life events

Watching the nest

The return of a mother robin


This spring I was thrilled to have a robin return to the nest on our porch to lay her eggs. I had left the nest there with the hopes of this happening. The nest sits atop an IKEA mirror cabinet and is afforded protection from the elements by virtue of being under our overhang. I was so excited about the creation of the nest last year that my husband installed a little wireless camera so I could watch the whole process unfold. Robin voyeur. Therefore, when I saw robin mom #2 (I would love it if it was the same robin mom as last year, but even I have to acknowledge this may be unlikely) start remodeling the nest, my first instinct was to turn the camera back on and watch from my home office computer.


Soon, we had 4 beautiful light blue eggs.

Gorgeous blue eggs.


A week or so later, two somewhat homely birds suddenly emerged and mom and dad robin took turns literally feeding them all day.


A day or so later, #3 baby finally hatched. I kept looking and only seeing three babies, and kept thinking that maybe this was the limitations of my camera and that somehow #4 was just never in view.

About 10 days after the first births, baby #1 was gone. Baby #2 soon followed. Each would get in and out of the nest a bunch of times, testing the waters (by sitting next to the nest) before flying away for the first time.

Baby #3 hung out a few days longer, befitting his third child status. I grew pretty attached to him and one day walked up and started talking to him as he was in the testing position next to nest. Suddenly, he flew out of the nest right in front of my face. I involuntarily let out a blood curdling scream which brought the mother robin from out of nowhere to protect her progeny. They flew away together to the wooded area of our yard.

Baby #3 getting ready to leave the nest, a day or so before my up close and personal meeting with him.

Recovering my wits, I went in to look at the empty nest from my computer. There it was. Egg #4. Never hatched. I felt kind of sad, but a part of me also chalked it up to nature. This is what happens sometimes, And mom needs to move on and take care of the three that hatched. It’s her job.

The one that didn’t hatch.

The parallels to my own motherhood were not lost on me. Thoughts of my miscarriage 13 years ago as I looked at egg #4 and the robin that would never be.

But other thoughts soon followed.  About how in the robin mom world, babies turn into teenagers in 10 days, and mom has to quickly transition from spending all day feeding them as babies to letting them fly which is literally a leap of faith.

No doubt I am not as good at this as robin mom.  I remember when my kids were little and I felt like every day was testing my mettle, older relatives and friends would say things like “just wait, you think this is hard? Wait till they are teenagers!” or “little kids, little problems, big kids, big problems.” Of course, this was never as helpful as these folks thought it was in telling me these “pearls of wisdom”, but I can’t say it isn’t totally true.

The teenage years of mothering are tough. Even the terrible twos are balanced by lots of snuggles and “I love yous”. Teenage years not so much.

And yet, it is probably the time when your kids may need you the most. A time when feeling as unloved and unappreciated as you do at times, you have to keep going. Watching them like the robin mom as they test the waters and get ready to fly, and helping to protect them from people and things that might be threats (even inadvertent ones like my talking to robin#3).

And so, I will keep on watching, close but not too close. And waiting to jump in in case I am needed. And snuggling my dogs for those times when the hugs from a teenager are few and far between.







kales@umich.eduWatching the nest
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Beyond Valentines: Lessons from my relationship heroes


Today is Valentine’s Day: a day of hearts, flowers, chocolate and the hope for love. In our family, Valentine’s Day was always also a family holiday, where my mom gave each kid their own little gift. One special gift I recall my mom giving to me on Valentine’s Day when I was about 10 was the book “The Secret Garden” with an inscription about how much she loved me. So I grew up loving Valentine’s Day because I felt so cherished.

By the time I got to high school, Valentine’s Day had upped the ante. Some club in our high school had a fundraiser where they sold carnations that people could give to each other: white for a friend, pink for someone you were interested in, and red for someone you loved. Tired of getting all white flowers one year and seeing the cool girls walking around with bouquets in a symphony of pink and red, my friends and I decided to get crafty and give each other the pink and red ones, “signed” by the boys from other schools we were interested in (the boys really existed, but clearly were not clued into Hershey High School’s carnation of love system). I cherish that memory because it demonstrates our ingenuity and a sort of “Galentine’s Day” solidarity before that was a thing.

My friends Jocelyn and Chantal and I did Galentine’s Day without knowing it.

