quality

Yesterday I had to take Cal for a checkup at the video-game-magical-treasure-chest-flat-screen-TV-playing-wall-to-wall-cartoons emporium, also known as the pediatric dentist's office.  Can I say, first of all, how awesome I think the culture of pediatric dentistry is?  Getting your kids--or at least my kids--into that chair is kind of a hard sell, but they sure hit that right combination of bribery and computer-animated video hypnosis to make it a much more positive experience.

Anyway, the only appointment I could get was at 10:00am, which means that Cal missed the morning at school, and when I saw what time it would be by the time I dropped him back off (after lunch, halfway through recess, with only two hours left before dismissal) I decided to just get his assignments from his teacher and keep him the rest of the day for some quality time, just him and me.  It's something we don't get to do very often.  We need to do it more.

The fact of it is, although I talk about Cal much more on this blog (first pass effect, I guess), Mack actually much more attention from me when I'm home.  The thing it is that Mack is little, and just in terms of the activities of daily living, he needs a lot more minute-to-minute maintenance, whereas Cal I can just tell to go do his homework or go read a book or please wash your hands and get ready for dinner.  He's pretty well-behaved too, which means that for the most part, he doesn't need me on top of him for every single last detail.  Which is good of course, but when you work a lot and have two kids, I think it sometimes means he gets less actual time with me outside of the purely purpose driven tasks and me prodding him to hit all the points he needs to hit before bedtime each night.

Yesterday, we went to the dentist.  Then I took him out for lunch at Five Guys Burgers and we stopped by Staples to pick up one of those plastic report covers for a school project due next week before finally heading home.  The dentist, burgers, and a plastic report cover.  But just him and me.  Cal told me later that it was one of the best days ever.

I told him we'd do it again soon.

second opinion

Yesterday after I gave my Grand Rounds (which went well by the way, at least to the extent of my experience giving it), I was in a good mood and celebrated by taking my car to the fixit shop.  Well, actually, the second thing had nothing to do with the first, it just sounds more festive that way.

All the important mechanics were fine (you know, like the wheels, the engine, the other...drive...pistons), but there was something wrong with my trunk. To be clear, the trunk was working JUST FINE up until we went camping last weekend, when:

JOE

Hmmm.

MICHELLE

What "hmmm"?

JOE

Could you open the trunk of the car before?

MICHELLE

You mean was I able to open it earlier today?

JOE

Yeah.

MICHELLE

Well, of course, that's how I crammed all those sleeping bags and blankets and camping stuff in there.

JOE

Hmmm.

MICHELLE

WHAT "HMMM"?

JOE

I think I just broke the lock on your trunk.

The trunk could no longer be opened by the car key itself, nor by pulling the lever in the driver footwell, though oddly, the remote control keychain button still worked.  I didn't think this was a big deal at all--usually I open it with the remote anyway--but Joe pointed out that if we ever lost the keychain or it malfunctioned, we would be toast.

"OK, so I'll stop locking the kids in the trunk then," I responded (I thought) quite reasonably.

Joe made me take the car in anyway.

The car fixit place (I just took this one picture there of the pretty rust pattern, though I realize this photo makes it look like a vehicular internment camp--not that far off, I guess) told me that I should expect to leave my car there for at least the rest of the day.  They would most likely have to dismantle the whole trunk, replace the lock apparatus en bloc if (IF, they emphasized portentously) they could locate the correct parts, a process that might take a day or two.  When I balked at the day or two (or two? Two days?  TWO EARTH DAYS?) they replied that they would make their best effort to at least have the car in drivable condition by nightfall, though under no circumstances (they underlined this with an eye-roll, to illustrate how crazy this would be) should I expect the trunk situation to be anywhere near fully resolved without another one or two visits for full repairs down the road.

Anyway, I thanked them for their opinion and diagnostic time, and proceeded to take my car to a Toyota dealership across town.  (Not to ruin your fancy doctor car dreams, but I drive a used Toyota Camary with a sizeable dent on the rear drivers side.  If you see me on the road, say hi, I'll be the one gripping the steering wheel in panic.)  At the dealership, the guy looked at my trunk for two seconds, clicked something over in the lock mechanism, and said, "There.  You're good to go."

