identify that medical equipment, question mark edition




Most of the time when I see a piece of medical equipment, I can appreciate if it looks weird, even if I know what it's used for. And then sometimes I see something, like this pile of stuff outside the cardiac ORs, which leaves me completely mystified. I have been trying to figure this one out for weeks.




Can someone please tell me how this is not an eggbeater?
working through my working mom guilt





I'm going to be working late this upcoming week, which means that I probably won't be home for dinner at least four of the five nights. So I made some food for the kids. A lot of food. I stockpile food like it's love. Soups, stews with lots of vegetables, pastas of various sizes to accommodate differential mastication ability, and tons of washed, cut fruit. Healthy food. Mom food. I think I do this to make myself feel better. What I will lack in time this week I will make up for with fastidiously labeled Tupperware.
harshing your mellow

So since it was the end of Cal's big week, we let him choose where we were going to have dinner. The choices were:

  1. Vietnamese food
  2. Pizza

Guess which one he chose?




Man, that was the worst pho I ever had.

I know everyone complains about what their kids will eat, but you know, I feel like Cal had a much more varied diet back when we lived in New York. Sure, part of it is probably his age (he's just so much pickier now, he likes chicken but not when it's cooked that way and not with that kind of sauce and not with those green things on top and I don't like those black dots etc. etc. until you just wish that food came in pill form or at least in some form of suppository) but part of it is probably also that there's just not as much day-to-day variation in the food available. Yes, I know that I could just cook all sorts of different foods at home for Cal, cuisines from all different lands, and then he would have to be exposed to it...but that would involve me cooking. Me. COOKING.

Ah well, at least Mack will still eat anything.




(I know that me showing you a picture of a kid eating pizza isn't exactly evidence that he'll "eat anything," but trust me, there is nothing that he won't cram into that gaping maw of his. Edible or not.)

The pizza place we usually go to around here (I know in New York there are a billion different choices--insert obligatory "Ray's Original Pizza" joke here--but in Atlanta we've only found one place that makes a halfway decent crust) is a franchise called "Mellow Mushroom Pizza." I know that totally sounds like some sort of bong shop, and I thought I was reading too much into it as well the first time I heard that name. However, let me assure you that your first instincts were correct, and whoever opened the first of this chain of pizza restaurants was clearly smoking a lot of weed. I'm pretty secure in saying that, if for no other reason than that any person commissioning a full wall "Alice in Wonderland"-inspired mural--drawn in the style of "Fritz the Cat"--was most probably high.




The gigantic wood-carved wizard leering at you as you walk into the door really also sets the tone, don't you think? Let's just hope that the mushrooms on our particular pizza were merely of the "white button" variety.
well, to be honest, they do all look kind of the same




JOE: Cal, look at these art projects! These look great!

CAL: Yeah.

JOE: Which one is yours?

CAL: You know, that's a good question, Dad.

JOE: Yeah, it sure is. So which one?

CAL: Um...I don't really know.




(It was this one.)
ideal tenents

Well, that was a good discussion. We are a good bunch up in here.

So, I'm doing some studying for the Oral Boards, mostly boning up on areas that I don't really do every day anymore, like Peds, OB, and complex intracranial neurosurgical anesthesia. I am remembering a lot of things that I have blissfully forgotten. Like the many hours I spent holed up in those dark neurosurgical ORs dripping CSF out into a little baggie in an attempt to "loosen" the brain for my neurosurgical colleagues while they were digging around. And the delightful phenomenon of uterine inversion, in which the postpartum uterus actually turns itself inside out and pokes out the vagina. Ah, residency. Those were good times.

Anyway...

So you know that we just moved in October into a house that we are renting from some nice folks (see: Southernism!) who had to move up to Philadelphia before they were able to sell the place. The house is a little old, and probably not the most enviro-friendly of dwellings (windows not weatherproofed, no low-flow toilets or showerheads) which makes it somewhat expensive from a utilities point of view, but it's a great neighborhood and close to Cal's school and easy for Joe to get to work and blah blah blah boring talk. Anyway, we have a one-year lease at this house, which seems kind of like a long time when you're a student, but for me just makes me think that there's barely any point of unpacking because what's the point, we're just going to move again in a few months anyway. Which is mostly fine, since we don't mind living among the boxes and we never have people over anyway (30% due to embarrassment, 70% due to anti-social tendencies). Anyway, the boxes are great for covering up all the outlets that Mack finds inexplicably fascinating and for building various child-proofing barricades, like in Les Miserable. (Primary intent of the barricade in Les Mis: defiant show of uprising! Secondary intent: to keep Gavroche out of the computer room.)