As an adult, Valentine’s Day continues to be a family holiday for us. I plan to give each of my kids a little something today. But alas, my husband is away on a work trip this week, so in a sense, I find myself in the carnation situation again. After almost 25 years together, it is ok, because our love is more than hearts, flowers and chocolate (although Pat if you are reading this, flowers would be nice. They do have phones and the internet in Minnesota).

It gets me thinking about marriage and how to get it to last, it has to be more than the Valentine’s Day stuff which while heady and exciting, will not get you through the hard times. And in any marriage, there are hard times. So for Valentine’s Day, I thought I would ask five couples who are my “relationship heroes”, people who have great loving relationships after many years, how they do it. What I love about their answers is that, while each is a bit different, you will find common themes embedded.

Dr. Ling and Betty Tan: The Tans are ethnic Chinese who emigrated from Indonesia in the 1960’s to the US. The Tans have been married for 56 years, years that included Ling’s stellar success as a physician and Fulbright Scholar in his 70’s as well as the tragic loss of their beloved son Bobby 25 years ago. Through it all, the Tans have retained their love, faith, compassion and common interests (they are avid ballroom dancers). They are my relationship goals for their easygoing presence with each other as well as everyone they meet.

Helen: Dr. Tan, I am writing a blog post about beyond Valentine’s Day. Any thoughts about how you and Betty have sustained marriage through life’s ups and downs?

Ling:  Helen, this is a question that’s not too easy to answer. I guess most of it just happens naturally or perhaps instinctually. But like in all enduring relationships, a good compromise is necessary, where the process of give and take, or push and pull consistently apply. Certainly love and patience help quite a bit. To be respectful to one another, show loving kindness and thoughtfulness, generosity and gratefulness, and have the capacity to forgive are all important ingredients to a sustained marriage.

Helen: One more question, any wisdom on handling fights?

Ling:  As a husband I always follow the two rules: Rule #1: The wife is always right.  Rule #2: When in doubt, quickly go back to Rule #1.  As a wife, you always allow the husband to have the last words, which are “Yes dear”.  Whatever the fight was about, always make up before sleep.

Ling and Betty on their wedding day 56 years ago and today.

Drs. Tony and Joyce Kales: Full disclosure. These are my parents. I have written about them quite a bit, but in a nutshell, they were famous psychiatrist-researchers who had three wonderful and fantastic (especially the middle one) children. Their ups and downs included many career successes as well as some personal losses including the premature deaths of each of their brothers. They share a faith, with Joyce having become Greek Orthodox later in their marriage, and a passion for all things family, and have been married for 55 years. They are my relationship goals for their steady commitment to family.

Helen:  I am writing a blog post about beyond Valentine’s Day. Any thoughts about how you and Dad have sustained marriage through life’s ups and downs?

Joyce:  We believe in perseverance (stick with what you know is right), love (of the type described by St. Paul) and hope (this too will pass). We pray together. We try not to dwell on problems, but on solutions as in “don’t complain about the darkness, but light a candle instead”.

Helen: One more question, any wisdom on handling fights?

Tony:  When you are really angry, you start not to think clearly. As Dick Vitale used to say during basketball games, that is when you “need to take a T.O. (time out) baby!!

Tony and Joyce surrounded by their kids and grandkids.

Lynn and Tim Holland: Lynn was my daughter Tasia’s preschool teacher from when she was a baby to when she was in kindergarten. As such, Lynn became a friend and part of the family as did her wonderful husband Tim. Earlier in their marriage, the Hollands sustained tough times with the help of counseling and stayed together and have now been married 36 years. They are my relationship goals for a couple who are truly best friends and enjoy each day together in wonder and laughter.

Helen:  Lynn, I am writing a blog post about beyond Valentine’s Day. Any thoughts about how you and Tim have sustained marriage through life’s ups and downs?

Lynn: Haha. We are arguing about what to say!! So, having a sense of humor and being kind to each other. Turning towards the other person. Tim says putting each other first and gratitude. We also spent a lot of time and money on therapy. Couples and individual. For when you hit those speed bumps of life.

Helen: One more question, any wisdom on handling fights?

Lynn:  We always say, fight fair and fight in the present. Don’t dredge up the past.

Lynn and Tim, living their dream on a daily basis.

Karen and Angelo Ialacci: Karen is my cousin and she and Angelo have become the hub of my generation of my big fat Greek family (Angelo has his own big fat Italian family, so he gets it). They are in business together, running numerous pizza franchises. They have also weathered the illnesses and surgeries of their children, always together, always with grace and humor. They have been married for 30 years and are my relationship goals for a couple who is always keeping each other laughing and retaining a positive outlook despite whatever curveballs life throws at them.

