30 posts in 30 days, day 27: bad idea



A foolproof way to ensure that at some point, your wedding rings will end up in the toilet.

30 posts in 30 days, day 26: refresher




I got an e-mail from the education office a few weeks ago alerting me that my BLS and ACLS certification was set to expire in June. So tomorrow I have to take a refresher class from 4pm-10pm to keep my paperwork current.

I've heard that the recert class is relatively painless (for example, lasting only 6 hours as opposed to 3 full day courses for the original certification--can someone please explain to me why BLS training should require a full day? Though actually, now that I think back on it, we had to take a BLS class in high school, and that course lasted a whole semester) and I know that it's the law that I get recertified every two years...but still, I resent having to go at all. Because I would rather be home. In my house. Where I live.

Also, there's something ridiculous about spending all day intubating and giving life support to humans, only to spend the entire afternoon and evening "learning" how to intubate and resuscitate a plastic dummy with no legs.

Currently reading: "Different Seasons." Did you realize that of the four short stories in this book, three have been made into movies, two of which were actually very good? Unfortunately, the movie version of "Apt Pupil" starred David Schwimmer (WITH A MOUSTACHE!), which almost precludes the possibility that it could be watchable.

30 posts in 30 days, day 25: sensitive new age guys




Afterwards they wrote some poetry and talked about their feelings.

30 posts in 30 days, day 24: anniversary


JOE
Happy four year wedding anniversary, honey!

MICHELLE
Yay! Happy anniversary!

JOE
I love you.

MICHELLE
I love you too. Four more years! Four more years!

JOE
(Silence)

MICHELLE
Well, not only four more years.

30 posts in 30 days, day 23: plan b


The worst thing about getting the match results yesterday--well, one of the worst things--was that I was overnight call last night. So Joe and I won't even get to see each other until this evening. There was a quick text-page and phone exchange of information at around 12:20pm, after which we both had to get back to our respective patients (mine on the table, his at the clinic), and another 10 minute phone call touching base right before he headed home in the evening. After work, Joe went out for a beer with his oculoplastics mentor, who in all my dealings with him has been a really great guy (if a bit of a workaholic, not that those things are mutually exclusive) and who was also really surprised about how the match played out. However, he made an important point that of the 60+ applications the New York program got this year, they only interviewed 10 residents, the best of the best. And of those 10 candidates, five of them, like Joe, didn't end up matching this year either. I suppose when you have a dozen spots and more than 60 candidates, you're looking at 50-something people who don't match at all. And so it goes.

At this point, after all the stress and anticipation and whatnot, I think Joe just needs to take a break from thinking about this altogether and chill out for a few days. After all, nothing immediate is changing. Our plans for next year are still the same, me finishing my last year of residency, he precepting and doing a variety of attending-y things at several hospitals around the city. It's going to be a good year for both of us. The thing that we eventually have to figure out, however, is our Plan B for the year after that.

Honestly, we never really got around to thinking about a Plan B.

What I am almost certain will end up happening is that Joe is going to reapply. He wants to do a fellowship for certain, and the ophthalmology fellowship that he wants to pursue is oculoplastics. So there's that. The thing with these plastics fellowships, though, is that they are two years long, and each program takes a fellow only every other year. There are programs (the ones that we applied to this time) that take applications for the even-numbered years (in this case, to start July 2008), and there are the other half of the programs, roughly the same number, that take applications for the odd-numbered years. If we reapplied next year, we'd be reapplying for a totally different pool of programs in totally different places. And as usual, they are all pretty far-flung, which means more traveling, more weeks away from home and time away from Cal, more call schedule shuffling for me, more expenses, less vacation time. But you do what you have to do, right? I mean, if he still wants to go through with it all. Just the thought of running that race again is exhausting, especially when it is toward an uncertain end.

The second thing to think about now is this. Even if he matches with the next round of applications, that will be to start fellowship July 2009. Which means I'll have an extra year to kill before we relocate. (If we match for July 2009, there is no question about the relocation issue, as New York is an even-year program.) So what to do with that extra year? Get a job? Apply for a one-year fellowship myself? Stay in New York? Move elsewhere, with the possibility of moving again in a year? Joe's mentor has offered to try and hook Joe up with some big names in oculoplastics for a year of study, but we almost certainly will not be able to spend a year in London or Vancouver. Last I checked my handy dandy map, those places aren't even in America. Maybe if Joe were single, or if we didn't have Cal or Cooper, or if we were these crazy free-spirited nomadic-type people. But I can't even imagine what would be entailed in just picking up and spending a year abroad like that, especially in terms of negotiating the mountain of paperwork that would be involved in being able to practice medicine outside of the United States. That's just too overwhelming to even contemplate for just a one year stint.

So one way to look at things is that the future is more unsettled than ever. Another way to look at things is that we have a wide open field with unlimited possibilities. The world is our oyster! Though if I actually said those exact words unironically, my head might crack open and rainbows and singing butterflies would come shooting out.

Currently eating: Organic Oreos from Whole Foods. My sister told me about them and I was like, jigga-what? Organic Oreos? Go back to your yurt in Berkeley, you hippie! But then I tried them and they were actually better tasting than regular Oreos. The cookie part is crunchier and the cream filling is more flavorful. But don't worry, I'm sure they're still plenty unhealthy for you.

30 posts in 30 days, day 22: sometimes you get the elevator, other times you get the shaft

With only a dozen or so spots around the country, it might have been overly cavalier for me to assume that Joe would get one of his top two choices in the fellowship match. I figured at worst, we would at least match in one of the top five programs on our match list. "But it won't come to that," I told Joe as recently as this weekend. "You'll match high on your list. We'll be in New York or Columbus."

What I wasn't expecting was that we wouldn't match at all.

In retrospect, maybe it's not so surprising. A highly competitive fellowship within an already highly competitive field. Only about a dozen spots available each year, spread out around the country (see the sadly deficient though colorful map from yesterday's entry--"West Virgina" indeed). An insular culture in which personal connections or hidden agendas count as much as anything on your CV. All these factors should make today's match outcome perhaps slightly less shocking. And yet, I AM FLOORED.