So I was fine with us living like shantytown people and had frankly stopped noticing the boxes, but then our landlords were in town this past weekend and wanted to come by and check out the basement, as there had been some flooding a few months ago and they wanted to survey the damage. They didn't give us very much notice, so I spent the better half of Saturday afternoon cleaning what I could and shoving what else I couldn't clean into a variety of unlikely to be opened closets. But there was nothing that I could do about this:




All our Christmas decorations are still up. Yes, all of them. Tree, stockings. The lights are even still hanging in the windows. And I'm sure I didn't need to point out to you that Saturday was the first day of spring. Awkward!

Anyway, after some uncomfortable silence in which the owners pretended not to notice or were decided whether or not to say anything, I cheerfully told them that since it was almost Easter, we just decided to leave up the decoration from Jesus' first birthday party and celebrate clear through April. I think they bought it.
so, health care reform




I've been staying away from this for a while because it's just such a divisive topic around these parts that I felt the better part of valor would be just to keep my head down and thoughts to myself. I would probably feel differently if I still lived in Manhattan (aka Liberal World *) but the fact of it is that I work in Georgia where I often feel that my political views are in the minority and thus in the interest of fitting in and not getting into crazy scream fights with people, I'd best just go about doing my job without the political side-conversation. But then the health care reform bill passed yesterday, and I've been writing this blog entry in my head all night. So here it is, apologies if it's rough, but this is not a multiple-draft proofread missive, I'm just spooling it out here.

The healthcare system needs reform, and I cheer the passing of the bill. There is tons that I could talk about, see here for more wonkish details (I am not the expert on this topic by any means, nor do I pretend to be), but the reason I stand behind the idea of healthcare reform is a simple philosophy, perhaps too jejune for most, is this idea: "The essence of civilization is that the strong have a duty to protect the weak." ** (In fact, I think that's part of what I was trying to say about the issue of vaccinating, which brings up very similarly contentious issues about personal freedoms and taking responsibility for others--not to stir that pot again.) "The essence of civilization is that the strong have a duty to protect the weak." Do I believe that? Yes I do. Working in medicine, this is a version of what we do every day.

This bill affects me personally, of course, though not in the same was as many people. For instance, I have health insurance. I make an income above what would qualify me for the expanded Medicare benefits proposed. In many ways, the passage of this bill into law will be detrimental to me personally, at least when it comes to my bottom line. When Joe starts making his attending salary and adds to our household income, our taxes will go up quite a bit. Decreased compensation for the work that I do under the Medicare reimbursement scale will mean that I make less money. (Anesthesia practice as whole is particularly vulnerable to this beyond most other specialties, see: "The 33% problem." For more, read this or other memos from the president of the ASA.) As the most junior member of a private practice anesthesia group, do I worry that such financial implications could endanger the very fact of my job? Yes, I do. I have two young kids at home, how could I not worry about it?

But--and again, I can feel that this is going to come off as irrepressibly naive, but to hell with it, as a young doctor, don't I deserve to play Pollyanna for a little bit longer?--there are bigger issues at play here. The world is bigger than just me and my family. Or even from a more selfish standpoint: it could be me. If there's one thing that Joe's bout with myocarditis this past summer taught me, even more than working with patients all day, is that as young and healthy and invulnerable as we may feel, we are all just one breath away from catastrophe. And if catastrophe landed in my front yard, wouldn't I be glad to live in a society that didn't just champion the notion of "every man for himself"? The essence of civilization is that the strong have a duty to protect the weak. Call it socialism, call it communism, whatever you like. I may be strong now, but I know that could all change at any point, and it gives me comfort to know that if and when it does, this is not a society that will turn its back on me.

