because disasters are apolitical but choices aren't

One of the things Joe and I were discussing (because we are SO ERUDITE--in between making a series of fart noises, both faked and authentic, and then blaming them on the dog) is the impact that Hurricane Sandy and its aftermath is going to have on the election. It's difficult to calculate, I think.

First, the regions hit hardest by the storm (that is to say: the Northeast) are traditionally firmly Democratic, and logistically, it may be difficult for people to turn out and vote come Tuesday. But will this actually make any difference in the electoral college, or will it just impact the popular vote?

Secondly, people inside and out of the affected regions may respond differently based on their perception of storm readiness, reaction and aftermath. I think that overall the reaction has been largely positive (at least compared to the level of preparedness for Katrina, "heckuva job Brownie" and all), but it's clearly a difficult time for everyone impacted. Will that change anything come election day? Again, difficult to say.

Campaigning for both parties has obviously been put somewhat on the back burner, or at least a burner off to the side--for the president firstly because he's busy, you know, leading the country during a crisis; and somewhat for the Romney camp as well, to (rightly) avoid politicizing and tragedy and, perhaps more importantly, avoiding the opportunity to say anything completely offensive of tone-deaf to those suffering losses. What did these two campaigns have planned for the final two weeks of the campaign? Would that have made a difference either way?

And on and on and on. Like I said, the political effects are incalculable, and though I think the post-mortems at the end of next week will pick apart this and that trying to frame whatever the outcome ends up being in the light of inevitability, but that's all Monday morning quarterbacking to me. Regardless of whichever presidential candidate wins the election, the effect of an unprecedented natural disaster of this scale is as unexpected as it is difficult to predict.

But there's one thing I do know that everyone can take away from the stories of Hurricane Sandy, and which is: you are not immune. Terrible things happen, and they can happen to any one of us. The single mom in Staten Island and the hedge fund manager in Tribeca. The elderly couple in New Jersey and the CEO in the Hamptons. Terrible things can happen, and they can happen quickly, unexpectedly, without prejudice. And all of us, whether we think we will or not, will occasionally be grateful for some help.

I think back to my own reaction to the aftermath of Hurricane Katrina in the days and weeks that followed that particular storm. I was shocked and horrified and of course I pledged my support and dollars to help the survivors, but still, even though it happened in my own country, it all still felt a little removed for me. I admit that fully. The words and the situation: Lake Pontchartrain? Levees? Superdome? It seemed so foreign from the everyday life of a dyed-in-the-wool New Yorker that my empathy, and my ability to relate, while present, still felt a little bit distant.

But this? Oh, this.

I walked here, on my way back from a late night out in med school after finals, from restaurant to dive bar to seedy club, trying to find my way back to the subway station to take me home.

Over the course of high school I got off at this subway station hundreds and hundreds of times.  We'd take the 6 train one stop down and switch here to catch the express, or maybe venture above ground to get something to eat, or browse through the new CDs at HMV (remember when we used to do that?), or just walk around and people watch.  Do you know how vast, and how deep those tunnels are?  Do you know how much water it must take to fill them up?  I don't.  I can't even imagine.

The cutoff for power outages on Manhattan was at 25th street and south.  I used to live on 25th Street and Second Avenue, on the 19th floor of our building.  Most likely we would not have had power.  Now, with three kids, in the chill of November, it's difficult to imagine how we would have handled it, though I can say for sure we would not have done it with the grace of those in New York the even more seriously affected outlying communities.  Probably I would have just cried.  Well, cried and eaten all the ice cream, like we did after that big power outage in 2003.  (IT WAS GOING TO MELT ANYWAY YOU GUYS.)

We lived just a few blocks away from NYU Medical Center (it is, in fact, the hospital at which I was born), which of course was evacuated after the storm when the power went out and the backup generators failed.  I can't even imagine what it must have been like for those staff working that night.  I read accounts of patients, fresh CABG post-ops and others, being walked down 10 flights of stairs or more to evacuate after the elevators failed, NICU babies being carried out one by one, nurses and housestaff and techs and everyone forming lines up the stairs passing buckets of fuel up the fire escape to the emergency generators after the fuel tanks in the basement of the hospital became overwhelmed with water.  I think: what if I had been in the OR at that time with a patient when all the power went out?  What would I have done?  I see myself reaching for the ambu-bag, sending someone to run for more IV induction meds, and holding up the flashlight we keep in the bottom drawer of our anesthesia cart so that the surgeon could see enough to sew faster.  I can kind of imagine it.  But also, of course, I totally can't.  Not really.

