on being "that parent"

Perhaps this is an overly strong sense of introspection on my part, but reflecting back on our dental experiences of late, I wondered if I was being "that parent;" that is to say, the kind of parent that, as a former peds resident, I dreaded. You know...THAT PARENT. One thing that I appreciate now (that I didn't appreciate when I was a peds resident, because I didn't have kids yet) was that the many of the parents that I found difficult to deal with were simply tireless advocates for their children, parents who had been around the block enough times that they realized how fallible the medical system and the people behind it really are, and as such felt the need--or perhaps to obligation--to push and prod and question every single move. As residents, people still growing into the notion that we truly belonged in those white coats, this advocacy from parents tended to rub us the wrong way. There's nothing that exposes the naked insecurity in a young doctor more than a patient (or the parent of a patient) questioning whether or not we really knew what we were doing. Do I know what I'm doing? Of course I know what I'm doing! I went to medical school! See this nametag? Says "MD" on it right here! M fucking D! Now let me go hide in a corner and consult my Harriet Lane obsessively.

Cal's doing really well, by the way. He rested on the couch after his dental appointment, took a long nap that afternoon, and since that time has been basically back to normal, with the exception of a puffy lower lip where, I think, some instruments were positioned. His gum abscess looks much, much better, and we're just going to finish out the antibiotic course for the rest of the week (as counseled by our dentist) and then return to business as usual. I did have a slight fear that our dentist would be somehow annoyed at us ("Ugh, those parents!") for starting the antibiotics in the first place, or for overstepping our bounds in some way, but since he basically told us, "Thank god you didn't wait to start him on that Augmentin" in so many words, I'm a little less concerned at being perceived as a practitioner's worst nightmare--that is to say, overly protective parents with a key to the apothecary.

I also don't know why I'm so worried about perception when it comes to me and my level of participation in my own children's medical care. The few times that I haven't spoken up in a clinical setting with my kids in an effort to be polite and unobtrusive, I've regretted it. Is my desire to be a "good patient" at odds with my efforts to be a "good parent"? Are they necessarily mutually exclusive? Part of me feels like the answer is yes: I recognize the inherent hypocrisy but I know there's nothing that a doctor loves more than a patient that just nods and says yes and defers to your every decision. We've thankfully been very lucky in that our interfaces with the medical community have been brief and goal-oriented, and we've never disagreed with any of the medical decisions that our practitioners have made, but it certainly makes me think about where the boundaries are when you are both the medical practitioner and the parent. Anyone have any insight? Where do you draw the line? For example, I personally would never administer anesthesia to a family member or someone I was close to--I think emotion gets in the way of clear-headedness. But outside of the OR, I'm still not really sure.

Anyway this entry is starting to meander and it's a school night so I'll just close with this last: I am not above using toys to defray trauma from endured unpleasantness, and this latest visit to the dentist office was no exception.




It's Cal's first Lego set. I know a lot of kids play with Legos, and it's not like he's some kind of prodigy or anything, but I really was impressed with his ability to assemble these, because some of the pieces are very, very small, and there is a fair level of complexity to these designs. (He just followed the instructions that came with the box, not like he synthesized them from scratch, but with minimal adult assistance--I just came back in the room after an hour and there they were.) I think it's going to be a Very Lego Christmas around here.

so about that root canal




I noticed about a week ago that the gumline around Cal's tooth, the one that was halfway fixed (hardwon pulpotomy without a crown) was looking a little friable and red. Actually, to be quite frank, it was bleeding. Bleeding Gums Murphy, he was. It was also a little tender, and when I felt it, it was kind of boggy and bubbled out from the toothline. Fearing abscess and just a mere eight days away from when we were scheduled to go back into the dentist to finish our dental work under IV sedation, I asked Joe to pick up some Augmentin on the way home from work (one of the benefits to being and/or marrying a doctor is that you can have your spouse pick up prescription medication on the way home from work as you would for a eggs or milk) and had Cal on an twice daily schedule of antibiotics to try to minimize the chance that whatever it was would progress to some bigger problem.

Funny how your fears are totally steered by your area of expertise--Joe, being a facial surgeon, was worried about osteomyelitis of the jaw. I was more worried about a rapidly growing trachea-displacing abscess. (I've had to do a couple of cases with airway-threatening dental abscesses, and the lesson I have learned from these are that the human mouth is an absolutely disgusting cesspool. Almost makes one wish they had chosen a different specialty.) Anyway, when we got to the dentist this morning, we told the dentist what we saw and what we'd done (the gum swelling was much better already), and even though we were worried that the week of antibiotics would mask any worse signs of infection and possibly cloud the picture for Cal's definitive treatment, apparently what the dentist saw inside was enough for him to opt for this:




The definitive definitive treatment. (Also shown in the picture above, evidence that I wash my hands too much. FOR WORK HYGIENE, not for the crazy.)

So anyway, the dentist said that Cal definitely had an abscess forming up in there, he's glad that we'd already had him on antibiotics for a week, and feels that we should continue on them for another seven to ten days. I'm not thrilled that Cal's tooth was bad enough to require extraction, but glad that at least we took what in my mind was probably the safer and more conservative approach, as opposed to capping the abscessed tooth and then ultimately needing to extract it anyway. We had anesthesia there, might as well get it done and cleaned out and end ToothWatch 2010: Will it or Won't it?

We still need to go back and get Cal fitted for a spacer, because apparently when his six-year molars come in all his teeth are going to get pushed around and that gap is going to screw up the orientation of all his tooth parts (DENTAL TALK! I love it!) but in theory that should not be painful and we still have a little time before that needs to get done, so we can...just think about that another day. (Even with the wonders of anesthesia, Cal has requested that we never ever take him back to "that place"--I for one plan to dodge the subject for as long as possible.) So right now, let's concentrate on the fact that it looks like the Tooth Fairy's going to be visiting our house a little earlier than we expected.

my three sons

Got my bound galleys in the mail yesterday!