I mean, OK, I know that the odds are stacked against anyone hoping against hope to land a plastics fellowship. An online ophthalmology forum that I happened across described such a feat as the equivalent of "catching a Hail Mary," which I'm not even what that means (football? maybe?) but was reassuring and depressing all at once. The match is like that sometimes. Sometimes the black box spits out something good, and sometimes it spits out something bad, but either way, you don't exactly know why.

But what really gets me is, if Joe didn't match, WHO DID? He's chief resident at a big-name hospital, topped out on all his tests, published papers, and been mentored by one of the big names in oculoplastics, who has proclaimed him the best resident he's seen in 15 years. He got interviews almost everywhere he applied, and got great feedback through the attending grapevine. Joe says I was overly confident, but I will maintain until my dying day that my level of confidence in his candidacy was appropriate. He is a good-ass doctor, and a bad-ass surgeon.

I'm not bitter, because hey, any excuse to put off getting my driver's license is a good excuse, but my god, what do you have to do to land this fellowship? Shoot laser beams out of your eyes? Fly around the world backwards so fast that you actually reverse the Earth's rotation on its axis and turn back time? Thereby saving Lois and Jimmy from the earthquake caused by the bomb that Lex Luthor hijacked? IS THAT WHAT YOU HAVE TO DO?

I don't know what else to say. I am shocked. I feel bad for Joe, who is certainly taking things pretty well, considering, but you don't spend a year working towards something, with all the applications and interviews and travelling and the money, dear god the amount of money we've spent on this process--and not just feel totally beat down when in the end you have nothing to show for it. I don't know what we're going to do next, be it scrambling for another fellowship spot or applying again next year or just to say the hell with fellowship altogether, I'm going to become an attending and swim in my pile of gold coins. We're just going to let the matter rest for a few days and regroup, and maybe by next week we'll be ready to talk about What Comes Next.

I just still can't believe it.

30 posts in 30 days, day 21: waiting



So Joe's match day is tomorrow. We are nervous and excited. Rather, Joe is nervous, I am excited. To review, these are our top four programs (in alphabetical, not rank order):

Representing the Midwest: Columbus, OH
Representing the Rectangular States: Denver, CO
Representing the Southeast: Miami, FL
Representing the Northeast: New York, NY

We will find out around noonish tomorrow, per Joe. I think he has to check the match results on a website or something. What, no phone call? Who knows. The process is inscrutable. We will tell our families first, of course, and then I will post our results here.

Eek.

30 posts in 30 days, day 20: compartmentalization

I wish my need to organize and make things neat generalized to my own home.

30 posts in 30 days, day 19: perfectionist


Above, a picture of Joe watching a videotape of a cataract surgery that he did recently. He watches those things like boxers watch tapes of their old fights, analyzing technique and looking for mistakes. And then he goes outside and Mick makes him chase a chicken.

30 posts in 30 days, day 18: the son of the cooper report

Hi! Look at me! Hi! Hi!

I'm Cooper! I'm standing here!

Now I'm standing over here!

Hi! Helloooooo! COOPER! Here!

Hey, are you going to eat that?

Oh, you are? Hey, no problem. That's cool. You go ahead and eat. Enjoy yourself. I'll just be hanging out right here, next to you. Riiiiiiight here. No no, don't mind me. You just keep eating. Looks good. Is it tasty? It must be. I can tell by the way you're chewing it. There you are, with the food. Eating. And me, not eating. Just watching.



Hey, so I haven't checked in in a long time! Not since right before THE CAL came to live with us. Why, there's THE CAL now, clomping around in Joe's boots and screeching. THE CAL is everywhere. THE CAL is loud. To be honest, when he first came home, I really didn't care much for THE CAL.

First of all, he was pointless. He just LAY there being inedible and did NOTHING. Therefore, POINTLESS. Second of all, after he got home everyone kept telling me to BE QUIET and CALM DOWN when people, I WAS ALREADY BEING QUIET AND CALM. So calm! And quiet! VERY VERY CALM AND QUIET! Anyway, it was THE CAL that was making all the noise, I don't know why they kept making it out like I was barking all the time. Yes, sometimes I bark, but only when I have a VERY GOOD REASON to. Like when I hear people talking by the elevators. Or when I see other dogs walking down the sidewalk. Or sometimes when I breathe air that has a barky smell.

So yes, anyway, THE CAL came to live with us and took up a lot of space with his pointless being and his useless clutter and untouchable toys. It was boring and it was a waste and frankly, I was a tiny bit jealous. I mean, come on, a BABY? What's the last time you saw a baby do something AWESOME like kill a cockroach and then toss it up in the air with his jaws and then roll around in the roach's partially chewed carcass? Babies are so overrated.

But then about a year ago THE CAL started to become slightly less pathetic. He started standing up and doing stuff. He started thinking that I was very, very funny, perhaps the funniest thing he's ever seen. Most importantly, he started eating food. Suddenly THE CAL became very, very interesting to me.

We have a whole system worked out and everything. Want to know it? OK, here it is. THE CAL is in his high chair for lunch. I hang out by the base of the high chair, but casually, very casually, like I don't have a care in the world. Food? What food? I don't care about the food being passed around two feet above my head. THIS IS PART OF THE SUBTERFUGE.



Then near the end of the meal, when defenses are low, THE CAL will casually take a piece of food in his hand and caaaaaasually hang it over the side of the high chair. I continue to pretend like I don't care, because food is for mortals and therefore beneath me. But really, I do care. I use a Method Acting technique. Usually I try to think about something to which I am utterly indifferent. Like, oh, say, obedience training. There. I have achieved the correct degree of bored detachment on my face. It's magical.

We wait for the right moment. Then, when the adult figure is suitably distracted (ants on tabletop, phone ringing, ubiquitous Britney Spears analysis in tabloid magazine), THE CAL will let the food fall, and I will be all over it in a flash of teeth and fur. Sometimes I catch it in midair. Sometimes I do a flip. It's a well-oiled machine, people. What a team.