Do I have reservations about parts of the bill? Of course I do, it's far from perfect. In particular, I am very nervous about any move towards cost-containment in healthcare (and of course it is undeniable that healthcare costs are, everyone's favorite verb, "skyrocketing") without addressing the incredible cost of practicing defensive medicine. The cost of malpractice insurance, performing procedures that tests that in all honesty do not need to be performed, the Cover Your Ass style of defensive medicine, all because anyone who has ever watched any form of daytime television can tell you that there are hoardes of slavering law firms out there ready and willing to sue your doctor for any old thing.

I am nervous about the prospect of undervaluing the work and expertise of doctors in the name of cost-containment, and the judgments made that paraprofessionals of all stripes can readily step into the roles that doctors once occupied for the simple fact that mid-level providers are cheaper. I don't like the idea that non-medical people may be making judgments on the importance or value of certain aspects of care, and I don't like the idea that hospitals and doctors may be penalized (general practitioners nonwithstanding) and devalued while being expected to accommodate the huge influx of sicker patients that this new law may avail of healthcare. And, of course, the size of federal deficit makes me nervous. I didn't even get a credit card until halfway through med school, because the idea of debt made me so uneasy. So there's that, too.

From a more detached point of view, though, it's really an interesting time to be starting out in my medical practice. Watching some of my more senior colleagues reacting to these imminent changes, part of me is glad that, as a rookie who just stepped into the ring, all I really know is how to do my job. (And even that, at times, is questionable. Kidding! Sort of.) But seriously, there are obviously going to be changes coming down the pike. What these changes will be and how they impact our lives remains to be seen, but I'll be here, and I guess we'll all figure it out together.

So the bill. It's not perfect. I don't love everything about it. But societally, it's a huge first step, and overall a good one. Not everyone agrees with me, particularly in this neck of the woods, but that's OK, we can disagree and listen and try to convince each other and then talk about it some more. And in the end, isn't that one of the key things about living in a democracy?


* "Don't you see the rest of the country looks upon New York like we're left-wing, communist, Jewish, homosexual pornographers? I think of us that way sometimes and I live here." -- Woody Allen, in Annie Hall

** This quote was taken from a speech by George W. Bush. Yes, you read that right. Of course, he was talking about something else, but still, the sentiment is generalizable.
person of the week




So Cal is this week's "Person of the Week." I keep calling it Gold Star Day but Cal reminds me that Gold Star Day is only for three year-olds, he's in Pre-K now and he's four-and-three-quarters years-old now Mom, jeez. Fair enough son, fair enough. Magical Sparkle Snowflake Day it is.

Part of being Person of the Week (file this under homework that is more for parents than it is for kids) is bringing in a poster about yourself. I'm not really sure what such a poster would entail, though I caught a glimpse of some hanging in the classroom, which were elaborate pictographs of family and vacations and various passions like Disney Princesses or pizza. So I hope that Cal's poster fits the bill. I think it turned out pretty OK, despite the fact that Cal wouldn't let me help him do this really cool offset letter effect in which I cut out the letters of his name in two colored cardstock and made it look like his name was popping out in 3D. You don't understand my vision, kid, just run along and let me do my poster...I mean, your poster...in peace.

(Anyway, click here for annotated notes of Cal's poster. This is now officially more information than you require, but humor me, grandparents are interested.)
blank check

In my anesthesia group, the second call doc is known as the "Rover," which sort of means that they are the out of OR everyman. Aside from administering anesthesia in the endoscopy suite (11 cases yesterday, thank you very much) we are also the doc that gets called for all new pain consults and central line placement requests, as well as anything else that people may need. The pain consults are mostly what you'd expect--post-surgical pain management, acute on chronic pain, oral conversions of IV narcotics, what have you. But now, twice, I've gotten called from services that want me to write narcotic prescriptions for patients being discharged from the hospital. Let me be clear: they are not asking for advice on what oral pain meds to discharge the patients on, or recommendations about conversions or tapering or dosing. They just want me to show up and write a prescription for the patient to take home with them.

NURSE: Dr. XYZ said to call you guys to come write the morphine prescription. She's supposed to be discharged right after.

