the underwear drawer

into thin air and back again

2012-01-27T20:56:00.003-05:00

It's been a little bit of a hectic week. On call Tuesday night, flew out to Sacramento Wednesday to give two talks at UC Davis on Thursday...

(Which, while on the subject, thank you, UC Davis! You were lovely and gracious hosts and an impressively progressive school to boot. I have no doubt that you're producing some of the nations finest future doctors, and the administrative attention to the well-being of those future doctors is so admirable. Bravo to you all.)

...and then hopped back on a red-eye back Thursday night which dropped me back off in Atlanta at 6:00am this morning, in time to take Cal to school. Then I went home and slept in my bed, like a lot. Well, four hours. But it felt like a lot. Now I'm all woozy and I don't know where I am or what time it is. And it is to this that I attribute the fact that Cal totally creamed me in chess twice this afternoon.

Now GRANTED I haven't played chess in over ten years (like, I couldn't remember which side the queen went on the board relative to the king) and GRANTED I gave Cal a couple of do-overs ("Are you sure you want to do that?" is my usual warning for him to re-think his last move), but also, I fully admit that I am terrible at chess. Also Cal has just started reading this new chess strategy book (the book says says its for kids but I tried to read it and I could not understand what they were talking about--it was like reading a deck of cards, or deciphering glyphs on some kind of Da Vinci Code-esque ancient rune) so now he's learning tactics and saying things like ROOK SACRIFICE KNIGHT FORK and I am still...not good at chess. Like, at all.

Anyway, we ordered pizza for dinner and now we're all going to vegetate and play Lego Star Wars Wii and then I'm going to sleep some more and maybe obsess a little bit more about whether or not that fact that I'm more nauseous and more run-down with this pregnancy than with my first two means something. My first instinct is just that I'm older now than I was the first two times around, and therefore infinitely more decrepit. But then, of course, it could also possibly (possibly) mean this.

I have an appointment on Wednesday, at which point my OB offered an ultrasound to confirm the position and dangle (or lack thereof) of Thing 3's bits, so place your bets now.

continuity of care

2012-01-22T21:25:00.008-05:00

Let's talk, for a moment, about childcare.

It's a topic that I've meant to discuss for a while, and certainly I addressed it a little bit in my book, but as a family with two parents who work long variable hours outside of the home full-time, our childcare issues fall into a specific subset. That is to say, without putting too fine a point on it, that we are utterly, utterly dependent on full-time, reliable childcare in order to function day-to-day. Neither Joe nor I work part-time or any kind of variable/abbreviated hours. We both work in the OR, which means we invariably leave home before sunrise, before the kids wake up. We both take overnight call on a rotating basis. This is not to be self-congratulatory or masochistic, and does not make us better or worse parents (though I'm sure there are those that would argue each side), it's just the life we lead and we've found a solution that works best for us.

However, before I get into the specifics of childcare, let me say first that none of this could work without an equal, fully-invested partner in parenting. Joe and I had Cal early on in our medical residencies. We were both at a critical point in our training, and both of us had responsibilities to our jobs and our patients that were equivalent and inarguably important. So we've always, always, always viewed the division on parenting responsibility 50-50. There were some minor variances here and there (for example: more difficult rotations month-to-month, the fact that Joe never got post-call days off but occasionally would get to leave for work later than I did, etc.) but on the whole, from the moment we first became parents, it's been right down the line. We make sure one of us is always home every single night--if we need to, we'll trade call or make pre-emptive schedule requests to ensure that this is the case. If I'm going to be home late, Joe tries to get out earlier. If Joe has a journal article that he's getting ready to submit, I watch the kids. We both have demanding jobs but this obviously doesn't make parenthood itself any less so, therefore when it comes to childcare, we've always been of the philosophy that "if you can't do it, I'll try to do it" and vice versa.

However, the fact is that both of us work all day on most days, and as such, we need to have a childcare solution to cover those working hours. What we have, and what we have always had, is a full-time nanny. I know this is a bad word for some people, and I can almost hear the squelching sound from the pile of shit that I am stepping in by telling you that I choose to practice medicine full-time and employ a nanny, but there it is. We pay someone to watch our kids during the day so that we can go to work.

In residency, it was unavoidable. We were in New York at the time, but having family members take care of the baby was not an option (both of my parents are also physicians that work full-time, and besides, they did not want nor should they have felt obligated to drop their practices in order to take care of their grandchild--they worked full time even while raising their own kids, after all; and Joe's parents, while both retired, live in Ohio). We also had the kinds of jobs that were not amenable to a daycare-type solution. I know that some dual-resident families make daycare work for them, but like I mentioned before, Joe and I both have OR-based specialties, and as such, we were both expected to be at work well before most daycare centers opened--and yes, this includes the hospital-based daycare at Columbia. So we hired someone to come to our house, take care of the baby, and stay with him until one of us got home in the evenings.

As I've undoubtedly pointed out many times in the past for those in similar situations, finding a nanny, particularly as a medical trainee, is not simple. First of all is the matter of the hours--it is difficult to say the least to find someone willing to show up at 5:45 every single morning, and for most nannies it's a dealbreaker. The variability of the hours is also a problem--you have to understand that most nannies in New York (and certainly elsewhere) can find much more agreeable hours in basically in basically any other household. A third issue is, obviously, the cost. Childcare to this day is our number one largest household expense, but that's probably as it should be. There was a period of time (before we finished residency) where our nanny was getting paid more than either Joe or I was for working at the hospital. But this is the solution that has worked best for us--the only tenable solution really--and over the past six years, we've always had a full-time nanny. Our current nanny has been with us for the past three and a half years, since we first moved to Atlanta. She loves the kids, and they love her. She's family.

Even now, that both of our kids are in school (Mack goes to preschool all day, three days a week), we still employ our nanny full-time, because Joe and I leave for work too early to drop off, and for the most part work too late to pick up from school. And there are all the school holidays that are not hospital holidays. Presidents Day and MLK Day and Teacher Planning Day (SO MANY DAYS FOR PLANNING) that we need someone to stay with the kids, to say nothing for the unexpected off days--snow days, ice days, sick days. I know in the eyes of many Joe and I must be monsters for not taking off days from work when the kids are home sick from school, and who knows, maybe we are, especially since we are leaving our sick kids in order to go take care of sick strangers. But the fact of it is that school aged kids get minor stay-home-from-school illnesses, like, all the time, and as long as I assess that they are OK--and by that I mean able to take and keep down fluids, making good urine, not stuporous--I make them chicken noodle soup the night before and stock up on juice and Motrin and keep in touch with our nanny throughout the day. And then in the evenings, either Joe or I gets home--occasionally even both of us--and we'll take it from there.

In many ways, our childcare model is much like the practice of medicine. It's about continuity of care. The way our household works, no one can be with the kids all the time, around the clock every single day--but we have a team, and we have a system, and we make sure that handoffs are careful and that the time each of us does spend with the children is of the highest quality. One could argue that abbreviating the work schedule of one or both parents might be better for our kids (oh, who am I kidding--no one ever thinks that of Joe, mostly people ask me, "So, do you think you'll eventually go part time?") and I think that, for each individual household, that can be difficult to say. But I choose--choose--to work full-time. I don't speak for anyone else, I'm certainly not telling anyone else what to do, but this is what works best for our family.

I'll tell you something that I've noticed in particular. Whenever the discussion comes up about work-life balance and the choices that we (mostly women) make, the discussion essentially gets boiled down an issue of financial burden versus parental responsibility, and it invariably seems that the sentiment is that if parents (mothers) have the option to work part-time or opt out of working outside the home, they should, for the good of the children. That choosing to work outside the home full-time is either born of financial necessity ("we can't afford to get by on less than two full incomes") or selfishness, abdicating the responsibility of caring for ones own children in favor of escaping the drudgery of the homestead and having more disposable income for your minks and Rolexes and Lego Star Wars sets or what have you. To this, I would like to present a third viewpoint. The fact of it is: I like working. Not because I feel indebted to the medical machine, not because I have to, I just like what I do. I like being a doctor, I like practicing anesthesia. I trained for almost a decade to take care of patients, I want to do it more than part-time, and I want to do it well. This does not mean that doctors who work part-time (men or women) don't like medicine, or are worse/lesser doctors, or cheating the system. It also does not mean those who choose to spend the working day apart from their children care any less about the well-being or upbringing of those children. I can only speak for myself, but I honestly enjoy my responsibilities outside the home too, and my choice is to work full-time.

Are there weeks that I spend a little too much time at work and miss my kids? Certainly. Are there weeks that I wish I had an extra day or two outside of the hospital to just catch up with them, with myself, with anything? No doubt. Are there things that I miss for work that I wish I didn't have to--performances, class parties, sports days? Oh lord, almost every month. But no one said adulthood was easy, and parenthood is almost certainly less so. One thing it is about is adaptation and compromise, and finding your niche in balancing parenthood and career, perhaps in some cases deciding to choose one over the other entirely. And I feel fortunate in many respects to be in a profession fulfilling enough that the decision of how I want to divide my time between work and home is, indeed, a difficult one.

Thanks to the commenter in the last entry for bringing up the topic, and reminding me that it's one I've long wanted to talk about. There are lots of niches, lots of solutions, we found the one that, for now, works best for us. What about you? Other working parents, what's your niche, and what adaptations and compromises have you found that work best for you? (Everyone be nice please.)

* * *

Oh, and here's one for you, pregnancy enthusiasts/perverts. Me and Thing 3 at 15 weeks. Unlike with Cal, I didn't take many expanding midsection pictures the last time around (until it got, like, crazy), but this time I am acutely aware that this is almost certainly the last time I will go through this particular fascinating biological process so I'm trying to savor it in all its bloaty, body-snatcher-y glory. I took this picture inside my closet but cropped out the edges because no one needs to see that many pairs of scrubs and long sleeved T-shirts, NO ONE.

(If you work with me, I apologize--please try to unsee these pictures by the time we run into each other in OR or in the doctor's lounge while pretend not to be fighting over who gets to the coffee machine first.)

hopefully it will be more like a "Toy Story 3" than a "Godfather 3"

2012-01-18T09:33:00.005-05:00

It's different your third time around, certainly.