In the final days before the election it's hard to conceive of people who are still undecided about who to vote for, but I know they must be out there because the news and the polls say its true.  And I ask these people to think not just about jobs or the economy or foreign policy (though these are, of course, also crucially important issues) but to also think about the role of government in the face of crisis.  In the face of bad things happening, indiscriminately and free of political bias.  And think not just of how the candidates are reacting now, but of what they've said in the past.  About the role of government.  About "dependency" and "entitlements."  About the size of government and how some might propose both a smaller government with a diminished role and ability in providing help to its citizens in deep trouble, but also concurrently one that paradoxically insists of legislating and restricting our personal lives.  Think about these things.  And then go vote.

It's easy to accuse and tell people what they should have done or what you would have done when bad things don't tend to happen to you, but Hurricane Sandy reminds us in the most explosive and shocking way possible: bad things can happen to us all.  And everyone needs help sometimes, and sometimes the help we need is bigger than that which individuals or private institutions are able to provide.  And it's a credit to our civilization when we as people, and yes indeed as a government, are able to help those least among us.  Because next time, it could be you, too.  And where do you want to be living, and under what kind of leadership, do you want the next time something does?

My family are all OK, thankfully.  Much love to my friends in New York and the surrounding areas devastated by the storm--I'm with you in spirit if not in person.  If you need help, just ask.  And if you're looking for ways to help, two good starts are here and here.

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.

one of these things is not like the other

I was driving the other day when I got stopped behind this car, which was, in the fashion of the times, bedecked with many an opinionated bumper sticker.





Now, this is not a knock on the politics expressed via bumper sticker. People certainly have the right to express themselves via rear window decal, just so long as it isn't with a "Calvin peeing" logo. However, it occurred to me that one of these bumper stickers was not quite in line with the others. See if you can spot it.








(Note also, that the hood of my car was covered in a fine dusting of yellow pollen. Welcome to springtime in Atlanta. I can't tell if everything is yellow because it is coated in pollen, or if it is actually my eyeballs themselves that are coated.)

so, health care reform




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

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

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

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

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

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

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

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


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

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

one last thing about this and i promise i will stop

I was posting this in the comments section, but it was starting to get rather long, and in any event, my browser ate it, so I thought I would just post it here as a follow-up to the post yesterday.

First off, I want to extend an invitation to those people who are reading who are anti-vaccine to talk about why they don't vaccinate. I think we are overall very civil here, and if the concern is not about the so-called link to autism (as one of our commenters noted), then what is the concern? Some vague unease about "chemicals"? Concerns about "overwhelming" baby's immune system? Seriously, I want to know, not being snotty. It is hard to have a conversation about this without coming to (virtual) blows, so I would love to be able to talk about it rationally here, not even just to try to convince one side or the other, but just to visit the other side's perspective. (Obviously this need not be said, since we are all grown-ups here, but if anyone is brave enough to present their personal concerns about vaccines in what seems to be a very pro-vaccine forum, we all should play nice.)

The second thing I wanted to address was the fact this topic never fails to make me as both a mother and physician so enraged--not annoyed, not puzzled but actually angry, like I'm taking people's anti-vaccination sentiments as a personal affront--and I wonder why. After some thought, I have come up with this: I am taking it personally. And here is why.

As someone who works in healthcare, with sick patients, I see every day the injustice and horror that is illness. Preventative healthcare is a wonderful thing, perhaps the best kind of medicine that we can practice. Along with a healthy lifestyle, protecting against preventable illness is a big part of that. As a doctor, it's quite simply the very best that we know how to do.

When I go go onto these internet parenting boards, to read this anti-vaccination literature and hear the rhetoric, we see people who are not only rejecting we have to offer, but who vilify doctors and other healthcare workers--people who have devoted decades of their lives to caring for children and families--for working their hardest and giving the very best of what modern science has to offer, it quite frankly hurts my feelings. It's not paternalism, it's not about me wanting to tell patients what to do and for them to comply mindlessly, it's about me wanting to do my job and provide the best; and then feeling like people reject my efforts and recast my motives as somehow evil, greedy, or just plain ignorant. It hurts my feelings.

So yeah, I take it personally. I respect a parent's intuition and I respect the fact that no one feels great, myself included, about bringing their baby in, making them cry by jamming them with needles filled with seemingly mysterious antigens and preservatives. I know first hand that the desire to protect your children from all real or potential harm is beyond conscious thought, it is instinct.

But I respect science, too, and I have based my life around that. In lieu of religion, I have science. And the impulse to prosthelytise is equally strong. And just like people who prosthelytise about religious faith, I am doing so not to force you to be like me, not to scorn or humiliate you for possibly being of a different faith, but because I care about you and your children and families, and I want what all best evidence I have points to being the most effective way to stay out of my hospital.

