Showing posts with label advice from the trenches. Show all posts
Showing posts with label advice from the trenches. Show all posts

straddling

I had to take our minivan to the dealership for a physical (I don't know--what do you call it when you have to take your car in for a visit to the car doctor? A well-car check? I plead ignorance and this parenthetical is now threatening now to take over the whole intro) and at the dealership they have honest to god carrels in a room off the waiting area, like a damn library. On one hand--how great! A quiet area with a desk and a chair and a power outlet to get some actual work done! And on the other hand--how long do you expect that I'm going to be sitting here, exactly?




Well, nothing like a stretch of captivity to force you to update your foundering blog. Ahoy hoy.

Last week was my last week of working full-time. My first "official" week of working at a 60% schedule is actually the week of Labor Day, but I had this week fortuitously scheduled as a week off from almost a year ago, like I planned it this way the whole time, for transition. It's not so much a vacation as purely a maintenance period for our family (MAINTENANCE! That's the kind of car visit I'm at now! Le mot juste!) meaning yesterday I took Mack to the dentist and tomorrow I'm taking Nina for her one year well-child check and now I'm here looking at a wonderful hubcap display and wondering if I should get purple under-light effects to make our suburban splendor-mobile that much more splendid. I mean, it seems excessive and yet this pamphlet makes such a compelling case for them...

I am so excited to enter this next phase of being more engaged or at the very least present for my out-of-hospital responsibilities, but I acknowledge that various internalized cultural attitudes have been a little difficult for me to shake. Namely, I find that I really have to check myself from being too defensive when people talk to me about my part-time status. 


JOE
(As we are engaged in high-level strategy talks about managing yet another week of juggling 
call schedules, OR and clinic times, childcare, meal timing, and after school activities)
Man, this is hard. I can't wait until you start slacking off at work a little bit.

MICHELLE
SLACKING OFF?

JOE
I mean...not slacking...I mean...you know what I mean! Working less! Working less at the hospital!

MICHELLE
THERE IS NO SLACKING INVOLVED HERE. NO SLACK
ALWAYS WORKING! HARD WORKER ME!



Or possibly this:


CO-WORKER
So, you're going part-time, huh? Sounds nice.

MICHELLE
(Cautiously)
Yes...

CO-WORKER
Gotta go be mom. I get it. I wish I could do that.

MICHELLE
DO YOU THINK THIS WAS AN EASY DECISION OR SOMETHING?
BECAUSE IT WASN'T! NOTHING EASY! EVERYTHING HARD!

CO-WORKER
Uh...
(Starts backing away, feeling for the doorknob)


And also:


RANDOM PERSON
Hello--

MICHELLE
(Pointing)
AND YOU! I'LL HAVE YOU KNOW THAT I HAVE AN EXCELLENT WORK ETHIC.

RANDOM PERSON
Aha. Huh. Well, as I was saying, "Hello, and welcome to Target."


Anyway, sorry world. Obviously I am having feelings. It's like I'm all messed up on my Erikson's stages. Instead of "Generativity vs. Stagnation" I've regressed back to "Identity vs. Confusion." (Also, can we all acknowledge that the fact that I even remember any of this from second year med school psych is pretty fucking impressive? OK, not so impressive, but notable at least.)

I don't know why I default to the defensive--maybe I need to prove to myself and everyone that I'm not "slacking off" or "opting out" or taking some slow boat to Shangri-La. Not that anyone has implied that, I think it's pretty clear that going part-time at work amounts more to scaling back on one type of (rewarding, highly-paid) work and scaling up on another type of work which is both unpaid and elicits a less direct, calculable form of appreciation. Not that I need my head patted constantly, but I think many of us have experienced the Moebius strip that is the endless cycle of keeping a three-kid household running smoothly, and how the loss of old workday landmarks can make things both easier and harder.

I know I'm probably stomping all over the landmines with this but just hear me out, I'm sitting in the backroom of a Toyota dealership waiting for them to finish checking my brake fluid or god knows what else so this is a bit of a rush job. I realize that my defensiveness is just part of my natural adjustment to our new situation (see also: guilt at bringing home less bacon than I was before, particularly after many years of being the primary or equal bacon...herder) but this all makes me happy that I have the option to partially scale back as opposed to having to make a binary choice to be all in or all out. The identity loss I'd have without some career focus would definitely be traumatic, and I think that this option, the part-time option, might allow me the best of both worlds. That's the theory anyway, and hopefully once I see that, I'll stop alternately taking everyone's head off and showily doing one-armed push-ups to prove that I'm JUST AS POWERFUL AS I EVER WAS.

(Psychological problems! I has them!)


*          *          *


I was going to write some more stuff here, but in the interest of just getting this up and saying BLOG UPDATE: MISSION ACCOMPLISHED I'm going to save that for next time. My goal in general, by the way, is for there to be a next time more consistently, and to do a little more writing in addition to the other thousand things that I've been neglecting in the past year. And now I have no idea how to end this  entry so I guess I'll just put in this video of Nina lurching around because didn't you hear, she's a toddler now.  Unreal.




recalibrating

I know there's a touch of irony in adding this disclaimer given that I haven't updated this blog in, like, half a year, but: LONG ENTRY AHEAD.

There's a snippet of a cartoon I remember from my childhood--I can't remember if it was "Tom and Jerry" but if it wasn't it was in a similar vein--where a mouse is reclining in a hot tub. He's sitting back with his arms along the rim of the tub, maxing and relaxing as cartoon mice do, wearing that look of smug satisfaction he was prone to. (As an aside: I never liked Jerry. I always thought he was a real jerk to Tom, a cat who was just fulfilling his evolutionary imperative after all. Ditto Road Runner. Ditto those capering harpy kids that keep taking the Trix away from the rabbit. JUST GIVE HIM A BOWL, YOU ASSHOLES.)

So anyway, the mouse. He's enjoying the hot tub. He's relishing the water, the heat. But the water starts to get a little bit hotter. And a little bit hotter still. Suddenly it's not so comfortable anymore. Not hot enough that he wants to get out of the tub or anything, but just...hotter. He starts sweating. His fur starts getting a little frizzy (from the humidity, you understand). Then, finally, he turns around and notices the cat behind him, slicing onions and carrots to add into the now boiling water. (My memory of this part is not quite as clear, but the cat may have been wearing a chef's toque.)