Of course the final book is going to be in hardcover, and the paper quality is going to be better, and the spine and back cover will hopefully look less...temporary...but goodness me, how exciting. Exciting to me that is, not necessarily to Mack and Cal, who could not even look away from the TV long enough for me to explain why I was wedging a book between them and taking pictures.

(And of course, I am obligated to remind you that the book! is available! for pre-order! exclamation point!! OK, advertisement over. Have a good Thursday.)

a good way to kill eighty minutes on a rainy morning

I'm post-call today, so after dropping Cal off at school I took Mack to the Fernbank Museum of Natural History, because it seemed enriching somehow, and at bare minimum, it was indoors. (It's raining today.) All it did was make me miss the real Natural History Museum. I know it's not the museum's fault--it's small and doesn't have a lot of exhibits so it does the best with what it has, but there was not a lot to look at is all I'm saying. They also seem to have overestimated mine (and everyone else's) level of interest with the history of Georgia's marshlands. However, there were some dinosaurs, so that's something.




Despite it's drawbacks, we do have a family membership to this museum, as we do to a handful of other child-friendly area attractions, not because we're such civic boosters (though I do think that the Zoo Atlanta membership is worth it) but because the tickets are so ridiculously overpriced that if you're planning on going more than once a year with any permutation of adults and children, getting a membership is likely fiscally advisable. Also you feel less bad about leaving after an hour and a half when you don't have to pay for your ticket each and every time.




(Not pictured, Laura Dern elbow-deep in a pile of poo. That was me, later. Thanks, Mack!)


* * *


With respect to yesterday's post, a couple of people guessed correctly that the picture showed the fluid head of the extracorporeal shockwave lithotripsy...uh, thinger...for pulverizing kidney stones. The one thing I have learned from providing countless anesthetics for cystoscopy is: NEVER GET A KIDNEY STONE. That is all. As for the three older "identify that medical equipment" posts, the answers are: a water cooler for the OR table cooling blanket used during a cerebral aneurysm clipping; a variety of neurosurgical headholders (Mayfield pins, horseshoe, whatnot), and "candy cane" leg holders for the lithotomy position. All disgusting in different ways.

As you were.

name that medical equipment




I've been meaning to bring this one back for a while, but everything I've found has been either too easy or too clearly just some closeup of some part of the anesthesia machine. See some past "name that medical equipment" editions here, here, here, here, here, and here.

(The comments section on the three oldest posts do not show any comments because I was using a different and now defunct comment hosting system back then. If you are DYING to know if you were right in your guess, I will post the answers to these old entries tomorrow.)

OK, I'm on call tonight. See you on the other side.

wherein i lower the bar a little more for us all

I get asked a lot who does the cooking for my kids (the first most common question is who takes care of my kids during the day when Joe and I are at work, to which I am tempted to answer: the TV) (actually we have a nanny) (a human one, not just a euphemism for the TV) and while I will occasionally give some bullshit answer about doing some cooking on the weekends and trying to have a lot of fresh fruit around, the real answer is that without Trader Joe's, we would all be dead.

I don't mean to turn this into an ALL REVIEWS, ALL THE TIME blog, but I know many of us are busy, and though most of us probably cook better than I do (all my "cooking"--I used that term loosely--must be able to be completed in a single pot or saucepan or else I am simply not interested), I just wanted to review some of the new things I've tried at Trader Joe's that the kids like. Maybe this can be a recurring blog topic--I know they had a similar segment on some of the earlier episodes of "Jordan Jesse Go!", but while those segments were used to comedic effect, these reviews are deadly serious.

(DEADLY.)

The other thing is that I know Trader Joe's has the sometimes annoying, usually revitalizing habit or rotating certain items in and out, so there's usually one or two things that I happen across in the frozen or ready-made aisle that I would like to try, though I'm not sure if I'm willing to take the risk. I am risk averse. So anyway, I'll review some of the new products that I tried and liked, you can reciprocate in kind in the comments section, and so we will all prosper.

Mainly, my main considerations when shopping for food at Trader Joe's are this:

1. Will the kids eat it?
2. Can it be prepared in under ten minutes? Preferably via microwave? I will skillet things and suchlike, but my nanny is even less cook-y than I, so if I'm not the one preparing (read: heating up) dinner, it's got to be microwave, toaster oven, or, you know, vichyssoise.
3. Can I at least pretend that it has some nutritive value?
4. Does it cost $10 or less? (Luckily almost everything at Trader Joe's is $10 or less, so the answer is usually yes.)

OK, first up, this turkey bolognese sauce:




Look, I have that Prego sauce in a can too. (Yes, I know it's easy to make your own spaghetti sauce, shut up already, Racheal Ray, GOD.) But sometimes you want a little protein in there so your kids don't get kwashiorkor. Also, meat sauce tastes good. Plus, pasta and kids = success. I got this turkey bolognese for the first time last week. Three days later, I went back and got three more boxes for the freezer. Guys, it's good. And it's frozen, so you can keep it for months, ready to unthaw and spoon over your fusilli or what have you at the drop of a hat. Put some fresh parsley over it if you're fancy like that--I'm not, but I do appreciate that this sauce has a somewhat finer flavor than your usual prepared pasta sauce, which is usually just like a can of Hunt's tomato sauce with lumps in it. It's also not too salty, a major fault of many other brands of prepared pasta sauces. You can probably get four to six kid-sized meals out of this serving of sauce (depending on how big your kids are), or feed two hungry adults.

Next up, this beef bourgignon:




(How do you say that anyway? I've been pronouncing it bore-zheen-YON, but then I kind of mumble it in case I'm saying it wrong so no one notices that eight years of French class in my formative years taught me nothing.)