Having your first baby is exciting. It's new and it's amazing and the change from being childless to parenthood is probably the biggest transition of many people's lives. Also you buy a lot of stupid crap that you don't need, like weird baby swings and matching crib linens and tons and tons of size 0-3 month onesies that get worn approximately one and a half times before being outgrown or irreparably soiled.

Your second baby is exciting too, in a different way. It's the idea of having kids, plural. The prospect of giving your first child a sibling. Most of the hand-me-downs are still around and none the worse for wear yet, and there's the newness and challenge of having not one, but two kids to divide your attention and time. I remember right before Mack was born, and dealing with Cal, who as we all know is a lovely boy but at three years old he was THE WORST--thinking, "I can barely deal with raising one, how can I possibly handle having two of these monstrosities around?"

When you get pregnant with your third kid, it's a little different. It feels like eyeing a big building project, analyzing the time and cost and supplies and labor (ho ho), frowning, making notes, then nodding and mentally slapping your cheeks with your hands, saying, "OK, I guess we can do this again." And this is not to take any of the happiness or romance out of the equation--certainly it doesn't need to be said that we love our children and baby children are a particular brand of adorable, like sweet, smushy little pillows that don't know how to argue with you yet--but it's all a little more grounded in reality this time around. Here's what we need to do. Here's what we need to get. Here's what we need to worry about now, and here's what we need to think about later. The fact that we'd already given away all (and I mean ALL) of the boy's baby stuff to Goodwill this spring certainly sets the stage for our mindset a little bit when we found out that we were in for Thing 3, but I can't say it's been a terribly difficult adjustment once we settled into the idea. What? We're what? So we're going to do this now? AGAIN? Fine. I mean, good. That's cool, let's do this. OK. OK.

Besides, we like babies.

* * *

We told the kids last weekend. We debated back and forth about the perfect time, and decided that we'd wait until the results of the nuchal lucency and first trimester sequential screening (is that what it's called? OB-types, help me out here) came back clean before burdening their little heads with the foreknowledge of impending competition for the throne. That night, we bought a bottle of sparkling grape juice, poured out some for everyone, and told the boys that we were having a little celebration.

"For MLK's birthday?" asked Cal.

Well, no, not exactly, we explained. And after talking a little bit about FAMILY and FEELINGS and how LUCKY WE ALL ARE to have each other, we showed Cal the ultrasound photo and asked him what he thought it looked like.

He held the picture up, cocked his head, squinted a little bit.

"A rock?" he suggested.

"ROCKS!" said Mack agreeably, downing the rest of his sparkling grape juice and then reaching for the rest of the bottle.

* * *

Thanks for all your input about Cal and school, by the way. I can't say it makes the decision any easier, but more perspective is always good, I think. As for some of the clarifying particulars, I'll go into them here: we really like the school he's at. He's at a public school now, but it's an excellent public school in a fantastic school district (it is, indeed, the reason we moved to this neighborhood in the first place) and we actually like it quite a bit better than the private school he'd been attending the the three years prior. The teachers are excellent and the resources are very good, and we are not looking at changing schools at this moment. They do have a "gifted" program that Cal has already tested for--this discussion about what grade he's going into next year is actually distinct from that program, which I believe is offered as an "enrichment" curriculum for those kids who test into it, not an entirely separate, self-enclosed class.

We had floated the idea in the fall of Cal doing at least his math, and possibly also his reading curriculum with the class above his own, but this was problematic for several reasons. First of all, it seemed disruptive. Cal really bonded with his first grade teacher, and we really wanted him to make some friends in his class--he's never been the kind of kid that easily and immediately has five best friends wherever he goes. Pulling him out of his class once or twice a day not only seemed counterproductive to some of the social aspects of schooling, but also would have undoubtedly made Cal extremely self-conscious--he's not the kind of kid that likes a lot of attention being drawn to him. The other thing that would make this kind of "partial advancement" difficult is that ours is a very big school district--big enough that, a few years ago, they split up the elementary school into two separate campuses. Kindergarden, 1st and 2nd grade are all on the "primary" campus, where Cal is now, whereas 3rd, 4th and 5th grade are at the "intermediate" campus about half a mile away. "What's going to happen to Cal after first grade if he's already done with second grade math?" one of the school administrators brought up. "When he's in second grade, he can't very well get on the bus to go to the intermediate campus for third grade math every day." So there's a logistic, geographic issue there as well.

I think there are arguments for both sides, and I also don't think that what held true for me or Joe or other people will necessarily hold true for Cal, so it's really quite a difficult decision, as a parent, to make. Joe and I have gone back and forth whether we should involve Cal himself in this process, but the fact of it is that Cal doesn't like the idea of change, any kind of change, at all, and will stress about it incessantly, whereas once the decision has already been made and presented to him as a matter of course, he often will adapt to the situation seamlessly. (Par exemple: we wanted Cal to have an afterschool activity, and we figured he would like karate class. "Why do I have to do that?" he wailed, teary-eyed, when we told him. And every night for weeks, up until the start of karate class, "I'm not going to like that, why do you have to make me go there?" as though we were sending him to the salt mines. After his first class, he loved karate, and we just signed up for the second semester on his insistence.) Anyway, it sounds a little paternalistic (because, uh, we're his parents), but sometimes...sometimes Cal doesn't always make the best decisions for himself, rather the easier decision. Which, I guess, is as it should be. He's six. That's our job, and he leaves the hard stuff to us.

Anyway, we're going to have a meeting with his teacher on Thursday, and then we'll talk about it, and talk about it, and talk about it some more. And then, hopefully sometime before May, we'll figure it all out. Or not.

the rule of threes

2012-01-16T05:48:00.005-05:00

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

THREE

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

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

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

I love you, little man.

THIRD

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

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

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

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

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

TRIO

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

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

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

your self-esteem boost for the weekend

2011-10-29T10:00:00.004-04:00

When we first moved into this house, we noted that the previous owners had added a few design flourishes which were a little bit, shall we say, rococo for our tastes. Some of them came down immediately--the full wall mirrors in several areas, the gold-painted mirror flanked by a roulade and cherub motif in the half bathroom. But some of the others, like the gold (colored) doorknobs on the French doors throughout, while not quite my taste, seemed innocuous and certainly functional enough.

Seemed.

The problem with these doorknobs, I've found, is that I keep getting hooked on them. Not anyone else, just me. Everyone else in this house is either tall enough or short enough to avoid this particular problem, but at my height (5'2" and a half--and if you don't think that half inch is important, you much be much taller than 5'2") these doorknobs all over the house are right at waist height. Belt loop height, to be exact. I keep getting hooked on these doorknobs. And you would think that it's easy enough to unloop oneself, but look at that doorknob a little closer. The loop is a little bit spiralled, like a nautilus. Like one of those barbed fishooks. And once you get hooked, it's actually unusually difficult to extricate yourself.

Yesterday, I went to Costco to do some grocery shopping. We had a nice time in Orlando, but when we came home the food situation in the larder was a little bare-bones, and breakfast that morning was somewhat thin, which inexplicably panicked the kids. (Under normal circumstances I don't think they'd have any trouble with a breakfast of cereal and milk, but the fact that that's all there was to eat suddenly had them eyeing the USDA food pyramid and acting like we were the Joads in Dust Bowl Americana or some such thing.) So anyway, I went to Costco and stocked up on, whatever, a coffin-sized flat of strawberries, cinder-block sized bricks of cold cuts, the like--and headed back to the house to stick the perishables in the fridge before heading out again to pick up the kids from school.

Only, as usual, I got hooked on the doorknob. One of my back belt loops. And I had turned the home security alarm on before I'd left for the store, so now that was counting down the 40 seconds or however much time I had to punch in my code until the alarm went off. I calmly laid down my drum of peanut butter and body-bag-sized sack of raisins and went about calmly disentangling myself, only to grow increasingly less calm as the second continued to tick by and I was still caught on the spiral of the doorknob hook. Looking at it straight on, it seems like it should be easy enough, but looking at it from above and behind, for some reason I couldn't get my belt loop out.

The forty seconds elapsed, and now the external security alarm started to go off with a loud whoop whoop whoop sound which, in theory, would bring the police (or at the very least, a local citizen militia) running to help defend the old homestead. I began to panic. I had to turn off that alarm, but the security pad was at least ten feet away on the far wall of the kitchen. Plan A, the straightforward plan, was not working, so I thought: my pants. If I can't get my pants out of the doorknob, I had to take off my pants instead.

So I took off my shoes. I undid my top pants button and unzipped the fly. As I started to shimmy out of my pants it occurred to me that if someone did show up to investigate the alarm, what they'd find would be a pair of beige corduroys hanging from my kitchen door, and me, pantsless, standing in a scattered pile of bulk pistachio nuts, BUT NEVER MIND ABOUT THAT NOW, JUST TURN OFF THE ALARM, DUMBASS.

It took a little while longer to realize that it's actually pretty difficult to take off your pants if you can't pull your pants down--the pants were still hooked on the doorknob at waist-level, remember--when suddenly, I was free. Free! I KNOW WHY THE CAGED BIRD SINGS, FUCKERS! What happened eventually was that the beltloop broke. Thank you, Gap Incorporated, for your shoddy tailoring. I hurriedly punched in the security code, stopped the alarm, and waited for the security company to call and make sure that I was OK, just like in all those commercials where the dark-clothed, stocking capped burglar (in broad daylight, like, nice camoflage job, guy) inexplicably tries to break into that house in where the mom and her daughter are baking cookies or whatnot else wholesome and good.

The security company never checked in, by the way. And while, yes, there was no real emergency, it was just me, my pants, and an over-designed doorknob, for all they know, I COULD BE DEAD. Whether it's a good thing or a bad thing that no one in this densely populated neighborhood came around to witness my shame, I can't quite decide yet.

next stop, Madame Pomfrey's

2011-10-28T11:08:00.008-04:00

OK, not to make this page, like, HARRY POTTER CHAT or anything like that, but do you have a kid in your life who likes Harry Potter? Because then by all means, if you're ever in Orlando, take them to Universal Studios and go to The Wizarding World of Harry Potter. Because oh my god you guys, HARRY POTTER.

We were in Orlando last week for the annual meeting of the American Academy of Ophthalmologists, which basically gave us a great excuse to do something that we wanted to do anyway. Universal Studios even had a night where they kept the park open for special extended hours for Academy members and their families, and while this meant that none of my outdoor pictures turned out at all (my cell phone camera does decently with low light conditions, but there are limits, after all), you'll just have to trust me that, perhaps especially at night, this place looked really magical.

