playing the game


MICHELLE
So how did the school visit go?

JOE
It was fine, the school was really nice, but it was weird because we were touring with one other family.

MICHELLE
Oh, it was a group tour?

JOE
Not really much of a group. Just me and Cal, and then these two parents with their kid.

MICHELLE
Both parents showed up with this other kid? Did you explain that I was at work? At my job? Where I work? Did they think Cal comes from a broken home? YOU HAVE TO EXPLAIN IT TO THEM!

JOE
Didn't really come up.

MICHELLE
Well, how was the tour anyway?

JOE
Kind of annoying. The other parents were Playing The Game.

MICHELLE
What do you mean?

JOE
They were being aggressively competitive.

MICHELLE
Oh lord.

JOE
The mom was really trying to sell the fact that she had gone to a Montessori school when she was a kid too, so it was like, their destiny to send their kid to this place. The mom kept pointedly saying stuff like, "Oh, I remember all those valuable lessons about handwashing from when I was in Montessori. Could we see the sandpaper letters?" Then she would fondle them lovingly with her eyes half-closed and sigh, "Ah, they're EXACTLY AS I REMEMBER!" That kind of thing.

MICHELLE
Playing the legacy card. Don't tell me they have a secret Montessori handshake.

JOE
And their kid was kind of aggressive too. Every time Cal would pick up and play with a toy, the other kid would push him aside and take the toy away. Like, Cal was playing with this little wooden abacus thing, counting the beads, and the other kid shoves him over and starts pushing the beads around. Meanwhile, his mom is asking him, "AIDAN, WHAT PLANET DOES THIS ONE LOOK LIKE?"

MICHELLE
Uranus.

JOE
I was thinking, "Hey, maybe my kid doesn't know what Mercury looks like, but at least he waits for his turn."

MICHELLE
But the school was nice?

JOE
Yeah, I really liked it. I would be super psyched if Cal went there.

MICHELLE
Well, good.

JOE
But let me tell you, if it came down to one spot between us and this other family, we would never get it.

MICHELLE
Well, don't say that. Just because they were Playing The Game? And doing the Montessori secret handshake? We're good too. Our kid is smart too.

JOE
Yeah, but these other parents were really schmoozing it up. They knew exactly what buttons to push. They were like professional preschool applicants.

MICHELLE
They probably are.

JOE
Oh well, it was nice, anyway.

MICHELLE
Maybe we need to be aggressive too. You know, if everyone else is Playing The Game, maybe we have no choice but to Play The Game.

JOE
I don't know.

MICHELLE
"Cal, what's Planck's constant?"

JOE
We would just start hating ourselves.

MICHELLE
"Cal, how do we say 'thank you' in Afrikaans?"

JOE
And we'd be just as bad as them.

MICHELLE
"Cal, remember how you solved Fermat's theorum last year? Why don't we wait for little Aidan to stop eating paste so we can explain it to him?"

JOE
Even if he doesn't get into any nursery schools, it's not the end of the world.

MICHELLE
But it would be good for him to go to school. You know, just to play with other kids. And, you know, maybe learn some stuff.

JOE
Yeah. It would be good.

MICHELLE
Well...was this other kid cuter than him?

JOE
Oh, come on. Of course not.

5:45 at the met life building




The sun is setting earlier and earlier. Very depressing.

Speaking of depressing, it just occurred to me today that we haven't yet moved the clocks back an hour for Daylight Saving Time. Didn't it used to be earlier in the year? (Apparently, yes.) Anyway, I did some investigating, and it turns out that we're going to "fall back" this upcoming Saturday, on the day that I'm taking call. An extra hour added onto my already painful Saturday call! Damn you, George Bush! First the war, and now this!

junior's

A storefront near the police academy in our neighborhood:





Nothing says good business like a baby with handcuffs and a nightstick.

this is why

(Me with Cal, October 2005)

Those of you who have been reading this blog for a good long while (or who at least have plumbed the depths of the archives) know that before I started my Anesthesia residency, I spent two years as a Peds resident. Yes, that was me in the bear costume. (Just kidding. I had a monkey costume.) (Also just kidding.) (Or am I?)