I've thought of that cartoon clip a lot in the last year.

But let me back up for a second.

If you've ever followed this blog with regularity in the past (though I'm sure with my sporadic updates I've winnowed that number down to only the die-hardest of die-hards) you've probably noticed that I haven't had the time to write much of substance since I went back to work after my maternity leave last September, and that I haven't updated basically at all since December. The reasons are all those that you could probably expect: busy job, three kids, and the responsibilities and duties associated therein. The explanations are always boring because everyone's reasons for being busy are pretty much the same, but to put it in medical terms: it's just a matter of triage.

It's hard to know where the tipping point was--though I have to presume that it was at least in part associated with the addition of our much-beloved third child into the mix--but at some point in the last year, things started getting hard. Not impossible, not un-doable, but subtly, Joe and I started to notice just how tight things were getting. Time was tight, at home, with the kids, with each other. Emotional resources were tight. Patience was less of a resource we could reliably depend on. The days and weeks started becoming these things that we were enduring, rather than living, let alone enjoying. Again, the imagery from an old movie comes to mind--inmates in a prison, grimly notching off yet another day on the wall of their cell.

I don't mean to imply that our life is a joyless dirge--far from it. We love our family, we love our jobs. Even working the hours that we do, we try carve out quality time when we can--long weekends, holidays, family vacations where they fit in. We bolus our family time because our basal infusion rate is so parsimonious, but we do make an effort to compensate. And we liked to tell ourselves that this bolus dosing was sufficient, and it worked...not well, but well enough.

But it didn't change the fact that over the past few years, and over the last year in particular, the feeling of our everyday lives becoming something that we were tolerating started to feel more an more pervasive. When you only see your kids for an hour or two at the very tail-end of each day, only to perform the most basic of maintenance for them (bath! brush teeth! yell at them for not taking their baths and brushing their teeth quickly enough because I'm tired and they're tired and everyone's tired so LET'S ALL GO TO BED AS SOON AS POSSIBLE) you start to feel like you're consisting on a diet of discarded crusts in an otherwise empty pizza box. Maybe you can piece together a life in these scraps of the day, but split between three kids, it's simply not enough time.

Joe and I have been discussing for years our long-term outlook for modifying (read: decreasing) the work hours for at least one of us to have more time with the kids, and for the longest time, our party line has been: soon. We're going to do it soon. "Maybe in a few years or so," was the stock phrase. But there was always the next thing. We'll think about it when I finish my fellowship. We'll figure it out it when I get more settled in my job. We'll do it if I make partner in my group. Later. We'll do it. But later. Meanwhile, time marches on.

Then: I was talking with one of my partners at work a few months ago. He has four kids, the oldest of whom had just turned eight. "I just realized," he said as we were chatting in the front hall of the OR, sidestepping a stretcher careening down the hallway from the PACU, "that he's eight. In another eight years, he's going to be in high school, driving, getting ready to go to college. Half my time with him is already done. I mean, they come home after they go to college and all, but you know what that's like. It's not the same. Half my time of having my son in my house is over already."

There feeling that I had after having that conversation was not unlike being wrapped in a piece of wet burlap and gently asphyxiated. Because Cal was turning eight too. Half our time raising our oldest son in our home was done, and not only had this particular calculus not ever occurred to me, but looking back, I can't say I really know where those eight years went.

Because see, we've always lived like this. Cal was born when we were residents. His entire life--and thus of course, Mack and Nina's entire life too--we've worked. Both Joe and I have worked our tails off. We're not residents anymore of course, and some of the specifics of our jobs have changed from year to year, but the fact of it is that we each work on average 50-60 hours a week, more if we're taking weekend call, and although we've been saying for years that we were going to try to get more control of our work schedules to put some more time into our family life, it hadn't happened yet. The decision point was always pushed off down the road. Later. Soon. Not yet. Someday. And now Cal was turning eight and I have no idea how time passed so fast.

If I'm going to be completely honest with myself I'm sure some of this particular grim inertia was also linked to a perverse macho pride. I've always spoken a lot about work-life balance in medicine and how these antiquated notions, about doctors functioning as around-the-clock automatons sacrificing their personal lives for the greater good, would have to evolve along with the rest of the world. But I think that in some ways I felt safe championing the choice for others to go part-time because I myself chose to work full-time. You do what works for your family, everyone's definition of work-life balance is different. But saying it from the vantage point of someone with three kids and still worked full-time herself felt like a secure platform from which to proselytize, like I was somehow above reproach from people who might accuse all part-time doctors of being lazy or uncommitted. DO WHAT YOU NEED TO DO; BUT AS FOR MYSELF, I AM DOING ALL THE THINGS.

And to be honest, we were getting by. It wasn't wonderful, but it was OK. We were surviving. Maybe we weren't "living our best life" to invoke an Oprah-ism (and I don't even know how I know that since I never even watched Oprah) but...day to day, we were getting by.

And then, the week before Memorial Day, our nanny of five years quit. With no warning, and giving zero notice. She just left one day and mentioned on her way out the door that she wasn't coming back.

Boom. Game-changer.

I'm not going to talk too much about the nanny thing because frankly, after probably the most stressful two months of our lives, I'm just over it. It wasn't even so much the issue of finding a new nanny--though that, obviously, was a huge part of solving our problems, at least in the short term.  But the larger and more important part was having to honestly evaluate our life, our choices, and just how much time we did indeed spend at work, away from our children. It was like turning the stark, faintly buzzing fluorescent exam light onto the fish-white underbelly of what kept things functioning at a level that passed as "OK" for the past five years. And what we realized was that: it really isn't OK. Having to outsource this much of our children's care--of our children's lives--to someone else, particularly someone who after five years could walk out on them without so much as a backwards glance...is not OK.

(This is putting aside the obvious logistical difficulty of finding a non-live-in person to work 50-60 hours a week. It's a tough sell to say the least. One suggestion, perhaps less helpful than most, was that we should just hire two nannies. To which my reaction was, if you have to hire two people to take care of your kids while you're at work, it's possible you're not spending enough time with your kids.)

So. Joe and I discussed and agonized and number crunched and evaluated. We talked to a lot of people. We agonized some more. And what's going to happen now is this: as of September 1st, I will be going part-time at my job. Joe and I would have been fine with either one of us working less, but because of the ways our jobs are structured, it makes more sense right now for the part-time working parent to be me. My new schedule will have me working three days a week, mixed in with my share of nights, weekend and holiday call. And my main goal for the other two days of the week? To do some of the things that I've never been able to do with my kids because I've haven't had the time. Simply to be around more.