The area is set up as some sort of amalgam of Diagon Alley and Hogsmeade, and while there were a few rides and a replica of the Hogwarts Express (which puffed smoke but didn't actually go anywhere), the area basically consisted of numerous storefronts (Zonko's! Dervish and Banges!) and food vendors (Three Broomsticks, scattered Butterbeer stands) in order to move Potter-branded merchandise. And I realize that that's sort of the cynical reality of things, and that everything was of course ridiculously overpriced and designed to prey on your love of the books or your weakness for indulging your own children--but look guys, I'm not made of stone. Kids, hope you're in the mood to stay up late, because WE BE GETTIN' SOME CHOCOLATE FROGS AT HONEYDUKES.

The absolute best thing at Harry Potter World though (and the one thing that Cal really, really wanted to see) was Ollivander's Wand Shop.

The wand shop was set up as more of a show really, where small groups of about thirty people at a time were escorted into the store and Ollivander picks a kid out of the throng to perform what they called a "wand-pairing demonstration." The demonstration is much as was depicted in the movies--Ollivander hands various wands to the chosen, instructs him to do some kind of magical task, and the magic goes all haywire until Ollivander finally picks the correct wand, at which point a spotlight shines and aaaaaahhh! a chorus of angels sings from on high because the wand has selected the wizard, blah blah magic talk.

This bit of whimsey, of course, is followed by the cold hard reality of them shuffling you out to the storefront where you have the "option" to purchase the special, magical wand that chose you above all others. (You'll notice that I put the word option in quotes, because really, unless you're some kind of steely-willed gorgon, there is no way in hell after that little show where your kid is looking at you with the wide-eyed wonder of oh my god, this shit just got real that you're not going to buy that thing. There's just no way. In fact, if you're really determined not to shell out for a wand, do yourself a favor and don't even walk in there. I WARNED YOU.)

I do also find it ironic that it was the annual meeting for the American Academy of Ophthalmologists that led to a night of so many kids running around pointing long tapered sticks out in each others faces, but perhaps they haven't been doing as many ruptured globe or orbital trauma repairs as usual and want to make up the shortfall before year's end. Well played, ophthalmologists. Well-played.

lumos

2011-10-13T14:11:00.014-04:00

I was excited when Cal started making the move from reading-as-deciphering to reading-for-comprehension because finally, finally, we could do nerd stuff together. As a child endowed with neither facility at sports nor a particularly gregarious nature, I read a lot of books as a child, many of which I remember vividly to this day. Not that they were all quality books by any means--I do think I read both "Sweet Valley High" and "The Babysitters Club" series in their entirety well beyond the age when I should have known better--but I read a lot of other books too. And I read constantly. I read at dinner, with the book in my lap under the table. I read in the shower (note: not advisible). I read on the subway on the way to school, and I read when I was outdoors, ostensibly getting some fresh air and exercise. I read a lot. So when Cal started to get to the age where he could actually start read on his own, for fun, I was super-excited, both for him, and for me to finally have an excuse to re-read the full Beverly Cleary opus.

And I have to admit, it was a bit of an uphill climb at first. Cal liked being read to (I think I'd mentioned the "Illustrated Classics" series here already, and he particularly enjoyed the science-fiction-adventure story picks of that lot--your War of the Worlds, your 20,000 Leagues Under The Sea, what have you) but I still think he viewed reading for himself as a bit of a slog. I got him some easier chapter books (in particular he had mentioned reading some of the "Cam Jansen" books at school--basically your standard kid mystery series, Case of the Missing Dinosaur Bones, that kind of thing--and while it didn't seem like great storytelling I did particularly like that the protagonist was a girl and her best friend was a boy who was always babysitting his baby brother) and Cal worked his way through a dozen of those, mostly when I asked him to. But it still kind of felt like that to him: work. He'd read two or three chapters after school, mostly on assignment, and then, duty dispensed, he'd go and do something he really wanted to do, like write the definitive illustrated reference guide to prehistoric reptiles or some such thing.

I figured I wouldn't push it. I figured he wasn't ready. I figured (and this I kept to myself, but with growing dismay) that not every kid loves to read, and just because Cal didn't want to read in the bathtub didn't mean that he wouldn't have a rich intellectual life. (This was a recurring theme--many of my paperbacks from childhood and adolescence were more than a little warped from water exposure.)

I got the Harry Potter series for Cal...kind of...but also just because I thought they were books that were worth owning, period. I expected Cal would like to read them eventually, of course, but I didn't really think he'd be quite ready for them yet--some of the writing and plot are a little dense at points, and the dialogue and vernacular is a touch continental (stuff like Ron exclaiming "bloody hell!" all the time, people referring to large groups of students as "you lot"--which I guess is the British version of all y'all) but, you know, I figure we'd have them lying around for later, and maybe Cal would pick them up and leaf through them if and when he wanted to.

A couple of months ago, we started reading "The Sorcerer's Stone" to Cal at bedtime. We watched the movie. Cal started getting interested, pointing out that while he liked the movie because it "showed what things look like," he liked the book better because it had details and some side plots that necessarily got dropped from the film version. (I'd argue, actually, that they weren't judicious enough in their editorial process for that first film--have you tried to re-watch that thing? God, it's like Exposition City, and it just goes on forever.) We got through "The Chamber of Secrets," Joe and I reading most of it aloud, Cal reading some of it himself. First he read it aloud to us. Then I started noticing him silently reading it alone, while I was cooking dinner, or taking care of Mack. We finished the second book and instantly he picked up "The Prisoner of Azkaban." He started reading in the car. I took him to Target the other day (to buy underwear for Mack, remember), and he was reading as we made our way down the aisles. These past few weeks, we've been seeing more of this:

He has one of the lanterns from our camping trip in the bottom bunk of his bed, and he says up late, reading Harry Potter. He begs us to let him read for ten more minutes, to let him finish the chapter, he'll go to sleep right after, but it's the part with Quidditch, mom, just let me finish the part with the Quidditch. Right under our noses, he's made the jump from reading for comprehension to reading for enjoyment.

I guess the real conclusion from all this is something that no one needed me to point out, which is that J.K. Rowling is a very good writer. That, and maybe we need to get a better reading light for Cal's room.

the underwear drawer

2011-10-10T19:16:00.002-04:00

I can be a gunner as much as anyone else, but when it comes to my approach towards getting my kids reliably toilet-trained, my attitude can euphemistically described as...well, lackadaisical. To be fair, that's their attitude toward the enterprise as well (toilet training is one of the few "big boy" things in which Mack has absolutely no interest--his approach towards pooping in a diaper is the same as Homer Simpsons take on littering: "It's easier. Duh."), but we figured he's not quite ready and we're kind of lazy, so let's all kill the earth a little more and subscribe and save on Amazon Prime, shall we? (Diapers. I'm talking about buying diapers.)

Thankfully (?) the preschool that we're sending Mack to has a more hardline approach towards the matter, and now that he's moving up one level (from the two-and-a-half year-old classroom to the two-and-three-quarters year-old classroom, apparently) they are going full on immersion therapy. No more diapers at school. Only underwear. Sink or swim. Oh, and also, please send in four or five spare changes of clothes for the first few weeks.

We had a few pairs of underwear lying around (I had originally bought them about six months ago as an enticement towards the idea of toilet training--Mack cheerfully tugged one pair on over his diapers and and pair over his head and has continued to wear them this way ever since, so the bloom is kind of off the rose for that one) but this afternoon, in anticipation of the new, uh, addition to his curriculum, we bought a few more packs of briefs for the rotation.

I'm sure in the next few days we're going to be pretty sick of washing these things, but you have to admit--those teeny tiny underoos are pretty freaking cute.

where context is key

2011-10-02T16:33:00.012-04:00

The season that it is cool enough to wear sweaters and scarves, but not cold enough to have to wear those big poofy winter jackets. Since we live in Atlanta, weather like this will last until, oh, just around Thanksgiving, and resume probably by the end of January. Not a bad deal.

(Also, if you're thinking that the only reason to have kids is to dress them up in cute little clothes for the fall, you're 75% right. The other 25% is to legitimize buying a lot of Halloween candy. DO IT FOR THE CHILDREN.)

Anyway, this spawned a good amount of discussion on Twitter when I first posted it, but I just wanted to open it up here in the > 140 character arena. An article in The New York Times today detailed the growing trend of non-physician practitioners (such as, to give one example, nurse practitioners) introducing themselves as "doctors" to patients in a clinical setting. One argument is that, as someone with a doctoral degree, they deserve the honorific, and earning these doctoral degrees (I'll quote directly from the article here) "can help them land a top administrative job at a hospital, improve their standing at a university and win them more respect from colleagues and patients."

My personal take is this: indeed, anyone who earns a doctoral degree has earned the right to be called "doctor." No one is disputing that, or taking respect or recognition from anyone who has earned that doctorate. But I would also point out that the term "doctor" has a very specific meaning in a clinical setting, and that the shades of grey ("I'm not a medical doctor but I do have a doctorate in nursing,") can be confusing or simply lost on a patient or their family, especially in the setting of an already complicated interaction in the hospital.

Some people argue that there is ego involved, and I don't doubt it--and might I point out there's likely a lot of ego on both sides, from the physician side for wanting to "defend" the title of doctor, and from the non-physician side in their desire to assert their own rich and well-deserved credentials. But like with most things in medicine, context is everything, and if we can all agree that the shades of differentiation of the term "doctor" are particularly fraught in the clinical milieu (and thus confusing to patients) perhaps ego can and should be put aside in the name of transparency.

There is also the issue of responsibility. In most situations in the hospital, the physician has the ultimate responsibility for the patient and what happens to them. As the physician, I am the bottom line, and whatever happens "under" me (someone misinterprets my order, a medical trainee under my supervision causes patient injury, a medication error occurs not directly because of me but under my watch)--in the end that's my responsibility and no one else's. When I introduce myself as "Doctor Au," that's part of the implicit understanding, and patients need to enter into that doctor-patient relationship where trust and the assumption of that ultimate responsibility go hand in hand. It may not seem like more than semantics to some people, but when you present yourself to a patient as their "doctor," in a hospital, that has to mean something very specific, for the understanding and ultimately the protection of the patients under all of our care.