The other thing that would have enraged me, by the way, with all the fury of a mother bear protecting her cubs, would be if Mack had somehow gotten the measles from an un-immunized kid before he was old enough to get his own vaccine. Luckily we he got his first MMR last week, so at least that's one less thing to worry about.

that squishing sound

I don't usually link to other blogs (not out of high principle or anything, I think I'm just generally not very plugged into internet "communities" as a whole and also I'M SHY) but I wanted to post this link to the most recent entry on Alice Bradley's blog, "Finslippy" about the vaccine debate. (Warning: video!) The topic of the debate is: who do you trust more, doctors or other parents?

But first, full disclosure: a lot of these so-called "mommy blogs" make me insane. I love "Finslippy" (I think Alice writes incredibly well and with great humor, and she's a Wellesley alum besides) and I think that Julia from "Here Be Hippogriffs" is another blogger who writes beautifully, with humor and nuance) but generally I find myself becoming short tempered with mommy blogs where, shall we say, perspective becomes a little unhinged from reality. I will say no more about this, because when I know I am about to step into a big pile of shit, I do not need to make the shit mound any deeper.

What bothers me particularly about some of these online mommy communities, however (aside from the fact of insisting to use "mommy" as an adjective attached to everything--perhaps this speaks to my own bias, but I feel that it essentially neuters mothers by using a cute diminutive, something akin to calling Frances "Baby" in "Dirty Dancing"), in particular when it comes to debates like whether or not to vaccinate, is the fact that doctors are so often cast in the role of the bad guy. Those evil doctors! Those dumb doctors! Those greedy doctors! They don't know! They don't care! They just want to make money off the booming commercial market that is vaccine production! Anyway, no one knows anything my kid as well as I do! It may not be scientific, but my mommy intuition trumps all!

The thing that drives me nuts about this debate, aside from the anti-vaccine crazies (about which a little more later--enough has been said about this without me needing to add too many words into the ocean of discourse on this topic), is this: sometimes doctors are mothers too. Sometimes doctors and mothers are the same people! Mothers that have gone to medical school! Doctors that have reproduced! The novelty of it all! I know this is hardly the main point to make about this topic, but that's something that has always irked me to no end about this Mothers vs. Doctors debate. (And Alice, thank you for trying to call attention to this, but of couse I'm not surprised that they edited it out. How can there be an "Us vs. Them" if there is no "Them"?)

And look, I'm not saying that doctors know your kid better than you do. Obviously I know my kids better than my Pediatrician does. But loving my kids does not mean that I know everything, nor does it mean that I can protect them from everything bad that could possibly happen, much as I wish I could. Loving my kids does not make me an infectious disease specialist. It does not make me a pulmonologist. It does not make me an immunologist. In the hospital, when I call a consult on a patient, I listen long and hard to what the consult is saying. It behooves me to do so. I know the patient better than they do, but they are the experts in their field while I am the expert in mine. If I am of the mindset that the consult I'm calling is an idiot and maleficent and isn't going to make the right recommendations, why do I call that consult at all?

Look, I don't meant to discredit those who are anti-vaccine by calling them "crazies." The Lancet has taken care of that for me. (Oh, snap.) All I'll say is to repeat something I heard on NPR, which is that it's very easy to scare people, and it's very difficult to un-scare them. Just look at the opinion posited in the video to which I linked, for the mother who refused the MMR vaccine because Jenny McCarthy apparently had such compelling evidence of how it clearly caused her son's autism; but who clamoured for the H1N1 vaccine because it was in the news, all SWINE FLU WILL KILL YOU AND EVERYONE YOU LOVE, OMG, TIME TO START DRINKING PURELL. Easy to scare people, almost impossible to un-scare them. Someone should do a study on that.

living history

Mack, I know someday you will thank me for propping you up in your carseat to watch Barack Obama's swearing-in and inauguration speech. Even if you slept through the whole thing.

brand new day




For all the thrilling and historic aspects of this election, and there were many, the thing that excites me the most is the idea that years from now, when Cal is my age, he may not understand why it was such a huge deal to us old geezers that way back when, we managed to elect as our nation's 44th president a man named Barack Hussein Obama.

Today is a good day.

Done and done.

now i will have three children

I know we are not supposed to be buying unnecessary things in These Uncertain Economic Times (and perhaps hunkering down in a bunker with our liquidated assets instead, waiting for the End of Days) but dude, with a new bike, a beautiful autum, a new baby on the way and three sets of grandparents due to visit all in the next few weeks, having a functional camera started seeming less and less like an unecessary thing. And after ascertaining that they don't, in fact, manufacture the Nikon D70 anymore, and that fixing our old D70 (whatever is ailing it--the camera version of leprosy, perhaps) might cost at least half as much as a new camera, we decided that we should upgrade and I ordered the Nikon D90, on the condition (per Joe) that this was to be our joint early Christmas present to each other. Also, I ordered just the body of the camera, as the Nikon lenses we already own are interchangeable, as are the batteries and a good number of our camera-related accessories, thus saving us many of our rapidly depreciating American dollars! See, thrifty!