I know this all seems unnecessarily melodramatic of an announcement to some, because plenty of people in a multitude of fields choose to work part-time. But for me, it is a big deal, because to be honest, when you're accustomed to following a prescribed path, swimming against the current for a change can be scary. And there are a lot of issues--job guilt, fear of resentment from co-workers or being perceived as less than fully committed to medicine, concerns about crippling my career potential--that I'm working through having finally made this decision. There's a fear of not wanting to let people down.

But that's it on the other side too, isn't it? I don't want to let people down. I want to do my job well. All my jobs. And I think that right now, I need to spend more time with my kids. Nothing's broken, I still love being an anesthesiologist, and the fact that I've worked full-time for the first eight years of parenthood wasn't the wrong call nor has it damaged our family. It's just that our choices then are not the same as our choices now, and when we have better options we owe it to ourselves to take them. We could be making more of this life. We could be doing better.

I'm not going to be there hovering in the periphery for every single second of my kids' lives, nor frankly should I be. But I'm looking forward to just being around more.




So that's what's going on with us. In most ways, it's really no big thing. But in other ways, it's the biggest thing.

Wright State University Boonshoft School of Medicine, commencement address, May 24, 2013

Good evening and congratulations to the Class of 2013!
I graduated medical school almost exactly ten years ago today (which sounds like a much longer span of time than it actually feels) so naturally when I started to write this address I thought back to my own med school commencement ceremony, or what little I remember of it.  Particularly I tried to recall the invited speaker we had that year and what pearls of wisdom he imparted, so that I could frankly plagiarize them and pass his pithy truths off as my own.
The problem is, I can’t remember anything he told us.
Our med school commencement speaker for 2003 was Jimmy Breslin, a reporter for the New York Post and certainly a more illustrious figure than I.  And he had a very well-written speech—I mean, probably he did, because again, I can’t remember—but all I really do recall is that he spoke a lot and he spoke for a long time.  And I remember thinking to myself, as I sat there in my academic regalia, sweating under the layers of polyester like one of those cook-in-the-bag microwave meals, that this man and his endless speech were the only things standing between me and my medical degree.
(He did eventually stop talking, by the way.)
I can’t convey to you what an honor it is to be invited to share this day with you all, which with the possible exception of this address, is likely one of the most important and memorable days of your life.  So when I sat down to write this speech, I had only two goals in mind.  First goal: to give you real advice that you can actually carry with you for the long road ahead.  And my second goal: keep it short.
Now, as a fourth year medical student, you probably already experienced the fact that the world is teeming with people all too eager to give you advice.  Much of the advice from senior doctors in particular will be strangely centered around when, how and if you should eat, sleep, and eliminate during residency.  (Clearly people have strong feelings about such things.)


But as a fairly junior attending physician myself, the idea of giving you all advice outside the realm of the purely practical does feel a little presumptuous.  The field of medicine is constantly changing—maybe now more than ever before—and I can’t pretend that I know what the future will look like any more than you can. Therefore, I only have one piece of advice, so as to make it easier for you to remember, and that is this:


Remember who you are in this moment.
And who, exactly, is that?  At this moment, you are a fourth year medical student, just minutes away from being granted your medical degree. You are proud, and you should be.  You are excited, and you should be. You are a little apprehensive about what comes next—intern year, residency, the hours, the new responsibility. That, you should be too, but I’ll not belabor the point—other than pregnancy, there’s no condition about which people like to recount horror stories more than medical residency.  Finally, and perhaps most importantly, you are still idealistic. I hope, at least, that even at the end of medical school you have retained the idealism that brought you into medicine in the first place.

And why did you go into medicine? I’m sure there are a host of different reasons, phrased in a number of different ways—but I think, and I hope, that it all boils down to this: you want to help make the world a better place, one patient at a time.  And right now, this seems like the most obvious thing in the world, the thing that has powered you through years and years of books and finals and 4:00am scut rounds done on no sleep and an empty stomach.  You’re doing all this not just for yourself, not solely for any kind of personal glory or reward, but to help other people.
Remember who you are in this moment.
Older doctors, particularly the more cynical ones, will speak of idealism as though it’s a bad thing, some sort of marker for naivite.  But I’m going to tell you this right now: idealism is never a bad thing.  And idealism seasoned with experience is maybe one of the very best characteristics a doctor can have.
Remember who you are in this moment.  A young doctor on the cusp of doing great things.  Some of these great things will be large acts, the majority of them will be small, but all of them will stem from who you are in this moment, who is someone with the energy, idealism and work ethic to make the world a better place.  With all the pomp and circumstance of this particular day and all those that preceded, it seems like the concept of service would be difficult to forget.  But believe me when I tell you that forgetting is the easiest thing in the world.  I have forgotten it many times myself.
Because there will come a night on call during internship when you’re going to feel beaten down and tired and regretful of having ever gone to medical school in the first place. And right when you manage to sit down, the first time that you’ll have had a chance to sit down all night, the charge nurse on that floor will yell at you for sitting in her special chair. And right then, you will forget who you are in this moment.

Or during residency, you’ll have a patient who will push all of your buttons.  And that patient will be loud and belligerent and unappreciative and will say things that make you feel inadequate even after the hours and hours of work you’ve put in trying to take care of him. That patient will make you angry, unsympathetic, and when that happens, you will forget who you are in this moment.

Or there there will come a time when you’re an attending, after you’ve been working late for the fourth evening in a row. This will be the one day that you have any hope of getting home to see your spouse and kids before bedtime, and right as you’re finishing up your dictations and ready to hit the door, an emergency case rolls in that no one can staff but you.  And that particular evening, you will forget who you are in this moment.

Cynicism is a protective adaptation.  It is a shell that doctors build around themselves after they feel that they’ve worked too hard, seen too much, been burned too many times.  It’s a way for doctors to broadcast to their colleagues and to the world at large that they’re so expert in the human condition that nothing surprises them anymore.

But don’t be that person.  Don’t be the cynic.  Be for the rest of your career as you are today, someone who doesn’t tuck your idealism away like an obsolete relic of your years in training, but proudly wears it on the lapel of your white coat. 

