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.

20 weeks, and snake...surprise

20 weeks! And I'm not even wearing scrubs!

When I knew I was giving that talk at Wellesley, I took three vacation days this week--Monday and Tuesday to get there and back (if at all possible I like to limit all business-like travel to 24 hours, that way, it's not any different for the kids than me being on call) and Wednesday to decompress in case travel was awful. GOOD PLANNING, ME. Having the extra day off also allowed me to squeak in my 20 week OB appointment without too much logistical hassle, which was nice. I like making doctor's appointments for the morning if I can, because I figure it's less time for the practitioners to accumulate serial delays over the whole day of seeing people (they are inevitable, and really not their fault, especially if they are trying to do a good job with each patient), but because of my work schedule, usually I have to make appointments for the afternoon.

Also, I would like to point out (see above) that you can find plenty of maternity-ish tops in non-maternity sections, see that Old Navy tank up above. It probably won't work in another month or two, but generally (and this I found with my first two pregnancies as well) Old Navy and some other stores tend to cut their clothing overlarge and somewhat billowy, so what may be a really unflattering shape for a non-pregola (I would never have bought this shirt under other circumstances) works out great for the parturient, at least up through the second trimester. Also, non-maternity clothing tends to be cheaper, because it's not considered "specialty." More choices in cut and color too. I got a whole scad of these T-shirts when they were super on sale after Christmas (I ordered my usual size but in "Tall" so I could have a longer shirt-tail to cover the unfortunate elastic waisting of my pants) and they look much better than regular maternity T-shirts, which can tend to have more of a tent-like cut. Anyway! Girl talk! Clothes! Shopping!  (These links are not sponsored, by the way, I just thought I'd share what I've learned from clothing myself these past three pregnancies. Especially since, not knowing what I know now, I gave ALL my maternity clothes to Goodwill this past Spring after we moved--like, SMOOTH MOVES, EX-LAX.)

Wait, what?  You want to know about what?  The...oh!  Right.  The ultrasound.

Let me say first that I really like this OB practice we're with.  I was a little less than crazy about the group that we used for Mack (and obviously I'm not going to say who they were), but given that we've moved since then and would probably be delivering at a different hospital anyway, it was as good a time as any to switch practices.  Anyway, this group is a bit smaller, more personal, and they spend quite a bit of time talking to their patients, which, even as a third-time-arounder, I really appreciate.  Also, for all of the routine ultrasounds, an OB is actually doing the scan himself, which is very nice, especially since he really explains what he's looking at and isn't bound, like a tech, to not make diagnostic calls or say certain things for medicolegal reasons.  Anyway, we like both doctors with this group a lot, and I think they are excellent clinicians.

And we got some really nice pictures.  (Ignore the "Wondershare" watermark, it's just because I had to download some software to do the video file conversion blah blah blah nerd talk. CARRY ON.)







"Hey little guy!  Look at him go!" said Joe, when he saw Thing 3 moving around.  (I'd forgotten that he's only seen still images thus far.)

"Yeah, he's moving around a lot now," I confirmed.  We walked through the head, the heart, the abdomen, the cord, looked at his little face, his arms, his legs, everything.  "He looks great!"

"Yeah, he does," the OB, measuring this that or the other thing.  "Although, if we keep calling him 'he,' I guess we should actually look at that part too, to confirm."

"Oh yeah.  Sure, take another look."

"What did I say last time?" the OB asked, flipping through my chart.  "We said boy?"

"You said you were 99% sure he was a boy, but you also said couldn't get a super-fantastic view."

"OK then, so let's see here..."  He looked.  Then he looked.  Then he looked again.

Joe and I also looked.  "Uh..."

"I said boy?" The OB froze the frame. "I was wrong there.  Nope, totally wrong.  It's obvious now.  Huh, funny, usually when I made a wrong call, it's the other way around."

"Well, it was only 16 weeks..."

"Yeah, more difficult to say on a 4 oz. 16 week fetus...though, usually, I have to say, it's pretty obvious even at that stage.  Regardless, I think it's pretty clear now."

"Wait, so..."

"It's a girl.  100% certain this time.  You guys are having a girl."







WE'RE HAVING A GIRL.

Well, hell.  I hope she doesn't mind wearing a whole lot of blue clothing for the first 3 months.

Obviously we're thrilled to bits and aren't fussy about the clothing--and whatever, babies can't read anyway.

