When There's Such a Thing as Too Much Medicine

This past weekend's New York Times magazine cover story, "Our Feel-Good War on Breast Cancer," explains how a very well-meaning campaign to save women's lives has terrified women and resulted in unnecessary medical interventions, without actually saving lives.

It was impossible to read the story without feeling strong emotions. We all know someone who is a breast cancer survivor, and we are of course grateful that those friends or family members (or ourselves) are well. But what does it mean to be a survivor of a disease that may not have needed treatment all all? What if the treatment is permanently damaging, but does not change the overall outcome? The idea of watching and waiting doesn't sit comfortably with many of us patients. We want doctors to heal, and to act. But what if, sometimes, there's nothing at all to be done? What if the research supports watching and waiting?

Yet who among them would dare do things differently? Which of them would have skipped that fateful mammogram? As Robert Aronowitz, the medical historian, told me: “When you’ve oversold both the fear of cancer and the effectiveness of our prevention and treatment, even people harmed by the system will uphold it, saying, ‘It’s the only ritual we have, the only thing we can do to prevent ourselves from getting cancer.’ ” (Peggy Orenstein in New York Times Magazine, 4/28/13)

All this made me think about the over-medicalization of birth. Replace the words cancer with "birth" and "prevention and treatment" with "caesarean", and you have yet another area where women's bodies and selves are often being harmed under the guise of being saved.

There are many reasons why 1 in 3 births in the US are by cesarean, but an important one is that women are oversold the fear of birth. Because birth most often takes place in the hospital, where people usually go to have pain-free operations under sedation, people (both men and women) often believe that women should be passive and calm when they give birth. When if fact, birth is not designed to be a passive experience. To give birth, women need first and foremost to be empowered. They need to be reminded that their bodies are designed to give birth, and be given the freedom to follow the signs that there own bodies are giving them in labor--to move around, to stay upright,  to have privacy, to vocalize, and/or to do whatever they need or want to do (with whomever they need or want present to help them).

But instead, women are sold fear. When I was pregnant with my first daughter, I told one doctor that I wanted to have a normal (intervention-free) birth, and she responded by saying, "Don't set yourself up for disappointment." Not one word of encouragement. Birth is not easy, but it's a lot harder when everyone around you tells you you can't do it. (This is why I hired a doula: I needed to have someone in the room who knew what normal birth looked like, and who believed in me.)

Many women who have unnecessary caesarean births are told by their doctors that the surgery was life-saving. But what they aren't told is that it is the cascade of interventions that have become standard in hospitals that often leads to the moment of distress: making women lie on their backs in bed attached to an IV, preventing them from eating and drinking, attaching them to continuous fetal monitors, giving them medicines that prevent them from moving around and actively using their own bodies to move the baby down through the pelvis--all of these interventions work against a woman's ability to give birth normally. These interventions often cause labor to stall, or make a woman's efforts at pushing less effective, or cause the baby's heartbeat to drop, all of which can lead to the fearful all-too-common moment when the doctor announces that this just can't go on any longer--the baby must be taken out now.

Just like women are "oversold both the fear of cancer and the effectiveness of our prevention and treatment", women are also oversold the fear of birth and the effectiveness of the cascade of medical interventions that supposedly make birth safer. But surgical birth is not safer, and it is not without consequences, both physical and psychological. 

One thing I know, as a health care consumer who has given birth three times in this country, is that trying to have a normal birth in a hospital is an uphill battle. (The exception was my second birth, which was midwife-attended in an in-hospital birthing center.) I also know that birth can be beautiful, empowering, fear-free and peaceful.

The result of all this, for both birthing women and for women considering mammography and/or cancer treatment, is a confounding quagmire wherein doctors are trying to treat and satisfy patients while protecting themselves from those same patients--who have the right to pursue justice in the courts if they don't like the outcome of their birth/ illness. One thing patients forget (encouraged by a litigious environment) is that life is not without inherent risks; doctors may do their best, and a certain percentage of the time, things will not go right. In court, a doctor can defend herself better if she did something, than if she did nothing. Even if nothing would most likely in most cases, based on research evidence, be better and safer. 