Apparently we (Joe) had automatically engaged the trunk into "valet mode," which I wasn't aware existed but I guess is what you do if you are getting your car valet parked but don't want the parking people to look into your trunk and see you stash of dead bodies or whatnot in there.  The trunk wasn't broken at all.  It was such a no-brainer the people at the Toyota place didn't even charge me.

So from a multi-day, labor-intensive, thousand-dollar estimate to a problem that was fixed with a seasoned eye, some common sense, and a flick of a switch.  I guess this would be a good time to draw an analogy back to patient care, but I think you can probably take those last few steps on your own.

country roads

And...we're back!  

We spent the weekend camping at Red Top Mountain State Park, and if I can say one thing for North Georgia, it's that they do their nature up right, son.  This is the first time we've gone camping as a family, but Red Top Mountain on Lake Allatoona, less than an hour north of Atlanta, was impressive--gorgeous, seemingly remote without actually being so, and (to my inexperienced eye) incredibly well maintained.

 

The pictures kind of make it look like we trekked out to the middle of Nowheresville, but it was hardly a survivalist exercise--there were park offices and picnic shelters, bathrooms and showers, even a mini-golf course near the campground rental office.  There were a range of different sites available, but the one we got had a fire ring, a water pump, concrete picnic table, raised tent pad, and two electrical outlets.  You know, so we could plug in our Wii.  

(To be clear: we did not really bring a Wii.  It was nice to have power to pump up the air mattresses and charge our cell phones, though.)

The kids obviously had a good time, and were a little crestfallen this morning when we got ready to go home.  Given the effort of getting there and setting up our campsite just so, I can see the argument that going for just one night is a waste, but I just did not want to shower at a campgrounds, and 24 hours was basically my aseptic limit.  Maybe next time we'll stay for two nights.  Maybe.

The hobo stew was a great success, to the point that I'm thinking I might just make up similar packets to stick in the oven for the kids' dinners on nights that I'm working late.  Someone in the previous entry's comment section pointed out that I had folded my packets wrong, but I'm pretty sure that there's not that much nuance to the fold--the main goal of a hobo stew packet is just making sure that your ingredients stay in and that the ashes stay out, and that you you a thick enough foil (or enough layers) to make sure that the packets don't rip when you flip them.  I put precooked chicken-herb sausage, peppers, roasted corn, potatoes, and butter in our packets--there was a little sear on the sausage in the end, but unsure of the timing of the cooking process (in particular the potatoes, which were raw and take longer than anything else), I leaned towards going a little over on time.

The night was fitful at best.  Joe an Mack both snore (I'm aware that a two year-old probably shouldn't snore, but he's had a stuffy nose so I blame that--I also would like to throw it out there that I don't know a single anesthesia provider with a family member that snores who has not tried to do a chin lift/jaw thrust on them at some point) and Cal, while silent, sleeps with the ponderous and deliberate pinwheeling motions of one doing somnambulist Tai Chi.  So there was the snoring and the kicking and the air mattress adjustments and the crickets and then the more snoring, until finally, at some point, it became morning.

All in all, camping was actually pretty fun.  Things I'll remember for next time:

1.) Bring a change of shoes for everyone.  It would have been nice to have slip-on shoes at the campsite for getting in and out of the tent, and besides, Mack walked through so much water and mud that his shoes were completely soaked through.

2.) Christmas lights!  Once it started getting dark it got, like, really dark, and I saw that some of the more experienced campers around us had strings of Christmas lights that they used to ring their tent sites.  Not only did it provide great ambient light, but it looked a hell of a lot more festive and warm than our two puny LED lanterns and Cal's tiny headlight.

3.) Less food, more drinks.  I brought a lot of food (thinking, perhaps, of the Donner Party), but knowing that there was water on site, I only brought a mess of juice boxes and some milk for the kids.  The water that came out of the pump at the campsite looked clear and smelled fine, but last I checked you can't see Giardia (colloquially known as...snerk..."Bever Fever") with the naked eye, so we boiled all our water before drinking any, and the kids were not really wild about drinking warm water.

4.) Our own stash of firewood.  Joe made a last minute trip to the hardware store to get a couple of cords of wood, which was lucky because it had been raining the few days leading up to our trip and though it was sunny all weekend, everything on the ground was damp.  We brought three bags, but we used it all up and we were only there one night.  Add to that point: more kindling and an extra one of those Bic firestarter sticks probably would have been a good idea too.