HOLY SHIT, WE'RE HAVING A GIRL.

rooty tooty fresh and fruity

Joe had to go to the annual meeting of the Georgia Society of Ophthalmologists all day today (which I'm sure was exactly as exciting as it sounds), so I took advantage of my relative high energy level this morning and took the kids to IHOP for breakfast, and then to the playground.

I'm not sure that Cal's ever had a Belgian waffle before, having only eaten their toaster-ready brethren. He was very impressed by its goliath proportions.

Mack and I shared a pancake combination plate, which means that he stole all my bacon and refused to eat anything else, even though I poured three kinds of syrup on the pancakes. THREE KINDS OF SYRUP!

Syrup application, in case you were wondering, is a serious business.

Hide-and-seek at the playground. You'd think from Mack's covering his face that he'd be the one counting and then seeking, but actually, he's the one hiding. Because if you cover your face, no one can see you.  Think of all the research money the armed forces could have saved if only they understood this principle!  (Cal also noted that the fact that I was standing there taking pictures of him made Mack particularly easy to find.)

My penchant for striped shirts, exposed.

I know this was just a pile of pictures, but that's basically all I got. Oh, that, and this: one more Whitney Houston tribute courtesy of Randy Watson and Sexual Chocolate.





I suppose I could write more now, but I just downloaded Season 2 of "The Walking Dead" from iTunes (which includes all this "Behind the Scenes" cast commentary) and it's pretty much blowing my mind that Andrew Lincoln not only doesn't have a Southern accent in real life, but, in fact, has a British accent. It's Downton Abbey with zombies!

help me help you

Off the top of my head: five tips for people who might need to undergo anesthesia.


1.) Know what medications you're taking, and know what you're taking them for.

I guess this must seem easier for us, because by and large if you're reading this you are on the younger end of the spectrum, statistically more likely to be healthier and on fewer medications, and demographically at least somewhat medically inclined, but--you'd be surprised how many people have no idea what medications they're taking or for what condition they were prescribed.

Patients--please know what medications you're taking! It really makes a difference, and can affect how your body might respond to anesthesia or the various insults of surgery. And it's often not quite enough information to tell me that you take "a blood pressure medication," because there are many different types and they all work through different means. Is it a beta-blocker? An ACE inhibitor? A diuretic? An alpha-2 agonist? And guess what--even if you don't know half of what I just said, it doesn't matter. Just know the names of meds you're on, tell me, and I'll figure it out, because it's my job. If it's hard for you to remember, write your med list down or have a family member help you. Carry the list with you in your wallet if necessary.


2.) Know your own medical history.

Equally important, see above. Do you have a scar over your sternum? Do you have a device implanted under your left pectoral muscle? Sure as hell I'm going to ask you about it. I'm not being nosy, I need to know these things to make sure I can take care of you in the safest way possible. If you can't remember, or have a hard time because you have a long medical history, write it all down (list of diagnoses, surgeries, doctors with contact info) and carry it with you, maybe along with your med list. Better yet, keep it as a file on your computer, so you can update and print it out as necessary.

I know it's annoying to have to answer the same questions again and again, but it's a matter of safety as well. So bring your information. And don't just trust that, "it's in the chart," because sometimes it's not. Anyway, a good medical practitioner doesn't just trust someone else's History and Physical, they do their own.


3.) Do yourself a favor and think long and hard about your allergy list.

As an anesthesiologist (or even as a doctor in general), when I ask you about drug allergies, what I'm really asking you is, "will the benefit of me giving your a certain medication as indicated be outweighed by an adverse reaction of giving you that medication, and do I have good alternatives?" Putting lots and lots and lots of drugs on your allergy list to which you're not actually allergic does nothing but tie my hands to treat you in the safest and most efficacious way possible. Feel free to tell me if you tolerate some meds worse or better than others--if Flagyl makes you queasy or that historically you respond better to morphine than Dilaudid. I do want to know these things, so yes, tell me. But when you tell someone that you're allergic to every antibiotic on the planet because sometimes antibiotics give you the runs, it can really hamper our ability to treat you in a safe, effective, evidence-based way, because the word "allergy" means something very specific in medicine, and we take that word very seriously.