Helen:  Karen, I am writing a blog post about beyond Valentine’s Day. Any thoughts about how you and Angelo have sustained marriage through life’s ups and downs?

Karen: We believe marriage is a forever thing. You don’t enter into marriage thinking it may not work out. It’s important to choose the right person. We definitely laugh a lot and give each other the space we need. That’s kind of hard because we are together 24/7, but we enjoy each other’s company.

Helen: One more question, any wisdom on handling fights?

Karen: I let Angelo win! LOL. Or at least he thinks he’s does. If we are in a real heated argument, we each go to a corner to cool off and meet back and talk, but we always get through it.

Karen and Angelo, partners in pizza and in life.

Lauren and Rich Grubb: Rich was in my high school class (Hershey High Trojans ’83!) and married Lauren who is the younger sister of another classmate. I became reacquainted with Lauren on Facebook where I have grown to greatly admire her approach to life and her marriage to Rich, which is one of the most solid around. Notably, Lauren sustained a traumatic brain injury four years ago in a car accident and lives daily with the consequences including severe migraines and memory loss. After 30 years of marriage, she and Rich continue to create a beautiful life with their three daughters, and are my relationship goals for their continued devotion to each other and their commitment to celebrating the small moments each day. As you will see in her responses below, despite her TBI, Lauren is also one of the most eloquent writers I know.

Helen:  Lauren, I am writing a blog post about beyond Valentine’s Day. Any thoughts about how you and Rich have sustained marriage through life’s ups and downs?

Lauren: I think when you love someone, you find a way to work through the highs and lows. In sickness and in health – these wedding vows have been our test of our marriage these last four years. The easier thing for sure would be to just give up. So many times I say to Rich, just go, be free of all of this with me, but he always says in return “um ya no, that’s not an option, next?”…which makes me feel special despite my deficiencies.

Communication has always been key for us. We have a rule that if something is bothering us we talk about as soon as we can.

Our faith too motivates us to not give up and is our foundation that we built our marriage on.

Taking time to make US the priority, by having date nights, giving little surprises, get aways, walks, slipping uplifting notes in lunches, inspirational quotes or just a thank you or an I love you by text in the middle of the day can recharge the mundane. These are all essential ingredients to our marriage. The unexpected spontaneous moments keep life fun too. Not everything needs to be planned.

Hugs. Hugs and more hugs. Never enough hugs. A hug is saying ‘hey I got you and I’m not going to let you go at it alone’. We are a team and team’s only are a team if we all are working towards the same goal.

Our goal is to be together as long as life allows. I definitely married my best friend. He makes me laugh with his silly moments. I feel fortunate but marriage is still not easy. But we aren’t promised easy, or even happiness, and knowing that makes the work that goes into a strong marriage worth it all in the end despite the tough trials that come with this journey.

Helen: One more question, any wisdom on handling fights?

Lauren: Life is about choices. Marriage is about choices. Compromising is a way to agree on decisions.

Lauren and Rich, then (1985) and now

So there you have it. Enjoy the flowers, chocolates and hearts today. But to get beyond Valentine’s Day, consider the advice of these relationship heroes.

kales@umich.eduBeyond Valentines: Lessons from my relationship heroes
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How to Age to 100: Family, Friends, Faith, Forests, and Football

For this post, I have a guest contributor, my husband’s stepmother Georgiann Gibson. Georgiann is a positive ager herself, retired and traveling the world with my father-in-law Pat. She has written a wonderful post in honor of Pat’s mother, Helen Gibson, who will turn 100 this week. Helen is an amazing woman who has a singular outlook and approach to life. Georgiann encapsulates it so well in her 5 F’s (Family, Friends, Faith, Forests and Football). Enjoy!

My mother-in-law will celebrate her 100th birthday this week. Among her many blessings is a loving family, some of whom live close-by and see her regularly, good health and a strong mind (albeit somewhat challenged in the short-term memory department lately).  When I think of Helen and how she has aged so well, a few of the words that come to mind are family, friends, faith, forests and football. Family, friends, and faith?  Pretty straightforward. Forests and football?  I’ll get to that.