MICHELLE: Wait, but I've never even met this patient before. I've never even heard of her. And I'm never going to see her again. I don't think it's really appropriate for me to be writing a morphine prescription for this person. Who's the primary doctor in charge of her care?

NURSE: Dr. XYZ.

MICHELLE: So why doesn't Dr. XYZ write the prescription?

NURSE: He says he can't.

MICHELLE: He "can't"? He's...not a doctor? He doesn't have a DEA number?

NURSE: He just told me to call you and for you to do it.

MICHELLE: Look, I want to help you, but I'm not going to do that. I can't just come and write narcotics for a patient that I've never taken care of, know nothing about, and am never going to see again. That's just completely inappropriate. Someone who is responsible for that patient needs to take it on themselves to write that prescription. Either the primary doctor on service or her primary doctor outside of the hospital. Someone who is going to follow up with her. Someone who is going to see her again, ever.

NURSE: But Dr. XYZ wanted you to do it.

MICHELLE: I'm not trying to pass the buck here, or give you a hard time, I know you're just following orders. But...look, if he wants advice on what narcotic to send her out on, or wants me to help him calculate the appropriate dose, that's fine. But I'm not going to come and just write a prescription for someone I never met. Frankly, I'm an anesthesiologist in the OR. I don't even carry a prescription pad.

NURSE: (Pause) So...you're not going to do it?

Any doctor with a DEA number can write a prescription for narcotics for patients that need it. Whether or not they want to take responsibility for writing those prescriptions is a whole other thing. Which begs the question...if they as the primary physician don't feel comfortable taking the responsibility, why would I?

Here's one for the comments section: What's the most inappropriate thing you ever got called for in the hospital?
how many times can i say the word bike in this entry? (lots of times.)

So now that Cal can ride a two-wheeler (mostly) without falling over, and Joe passed his stress test with flying colors (see: the myocarditis scare of 2009), we decided that we should all get bikes! And we can be the family that bikes together! On bikes! Also...BIKES!

This is the bike that I ordered:



I was going to get an old bike off Craig's List but then I noticed that this bike was basically the same price and also I didn't have to go pick it up at someone's house, which seems like a good way to get shanked. It is a very basic bike--I think it's only one speed, and it has a foot break instead of a hand break which basically means that it's for oldsters riding along the boardwalk in olden days Coney Island--but I do not need a fancy bike, as my ability to ride a bike is marginal anyway.

SOMEWHAT RELATED STORY FROM THE PAST: Joe and I went to Hawaii, oh, about nine months before Cal was born (ahem), and one of the activities we signed up for on this trip was a downhill bike ride down Waimea Canyon. It was a ridiculously easy ride, since they actually drove us up to the top of the mountain--we only had to bike downhill, which means that you barely had to pedal at all. But still, there was a minimal bike skills competency screening, meaning the morning of the bike tour you had to show up at the tour place and prove to the guides that you could bike in a circle around the parking lot without falling over. I barely made it through this screening process. They made me take one more circuit around the lot than everyone else because I was wobbling so much all over the place and they made sure as hell that I signed that release stipulating that I wouldn't sue them if I died. But anyway, spoiler alert...I lived! No, that's not just my reanimated corpse administering anesthesia to your grandfather by day and searching for tasty human brains at night! And the bikes they provided us for this downhill canyon tour were almost identical to the one I just bought, which I guess doesn't really prove much of anything expect maybe that it's the cheapest non-child bike on the market.

Anyway, that's my bike. Joe got a somewhat nicer bike, partially because he actually cares about the bike that he's riding and also partially because he's going to be the one with the baby seat strapped to the back, so there's slightly more invested in his choice of carriage and the fact that it will not fall apart. But who knows, maybe by this weekend (depending on how fast they arrive and how fast Joe can assemble them--the latter of which will probably be the rate-limiting step) we may be biking through the park en famille like that "Do Re Mi" number in The Sound of Music. Only in this version Maria loses control and runs over Mother Superior, who is not amused.
four wheels good, two wheels better!