(Also: no one is allergic to epinephrine. Your adrenal glands make epinephrine. If you were allergic to epinephrine we wouldn't be standing here having this conversation right now. Sorry, pet peeve. I don't blame patients for saying it, by the way--I blame the boneheads who, knowing better, write it down anyway and thus immortalize it in the medical record.)


4.) Don't eat or drink after midnight the day of surgery, but it's OK to take most medications.

The surgical team may ask you to hold certain medications prior to surgery, and most of these medications make sense to stop. Since you're not going to be eating for a good couple of hours the day of surgery, it makes sense, for example not to take medications that will further lower your blood sugar (meaning oral medications for diabetes, or your full dose of injected insulin--brittle diabetics, consult your endocrinologist for specific instructions). Also, as surgeons try to keep bleeding to a minimum when they're cutting on you, so with some exceptions in specific cases (like if you've recently had a stent placed in your heart for example, of if you risk for clotting outweighs your risk for bleeding), it's usually advisable to stop taking any blood thinners or certain anti-inflammatory medications for a period of time prior to the surgery date.

But for the most part, other medications are fine to take the morning of surgery, if that's when you usually take them. In fact, I prefer it if you take most of those morning medications, particularly including any medications for your heart, your blood pressure, any breathing issues you might have, or medications for chronic pain. When you think about it, it makes sense: you want to be medically optimized for surgery, not with your blood pressure through the roof, wheezing, and with your pain out of control even before incision.

 Have questions about taking or stopping a specific medication before you get to the OR? Ask to speak to an anesthesiologist prior to your surgery date. Don't just call the surgeon's office and ask--often the person fielding the call (not always a medical professional) will not have the first clue, and will instead say, just because he or she thinks it's the safest answer, "don't take any medications the day of surgery." I had a myasthenic patient come in for an afternoon surgery having skipped several doses of Mestinon because the secretary she talked to told her not to take her meds. Like I said, if you have medical questions about day of surgery medications, ask to talk to an anesthesiologist beforehand. Again: it's our job.


5.) If you have any specific fears or concerns about the anesthesia itself, let us know beforehand.

Help us help you! Are you claustrophobic and hate the idea of having a mask over your face? Do you have a needle phobia? Did you have a family member with a very bad reaction to anesthesia, or have you yourself have a traumatic anesthetic experience in the past? Do you have questions about "The Michael Jackson Drug" and want to know exactly how the same fate will not befall you? Let us know! We can help you! There are things we can do to make things easier! Better! Smoother! Less scary! We have all sorts of tricks in our bag, is all I'm saying. We just need to know when and for whom to pull them out.


Medical professionals in this or other fields: another other tips?


* * *


For people of a certain age, Whitney Houston runs throughout the soundtrack of our childhood and adolescence. So if you want to pretend that you've never been alone in the bathroom hoping that the tile acoustics would help you better belt out the chorus of "One Moment in Time," I'd think I'd have to call you a damn liar.





Thank you, Whitney. You were transcendent.

the rule of threes

It's been a bit of a hiatus, one not deliberately planned--certainly if I had planned it I would have left a less humiliating entry at the top of the page--but after a period of time the interntia became sticky, and for that prolonged silence, I apologize.  Obviously plenty has happened in these past few months (see: the entire holiday season Halloween through New Year's--HAPPY EVERYTHING TO EVERYONE), but as for the highlights, allow me to present them in triptych.

THREE

Mack turned three about a week ago, and although I could go into the same hackneyed parental lament about how it seems like he was just born yesterday, how I remember when he was just a wee infant and look at him now--in other, more concrete ways, it is utterly plausible that three years has gone by.  I got pregnant with Mack at the end of my residency, and he was born about five months after we moved to Atlanta.  Three years ago?  Seems about right.

But don't let me hog all the commentary, marvel yourself at how three years can somehow transform this:

...into something as adorably wacky as this (and please excuse the background shambles that is our home office, a.k.a. the room where all the world's paperwork and power cords go to die):

I love you, little man.


THIRD

For a couple of months now, Cal's teacher has been floating the idea that we might want to consider skipping Cal ahead into third grade for the next school year.  It's not something Joe and I have pushed (or indeed, even brought up initially) because the memory of this is still pretty fresh in our minds, but after Cal's teacher brought it up the third or fourth time, Joe and I are starting to realize that we might have to make a decision one way or the other.  