I do believe that doctors want to do right by their patients--that they want to protect women and give them what they want. But I also think that the system sometimes acts against what is actually in women's best interests. Doctors too often worry about worst-case scenarios, so they treat every patient as a potential disaster. This attitude may protect a small percentage of women, but it has the potential to harm many more. 

Cultural Clash: The Woman in the Niqab and I

During a summer trip to Southeast Asia in 2001, Josh, Nina and I spent about a week in northern Malaysia. In Georgetown, the former colonial town with an intoxicating mixture of British, Chinese, and Indian influences, we took a funicular up to the top of Penang Hill. It was a rather ordinary touristy thing to do: a cool mode of transportation, with a view at the top.

I remember that day not because of what we saw out the window, but because of our fellow tourist passengers inside the car. We travelled up the hill with what seemed to be an extended Saudi Arabian family. The men were dressed like tourists from anywhere: plaid short sleeve shirts, jeans, sneakers. The kids--both boys and girls--also looked pretty typical, as I recall, wearing shorts and t-shirts. But the women looked different. They were each wearing a black niqab: full body, head, and face coverings, leaving only their eyes exposed.

The woman sitting directly across from me had carefully made-up eyes, with dark eyeliner, sparkly eye shadow, and thick mascara. As she spoke to her family in a language I couldn't understand, those eyes, huge against the vast blackness of her coverings, seemed to keep tabs on me. I wondered what it was like to be her. And on her behalf, I felt angry. Angry that she had to hide, as if in shame, while the rest of her family was free to live in daylight.

And at the same time, I imagined that she was doing the same to me. I felt her eyes looking me over. I can't remember but I was wearing, but my best guess would be shorts and a tank top. It was summer in Malaysia, after all. Was she scandalized by my exposed skin? Or was she desperately jealous of my freedom?

I'm thinking about all of this today because the New York Times has a Room For Debate discussion on the recent feminist protests against the hijab, or Muslim headscarf. A counter-protest by a group of Muslim women defending their right to wear the hijab points to the problem with outsiders like me engaging in the fantasy of imagining that we understand the motivations of people of other faiths and cultures.

I believe in women's autonomy, so if women want to wear a covering or veil, that is their right. But sometimes practices are so culturally entrenched that the people most hurt by them will argue in their defense. (See: women spitting and shouting at other women praying aloud at the Kotel in Jerusalem).

I can't help but having a strong reaction to seeing women (and girls) hiding under fabric. My understanding is that females in Muslim societies cover themselves at least in part to protect men from sexual longing and/or misdeeds. Because of course, men are animals who can't control themselves, and of course, that problem falls squarely on the shoulders of women.

Here's when I admit that I don't understand Jewish women who cover their heads after marriage, either. I don't believe that women belong to men; I do believe that men are capable of controlling their sexual impulses; and, most importantly, I don't believe that whether or not men are tempted by women is at all a woman's problem. I have trouble seeing women covering and/or shaving their hair after marriage as anything but a sign of old-fashioned patriarchy. Unfortunately, patriarchy is woven deeply into the fabric of Judaism, and it's those aspects that are hardest for me to reconcile as a modern woman and as a feminist.

That said, I fully admit that I am limited by my own world view. That day in Malaysia, sitting across from that intriguing pair of unknowable eyes, there was no conversation between us tourists from opposite parts of the world. But there was an abundance of wonder.

On Learning at School,Test-Free

So I've heard that kids are taking these new tough tests this week in elementary schools across New York. I've seen some nasty-hard sample questions on Facebook, and I've heard stories of students and teachers and parents all getting nervous about what the results will say about them, and/or the new standards.

It's all rumors to me, because my kids go to a progressive (private, Jewish) school, so they don't take those tests. In fact, my kids, thus far, don't take tests. Period.