Be ready for everything you think you know now to change. Be open to new experiences. But always remember who you are in this moment.
Congratulations to the Wright State University Boonshoft School of Medicine Class of 2013.  Congratulations, doctors. May each of you have a long, fulfilling career filled with interesting patients, challenging days, and a lifetime of surprises. The rest of us have been waiting for you, and are so happy to have you join the team.
Now roll up your sleeves and get in here. We’ve got a lot of work to do.  

great and lesser expectations




I had Cal three weeks after starting my training in anesthesia--a highly conspicuous move that I think indelibly branded me for the rest of my academic career as "that pregnant resident"--so I think it's fair to say that I have some insight into the assumptions that people tend to make about people mixing family with a career in medicine.

In most ways I imagine it's not unlike mixing family with any intense or high-powered careers--look at all talk that Marissa Mayer's pregnancy incited after she was named the new CEO of Yahoo. (Aside: I'm not saying that my career is anywhere near as high-powered as that of Marissa Mayer, just that the case is emblematic). Particularly in the field of anesthesia, where I'm in the room but often lurking in the background or behind a drape, I've heard a lot of conversations about medicine, other physicians, and things that fall in the rubric of "lifestyle choices"--conversations that maybe weren't meant for me to hear.  But as a result, and as a result of living my own life, I can say for sure that women in medicine (physicians in particular) who choose to have children during the most active parts of their careers suffer under what I'd describe as a handicap of perception.

Perception. Not an actual handicap, but one of perception. There's a Chinese saying that my dad always uses that roughly translates to, "When you're walking through someone else's pumpkin patch, don't bend over to tie your shoes." (OK, that's a very rough translation--I don't think the parable from which the saying was taken originated during a time when shoelaces were a particularly popular feature of Chinese footwear.) What it means is: if you're in a setting that breeds suspicion, try hard not to do suspicious-looking things, no matter how innocent they actually may be. Because you may be just tying your shoes in the middle of that pumpkin field, but a casual observer might be inclined to think you're actually stealing those pumpkins.

I think that in medicine (and perhaps in the working world in general but what the hell do I know, I've never had a real job doing anything else) people are quick to assume things about working mothers, not too many of them flattering. I'd like to say "working parents" because believe me, I'd love for us to get to a point where there is actual gender parity on the issue (to be fair, I do think that Joe and I do have gender parity when it comes to parenting, but...we do have to leave our household occasionally and interface with the world) in the year 2012, this is still more of an issue of perception for working mothers. The following is a list of some of the things that some people are quick to assume about women with children who work outside of the home.


1.) We don't work as hard.

2.) We complain when we do have to work as hard as everyone else.

3.) We want special favors and allowances in the workplace because having kids somehow entitles us to them.

4.) We are unreliable because something's going to come up with our kids and we're either going to leave our co-workers with the extra work, or sometimes leave our jobs entirely.

5.) We just don't care as much about our jobs as our counterparts.

5.) All this is somehow inevitable.


The problem with other people's perception, especially those colored by preconceived notions, is that there's very little that you can do about it.  It has very little to do with you, and sometimes even very little to do with reality itself.  And that perception can be insidious, like a Chinese finger trap--the harder you struggle against it, the tighter it binds you.  (Yes, again with the Chinese.  WE HAVE A RICH CULTURAL HISTORY, OK?  Actually I have no idea whether Chinese finger traps are actually Chinese, or just "Chinese," like fortune cookies or General Tso's chicken, but whatever, it's not germane to the metaphor.) You want for all the world to defy the lowered professional expectations that people have of you, to prove them wrong, but sometimes it feels that the harder you try, the more you're reinforcing them nonetheless.

So what I think a lot of female physicians with kids do--and what I know I certainly do--is overcompensate. You do it all and then some. You work even harder. You try to never complain about your schedule or your hours while you're at work. Not only do you not ask for special favors, you embrace situations that allow you to prove that fact. In other words, you try to work as much and as hard as everyone else, and then you go a little bit farther, just to make sure. You try to be above reproach.

Sometimes this works. Sometimes it doesn't.




I think often now about Michelle Obama, particularly during the president's first presidential campaign, and how hard she and her team had to work to control her image.  The reasons people might have a negative impression of her are perhaps multifactorial and not entirely flattering of a portion of the electorate, but there seemed a point where every little thing she did or said, no matter how innocent, was misconstrued as playing right into her detractors' expectations.  (The endearing but now notorious fist-bump comes to mind.)  Sometimes it feels that way to me too.  Representing not only myself, but working mothers in medicine as a group, I am very aware of trying to present myself, present all of us, in the best possible light.  Again, overcompensating.  I think this explains a lot of my personality at work, which I have often classified as "aggressively pleasant."  As in: I will be easy-going and pleasant to work with if it kills me.

Sometimes this gets pretty tiring.

I also will note that there's a segment of people who will respond to this blog entry with the opinion that I and others like me are far too sensitive about these issues, reading meaning into things that have no meaning, turning mountains into molehills.  I am perfectly fine with people responding however they want (as someone who has been writing online for more than a decade, I think that if it's your right to publish something online it's the right of your readers to respond, even if they disagree with you) but I also think that actually being a working parent in medicine, a working mother in particular, lends you a perspective that you don't have access to otherwise.  So saying that we're overly sensitive to the issue of low expectation or perception bias is, to me, a little like a straight person saying to a gay person that they're being too sensitive about homophobia, or a white person saying to a Latino that they're too sensitive about racism.  Or, maybe, like Mitt Romney condescendingly telling poor people that they just don't work hard enough.  If you don't know what you're talking about, sometimes it's best not to talk.

I would love to hear your own stories about whether or not you feel that working parents in medicine are stymied by lowered expectations or perception bias, and what you all do in your lives to roll with the punches.  Because though the natural (or perhaps easiest) reaction is, "Screw 'em! Who cares what people think?" (this is Joe's response, for example) the fact of it is--I do care.  I care what people think of me in my career.  I care not only about being a good doctor, I care about being perceived as a good doctor.  I care not only about having a good work ethic, but about having that work ethic be a key part of how people see me. I care.  Maybe not as much as when I was in training (when I wouldn't even have dared to write a blog entry like this at all, for fear that I'd be seen as "whining") but I still care a lot.  So until I stop caring, or society changes as I continue to hope it will, I guess I'll keep walking through this field, head up, eyes straight ahead, and try not to look like I'm stealing pumpkins.

it's in the bag, baby

It occurred to me that now that we're about a month out from delivery, I should probably think about having a hospital bag ready.  This is my third kid so I have a fairly good idea of what I'll need (and more importantly, what I won't need) but even with Cal, I tended not to overthink my packing strategy.  Part of it is that I like to idealize as little time in the hospital as possible, but I admit the other part may just be my reactionary response to having worked on L&D (both as a Peds and an Anesthesia resident) and seeing moms who brought in, like a living room's worth of stuff and realizing that they were most going to have to pack all that up and carry it back home in 24-36 hours.  So I keep it simple.  Anyway, if I forget anything, Joe can always run home and get it later.  You know, like all my potpourri sachets and serenity talismans.