In my mind, if someone calls themselves "doctor" during a professional interaction in the hospital, I assume that they are a physician, and I think I'm safe to say that most patients feel the same way. Just the same way that, if I'm in a college French class and the professor introduces him or herself "Doctor Webb," I assume that they have an academic doctoral degree and don't start, you know, taking off my clothes and showing them my rashes. In medicine, context is everything.

(Incidentally, on the flip side, if a patient asks me to call them "Doctor So-and-so," I will absolutely oblige them, no questions asked. But then again, I will pretty much call a patient whatever they ask me to call them, including the one patient I had who specifically requested that, when we woke up him up from anesthesia after surgery, we address him as "Big Poppa" because it was the only name he really responded to. No problem, uh, Mr. Poppa.)

quality

2011-09-30T13:43:00.005-04:00

Yesterday I had to take Cal for a checkup at the video-game-magical-treasure-chest-flat-screen-TV-playing-wall-to-wall-cartoons emporium, also known as the pediatric dentist's office. Can I say, first of all, how awesome I think the culture of pediatric dentistry is? Getting your kids--or at least my kids--into that chair is kind of a hard sell, but they sure hit that right combination of bribery and computer-animated video hypnosis to make it a much more positive experience.

Anyway, the only appointment I could get was at 10:00am, which means that Cal missed the morning at school, and when I saw what time it would be by the time I dropped him back off (after lunch, halfway through recess, with only two hours left before dismissal) I decided to just get his assignments from his teacher and keep him the rest of the day for some quality time, just him and me. It's something we don't get to do very often. We need to do it more.

The fact of it is, although I talk about Cal much more on this blog (first pass effect, I guess), Mack actually much more attention from me when I'm home. The thing it is that Mack is little, and just in terms of the activities of daily living, he needs a lot more minute-to-minute maintenance, whereas Cal I can just tell to go do his homework or go read a book or please wash your hands and get ready for dinner. He's pretty well-behaved too, which means that for the most part, he doesn't need me on top of him for every single last detail. Which is good of course, but when you work a lot and have two kids, I think it sometimes means he gets less actual time with me outside of the purely purpose driven tasks and me prodding him to hit all the points he needs to hit before bedtime each night.

Yesterday, we went to the dentist. Then I took him out for lunch at Five Guys Burgers and we stopped by Staples to pick up one of those plastic report covers for a school project due next week before finally heading home. The dentist, burgers, and a plastic report cover. But just him and me. Cal told me later that it was one of the best days ever.

I told him we'd do it again soon.

second opinion

2011-09-29T15:34:00.008-04:00

Yesterday after I gave my Grand Rounds (which went well by the way, at least to the extent of my experience giving it), I was in a good mood and celebrated by taking my car to the fixit shop. Well, actually, the second thing had nothing to do with the first, it just sounds more festive that way.

All the important mechanics were fine (you know, like the wheels, the engine, the other...drive...pistons), but there was something wrong with my trunk. To be clear, the trunk was working JUST FINE up until we went camping last weekend, when:

JOE

Hmmm.

MICHELLE

What "hmmm"?

JOE

Could you open the trunk of the car before?

MICHELLE

You mean was I able to open it earlier today?

JOE

Yeah.

MICHELLE

Well, of course, that's how I crammed all those sleeping bags and blankets and camping stuff in there.

JOE

Hmmm.

MICHELLE

WHAT "HMMM"?

JOE

I think I just broke the lock on your trunk.

The trunk could no longer be opened by the car key itself, nor by pulling the lever in the driver footwell, though oddly, the remote control keychain button still worked. I didn't think this was a big deal at all--usually I open it with the remote anyway--but Joe pointed out that if we ever lost the keychain or it malfunctioned, we would be toast.

"OK, so I'll stop locking the kids in the trunk then," I responded (I thought) quite reasonably.

Joe made me take the car in anyway.

The car fixit place (I just took this one picture there of the pretty rust pattern, though I realize this photo makes it look like a vehicular internment camp--not that far off, I guess) told me that I should expect to leave my car there for at least the rest of the day. They would most likely have to dismantle the whole trunk, replace the lock apparatus en bloc if (IF, they emphasized portentously) they could locate the correct parts, a process that might take a day or two. When I balked at the day or two (or two? Two days? TWO EARTH DAYS?) they replied that they would make their best effort to at least have the car in drivable condition by nightfall, though under no circumstances (they underlined this with an eye-roll, to illustrate how crazy this would be) should I expect the trunk situation to be anywhere near fully resolved without another one or two visits for full repairs down the road.

Anyway, I thanked them for their opinion and diagnostic time, and proceeded to take my car to a Toyota dealership across town. (Not to ruin your fancy doctor car dreams, but I drive a used Toyota Camary with a sizeable dent on the rear drivers side. If you see me on the road, say hi, I'll be the one gripping the steering wheel in panic.) At the dealership, the guy looked at my trunk for two seconds, clicked something over in the lock mechanism, and said, "There. You're good to go."

Apparently we (Joe) had automatically engaged the trunk into "valet mode," which I wasn't aware existed but I guess is what you do if you are getting your car valet parked but don't want the parking people to look into your trunk and see you stash of dead bodies or whatnot in there. The trunk wasn't broken at all. It was such a no-brainer the people at the Toyota place didn't even charge me.

So from a multi-day, labor-intensive, thousand-dollar estimate to a problem that was fixed with a seasoned eye, some common sense, and a flick of a switch. I guess this would be a good time to draw an analogy back to patient care, but I think you can probably take those last few steps on your own.

country roads

2011-09-25T15:50:00.009-04:00

And...we're back!

We spent the weekend camping at Red Top Mountain State Park, and if I can say one thing for North Georgia, it's that they do their nature up right, son. This is the first time we've gone camping as a family, but Red Top Mountain on Lake Allatoona, less than an hour north of Atlanta, was impressive--gorgeous, seemingly remote without actually being so, and (to my inexperienced eye) incredibly well maintained.

The pictures kind of make it look like we trekked out to the middle of Nowheresville, but it was hardly a survivalist exercise--there were park offices and picnic shelters, bathrooms and showers, even a mini-golf course near the campground rental office. There were a range of different sites available, but the one we got had a fire ring, a water pump, concrete picnic table, raised tent pad, and two electrical outlets. You know, so we could plug in our Wii.

(To be clear: we did not really bring a Wii. It was nice to have power to pump up the air mattresses and charge our cell phones, though.)

The kids obviously had a good time, and were a little crestfallen this morning when we got ready to go home. Given the effort of getting there and setting up our campsite just so, I can see the argument that going for just one night is a waste, but I just did not want to shower at a campgrounds, and 24 hours was basically my aseptic limit. Maybe next time we'll stay for two nights. Maybe.

The hobo stew was a great success, to the point that I'm thinking I might just make up similar packets to stick in the oven for the kids' dinners on nights that I'm working late. Someone in the previous entry's comment section pointed out that I had folded my packets wrong, but I'm pretty sure that there's not that much nuance to the fold--the main goal of a hobo stew packet is just making sure that your ingredients stay in and that the ashes stay out, and that you you a thick enough foil (or enough layers) to make sure that the packets don't rip when you flip them. I put precooked chicken-herb sausage, peppers, roasted corn, potatoes, and butter in our packets--there was a little sear on the sausage in the end, but unsure of the timing of the cooking process (in particular the potatoes, which were raw and take longer than anything else), I leaned towards going a little over on time.

The night was fitful at best. Joe an Mack both snore (I'm aware that a two year-old probably shouldn't snore, but he's had a stuffy nose so I blame that--I also would like to throw it out there that I don't know a single anesthesia provider with a family member that snores who has not tried to do a chin lift/jaw thrust on them at some point) and Cal, while silent, sleeps with the ponderous and deliberate pinwheeling motions of one doing somnambulist Tai Chi. So there was the snoring and the kicking and the air mattress adjustments and the crickets and then the more snoring, until finally, at some point, it became morning.

All in all, camping was actually pretty fun. Things I'll remember for next time:

1.) Bring a change of shoes for everyone. It would have been nice to have slip-on shoes at the campsite for getting in and out of the tent, and besides, Mack walked through so much water and mud that his shoes were completely soaked through.

2.) Christmas lights! Once it started getting dark it got, like, really dark, and I saw that some of the more experienced campers around us had strings of Christmas lights that they used to ring their tent sites. Not only did it provide great ambient light, but it looked a hell of a lot more festive and warm than our two puny LED lanterns and Cal's tiny headlight.

3.) Less food, more drinks. I brought a lot of food (thinking, perhaps, of the Donner Party), but knowing that there was water on site, I only brought a mess of juice boxes and some milk for the kids. The water that came out of the pump at the campsite looked clear and smelled fine, but last I checked you can't see Giardia (colloquially known as...snerk..."Bever Fever") with the naked eye, so we boiled all our water before drinking any, and the kids were not really wild about drinking warm water.

4.) Our own stash of firewood. Joe made a last minute trip to the hardware store to get a couple of cords of wood, which was lucky because it had been raining the few days leading up to our trip and though it was sunny all weekend, everything on the ground was damp. We brought three bags, but we used it all up and we were only there one night. Add to that point: more kindling and an extra one of those Bic firestarter sticks probably would have been a good idea too.

Anyway, it was a nice weekend. Now that we have a little more of a system down (not to mention most of the gear), we'll definitely be back to camp by Lake Allatoona again--and maybe next time, we'll get there early enough to get a campsite directly on the water.

outward bound

2011-09-23T19:05:00.001-04:00

Against what I consider to be one of my better instincts (and I would classify most of such instincts to be related to maintaining integrity of the integumentary system and related parts), Joe and I decided that we're going to take the kids on a camping trip this weekend. I have nothing against wholesome family fun per se, and despite my bookish and wan appearance have even been on a camping trip or two in my own youth, but here, in no particular order, is a list of some things I hate, and which make spending a night in the woods a bit of a hard sell:

Being dirty.
Being cold.
Bugs.
Not being able to take a shower.
Sleeping on the floor.

(Is hate too strong a word? Maybe. And yet...you've seen bugs, right?)