The main sticking point is this: if academics was the only thing we cared about, yes, absolutely, we would be for skipping Cal a year ahead.  School is too easy for him, and he's getting bored.  However (and this is a relatively big however), Cal has a couple of problems that don't necessarily translate into academic achievement, though it can (and may) color his experience at school.  The main issue in our mind is that Cal is already young for his grade.  His birthday is at the end of July, which usually makes him one of the youngest kids in his grade, and in this era of red-shirting kids in kindergarten, he's already up to a year younger than some of the kids in his own class, even before shuffling around.  Now, this may or may not be a big deal (I myself was skipped ahead a year in school so I at least have some personal perspective--and my birthday is at the end of June) but I also have to take into account that I was a small Chinese girl going to school in Manhattan, in settings where (and excuse me for generalizing) issues of physicality or athleticism or physical development were not a real big issue, at least not that I could perceive.  

However, Cal will be a small-ish boy growing up in Georgia, where, insofar as I can ascertain from my proximity (if not direct involvement) in youth culture, physicality is kind of a big deal.  Everyone talks about football.  Everyone plays sports.  I see some of the kids in Cal's class now, and lord, they are massive.  They are good kids, I have not seen or heard any word of bullying or rough-housing or even so much as a double-dog-dare, but remember, this is just first grade--these things may change.  And to say nothing about the cesspool that is middle school, what with puberty and hormones all coming into play.  Do I want to put Cal in a situation where he's ten years old and in a locker room full of classmates flaunting their fistfuls of chest hair?  Is it going to matter?  Like I said, maybe it doesn't, and I'd reiterate that I skipped a year and had a perfectly well-adjusted and un-traumatic adolescence--that said, I went to a very academically-oriented high school so it's possible that such things didn't matter as much there as they might in the real world.  

But.  Cal is bored, and I think we're beginning to see it.  In some ways, I guess he kind of likes that school is so easy--all the less effort to expend, my dear--but is this how I want him to grow up, floating along with minimal effort because he knows he doesn't have to do anything more to do "well"?  (However, Joe would like me to point out that, indeed, this is just how he went through life basically up until grad school, and LO, LOOK AT HIM NOW.  Both sides of the coin, we are.)  It's beginning to show in Cal's motivation at school.  He just isn't interested in doing things.  He'll do the work that is put in front of him, of course, but in the past few months, his participation has taken a subtle turn from compliant to grudging.  Is it just because he's bored?  Is it a developmental thing?  Is he just (and I would be perfectly happy if this were the reason, honestly--Cal's never been known for his extroversion) starting to have more fun with his friends and starting to act more like a goof-off first-grade boy?  Would stepping up his curriculum even affect this?  I don't know.  

Which brings up the broader issue: what is our goal here?  What do we want for Cal?  What's going to help him succeed the best?  Our goal has never been to hustle Cal through school as quick as possible (in fact, now that we're in public school, the idea of giving up a whole year of not paying tuition smarts quite a bit, though less than the idea of MY BABY ultimately leaving us to go to college a year earlier than we anticipated) but given that this option is being presented to us by Cal's own teacher makes us wonder if, for all our hand-wringing, we're holding him back.  But what makes someone successful in life ultimately?  Having a good experience in school certainly helps, but what defines that good experience?  Finding and being pushed to your limits academically?  (Not that we think third grade math is "the limit," of course, but certainly having to use a few more neurons isn't a bad thing.)  Or having the space and room to grow socially without the stressors of being smaller and slower and younger than everyone else?  What is our goal?  What's going to be best for Cal?  Or, at least, less worse?

TRIO

Well, in the event that we screw up those first two kids, at least now we know that we'll have an extra in reserve.  And if I may observe (despite the blurriness of this photo, which was taken with my cell phone camera because our scanner isn't working for some reason), real-time 3D ultrasound technology really is amazing.

(Coming July 2012.  Check local listings for details.)

Thanks for sticking around, everyone.  It's good to be back.

mack cheats at air hockey

AND NOW THE WHOLE WORLD KNOWS IT.

walking with the dinosaurs, with apologies to the BBC

I know it's unseemly for me to gush, so I'll just say that this video Cal made (I helped with the editing and some of the A/V) has a certain Ed Wood-ian charm.

tripping to the light linktastic

First off, you guys knew there was virtually no way that I couldn't respond to this Op-Ed in The New York Times from this weekend right?  In case you hadn't read it, a quick excerpt to whet your appetite:

Students who aspire to go to medical school should think about the consequences if they decide to work part time or leave clinical medicine. It’s fair to ask them — women especially — to consider the conflicting demands that medicine and parenthood make before they accept (and deny to others) sought-after positions in medical school and residency. They must understand that medical education is a privilege, not an entitlement, and it confers a real moral obligation to serve.