(That was a joke.  Sorry, potpourri enthusiasts.)

So first, obviously, is clothing.  What clothing is comfortable, adjustable, shapeless, and most amenable to getting stained by biologic fluids?  Why, scrub pants, of course.  The world's most perfect garment.




I bought a fair number of those "nursing tops" when Cal was born (the kind of tank tops with the snap-down hooks and panels for easy boobage) but subsequent to that have realized that, for the less well-endowed of us who are less modest and/or have more experience breastfeeding, a regular shelf-top cami works just fine, and can be found for pretty cheap pretty much anywhere.  I have a bunch of these types of tops from Old Navy, Forever 21, and even Costco. (Kirkland brand, ho! The other benefit of the Costco brand is that they are extra stretchy and cut very long, so I've been able to wear them as a layering piece for the entire pregnancy.)




Hospitals tend to be chilly so I packed two cardigans also (essential feature being that they are a coverup that opens in the front--you could bring a sweatshirt or whatever, I guess, but it would be a pain in the ass for breastfeeding, and anything with a zipper front might get scratchy near a baby's face).  The tank top and soft elastic-waisted skirt are going-home clothes for me--again, just soft, stretchy stuff that can go right in the laundry.

Oh, PRO TIP: anything that the hospital offers you that is disposable, including but not limited to: diapers, pads, underwear, those freezy ass pads, squirt bottles, those big water jugs with the straws--you take that shit and you bring it on home with you.  I packed two pairs of my own underwear just in case they've cracked down on the giveaways, but I will just tell you that I took care only to pack black underwear, and if you need to ask why, you probably don't really want to know the answer.




Baby's going home outfit.  I know it's all very plain and the pants for sure are going to be, like, way too big (they're 3-6 months) but I hardly bought any newborn clothing because it's proven to be such a waste of money in the past, and whatever 0-3 month clothing I do have is very, very boyish.  Like, they literally have the word "BOY" on them.  And to be clear, I don't mind that one bit--it is my contention that babies can't read and I'm standing by that--but I just want to avoid weird looks from the nursing staff.  I don't even think the baby really needs pants even--we're talking about Atlanta in July--but, you know, I'm thinking about fussing with carseat buckles and those skinny little chicken legs that they have at that age should probably be encased in something.

Not pictured:

  • Toiletries (I used the hospital toiletries for my first two kids, but this time I think I'll bring my own because I'm so high maintenance like that, me and my products--also the hospital-brand toothpaste is very gritty feeling and barely minty, so it feels like brushing with caulk)
  • A nicer, non-iPhone camera that I'll probably hardly use at all because it's such a pain to get it out of the bag and download the photos in order to e-mail them, blah blah blah, first world problems.  Actually, the camera on the iPhone is really pretty nice, I find that I'm using my "real" camera less and less, but it seems kind of mean to the new kid not to even bring it, so OK, into the bag it goes.
  • Nursing pads (I like to use these but if anyone has any better suggestions I'm open to them)
  • The usual wallet, keys, laptop, power cords, assorted hospital paperwork, etc.

And...that's it.  Keeping it simple.  It's basically all I used in the hospital for the first two kids, but if there's anything essential and awesome that I never knew I was missing, let me know--there's still plenty of room in there.



sink or swim

Hope you're having a good Memorial Day weekend, everyone.  As we enjoy our holiday, of course let's not forget our brave men and women in the armed forces, without whom this beautiful summer weekend with our families and loved ones would not be possible.

In the States, Memorial Day marks the official start of the summer season, and this makes me realize that the idea of summer, to someone in or recently departed from academic medicine, is very different from the idea of summer held by the rest of the population.  For most, summer means school's out.  Summer means vacation.  Summer means sunshine and barbecues and leisure.  But for the eight years that I was in academic medicine (I'm leaving out the year that I was a first-year med student, since first-years usually get their summers off, though they usually spend the time doing something unbearably earnest), summer meant one thing: new beginnings.

The Gregorian calendar begins in January, and most schools from elementary to university begin somewhere in the neighborhood of August/September.  But in medicine, the new year always begins towards the beginning of the summer.  One chapter ends, another chapter begins.

During the summer, usually on or close to July 1st, everyone in academic medicine moves up a peg.  Third year med students become Sub-Is.  Interns become residents.  Residents become new attendings.  New people come in to fill the spots vacated.  Everyone is in new roles, figuring out what they're supposed to be doing.  Want to know why the conventional wisdom is that you should never be admitted to a teaching hospital in July?  That's why.

Here's an excerpt from my book that I was thinking about today, and after the excerpt I'll tell you why.

A sub-internship, or “Sub-I” (as it is known to those of us who cannot get through a sentence without acronym or abbreviation) is basically the training bra of residency. It is a pre-requisite for graduation from medical school, consisting of a month where we assume the patient load and care responsibilities of a first-year resident (or “intern”), albeit with the increased supervision and support required by logic and law. It is a dress rehearsal for the real thing.

In one sense, being a Sub-I the logical progression from being a third year medical student. See one, do one, teach one is one oft repeated credo of academic medicine, and after a year of watching residents in action, it seems due time for us to start “doing” on our own. Sounds reasonable enough. However, the reality of the transition from third-year med student to Sub-I is more like being lifted dripping from a knee-deep wading pool in which beach balls and foam noodles lazily float, and thrown headfirst into the churning ocean, your only instructions being to keep your head above water and not die.

So.  Cal learned how to swim today.