Aside from "Why did you decide to switch out of Peds?" (the short, vastly oversimplified answer: I couldn't find a career path that I was happy with in Pediatrics, and I couldn't envision what I saw myself doing within the specialty ten years down the road), the question I am most commonly asked is, "Are you going to do a Peds fellowship?" That is to say, a fellowship specializing in Pediatric Anesthesia. This question makes good sense. I think that when I switched fields with 2/3rds of a Peds residency under my belt, most people assumed that I was eventually going to specialize in Pediatric Anesthesia. Heck, I assumed as much. But obviously, I am not. Inquiring minds want to know why.

As with most big questions, there are several answers. There are knee-jerk answers that I can give that almost anyone will believe, because they contain elements of truth. Practicing Pediatric Anesthesia is stressful, because things can go wrong quickly. The stakes feel much higher. Lots of people will want to sue you. Trying to learn all those syndromes makes my head spin. And while I have thought some or all of those things at some point during my rotations through the [Children's Hospital] ORs, there is one bigger, underlying reason that I probably will not end up doing Peds Anesthesia. The reason is that, as a parent, I just don't like taking care of sick kids.

This should not be confused with not liking the kids themselves, or not liking being in the position to help. I just don't like the reaction that it elicits in me, this kind of primitive dread and sadness, empathizing with the parents and yet trying to distance myself in the attempt to fool myself that bad things can't happen to me or my family. But bad things clearly happen all the time, and the attempt at distancing never works.

I preop a five year-old oncology patient, whose mom tells me that he was perfectly healthy until he was diagnosed at age three, when routine blood testing turned up some abnormal results. The first thing I think, before I can help myself, is, "Cal isn't three yet."

I bring in a patient to the OR with her parents for a elective outpatient procedure, and we mask induce the kid, I see both parents have tears streaming down their faces. Instead of thinking that they're overreacting, as I might have a few years ago ("It's just a tonisllectomy!") I realize that I probably would react the same way were my kid having surgery.

I round with the Pediatric Pain team on a patient who has end stage disease, and who is probably going to die within a matter of days. The kid is almost exactly the same age as Cal. There have been a series of meetings with the family about code status. To the team's consternation, despite understanding the terminal nature of their child's disease, the parents want (as my attending puts it) "the full court press," meaning intubation, chest compressions, ICU transfer, whatever is needed when the time comes. Hushed conversations are held at the nurses station in which the following sentiments are expressed over and over. What are these parents thinking? This kid is dying! They're really going to put him through all that? They're just prolonging his suffering! And for what? A few years ago, I may have been arguing this exact same thing. But now, though the doctor in me agrees with the medical team, the parent in me can't quite fault the parents for holding on for every last moment. Their baby is dying, and he's only two years old. Who can blame them, even knowing that the outcome is certain, for wanting just a few more days, another hour, another minute to hold him, smell his sweet little head and give him every possible chance, beyond hope, to live? In the patient's room on rounds, I start to tear up, and I am thankful that the room is dark, and that I am standing off to the side of the scrum.

Playing the "I have kids" card is no doubt something of a cop-out. Most of the Peds Anesthesia attendings I know have kids, and virtually every Peds attending I've ever met has a family as well. Sure, they have their moments too, especially when one particular patient or situation hits particularly close to home, but overall, they are able to be empathetic without letting it get in the way of doing their jobs well. So I don't know why every time I'm rotating over on the Peds side, I become Little Miss Sensitive. With rare exceptions, I don't think it shows, and it hasn't really affected my work or anything like that, but I just don't like the way it feels to have all that extra emotion in play. When I'm at work, I want to focus on my work, thinking about every patient and reflecting back on how everything is making me feel is exhausting.

