Editor’s Note: This article was published on September 8, 2021, at NEJM.org.

Perspective

Peak Moments — When Kindergarten Is High Risk

List of authors.
  • Sasha D. Mallett, M.D., M.P.H.

Article

Before my son left home on the first day of school, I took his photo — attempting, like generations of parents before me, to hit the “pause” button on life for a few seconds, capturing the start of a new chapter of childhood. The photo contained 5 years of excitement and anticipation that led up to this point.

But it also captured another reality: the relief of having made it safely to this milestone and the fear of what lies ahead. Beneath the surface of this seemingly normal childhood experience was an anxious mom, hopeful that this new beginning does not cause an end. As an immunocompromised mom living during a pandemic, I know that my child’s daily experiences and my health are inherently held in tension. It is an unfortunate facet of my life that allowing my son to have the full range of childhood experiences — going to preschool, playing with friends — will, at times, result in a decline in my health. Sometimes this decline is minimal and temporary, other times it’s enough to warrant additional treatments or time off work; but with Covid in play, I fear it could be worse.

My son’s entry into this world was traumatic and scary — we both came within moments of death, but thanks to swift action by my Ob/Gyn and the hospital team, we narrowly escaped tragedy. After 36 hours of labor, my uterus unexpectedly ruptured, and we were rushed to the operating room for a 3-hour surgery that saved our lives. I remember lying in my hospital room, as my body was slowly recovering and my son was in the NICU, and thinking, “I hope he goes to school one day.” I daydreamed about a future in which I had a contemptuous, ungrateful teenager who wanted nothing to do with me.

In the months that followed, I was diagnosed with several chronic illnesses: an autoimmune disease called Sjögren’s and a rare immunodeficiency called CVID (common variable immunodeficiency). As a result, I don’t make antibodies and cannot fight infection or mount a response to vaccines. If you made a list of illnesses not to get during a pandemic, CVID would probably be near the top.

They say that a near-death experience can crystallize the fragility and preciousness of life. Our brush with death, my development of life-limiting chronic diseases, and now our experience living through a pandemic have all been scary and sad. But they have also left me with an appreciation for the routine aspects of our daily life. The quotidian tasks of brushing my son’s teeth, arguing over bath time, prolonged bargaining at bedtime — none of these moments would occur if neither of us were here. Though not immune to parental frustrations or day-to-day exhaustion, I appreciate that life is delicate, like a house built on stilts: the foundation isn’t terribly sturdy, but the view still feels worth it. I remind myself to take in the beauty by whispering “peak moment” when I experience a simple pleasure: reading a bedtime story, taking a family poll about what type of birthday cupcakes to make, rushing in for a hug when my son gets hurt. Murmuring these words reminds me that our lives are just a collection of moments.

At the end of February 2020, my illnesses dragged my family into strict lockdown when Covid hit our area. Since that time, we haven’t been indoors with any human who doesn’t live with us, had any food prepared outside our house, entered a grocery store or restaurant, or touched anyone besides one another. We haven’t seen most members of our extended family, taken a trip for leisure, or participated in any “reopening.” Everyone has “risk dollars” that they get to spend during Covid, but we each had a different starting balance; mine was a lot lower than those of other moms I know, so we’ve been extra cautious.

The decision to send my son to school is thus a full 180 from the ultrarestricted lifestyle we’ve grown accustomed to. Though I know there’s been significant debate about the safety of reopening schools, I remain hopeful that I’ve made the right choice in spending my risk dollars this way. We can’t remain in this tuck-and-hold posture forever. Pandora’s box has been opened, and Covid is well on its way to becoming endemic. Our task now is to find ways to move forward with some semblance of normalcy, acknowledging that the risk–benefit calculus of our lives may never look the same as it did before the pandemic.

The past year and a half has been a time of estrangement — from the lives we once knew, the closeness of friends and family, and the places we used to inhabit. But for our family of three, it has also been a time of deeper connection and attunement with one another. Were it not for Covid, I would have continued to go to my full-time job outside our house, seeing my son for those harried few hours encompassing dinner and bedtime. While I had the privilege of transitioning to virtual work at the outset of the pandemic, I also scaled back to accommodate life without outside child care providers. For the first 14 months of the pandemic, before there were vaccines, my husband and I reconfigured our work schedules so we could both continue working with zero child care assistance. It was exhausting, but I treasure the closeness it gave us. It turns out that even after so many months of spending every day together, I still care deeply about how my husband and son spend their days and how they’re feeling. My son’s entering kindergarten marked the end of this conjoining of our daily rhythms.

All parents in our society must eventually face the truth that raising a child and creating an environment in which they can flourish sometimes requires letting go of a piece of oneself. Becoming a parent means giving up our bodies as we’ve known them, our sleep, our time, in exchange for one of life’s greatest rewards: the beauty of watching and supporting another living being as they grow in this world. I wish I didn’t have to face this Sophie’s choice and that my son’s experiences weren’t pitted against my physical health. I wish I weren’t the only mom I knew who had updating their advance directive on their back-to-school to-do list. But if I had it to do all over again, I would.

So before he entered kindergarten, I had conversations with my son about the importance of adhering to Covid safety measures. Remarkably, like many kids his age, he’s taken to these precautions with light-hearted indifference and laudable alacrity. It’s no big deal, Mom, this is just how we do things now. One thing this pandemic has taught us is that, by and large, children are more resilient than we give them credit for. Their ability to roll with fluctuating rules and restrictions offers a lesson in parenthood: that children have much to teach us about resiliency and adaptation to an ever-changing environment.

As I photographed my son on his first day of school, I embraced the normalcy of the experience. But I also carried the weight of concern that lurked in the background. I hope I get to continue to experience life’s peak moments and my son’s ordinary milestones for years to come. I hope I will live long enough to look back on this photo decades from now, much as I still gaze at the photo of me holding him for the first time. I imagine it will take on a similar luster — of consummate relief, joy, terror, and a deep appreciation for normal events.

So I offer this plea to my son, the universe, or any other parties that may be in charge: please, send him home each day with his backpack full of craft projects and letter-writing exercises. Send him home with insights about the world, new friends, and a willingness to share. And if it’s not too much to ask, please do not send him home with Covid. I worry that the mechanical parts of me that have been fighting so hard for years to remain intact might finally break, and if possible, I would like to continue being his mom for a good while longer.

Funding and Disclosures

Disclosure forms provided by the author are available at NEJM.org.

This article was published on September 8, 2021, at NEJM.org.

Author Affiliations

From Kaiser Permanente Northwest, Portland, OR.

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