I recently spoke with a college student who asked me if anesthesiology is a good field for women. She didn’t want to hear that my days are unpredictable because serious operations can take a long time and emergency surgery often needs to be done at night. What she really wanted to know was if my working life was consistent with her rosy vision of limited work hours and raising children. I doubt that she welcomed my parting advice: If you want to be a doctor, be a doctor.

(Italics and bold face I added for emphasis, but the words of the actual article are reproduced verbatim.)  So! Thoughts? I had a few. And I posted them here. I hope this doesn't count as some sort of cop-out substitute for an entry, but as both article probably highlight, the role of a physician parent is fairly busy, and there's only so much time in the day for writing, as much as I might love to do it.

For those somewhat less interested in the issue of out-of-home-working parenthood, here is a video from this weekend. As you can see, Cal went from being somewhat nervous in the water to staging his own underwater Cirque du Soleil.

And finally, remember to check out the awesome JetPens and book giveway in my guerilla marketing contest! Don't stress, your entry doesn't have to be anything XXX-treme, it could be as simple as starting a Twitter word-of-mouth campaign or sharing a link to the book on your Facebook page! Just e-mail me with a link to your entry to officially enter the contest! (This is just so I can keep track of everyone.) They're really good pens, guys. And it's a pretty decent book too, on an issue--the balance of medicine and parenthood--that clearly needs to be shared and discussed.

That about sums it up.  Hope you had a good Monday!

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.

the life aquatic

I've been a little sporadic with the updates lately, and I apologize for that.  It's just that--well, I was away from home for about a week, and even though I'm really glad that I took the time for the book tour, I had a lot of guilt about leaving my kids, as one does.  It's one thing to be away for work--especially when you work in medicine, most of those long days and late nights can at least be couched in obligation or altruism, I DID IT FOR THE GOOD OF MANKIND and all that.  But there's no way around it, leaving home for a week to do book promotion was in large part elective and as such, felt somewhat self-indulgent, so I've been trying to make it up to my kids since then.  Mostly this involves spending a lot of time with them and taking them to the pool, largely so that they could cower by the water and tell me how cold it was.

(At the end of that clip, do you know how hard it was not to start launching into some discussion about hyperventilating at an FiO2 of 100% prior to breath-holding?  Don't know what I'm talking about?  Better for you, really.)

I had my last book event (for this round of book events, anyway) this past Thursday at the Atlanta History Center, and I have to say, it was the event that I was the most nervous about, mostly because 1.) people had to buy tickets to get in, which ramps up my responsibility not to be a blithering idiot somewhat, and 2.) this particular audience, more so than any other event on my tour, had the highest percentage of people who knew me in real life, and whom (I imagined) would spend the rest of my life giving me pitying glances wrapped in dulcet words of encouragement if I really bungled my talk.  I don't like to speak from a lot of notes (there's something inorganic and stilted about being too prepared; see the last Grand Rounds I gave for evidence) so while I had a few bullet points to sort of lead me down the garden path, largely I spoke extemporaneously.  It actually went pretty well, I think.

If you look all the way to the back of the room, you can actually see Cal sitting at the table playing iPad, which I specifically told him to do not only so that he wouldn't get fidgety, but so he wouldn't be paying attention to any of the bad words I was saying during my reading excerpts.  Mack was running around in the lobby (he kept pointing and shouting "Mama! Mama!" while I was at the podium so Joe removed him expediently and they spent the entire evening looking at Atlanta History Center promotional posters), and the one other kid in the audience was, like, 4 months old, so who cares, BABIES DON'T KNOW ANYTHING.  Who knew a memoir about medicine and parenthood could be so corrupting?

Anyway, it's been a very exciting two weeks, but I'm really glad to be going back to work tomorrow.  For all its fallibility and uncertainty, there is a certain concreteness to medicine that I miss, as well as that feeling that that feeling that small everyday actions can make a large, lasting difference.  I know that's true in life overall, not just in medicine, but in a hospital at least, there's usually coffee and day-old donuts hiding somewhere.