He's going to be six in about two months, so he's definitely not, shall we say, precocious in his mastery of water survival tactics.  He had all the requisite skills to swim, but mostly he's just been kind of nervous around the water.  Didn't like to put his head in.  Didn't like to be in the pool without a flotation device.  Worried about getting water up his nose.  Worried about sinking.  I don't think he quite trusted, despite a number of increasingly scientific demonstrations about human tissue and buoyancy, that he would float.  Being a bit of a late swimmer myself, I remember that feeling well.  But I also knew from my own experience that all it would take was one moment--one leap of faith, or more accurately a second of forgetting his own doubt--for him to realize that yes, he was going to be OK in the water after all.

It's med school graduation season now, of course, and I hope it doesn't sound disingenuous (because it is quite simply the truth) that I often think about the crop of newly minted practitioners joining us in the real world.  And look, I don't have any good advice, I'm new enough at the game that I'm still trying to figure things out for myself.  But there's going to be a moment for all of you when you look up and realize that you're doing something that you didn't think you knew how to do.  That something you practiced and practiced and practiced somehow, likely while you weren't paying attention, became automatic.  That in the recesses of your brain, you actually knew something, remembered something, that will help an actual patient in your care.  It's that moment--the leap of faith, the forgetting of your doubt--that's going to make you realize something that you're only being told now and may not quite yet believe.

You're a doctor.

Welcome to the team.

we made it

A few tips on taking long trips with small children.

1.) There is no such thing as too many plastic bags.

2.) If you can find some way to impregnate their lunch with some variety of sedative-hyponotic, bully for you, because that's what I should have done.

3.) No, we are not there yet.

4.) I don't care how many difficult airways you managed to intubate under duress or how many crashing patients you managed to drag back from the brink of death--bring along a secret stash of treats for the car and produce it at the proper moment.  YOU WILL BE A HERO.







5.) Kids at play will never let you take a picture of the front of their heads, so just stop trying.

then and now

So!  Match Day!




Match Day, for those lucky enough to not know, is the day that fourth-year medical students across the country find out where they will be doing their residency training.  Our Match Day was--oh lord, could it have been?--EIGHT years ago.  I was much more awake that morning than most of my classmates, who had been up late partying the night before at "Super Night," our name for the big annual pre-Match bash at the med school.  I'm sure a similar tradition exists at medical schools around the country, and though regional differences surely exist, there is one commonality of which I'm almost certain: the involvement of booze.

I myself was still recovering from a bout of peritonitis when my acute appendicitis in February was misdiagnosed and I subsequently developed a small bowel obstruction and a perforated viscus (TRUE), and so during Super Night I was on Flagyl and couldn't drink anyway.  It was still fun though, and basically ensured that I was not hung over the following morning for Match Day, enabling me to recall each nerve-wracking minute in crystal-clear detail.

I'd heard that in the olden days, Columbia had a tradition of holding Match Day in a giant auditorium, where one by one, students from the fourth-year class were called up to a podium and handed an envelope with their match results, which they were then to open in front of everyone and read aloud, into a microphone.  Of course, not everyone always matches exactly where they want to match, so this ritual (thankfully) came to be regarded as somewhat inhumane, especially in the already high-pressure environment that is med school.

So by the time Joe and I were cycling through in 2003, they had reduced Match Day down to a reception at the faculty club, with a table full of labelled envelopes off to one side of the room.  People could take their envelopes and leave, or open their envelopes there with everyone else.  Within this group, there were people who would open their envelopes and cheer, others who would open their envelopes and start crying, and possibly some that would open their envelopes and promptly punch one of the poor waiters who was trying to pass out shrimp cocktails on toothpicks.  One hopes against that last option, for the waiter's sake.

I am telling you this because the fact of Match Day, and the ritual of Match Day, is one that makes you think that Match Day is probably one of the biggest days in your life.  And it really seems that way at the time.  Hell, Joe and I were getting married about a month afterward, and I think I had put in more time, energy, anxiety and thought into Match Day than I had about the wedding.  It was a big fucking deal, this feeling that the rest of your life was hiding inside this one thin envelope.  It was a big deal, but also...it wasn't.

It was eight years ago.  This is what I can tell you now.  I matched at my first choice program, which was in a Pediatrics residency at the Children's Hospital of New York at Columbia.  Eight years later, I'm not even in that field anymore.  Joe matched in his first choice program too for residency, but for his transitional year, he got his absolute last pick, a fact which deeply dismayed him.  Didn't matter.  He had a great year, got excellent training, and he still has many fond memories of that institution to this day.  We had friends that failed to match at all, and who instead scrambled into spots in other fields, or in cities they never dreamed of living.  They are all successful, happy, healthy, and practicing the kind of medicine they want to practice today.  They have significant others, spouses, children, and they are enjoying their lives in medicine just as much as their lives outside the hospital.  They are happy.  It all works out.

Most of you are probably pretty excited today.  Some of you maybe aren't.  Some of you are dealing with hard choices, and I know that talking about this now doesn't make those choices any easier.  But if you went to med school, I know you have a long memory, so I'll tell you this: some day in the future--five, eight, ten years from now, you're going to look back on this day, this Match Day.  Then you're going to look to the present, at the life you're leading now.  And you might not be where you thought you would be when you were a medical student.  Hell, look at me, I thought I was going to be a pediatrician in academia, and now I'm an anesthesiologist in private practice.  You can't find two more different fields.  I couldn't have predicted it.  But it all works out in the end.  It really does.  You'll find where you need to be, what you need to do, who to go there with, and you'll get there.

So congratulations to all the fourth year med students in the Class of 2011!  Can't wait for you guys to graduate and join the team!

Now on to what's next.

it gets better

The lowest point in my residency was in January of my intern year.  I was a Pediatrics resident back then, doing a month-long rotation on "Team 2," which is what we called the general inpatient pediatric team, with a focus on the patients on our liver transplant service.

It was a very long month.

I'd get to work at around 5:45 every morning to pre-round, and invariably leave after dark every night--not difficult, considering that, in January, it seemed like it started to get dark around 3:30pm every day.  I was there much later than that, of course--most nights I'd leave around 7:00pm, unless I was on call, in which case I'd leave at around 10:00am the following morning.  We'd have pre-rounds and then rounds, then attending rounds and work rounds, followed by teaching rounds and radiology rounds, with time at the end of the day for sign-out rounds.  Twice a week we'd have Grand Rounds and Chief of Service Rounds.  How we ever got anything done with all this rounding, I'll never know.  How I ever got to spend time with any patients in between all these rounds is even more of a mystery.  It just felt like a day of endless, endless scut.  Losing the forest for the trees.  It would be a day full of writing down numbers and pagers beeping and phone calls and faxes and entering computer orders, and not nearly enough time practicing medicine or spending time with patients.  And then I'd go home and collapse and wake up at 4:15 the next morning to go in and do it all again.