Anyway, I dislike many of the elements of camping, but be that as it may, we're going camping this weekend because it seems nutritious and cleansing somehow, the spiritual equivalent of a high-fiber cereal, and besides the kids have been begging us to go camping for almost a year now. Who am I to cruelly deny them the simple pleasures of getting a billion bug bites and then tracking dirt clods and sweat into the sleeping bag, where I will spend a fitful night tossing and turning, maintaining a state of cat-like readiness in the event of bear attack or chainsaw massacre? Only their mother who loves them, THAT'S WHO.

(Did I also mention that there's no Wi-Fi in the woods?)

Anyway, I exaggerate my low tolerance for All Things Nature, but to be fair, I like looking at fall leaves and verdant vistas just as much as any of my other vaguely geriatric pastimes, so we're all actually pretty excited about our camping trip. So excited that, in the spirit of the proceedings, I even made four servings of "hobo stew" to bring with us and bury in the coals for dinner.

(If you are guessing that I was mainly swayed by the appending of the descriptor "hobo" to anything, you are correct, but our hobo stew contains chicken herb sausage with garlic and shallots garnished with a not insignificant amount of butter, therefore promising to be, if not tasty, then at least filling.)

We're leaving tomorrow morning. Real-time Twitter updates for your fish-out-of-water amusement as iPhone connectivity allows, otherwise have a good weekend and we'll catch up when (and if) we return.

warning

2011-09-20T15:14:00.002-04:00

I've got to say, once I finally figured out how to make a mouse-over image change (and granted, it wasn't that hard to do but you'd never be able to tell from how long it took me to figure out how to get it right), I just want to make a mouse-over image change for everything. EVERYTHING.

But I guess I'll just quit while I'm ahead.

break Joe's website

2011-09-17T10:45:00.008-04:00

So as you all know, Joe recently switched jobs, so for the past week or so I've been trying to help him build a professional website (professional meaning for work, not as in designed by a professional) because how else are patients ever going to find him and know how awesome he is? My proposal went like this.

MICHELLE

You need a professional website.

JOE

I do?

MICHELLE

It has to have your credentials on it, and all the information about the surgeries you do,
with, like, "Before" and "After" photos and contact information and post-op instructions
and such, because blah blah blah online presence marketing Internet searches social media blah.

JOE

What is an "Internet"?

MICHELLE

Let me...just do it for you.

So we made this:

I designed and built the site, while Joe provided the content. It's still a work in progress, but I think it's starting to look...pretty decent. I personally have a bias when it comes to doctors' work sites--many many of the plastic surgeon websites I've seen I think come off a little too glitzy (and I realize that this is somewhat dictated by the nature of the work and clientele, but there comes a point where patients may have a hard time telling if they're researching a doctor or reading US Weekly). For Joe's site, though, I wanted a simple, clean interface with all the medical information and professional credentials easily available. Joe does such good surgery and his professional pedigree speaks for itself, I thought it would only be distracting at best and cheapening at worst to gild the lily with, like, animated lens flare effects and an Enya soundtrack.

But anyway, do me a favor and look at the site. Look around on all the pages and see if they read well, click on the links to make sure they all work. I know some of this is a matter of personal taste, but does the website flow well for you? Is there anything not on the page that, as a patient, you would want to see? Click around a lot, roll around, try to break it, think of it as a couch at Ikea that you're trying to decide to buy for your family room, then e-mail me or leave a comment to let me know what needs to be fixed. Remember, this is still a work in progress (in particular, I have an "FAQ" section and a "Patient Testimonial" section that we're still working on) but in general, how does it look?

As for the subject of trying to build a website with your spouse looking over your shoulder, I will add this conversation from this morning.

MICHELLE

(Painstakingly editing HTML to adjust photo alignment and spacing, because the Blogger

"compose" interface is a piece of doo and has already taken years off my life.)

JOE

Hey, you should try to use HTML! Or something! For the website!

MICHELLE

(Pause)

Have you ever seen that site, "Clients from Hell"?

JOE

Yeah, you showed me that once. Hey...why are you bringing that up now?

MICHELLE

No reason.

Thanks guys!

(By the way, I've test-driven the site on Google Chrome, Safari and Firefox and it renders decently on all of them so far as I can tell--however, if you're using some kind of antiquated browser, NO PROMISES.)

as time goes by

2011-09-11T00:53:00.004-04:00

I don't really know what this says about me--probably nothing good--but I'm glad that September 11th doesn't fall during the work week this year. Something about the idea of having the day, in all its past, present and future incarnations, commentated on relentlessly on the TV in the anesthesia lounge (I was going to say CNN but to be honest it seems that the default setting is usually Fox News) is more than I really have the stomach for. As a native New Yorker who was in the city on the day of the attacks, I, like many, still feel that it's a little bit of a tender spot. And I think I've talked in the past about how much doctors dislike having feelings.

Ten years later, the events of September 11th have arrived at their final resting place in history, though it's hard for me to put my finger on exactly where that is. More often then not now, when I see it referenced (and granted, I no longer live in New York), it's held up as an emblem more than anything, or used as a supporting argument for this that or the other thing. It's the stuff of decals, of commemorative plates, of tattoos and of posters. And it makes it feel important but distant, like something horrible you'd read about in a book but hadn't actually lived through yourself. The distance is inevitable. Time makes everything less raw, a little less messy, and filters our memories through experience.

We even have a whole other language for it now. September 11th is now "nine eleven." I remember on the day of the attacks one of the doctors in the OR was speculating whether or not there was any significance to the fact that the date spelled out "9-1-1," as sort of a wink to the emergency response system that would surely be activated. We didn't know to call it "nine eleven" then, the date itself at that time was nothing special. In the weeks to follow, the smoking craters where the Twin Towers stood and where remains and debris were being excavated were still being referred to as "The Pit." Not until later did the language of "Ground Zero" take hold, though now, you say "Ground Zero" in reference to Lower Manhattan and everyone knows what you're talking about. Why do I bring this up? I don't know. Maybe because it's midnight and I'm on call and too wired to go to sleep. Or maybe because, as strange as it sounds, I miss there being a time where that whole other language didn't yet exist.

Joe and I broke up shortly before September 11th, 2001, did I ever tell you that? I probably didn't, it even in those early days of my blog I didn't exactly consider it grist for the mill, and I can't even remember why it was that we had broken up at the beginning of our third year of medical school, shortly after our OB rotation in Stamford, CT. (I blame OB, personally. Or maybe Stamford. Probably both.) Anyway, we'd broken up for some reason, and it was weird and awkward, because we were still in the same clerkship rotation group after all, and we still had to see each other every single second and act all normal and professional, which if you don't think was torture you've obviously never dated anyone before. On September 11th, we were on one of our Surgical Subspecialty rotations, which I thought was a blessing because we got split up into smaller groups--I was rotating on Pediatric Urology, whereas Joe was, I think, rotating on ENT (Otolaryngology for your purists out there) in an entirely different part of the hospital. It was a relief to be away from him, so I thought. But after those planes hit that day, Joe was basically the only person I wanted to be with. Six months later, we were engaged.

I don't really know what my point is with all this, and I know it sounds incredibly short-sighted or even mean-spirited to begrudge the way that the events of that day have become more totemic than real. It's just that I can't help but to think that way. It wasn't a T-shirt. It wasn't a bumper sticker. It wasn't a picture on a TV. It was real. The little things make it real, and each year that passes, the edges of those little things becomes increasingly softer. But I still remember. The blaring radio at the bagel store across the street from the hospital. The smell of that fall morning walking into work. The jungle animal print cap the anesthesiologist was wearing in the OR when we heard the news. The way the smoke looked rising up to the sky, thick and billowing at the base, then spreading out into a blanketing haze.

It was real. It happened. We were there. And you can print as many banners and lawn signs as you want, but New Yorkers don't need to be told to "Never Forget." Because we never will.

ch-ch-ch-changes

2011-09-09T09:39:00.001-04:00

When I'm not trying to work or sleep or keep my fool kids from killing each other (it's sweet actually how much they love each other--they hug and kiss and everything, which if you don't think is adorable I have some concern for the cold black granite that is YOUR HEART--but hand-in-hand with this adorable snugglefest is the fact that they fight like puppies crammed into a wicker basket only given one very small squeak toy to share) sometimes I try to update this blog. Clearly I have failed these past two weeks. But that Virgina Apgar thing was still pretty cool, wasn't it?

(Crickets.)

The big news these past few weeks is that Joe has left the world of academia and has now joined Paces Plastic Surgery, an excellent and highly respected plastic surgery group in Atlanta. It was tough to leave the university setting, but we're all very proud of him and excited for his prospects. To be totally honest, Joe is one of the very best doctors I know, and he cares about people and families more than just about any practitioner I've ever met. His patients are very lucky. So here's to new beginnings for him, and for us.

Cal has been...well, Cal has been great. You probably remember that I had some reservations prior to the start of this school year (we just switched schools, after all, so I had some concerns about the, shall we say, elasticity of the curriculum) but we've been pleased and actually delighted at how attentive and responsive his teachers have been, especially given that we'd actually not said anything to them at all.

"Maybe we should tell them to give him some harder math problems," Joe said near the beginning of the year, as we looked at Cal's homework (which was a giant worksheet of, essentially, counting problems).

After I duct taped him to his chair and stuck a sock in his mouth, I hissed at him don't you dare say anything, because it was the first week of the school year and the last thing I wanted to do was position us as the insane pushy Tiger Parents who don't know when to shut up. I wanted to trust the teacher to make that assessment on her own. Cal had a long history (particularly in preschool) of being perfectly able to do things well, but being too stubborn to show anyone that he could. It led to talk of remediation a few years ago, for chrissake. So I figured, just let it be for now. Cal would either show what he could do, or he wouldn't. And the teacher would make an assessment of what he should be doing, or she wouldn't. But the first two weeks of school was way, way too early to start inserting ourselves and insisting that, HEY, MY KID CAN READ HARRY POTTER AND DO MULTIPLICATION, ARE YOU DOING HARRY POTTER AND MULTIPLICATION IN SCHOOL YET? There's a fine line between advocacy and just being a pain in the ass.