So Cooper, you may be asking, you get the food, but what does Cal get? Well, invisible internet persons, let me tell you. I am a fair dog. I do what's right. If THE CAL shares his food with me, it's only right that I share mine with him. And he appreciates it, I can tell. You should just see the look on his face when he's trying to chew up my kibble with his pathetically small teeth. But just make sure Michelle doesn't catch him doing it, because for some reason she gets all bent out of shape at the mere thought of her kid eating processed farm animal offal and fillers, and then I just have to say, NOW WHO NEEDS TO BE QUIET AND CALM DOWN?

Currently thinking: I need to shed 30% of my body weight in fur for the Spring. Maybe I'll do that tomorrow. Right after Michelle finishes sweeping the floor.

30 posts in 30 days, day 17: rear window

Cal and Coop each engaged in their respective favorite activities. Cal playing with his cars, Cooper looking out the window, barking at invisible ghost dogs.

extra extra

This just in, from The New York Times:

_________________________________________
Doctors Remove a Gallbladder Through the Vagina
By DENISE GRADY
Published: April 20, 2007

Doctors in New York have removed a woman’s gallbladder with instruments passed through her vagina, a technique they hope will cause less pain and scarring than the usual operation, and allow a quicker recovery. The technique can eliminate the need to cut through abdominal muscles, a major source of pain after surgery. (Click here for the full article)
_________________________________________

I will keep my mouth shut about what I actually think about the procedure (this is called "discretion"), but I can tell you that I had a great front row view for the whole thing. Guess who did the anesthesia?

Currently reading: "The Children of Men." Very chilling.

30 posts in 30 days, day 16: eskimo

Even though I did embark on this "30 posts in 30 days" thing partially (as one reader noted) as a way of doing penance, I have to say that it really is great for breaking down any barriers one might have about posting regularly. Now I realize that what I put up there doesn't have to be profound, or long, or even good. It just has to be there. Though there are some limits to that, I imagine. I probably shouldn't continue my stream (as it were) of urine-themed posts, for example.

The first thing my patients usually remark upon when we bring them into the OR is how cold it is in there. And it is. Very, very cold. I used to wear one of those warm-up jackets, but stopped, because it wasn't possible for me to wash it every day and I figured it was just a giant fomite, soaking up urine and blood and remnants of Code Brown. Disgusting.

The reason the ORs are so cold is for benefit of the people scrubbed, who are basically wearing the equivalent of blue plastic garbage bags under hot lights for hours at a time. However, for the rest of us ungowned, patient included, it is torture. I've seen circulators under a full mound of blankets with only their faces poking out, lips blue. Med students sometimes light small fires in the corner and huddle together for warmth. If I am at a comfortable temperature, I can guarantee that my scrub tech and surgeons are sweating. So we keep it cold.

But the thermostat is right next to my anesthesia cart. This to me is like a particularly sadistic form of torture. Look, but don't touch! It's like Tantalus.

30 posts in 30 days, day 15: spongebob wetpants



Cal and I went to the indoor playground yesterday when I was post-call. This is a very ritzy indoor playground--the playground itself is nice, but they also have schmancy things like a boutique (not a store, a BOUTIQUE) and mother/baby yoga classes and ORGANIC CAFE as well as other other high-end offerings that make me wonder if I am really spending enough time with Cal going through his Latin word root flash cards.

Anyway, at one point Cal ran over and sat on my lap with a dreamy expression on his face. And why not? I thought, the boy LOVES HIS MOTHER. And why does my lap feel so warm? Well friends, suffice it to say that this is the last time that I will be taking Cal out without a change of pants in his diaper bag. So I had to buy him a new pair of pants at the BOUTIQUE. And they were expensive. However, stripey, so that's a plus.

30 posts in 30 days, day 14: foley

MICHELLE
You know, I know we do disgusting things all day long, but for some reason, there's something particularly gross about emptying out a patient's Foley bag.

ATTENDING
True. Well, you should be used to it. You have a baby.

MICHELLE
Yes, but I don't collect my baby's urine in a plastic bag and decant it into bottles. And I certainly don't take those bottles, put them up next to my face and squint, trying to figure out the exact volume of urine my baby has peed and whether or not I need to give him more fluid based on its color.

ATTENDING
Fair enough.

MICHELLE
Or at least I'm not admitting to it.

30 posts in 30 days, day 13: but what if you're a she-male?

Here's another sign at work that bugs me, even though I'm not even quite sure if it's incorrect. Doesn't "female locker room" somehow indicate that the room itself is female? Shouldn't it say "women's locker room"?

Obviously I spend far too much time thinking about these things.

30 post in 30 days, day 12: nor'easter

Well, I'm glad we went out yesterday, because today has been the equivalent of hiding out in a bomb shelter.

photos by Peter Morgan/Associated Press

We've just been holed up inside all day because of the storm. It is, as the weather report insists on calling it, a "nor'easter." Why not "northeaster?" What, the additional -th- too much of a mouthful, I suppose. Or maybe it's supposed to be emulating the speech patterns of old New Englanders who speculate about the weather while sitting on bales of hay and squinting distrustfully at out-of-towners.

Remember back when you were a kid and went to summer camp? And how on days that it rained they just kept you all contained in some ostensibly dry room room (which always smelled damply of mildew anyway), and attempted to tamp down the frenzy of your youthful indignation by anesthetizing you with endless playings of "Charlie and the Chocolate Factory" (psychedelic Gene Wilder version) and rounds of Bingo? That's what today feels like.

This would be a great day to just watch some marathon of a mindless cable network reality show ("Project Runway" comes to mind--I do love that red-headed brassy mom from the last season), but for the last few months, our cable has been broken. I don't know exactly when it stopped working, but one day we tried to watch TV, and we realized that the only channel we were receiving was Telemundo. So unless you want to watch "¿Qué Hay de Nuevo? con Mónica Noguera" or "Tierra de Pasiones," you aren't going to be watching much of anything. Except perhaps football--oh, excuse me, "fútbol".

Currently reading: "Better." Also, this article in the Times about the new hip resurfacing surgery, featuring one of our orthopedic surgeons.