It was shortly after this that I decided to switch fields, to Anesthesia.

But this entry is not about me and my switching residencies (though this is easily the topic that I get the most e-mails about--I think I've addressed it a couple of times on this blog, but for the most fully fleshed out explanation of when and how and why I switched residencies, I'd recommend you check out the book, it's probably one of the sections I spent the most time editing in order to get the details right), it's about something else that I want to talk about, which is this: residency can be deeply depressing.

And let's get this straight.  I liked residency.  Really, I did.  Yes, it was hard, and yes, I was tired basically all the time, but I expected that, and now that it's over, most of my memories are affectionate.  Residency, like medical school, was full of stories, and many of them, in retrospect, are funny--not at the expense of patients, but at my own expense, because lord, how serious and inexperienced and bumblingly well-intentioned I was!  But that first January of my intern year, I was very close to being clinically depressed.  It just all felt so grim and featureless and endless, and I felt more and more like I was just some kind of task-programmed automaton, not like the doctor that I thought I was supposed to be at this point.

 I wanted to quit.  Not just quit being a Pediatrics resident, but quit medicine altogether.  I was unhappy.  I didn't like my life.  I wanted to be done.  I know that this comic was intended to be a joke, but there were time, real times, when I passed by a Gap or a Starbucks or whatever, saw that they were hiring, and seriously considered stopping by to fill out an application.  At least they don't make you take call at The Gap, folding chambray button-down shirts at 2:00am.

Now I'm going to tell you a secret.  Everyone who has been through a residency has felt this way at some point.  Everyone.

Maybe you're feeling this way right now.  So here's another secret.  There's more to life than this.  Even though it feels like residency is your life, it's not.  There's more to life.  There's more to you.  And it gets better.

It gets better.

There's this great line from "A League of Their Own," which I adapt and quote often. "[Medicine] is supposed to be hard. If it wasn't hard, everyone would do it. The hard...is what makes it great."  However, don't get me wrong, I don't equate suffering with nobility.  Suffering is just suffering.  All I'm saying is that it's hard, but there's more, and you deserve to experience all of it.  Don't let your residency consume you, and don't let it make you believe that there's nothing else, or that there are no other options.  There's always more.  There's always what's next.  And you know what?  If you're really unhappy, and you want to leave medicine, there's always that too.  It's OK.  There's no shame in changing your mind.  The shame is hating your life, really hating your life, and doing nothing about it.  Who wins in that situation?  Not you, not your patients.

It gets better.  I know it's winter, and winter for a resident is long (oh lord, it's so long, it feels like you'll never see the sun again) but it gets better.  Just remember that.  Remember that you're a person--an intelligent, good person with free will, not just a cog in a machine--and I swear to you, the rest will follow.

windows



I saw these window washers on the outside of the hospital building this afternoon (look carefully, they are on a hanging walkway near the bottom towards the right) and the first thing I thought is: those guys are never going to finish. Here's another shot of the same building, reflected in the windows of another, equally glassed-in hospital building across the street, the window panes of which I'm sure these guys are also going to have to wash.




It just seems like such a Sisyphean task, because by the time you're done with the last window, it's probably time to start cleaning the first window again, especially so close to the traffic pollution on the highway, or in the spring when the pollen here is so bad. And then I thought: how fitting, because that's exactly what working inside the hospital feels like sometimes too. So many patients. So many issues. You finish one and the next one pops up. Endless. And, after a while, it can all start to run together.

But you keep going, and keep working, and at the end of the day, you can hopefully look back and see that maybe you made things a little better. And then what? More windows to clean. More patients to take care of. So you come back the next day and you do it again and again and again and try, as best as you can, to help.

At least, that's what I thought very briefly, in the three minutes it took me to walk from the ORs to my car. And then I drove home, kissed my kids, and got ready to do it all again tomorrow.

to excess

I sometimes have a problem falling asleep--not for lack of being tired, mind you, but I get into that loop where I am thinking lots of thinks and my mind gets a-racing and next thing I know it's 1:00am and I have to wake up for work in four hours. So sometimes I will take 25mg of Benadryl to help things along. It's just a Tylenol PM without the Tylenol, not habit-forming (so far as I know--maybe some smart neuroscientist among you can tell me if there have been any long-term studies on upregulation of central muscarinic receptors after long-term antihistamine use for whatever reason--but like I said, so far as I know) and man, it works.

I still remember when I was hospitalized in medical school for peritonitis--it's a long story but the short version is that I had appendicitis and they sent me home from the ER and my appendix perfed, which led to about a month of GOOD TIMES--and in the hospital I was prescribed IV Bendadryl prn for sleep. Most of the patients had the standard Ambien PRN reflexively penned into their charts by some dutiful little first-year resident (just like how every patient no matter what they were admitted for* is written for Tylenol PRN, because one less call from the floor for a Tylenol order is possibly one more minute of sleep before the next call from the floor) but since I was NPO (nothing by mouth, you know, because of my guts was all FULL OF PUS) I was written for IV Benadryl instead. I initially thought it was weird to be prescribed an antihistamine a sleep aid, but boy howdy, I am a believer now.

Anyway, I couldn't fall asleep last night, despite initial indications that I would barely be able to stay awake until midnight to ring in the New Year. Only instead of one 25mg Benadryl, for some reason, I took two. Not really sure why, but I'd been taking Benadryl for the past few days (Joe's Aunt Sue, with whom we were staying this week, has two cats that I was unfortunately allergic to--somewhat disgusting aside: I have been told that the major trigger for cat allergies is not so much the cat fur itself rather the cat spit, with which each cat hair is lovingly coating in the process of self-grooming, a factoid that I could have probably done without) and I figured...well, I don't know what I was thinking. Anyway, 25mg = good dose, 50mg = probably overkill. I barely even moved until 9:00am, which is very late for me, at which point the kids practically pried me out of bed with a crowbar. (An acoustic crowbar, but either way, it's metaphorical.)

Here's to hoping your New Year's Eve was less excessive than mine, I guess.

