Z and I send our love and thanks to Meghan and the entire team at Avery’s Angels for Raphael, and for the important work they do each day to help families going through medical hell or unimaginable loss.  

If you know of any organizations, blogs, or helpful tips that should be included on my resources page, please let me know!

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Tales of a Line-Free Kid: The Pinch

Being line-free has more advantages than I can quickly catalog here, but it also has one definitive drawback: needles.

Malabsorption necessitates frequent blood draws to monitor vitamin levels, hydration, liver enzymes and a plethora of other things. Depending on what else is going on with his health, L has had monthly, biweekly, weekly or occasionally even daily labs since he was born. However, with the exception of a brief stretch in the summer of 2014, L has also had a line of some sort his entire life. That means that we have had the good fortune (can we really call it that?) to have been able to draw his labs through his line, needle- and pain-free. Because we were, erm, between doctors for several of those line-free weeks in 2014, he has had a grand total of one traditional blood draw in his entire life, at around 15 months old when he was too young to remember.

Until today.

I was nervous, heading into our appointment today. I have friends with kids – small children, far too young to be so brave – who are so accustomed to needles that they chatter and giggle through labs. There are others, though, many others, who have been so traumatized by extensive poking and prodding that they require sedation for even the simplest blood draw. L does well when we explain to him well ahead of time what’s coming, and for a 3.5-year-old he is very receptive to being reasoned with, so I hoped I could employ some of the tactics we have long used to talk him through dressing changes; but, thanks to regular dressing changes, he also panics when we so much as pull tape off his skin. I felt as though an awful lot of weight was riding on how I managed this first needle.

In the empty waiting room, we made a game of squeezing together into each of the extra wide chairs. As the panicked screams of another poor little soul rose ever-louder from the back, I amplified my laughter in a futile attempt to mask what awaited him.

Finally, it was our turn. “I’m scared,” he whispered.

“I know, buddy. But remember what we talked about? I’ll be with you the whole time, and it’ll just be a little pinch and then it will be all done.”

The phlebotomist led us to the back, and L climbed up into her giant chair unprompted. He was immediately taken with the perpetual motion toys on her desk (Dory! A pterodactyl!), and perked right up when I offered the holy grail of distraction: YouTube toy review videos (curse you, Ryan’s mom, but in times like these I am grateful for every shrill unboxing. And by times like these I mean blood draws, 5 am, and when I just want to pee in peace for once, dammit).

As she pulled out the needle, I was irrationally taken aback that there was no warm up, no sleight of hand. All of a sudden, there was a big shiny needle just staring at us. “All right, here we go,” she said. “Just a little pinch.”

I braced myself to hold him down, as I’ve had to do far too many times before, but he gave only the slightest whimper when the needle went in, and another small whimper when it came out. He watched like a hawk as she wrapped his arm in coban – red, because she had heard him say red was his favorite color as we watched the blood flow into the syringe.

He turned to me, and I held my breath, waiting for his words.

“Mama.”

His little voice was very stern.

“That pinch made a HOLE.”

“Yes, buddy, it did. I suppose I should have said it would be a poke instead of a pinch. But it wasn’t as bad as you thought it would be, was it?”

“Yes, it was! It was exactly as bad as I thought it would be –”

My mind raced to come up with exactly the right words to steer him back in the right direction. But there was no need:

“Can I have more stickers?!”