30 posts in 30 days, day 11: because I don't have a flickr account

Doing all these mobile photo posts in the past few days makes me realize that my phone cam really is a piece of crap. I have the Sidekick II, which not only is an embarrassing Paris Hilton-endorsed phone, it's not even the latest generation Paris Hilton endorsed phone. I'm so 2005. I was considering upgrading my cell phone (I've had this Sidekick II for about two years now, and before that I had the Sidekick I, which I got when I was an intern, roughly five million lifetimes ago), but Joe is begging me to wait until June before I do anything. I think it's his not-so-secret fantasy that we will have matching iPhones when they finally hit the market. I'm not sure that I could quite trust myself with a $500 phone (being quite clumsy sometimes), but I do have the gadget lust, and it coincidentally is my birthday at the end of June, so maybe I will wait.

And now, since it is the weekend, please indulge me while I post pictures of my kid, taken with my real, non-phone camera. (It is a Nikon D70, by the way--a couple of people have asked.)



Here's Cal last weekend at the indoor playground, playing basketball before that jerk kid came over and started clawing his face off.



Cal in a box. We get our groceries from Fresh Direct. Is this a New York thing? Do other people order their groceries online? For us, it is cheaper than going to the actual supermarket, and the produce is much better.



A fair representation of how Cal looks maybe 10% of the time. Perhaps his breakfast was insufficiently delicious.



Cal's latest obsession: cars. Did we somehow subconsciously push him into societally gender-"appropriate" play? Hard to say. He had a few cars floating around in his toy mound (along with stuffed animals, a play kitchen set, some musical instruments, crap like that) and at some point, he just zoned in on them and started preferentially playing with the cars. So of course we went out and got him some more cars. And then we bought him a six pack of beer, some guns, and the Char-King Imperiale.



Cal's way of playing with his cars proves that he is my son. Sometimes he'll just push them around on the floor, or up the walls (most of them have "pull-back" action, which means that their wheels click and whirr impressively), but his favorite game is lining the cars up along the windowsill. He will drive them slowly from one end of the windowsill to the other, parking them carefully bumper to bumper in a straight line. He is very careful to get them lined up just right.




If it wasn't for the fact that Cal will be going into medicine only over my dead body, he would be a good anesthesiologist.

Currently reading: "Better." There's something inspiring about a doctor who's so unafraid to be honest about problems with the system and even his own shortcomings. We live and work in a culture of blame, but if we could get away from that just a little, we really could be a lot better at what we do.

30 posts in 30 days, day 10: at least we had masks

I noticed that I'm writing much more about work-type stuff now that I've started doing these mini posts. Probably because usually, between privacy issues and the humdrum of routine, there's not all that much to say about work that would fill up more than a sentence or two anyway.

Yesterday I was in a case where the surgeon kept farting. I don't think he was embarrassed or anything, because he certainly wasn't trying to hide it. Poot. "Woah, there's another one," he'd note mildly, perhaps for the operative record. Braaap. "I haven't been eating anything different, I swear." I tuned out when he and the scrub tech started discussing dietary choices and the gaseous potential therein. ("Potatoes, definitely potatoes.")

I pitied all of us, being in that room, but I felt especially bad for the med students. There were three of them standing in a row, about two feet behind the surgery attending, their eyes watering. I could tell they were just scouring their mental editions of "Surgical Recall" trying to figure out the correct etiquette for this situation. Move away or stay put? Acknowledge or ignore? Laugh or cry?

30 posts in 30 days, day 9: 6:00am on the fdr

The thing that bugs me the most about the show "Grey's Anatomy" (well, there were so many things, and I only watched half of one episode) was that they always show the residents strolling into work in full daylight. Surgical residents! Waking up after sunrise! Maybe they work in Iceland during summer months only.

30 posts in 30 days, day 8: there, their, they're

On the heels of yesterday's post, looks like people started taking matters into their own hands. (It wasn't me, I swear.)

30 posts in 30 days, day 7: quote unquote

My pet peeve is incorrectly punctuated signage, the most annoying subset of which involve abuse of quotation marks. A sign by the main entrance reads: ALL EMPLOYEES "MUST" SHOW I.D. All this does is make me not want to show my I.D. What, I "must" show my I.D.? But not really, right? Because it's in quotes?

Better hope they don't put up plaques reading PLEASE DO "NOT" CORRECT SIGNS WITH SHARPIE.

30 posts in 30 days, day 6: back in the saddle again

Coming back from vacation really throws you off your game. What is all this stuff?

30 posts in 30 days, day 5: aggravated assault

Cal is something of a gentle giant. He's tall for his age, but kind of shy, and if other kids push him around or take away his toys, he mostly just shrugs it off. Actually, sometimes when other kids take toys away from him, he claps, as though to say, "Oh yes, I didn't want that toy anyway, good for you for taking it away at this choice moment." Pushover.

Yesterday at the play place (I call it "the play place" but I guess it would be more accurately termed an "indoor playground" or some sort of kinder-enrichment-wurld) Cal got victimized by a tyke-sized bully. In retrospect, maybe I just should have kept Cal away from the kid altogether, because even from afar, I kept hearing his dad say things like, "No pinching!" and "Don't push the baby, he was just trying to play with you!" but I'm just trying to let Cal interact more with kids his own age and learn to deal with jerks, because it's good practice for life. So Cal was playing next to this other kid in the pretend supermarket section of the play place, and I guess the other kid didn't like the looks of him or something, because he suddenly started pushing Cal away (I want to say "strangling," but don't want to sound alarmist--what do you call it when someone pushes you away with both hands around your neck? Strangling? Yes, I thought so) and pinching and scratching Cal's face.


The other kid's dad interceded in short order and pulled his little wolverine off Cal--to his credit, the dad was mortified and made the wolverine come over not once, but twice to apologize. I made my face very mild, accepted the apology on Cal's behalf, and then took him out to the sinks to clean off some of the blood. Yes, blood. He drew first blood.

Jerk.