I know what you're thinking. Red wine sauce? Kids won't eat that. I had the same concerns, so I just got one figuring that if the kids hated it, at least Joe and I could eat the remainder. But it actually isn't that red-winey--actually much less so than the beef shortribs that TJ's occasionally pedals in the refrigerated ready-made foods aisle, but which Cal LOVES--so I think that on the kid front, it's highly palatable. It also doesn't come with quite as many giant meat chunks as depicted on the box, and with somewhat more sauce (which, as mentioned, is not winey but still very meaty) so it becomes quite an ample meal spooned over noodles or rice or potatoes or what have you. I would consider cooking a side vegetable--the only identifiable vegetable I saw were pearl onions--but overall, I was impressed with this entree. Maybe four meals for kids, depending on how much starch you serve it on top of. I know it's probably supposed to be two adult servings, but I could easily finish this whole thing myself if I was really hungry.

Finally, not a new product, but an old standby in our household:




Look, I'm not going to pretend that this is healthy. It's not. It's elbow macaroni and a lot (A LOT) of cheese. But kids like it. Serve it as a side, save some for leftovers, and it won't be overkill. We always have a box or two lying around for emergencies. At least it's better than that powdered orange stuff. Pro tip: after you heat it up in the microwave for six minutes, give it a stir, and then (if you're kids aren't howling for blood because they're so hungry Mom OH MY GOD SO HUNGRY MOOOOOOOM) stick in in the toaster oven on toast for another few minutes. Gets a nice crust.

What do you like at Trader Joe's? And more importantly, do your kids like it? I got these new curry panang sticks there this past weekend, but I'm under no illusions--that one's for me.

germ theory

I freely admit that I have a somewhat overanxious approach to hand hygiene. Blame the eleven years of medical training, but I wash my hands at least twice an hour when I'm at work, and so as corollary get a little itchy if my kids don't at least wash their hands after playing outside, after toiletting or before meals. I know I can be a little extreme about it at times (sometimes I instigate a fresh round of handwashing if the kids are pawing at me and their hands feel a little tacky), but I can't help it, it's a reflex. I just get the willies about dirty hands, and I'm long past trying to rationalize it.

(I am also past rationalizing why I feel itchy whenever I see the CONTACT ISOLATION sticker on a patient's chart, even if I haven't even touched them yet. It is beyond reason, can't be explained, it just is.)

Cal is actually pretty clean for a five year-old boy. Blame nature or nurture, but he never really liked getting dirty and for the most part keeps himself reasonably free of dirt and contagium, if not sweat. (Cal sweats a lot, which is part of the reason we keep his hair so short.) But Mack is an entirely different creature. Despite all best efforts, he is just grimey. He likes dirt. He likes mud. He likes putting things in his mouth. In a wide open field, he will find the one patch of sodden, dirt-soaked gravel, pick up a handful of mucky rocks, try to pop them into his gaping craw, and then, afterwards, pick his nose lustily. But don't believe me, the pictures do not lie.




Let's zoom in, shall we?




It's not just this. Every single close-up picture of Mack shows some evidence of a thin scrim of dirt or sand or crumbs or crystalized boogers. He is messy. He is slimy. He is snips and snails and puppy dog tails.




I am trying to get over my deeply ingrained revulsion of uncleanliness (remember, of course, that my obsessive personal cleanliness is to your personal benefit, patient on whom I am placing an epidural or central line or who I am just generally touching) but sometimes...sometimes it gets hard. Like earlier this week, when I took the kids out for dinner to a restaurant with outdoor dining, and in the middle of the meal Mack slithered to the floor (which was the sidewalk of a street, a street that people walk on with the soles of their shoes), started heartily rubbing the concrete with his palms, and then, before I could even respond, crammed both hands into his mouth. Child, that is disgusting. I just want you to remain alive, you understand. Alive, and free of toxoplasmosis. And granted, Mack is always bouncing between one viral illness to another, a fact that I attribute to both the fact of his general grottiness and the fact that he has a school-aged sibling--but he is hale and hearty and probably is developing a stronger immune system than the rest of us put together. Mostly from the fact of him sticking his finger up the dog's butt and then licking that same finger seconds later. It's all immunology in action. And as long as I don't have to witness it, I'm fine with it in theory.

IN THEORY.


* * *


A little more about the new camera, since there seemed to be some interest (and I will assert as usual that I have no corporate ties to Panasonic or any affiliated enterprises).

I don't consider myself a photographer. I'm an enthusiast certainly, and I enjoy photography, though for the most part this is limited to me understanding the various qualities of light that make taking pictures of my kids advantageous. But I do enjoy photography and I have a very basic knowledge of photographic principles, and as such, I would like to present my layman's review of the Panasonic Lumix GF-1.

First off, if you are interested in this camera, read the technical specs and details here, and then read a better review here. For me, the review is as follows. I love my SLR (a Nikon D90), but I found that of late, I was using it less and less simply due to the bulk of carrying a giant SLR around. As seen recently, during our day trip to The Rock Ranch, it was a gorgeous fall day and I really wanted to bring our "big camera" to get some good pictures of the kids, but I was already toting a stroller and a diaper bag and a cooler full of snacks; the last thing I wanted to do was to bring yet another bag with a heavy SLR to tote around my neck all day. (I ended up just using my iPhone, which took some good, though not great, pictures of our day.)

Enter the Lumix GF1. I had read some reviews of this camera in weeks leading up to the purchase, and about the Micro FourThirds technology that was allowing for near digital SLR pictures with half the digital SLR size and bulk, but it wasn't until I saw the quality of the portraiture that I decided to pull the trigger on getting the GF1 myself. (Also, full-disclosure, Joe was out of town at his Academy meeting and I was all alone and kind of mad at him and prone towards an impulse buy--though an impulse that, now in retrospect, he fully supports.)

I've taken close to 500 pictures with this little camera in the past two weeks, and I am fully comfortable saying that it is an incredible device. First off, let me say this: it's the lens, not even necessarily the camera, that makes the purchase for me. I got them both together as a kit, but the fact that it's a prime lens (meaning a fixed focal length lens with no zoom capability), and the fact that it's so small, that makes it a real winner for me. I'd worked with a prime lens before, and though a few years ago I found it a little limiting (don't know quite why, but I distinctly remember at the time feeling like the lack of zoom capability was like being hobbled)--since that time I'd gotten quite used to taking pictures with my dinky little cell phone camera, after which point the need to frame pictures by physically moving closer or farther from my subject felt like much less of an impediment.