My OB once told me (over an operating table--I was administering anesthesia for a C-section that she was performing) that the moment your child is born, "so begins a lifetime of low-grade worry." That's probably one of the truest statements about parenthood that I've ever heard. And rotating on Pediatrics now, after Cal, has the tendency to fan that low-grade worry up into a flame. I could happily live the rest of my life without having to hear yet another story about how a perfectly healthy four year old suddenly and mysteriously went into fulminant liver failure, requiring a transplant. There's still some conflict in that, of course. The doctor in me finds it fascinating, wants to know the details, see the labs, hear the history. And the parent in my wishes that I could just stop thinking about it.

I'm sure that if I did this all day, every day (in short, if I did end up doing Pediatric Anesthesia), I'd get used to it all, and it wouldn't be as difficult anymore. But I'm not sure I want to do that either. Not that I'm casting any disparagement against those that can do that type of work, because clearly, they are amazing, and I'm glad that they have decided to take on what I and probably a lot of other people could never do. I'm just not sure that it's not supposed to be difficult, so see these things we see, and do the things we do. Part of me thinks it should be hard, and to lose that fear and sadness for these families, and for ourselves, is losing something important.

So, anyway, in answer to your question: that's why.

flying bugs





Today was a soggy, rainy mess, so we decided to go to the Natural History Museum and check out their Butterfly Conservatory Exhibit. After looking at the ticket prices (steep) and calculating how many times we were going to visit the museum this winter alone, we decided to get a family membership, which buys us free admission for the rest of the year. Not only is it emminently affordable (the price of our admission today would have been more than half the cost of the membership itself) but most of it is tax deductible. So hooray for that. Anyway, now that zoo season is winding to a close, Cal's going to need somewhere to go, why not let him learn about biodiversity or the indigenous peoples of South America while he's at it? Also: IMAX! It's win-win.

I didn't get too many good pictures from our day, though. The museum is fairly low-light, so either you get a lot of blurry pictures from the slow shutter speed, or these dark, glarey pictures with flash bouncing off the glass. What I would really like to do one of these days is go in with my tripod, and take some long-exposure low-light pictures. Some of the exhibits would really photograph beautifully under the right conditions. I meant to do that right after I bought our current SLR camera three years ago, but I never got around to it, and then Cal was born, which meant that I never had any free time again. But anyway, now that we have this MEMBERSHIP, maybe I can try to make some time later this fall, during my vacation in November. More artsy, less fartsy.

why my pants are falling off




You know what I think I need? MORE PAGERS.

(Left to right: My cell phone, the Peds Trauma pager, the Peds Arrest pager, the Peds Pain pager, and my own personal pager.)

no further proof needed that i am rotating through pediatrics this month




The only Band-Aid I could find at the nurses station after cutting my finger opening a fentanyl vial earlier today.

(OK, a slight lie. There was another kind of Band-Aid, but it had the even-more-offensive-than-Barbie-not-to-mention-ill-named Bratz on it, so really there wasn't much choice.)

things that i am thinking about right now

• Do people who are assholes know that they're assholes? I mean, maybe some of them do, but a lot of them seem clueless as to their brazen assholishness, which, while astounding, is probably more palatable than believing that people are actually deliberately assy.

• You know what's good? Grey's Papaya hot dogs. You would think that describing a hot dog as "crunchy" would probably not be a good selling point, but they are kind of crunchy, the same way that Krispy Kreme donuts are kind of krispy.

• I know I'm, like eight years behind on this, but "The West Wing" is a really good show. They talk really fast in that "Gilmore Girls" kind of way, but not so much with the girly. And I can pretend like it's educational, like Social Studies class.

• Monday night I came home late because I was on short call and I had to see three inpatient preops before leaving the hospital. When I got home, Cal insisted that I give him his bath instead of Joe, because apparently NO ONE can fill the bathtub like I can. It's a gift. I could not say no, even though Joe offered to take bath duty, because I already have The Guilt (see above, working late, etcetera). Which is how I ended up sitting on a stool next to the bathtub, alternately washing Cal with a rag on a stick and eating dinner off the lid of the toilet.
  