(I know what you're thinking. How will they ever get into Harvard? Or, for that matter, Columbia or Wesleyan?)

The differences between styles of education can and will be debated from here until the end of time, but the subject is in high relief for me this week because the high-stakes testing in neighboring schools happened to coincide with our spring conferences.

Yesterday, Bella talked us through her achievements thus far in fourth grade at her portfolio conference--a parent-teacher-student conversation, which is progressive education's answer to the classic parent-teacher conference. Her portfolio was amazing, not because it was fancy or typed or decorated or perfect, but because it was a selection of the varied work that Bella has done this year--work that she herself chose, explained, and reflected upon.

When parents complain about progressive education, they often say they feel like their kids aren't learning anything. In an educational environment that de-emphasizes tests, homework, and other quantifiable measures of achievement, the majority of the learning takes place during school hours, and within school walls. Parents don't see the learning, because they aren't present when it is happening.

The portfolio conference, for me, was like a flash-flood of evidence of all the learning that is occurring. Throughout the year, students select samples of their work from each subject, and write their thoughts about what they enjoyed and found challenging in doing the work. The result is an impressive, highly personal record of each child's individual learning and their thoughts about what they learned. That binder demonstrates the real purpose of education: to help kids grow as thinkers.

This wasn't the first time I was won over, in a conference, to the benefits of child-centered, constructivist education. Josh and I once attended a 45-minute parent-teacher preschool conference during which the teacher showed us our kid's art, showed a photo of her making the art, and read from a transcription of the conversation that took place while she was making the art. This all, by the way, was when she was age three. At that Reggio Emilia - style preschool, there was a real belief in the value of the thoughts and intentions and creativity of young children. It may sound over-the-top--it's just preschool, I get it--but without doubt we left that conference confident that her teacher knew her as an individual, enjoyed her, and valued her as someone capable of achieving wondrous things. It was kind of awesome.

Of course, Bella's older now and we expect different things from her school. (If only there was as much art education in elementary school.)

We didn't need the spring conferences to tell us that our kids are learning things at school, as they tell us themselves about their units of study, and we see them developing and growing as curious, thinking people. But as a parent, it's nice to see the evidence.

On Being News Interpreter to My Kids

I'm no news junkie, but this has been one of those weeks when it's almost impossible to pull oneself away from the news. Even now as I write this, I'm refreshing the New York Times web site every few minutes to find out if my Boston neighbors can let out their breath. I'm still holding mine.

And at the same time, it's been hard to listen to, watch, or read the news with my curious, observant kids present. "What happened?" I was asked this morning, as I was desperately trying to listen to Morning Edition to find out, myself, what happened in Boston overnight. Desperately, because of the apparent urgency--the way in which it was clear that the radio hosts didn't know themselves exactly what was happening--and also, because my kids kept interrupting me with their own questions. Bella asked me turn off the radio so I could explain to her the news that I had barely been able to hear or digest.

Kids think we know. Not only are we supposed to know what's happening, but we're supposed to filter the news to them in a sensitive way that makes them feel safe. The National Association of School Psychologists says to: 

• 1) Be careful what little eyes see and ears hear. Children are less able to handle the intensive, detailed coverage of an event.
• 2) Reassure children that they are safe. Remind them that trustworthy people are in charge and helping.
• 3) Maintain a normal routine. Model calm and control.
• 4) Stick to the facts. Don't stereotype people that might be associated with violence.
• 5) Keep the lines of communication open. Be aware of children's emotional state.

It used to be I tried very hard not to let my kids know when bad things were happening in the news. Here's when I admit that this week, I mostly gave up.

 Last night, after the surveillance videos of the bombing suspects were released, I spent a few minutes scrutinizing the videos online, bewildered by the very unprecedented nature of such a manhunt. "Who are they?" Bella asked, before I could even get to the bottom of the article. And so began a conversation about suspects and manhunts and surveillance videos and many, many questions to the effect of, "but HOW did they know it was those two guys? Out of all the people who were there?"