Anyway, the camera works great for my purposes. Unlike a point-and-shoot, there was minimal lag between pushing the button and the shutter firing (this was a distinct frustration for me back in my point-and-shoot days, that the shutter would deploy full seconds after pushing the button at which point the kid or dog would no longer be doing whatever endearing thing I was trying to take a picture of), the light sensor of the camera is great, and the lens is top notch. The camera itself feels substantial, like metal and glass, and while I would argue that it could have a more secure grip, getting a wrist-strap has more than taken care of my fear of dropping the whole works. Having a lens with a wide aperture has also allowed me to take a lot more low-light pictures than I would ordinarily be able to (I will use the flash if I have to but overall I vastly prefer relying on natural light), and though the narrow depth of field is problematic when trying to take pictures of a kid that never stops moving, EVER (read: Mack), it does produce rather gorgeous (if I may say) pictures of a subject who holds still, or does not mind posing.





It comes with a host of other lenses as well, but I did not look at any of them outside of the prime f/1.7 lens, because to my mind, toting around a big lens rids this camera of its key advantage, which is portability. Anyway, I'm no photographer, but as mentioned I haven't touched my SLR since. So if you're looking for a cheaper, smaller, lighter SLR alternative, look no further. I'm sure that there are drawbacks versus a full SLR, but for the casual photography enthusiast, they are neither evident nor limiting.

Anyway. Have a good weekend, everyone.

post-call day off

This week has been somewhat busy, so apologies for the lack of posts. I'm not going to make up for it much today, unfortunately. I just have one observation. Overnight call can be hard--no one likes to be Last Man Standing for that late case in the OR, and one sick patient can be downright harrowing when no one else is around. But I am lucky enough to work in a practice where I get post-call day off, and that trade-off, in my opinion, is well worth the pain.






Full post-call picture set here. By the way, as some of you have noted, I have been playing around with a new camera (a Panasonic Lumix GF1 with fixed focal length lens--the 20mm f/1.7 to be precise) and I absolutely love it. It is tiny little camera that is much easier to carry around than my SLR, and with that quick little lens it is a gem. I don't know why I am saying this, because for some reason this seems to enrage this dissidents whenever I get a new camera (admittedly, my old camera still works so I didn't need a new camera per se, but I rarely buy things for myself and since we do not live an exorbitant lifestyle and photography is a hobby I will give myself a pass)--but if anyone wants to know my opinion about the Lumix GF1, I will say: I may never touch my SLR again. I love this camera. A more detailed review perhaps in the future, but if you're looking at this camera with this lens, my vote is an unqualified YES.

and now, some gourds

Now hear this! Cal likes gourds!

Mack, meanwhile, merely tolerates their presence.




Say what you will about the summers in Atlanta (OK, I'll say it for you: way too hot, monstrous mosquitos, lasts about three months too long) or the winters (cold enough to be uncomfortable but not cold enough to snow) or the spring (oh my god the pollen, THE POLLEN) but the fall? The fall here is gorgeous.

(We were at the botanical garden, by the way, not just some random gourd factory. Also, the flowers were professional flowers, not just spontaneously sprouting outside our front door. I said it was nice here in the fall, but it's not freaking Shangri-la.)

two's company

I would say that Mack's powers of conversation now approximately equal that of a mid-level sign-language gorilla, in that it mostly consists of parroted phrases, a stock collection of food/toy nouns, and a selection of emphatic compound phrases mostly reserved for expressions of displeasure. ("I want to!" when we're preventing him from doing stuff, versus "Don't want to!" when the tables are turned, etcetera.)

Anyway, he's cute, is all.




Ever since Mack was born (oh man, almost two years ago--time marches on) people have been asking me when I was planning to have "the next one," or when I was going to "try for a girl." And let's be clear here, I have nothing against girls--certainly they lay claim to the lions share of cute clothes and accessories and I am told they are somewhat (though not absolutely) less likely to attempt things like base jumping off the kitchen cabinetry. However, as the oldest child in a family of three daughters, I have always found this societally ingrained push for parity in family gender balance puzzling. As though everyone expects us to take part in a family version of one of those reality show BATTLE OF THE SEXES and they just want the teams to be fair. It also makes me wonder--if Mack had been a girl, would I be getting quite as many queries as to the status of the next hatchling? Or would people more readily assume that we were done?

Let's just say right here that Joe and I have no immediate plans to have more kids. For one, we can't really afford it right now. For two (secondly?) we have more than enough on our plates at the moment. Maybe we'll feel differently when Mack is a little more self-sufficient, but in my opinion, there's no more effective form of birth control than a kid who requires adult intervention for every single bodily need in life, both consumptive and expressive. (Well, perhaps that's overstating things somewhat--he can breathe for himself. Has since birth. My little prodigy.)

We have not ruled out having more kids. We still may a few years down the line. But right now, we're good right here. We're fine with our two smelly boys. If we do end up having another kid, that'll be fine, we'll be happy. But if we don't end up having another kid, I think I can abide with these two. Right now, two is enough.

m & m & m

I had to present at our monthly departmental M & M conference today, which unfortunately in medical shorthand stands for Morbidity and Mortality rather than whatever else M & M stands for in the real world. (DID YOU KNOW? The candy name M&M is taken from the first letter of the inventors' last names, Forrest Mars and Bruce Murries. Now go impress your friends, of which you probably don't have very many if you routinely try to impress them with your formidable bank of candy-related trivia.) My case involved no mortality and no detectable morbidity, but it still was sort of excruciating to stand up and present it because it was one of those cases where the only thing that caused a deviation from the charted course was straight up human error. The worst kind of adverse event, in my opinion. Sometimes bad things happen because the patient is sick or because of some catastrophic event or because who knows why, and sometimes there are bad cases that you can talk about for days, because they're just so complex and nuanced and what if we had done this? Or what if we had done that?