Born at home near a small Nebraska town to an Irish-Catholic family (the O’Rourkes), Helen grew up on a farm with three sisters and two brothers. She rode to school on a horse and was educated in a one-room schoolhouse.  Whip smart, at a time when only about 30% of Americans graduated from high school, she graduated early, at the age of 16. Her graduation class had 30 students.

Helen as young woman

Helen as young woman

After graduating, she moved into town where she worked at a jewelry store for a salary and tended the owner’s family for room and board. Money was usually not in great supply during much of her life; she learned to use it wisely and save for things that meant the most – like a move west to marry her husband “Hoot”. That decision to move to Idaho showed Helen’s willingness to take well-reasoned risks and her sense of adventure. It was a good decision that led to a wonderful life.  (An interesting aside: One of her brothers married Hoot’s sister and several of the offspring in each marriage look enough alike that they could pass for twins.) Her family members were friends, and her friends were held dear and treated like family.

Life was not perfect for Helen and Hoot. Like all families, they had their share of ups and downs – tight financial times, family members dealing with and eventually overcoming alcoholism, and a young daughter with polio, to name a few. They differed politically too; Hoot (a staunch Republican) used to jokingly ask Helen (a life-long Democrat) why they even bothered to vote because they each only “canceled each other out”. But most issues were overcome with prayer, respect and support for one another and hard work. Disappointments and failures were taken in stride.

Helen now has 14 grandchildren and 26 great-grandchildren. Until very recently, Helen was the central hub for information related to what was going on in the family as while some of her kids and grandkids live close-by, many are now scattered across the country, and even world.  She liked to know the latest news everyone had to share and always kept track of where her ‘kids’ were.

The extended Gibson clan at the last family reunion

The extended Gibson clan at the last family reunion (Helen is fourth from left in first row)

Helen has led an active life. Raising five kids and running a farm while your husband works tends to keep one active in its own right. And, as if that wasn’t enough, she also worked a part-time job for a while to help save enough money for Hoot to buy a business. Like many moms, she took her turn leading cub-scout troops, coaching baseball and guiding 4H projects. She also headed the Ladies Auxiliary for the Meridian Race Track and coordinated efforts for the local Heart Fund. After her husband died, she began her many years as a volunteer working at the St. Vincent De Paul Thrift Store. She developed quite a reputation for restoring donated rusty cast iron pans to like-new condition, and was loved and admired by all who worked with her. She was on a bowling team until the age of 89 (when she quit because she felt that her score was no longer “up to snuff”) and, until two years ago, was still driving herself to church, doctor appointments and the grocery store. She was able to continue driving because she demonstrated good judgment and limited her driving to daylight hours, short distances and safe road conditions.

Always a devout Catholic, her faith and devotion to her church grew even stronger over the years. She was a long-standing member of the Altar Society and rose through the ranks to their presidency. She volunteered for her church’s Perpetual Adoration service ministry and for many years she attended mass twice a week. Her faith is linked to a uniquely strong sense of positivity. She is the most positive person I know.  She is content with her life, she never complains, and she is always grateful for her many blessings.

Helen owns a very rustic cabin located in the Sawtooth National Forest, hence, the “Forest” reference. The cabin is small, simple, and like her, is treasured by the family. Whether hiking, fishing, tossing horseshoes, relaxing on the deck with a good book or engaging in a “friendly” (read cut-throat competitive) card game, there is something for everyone to savor. The cabin is nestled in a small dale among giant Ponderosa pine trees, sage and wildflowers. Deer frequent the salt-lick and hummingbirds flutter around her geraniums. Only an occasional bear is sighted in this, their natural home, which we share. The cascading water in a nearby creek provides a soothing auditory backdrop, and, as always, being in nature heals the mind and nourishes the soul. It is a little piece of paradise and one more thing that binds the family generations together.

Now, how does “Football” fit into the description of a 100 year-old woman? For many years she, along with most of the Gibson clan, has loved watching football–it is almost a second religion to them.  And of course, given her religious affiliation, she has always had an affinity for Notre Dame’s Fighting Irish. Watching college football is one activity that binds her family together through the generations. Everyone claiming their own favorite teams has created both friendly rivalry and camaraderie. Now she keeps up with most games on TV, but until just a few years ago, each fall she attended a Notre Dame football game with her daughter’s family. Braving cold and snow, she rooted in person for “God’s Team.”