Anyway, it was a nice weekend.  Now that we have a little more of a system down (not to mention most of the gear), we'll definitely be back to camp by Lake Allatoona again--and maybe next time, we'll get there early enough to get a campsite directly on the water.

outward bound

Against what I consider to be one of my better instincts (and I would classify most of such instincts to be related to maintaining integrity of the integumentary system and related parts), Joe and I decided that we're going to take the kids on a camping trip this weekend.  I have nothing against wholesome family fun per se, and despite my bookish and wan appearance have even been on a camping trip or two in my own youth, but here, in no particular order, is a list of some things I hate, and which make spending a night in the woods a bit of a hard sell:

• Being dirty.
• Being cold.
• Bugs.
• Not being able to take a shower.  
• Sleeping on the floor.

(Is hate too strong a word?  Maybe.  And yet...you've seen bugs, right?)

Anyway, I dislike many of the elements of camping, but be that as it may, we're going camping this weekend because it seems nutritious and cleansing somehow, the spiritual equivalent of a high-fiber cereal, and besides the kids have been begging us to go camping for almost a year now.  Who am I to cruelly deny them the simple pleasures of getting a billion bug bites and then tracking dirt clods and sweat into the sleeping bag, where I will spend a fitful night tossing and turning, maintaining a state of cat-like readiness in the event of bear attack or chainsaw massacre?  Only their mother who loves them, THAT'S WHO.

(Did I also mention that there's no Wi-Fi in the woods?)

Anyway, I exaggerate my low tolerance for All Things Nature, but to be fair, I like looking at fall leaves and verdant vistas just as much as any of my other vaguely geriatric pastimes, so we're all actually pretty excited about our camping trip.  So excited that, in the spirit of the proceedings, I even made four servings of "hobo stew" to bring with us and bury in the coals for dinner.

(If you are guessing that I was mainly swayed by the appending of the descriptor "hobo" to anything, you are correct, but our hobo stew contains chicken herb sausage with garlic and shallots garnished with a not insignificant amount of butter, therefore promising to be, if not tasty, then at least filling.)

We're leaving tomorrow morning.  Real-time Twitter updates for your fish-out-of-water amusement as iPhone connectivity allows, otherwise have a good weekend and we'll catch up when (and if) we return.

warning

I've got to say, once I finally figured out how to make a mouse-over image change (and granted, it wasn't that hard to do but you'd never be able to tell from how long it took me to figure out how to get it right), I just want to make a mouse-over image change for everything.  EVERYTHING.

But I guess I'll just quit while I'm ahead.

break Joe's website

So as you all know, Joe recently switched jobs, so for the past week or so I've been trying to help him build a professional website (professional meaning for work, not as in designed by a professional) because how else are patients ever going to find him and know how awesome he is?  My proposal went like this.

MICHELLE

You need a professional website.

JOE

I do?

MICHELLE

It has to have your credentials on it, and all the information about the surgeries you do,
with, like, "Before" and "After" photos and contact information and post-op instructions
and such, because blah blah blah online presence marketing Internet searches social media blah.

JOE

What is an "Internet"?

MICHELLE

Let me...just do it for you.

So we made this:

I designed and built the site, while Joe provided the content.  It's still a work in progress, but I think it's starting to look...pretty decent.  I personally have a bias when it comes to doctors' work sites--many many of the plastic surgeon websites I've seen I think come off a little too glitzy (and I realize that this is somewhat dictated by the nature of the work and clientele, but there comes a point where patients may have a hard time telling if they're researching a doctor or reading US Weekly).  For Joe's site, though, I wanted a simple, clean interface with all the medical information and professional credentials easily available. Joe does such good surgery and his professional pedigree speaks for itself, I thought it would only be distracting at best and cheapening at worst to gild the lily with, like, animated lens flare effects and an Enya soundtrack.

But anyway, do me a favor and look at the site. Look around on all the pages and see if they read well, click on the links to make sure they all work. I know some of this is a matter of personal taste, but does the website flow well for you?  Is there anything not on the page that, as a patient, you would want to see? Click around a lot, roll around, try to break it, think of it as a couch at Ikea that you're trying to decide to buy for your family room, then e-mail me or leave a comment to let me know what needs to be fixed.  Remember, this is still a work in progress (in particular, I have an "FAQ" section and a "Patient Testimonial" section that we're still working on) but in general, how does it look?

As for the subject of trying to build a website with your spouse looking over your shoulder, I will add this conversation from this morning.