And then there are cases where just just flat out make a mistake, and let me tell you, that is much, much harder to talk about. Because it's embarrassing, that's why. Not sure why that's the case--after all, I'm pretty sure that the only way that a human being can not make a mistake is when there is only one possible outcome to any particular action, and even then, I'm sure someone somewhere would find a way to screw that up. I know that we all like to think that we're infallible, but the truth of it is that the sooner that we realize how easy it is to make mistakes, the less likely we'll be to make them. Probably.

So that's why I like M & M, though I admit to liking it slightly more when I'm not actually presenting.

I know that physicians historically have a terrible record of admitting when mistakes have been made, and to my credit, I told the patient in this case immediately when I realized that we had gone off course. As bad as it is to make mistakes, hiding or ignoring mistakes that you know you made is infinitely worse--it's simply a matter of intent. Just take responsibility for what's yours. Own up. I didn't intend for this to happen, but here's how we're going to try to make things right. Mending. Which, I guess, could make for the third "M."

And now for no particular reason, pictures of my kids in the bathtub. Don't worry, no indecent bits, you perverts.

the misery olympics




There's an unfortunate phenomenon that I started noticing in residency, which is that of competitive suffering. The process of medical training is, of course, grueling (you don't need me to tell you that) but also beset with the notion that no activity is worthwhile unless it is somehow miserable. I went along with this during my medical training--what's residency, after all, without complaining, the one acceptable outlet for our drudgery--but as the years go by, it just starts to become increasingly unseemly. Certain people seem to have taken the adage if it's not hard, it's not worth doing and expanded it to: whoever suffers the most wins. Which, you know, is just not true. Also, given that we're working every day with patients who I'd argue are going through much more difficult things than most of us could imagine, it's probably not appropriate to complain about doing things which, while certainly aggravating in the moment, simply boil down to us doing our jobs.

Anyway, I'm not going to do that anymore is my point.


* * *


So here's a link to an article in today's New York Times:

Where Having it All Doesn't Mean Having Equality

I think that the overarching point of the article is the gender gap persistent and pervasive in France, despite what most of us in the states would perceive as luxurious socialized benefits (four month paid maternity leave, subsidized on-site child care, what have you) but the thing that really struck me is how it echoed some points of the post that depressed people so much from last week, wherein I posited that "having it all" was impossible. An excerpt from the article:

“French women are exhausted,” said Valérie Toranian, editor-in-chief of Elle magazine in France. “We have the right to do what men do — as long as we also take care of the children, cook a delicious dinner and look immaculate. We have to be superwoman...”

...At 31, Fleur Cohen has four children and works full-time as a doctor at a Left Bank hospital. As she drops her youngest at nursery in stilettos and pencil skirt you would never guess that she gave birth only three months ago...

...Forty percent of French mothers undergo a career change within a year of giving birth, compared with 6 percent of men. Both parents have the right to take time off or reduce their hours until the child turns three — but 97 percent of those who do are women.

Women spend on average five hours and one minute per day on childcare and domestic tasks, while men spend two hours and seven minutes, according to the national statistics office Insee.

In Paris, Ms. Cohen’s husband is a doctor, too. But she bathes all four children, cooks and does the Saturday shopping — largely, she insists, by choice. “If I didn’t prepare food for my children, I would feel less like a mother,” she said.

At work, meanwhile, she plays down motherhood. She sneaks down to the hospital nursery to nurse her baby son, and tries to stay longer than her male colleagues in the evenings. Otherwise, “everyone will just assume that I’m leaving because of my children and that I am not committed to the job.”

Anyway, if my post from last week stirred up any thoughts, you should read this article. I have come to no definitive conclusions, only that the stressors of balancing work and family are universal and not at all unique to life in these here United States.


* * *


Joe's heading to Chicago for the rest of the week to attend the annual meeting of the American Academy of Ophthalmology. He goes every year, and while I realize that this is an academic obligation and to some degree required for his professional development (see: networking, lectures, whatnot) it also means that there will be no divide-and-conquer school of parenting this week. Even working occasionally long hours I find it generally manageable with one kid; with two kids, however, I am quite simply outnumbered, so all I can say is hats off to the single parents, because this shit is hard. I don't wish to belabor this point, because there are plenty of people who work harder than me both inside and out of the home, so hearing about my petty first-world stressors are probably annoying at best and galling at worst.

(As an aside that I just know I'm going to get lambasted for but don't have the good sense to filter because I'm trying to write this really quickly before "Dora the Explorer" ends: I along with everyone else on the planet of course occasionally will check into Heather Armstrong's blog Dooce--I admire her business savvy and am in awe of the media empire that she has built from the ground up, though this recent spate of her Misery Olympics complaining about dealing with her 10-month old daughter alone while her husband and older daughter were out of town on a trip really tweaked me the wrong way. I admire her inimitable voice and of course her tenacity in the face of some occasionally vitriolic and usually anonymous detractors--some might include me in this grouping now, though I want to say again that I greatly respect her work and am far from a heckler--but wish that we could all just agree that her unique situation is no longer relatable to the average working parent. As a somewhat connected aside, I also don't believe in a blogosphere--gah, that word again, but there's no better equivalent--where anything short of slavering devotion is construed as "hating" and trying to tear someone else down, so I hope that this observation is taken in the right and socially appropriate way that it was intended.)

Anyway, I was stressed about Joe leaving and grouchy as a result, so we were not able to part on the warmest of terms, which I absolutely hate but had too much pride (some might say stubbornness) to rectify before he was out the door. If only we could have EEGs hooked up at all times to translate what we're really thinking and feeling, like that baby translator that Danny DeVito invented on "The Simpsons," life would be a lot more straightforward.

parents, lock up your daughters





Ever since I discovered that you can chance the settings in Hipstamatic to take high print quality images and change the viewfinder mode to "precision framing," I have not used any other photo applications for my iPhone, with the exception of shooting the errant snippet of video. It doesn't perform great in direct sunlight (tends to blow out the whites) and the light sensor isn't sensitive enough to get great crisp shots of moving subjects, but dude, it's just a phone camera after all. Anyway, what the hell do I look like, Diane Arbus?

nonymous

Hey everyone, thanks for all the feedback on the last entry! Lots of good questions and issues, please keep contributing in the comments section if you're inclined. I might as well explain the background a little bit first, because I see no reason not to--at worst, nothing will come from it but it'll provide some interesting topics for future blog posts at least.