Living to be 100 years old is quite an accomplishment. To reach 100 with most of your mental faculties in tact and relatively good health is like gold dust. Is it luck? It’s hard to deny that luck doesn’t play some part. Is it good genes? Surely, inheriting good genes is key. But there is more.

Helen has lived an admirable life of hard work, strong values, love, and commitment to faith and family. With her positive outlook, she has continued to serve others until later in life, maintaining interests and participating in physical and mental activity. In five words: family, friends, faith, forests and yes, football. Happy 100th Birthday Helen!

Helen now

Helen now

kales@umich.eduHow to Age to 100: Family, Friends, Faith, Forests, and Football
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The Power of “I don’t know”

My team and I recently had the privilege of attending a course on “Lean” management in healthcare. In a nutshell, Lean is the idea of making work processes visible and understandable, digging deep to find the root causes of problems, making incremental changes to the processes, and then evaluating the effect on the results. Note that I didn’t say “jump to a solution”. We admit that WE DON’T KNOW WHY something is happening. Sounds simple, but it is deceptively hard.

Three examples:

Example One: During our Lean training, our course leaders craftily immersed us in a “Lego Emergency Room” simulation for the first two days. My team was “Team 4”. Team 4 had 8 people who were assigned a job (e.g. registration clerk, triage nurse orderly, ER doc, lab tech, etc). Our overall goal was to get 15 lego patients thru an ER process at different sites (tables).

DSC05382s2Our first run was a spectacular failure. Broken Lego patients, a long waiting room line and loss of money. We only got 1 patient through the process intact. The facilitator came to our group and in debriefing asked us what we thought we needed. “More doctors!!” we cried! “It’s obvious that doctors are the rate-limiting step!”.

However, over the next day as we dug deeper into understanding the process, mapping it and looking at root causes, we discovered that counter to our strongly held biases and assumptions, the rate limiting step (bottleneck) was actually…..CLEAN ROOMS! Meaning our ability to efficiently and effectively evaluate and treat patients in our ER was limited not by our single doctor and his/her speed, but in our ability to have a clean room ready to receive a patient.

Long story short, we eventually caught on and fixed it and we began to transform our ER. A real AHA moment and we couldn’t have had it until we put aside our assumptions and admitted we DIDN’T KNOW why our Lego ER was a mess.


Example Two: A big part of my job right now is teaching doctors, other healthcare providers and family caregivers to say I DON’T KNOW when it comes to behavioral symptoms of dementia (agitation, anxiety, wandering, inappropriate behaviors, etc). Many of these folks will see a behavior like agitation and prescribe (if they are a doctor) or ask a doctor (if they are not one) to prescribe a medication. That’s where unlearning this assumption (difficult behavior=need for medication) comes into play. Just like in our ER simulation where we thought the answer was more docs and it turned out to be clean rooms, often the “answer” to a behavior like agitation is found not in a medication, but in figuring out the root cause of the behavior: a urinary tract infection, boredom, an overstimulating environment, etc. But before we can figure out the root cause, we have to convince doctors and others that they need to admit that they DON’T KNOW why a behavior is occurring and start brainstorming the possible causes. In many cases, if we assume any behavior is a “medication deficit”, we miss understanding the actual cause and being able to correct it.


Example Three: This one is personal. Eleven years ago, my son Theo was born. He was born two weeks early (a scheduled C-section, since I had 2 “failed” vaginal births with my girls). To our surprise and terror, Theo “went blue” shortly after delivery, just after we had arrived in our room. He was whisked out of my arms into the Neonatal ICU. There, he spent two weeks where they tried to figure out why he had apneas AND a club foot with zillions of tests including brain scanning. All negative. This one is harder, because despite a lot of effort, unlike in the Lego ER, the team couldn’t find a root cause. So, one doctor (who will forever live in infamy in our memories) told us that Theo probably had some type of neurological syndrome (he wanted to tie together the apneas and club foot) and would likely have developmental problems, but “not to worry” because “there are special schools for those children”. We were of course, devastated. About a week later, our wonderful regular pediatrician appeared at Theo’s bedside. She looked us in the eyes and said “We don’t know why Theo is having apneas. Another possibility is that he needed more time in utero. Instead of 34 weeks, maybe he needed 38 to fully develop. The club foot may be unrelated. But the bottom line is that Theo will tell us what he needs and we will follow his development and go from there”.