• I think posts that are all bullet points are a cop-out too.
  

yip yip yip





I bought Cal the most annoying toy in the world a couple of weekends ago, one of those yipping animatronic dog toys off the streets of Chinatown. Though we have an actual live dog in the house, Cal seems largely indifferent to Cooper's presence, while this new robo-dog is apparently the greatest thing that has ever happened to us in the history of ever. Since he loves it so much, I guess it's here to stay (at least until some more annoying toy catches his fancy) but man, the noise that thing makes just cuts right through into your brain. Not to mention that it's MADE IN CHINA, which means not only does the battery casing keep popping open, the dog's fur is probably impregnanted with lead and poisoned children's cough syrup.

fitzgerald & fitzgerald




One of the more glossy of a ubiquitous breed of subway ads that ask the average commuter, "HAVE YOU OR ANYONE IN YOUR FAMILY EVER BEEN SICK, FOR ANY REASON, EVER? BECAUSE YOU COULD SUE SOMEONE!" There's a new one out there that asks, "Have you suffered from kidney failure or a stroke after cardiac surgery? Call us at 1-800-LAWYERS for 50% more suing!" Yes, people who require heart surgery certainly are a low-risk population for renal failure and stroke, it must take a total asshole bonehead of a doctor to not be able to reverse years of chronic disease!

But my point is not about the crazy litigious culture of American medicine, or how it unfortunately impacts our approach as practitioners (covering your ass becoming as important as actual patient care), but rather about the unfortunate poster boy for Fitzgerald & Fitzgerald. (Please note, also, that their logo in the lower left corner appears to be a pugnacious leprechaun wearing boxing gloves.) I can think of a number of ways to appear in your own ad that could actually make people want to solicit your services. Standing in front of a bookcase of law journals. Looking meltingly sympathetic. Holding a basket of puppies. Or better yet, a basket of money. But instead, Counselor Fitzgerald has appeared on his own billboard looking like the most he's going to do is wave his cane at those damn meddling doctors and threaten them with a hose if they don't get off his lawn.

raspberries for cal





Going berry picking with a two year-old and trying to come away with any berries at all is a task that would make Sisyphus proud. Also, because I was right next to the camera mic (filming, you know), the part where I interject, "NO CAL, ONLY EAT THE BERRIES THAT MOMMY AND DADDY PICK FOR YOU" sounds extremely loud and yell-y, like I am a crazed mother unit. But in my defense, I would like to point out that many of the berries had moldy spots and/or bugs on them, and I didn't want Cal to eat a bug. Like with Halloween candy, I wanted his berries to be screened before consumption. Didn't work with all the berries he crammed into his maw straight off the bush while my back was turned, but oh well, I tried.

the great pumpkin




As you can see, we went pumpkin picking today at this place. You can see the full photo set on my Flickr account. Oh, so apparently, there's this thing called Flickr! And you put photos on it! And people can look at them! Who knew? (Just kidding, I know I am totally late to the party on that front. I have no idea what Facebook is either.)

a pound of cure





A sign posted next to one of the sky bridges in the hospital, which connects adjoining buildings. It's all part of the hospital's fitness campaign, in which it urges employees to do such things as take the stairs instead of the elevator, or eat vegetables as opposed to slabs of fried lard. (The mascot for this campaign, by the way, is a bumblebee on a treadmill. As in, "BEE fit!" Also, let's BEE friends.)

I suppose they mean well with these little aphorisms, but telling someone that in doing something every single day for an entire year they would only lose ONE MEASLY POUND almost seems discouraging to me. Unless you actually were a bumblebee, in which case a pound would probably be a lot.

re-entry not permitted

A sign posted on the door of the compactor chute next to our apartment:




Usually I love living in the city. But sometimes I don't.

courier service




Yesterday I offered to run a coag sample down to the stat lab prior to surgery. (We needed to know what the patient's INR was off coumadin to see if it was safe to do neuraxial anesthesia). Man, I haven't hand-delivered a sample to the lab since I was a med student. Oh, those were simpler times.

