hello, dolly

I've become a joint-custody dad kind of blogger. We don't get a lot of time together during the week, but every other weekend, BAM, it's toys and ice cream and candy for everyone! Now who wants some pizza before we go to the movies?

Anyway, I kind of want to buy Cal a doll. The main reason for the doll is that Cal loves to stroke hair, so I think if he had a doll with quasi-realistic hair on it, then he would go coo-coo for Cocoa Puffs. The second reason for the doll is that I want to send him the message that it's OK for boys to play with dolls, so he doesn't grow up to be some male chauvinist. And the third reason for the doll is that his birthday is coming up, and the toy wagon and tricycle and building blocks we're getting him just ISN'T ENOUGH LOOT.

The problem with buying a doll is the simple fact that dolls are creepy.

"Hello. I will kill you while you sleep."

[Hey, did anyone ever watch that old Anthony Hopkins movie "Magic"? Where Anthony Hopkins played a ventriloquist named "Corky" (heh)? And he had a dummy named "Fats" (double heh) that looked just like him? And wore the same clothes as him and everything, only miniaturized? And the dummy KILLED PEOPLE? Because it was EVIL? Aaaah!]

Aside from the no-ventriloquist-dummy rule, I don't have a good sense of what kind of doll I want to get, except that the doll has to have hair, and I'd prefer it not to be some blonde-haired, blue-eyed babydoll, lest Cal develop some sort of a self-hating Pecola Breedlove-type complex.




The first doll that I thought of were those freaky "Cornsilk Kids", an offshoot of the Cabbage Patch Kids line with less yarn-y, more realistic hair. They even have multiple different ethnicities of Cabbage Patch kids now, which they didn't really have when I was growing up (though now that I'm remember, I think I did have one friend with a black Cabbage Patch Kid), so I thought this might be promising. However, a preliminary search turned up only this:




This is the "Asian" Cabbage Patch Kid, I suppose as indicated by the hair and the fact that the eyes look kind of fucked up. BUT IT'S A FAIRY. I mean, I don't think that it'll warp Cal's sense of gender identity to play with dolls, even girl dolls, but people, THERE ARE LIMITS. I was figuring that maybe I could just get the doll, strip it, and dress it in one of Cal's old pajamas or something, but then I realize that this was a collector's piece or some such thing, not a real Cabbage Patch Kid, and was therefore only six inches tall. Ah.

Scrolling through the "Ethnic Dolls" section of the Toys R Us website seemed like it might turn up some reasonable options. This a found in a series of foreign language-speaking dolls, that not only kill you in your sleep, but do so while screaming "COMO ESTA USTED? UNO DOS TRES!"




Really, I guess that doll isn't so bad, but it looks like the hair is kind of yarn-y, which defeats the whole purpose of having a doll stunt-double so that Cal can stroke hair while I'm on call overnight. Also, I'm not crazy about the whole talking doll thing. I suppose I could just not put batteries in it, but I just feel like it would have a hard mechanized core along with EVIL in its SOUL.

So I don't know where I'm going on this whole doll thing. Maybe I'll just do what I was planning to do in the first place, which was to just cut out all the excess and just buy Cal a wig to play with. A wig for his first birthday. Thus ensuring that he will grow up to be a drag queen.

Currently eating: Cinnamon sugar pita chips from Trader Joe's. The Manhattan Trader Joe's is like a zoo. Go on a Sunday afternoon and the checkout line winds halfway around the store. And yet I still go. Because I love the pain.

dead again

First, a couple of new pictures of Cal, because it's been a while:









The kid is going to be a year old next month. Man. How did that happen?


* * *


I know, it's been a while, but I must respectfully report that the SICU has been kicking my ass. It's not the most difficult rotation, but it's just a little hard to manage time-wise. One of the main problems is that when we're on call, we work a 24 hour shift from 1pm to 1pm the next day, which means that you don't really get a full rest on your post-call day, and for those of us who aren't able to really sleep in the morning of (read: human alarm clock pulling your hair and demading breakfast), there's not really much rest pre-call either. Put this all together with a few busy calls in a row and this equals NO SLEEP, EVER. But hey, it's just one more week, right? Then I'm off to my OB rotation, where I will also get no sleep because of the screaming pregnant ladies, but at least will be able to go home the morning post-call.

The thing about working in an adult ICU is that people die. Like, a lot. And then it is sad. And also you have to sign a lot of papers afterward attesting to the deadness. I would have thought before this that it would be relatively easy to tell when a patient was dead, but let me tell you--not so much all the time.

Like a few nights ago when I was on call, the nurse came over to tell me that one of my patients had just expired. (That's the terminology they use in the unit, not "passed away," or "died," but "expired," like a carton of milk left on the shelf for too many days.) It was a totally expected outcome that we had in fact been waiting for--the patient was DNR and had all pressors and aggressive resucitation withdrawn--so I wasn't surprised to hear that she had gone asystolic. The family was there, and I wanted to give them some time alone, so I went about the bureaucratic business of declaring someone dead--calling the medical examiner, calling the admitting office to get the death certificate printed up, that kind of thing.

About five minutes later, I went into the patient's room to talk to the family. They were there, they were crying, and there were a lot of them in the room. The patient was lying on her bed, being dead. And then suddenly she opened her mouth and made sort of a gasping movement. The nurse looked at me. "Agonal breathing," I said, and motioned for her to take the patient off the vent to avoid freaking the family out. She did, and we waited for the movements to stop. And waited. She had been asystolic now for about ten minutes, and the nurse had since turned the monitors off. "I know she's dead," I said, feeling less and less sure of myself, "but...could we just flip the monitors back on for a second? I just want to see." The monitors came back on, and we saw the EKG tracing at flatline. Flatline flatline flatline. And then, one little blip. Many seconds passed. Then another blip. And then--I really couldn't believe what I was seeing--more and more beats until she had an irregular heartrate of about 50. "It's probably just PEA," I said, ostensibly to the nurse but mostly to myself, "nothing we're going to do anything about," since the patient's family explicity wanted no resucitation, no cardioactive drugs. But to confirm, I went to feel for a pulse.