The breathing issues resolved within the next month and Theo thrived and developed. As with any child, there have been bumps along the road (he will never be a track star because of his corrected club foot), but the bottom line (eleven years later): Theo just “graduated” from fifth grade with A’s in most of his subjects. He is a little engineer who can take the most complex lego set and build it in an hour. During the past 11 years, at times, it’s been hard for me because the words the neonatologist uttered have been imprinted at the back of my mind. I have had to watch Theo’s lovely mind and personality unfold NOT knowing automatically that all would be ok.

My beautiful boy.

My beautiful boy.

But in the end, isn’t that true for all of our lives? We never really have any full reassurance it will “be ok”. We have to go about our daily existence not fully knowing and dealing with whatever we are dealt.

Despite these experiences, sometimes, it’s still can be really hard to say I DON’T KNOW. Especially for a doctor. I have to stop myself all the time. We are expected to have all the answers. But often it is the best first step. And often, like our amazing pediatrician,  the best gift you can give a patient or family is to say, “I am not sure. Let’s figure this out together.”



kales@umich.eduThe Power of “I don’t know”
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Soon I’ll be 51 years old…

Theo is now eleven and big enough to ride in the front seat of the car. From there, he mans the XM radio like an Ibiza DJ spinning on multiple turntables. His favorite song right now is the beautiful “7 years” by the Danish band Lukas Graham. We heard it on the way to church yesterday and I was struck about the life stages it discusses. Cause duh….geriatric psychiatrist brain can’t be turned off. But also because tomorrow is my birthday. Fifty-one big ones. And surprisingly I feel pretty good about it. Not 7 years old good, but certainly not 49 years old dreadful.

So indulge me on an autobiographical “This is my life” using the lyrics from “7 Years”.

Once I was 7 years old, my mama told me,
Go make yourself some friends or you’ll be lonely,
Once I was 7 years old

It was a big, big world but we thought we were bigger
Pushing each other to the limits, we were learning quicker

Me with my Dad and older brother at 7. Cute and pretty optimistic about the future.

Me with my Dad and older brother at 7. Cute and pretty optimistic about the future.

Here’s me at 7. Just moved from LA to the bucolic town of Hershey where my physician parents had jobs at the new Pennsylvania State University Medical Center. I was learning cursive at the time and recall that my favorite signature was “Helen the Great”, indicating that I had not been yet been knocked down by life (that was coming soon, see 11 years old). A pretty sweet time in life.

By 11 smoking herb, and drinking burning liquor
Never rich so we were out to make that steady figure

Once I was 11 years old, my daddy told me,
Go get yourself a wife or you’ll be lonely
Once I was 11 years old

I always had that dream, like my daddy before me
So I started writing songs, I started writing stories
Something about that glory, just always seemed to bore me
‘cus only those I really love will ever really know me

So, here’s where Lukas Graham and I diverge. I didn’t even know what herb or burning liquor were at eleven. I had moved into a really geeky stage (by 13 the transformation was complete: Dorothy Hamill haircut AND ginormous glasses AND braces). Thank God for my best friend Jocelyn for getting me through that period with inside jokes SO funny that I would almost pee my pants on bus rides to and from school.

Ah yes. Most awkward time of my life. Here for you. Immortalized.

Most awkward time of my life. Even the kitten knew it.

This period lasted for three long awkward years. Finally, I emerged from my giant cocoon in 9th grade, shucking my glasses and braces, new perm (YAHSSS. That’s right, a PERM bitches!), and some loss of baby fat. I was told by one of the popular girls that they “were all talking” and thought I had “the best butt in school” (not gonna lie, this declaration may still be one of my greatest achievements). But (again unlike Lukas Graham), my dad (an uber-protective Greek father) certainly wasn’t goading me to have a boyfriend. In fact, he blocked my first date in 9th grade (to see the Steve Martin movie “The Jerk”) to my ultimate devastation. The boy in question quickly moved on and the heartbreak I felt was awful. I still remember the first (but not last) time of  feeling that black, bleak feeling, never having felt so unhappy before.

Me and my brothers. I am fourteen. Hard to believe this is the same person as above, right?

Me and my brothers. I am fourteen. Hard to believe this is the same person as above, right?

I moved onto some relatively successful teen years (not Molly Ringwald in the Breakfast Club-successful, more like Molly Ringwald in Pretty in Pink-successful), finding a sport I loved (cross country), my first kiss (age 16, remember I had my dad watching me like a Greek hawk, so give me a break. And in an “only in Hershey PA moment”, it was in the Kissing Tower at HersheyPark. With a college boy that I was in luuuuurve with. Pretty nice, right?!).