So we didn't say anything. Cal has been having fun at his new school. He loves his teacher. He is making new friends. These are the big things. But also, on the other end of things, his teacher has told us that she's going to start pulling him out of their regular math class and that the "Enrichment" teacher is going to design some special extended projects for him to do during that time so that he doesn't get bored. This really makes me happy, because the worst thing that could happen to Cal would be for him to become disenchanted with school--already he's asked me why, if school is so easy, does he have to go every day. (Because of THE LAW, son.)

Anyway, I'm really impressed with the school's flexibility, it's certainly beyond what I had expected, and I'm even more glad that they came to that decision outside of me or Joe pushing anything. Or perhaps it was Cal doing the pushing, as he'll regularly finish up his homework, and then, on the blank page on the back, write himself an entire new worksheet of more difficult math problems, and then finish those too.

I'm proud of my boy, is all.

(ASIDE FROM MEMORY LANE: When I was in fifth grade, I remember the teacher letting me and this other boy, Frances, do our own writing activities during the phonics curriculum, because phonics was, well...pretty ridiculous. So what Frances and I decided to do was a booklet of political cartoons centered around the 1988 presidential elections, where we lampooned each candidate, as well as the sitting president at the time, Ronald Reagan. I believe there were a couple of comic strips featuring Mikhail Gorbachev as well, and I remember studying his nevus flammeus very carefully so I could draw it just right. And that, friends, is what you call a Baby Nerd.)

It's probably been observed to the point of stereotype that after a bringing into the world a particularly bookish, adult-oriented child, your second child is bound to be the human equivalent of a monster-truck rally, and that is most definitely the case at our house. Mack is like...well, he's like a Mogwai. Starts off real cute, ultimately destructive, and should not be fed after midnight. (If it turns out he starts multiplying in number after he gets wet, however, we're in big trouble.)

The weather has finally started getting cooler here, and after four straight months of 90+ degree weather, I could not be more ready. It's been a long summer, but autumn smells like beginnings.

"my dear Doctor Whipple..."

2011-08-25T18:32:00.003-04:00

I was doing some internet research today when I happened upon some copies of the original letters written by Virginia Apgar (yes, that Apgar) to Allen Whipple (yes, that Whipple) concerning the formalization of medical training for perioperative care, into what would eventually become the Department of Anesthesiology at Columbia Presbyterian Hospital.

Now I don't know if it's just because I'm a dork (certainly) or because the players were such medical legends that getting a chance to read their correspondence (along with handwritten notes jotted in the body and along the margins!) feels like watching history unfold in real time. Or perhaps it's just seeing that familiar address on that old letterhead--the correspondence below detailing the formation of a department where, seventy years later, I myself would train--that got me all goose-bumpley. But certainly, there's a reason that these were called The Days of the Giants, and Virginia Apgar no doubt stood tall among them.

For more on Dr. Apgar, they have quite a trove of biographical information, pictures, and letters in the "Profiles in Science" section in the National Library of Medicine. Definitely worth checking out if you're a medical history wonk. Or just look at this picture of C. Everett Koop and wonder why people don't grow beards like this anymore.

mack cheats at air hockey

2011-08-22T16:23:00.001-04:00

AND NOW THE WHOLE WORLD KNOWS IT.

the taller it grows, the lower it bends

2011-08-21T19:44:00.002-04:00

I know I haven't posted a lot this last week, but here, just because it looks so darn mystical, are some pictures of my kids in a bamboo forest.

It looks like the freaking mountains of China in those pictures (and frankly, in real-life as well), but it's actually just the back edge of a cluster of homes just a block or two off a major road here in metro Atlanta, right near hospitals and malls and giant highrises. Atlanta, you are one weird city.

(I'm just going to put this part here because, next to medical stuff, photography is quite possibly the thing I get e-mailed the most frequently about: the square pictures I post on this blog (but more frequently here) are taken with my iPhone using the Hipstamatic app, with the lens and film combo that come with the app itself--John S lens, Ina 69 film. I've tried many, many other photo apps, and this app, with this combo, is still my default, because in my opinion it produces the best quality pictures in the right lighting conditions--ideally natural light in partial shade. On a broader note, the advent of digital photography overall has turned the hobby from a fairly expensive one to one that, minus startup costs, is essentially free, and one that more than ever can be both personal and public. As much as I like my "real" camera, until digital cameras start adopting some of the smartphone features that allow you to instantly share photos online, my smartphone camera is the one I'm using basically 95% of the time. Because the best camera is the one you have with you when you want to take photos, right?)

Apologies again for the lack of updates. To be honest, we are going through a little bit of professional upheaval at the moment--nothing catastrophic, but also nothing that I can talk about here very much here, so I'll just leave it at that for now. I hope you're all doing well and that you're enjoying the tail end of your summer.

** Residents of Los Angeles! Tomorrow at 11:00am your time (2:00pm my time) I will be doing a 50-minute live interview with Allen Cardoza and Dr. Melody Foxx on LA Talk Radio on their show "Answers for the Family," about the book and issues related to families and whatnot. I don't actually know what we're going to talk about actually, so tune in, find out with me. It's a live interview, right? THOSE ARE ALWAYS EXCITING, in that Christians and lions kind of way. (It also looks like they post the audio for their shows afterwards as well, so for non-Californians, I'll get the link up here after it's done. Unless the interview is terrible, in which case I'll just bury the evidence.)

up the creek, no paddle

2011-08-14T15:02:00.003-04:00

On call at the hospital yesterday, I had a beautiful grand scheme: finish rounding on my service first, then afterwards, reward myself with cup of coffee and some breakfast. I was just in the middle of talking to the last patient on my list and trying to decide whether I should get bacon or cheese grits (to be honest, probably both) when then announced a code overhead in the ICU. Ten hours later, I had my first meal of the day, which was a handful of Twizzler nibs crammed into my gaping maw as I waited for the water to heat up for my ramen noodles. I only tell you that because the old adage they tell people in medical school is true. Eat when you can, because you never know when your next meal will be.

Anyway. That was yesterday.

One of the things that I find wonderful about Atlanta (and while my heart will always be in New York I am not immune to the charms of the South) is how much public green space there is everywhere, even within the city proper. Joe and I were trying to figure out what to do with the kids this morning--I'm still on "backup" call today and didn't want to stray too far, but Cal and Mack were acting like one of those nature shows where hatchlings turn on each other and eventually cannibalize the runt. (Unclear who is the runt and who is the Alpha in this equation, I guess if I was interested in finding out I could have just let their youthful exuberance play out to its eventual gruesome conclusion, but I just cleaned the floor last week.)

Anyway, Mack has been talking and talking and talking about going fishing for weeks now, and barring the freedom to go to any actual fishing spots, I pointed out that we did, in fact, have a nature preserve about a block away from our house. To call it a "nature preserve" is, in fact, a little grandiose--it really just amounts to a creek that runs a few miles behind a stretch of residential housing and listlessly spreads into a nearby duck-and-turtle pond--but it's close and there's water in it, so off we went.

There was a sign at the trail head with notations on various animal tracks (Bobcats? Really?) which I was inclined to breeze by, but of which Cal made very careful notation.

When we got to the creek bed, the water level was very, very low--I guess we've been a little minus on rain lately, and what little water there was amounted to a trickle of ankle-deep runoff with a few minnows in it. No matter. A stick with some twine and a pinecone tied to the end was all Mack needed to amuse himself for the next hour.

I think Mack was fully expecting to catch a fish, and I'm just glad that he didn't pitch a fit when his dangling pinecone failed to attract anything more than assorted natural detritus from the creek bed. Cal did a little "fishing" too, but spent most of his time amusing himself by skipping stones on the water and playing with a tire swing that someone had fixed up down near the water's edge. I think it would have been a little more thrilling had the water level actually been higher, but I think he had fun all the same.

Mack, looking admiring, then apprehensive.

So actually, that was pretty fun. What I always tell people about New York is that there's so much to see and so much to do that you'll never get bored, and that much is, of course, true. But to live in the metro area and yet have a nature trail and a creek a three minute walk from our front door? For my kids, I'll take that too.

god bless the swedes

2011-08-09T20:13:00.002-04:00

The real injustice of this week is that it's only Tuesday. Oh my god, so tired. Anyway, it's a really busy week at work, and since I'm on call this weekend so it's only due to get worse--however, to placate the voyeuristic and the design-minded, let me show you what we did with the family room of our house this weekend.

OK, so first, the before. I don't have any good "before" photos, because who has time to take them, right? But here, for your viewing pleasure, are some pictures off the real estate website when the house was listed. The notations were originally for Anna Beth, who I asked to lend a hand and fancy eye to the proceedings, but they serve as a pretty good general indication of how I felt about this room, which was that it was beige, tile-floored, and felt like a 1980's "modern" living room, which is to say: not very modern at all.

Anyway, the former owners of this house were amazing and we're more fond of them than we probably have any right to be (seriously though, they are adorable), but an older retired couple with no kids has different living space considerations than we do. (Exhibit A: so many highly breakable things balanced atop so many other highly breakable and questionably balanced things.) It was a nice room they way they had it, and it has nice light both inside and out, but it just felt kind of beige and cold to me, and with all that tile, there was more than a little bathroom-y vibe to it all.

In my rich fantasy life, I thought of a lot of ways to warm up the room--replacing the tile floor with hardwood (or at least laminate) was one. But we had a pretty tight budget to work with, and some fairly specific needs. Mainly, we needed a convertible guest room. Our house has three bedrooms and no basement, and therefore no dedicated guest space. Granted, we've only had Joe's parents stay overnight up until this point, but remember also that Cal is getting into Sleepover Age and the desirability of an overnight rumpus room in which to put our Wii and contain the restless natives cannot be overstated. So anyway, we basically needed a room where we could put a fold-out bed for grandparents; if the kids could use the room for recreation and chicanery the rest of the time, all the better.

Anyway, we worked on it this weekend, and this is what the room looks like now.

Again with the crazy rug. I LIKE THE RUG, GUYS. Originally I had gotten a jute rug for that area, but between the tile and the walls and the couch, everything just felt very neutral, and I just wanted something warm and vibrant to brighten up the room. And if that rug looks familiar, it's because you've seen it here and here before. (Yes, I realize there is still one moving box there by the door, but it's headed for Goodwill.)