 I wanted to say: "You'll understand better when you're old enough to watch Homeland, honey." It's when real life is full of the stuff of grown-up TV, that parents get tested. 

This was the week, too, when I had to explain to my daughters that the US Senate had failed to pass the gun control measures that are needed to change the culture of guns and increase safety in our nation. We as a family have written letters, started and signed petitions, and attended rallies to show our support for these measures. And I was left having to explain to my kids about the NRA, and about some Americans' love affair with weapons, and about the way political campaigns work. I also told them that there are a lot of people who care deeply about gun safety, including our president, and that hopefully change will yet come.

At the time of this writing there are 12 people confirmed dead, with at least 40 still missing after the fertilizer plant explosion in West, Texas. Somehow, with all that's happened this week, I don't think my kids know about this terrible tragedy, yet. If and when they ask about it, I will tell them what I know, and how I feel: sick with sorrow.

Perhaps all we can ever do, as parents, is be ourselves. 

How Fragile We Are

This morning as I was scrambling through the morning get-the-kids-out-of-the-house routine, I heard a story on the radio about how the horrific Boston bombings, like other previous terror events, remind people about the fragility of life.

There I was, filling lunch bags, making tea, spreading spreads on toast, and rushing, rushing as usual, as I peppered my girls with the regular old questions: Did you brush your teeth? What about your hair? Go to the bathroom? Pack your backpack? Bring your book? Hurry, hurry, I said. We're running late.

And in the midst of that most mundane chaos, the radio reminded me that a father in Boston lost his eight-year-old son on Monday, while his wife and daughter's lives hang in the balance. Almost two hundred people, though they survived the blast with their lives, will forever after live with different bodies than they had before that moment.

On Monday, maybe an hour or two before the bomb exploded in Boston, I sat at lunch explaining to a new friend what it was like to be in downtown Manhattan on 9/11, because she asked. It doesn't come up often. For many of us, that experience of watching our city burn, of breathing the smoke and seeing the photos of the missing collect on lampposts and bus stops, is like a barely-healed wound. We try not to pick at the scab.

I told her that I decided that day in 2001, when I was 26 years old and had barely started a new career in publishing after a gear switch out of academia, that I wanted to have a baby; that I didn't want to wait until I was older. Because how could I be sure that I would be around in some unknown future? That's what 9/11 felt like to me: a cliff that the world almost fell over. The end of time.

The year that would follow held yet more difficulty for my family. That winter, Josh's sister Nina was in a traumatic car accident in which she lost her left arm.

Returning on the train to NYC from visiting Nina in the hospital in Boston, I sat next to a psychologist researcher doing work on trauma. (Or maybe I dreamed that I did, because the coincidence seems too strong to be true. But sometimes, this is exactly how life works.) He told me that trauma equals loss and that the loss can take many shapes: a person, a limb, or even a state of innocence. Healing from trauma involves acknowledging and mourning the loss. And it takes time.

I wish those amputee victims in Boston could talk to Nina now, and see all the ways in which she has reclaimed her self; how she has fought to be the powerful and capable person that she is, even without the arm that she was born with.

Some people argued after 9/11, as they always will, that it is futile to bring children into a violent world. But there's a difference between being aware of fragility and giving up hope.

I became pregnant with my first child in the spring of 2002, within months of both 9/11 and Nina's accident. That baby was, for me and Josh, a source of healing.

Yes, I am reminded this week, yet again, that life is fragile. That although it may feel that way sometimes, getting my kids ready for school--like most of our daily stresses--is way less than dire. But let's not let the horror in Boston take away our hope. Sending thoughts of healing and strength straight up 95 North...

Goodbye, So Long, Farewell to Music Together

"Hello everybody, we're so glad to see you..."