November, 2007:




March, 2010:



His training wheels are officially gone, and off he goes. Part of me is still looking for the handle poking out of the back of his bike for me to hold on to. Which I could segue into some deep metaphor about kids growing up and learning to let go, but really, WHERE IS THE HANDLE?
after a brief absence, some things

So I go on some pro-vaccine bender and then don't post here for a few weeks. Sorry guys. Things have been busy all up in here.

Thing #1: So, I finished the final FINAL round of edits on the manuscript (also delayed by a few weeks due to Busy All Up In Here syndrome) and now I assume it is being combed through by the good people at the legal department at Grand Central Publishing, who I assume will help me purge it of the sue-worthy bits--not that the book is slanderous in any way, I would say everyone comes off as looking pretty good except for me, who comes off anywhere between dilettante and bumbling in my various rookie endeavors. But who knows, I am no expert when it comes to matters of defamation. I assume that they're at the very least going to make me change some names--all patient names and identities have already been changed of course, but most of the attendings' names are real, partially to give them credit for the roles they played (the good kind of credit), but also because I would start to have a hard time keeping people straight. Anyway, godspeed to you, legal department.

Thing #2: I cut Mack's hair! By myself! I was going to go the hippie mom/Hasidic Jewish mom route and just let it grow until he turned three, but it started to look really messy and crazed, like some species of mountain man. So I did it sort of sequentially, snipping at his hair about three times over the course of last weekend, and I deliberately left the front a little long to preserve that baby hair look as long as I could. But all false modesty aside, I think he looks pretty darn cute, like a little preppy. From Ted Kaczynski to Ted Bundy. Or something.




(That is a BEFORE photo, from the day prior to his haircut. It's not a terribly good picture of Mack but it's the best one I have to convey to you the fact that his hair was all over the damn place. I know, what you really want to see is an AFTER photo, but I don't have a picture of that yet, despite the fact that it was BABY'S FIRST HAIRCUT and it happened a week ago. Because I am lazy and also I don't love my kid at all.)

Thing #3: Other gratuitous baby picture!




Ha! He thinks he's people! (I was frantically pushing his hair behind his ears to get this photo, otherwise his mop would be completely consuming his face. You will be pleased to know that I didn't use any spit pomade, though as his mother it was totally in my right.)

Thing #4: We took the training wheels of Cal's bike. Personally, it took me a long time to learn to ride a two-wheeler (I don't think I learned until I was about eight), which I blame on three factors:

  1. General lack of athleticism and coordination
  2. Growing up in Manhattan
  3. Somewhat inscrutable biking instructions from my father to "turn the way you tilt, tilt the way you turn," which, even if you have some intuitive sense of how to bike without falling over, is kind of confusing and requires more thought than gravity will allow.

Cal seems unencumbered by my baggage, however, and seems to have taken to the stripping of his training wheels like some kind of normal kid with a normal vestibular system. Though he has to be reminded that, unlike his training-wheeled bike, if he stops pedaling, he will fall over. Just like how a shark will die if it doesn't keep swimming. (Luckily, Joe is the lead coach instead of me and he didn't say that last part.)




(Above: Cal pre-training wheel-stripping executing one in a series of what he calls "Cool Tricks." Other cool tricks include riding his bike with a variety of limb-extended-tongue-protruding combos.)

Thing #5: Is anyone out there getting the iPad first pass? Anyone? I was of the mind to wait until the second generation at the least (in the hopes that future iterations will include a camera), but Joe has been bitten by the gadget lust bug and seems to want to go for it this summer. Of course, he also jumped on the iPhone bandwagon very early, and doesn't even seem that embittered that they dropped the price of the first iPhone something like $200 a few weeks after he got his. I say fool me once, shame on Steve Jobs, fool me twice, shame on me for falling under the hypnotic spell of Steve Job's black turtleneck, but we'll see. Anyway, we theoretically may be seeing a little more money from my book advance later in the spring (they dole it out in goal-defined increments so you don't just roll over and give up when the going gets tough, I suppose), so perhaps we could have our own version of "Ramona and her Father," where we get treats on payday, like a sack full of gummy bears or dinner at Whopperburger.

(I really want to wait for the iPad to have a camera, though.)

Edited to add one more thing: OK, I have been shamed into it. Here is a post-haircut picture of Mack:




(As always, he looks vaguely appalled.)