Once I was 20 years old, my story got told

Before the morning sun, when life was lonely
Once I was 20 years old

I only see my goals, I don’t believe in failure,
‘cus I know the smallest voices, they can make it major,
I got my boys with me, at least those in favour
And if we don’t meet before I leave, I hope I’ll see you later

Once I was 20 years old, my story got told
I was writing about everything I saw before me
Once I was 20 years old

Med school buddies weekend in Quebec. Such good times.

Med school buddies weekend in Quebec. Such good times.

I like that the “meat” of the song is about the twenties. My twenties were a pretty amazing time. Looking back, it’s where most of set up to the action happened. Initially, being at college (Bucknell University) was tough for me having been pretty sheltered growing up and fighting some nasty anxiety issues. But I hit my stride towards the end of sophomore year with some wonderful friends, a boyfriend and a Spanish lit/language major. Finishing college, I got into several medical schools including University of Pennsylvania. I went with my gut (a pretty consistent theme in my life and one I am proud of) and selected a lesser ranked (but stellar and perfect fit for me) medical school in upstate New York, the University of Rochester. U of R was an incredible place and shaped me in ways that I continue to discover and appreciate. I continued my up and down/on and off relationship with my college boyfriend for 7 years. The ultimate breakup during medical school was painful but necessary.

Me and my mom during my intern year in my first apartment in Ann Arbor.

Me and my mom during my intern year in my first apartment in Ann Arbor.

Moving to Ann Arbor saw me and my crazy half-Siamese cat Samosa (RIP buddy. LOVE you. Hope you are stalking people’s calves up in heaven) in my own apartment. I shake my head in wonder at my stamina at that time, working like a dog as an intern on my medicine and neuro rotations and going out to the Nectarine till the wee hours whenever we could. Several of my co-residents and I became best friends and remain so to this day. In fact, one introduced me to my future husband Pat during a fateful evening at Gratzi. Pat is a logical engineer with a near-photographic memory for facts, but with a twist. He has incredible people skills and charm. I had grown up with a dad who was an intellectual and when something went wrong in the house, we heard, “Call the man!” (the “man” being a code word for whomever could fix whatever was broken). To meet a guy who was cute, funny, smart (national Merit scholar) and who could also hang dry wall and fix anything? I was hooked. We got married two years later in a big fat Greek wedding (you think I am kidding? The Greek band my Dad hired knew only one English song. So guess whose wedding dance was “Tonight’s the Night”?).

The first of MANY Halloweens together as Kurt and Courtney

The first of MANY Halloweens together as Kurt and Courtney

Soon we’ll be 30 years old, our songs have been sold
We’ve traveled around the world and we’re still roaming
Soon we’ll be 30 years old

I’m still learning about life
My woman brought children for me
So I can sing them all my songs
And I can tell them stories
Most of my boys are with me
Some are still out seeking glory
And some I had to leave behind
My brother, I’m still sorry

Pat and I with Tasia (age four) and Sophia (age one)

Pat and I with Tasia (age four) and Sophia (age one)

In our thirties, we had our three kids. Somehow, we felt like we had all the luxuries of time and we spaced them out quite a bit (Tasia when I was 32 ,Sophia when I was 35, Theo when I was 39). A miscarriage at 38 was one of the saddest times in our lives. But it also changed us in good ways; before that I was always eager to move the kids onto the next stage, it slowed me down and gave me an appreciation for what I had. We undertook new challenges when Theo was born with breathing problems (which resolved) and a club foot (now treated). Those challenges triggered a post-partum depression for me. It was a difficult time but resolved thanks to good treatment and unflagging support from Pat and my parents. I came out the other end and resolved to let the experience make me a better doctor, wife and mother.

In my work life, I was able to move through an academic career, attaining tenure in my early 40’s but not without a lot of teamwork from my husband who is a true supportive (and tolerant) partner and my parents who have provided pretty seamless backup over the years. To wit, my Dad assumed the role of “chief toilet paper and paper toweling replacer” with aplomb. I have a small group of really close friends whom I love dearly (can make me laugh till I almost pee my pants…and Jocelyn is still among them). Adopting two big rescue dogs has added another ring to the circus, but mostly in a good way.

One of my favorite pics of the whole gang. An outtake because Theo was pinching Tasia.