A few weeks ago, I got an e-mail from John at Glass Hospital (and an internist at the University of Chicago) who was interested in submitting a proposal for a panel discussion about the role of blogging in medicine at the Iowa Writer's Workshop's annual conference on "Writing and the Art of Medicine." I thought that sounded fun. So we (along with a third medical blogger--I'll not put his name here yet because I'm not sure that he's officially signed on though I hope he will) are working on putting together an abstract to submit. All credit to John who has done most of the research and who has written the first draft of the abstract. I just wanted to see what people would want to hear us talk about if we were to be lucky enough to be invited to present. (Also, I love corn. Corn is Iowa, right? Potatoes? No, wait, that's Idaho, Iowa is corn, definitely corn--I remember that from watching "The West Wing." You know, ethanol, government subsidies, Josh Lyman and whatnot. Sorry, I know a lot about certain things, but social studies is not one of them.)

I'll save some of the topics for later, especially in the event that we actually get to do this panel, but I want to address one thing, and that is the fact that I blog under my real name.

I started blogging way, way before the internet was the pervasive a social media force as it is now. And I started blogging under my real name because it never occurred to me not to. I think I really thought that the majority of people who would be reading my blog would be people I knew in real life, along with a random sprinkling of perverts or weirdos, because who the hell would read the blog of an unknown medical student except for people who somehow felt coerced into it? Obviously this was naive, but this was ten years ago, remember. We didn't know any better.

It's hard for me to say if I would have started blogging un-anonymously (nonymously?) if I started my blog now, in the age of the so-called "blogosphere" and Facebook and YouTube--but the truth is that by the time I realized that people were actually reading this thing, it was kind of too late. Short of shutting down this blog and starting a new pseudonymous one, there was no way to make people un-know who I was. And let's be clear here, that sounds way overly dramatic--I'm not a big-name blogger by any means, nor have I ever really tried to be. (I figured the more people that read this blog the more likely I would be to get in trouble, so I never really did all the blog-promote-y things like networking with other bloggers or linking to this that or the other guy or being super-active in other online venues. I just wanted to share my experiences as a medical student and, later, as a resident. If people wanted to read, fine. If people didn't read--also fine.) But anyway, I started my blog under my own name, and that's how I stayed.

That said, even if I could go back in time and could make the choice again, I don't think that I would blog anonymously. Obviously now it's more convenient for book promotion, but even that aside, I prefer to be out in the open about my life and my blog. I think it keeps you honest. And I think it holds you accountable for what you write. I've seen way too much "anonymous" action out on the internet, and though it is occasionally for good reason (for blogging in medicine I particularly understand the concerns), I've seen way too much craven sniping bullshit to want to be a faceless figure myself. What I put on my blog I want to be able to say to anyone to their face. I don't want anonymity to be an excuse or an alibi for any bad behavior that in which I'd be inclined to indulge--and believe me, I have inclinations towards plenty.

But obviously, blogging "out in the open" produces more restrictions on what I feel comfortable writing about. All of these restrictions are self-imposed. I don't talk about the fact that I have a blog unless people ask me directly (it's not a secret, I just don't want to be the dork blaring to people to OMG READ MY BLOG YOU GUYS!!!!) but I am totally open about the fact that I have one. If patients Google my name, my blog is the first (and second, and third, and fourth) link that pops up. As such, I feel the need to be accountable to my content as well. Long-term readers might notice that for the past, oh, at least five years, I haven't really talked about very much specific in terms of clinical content. Not much about specific patients or specific cases, and certainly any individual stories have been either significantly veiled or at least temporally displaced enough that it would be very difficult to identify anyone in specific. That's just my responsibility, and that's not negotiable.

I have been recognized, but believe me, it's not as glamourous as it sounds, nor is it a common thing. I've been recognized at the hospital, recognized at the supermarket, recognized heaving Cal in his stroller up the subway steps. But it's not a big thing. Usually it boils down to someone asking me, "Don't you write a blog?" or "Didn't you do those comics?" and me acknowledging. And then we move on. Sometimes people e-mail me that they recognized me on the street (this was more common in New York, where people actually walked on the street) but were too embarrassed to come up to me and say hi. You should not be embarrassed. I should be embarrassed, because I have scrub hat-head and am yelling at Mack to stop eating rocks. But you should say hi. (Hi!)

The people in my residency and the people at my current job are well aware that I write online. This has never been a problem for anyone, but I like to think that I have made sure that I write in such a way that no one should be able to have a problem with what I present online. I am well aware that I am representing not just myself, but the practice of medicine, my institution, and my colleagues. As such I hold myself to the same standards that I do at work. Discretion, honesty, and restraint where called for. I hope I've succeeded. I guess you guys will tell me if I fail.

When it comes to blogging about my family, this is well-tread territory for in the "mommy blogger" realm, so I'm not going to rehash too much, but I do talk about my kids and I do post pictures of them, despite what some (in my opinion, the more hysterical amongst us) warn me that this means people are going to kidnap and sodomize my children. Partially this is because my blog is part public, and part personal documentation--I like looking back on old entries, especially about my own kids, look at the pictures, and see how much all of us have changed. And partially, it's all coming back to the honesty piece again. I know that a good portion of people who read this blog are in medicine, and I feel a responsibility to represent my perspective on what it's like to balance a career in medicine and a family. Sometimes it's cute and fun, and sometimes it's tiring and difficult, and I want people to know that, or at least know one perspective.