MICHELLE

(Painstakingly editing HTML to adjust photo alignment and spacing, because the Blogger 

"compose" interface is a piece of doo and has already taken years off my life.)

JOE

Hey, you should try to use HTML!  Or something!  For the website!

MICHELLE

(Pause)

Have you ever seen that site, "Clients from Hell"?

JOE

Yeah, you showed me that once.  Hey...why are you bringing that up now?

MICHELLE

No reason.

Thanks guys!

(By the way, I've test-driven the site on Google Chrome, Safari and Firefox and it renders decently on all of them so far as I can tell--however, if you're using some kind of antiquated browser, NO PROMISES.)

as time goes by

I don't really know what this says about me--probably nothing good--but I'm glad that September 11th doesn't fall during the work week this year.  Something about the idea of having the day, in all its past, present and future incarnations, commentated on relentlessly on the TV in the anesthesia lounge (I was going to say CNN but to be honest it seems that the default setting is usually Fox News) is more than I really have the stomach for.  As a native New Yorker who was in the city on the day of the attacks, I, like many, still feel that it's a little bit of a tender spot.  And I think I've talked in the past about how much doctors dislike having feelings.

Ten years later, the events of September 11th have arrived at their final resting place in history, though it's hard for me to put my finger on exactly where that is.  More often then not now, when I see it referenced (and granted, I no longer live in New York), it's held up as an emblem more than anything, or used as a supporting argument for this that or the other thing.  It's the stuff of decals, of commemorative plates, of tattoos and of posters.  And it makes it feel important but distant, like something horrible you'd read about in a book but hadn't actually lived through yourself.  The distance is inevitable.  Time makes everything less raw, a little less messy, and filters our memories through experience.

We even have a whole other language for it now.  September 11th is now "nine eleven."  I remember on the day of the attacks one of the doctors in the OR was speculating whether or not there was any significance to the fact that the date spelled out "9-1-1," as sort of a wink to the emergency response system that would surely be activated.  We didn't know to call it "nine eleven" then, the date itself at that time was nothing special.  In the weeks to follow, the smoking craters where the Twin Towers stood and where remains and debris were being excavated were still being referred to as "The Pit."  Not until later did the language of "Ground Zero" take hold, though now, you say "Ground Zero" in reference to Lower Manhattan and everyone knows what you're talking about.  Why do I bring this up?  I don't know.  Maybe because it's midnight and I'm on call and too wired to go to sleep.  Or maybe because, as strange as it sounds, I miss there being a time where that whole other language didn't yet exist.

Joe and I broke up shortly before September 11th, 2001, did I ever tell you that?  I probably didn't, it even in those early days of my blog I didn't exactly consider it grist for the mill, and I can't even remember why it was that we had broken up at the beginning of our third year of medical school, shortly after our OB rotation in Stamford, CT.  (I blame OB, personally.  Or maybe Stamford.  Probably both.)  Anyway, we'd broken up for some reason, and it was weird and awkward, because we were still in the same clerkship rotation group after all, and we still had to see each other every single second and act all normal and professional, which if you don't think was torture you've obviously never dated anyone before.  On September 11th, we were on one of our Surgical Subspecialty rotations, which I thought was a blessing because we got split up into smaller groups--I was rotating on Pediatric Urology, whereas Joe was, I think, rotating on ENT (Otolaryngology for your purists out there) in an entirely different part of the hospital.  It was a relief to be away from him, so I thought.  But after those planes hit that day, Joe was basically the only person I wanted to be with.  Six months later, we were engaged.

I don't really know what my point is with all this, and I know it sounds incredibly short-sighted or even mean-spirited to begrudge the way that the events of that day have become more totemic than real.  It's just that I can't help but to think that way.  It wasn't a T-shirt.  It wasn't a bumper sticker.  It wasn't a picture on a TV.  It was real.  The little things make it real, and each year that passes, the edges of those little things becomes increasingly softer.  But I still remember.  The blaring radio at the bagel store across the street from the hospital.  The smell of that fall morning walking into work.  The jungle animal print cap the anesthesiologist was wearing in the OR when we heard the news.  The way the smoke looked rising up to the sky, thick and billowing at the base, then spreading out into a blanketing haze.