Yesterday I graduated from Music Together. It took me a long time--my first class was about 9 years ago. Louisa and I took it together three times. I would guess that I probably took it three times each with Bella and Ruby, too...although they were close enough in age that their classes overlapped (we went all three together), so maybe it was less. In any case, that's a LOT of singing the Hello Song.

Other than this one class, I was never big on baby and toddler classes. Ruby was full of energy and not into sitting in a circle, so after Bella started preschool, we stopped going to music and did a movement 'class' (indoor playground) at the Y once a week, when she was about 18 months. For New Yorkers, it's hard to know what to do with energetic toddlers in the winter. It's not uncommon for toddlers here to be enrolled in such classes as: soccer, cooking, art, gymnastics, yoga, ballet, etc. Some kids go to a class every day, or even more than one a day. But not mine.

So what kept me going back to Music Together?

• Routine: It's nice to have a place to go with a toddler, for routine, for a change of scenery, and for socialization. Especially for Louisa, the poor third child (see: Different Child, Different Parent.)
• Friends: Bella and I first went to MT with Missy and Anna, our original mom/ daughter friends. Back then, when Missy and I each only had one kid, it was great to have a scheduled weekly place to bond with another mom.
• Teacher: Erin Lee Kelly taught all three of my girls (even though there was a 6.5-year break). She can rock out with the toddlers, I'm telling you. She also has a lovely voice and a talent for getting nannies to sing rounds. We tried another MT teacher once--and then we went back to Erin. She's the best.
• Songs: Yes, the songs are hokey, but they're also catchy and have a real nice hippy vibe. (Josh jokes that Uncle Jerry is Jerry Garcia.) Louisa is so attached to the music that we are often held hostage to her musical tastes in the car: if that MT cd that we've all heard a thousand and a half times isn't playing, she will cry until we put it on. On the bright side, we know how to make her stop crying in the car.
• Music Enrichment: All three of my kids love music. Granted, their dad, grandma, and uncles are musicians, so it's an important part of our family culture. But they each love music in their own way. Bella likes to sing, Ruby likes to pick out songs on the piano and on the guitar, and Louisa hums all day long--often imitating strings of notes that she hears, just as she was taught to do at MT. The early experimentation with instruments, rhythms, and voice reminds me of the way that my kids experimented with art-making using a variety of materials in their Reggio Emilia preschool. It encourages kids to take in music viscerally, and to take ownership of the experience of music-making. Okay, maybe that sounds like a load of BS. But it's actually engaging and fun.

Despite all this, I must confess that lately I was finding it harder and harder to get myself to MT. The class is full of nannies, who seem lovely but who don't provide me with companionship. It's a long walk, and I'm often rushing to get there because of whatever meshugas is happening at home early on a Thursday morning. And it's getting to be nice outside, finally, so we can go to the playground for physical exercise instead. 

We're not done with music: we've just started six weeks of Bim Bom Baby, led by Cantor Shayna Postman, at our shul. The first one was this week, and Louisa loved it. Next fall, she'll start preschool. But Music Together is finally a part of my past. 

"Goodbye, so long, farewell, my friends...."

Think Like Dr. Mom: My Kid the Medical Mystery

The pains were so sharp they took my 7-year-old's breath away. She was doubled over, hands clutching her tiny chest, wincing. She was starting to cry. She looked to me, her face twisted up, all but begging me to make it stop. Then, after 20 seconds or so, it was over. Until it happened again, later that day, and then again the day after. Chest pain: in an elementary schooler? It didn't seem to make sense. Was she having a heart attack? I'd never heard of such a thing.

I never went to medical school, but I sometimes wish I had. My doctor and midwife friends know that I'm happy to listen to the gory, technical details of their messy medical cases. I'm an Atul Gawande--Jerome Groopman--NY Times' Think-Like-a-Doctor-column junkie. Plus, my dad is a doctor, the kind of doctor who likes to talk about his work and his cases (patients' privacy protected, of course). So I grew up with the most fascinating and colorful medical dinner conversation.