* Well, maybe not liver failure.

nerds of earth, I have your answer

It's been years since I've worn contact lenses regularly. I work some long hours, and I started noticing around the first year of my anesthesia residency that my eyes would get pretty tired and dry by the end of the day in contacts--it started feeling like that moment in your life that you switch from heels to flats, but, you know, on your eyeballs. (I'll give you a moment to process that imagery.) Also, with respect to my particular role in the workplace, there's something that I like to call "the splash factor"--all I have to do is look at my lenses at the end of the day and at all the projectile particulate that has accumulated there to make me glad that I always have a windshield in front of my eyes.

But you know, nice glasses can be expensive. My mom is an ophthalmologist, so for many of my formative years of glasses-wearing I relied on the insider connection with the optometrist to get a good deal on frames. However, in adulthood, I've had to get a few new pairs of frames (mostly related to my glasses getting smushed by someone's butt or cruelly twisted by my offspring--oddly, now that I never take my glasses off, my frames are much more protected) and every time I go to LensCrafters or what have you, I am floored by how much a pair of frames cost. A pair of designer frames (which, of course, are the only kinds that the big chains peddle) can cost anywhere between $150 to $300, and I'm not even talking about the ones with a blingity-bling Chanel medallion hanging off the sides.

At most chain optical stores, this also does not include the price of the lenses themselves, which--if you are a high myope like me and require a high-index refraction pair of lenses to lessen the Coke bottle effect--can jack up the price a couple hundred dollars more. Couple that with the fact that most people who wear glasses like to have a spare pair lying around for emergencies (see above: butt squashing, toddler torquing, etc.) and that's many, many hundreds of dollars for glasses.

Then I found this site called 39dollarglasses.com.

First of all, there are plenty of sites out there that offer cheap (albeit not brand-name) frames, some even for less than $39.00. However, 39dollarglasses.com is the place that I ordered my glasses from about a year ago, so it's the only one that I can speak to from personal experience. (Let me just explain in case this is in question that I am not sponsored by this or any company, nor do I generate any revenue or goodwill whether you click that link or not. I just really think that this is a hidden secret that people need to know about, because the last pair of glasses I got prior to discovering this genre of website cost more than six times the amount I spent on my web-bought frames, and now I am burning with self-righteous indignation against the brand-name glasses frame industry.)

The thing with glasses (which most of you who wear glasses understand) is that there is a highly specific fit, and not every frame fits every face. I know this as much as anyone--I have kind of a low nasal bridge (as many Asians do) and a roundish face, and on average I have to try on something like twenty pairs of glasses before I find a pair that feels right for me. So that's a problem with ordering glasses online--you can't try them on first. It's like buying shoes online. How particular are you about the fit of your shoes? If you are very persnickety, perhaps this is not the solution for you.

However, if you have a general sense of what kind of glasses look decent on you (I knew I wanted dark plastic frames with an ovalesque or rectangular shape), let me tell you a secret. The secret is in the numbers.




52-16-140 mm
128 mm
25 mm


Glasses come with measurements, did you know that? They do. Look, take off your glasses, and look on the inside surface of the stems. There should be three numbers. Those are the top three numbers listed above. The first one (in this case, 52mm) corresponds to the width of each individual lens bracket (or to be more precise: eye hole). The middle number (16mm) corresponds to the width of the nasal bridge piece. And the last number (140mm) corresponds to the length of the stem, which is the stick piece that goes over your ear. 128mm in this case is the width of the whole pair of glasses, and 25mm is the height of the lens frame (basically how librarian-reading-glasses-narrow or Carrie-Donovan-wide your peeping window is going to be top to bottom). If you can't try on the glasses before you buy them, these are the figures you need to know.

(I personally have kind of high cheeks so I know I can't get too wide of a measurement on the latter--I had a pair of rounded tortoise-shell glasses once that, due to the height of the frame, rested directly on my cheeks, and the constant feeling of having something on my face drove me, by small and insistent increments, completely insane. So insane that I eventually shelved those frames altogether and just swapped out the lenses into an old frame that I had lying around.)

So what do you do? Provided you already have a pair of glasses that fit OK and are not too different from the new pair that you want to get (for example, I'm not sure how it works with wire frames with the nose pads and the conversion to plastic frames), look at the numbers on the inside of your current glasses, and use those to extrapolate for the pair of new glasses you want to buy. THE NUMBERS ARE IMPORTANT. Trust me on this. No matter how adorable a pair of glasses looks online, if the numbers are not right, DO NOT BUY THEM, THEY WILL NOT FIT. This was of particular concern to me regarding the measurement for the nasal bridge; as a low-nasal-bridged individual, I knew that I needed a pair of glasses 16mm or narrower so that they would not slide down my face. If I went to Pearl Vision (or whatever) and tried on a pair of glasses, I would usually employ a test wherein I would put on the glasses and violently shake my head back and forth to see if the glasses would fall off. Since I cannot try on glasses online, I just go by the numbers. For the most part, if the nasal bridge part fits and the frames are not too wide for your head (example, if your current glasses are 128mm wide, do not buy glasses that are 134mm wide, even if they are super hot black with green trim OMG NERD CHIC!! Again, they will not fit). Believe me on this. I have spent way too much time trying on glasses to steer you wrong.

The glasses above are the ones I got a year ago, by the way. They are sturdy and well-made (not like the reading glasses you get next to the cash register at Walgreens or anything) and even with the upgraded package that offers a high-index refraction lens (you know, so the glass is thinner and not as heavy) it still came out to less than $80. For a pair of good glasses, that's a very, very fair price. (If you don't have a very strong presecription and don't need the high index refraction lenses, it's actually less than $50, which is yet another way in which people with better vision win. That and not needing glasses at all.) I got two pairs last winter--an heir and a spare, as it were--after my old pair of glasses from med school finally bit the dust (and yes, there was a period of time before the new glasses arrived that I was indeed wearing glasses haphazardly patched with some electrical tape, and also, briefly, some surgical suture) and I have been extremely pleased with them ever since. I even just ordered a pair of prescription sunglasses for driving, an extravagance that I'd never allowed myself, because really, who's going to pay hundreds of dollars for a pair of prescription sunglasses?

Not me. And hopefully, now, not you either.

(This post is not sponsored in any way. It's just ME sharing the good stuff with YOU. Now go forth and see clearly!)
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.