Cal calmed down after about five minutes and was back to playing soon thereafter. And he basically ignored me as I tried to give him some "Full House"-esque talk about how some kids like to play rough, and how even though it wasn't nice to pinch and scratch, the other kid had apologized, blah de blah. Soft "learning about our differences" music played in the background as Uncles Jesse and Joey looked on approvingly, their mullets swinging.

I left out that part where if that other kid tried to touch Cal again, I would kick his ass.


* * *


Today is my last day of vacation. Every time I come to the end of a vacation where Cal and I get to spend a great deal of time together, basically 24 hours a day less naptime (and even those are occasionally spent together), I wonder how he's going to react the next morning when I'm not there. Will he be surprised? Upset? Or will he just roll with it and not give it a second thought? Inevitably this takes me to questioning whether or not Cal would be happier if I were home full-time. After a week at home, you get so attuned to the rhythm of your kid's day, all the little small moments. I know I must be missing so much when I'm at work, and I wonder about how much Cal feels like he's missing too.

That's just working-mom guilt talking, though. I'm not going to stop working--when all's said and done, I like work, and anyway we need the second income--though I hope that after residency I will certainly be working fewer hours, and maybe fewer days per week. Also is the knowledge is that this week with Cal has been so nice precisely because it has been vacation time, by definition a break from the normal routine. If I were home with Cal every day, certainly every moment I spend at home with him would lose its significance and poignancy. I'm sure stay-at-home types don't spend every moment with their beloved children hugging and having meaningful exchanges, while in the background, a rainbow gently shimmers. Actually, that sounds more like a tampon commercial.

Since I'm going to be back at work, probably the quality and quantity of updates will diminish somewhat, at least on the weekdays. However, I promised myself 30 posts in 30 days and I am intending to keep to that. Just don't begrudge the typos.

Currently deciding: Whether or not I should culture Cal's rash. A word of explanation: Cal developed a rash on the back of his knees, with one prominent lesion that looked sort of annular, which made me assume that it was tinea and started treating it with an antifungal. However, my dad dropped by the other day (he's a dermatologist) and pointed out that both the site of the rash (behind the knees) and the fact that it was bilateral made a more convincing case for eczema. He said he would drop off a culture bottle so that we could make sure, though. "Just scrape some of the scale off with a #10 blade into the bottle," he said offhand, "I'll run the prep and we'll see for sure." I am leaning away from actually doing the culture though, because not only are the lesions already getting better with topical hydrocortisone, but because I think a 20 month-old lacks the ability to sit still with having a razor blade scraped against the backs of his legs. (Though I'll reconsider if the rash starts getting worse again.)

30 posts in 30 days, day 4: aye aye

The next time my patients ask me about general anesthesia, I'm just going to show them this:


It will really save me a lot of explaining.

* * *


JOE
So guess what they're going to give me when I graduate residency in June?

MICHELLE
I don't know. Money?

JOE
No.

MICHELLE
Um...a gift certificate to TGI Fridays?

JOE
No. A captain's chair.

MICHELLE
A what?

JOE
A captain's chair. You know, like in the Dean's office.
(Shows picture on brochure)


MICHELLE
Ah so. Are you the only one getting this, uh, captain's chair, because you're chief resident?

JOE
No, they give it all the third years.

MICHELLE
Wow. Well, it certainly looks...comfortable.

JOE
Not really.

MICHELLE
Do we have to accept it?

JOE
They're having it shipped directly here.

MICHELLE
Can we sell it on eBay?

JOE
It's going to be monogrammed. With my name on it. And it's going to say [University Hospital] Department of Ophthalmology.

MICHELLE
Well, that's nice, I guess.

JOE
Yeah.

MICHELLE
"Help, I'm a prisoner in the library!"

JOE
What?

MICHELLE
Nothing. Hey, I don't suppose we could just convince them to give us the money that they would spend on the, uh, captain's chair instead? You know, cut out the middle man, that kind of thing?

JOE
Honey, our very own captain's chair!

MICHELLE
Just looking at it makes my butt hurt. Where are we going to put it?

JOE
Right next to my sword.


* * *


So those math whizzes among you may have noted that if Joe is starting his fellowship in July 2008 but graduating residency July 2007, that there is something of a "gap year" during which time he will not be in training at all. This year is necessary, as I still have to finish my residency before we can relocate anywhere (if, indeed, we end up relocating), but the great thing about it is that because even a junior attending can easily make three times as much money as a resident even while working fewer hours, Joe will likely only have to work about three and a half days a week for my entire CA-3 year.

I cannot tell you what a load off my mind this is. First of all, I'm happy for Joe, because he's really put in a lot of hours over the past four years, and he deserves a nice break before fellowship starts. But secondly, I'm happy for Cal, because he and Joe will be able to spend a lot more time together. Imagine this, Joe will actually be able to spend time with Cal in the daylight! He'll actually get to take him to the park, to the doctor's office, to his music classes! There will finally be a member of this household who will be able to go to the Post Office and the bank during business hours! If I get held up at work, I don't have to worry, because I know that even if I can't be home on time, Joe almost certainly will be. Best of all, as a roving ophtho attending working between several different clinics, Joe will probably only have a total of a few weeks of call the entire year. And that's attending call, not resident call. The frequency of an ophtho attending actually getting called at night and needing to come in for an emergency operative case is...well, it's extremely low.

My next year is probably going to be rough (anesthesia being one of the few fields where the residency actually gets harder as you move up, instead of easier), but knowing that at least one of us has a more flexible schedule allows me to concentrate on work while at work, as opposed to worrying that Cal is going to forget what his parents look like.

Now I can just worry whether or not Cal is going to like Joe more than he likes me.




Currently reading: Patient records for my cases on Monday. I'm back on Neuro this month. Still waiting for my books from Amazon to come in. At this rate, my vacation will be over by the time they get here! Damn you, Free Super Saver Shipping! In addition to "Better," I also ordered that P.D. James book "The Children of Men," which unfortunately is only sold now with Clive Owen's picture on the cover, looking all broody and post-apocalyptic.