There was a pulse.

"Holy shit," I said, "she's back." By this time the family were all loitering in the hallway and sitting in the conference room down the hall, so I didn't have to act all cool and profesional in front of them when I was actually losing my shit. "Have you ever seen someone be asystolic for, like, ten minutes, and then get a pulse back? What the hell is this?"

"Sometimes it happens," said the nurse, all blase blah, probably because she had seen probably hundreds more people die than I. "What do you want to do?"

"She has a pulse, we have to put her back on the vent, right? I mean, her heart will stop again later on and we can turn it off again then, but if she has a pulse, I think we're kind of obligated to, right? Right?" I was completely out of my comfort zone, in the resident's worst case scenario of It's Life and Death and I Don't Know What The Fuck I'm Doing. I mean, what do you do when you declare a patient Dead and then, ten minutes later, they decide to become Not Dead?

So we put the patient back on the vent, I called my fellow (the first thing he said was "Why did you turn the monitors back on?" to which I answered, "She fucking had a pulse, dude!") I called the admitting office to tell them to hold off on that death certificate for now, and then I went to talk to the family. That was the hardest part, going to talk to the family. I do think they understood that the patient was, for all intents and purposes, dead, as people with no blood flow to the brain for ten minutes will be, but I think they were confused by the whole thing with the heartbeat and all. Join the club, people.

Anyway, the patient "expired" again a few hours later. "Let's wait another few minutes, just to be sure," I said, gun shy and leery of the whole thing. But this time the heart stayed silent. After about fifteen minutes, we turned off the monitors and took her off the vent.

I'm still trying to figure out what I learned from this experience. I would like to say that it's something profound about life and death and medical futility and ethics, but maybe it's more something like, "If someone's dead, don't turn the monitors back on."

Currently Reading: Ooh, I read a lot of books in the past few weeks! Thank you, New York City subway system, for making this all possible. Of course, all this leisure reading this means that I haven't done a lot of reading for work and therefore look like a moron when pimped on rounds. What? The New England Journal of what? Anyway, first I read "The Grizzly Maze," which was fairly interesting and makes me want to watch the documentary, though it's unlikely I will as I can't watch movies on the subway. Then I read "Prep," which I couldn't put down, and reminds me all too vividly of my own excruciatingly introspective adolescence. And now I'm reading "First They Killed My Father," which is about a family in Cambodia during the rise of the Khmer Rouge. So basically, a little bit of everything. (It was one of those 3-books-for-the-price-of-2 deals at Borders last month.)

'cause they'll never stay home and they're always alone

I know that I've been away for a while, and I apologize. I just started a month in the surgical ICU, and it has been somewhat difficult to get back into the flow of ward medicine. Let me tell you, I did two years of a ward-based medical specialty, and in that time probably did about four or five unit months (as in "intensive care unit," not Moon Unit Zappa) but man, after doing OR medicine for almost a year, I feel as green as a third year med student in July. What are these "rounds"? And "writing orders"? And having the same patients every day? The mind, it boggles. I can't believe there was ever a time that I thought I might want to be an intensivist. But if anyone is taking this down for the record: I don't anymore.

But enough about my boring work woes. Because they are woeful, and boring. Instead I will now talk about fears.

My fear is that, between Cal and work, I will find at the end of this residency that my marriage will be, like a neglected lawn, in a sad state of disrepair. Here's an illustrative example of how things are. Earlier this week, Joe and I were actually home at the same time for dinner. I had already made dinner for Cal that weekend and froze much of it into double serving-sized portions, so he was ready to go with his balanced meal, all chicken and veggies and rice and wholesomeness. What did Joe and I have for dinner? Ramen served in styrofoam.

The unfortunate and unavoidable truth of the matter is this. Where there is a priority system, Cal comes first, work comes second, and Joe and I as a unit comes third. For those of you who say that maybe Joe and I should come before work, I thank you for caring, but I think that if it were your mom being put under for surgery, or your grandfather getting his cataracts taken out, you would prefer the priority be on them rather than me and my husband being able to spend time together every night. I don't complain about this, I just accept this as our reality for right now, and try to assure myself that residency is, above all, temporary. That's probably how residents get through life, actually. We just keep telling ourselves that this all is temporary. Still, finite as it is, two more years is a long time.

This week, Joe and I saw each other for maybe a total of eight waking, non-commuting hours. Keep in mind that WE LIVE TOGETHER, so that's really not a whole lot of time. But what are we supposed to do about it? Give Cal the short end of the stick? Take crappy care of our patients? Can't be doing that. So we keep on doing what we're doing. Eke out a few hours here, a few hours there. This morning, we all went to the playground en famille, and it was great. But it'll have to last us until next weekend. Joe just got called into the hospital after we got back from the park, and I'm on call tomorrow, and then again on Friday and Sunday. So...see you Saturday, then. Sleep is for the weak.

I don't have a solution, or even a point, really. Only to say that mammas, don't let your babies grow up to be medical residents.

Currently reading: This article in the Times about music in the ORs. Personally, I like music in the OR, so long as it isn't too loud for me to hear my monitors, and so long as it isn't opera. (The iPod has revolutionized music in the ORs, by the way. But what are med students supposed to do now that there are no more CDs to changed?) An added point of interest is that most of the physicians interviewed in the article are from my hospital, so I get to be all like, "I know that guy!"