I am inelegantly excited to play with the new camera. Which, needless to say, I will not make the mistake of letting Cal touch until he graduates from high school. (If he graduates from high school. See that, no pressure! Let's see people make cracks about nursery school MCAT prep now! Our kid couldn't even piss in the toilet at school for a month and a half! Ah hah hah! Ha! Hmm.)

And also: A very interesting op-ed by Frank Rich in the New York Times about the unsettling turn the rhetoric in the presidential race has taken. Worth a read.

i still had to say it

Hi!

How about them politics?

Anyway, good discussion with the last post. Every time I post about politics, I end up regretting it in some way (people tend to get very impassioned, which is good, but it's a short step from impassioned to vitriolic and, "Yo Momma so fat she got a bunch of little Mommas in orbit around her!") but I guess that's a better alternative than apathy, which we've also seen enough of these past eight years. So there you go.

After school on Thursday, Cal felt a little queasy, and ended up puking copiously all over his nanny after school, and then on me when I came home from work. (Down my shirt. Into my bra. If he wasn't my kid, I probably would have puked myself, because ugh.) I was unclear whether or not it was related to something he ate (some kid in his class had a birthday party in school that afternoon, apparently--though I didn't see any cake in the mix, who knows, that may have come up with the first round) or if it was an actual GI bug, but my threshold for keeping him home the following day was fairly low, mostly for concern of spreading around some sort of class-wide contagion. However, he was absolutely perky for the rest of the evening, and bounded out of bed on his own at 6:30am the following morning, demanding cereal and ready for school, so I chalked it up to a tainted grilled cheese sandwich and off he went.

This weekend, Joe is puking. Which illustrates the basic pattern of outbreak in this household: whatever Cal gets, Joe gets, and I almost always remain basically untouched. I blame (or credit) my many months in the Peds ER in days gone by, which has apparently endowed me with the immune system of a bison. You know, one of those bison that never gets sick. Not that I didn't pay the price at the time. My second year of Peds residency, I got pertussis, for god's sake.




Anyway, we're in week 21. There's lots of moving around down there, and I'm starting to be able to discern actual limb movements rather than the more mysterious bumps and burps from a month ago that were more like, "could be baby, could be gas." My anatomy scan is this Thursday, wherein many important parts of the anatomy will be delineated, and one less-important piece of anatomy, but the only one that anyone else seems to care about, will hopefully be visualized. As for preference, I honestly don't care (I know everyone says that, but really, I don't) but I am taking predictions.

i know how much you love it when i talk about politics




I'm no political pundit, nor will I be the first (or last) to say this, but as someone who would have voted for Hillary Clinton--though I will now gladly vote for Barack Obama--McCain's choice of VP strikes me as calculating and, frankly, insulting to the woman voters to whom he is attempting to appeal. It's as though in their play for the disenfranchised Hillary voters, they are presenting the idea that all female candidates for high political office are basically fungible, and that women will vote for women regardless of the platform upon which they are running. "Hey look, another chick! You like to vote for chicks, why not vote for ours?"

I do think, however, that Palin is a great move to appeal to the conservative base that's still leery of McCain's loose cannon history, though, because man, is she a conservative's wet dream. A gun-toting, anti-choice, former beauty queen, multiparous hockey mom, who also has a dash of "naughty librarian" about her. Take off those glasses, shake your hair down, and man! In the words of Rush Limbaugh, "Yeah, plus she's a housewife, before that, she's a babe. I saw a picture." Making a great case for your own candidate there, Rush. I know she's supposed to be a good governor (of Alaska), and very popular to boot (in ALASKA), but forgive me if I can't help but to think that the reasoning behind her selection was a little more calculating than that.

Anyway. I will leave punditry to the experts. I just had to get that off my chest. Moving on.

Edited to add: Posted in the comments, but wanted to add it as an addendum here too...The "beauty queen, multiparous" etc. qualifiers I included were not meant to be pejorative (though "gun-toting, anti-choice" were kinda, but just because I disagree with her on those issues)--I certainly don't think that physical attractiveness or having kids takes away from your intelligence or professional qualifications, whatever they may be. Rather, I was trying to point out why certain people find Palin to be much less "threatening" than some other powerful women in politics and in other realms, who tend to get more of the "cold bitch" label.