One of my favorite pics of the whole gang. An outtake because Theo was pinching Tasia.

Soon I’ll be 60 years old
My daddy got 61
Remember life and then your life becomes a better one
I made a man so happy when I wrote a letter once
I hope my children come and visit once or twice a month.

Soon I’ll be 60 years old
Will I think the world is cold,
or will I have a lot of children who can warm me
Soon I’ll be 60 years old,

Tomorrow, I will be 51 years old. I feel good about where I am. Right now, I am trying to figure out my third act. I have been approached a number of times about becoming the Chair of a Department. Will I do it? Maybe. Maybe not. But the figuring it out is fun and I am learning from it. I look forward to grandchildren someday. And sooner than that, I am starting to not dread the empty nest that will be here when I am in my late 50’s.

Pat and I were alone over the weekend (with Tasia at college, and Sophia and Theo at sleepovers). We actually had the chance to just spend time together. What I think of as “oh yeah, I really like you” time. While we bicker and spar like Rockem’ Sockem’ Robots pretty often, we also repeat the “Cars” Mater and Lightning McQueen quote to each other: “I knowed I made a good choice” “In what?” “My best friend”.

I knowed I made a good choice in my best friend.

I knowed I made a good choice in my best friend.

Once I was 7 years old, my mama told me
Go make yourself some friends or you’ll be lonely
Once I was 7 years old,

Once I was 7 years old.

Thank you Theo for introducing me to “7 years” and triggering my retrospective birthday blog!

kales@umich.eduSoon I’ll be 51 years old…
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Say goodbye to your latency-aged child and say hello to your tween!


New morning rules. Note odor control is number one.

It happened this morning. I shared the list of rules that I had made up for Theo, our eleven year old son, with my mom. “Say goodbye to your latency aged child and say hello to your tween!” she chirped over the phone from Florida. (For those who aren’t psychiatrists or raised by two of them for that matter, latency age is the lovely, sunny stage of personality development, extending from about four to five years of age to the beginning of puberty.)

She’s right dammit. My always positive, full of hugs little boy is gone. The one who:

  • Would say he looooooved me so much when he was a toddler that my husband was known to say sarcastically “Yes, Theo, we KNOW. You LOVE mommy. Mommy loves you. Everybody loves everybody”.
  • Thought my singing in the car was awesome.
  • Would hold my hand. Anyplace, anywhere.
  • Could have two teenaged sisters fighting to the death in the background and would be oblivious.

Theo, age four

In his place, is a tween. A tween who:

  • Gleefully informed me the other day that he has “two hairs under each arm”.
  • Smells like an old-timey dockworker when he comes home from school (so…the Axe antiperspirant and footspray on the list).
  • Has made talking back into a new art form. Me “Stop talking back.” Theo “I’m not talking back” Me “You just did” Theo “No, I didn’t”. Ad infinitum. Not to forget the closely related: Theo “Stop yelling at me” (while yelling). Me “I am not yelling” (irritated but measured mom voice). “Telling you something you don’t like is not yelling”. Theo “You’re yelling again” (while yelling).
  • Couldn’t be found by his college freshman sister the other day in Walgreens. Was located by the magazine section. Wide eyed. In front of the Sports Illustrated swimsuit issue.
  • Adores swearing so much that facing a punishment for using bad words, invented his own new swearword (a form of “heck”=”hecken”. As in “what the hecken heck?”). We had to put our foot down when this escalated to “mother hecker”.

Theo, age eleven. Proud inventor of “hecken heck”.

And yes. I know he has to grow up. But he is my last child. The one whose every stage has been a “that’s the last time, I will ever…..”. At fifty, I certainly don’t want another baby. And given that my eldest is eighteen, I certainly am not ready for grandchildren. Another dog? I know another mom who has adopted a new dog every time one of her kids went off to college. My husband would head for the hills like one of those cartoon characters jumping through a wall and leaving only the outline of his fleeing body.

So, it’s happening. I have a more hairy, smelly, newly interested in girls, foul-mouthed version of my beloved Theo.

And there’s nothing I can do about it. Except to make sure that the Axe and footspray are applied early and often. But it is comforting that at the end of the day (when he is really tired), I still get to hear “Good night. I love you Mom.”

Postscript: I shared the blogpost with Theo who commented “I liked it when you said ‘dammit’”.

kales@umich.eduSay goodbye to your latency-aged child and say hello to your tween!
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