And now I'll leave you with this.  Here is a chicken in Uganda pecking at my book.  Why?  More like WHY NOT?

That is all.  (Thanks, Veronica!)

enter the multimedia

I know a lot of people these days are making "trailers" for their books (kind of like a movie trailer but...for a book) but my experience in watching these trailers is that unless you have some professional help and some reasonably high production value, these trailers look...not so good. I have no innate skill at video editing, and all my friends are the wrong kind of nerd, so no help there.

I did want to have some kind of video content leading up to the book release though, so what I came up with is this. We're going to do a web video series. It's going to be interviews (or soliloquies, depending on how adept the subject is at yammering on and on about this that and the other thing) about the medical training process. My goal is to keep these videos light and in the somewhat more humorous vein. I know everyone has their story of that first time a patient that they were taking care of died in some horrible way, but look, the last thing I want to do is post a bunch of depressing videos of heart-rending medical stories that will make everyone suicidal. I want this to be more of a feel-good collection of stories from medical school and residency, more in the funny-slash-humiliating vein. (And we all know that most humiliating stories become funny stories with enough time and distance. MOST.) I'm trying to find people to interview for this video series, but I think to start we'll just go with the easy "gets," meaning me and Joe. Here is my submission:





(Ah, yes, the freeze-frame that You Tube randomly chose is truly unfortunate. "Pull my finger!")

I was trying to find a really good story of humiliation to tell, but all that came to mind was this one, which is somewhat more in the uplifting, we're gonna make it after all vein. But let me keep thinking. I may dredge up a really good embarrassing story yet. Like the time I fell asleep in the front row of Grand Rounds and woke myself up by farting. Yes, that happened.

I'm going to post the videos here and also on the book website so that people can find them easily. My goal, though admittedly a stretch--the video itself was easy enough to film (I just did it with my iPhone) but the editing took a lot of time--is to interview a handful of people so we can get a few different perspectives. I'm just the guinea pig for this project, see--I don't just want a bunch of videos of myself. Maybe down the line we will even set up some way to take submissions, though they will have to be very carefully selected stories for patient privacy issues and of course to keep your clinical reputation relatively pristine. You know, like tell me a story about how you peed in a jar because you didn't have time to go to the bathroom on rounds. Don't tell me how you transected some guy's aorta while you were trying to take out his gallbladder.

Oh, and while you're at it, pre-order the book, will you? It would make my parents super happy.

also because I'm trying to forget that I'm on call tonight

OK, I'm holding this pager and I'm too superstitious to go to sleep so I'm just going to unbox this.

THE GUYS NEXT DOOR.





The Guys Next Door was (were?) a TV show-based boy band created by NBC to capitalize on the popularity of the New Kids on the Block. I think they were supposed to be The Monkees to NKOTB's Beatles, which is a flawed analogy in may ways in that neither of these 90's analogs had nearly the staying power of either of their 60's counterparts, but perhaps it's accurate at least in the sense of their relative popularity as compared to each other. The Guys Next Door, as self-described, were like The New Kids but with a black guy. (Just like All 4 One was like Boys II Men with a white guy.)





Look, I'm not going to lie and say I didn't watch "The Guys Next Door" religiously every Saturday morning, because I did. And I'm not going to say that I didn't have their one and only album on cassette tape, because I did. And I'm not going to say that I didn't have a favorite Guy Next Door and that I didn't debate the relative merits of the different Guys with my friends, because I DID, and WE DID. (For the record: it was Chris, the long-haired one. My friends preferred Damon and Patrick respectively, but I was like, "Say what?" No one liked Bobby, he was the George Harrison of the group, which is not to say that he was talented and deeply religious, just that he was somewhat homely.)

They Boys Next Door had several skills. One was exuberant dancing whilst wearing overlarge boxy blazers.





The second was sensitive emoting into the camera so as to make you feel like they were your boyfriend.





The third was Charlie Chaplin-esque comic pantomime.





Look, I don't know if you remember being an eleven year-old girl, or if you even want to, but I did and I do, and I just loved that stuff. It was like "Saved By The Bell" except with singing and without Screech and all those annoying girls in it lousing up the works. (Not that I didn't like the "Saved By The Bell" where Jessie, Lisa and Kelly formed that girl band and made that music video in a gym and Jessie got addicted to caffeine pills because OMG THE PRESSURE TO SUCCEED.) I have no regrets or embarrassment about this era in my development--not like I'm over here now, listening to Miles Davis' "The Birth of Cool" and nursing a snifter of brandy or anything--but the only, only point of this entry was to tell people that I, possibly like you, love and miss the youthful, candy-coated exuberance of "The Guys Next Door," as well as the relative naïvite required to fully appreciate them.