A view from the other side. I prefer empty space to furniture in general, but we needed something to put the TV on, and I insisted that whatever thing we got had doors to hide all the electronic detritus that lives near TVs (remote controls, Wii controllers, what have you). We have the TV balanced on a low open bookcase in the other room, and the sight of all those DVDs and wires flopping around in there is threatening to drive me slowly insane. I blame too many episodes of "Hoarders" but the sight of clutter really makes me itch now--clutter behind closed doors, however, is still OK. (The thing we have the TV on in this picture is actually a dining room sideboard from Ikea--Joe used his man skills to carve two holes in the back out of which to poke all our wires and connectors.)

Behind the couch and sitting area I put a little reading nook with all of the kids books, a furry rug, and some pillows to flop on. Joe thinks it is redundant to have reading nook here when already we have a rocking chair near another pile of bookshelves in a different part of the house (we have what might be charitably described as a crapload of bookshelves), but I reminded him that READING IS FUNDAMENTAL and at any rate, I liked having all the kid's books in one spot, and on low shelves that they can reach. I don't think I ever told you guys the story about how Cal once tried to climb up one of our bookshelves and ended up pulling the whole shelf down on top of himself (luckily there was actually very little in the bookshelf, which was a blessing but also probably contributed to the fact that it was so easy to tip over in the first place), but there you have it, Child Protective Services. All kids books on the low shelves, heaviest books on the bottom, strategic stabilizing brackets up top. PHYSICS.

OK, anyway, I just wanted to show you guys what we had worked on. It's not done yet, as obviously we have nothing to hang on the walls yet and clearly we have, like, way too many Billy bookcases (at present count we own six) but--there it is for now.

Tomorrow I have to present at our monthly M&M conference, which is always a wonderful learning experience but of course excruciating all the same. To celebrate, or to at least appease, I indeed will be bringing in to work a giant jar of peanut butter M&Ms with the intent of quelling the seething masses. Ask me tomorrow how that went over.

walking with the dinosaurs, with apologies to the BBC

2011-08-06T17:16:00.004-04:00

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

a more perfect union

2011-08-03T20:57:00.006-04:00

I was working on my Grand Rounds (about the ever-scintillating topic of perioperative antibiosis--a topic that I personally find engaging and endlessly fascinating, mostly due to the influence of Drs. Garvey, Prince, Lowy et al., but I understand most people find...uh, pretty dry) when a couple of colleagues steered me instead towards the admittedly sexier topic of the role of social media in medicine. It's a topic that other people have covered much more extensively, and I daresay with much more eloquence and expertise than I; though I've personally been writing online for coming up on eleven years, in some ways I feel like Willy Loman, who built his little house in the middle of a field and later found himself surrounded by skyscrapers. I'm not an expert by any means, and I'm not a pundit, nor do I aim to be. But do I have any opinions about the interface of social media with medicine?

Why yes, yes I do.

Let me say first that medicine, above all fields, is slow to adopt change. Sure, medical technology is evolving rapidly, but the culture of medicine, the technological change within our own ranks, moves at a glacial speed compared with other industries. See, for example, the excruciating pace with which we have moved to adopt electronic medical records. No other field in which the essential importance of recorded orders or observations, and the critical nature of interpretation error would be so inextricably tied to the the ability (or, as I see every day, the utter inability) to legibly hand-write notes with paper and pen. And don't even get me started on dictation. Or pagers. Who else in this day and age still carries a pager? I could go on, but at this moment I am chained to my dictaphone, hand-writing a patient note with quill on parchment while working the butter churn with my feet. Fresh butter in an hour, guys!

But the fact that medicine is slow to change does not mean that the rest of the world will follow suit. As we all have seen, the evolution of technology and how we use it has progressed at a blistering pace since I started writing this online journal as a med student in 2000. The year 2000 was before Friendster and MySpace--remember those? It was before Facebook and Twitter. It was before YouTube, Flickr, LinkedIn, and whatever other incorrectly punctuated, problematic vowel/consonant ratio site has evolved in the last decade. It was before blogs. Really, it wasn't that long ago, but the Internet was a very different place since then, and as both the Internet and the way we interface with it has evolved, the learning curve has been steep, particularly when it comes to the world's oldest profession (no, not prostitution) dealing with the world's newest media.

In many ways, medicine is like the military. It is a combination of a hugely public and yet extremely private field, and both are intensely scrutinized and regulated. So it is not surprising that medicine has been slow to adopt (or to even acknowledge) the Internet. Sure, the medical world has long viewed the Internet as an incredible repository for information--even the most steadfast of medical Luddites will use PubMed and be the better for it--but when it comes to social media in medicine, I think I'm safe in saying that at best, most established doctors think: why bother? and at worst, think that the personal and professional risk of engaging in social media is well beyond whatever marginal benefit can derived from it.

Do doctors have to have a web presence in order to do their jobs? No, of course not. Having a blog does not help me take care of my patient with the ruptured abdominal aortic aneurysm. Having a Twitter account does not help me intubate my patient with the critical airway. In some ways, interaction over the Internet is utterly peripheral to my everyday life of taking care of patients and my family, and possibly a distraction from those essential tasks. Medicine is about triage, and over the course of a busy day, with a lot of other pressing obligations, it's easy to look at something as seemingly frivolous as social media and think: it's not important.

But it is important. Certainly it's important to patients, who by overwhelming majority, and for better or worse, look to the internet as a source of medical advice before seeing any of us. It's important to hospitals and medical schools, who are finding out more and more how indispensable a strong web presence is from a business and marketing point of view. And I'm willing to bet that young doctors-in-training, most of who are in that key 18 to 34 year-old demographic, think that social media is very, very important. Look at this infographic from Mashable about how we interact with Facebook and tell me what you think. You can decry it, you can shake your head in rue, but you have to at least acknowledge that this is the direction in which society is moving. And then either bury your head in the sand and wish it away; or, as our training in medicine has taught us to do, you can observe and adapt your treatment plan.

Some medical institutions around the country have taken the stance that they will not allow their trainees to partake in social media at all. And forgive me for being blunt, but: that's dumb. First of all, most of our future doctors are already engaged in Facebook or Twitter probably both. Most of them read blogs, some of them may write them. So you can either ignore that, and place a blanket edict stating NO SOCIAL NETWORKING EVER, YOU KIDS DON'T KNOW WHAT'S GOOD FOR YOU AND WE DON'T TRUST YOU ANYWAY SO SIT DOWN AND SHUT UP AND READ YOUR DAMN SYLLABUS. Or we could start talking about it. We could start educating our medical students and residents about what is appropriate interaction with social media, and what could be construed as unprofessional. Instead of closing our eyes and wishing it away, we could start to be proactive and do what we were trained to do. Educate. React. Adapt. Here's a start. So is this. And this.

Let me just say right here that if there is ever anyone who was in the position to make mistakes with respect to social media in medicine, it's me. Having come of age writing a blog way before there were conversations about this topic (let alone newspaper articles, lectures, or studies) I just had one thing, and really it's all that each of us are left with and the end of the day when the noise dies down and the dust settles. That thing, quite simply, is common sense. You can't tell doctors to stay off social media entirely, and many would argue (myself for instance) that you shouldn't. Because social media has tremendous power for good. Dissemination of quality information. Access. Building community. Breaking down barriers between practitioner and patient. Humanizing the practice of medicine, and humanizing the experience of those in our care. But with the incredible power of social media comes great responsibility, particularly for those who see the human condition at its most vulnerable. And we need to start teaching our young medical trainees, from an earlier age, about common sense when it comes to its use.

Because common sense is not obvious. Sometimes it needs to be learned. Now, as an attending, if I have a patient in the OR now who is desaturating, I instinctively go through a series of "common sense" steps to troubleshoot the problem. At this point, it is ingrained. But would it have been as obvious to me as a medical student, or even a resident? Of course not. I had to learn it. Someone had to teach me. It feels like common sense now, sure, but only through experience did it become instinct.

The world outside of medical school is changing, and it will continue to change over the next few decades in ways that we can't imagine. The Internet isn't going away, and the way we interact with it as individuals is only going to get more fraught and more inescapable. This is progression. This is fact. So sure, we can hide or dismiss or disdainfully pretend we're above it all. Or, we can do what we do best, which is to roll up our sleeves, learn for ourselves how to deal with this brave new world, and then teach a new generation of doctors to do the same.

yersinia pestis, redux

2011-08-01T14:58:00.005-04:00

This is what I'm supposed to be working on right now: the slides for my grand rounds on perioperative antibiotics. Only I can't do that right now, because I'm super-busy looking at listings of taxidermied squirrels on eBay. LIKE, REALLY BUSY.

It is fabulous.

Oh, hello there. And to you too, with the mohawk, over there in the boot.

The artist captured the look of grim determination in this squirrel riding the rabbit quite well, don't you think? Look at the set of his little jaw.

I think this squirrel in the rocking chair is supposed to be leisurely crossing his legs, only squirrels legs don't do that, so instead it just looks like he's flashing his junk.

So you can see that while I would like to be making more slides about beta-lactam rings and the dosing schedules of fluoroquinolones, but...well, there's just so much John Rambo/squirrel hybrid fanfiction to write.

(As you were.)

shelf exam

2011-07-26T19:54:00.012-04:00

I've only ever watched, like, two episodes of "Hoarders," but it's enough to make me feel

1.) Vaguely reassured, that, despite my packrat tendencies, I'm not that bad (did you see the one with the lady that had two dried up dead cats under her rubble heap of trash? Like cat jerky they were, good lord). Also

2.) Slightly uneasy about my own clutter, to the point that, after I watched the last episode, I just started throwing things away to make myself feel better.

One thing that I've never been able to get rid of--even though we've moved five times (yes) since I started med school--is my books. I am unnaturally attached to the books. I have purged many of our other possessions, some of which would seem to have more sentimental value (Cal and Mack's old baby clothes went to Goodwill with the last move, for example--they were adorable and teeming with cuddly memories, but there's only so many outgrown onesies flopping around in boxes that I can abide) thought when it comes to my books, I have repeatedly put my foot down against giving any away. Because you can tell a lot about people by their books.

We used to have them somewhat categorized on separate shelves (all our medical books were clustered together in our workspace, for example), but at this point the fact of unpacking them seemed like feat enough, so everything is all jumbled together in a hodgepodge. Highbrow, lowbrow, and everything in between.