"flush twice if necessary"




Some very...detailed signage in one of the department restrooms. What, no diagrams?

talk about a black cloud




The other day, my assignment was to be the resident on arrests for the day. What this means is that I carry the "arrest pager," and anything there's anyone that needs to be intubated anywhere in the hospital, I'm there, like Johnny on the spot. Overnight, the anesthesia team captain carries the arrest pager until 7:00am, at which point the daytime resident takes over. I got to work a little early, so it was a bit before 7:00am, but since I wasn't doing anything else and I know there's nothing quite as liberating as getting rid of the dead weight of that arrest pager post-call, I decided to pick it up early.

The post-call resident was happy to see me. Handing me the pager, he intoned, "The arrest bag is all stocked. This thing hasn't gone off all night." The instant, and I mean the instant that I touch the pager, it starts beeping for a stat intubation in the CCU.

It probably would not have been a good day to play in the World Championships of Poker either.

america!




Guess where we went with our out-of-town guests yesterday? Man, could this picture possibly be more YAY, AMERICA? All it needs is, like, a bald eagle soaring over a baseball field. While holding a gun in its beak.

how to get kids to hate you

First of all, let me be clear that I know that I don't have the healthiest eating habits. I know that, OK? But at least I'm not a damn hypocrite about it.

My point is that Joe, Joe is the hypocrite. He may not be as unapologetic about it as I, but like most residents (or recent former residents, in his case), he eats like crap during the week. The problem with Joe is that he has to RUIN it for everyone else. For instance, as I have discussed in the past (wow, more than four years ago), how Joe pretends to be healthy is by eating all the junk food that I buy, though never actually buying any on his own, thereby creating the illusion that he is somehow not involved in said junk's food chain. When I finally get after him to REPLACE THE DAMN CANDY THAT YOU FINISHED, OR WE ARE GETTING DIVORCED, he will invariably do something asinine, either buying some crusty old man candy like Dots, or totally betray me by getting a bag of carob drops or some other hippy crap, feigning ignorance. In summary: eats just as much crap as me but refuses to own up to it, and tries to create some cloud cover of pseudo-wholesomeness. These replacement snacks that he buys are enjoyed by no one human, including Joe himself, and they sit in the cupboards for months and years before they are eventually stealthily discarded under cover of darkness.

Joe's sister is coming to visit us this weekend from Baltimore, bringing along her two oldest kids, who are eight and six. In addition to changing the sheets on the guest bed and whatnot, we made plans to do a little food shopping so that there would be enough food for everyone to graze on for the weekend. Joe was in charge of placing the Fresh Direct order. "Make sure to get some snacks for the kids," I reminded him, relishing the role of Fun Aunt. It's not like I wanted him to order pork rinds and a bulk box of candy bars or anything (though both of those items have seen the inside of our snack cupboards) but I was thinking, hey, it's school-aged kids, maybe we could get them a box of cookies, or maybe a carton of ice cream for dessert. However, what Joe decided to order for them was this:




Give him a few years. He's going to be the guy who gives out raisins to the trick-or-treaters. Or a handful of peanuts. Actually, we could just give out little baggies of this snack mix, since I guarantee you that this entire bag will still be around, unopened, on October 31st.

further perils of dressing the same as everyone else




I spent five minutes pawing through this pile trying to locate my white coat this morning. Maybe we should get alphabetized hooks.

let's see george w. bush try to win that one





I'm happy for Al Gore and certainly feel that winning the Nobel Peace Prize is just consolation for "losing" the 2000 presidential election. However, why does he look evil as all hell in these pictures posted in The New York Times, like he's plotting world conquest from within his shadowy cave lair?

babs, in memoriam




This may be difficult to believe, but it wasn't until about a month ago that a Starbucks opened up near [University Hospital]. Guess they didn't think health care workers drank coffee. Anyway, it's there now, across the street from the subway station, and doing a booming business and one might expect.