Perhaps because of my layperson's interest, or perhaps because it's just what moms do, I see it as part of my duty to try to diagnose my kids' ailments. I recognize that I still need to consult with an actual doctor to have them treated. But I'm the type of mom who doesn't call the pediatrician unless there's a good reason--and usually, a suspected diagnosis in mind (that drives you doctors crazy, I'm sure). Last week, it took several days of major sore throat complaints before I took one daughter for a strep test. (Sure enough, it was strep: both of my older girls have had it in the past month. No fever; just the sore throat. If only you could buy those swab tests in CVS.)

Infrequently, my kids present with medical mysteries. And it always throws me for a loop. 

With regard to the chest pains, I knew by looking at my daughter that she wasn't dying. But the pain was so excruciating that she was weeping, and the episodes were coming more frequently. She was becoming hysterical, and I had to do something. I consulted with my dad, who consulted with a pediatrician friend. They didn't know what it was, but because the pain was in her chest, Bella had to be seen. So we set off on a cross-city journey to an open weekend clinic. (This was three years ago, when we were living in London. Unfortunately, I was unable to contact our private pediatrician on the weekend, outside of office hours.) At the clinic, we waited a long while (of course), before Bella was examined by a young doctor, and then by her supervisor. They said it wasn't her heart or her lungs (i.e. not an emergency), and that if it continued to be a problem we should see her regular doctor. Basically, we learned nothing. Frustrating, and at the same time, unsurprising: I didn't know what was wrong with her, and neither did the professionals!

The pains thankfully lessened with time. At a sick visit to her pediatrician about a month later (tonsilitis), I mentioned the chest pains, the doctor examined her, and he knew exactly what the diagnosis was: something I'd never heard of! (Go figure). 

Before I disclose the solution to the medical mystery, I'll add that Bella has been experiencing the same breath-stopping pains recently, and it's been a cause of real distress for her, not least because I forgot, these years later, the diagnosis that the London pediatrician had so confidently told me. 

Last week, at a well-visit here in NYC, Bella explained her symptoms. I could tell that the doctor was a bit stumped. She asked: where exactly? and how often? Bella said: about three times a day, but just for short, twenty-second bursts. Because people (supposedly) eat three times a day, the doctor recommended that I take her to see a gastroenterologist. I knew this wasn't right--that it wasn't a GI problem, but since I couldn't remember the name of the diagnosis, I just had to smile and take the referral form. 

I also knew that until we found out what was causing Bella's pain, I would be unhappy and Bella would be worried. It's a mom's job to help a child at least know what's wrong with them, even if we can't always take away the pain.

I tracked down the name and email address of the London pediatrician, wrote to his secretary, and the next day had a copy of his examination letter from back in 2010. The diagnosis:

Costochondritis, also known as chest wall pain, costosternal syndrome, or costosternal chondrodynia^[1] is a benign^[2] and often temporaryinflammation of the costal cartilage, which connects each rib to the sternum at the costosternal joint, and is a common cause of chest pain. [Wikipedia].

After reading several articles online about the condition including one written expressly for kids, I discussed the diagnosis with Bella, and gave her the article to read. We both agreed that it sounded like exactly what she had. And blessedly, the condition is benign. Believe or not, ever since, she's felt better. Less pains, and less complaints. Is there a relationship between having a diagnosis and the way a patient experiences symptoms? Perhaps a subject of inquiry for my friends the medical researchers.

In the meantime, this is Dr. Mom, signing off.

Until We Teach Them

Remember. 

Today is Yom HaShoah, Holocaust Remembrance Day. Coming so soon after Passover, the holiday that is also about remembering, I am cognizant that for parents, this day is also about teaching. We need to teach our children about the Holocaust, so that they, too, can remember. Until we teach them, they have nothing to remember.

Nothing to remember.

It's strange, isn't it? To imagine living in this world not knowing that six million of your only-two-or three-generations-removed ancestors were callously murdered? But that is what it is to be a kid. You don't know, until someone tells you. 