30 posts in 30 days, day 3: three minute mystery

Taking Dreama's suggestion from the last post, I ended up doing a reverse phone number search on Elena's number. (I didn't try it before because I thought that only worked for land lines, not cell phones. Who knew? All of us now, I guess.) This yielded her cellular carrier (Sprint) and the fact that the number was registered to a person in New York, NY. For $15 more, I could obtain the name and address of said person. I started to proceed with the search, but then stopped. It had been three months. Wasn't it possible that Elena's account had been closed, and the phone number reassigned to someone else? Did I want to spend $15 looking up the address of some random person with a new cell phone? Or should I make sure first that the cell phone number was still registered in Elena's name?

I decided that I should call the number one more time, just to make sure that Elena's voice mail message was still on. If not, well, at least I could still call Sprint and see if I could get the old billing information for that number or some such thing. (My days as a Peds resident spending endless hours on the phone with Medicaid and various social work offices were finally paying off.) I called the number, and as it had the past ten-or-so times I called, it rang and rang. I waited for the voicemail to kick in. But this time it didn't. This time Elena picked up the phone.

"Hello?"

"Hello? Elena?"

Upon hearing me say her name, Joe spun around in his seat. "WHAT?"

So it was the "best case scenario" after all, in that Elena is fine, and healthy, and most importantly, alive. But I now feel terrible having said yesterday that the "best case scenario" was a family emergency that took her unexpectedly out of town. There was indeed a emergency, down in Florida, where some of her family lives. Several people were in an accident, one was badly injured, and one died. Elena had been down there for two months dealing with things, and was just back in New York briefly tying up her affairs and getting ready to move down South to be with her family. She was leaving for good in a week.

She apologized again and again for not having called us. She said that she had left her cell phone with some friends, who were entrusted with fielding her calls and telling her various contacts what had happened and where she was. Joe thought it was strange that she left her cell phone here instead of taking it with her to Florida, but I suspect it may have had to do with not wanting to pay the roaming charges that may have been incurred by taking the phone out of the immediate network. But I guess those friends didn't really do their job very well, because in all the times I called, I never reached a live person on the other line, nor were any of my messages returned. Elena was chagrined to hear this. She apologized again, and I told her not to worry about it.

She asked about Cal. I gave her an update. She said she missed him. I told her that if she wanted, she could come by to visit him and say goodbye before she left New York. She said that she would like that, and said that she would call and try to come by sometime next week. I told her to call us if she needed anything. We hung up.

So that's what happened. After all that, all I had to do was call her damn cell phone number again. It's a relief to finally know what happened, and hopefully, we'll see her again. I'm happy that she's OK (and frankly glad to be absolved of the guilt of should we have done more, and very glad that I didn't flip out and call the police early on in the "disappearance,"--that's probably the last thing she needed at that point), but sad that she's been going through so much.

Now to solve the mystery of the crooked banister. Somehow, I suspect there is a robot involved.




Currently reading: The latest "New Yorker." Cal joined this new indoor playground in our neighborhood, and we've been going quite a lot because the weather has been terrible for outdoor play as of late. So we go and he plays for an hour or two, and I sit there and watch him. Which is fun, sort of, but he is 20 months old and I am 28 years old, so the intricacies of trying to stack Duplo blocks sort of wear thin after the first 30 minutes. So I thought maybe I should bring a magazine. I figured that perhaps it would be frowned upon to read a magazine at the play place, because all the other moms are all ATTUNED to their kids and ENGAGED and probably teaching them French at the same time, but I figured that if I was sitting right next to Cal while reading it, making sure he wasn't getting involved in any toddler gang violence, it would be OK. Also, I figured that if I was reading "The New Yorker," it would be more OK than if I was reading "Us Weekly" or the like (though really, I wanted to read "Us Weekly") because "The New Yorker" is HIGHBROW.

(Well, all this rationalization and planning was for naught anyway, because I didn't get to read my magazine at all. Instead I built a little Duplo fort.)

30 posts in 30 days, day 2: errata

I actually realized that I misspoke with respect to the top three programs on our rank list yesterday. Or to keep it abstruse, perhaps I should restate it that our top four programs are Columbus, Ohio (home of the world's first Wendy's); Denver, Colorado (home of the elevated hematocrit), Miami, Florida (home of countless spry retirees); and New York City (home of Gray's Papaya, featuring the world's greatest hot dog). Not knowing where we're going to end up has not prevented me from doing relocation research, however. I'm just doing relocation research for three or four places simultaneously, figuring that hopefully one of them will pay dividends when the match results come in. Want to know about the school system in Columbus? (Shitty in the city, excellent in the suburbs.) The housing market in Miami? (Much cheaper than New York, with a preponderence of ceramic flooring). The anesthesia job market in Denver? (Not as rich as in some areas of the country, but there are some positions out there). The inability to focus my information gathering in any one area has forced me to realize that there are plenty of nice places to live outside of New York, and that it might actually be kind of exciting to try something new for a few years.

Or, we'll hate it and come crawling back, begging to be forgiven for our hubris.


* * *


Oh, speaking of hubris, I knew even as I was writing it that I was stirring up trouble. Remember back in January when I was talking about out perfect, wonderful two-nanny system? Well, literally days after I posted that entry, one of our nannies disappeared. Literally. Like we don't know where she is. It sounds kind of light-hearted when I write it like that, but actually, it's kind of scary, and we still don't really know what happened to her.

(Harp-like flashback music)

So we had two nannies, one who worked Mondays through Thursdays (I will call her "Roslyn"--perhaps I gave her some other pseudonym in the past, but I cannot remember it, it's all very Spy vs. Spy with the identity-cloaking here) and one who worked Fridays only (I will call her Elena). Elena (the Friday nanny--keep up, people!) we've known for a long, long time--she helped us combat entropy in our apartment about once or twice a month since before Cal was even born, which I know, makes us sound so haute bourgeoisie, like, uch, they have a nanny and a cleaning person? But anyway, just forget about that part for now.

After Georgia (the first, bad nanny that we fired) was no longer in our employ, we asked Elena if she would help us out with Cal once a week as well, because we trusted her and liked her and she had some childcare experience in the past, through her church group and all that. After we hired Roslyn we continued to have Elena come once a week, both for the backup system that I had mentioned, and because Cal seemed to genuinely enjoy having Elena around. It was a nice situation.