So anyway, blogging in medicine. It's a big topic, and I'm sure it's only going to get bigger. I would love to hear your thoughts.

i am trying to finish this entry without saying the word "blogosphere"

I know this is irrational, but when I'm on call for the weekend and everyone around me is celebrating how happy they are that it's finally Friday I kind of want to punch them in the nuts. (Substitute ovaries if the person I'm going to punch is a lady.) Being on call on the weekend is just depressing. I know I'm not on call every weekend, and we all take turns doing it, but man, there's something about walking into the ORs early on a Saturday morning before the lights have even been turned on--all the while knowing that normal people everywhere are either sleeping or playing with their kids or just generally doing leisurely things far, far away from the hospital--that just makes you feel forsaken.

But anyway, my point here is not to complain about being on call this weekend, rather to ask for some feedback. I have been blogging for just about ten years now, since the beginning of my second year of medical school. Except we didn't call them blogs then, we called them "online journals" or "personal web pages," and it never really occurred to me to not write under my real name, because of course, no one was going to read it except for people who knew me already, right? (Those were more innocent times--some would say stupider.)

Anyway, obviously the internet has changed a lot since the year 2000--or as we called it at the time, "Y2K," while we holed up in our impermeable canned food-stocked bunkers awaiting the apocalypse--and while I was not aware of any other medical-type blogs at the time that I started mine, now there are probably thousands. The fact of it is it's very easy to have a blog now, and many people have, though the range of medical blogs run the full spectrum of genres. Some are informational, some a personal, some are clinical and some are introspective. Some people blog under their real names and some blog anonymously, some blog for perspective and some blog to bitch about being on call this weekend. (Cough.) Probably in most ways, the reasons behind medical blogging aren't much different from the reasons behind much of the content on the internet, though obviously, the edifice of medicine presents some interesting overlay as well as unique issues and challenges.

Let's say that there was to be a panel discussion group of medical bloggers. Let's say there would be a presentation portion, and then an open discussion portion. What issues would you want that panel to hit upon? What topics would you want discussed? What questions would you ask? Or, if you're a medical blogger yourself, what particular difficulties or rewards have you come across that you didn't expect when you started writing online?

There is more to this story than just me asking idly, of course, but further information as events warrant--for now, let's talk blogging in medicine. What would you like to know? And what kind of stuff do you think I might like to know?

send in the frowns (they're already heeeere...)




Someone in the comments section noted that Mack always seems to be frowning in photos, and I have a response to that. He is not always frowning in photos. He is always frowning ALWAYS.




It's not the sun or the wind or that fact that something weird is happening. That's Mack's default facial expression. Appalled. He's going to need Botox by the time he's twelve.




Of course, the overindulgent parent's excuse is just that he's extraordinarily thoughtful. Sometimes I think that. He certainly is deliberate. He studies things a lot. He's a thinker. Sometimes when he falls, he doesn't cry. He just sits there and considers how much it hurts and whether or not crying is worth it. And he frowns.




Or maybe he's pooping.




He's been doing this ever since he was born. Above is a picture of him at nine weeks. Already he can lift up one eyebrow in a disapproving expression. He's a savant. A savant of looking pissed. That's just what his face naturally does. Even when he's having fun. He can smile. He just prefers to frown.




So anyway, I guess there's not much point to this entry. But my kid is pretty cute. So there's a point. Carry on.




Obligatory advertising section

Plug the first: My editor informs me that my book will indeed be available as an e-book (for Kindle and whatnot) in May. So yay! I myself read 85% of my books in Kindle form now, so that excites me. I also read a lot more now that I have a Kindle equivalent, mostly because I feel that my threshold for buying books is a significantly lower, mostly owing to the immediate gratification factor. E-books are good, if you don't mind the screen.

Plug the second: However, a physical book is a beautiful thing--there are some books that I would not trade in for e-books just because I like to hold them and flip through the pages. I don't think my book deserves to sit on the same shelf as my 50th Anniversary hardcover edition of "To Kill a Mockingbird" or anything, but if you do want to preorder a physical copy, it appears that the price on Amazon has dropped from $24.99 to $16.49. Which is less. MATH. So you should buy one. You know, to keep in the bathroom or what have you. What else are you going to read in there, the instructions on your toilet paper packaging?

somewhere between all and none




I've long ago come to the conclusion that as a working parent, "having it all" is a myth, one perhaps not purposely designed, but nonetheless effective, in making normal hardworking people feel bad. I'm going to say it right here, and go ahead and quote me: you cannot have it all. I mean this realistically, not pessimistically. I just think it's not possible, and the sooner you realize that, the sooner you'll stop beating yourself up about not being superhuman.




There was a time when I was younger (read: more naive) that I thought that "having it all" was a real possibility so long as I was willing to work hard at it. I would be really, really good at my job and I would spend a lot of good, quality time with my kids, and everyone was going to grow up with good moral values and excellent study habits and we would talk about how our days went over family dinner every night, a meal which I would not necessarily cook, but could certainly heat up. (Even at my most idealistic, cooking well never entered into the fantasy. Some limits I have always been aware of.)




I am now what the me of the past would consider a grown-up. And this is the reality of things. Aside from on the weekends, we never have family dinner. I am not home for the kids' dinnertime about half the time, Joe almost never is. The time I spend with them in the evenings is more goal-oriented than quality. Finish dinner, hustle everyone into the bath, let the kids play in the basement while I catch up on other things that have been ignored during the day, and it's the wind sprint of snack-milk-toothbrushing-books-bedtime. If Joe is home by bedtime (which thankfully he usually is now), we divide and conquer--he takes one kid, I take the other. And then we go to bed, usually by nine, because we have to get up early the next morning and we're tired, don't you know. I don't feel like I get much quality time with the kids during the week. And I definitely don't feel like I have time to do the things that will make me better at my job--reading journals, studying, reviewing questions that came up during the day. And that's what working parenthood feels like a lot of the time. Trying to do two important jobs in parallel, and half-assing both of them.




There are probably people with jobs more amenable to the constantly fluctuating schedule of the preschool child, but medicine in general is not really one of them. I have never been to one of Cal's classroom get-togethers. I can rarely make it to parent-teacher conferences. It is only through extensive planning, switching dates with other parents, and taking overnight call the night before that I can even hope to make it to such big events as Cal's Gold Star Day or his Person of the Week or his Lucky Strike or whatever they hell they're going to call his Super Special Snowflake MVP Day this year. Everything in schools seems to happen mid-morning, and having a mid-morning reliably free on a week's notice is just not something I can reasonably expect to accommodate.