Bella's initiation happened not by me and not by a teacher, but in that classic educational setting: on the bus home from school. She was in second or third grade; the girl who broke the news was a year or two older. It only took a half hour for her to come home in shock, with mouthfuls of questions about concentration camps and torture, Anne Frank and Hitler. 

I don't remember when I first learned about the Holocaust, but I do remember knowing, as a child, many older people who were survivors. I remember hearing those survivors tell their stories, as guest speakers at my Jewish day school. I remember watching all nine hours of the film Shoah, in my seventh grade Judaic studies class. I remember my eight grade English teacher assigned us to choose and read an autobiography, and then make a presentation in the voice of the author. One of my classmates chose Moonwalk and came to school as Michael Jackson. I chose Alicia: My Story, and came to school as Alicia Appleman-Jurman, a heroic survivor. I identified very deeply with Alicia, and I wondered with fear: could I have survived, as a child alone, the way she had? Always, when I heard survivors' stories, I imagined my family, thrown from our home, degraded and rounded up and marked for murder. Every story was personal.

I remember--I will never forget--visiting the sites of concentration camps Auschwitz-Birkenau, Treblinka, and Majdanek as a seventeen-year-old, with USY Poland/ Israel Pilgrimage. I remember that I expected to cry, and that at first I couldn't cry, and then I cried. I remember that it was horrible and  shocking and unreal yet real, and that all those things felt just right at seventeen, when my life was already full of heightened drama. I remember that I wrote poetry about what I saw, and that some of my friends made art, and that this made us feel affirmed.

I asked Bella, today, if she remembered that conversation on the bus that took place more than a year ago. She did. I asked if she remembered why she was so shaken by it. She told me that she didn't know, then, that there was such a thing as terrorism. It was an interesting answer because for my children--whose entire lives have coincided with the wars in Iraq and Afghanistan; who are used to being patted down in the airport; who learned about 9/11 on the day that Osama Bin Laden was killed--terrorism is synonymous with evil. Bella doesn't understand, yet, about degrees of terror, or about mass murder. 

It's up to me and her dad to teach her. 

Ode to a Childless Bystander

Oh hush, Frank Bruni. I'm sure you're a terrific uncle, but let's face it, it's just not that hard to be an uncle. You take the kids for a few hours, maybe an overnight here or there. You give them some really fab presents and some spirit-boosting pep talks. You probably buy them chocolates.

But being an uncle just ain't the same thing.

You uncles never have to say no; not when it counts. You never have a kid doing whatever they can to wear you down: begging, berating, crying, moaning and then, when you stand your ground (as you tell us feeble parents we never do--but we do, Frank Bruni, we do), have them tell you that you are the Worst. Parent. Ever.

You never have to deal with the middle-of-the-night plagues--the nosebleeds, the vomit, the urine, the shit. Other than your own.

You don't have to be a nurse, a counselor, a teacher, a psychologist, a tutor, an athletic coach, and a life coach every single day, to several different dependents.

This is not a complaint about being a parent. I love being a parent. I don't even mind the bodily fluids.

This is a complaint about a childless bystander judging other people's parenting. His own siblings' parenting, no less. And then, at the end of the piece, the sycophantic creed:

"Cut yourselves some slack. Take a deep breath. No one false step or one missed call is going to consign your children to an entirely different future. Make sure that they know they’re loved. Make sure that they know their place."

I like you, Frank Bruni. I actually enjoy your columns, usually, and find you a compelling writer when you discuss the struggles of your life and the causes that you care about.

But you know what would help us parents, most? Not having people like you stepping out of their place to write columns about everything we parents are doing wrong. And not giving the we're-better-than-you public an outlet to pile on the criticisms in their comments.

Especially as your ideas about authoritative parenting are not new: Wendy Mogel spread a similar message with more compassion in The Blessing of a Skinned Knee back in 2000.

And especially if, as you claim, none of it really matters anyway.