One Saturday shortly after I posted my last entry in January, I got a call from Elena. She just wanted to let me know that she accidentally left her cell phone charger at our place on Friday, when she had been over to watch Cal. I told her I'd keep it safe for her and she could pick it up on Monday, as she was planning to come by on Monday to help us do some cleaning. Did she need to come by and get it sooner than that? No, she said, Monday would be fine, and after exchanging some chit-chat and pleasantries, we hung up.

After work on Monday, I came home and asked Roslyn if Elena had come by. She hadn't. I didn't think too much of it--Elena had a busy and varied work schedule, and we weren't too rigid about the cleaning schedule anyway, we just allowed her to schedule our cleaning day for whatever was most convenient for her. It had happened before that Elena had to change what day she was coming by to clean last minute, and she would always call us a day or two before to let us know. She hadn't called this time, though, which was somewhat unusual. I figured she was planning to drop by the next day (she knew Roslyn and Cal would be home anyway, and she had the key to our apartment), so I didn't think much of it.

When I got home from work Tuesday night and saw that Elena hadn't been by that day either, I figured I'd give her a call. She'd been ill about two months prior (some sort of respiratory thing that kept her out of commission for a week or two), and I figured that she was probably home sick again. I called her cell, got her voicemail, and left a message basically checking in to see that she was OK, and to call us if she needed anything. I expected to hear back from her over the next few days. We didn't.

By the time Friday rolled around and she didn't show up for her day with Cal, we knew something was wrong. When it came to watching Cal, Elena had always been utterly dependable, and even in the rare instance that she was unable to make it in (as when she was sick in the fall), she would always call far in advance and let us know. For her to just not show up was completely out of character. We called her cell again and again, countless times over that week. We kept getting her voicemail.

There were a number of scenarios that Joe and I envisioned, each in different shades of grim. Best case scenario, we figured, was that she had a family emergency, and had to rush home to South America, where her parents and siblings were still living. Worst case scenario was that she was seriously ill or injured, in the hospital. Or worse. New York is generally getting safer, but that doesn't not generalize to all parts of the city, and I know that Elena lives in the outskirts of Queens, sometimes taking the subway very early in the morning or very late at night. I didn't say anything out loud, but I started reading the Metro section of the New York Times very closely.

The thing that Joe and I have discussed endlessly since this all happened is what we should do next. Certainly I feel that we have some sort of moral obligation to make sure that Elena is all right, but we're not really sure how we should go about it. Despite the fact that we've known her for over two years, when it comes down to it, we really don't know all that much about her. We know her full name, but both her first name and surname and the combination thereof are very common. We know approximately where she lives, but not her address. We know little bits and pieces about her outside life (other jobs she held, the fact that she went to a Christian church regularly, other places that she's lived before settling in New York several years ago), but absolutely no specifics. We don't know her land line number--in fact, I sort of doubt that she has a land line, though like everything else, I'm not certain about that either. We know her cell phone number but not her carrier, and given that we have her cell phone charger, there's a degree of confounding to the fact that we were unable to reach her through that number. Was her phone battery drained, or was she unable to answer for another reason?

Most importantly, we're not really sure of her immigration status. We honestly never asked. Maybe it's not cool to admit that, but hell, this is New York City, it's not an uncommon fact of life. My first instinct when we realized that she was "missing" was that we should call the police. I don't know what I would really tell them, but surely, there are resources that the police have to work up missing people. But is that really the right thing to do in this situation? First of all, we're not really as close to her as family members or even her friends through her church--we know hardly anything about her, we don't even have a picture. And furthermore, if she wasn't really missing--this was what we were especially worried about--would we actually be getting her in trouble? Clearly something is not right, but the last thing we want to do is make things worse for her. Or perhaps her uncertain immigration status has a role in this after all. Could she have been deported? Arrested? If the latter, I would hope that she would at least feel like she could call us for help, but like I said, we haven't heard from her.

Months later, I still have a lot of moral unease about this situation, what we did, what we should have done, if there's anything that we still should be doing. What do you think? What would you do? It's like Randy Cohen in "Ask The Ethicist." You be Randy Cohen.

My one consolation is that I know that Elena was very active in her church. Again, if I knew the name of the church or where it was, this could be a much simpler matter, but I don't. However, I know that she went several times a week, and volunteered regularly for a number of church-based programs with children and the elderly. She has friends, she is networked. If she really is missing, her congregation would know more about where to look and who to contact. It makes me feel better to think about this, but does not absolve me completely. Somehow the feeling of passing the buck, assuming that other people will do the right thing, turning a blind eye and telling myself what I want to hear. "All that is necessary for the forces of evil to win in the world is for enough good men to do nothing."

What would you have done? What would you do at this point?


Currently watching: "Manhattan." Classic Woody Allen. If for nothing else, watch it just to see the very young and very gorgeous Meryl Streep. And Mariel Hemingway.

hello? is this thing on?

OK, so I did an ICU rotation in January, and then more work things happened, and life continued to march by, and then suddenly it was April and I hadn't updated this page for three months. BUT! I am updating it now. Because of guilt. And because big life things are HAPPENING and I figured you all would want to know.

The thing about not updating for a long time is that the pressure to turn out a good entry and right all past neglect just grows to monstrous proportions once you're out of the loop for, oh, months. There's that feeling that the comeback entry must be so well and hilariously written and of SUCH PROFOUND INSIGHT that not only will the faceless legions totally forgive you for going incommunicado for the entire winter, but also fall in a stunned faint to the floor because MAN, YOU REALLY NAILED IT. So not updating for a long time leads to not updating for an even longer time, because you can't just slap some shit up there, it actually has to be good, and can't you see I'm CRACKING UNDER THE PRESSURE HERE? I'm so excited! I'm so excited! I'm so...scared! (Starts inhaling handfuls of caffeine pills.)

(And yes, I am referencing a Very Special Episode of "Saved By The Bell," what of it?)

But then I figured I would just pretend like there was no pressure because for god's sake, it's just a stupid blog--and just catch you all up on what's been going on. Good? OK.