On the other side of things, I have a stack of papers two phone books high of anesthesia study material that I've been meaning to go through for the past six months and which I have not touched. I have textbooks sitting hopefully on my bookshelf with their spines still pristine, because I have not yet had time to read them. I never spend time with adult humans outside of work. During the course of a normal work week, I almost never have cause to eat a meal unless it is as fast as humanly possible (at work) or standing up behind the sink (at home). So it seems that on both fronts, I'm not really making out very well.




The thing is, though, I'm starting to be OK with that. That's just how things work. Time spent doing one thing is time necessarily spent not doing another thing. I can't change that. I love my job and I love my kids, but I can't do both things at once. So depending on what's going on and the time of day, I have to prioritize. It's triage, plain and simple. And you do the best you can with what time and resources you have.




Some days I feel like I hardly see my kids at all. And some days--mostly a day after a day that I haven't seen my kids at all--I'll have the chance to get out from work early. And maybe that's the day that I decide, you know what, instead of trying to cook dinner and return all those e-mails and stressing about how many CME credits I still need to get this year in order to keep my medical license active, maybe I'll pick Cal from school and take both kids to the park. And then we'll play ball and feed the geese. And maybe we'll just hang out, and not worry too much about what time it is, or what cases I have scheduled for tomorrow, or the fact that the inside of Cal's lunchbox smells like carrion. We can worry about that later. Right now, we can just, you know, sit here. Sit here in the grass together and feed these fat geese.




It's not having it all, and it's not perfect, but most days, it's enough.

better than cliff notes

When I was a kid maybe a little older than Cal's age, I had this set of "illustrated classics"-- pocket-sized paperbacks with abridged versions of famous works of literature. I really thought these books were awesome. Some of my favorites that I remember vividly were "The Strange Case of Dr. Jekyll and Mr. Hyde," "Swiss Family Robinson," "The Time Machine," and "War of the Worlds." In other words, books that I probably would think are a total snooze now. My tastes run more towards contemporary literature nowadays (anything written after World War II usually is suspect in my book--I know this makes me a Philistine but I'm just being honest, just like I'm being honest when I tell you that I am a girl and I thought that "Pride and Prejudice" was SUPER BORING) but when I was a kid, I just remember being captivated by those illustrated classics.

I had no idea that they were abridged versions at the time, but somehow the fact that they were abridged made them better than the originals--like they cut through all the wordy embellishments and baroque flourishes and reduced the books down to pure scene and plot. That along with the pictures just made them fantastic to read. I know it's probably telling that I was the kind of kid who'd prefer snuggling on the couch with a stack of books and some old Halloween candy than--well, pretty much anything else in life--but really, I have very fond memories of those books.

Cal's been reading a lot more these days, and so lately, I've been trying to locate some of those old paperbacks. Not at my parents house--they moved since I was a kid, so any books from that era are probably long gone, sentimental value or not. But there is Amazon.com and eBay, after all. Still, I can't find the same versions of those illustrated classics. And believe me, I have looked. I found books in the same vein, in that they are classics, and they are illustrated--but no, I want the same books. EVERYTHING MUST BE THE SAME. I know, it's a disease. My child must enjoy what I enjoyed. (Next up: a Wilson Phillips CD.)

This is what I remember about the illustrated classics that I read.


1.) They were paperbacks.

2.) They were small. I want to say 4" x 5". You could cram one in your back pocket.

3.) There was a black-and-white picture every other page. Left side was the picture, right side was the text. Usually the picture was captioned by a pull quote from the text. Like, "The Swiss Family Robinson sailed to the island on a boat out of sawed-open barrels!"

4.) They came in a big box set of, like, 12 or 24 books.

5.) I think the publisher imprint was Moby? Or something like that. Anyway, there was a whale on the cover.


One more think about the illustrated classics series from my childhood is that I credit them for making me seem smarter than I actually am. For instance, to this day, I have not read the real versions of "Great Expectations" or "Little Women," but I know a lot about the plot of these books from the illustrated classics. You know, like how Jo sold her hair and how Ms. Haversham stopped all the clocks in her house and still wore her wedding dress around until she caught on fire. Now if only they had one about "The Portrait of Dorian Gray," so I would know something more about this painting under the bed that everyone keeps talking about.




Edited to add: Woo! Found some on eBay! Mission: Nerd Kid 2.0 complete!

meanwhile, back at the ranch...

We took the kids to The Rock Ranch this weekend, which is a cattle farm owned by the founder of Chick-Fil-A. I think the cattle ranchiness of the place is somewhat beside the point, though, as most of the grounds seems dedicated to its "Fall Family Fun" activities--train rides, corn maze, Tiny Town, what have you. I was all set to bring my real camera but at the last second , I just couldn't stomach the idea of lugging around one more bag, so all the pictures from the day were taken via the Hipstamatic app on my iPhone. I do love that app. I have a couple of other apps that simulate toy camera or instant camera-looking effects, but none do quite as nice a job as Hipstamatic. (I usually shoot with the John S lens and the Ina 1969 film, because I think it has the sharpest focus and I like the color of the resulting shots, even though they do tend to veer towards the green end of the spectrum.)












(Above: becoming Southern, exhibits A through I.)

Oh, on the topic of the book now being available for pre-order, I've gotten email from a good number of people asking me if the book will be available on Kindle or equivalent e-book reader. The answer is that I don't actually know. But I myself read a good percentage of books on Kindle now (rather, on the Kindle app for my iPad) so I totally understand the demand. I just went to the book's Amazon page and clicked the "I'd like to see this book on Kindle" link under the picture of the cover. Go ahead and do the same if you're interested in an e-book version. Not sure what kind of numbers they're looking for before they decide if Kindle-izing the thing is worth it, but I figure it can't hurt.)