It was real.  It happened.  We were there.  And you can print as many banners and lawn signs as you want, but New Yorkers don't need to be told to "Never Forget."  Because we never will.

ch-ch-ch-changes

When I'm not trying to work or sleep or keep my fool kids from killing each other (it's sweet actually how much they love each other--they hug and kiss and everything, which if you don't think is adorable I have some concern for the cold black granite that is YOUR HEART--but hand-in-hand with this adorable snugglefest is the fact that they fight like puppies crammed into a wicker basket only given one very small squeak toy to share) sometimes I try to update this blog. Clearly I have failed these past two weeks. But that Virgina Apgar thing was still pretty cool, wasn't it?

(Crickets.)

The big news these past few weeks is that Joe has left the world of academia and has now joined Paces Plastic Surgery, an excellent and highly respected plastic surgery group in Atlanta. It was tough to leave the university setting, but we're all very proud of him and excited for his prospects. To be totally honest, Joe is one of the very best doctors I know, and he cares about people and families more than just about any practitioner I've ever met. His patients are very lucky.  So here's to new beginnings for him, and for us.

Cal has been...well, Cal has been great.  You probably remember that I had some reservations prior to the start of this school year (we just switched schools, after all, so I had some concerns about the, shall we say, elasticity of the curriculum) but we've been pleased and actually delighted at how attentive and responsive his teachers have been, especially given that we'd actually not said anything to them at all.

"Maybe we should tell them to give him some harder math problems," Joe said near the beginning of the year, as we looked at Cal's homework (which was a giant worksheet of, essentially, counting problems).

After I duct taped him to his chair and stuck a sock in his mouth, I hissed at him don't you dare say anything, because it was the first week of the school year and the last thing I wanted to do was position us as the insane pushy Tiger Parents who don't know when to shut up.  I wanted to trust the teacher to make that assessment on her own.  Cal had a long history (particularly in preschool) of being perfectly able to do things well, but being too stubborn to show anyone that he could.  It led to talk of remediation a few years ago, for chrissake.  So I figured, just let it be for now.  Cal would either show what he could do, or he wouldn't.  And the teacher would make an assessment of what he should be doing, or she wouldn't.  But the first two weeks of school was way, way too early to start inserting ourselves and insisting that, HEY, MY KID CAN READ HARRY POTTER AND DO MULTIPLICATION, ARE YOU DOING HARRY POTTER AND MULTIPLICATION IN SCHOOL YET?  There's a fine line between advocacy and just being a pain in the ass.

So we didn't say anything.  Cal has been having fun at his new school.  He loves his teacher.  He is making new friends. These are the big things.  But also, on the other end of things, his teacher has told us that she's going to start pulling him out of their regular math class and that the "Enrichment" teacher is going to design some special extended projects for him to do during that time so that he doesn't get bored.  This really makes me happy, because the worst thing that could happen to Cal would be for him to become disenchanted with school--already he's asked me why, if school is so easy, does he have to go every day.  (Because of THE LAW, son.)

Anyway, I'm really impressed with the school's flexibility, it's certainly beyond what I had expected, and I'm even more glad that they came to that decision outside of me or Joe pushing anything.  Or perhaps it was Cal doing the pushing, as he'll regularly finish up his homework, and then, on the blank page on the back, write himself an entire new worksheet of more difficult math problems, and then finish those too.

I'm proud of my boy, is all.

(ASIDE FROM MEMORY LANE: When I was in fifth grade, I remember the teacher letting me and this other boy, Frances, do our own writing activities during the phonics curriculum, because phonics was, well...pretty ridiculous.  So what Frances and I decided to do was a booklet of political cartoons centered around the 1988 presidential elections, where we lampooned each candidate, as well as the sitting president at the time, Ronald Reagan.  I believe there were a couple of comic strips featuring Mikhail Gorbachev as well, and I remember studying his nevus flammeus very carefully so I could draw it just right.  And that, friends, is what you call a Baby Nerd.)

It's probably been observed to the point of stereotype that after a bringing into the world a particularly bookish, adult-oriented child, your second child is bound to be the human equivalent of a monster-truck rally, and that is most definitely the case at our house.  Mack is like...well, he's like a Mogwai.  Starts off real cute, ultimately destructive, and should not be fed after midnight.  (If it turns out he starts multiplying in number after he gets wet, however, we're in big trouble.)

The weather has finally started getting cooler here, and after four straight months of 90+ degree weather, I could not be more ready.  It's been a long summer, but autumn smells like beginnings.