The biggest thing that's going on for us right now is that Joe just submitted his fellowship match list. Don't talk about this around him, because he's all nervous and filled with self-doubt and whatnot, but the oculoplastics match is April 25th, which those of your with calendars or calculators or (better yet) calculator watches, can see is exactly three weeks from today. These past few months, he's been flying all over the country on interviews, wearing suits and being impressive and charming, running through airports throughout this great land of ours like some latter-day O.J. Simpson, minus the murderous insanity (mostly). We are ranking something like 8 or 9 oculoplastic programs (when I say we, I really mean "Joe," but since all of us are sort of tied into the relocation package, I really really mean "we") in various locations, but our top three choices (in no particular order--I must keep it abstruse like this because the fellowship match is something of a closed and black-box process, where neither side is really supposed to know the exact order of the rank list of the other) are Columbus, Ohio; New York City; and Denver, Colorado. So as you can see, our hopes and prospects are strewn hither and yon, which means that the result of this match is a source of great anticipation. Where we match is where we are going to move (or, in the case of New York, stay), for at least two years, starting July 2008. It will be where I find my first real job, where Cal will start school, where we will (probably) have another kid, where Cooper may get run over by a truck and get buried in some ancient Indian resurrection soil only to come back EVIL. The rank list is already submitted, so at this point all there really is to do is sit back and wait. But as you can probably imagine, the suspense of not knowing is killing me.

The other big thing that happened is that I finally got some rain boots! Well, no, I guess that's not really a big thing, but I just realized that Joe's fellowship match is really the only major news item. Everything else has just been chugging along. There was some snow in March, and I got sick of getting my feet wet, so I finally bought some rain boots. They are yellow with little apples on them! And rubbery! Then of course, it was sunny for many weeks, and I didn't get to wear them, even after I took my rain stick and shook it at the sky. Here Cal is modeling said boots, though they are more like those full-leg fishing boots on him. Note that he has clearly been watching "America's Next Top Model," what with the angulation of the shoulder and the hip.



The thing about not posting for a few months is that while a few months is nothing in the lives of adults, it's a lifetime in toddler time. Cal is bigger now. He says things. I shant bore you with a list of things that he says (such lists should be solely confined to the minds of parents and perhaps shared during select gatherings involving doting grandparents who clap when the baby farts) but suffice it to say, he talks. Also, he eats things and likes to play with toys. Hmm. Maybe not that much has changed in the past few months after all.

I was thinking of enrolling Cal in preschool after he turned two this July, not for SAT prep purposes, rather for socialization purposes. Cal is fine at interacting with adults, but around other kids, he's a little shy. So why not throw him into the shark tank that is nursery school, I thought? Learn how to form small Lord of the Flies-esque tribes, eat partially stepped on floor crackers, and become a hothouse for viral scourge! Brilliant! All I had to do was find a good nursery school nearby and sign him up, right? Oh, Michelle of the past, I, Michelle of the present, have so much to teach you. And yet I cannot.

What I forgot to note was the total cutthroat to-the-death cage match known as the Manhattan nursery school admissions process. What? say you, Admissions process? To nursery school? Yes, my friends. This is Manhattan, and everything is a scene. By the time I was starting to think seriously about enrolling Cal in nursery school, all the other families were already glued to their mailboxes, waiting for their acceptance (or, for shame, rejection) letters to come pouring in. Some reseach into the process what had already passed us by revealed that these other families had already had their kids tested, interviewed, written their application essays, and solicited their letters of recommendation. For their two year olds. FOR NURSERY SCHOOL. If you do not live in Manhattan (or maybe London), you perhaps think I am kidding, ha ha, with the mirth--only I am so, so not kidding. So I guess unless there's a half-day opening with the hospital-affiliated nursery school, Cal will just have to content himself with the life of a prince for another year. I'm not really sweating it too much, since I'm not totally convinced that he's actually going to be ready for nursery school at age two (he's still so shy in new situations, I don't want to create some sort of indelible fear complex in him before he's really mastered the whole verbal communication thing), but I guess we should just work on more opportunities for him to play with other kids his age. If only I were more friendly. And less scared of the other New York moms. Don't judge me, playground moms. I'm post-call.

Oh, and one last thing. We just got back from vacation yesterday. We went to Clearwater Beach in Florida. You may recall that we went to Florida last year too, though Sanibel Island that time. So why Florida again? Do we love Florida or something? Easy, amigos. It's Spring Break season, and Florida was the cheapest beach deal Expedia had to offer.








Why am I in none of these pictures? Because I am in charge of the camera. I'm no Annie Leibovitz, but Joe is a worse photographer than I am. I keep explaining to him that it's about COMPOSITION, and WAITING FOR THE RIGHT MOMENT, but then he goes ahead and takes a picture of the side of my head standing in front of a cement wall with Cal's head in the foreground, all blurry with his eyes closed. And then I have to wrest control of the camera back from him.



Oh, I just had to include this photo to show you how Cal is weird. This is a kid who does not like to get messy. All around us were kids slopping around in the surf and building sand castles and burying each other in muck, and Cal wouldn't even touch the sand. He hated the water, he hated the feeling of the sand on his feet. The only way that we could convice him to let us put him down was to cover up that horrible, horrible sand with a towel so that not one grain would touch him. That is weird, right? Don't kids usually like sandboxes and mudpies and all that?

There, I finally updated. I feel better. Maybe I should make some sort of commitment, 30 posts in 30 days or some such AA-sounding thing, to get back in the saddle. We could try it.

Currently reading: Waiting for my copy of "Better" to come from Amazon. I loved his first book. What is with this guy, though? Even the New York Times profile of him was practically drooling with accolades, "Tall, handsome, brilliant...a former Rhodes scholar and currently the recipient of a MacArthur 'genius' grant," and he's married with three kids, which at least implies that he has a life outside of work. You almost want to hate him for being so perfect, but in all of his writing, he seems like just a nice, down-to-earth guy. How unusual (optional postscript: "...for a surgeon"). I also read "Nineteen Minutes" on the plane, and I advise you only not to waste your time doing the same.