How about you? What bands did you love as a preteen, and miss beyond all reason?

nostalgia and farts

As I think I mentioned on Twitter (aside: if you don't follow me on Twitter, you might want to reconsider, because I'm actually updating there with some frequency now--unless you think me prattling on about the minutiae of my life is super aggravating, in which case, please continue not following me on Twitter), I have been trying to put labels on all my Blogger blog entries from the last seven years. The first three years of this blog are archived on my old Homestead site here and here (the less you read these entries, the better for you, I find them terribly embarrassing in both design and content but keep them up as sort of an archaeological relic, like the city of Pompeii), but I've been on Blogger since my intern year in Pediatrics, September of 2003, and thus have over 1,300 entries to sort through and catalogue.

That's a lot of entries.

I don't mind skimming through an old entry or two, that's kind of amusing in and of itself. But skimming through ALL of the old entries? Is excruciating. I've only made it back through July of 2008 (right after we moved to Atlanta, before Mack was born) and already I have flashback fatigue. Really the worst part of it (and I realize I may be alone in this, perhaps some people find the act of going through baby books a delight but I find it somehow lachrymose) is seeing how much my kids have grown in the past two and a half years--In Cal's case 100% and in Mack's case infinity percent. It's funny, it's cute, it's heartwarming to see the old pictures and read the old conversations and look at the old video, but it also makes me kind of sad. Because someday my kids aren't going to be little anymore, they're going to be big and grown up and not little and squashable, they're going to be adults and going out into the world and having their own lives and not need me and they're going to donate all their old toys to the local daycare center ruled by an evil despotic strawberry-scented bear. And then I will weep. Hell, I'll weep now.

Not to just indiscriminately recycle old stuff, but this one's worth it: a video from three years ago. Just three years ago. Mack's now almost the age that Cal was then. Sunrise, sunset.

good enough for me

I have to admit (rather sheepishly) that being on call on Thanksgiving wasn't really that bad. I went in early to do rounds for the pain service, did one case and one new consult, and then was able to enjoy the rest of the afternoon. I even got to join the everyone for Thanksgiving dinner (mostly because this year, Thanksgiving dinner was actually at dinnertime, instead of at lunch), with the family of Cal's best friend from school. It was very nice. We even got pity leftovers, which, as we all know, are the best part. I am, of course, still on call for the rest of the weekend, but that is neither here nor there. It's just a regular weekend at this point.

And anyway, now, there's this:




I admit I am feeling particularly smug about having finished the Christmas shopping for the kids about a week and a half ago. I was subject to some particularly vicious price-gouging last year (and not even on anything special, no Tickle-Me anythings or those weird robot hamsters, just regular little kid stuff) and thus decided to try and get the bulk of my toy-shopping done before Thanksgiving. I also took the liberty of helping select toys for various grandparents and great-grandparents in abstentia who usually just say, "I don't know what the hell to get them, just buy them something you know they'll like and tell me how much it cost," hence the respectable gift pile this early. Of course I do have to reconsider the wisdom of getting them, you know, more toys, because the basement already looks like this:




...but, you know. Kids and Christmas, it's just worth it. If you could have seen Cal fussing and rearranging the present pile and trying to diving their contents using both palpation and percussion, like some old school primary care doc, you would have died, believe me.


* * *


Also, completely unrelated to anything, this is quite possibly the best thing I have seen on YouTube in...well, ever.




Unfortunately, Sesame Street is, like, 75% Elmo now. I mean, Elmo is cute and all, but come on.

mackasaurus rex

First of all, hope you don't find the new design too disagreeable. I just liked having a page links bar across the top of the page as I do for the new book site, so I was tinkering with the blog design and one thing led to another and now suddenly I have two websites that are matchy-matchy, like fraternal twins whose mom insists on dressing them identical sailor suit rompers. Um...cute?

Anyway.