Mom-'n'-Pop-coffee-outlet crushing aside, I have no problem with Starbucks, but can't help but to fondly remember what used to occupy this store space at the corner prior to the inevitable landing of the monolith. Well, immediately prior, it was a Washington Mutual bank, which didn't really hold my (or the neighborhood's, apparently) interest. But before that, when I was a medical student, it used to be the site of BABS, which according to the overhanging sign was a nursing uniform store. I say "according to the sign" because you would not necessarily infer that from the window display at BABS, which mostly consisted of various spicy pieces of lace and imitation satin lingerie. Nor were men left out--I still remember the men's G-string that was displayed in the window around Christmas when I was a second-year med student, a saucy little number shaped like an elephant's head. With a trunk. Um...yes.

a jolly good fellow

Today I had a meeting with my department chairman and the director of the Regional Anesthesia fellowship at [University Hospital]. They said some words. Then I said some words. We all agreed that they had very nicely appointed offices. And later that day, I signed on as one of their fellows in Regional Anesthesia for the upcoming academic year. So you know what this means.




All that neuromuscular anatomy that I learned in medical school and rapidly forgot immediately after the final exam, on the assumption that "I'll never actually need to know this stuff"? I WAS WRONG.

pushing tin




We get a lot of air traffic over Manhattan. Either that, or we just have a lot of very skinny, linear clouds criss-crossing each other. A meterologic phenomenon!

routines

Weekend days where neither Joe and I are working are routinely spent pretty much the same way. We wake up. We go to the neighborhood diner to have breakfast. We stop off to get coffee on the way to the playground. At the playground, Cal engages in hijinks. Upon completion of said hijinks, we head home for lunch and naptime, stopping off to go to the ATM and run whatever errands need to be run. We are boring, predictable people.



Watching the dogs at the dog run. Joe wants to know if you are Sarah Conner. (Don't say yes.)




There's this art installation at Madison Square Park that we're hoping they will never take down. It's this life-size silvery metal replica of two interlinked trees, and it's just gorgeous. It went up this past spring, and it would be great if the could keep it up through the winter, but Madison Square Park seems to like to rotate its art with the seasons, so it will probably be gone pretty soon. Possibly replaced with something hideous. A couple of years ago, the winter art piece was this gigantic orange A-frame metal beam. For quite a while, before I realized that it was an art installation, I thought it was just scaffolding.



We walked by a sporting goods store on our way back from the park. Unfortunately, it looks like the person who made up this window display forgot to put pants on the male mannequin. Or perhaps that's the look now.



There was a street fair that we passed by on our way to the bank. Along with the standard booths of gyros and $5 pashminas, we also saw a stand selling five million bajillion model cars. The big mistake we made was stopping. After we finally managed to drag him away, the screams of protest really interfered with my ability to browse for knockoff bags and warehouse overstock socks.



More unclad mannequin legs, which for some reason were duct taped to the scaffolding outside the Housing Works. Naked plastic asses! They're so hot right now.

warning, nerd humor ahead




Up on the second story above this sushi restaurant near Irving Place is the so-called "In Situ Salon." Which I suppose means that they trim your hair while it's still on your head, as opposed to removing it and trimming it in a petri dish.

"good" dog carl





I've figured out the solution to all of Britney Spears' childcare problems. She should get a rotweiller.

note to self: get some paper

I need to stop using my leg as a note pad.

mothra




Another sweater destroyed by moths. We have a little bit of a moth problem in this house. While I certainly don't begrudge the moths their right to exist, and I haven't been as vigilant on the prevention front as I should have been (mothballs or cedar chip satchels or what have you), I just think that it's out of pure spite that every single one of my moth-eaten sweaters has a hole right in the center of the chest or abdomen. Why must they make a hole where it is most noticeable? A little hole on the sleeve, maybe along a cuff, or along the lower border of the ribbing, maybe even in the back. But right front and center, every single time? Now they're just being mean.

windbreaker season, again

sorry, surly

A sign outside a tapas restaurant. Ah alcohol, the cause of, and solution to, all of life's problems.