I downloaded some episodes of "Walking with Dinosaurs" off iTunes a few weeks ago, thinking nothing much in particular except that if my kids were going to be watching TV, at least the TV would be somewhat educational. I did not know what I was getting into, because Cal and Mack are completely and wholly obsessed with dinosaurs now. Cal is mostly interested in the wonkish way, reading and studying, memorizing names and characteristics and diets and eras. He's not as into the pretending aspect--I got the kids a tube full of these little plastic dinosaurs to play with, and after naming them all, Cal just looked at me and said, "Now what am I supposed to do with them?" He wants to learn about the dinosaurs. He doesn't want to be a dinosaur.

Mack, on the other hand...





I'm not quite sure what it is about the dinosaurs, but definitely there's something about their sheer enormity that appeals to kids. Even Cal, who takes something more of a scholar's delight in his paleontologic fervor, continually asks if X is bigger than Y or if Y could beat Z in a fight. That's much of the fun of it, I think. Being so small and the thrill of imagining something so big. I, on the other hand, look at my kids, imagine them being big, and relish that--for now at least--they're still so small.

Happy Thanksgiving, everyone.

take a look, it's in a book, a reading rainbow





Cal has suddenly expressed a Great Interest in reading. To be fair, he is very proud when he can read things on his own, but he still prefers being read to, because why should he have to put in all that effort when he can just lay back and let Momanddad mangle the more rickety portions of The Lorax for him? Reminds me of that Simpsons where Homer is in the hospital and sees that guy on the ventilator. "And here I am, breathing on my own like a sucker." (I paraphrase.)

But anyway, it puts a song in my heart to be a nerd and have my child express these budding nerdistic qualities (some of my most cozy memories of childhood are lying on the couch with a giant pile of books next to me--no, I was not very good at sports, nor did I have any friends, why do you ask?) so of course when Cal started talking about reading, I immediately pounced onto Amazon and ordered him a kings ransom of "I Can Read!" titles, Uncle Elephant, Frog and Toad are Friends, Bread and Jam for Frances etcetera. Oh, and Amelia Bedelia. It remains to be seen if the somewhat more nuanced fumblings of Amelia Bedelia will be above a four year-old's head (this is a kid who says that his favorite part of "Monsters Inc." is when Mike Wizowsky burps up the microphone) but whatever, we'll see.

I worked him into a fine frenzy rolling yesterday when I kept telling him that the books were set to be delivered that afternoon, that evening at the latest (creating the saddest possible tableau of him sitting next to the door looking for the mail truck) until I realized that it was President's Day and thus no mail delivery. And so it goes. But for sure they will come today, and frankly I am just as excited as he is. My little old man is becoming old for real!

voices that care

Was reading the New York Times article about the new version of "We Are The World" (to benefit Haiti, you know), when I remembered this other celebrity pastiche piece from the early 90's, "Voices that Care," which was made to support the troops during the first Gulf War--a simpler time in our nation's history when, if I recall correctly, they actually sold Operation Desert Storm trading cards (with gum and everything) at newsstands in my neighborhood. Laudably earnest sentiment of the song aside, you have to watch this video, because quite simply, it is awesome. The Nelson Brothers! Michael Bolton! Will Smith with a sideways baseball cap! Strange interlude in the middle with squiggly colored lines! Kenny G on his little weiner sax! FRED SAVAGE SINGING NEXT TO ALYSSA MILANO! Also, Dudley Moore for some reason. We're sending our love down the well (down that well)!





Awesome. I think I still have this cassingle in a shoebox somewhere at my parent's house. And so would you if you, like me, are a relic of an earlier time.

cal explains...why dogs can't drive

interview with cal

Now for parity, here is a video of Cal, in which I attempt to interview him about this and that.





I took the liberty of subtitling his responses since the microphone on my camera isn't very good, and Cal is alternately mumbling or talking with his mouth full--my fault for talking to him over dinner, I guess. However, please be aware that the subtitles only make it marginally more understandable, as the interview subject is three and a half and prone to fanciful tangents, while the interviewer apparently can't stop herself from making not one, but two Simpsons references to someone who cannot possibly recognize or appreciate them. Anyway, enjoy.

and he moves too





I haven't posted any video lately, certainly not since this summer, which is not to say that I haven't shot any video, it's just that [insert boring technical talk about cameras and computers and various compatibility issues therein here]. But! The issues are resolved! And so, to celebrate, I bring you this. (Warning: may be extremely boring if you don't like babies. There's no car chase or anything.)