Evidence that I don't just recommend books willy-nilly. My own copy of Michael Ruhlman's "Walk on Water" has damn near been read to tatters, obviously. (I used to have the unfortunate habit of reading in the bathtub, which no doubt accelerated the process.) So you can see why I basically had to resuscitate myself when I heard he wrote a blurb for my book.

I went through I period in college where I read a lot of plays. I also went through a period in college where I got used texts from the college bookstore for classes that I wasn't taking because I thought it would broaden my horizons or whatever. (Nerd.)

And then when I was in med school I got a book of pictures of 1000 olde timey tattoos, just the right size to keep in the bathroom on top of the toilet. Highbrow, lowbrow.

Ophthalmologists have the best words for Scrabble.

These EC comics were a Christmas gift from my parents. Somewhere, possibly still in a box, is a complete box set of "Crime Suspense Stories," "Weird Science," and "Weird Science Fantasy." A healthy proportion of the books on my bookshelf are actually comics or graphic novels, a fact that perplexes my mother-in-law a great deal.

I still have a handful of author copies for my own book lying around. It seems weird to have them out but I literally don't have anywhere else good to put them. But they're on a very low shelf, at least, so less visible, thereby making me a little bit less like Richard Dreyfus in "What About Bob?".

(I said a little bit.)

joyeux anniversaire a toi

2011-07-24T18:17:00.002-04:00

So the party on Saturday went well! Though here's a little before and after of the cake. So...before:

After:

Apparently there's nothing that ten six year-olds find more funny than smooshing Spiderman into a cake and creating a little playlet like he's drowning in a vat of quicksand. DELICIOUS QUICKSAND.

Cal's birthday is obviously over summer vacation, so we've always had to have these hodgepodge birthday parties where half of his friends are out of town, on vacation or visiting grandma. But now that Mack is school-aged and seems to be developing a rudimentary understanding what birthdays are (it's the thing where you eat cake, duh), I'm looking forward to his birthday next year, as it'll be the first time where we'll actually be able to have a traditional classroom birthday party. Mack already has it all planned out.

MICHELLE

Mack, when it's your birthday in January, would you like Mommy to bring cupcakes to school for you?

MACK

Yeah!

MICHELLE

And we'll have a birthday party for you and your friends and teachers at school?

MACK

Yeah!

MICHELLE

And we'll light three candles and you'll blow them out?

MACK

Yeah! Three!

MICHELLE

And we'll all sing "Happy Birthday to Mack"?

MACK

(Glowering)

No want you sing.

Anyway. We saw friends and ate cupcakes and the aforementioned wad of pizza, and that evening we had cheeseburgers and watched "Harry Potter and the Sorcerer's Stone," I seemingly having forgotten how plodding and dense the exposition in the first movie is, like, GET TO THE MAGIC PARTS ALREADY. (Should have skipped straight to "The Chamber of Secrets," except then I would have missed how adorable little Rupert Grint was before time and testosterone had their unfortunate way with him.)

Anyhoo, I hope everyone had a good weekend, and remembered to finish all their homework. Sunday nights always feel so laden with obligation and foreboding, don't they?

one of our own

2011-07-22T18:44:00.003-04:00

I got this e-mail today from the chairman of the Emergency Department of St. Joseph's Hospital where I work, and which I will share here, lightly edited for privacy purposes.

Dear Colleague:

On July 4th, after working the night shift in the Emergency Department, Dr. D.G. had a right ventricular hemorrhage with subcortical ischemic changes. He is currently in [the medical ICU] awaiting transfer to [a prominent local rehab center].

Mrs. G was recently informed that D’s insurance does not include benefits for inpatient rehabilitative services. This news follows a difficult financial year for the G family; D has also been supporting his brother’s family due to metastatic disease as a result of stomach cancer. His brother died three months ago.

Because D is now considered uninsured, [the rehab center] is requiring $60,000 prior to D’s transfer. We have requested donations from numerous sources including Saint Joseph’s Mercy Foundation, but no one source has the availability of the entire amount.

We would like to ask for your help in the form of a donation as soon as possible. The sooner D can begin rehabilitation the better chance he has for a positive outcome.

I talked about this a bit in an entry a few weeks ago, but again, when you're working in a hospital with sick people every day, mortality is all at once distant and immediate. Morbidity and human frailty are all around us, but at the same time, the very fact of its constancy makes it fade into the background. It's just the scene that you're in, but seemingly, it's never you.

But it could be. It could be you. It could be me. It could be your co-worker, your friends, you family. I've met this doctor several times (the Emergency Department and the Anesthesia Department, as you can imagine, have more than just a glancing interface) and this doctor is not old, maybe just ten years older than I. The day of his stroke, he wasn't feeling well. But he came in to do his job anyway. See the letter above: "...after working the night shift in the Emergency Department..." He came in to do his job anyway. Maybe he shouldn't have, but was the job he was trained to do, the duty he was called on to provide, which was to take care of sick people.

Now let's help take care of him.

Here's how.

(I apologize that this is so cumbersome as I'm not the one who set this up, but I'm told you're to click "Donate Online" --> "General Donation" --> "Other Fund" --> "Physicians in Need of Medical Care" and help however you can. And please pass this link around to anyone who you think may be interested.)

Thanks everyone. And have a good weekend.

why my post-call day off is equally exhausting as the call itself

2011-07-21T15:16:00.001-04:00

Scene: This morning, post-call, at the crack of dawn.

MACK

(Speaking very, very close, directly into MICHELLE's face)

Mom, want to get up. Want yogurt and toast. Get breakfast.

MICHELLE
Hmm? Snrg? Mrpgh? (Shakes self awake)
Mack, Mom is sleeping. She worked very late last night.

Go see if Dad will help you get breakfast.

MACK

No, you. Want you to get me breakfast.

MICHELLE

Dad can do it.

MACK

No, want Mama. Need you. You. YOU.

MICHELLE

OK, just give me a second...

(Long pause)

(Snoring)

MACK

Mom, get these blankets off! Off! Off! (Pushing blankets off my body.)

Don't cover your legs! Don't cover foot! Get up!

MICHELLE

Mack, Mommy's tired.

MACK

(Insistent)

NO NO NO YOU NOT TIRED.

MICHELLE

Groan. Fine. Fine. I'm up. I'm... (struggling into sitting position) OK, now I'm up.

Don't you know Mommy was working late last night? That Mommy needs to rest, like, occasionally?

Fine, now what do you want for breakfast? Toast? Yogurt?

MACK

Yes. Also need you change my diaper.

MICHELLE

You're pushing it, kid.

(Fin.)

favoritism

2011-07-18T19:35:00.004-04:00

So it's Cal's birthday party this Saturday. We're going to do exactly what we've done for the past two years, which is to go to the local municipal pool, get a wad of pizza (appetizing to refer to it as a "wad," I know), and let the kids go crazy. Do you want to see what I got for party favors? Yes you do. YES YOU DO.

Finger lights! They're like little tiny flashlights that you can put on your finger. Why? What is this for? I don't know, ask a kid! (Maybe they want to don their earth-colored hemp robes and re-enact that underground Zion rave scene from the "Matrix" sequel.)

Also, these lollipops that no one actually eats because they're too big to cram into your mouth and also don't actually taste that good, but that kids go nuts for because they are gigantic and rainbow, LIKE MY SOUL. (OK, I don't know what that means.)

Also, Whoopee Cushions, which I found a great deal on last night, after which I tweeted abundantly on flatulence related humor. I particularly like the helpful diagram (one presumes for prudes who have never seen a Whoopee Cushion) including the little word bubble that insists: "POO."

See, the thing with party favors is: I know they're kind of a waste. Kids play with them for two seconds and then they end up in the footwell of your car or at the bottom of the toy chest or soggy after a rain in the front lawn. I have plenty of post-other-kids-party detritus cluttering up my own house, so every year I think: I just shouldn't do favors this year. But then every year when I give out favors anyway (last year it was pencils and stickers and handfuls of leftover candy--I can't remember from which holiday, I'd like to think it wasn't Halloween but it well may have been) and it just makes the little guys so damn happy. So what's a couple more dollars thrown in the direction of your local party crap store for that kind of joy? It may well be just a gimmick, or at best a brief thrill, but at any rate the joy is full-bodied and genuine, and that's something we all need more of in our lives.

So...pass the Whoopee Cushions, and viva los farts.

while we're talking about it

2011-07-16T17:13:00.007-04:00

So some of you may have seen it already, but this AP article ran in The New York Times today, about a huge scandal that has embroiled that Atlanta public school system.

Atlanta Schools Created Culture of Cheating, Fear
By THE ASSOCIATED PRESS
Published: July 16, 2011 at 10:20 AM ET

ATLANTA (AP) — Teachers spent nights huddled in a back room, erasing wrong answers on students' test sheets and filling in the correct bubbles. At another school, struggling students were seated next to higher-performing classmates so they could copy answers.

Those and other confessions are contained in a new state report that reveals how far some Atlanta public schools went to raise test scores in the nation's largest-ever cheating scandal. Investigators concluded that nearly half the city's schools allowed the cheating to go unchecked for as long as a decade, beginning in 2001.

Administrators — pressured to maintain high scores under the federal No Child Left Behind law — punished or fired those who reported anything amiss and created a culture of "fear, intimidation and retaliation," according to the report released earlier this month, two years after officials noticed a suspicious spike in some scores.

The report names 178 teachers and principals, and 82 of those confessed. Tens of thousands of children at the 44 schools, most in the city's poorest neighborhoods, were allowed to advance to higher grades, even though they didn't know basic concepts.

One teacher told investigators the district was "run like the mob."

"Everybody was in fear," another teacher said in the report. "It is not that the teachers are bad people and want to do it. It is that they are scared."

For teachers and their bosses, the stakes were high: Schools that perform poorly and fail to meet certain benchmarks under the federal law can face sharp sanctions. They may be forced to offer extra tutoring, allow parents to transfer children to better schools, or fire teachers and administrators who don't pass muster.

(Read the full article.)

So...that. This is not a new story, by the way--it's been in the local papers for the past few months--but it's one that I've been following with more than a little interest. Because in a few weeks, we're going to be part of the Atlanta Public School system, when Cal starts first grade.

I would first like to point out that both Joe and I attended public schools up until we went to college, and Joe's dad is actually a retired public school principal. And of course, I'd also like to think that if reputation and historical data count for anything, the school Cal (and maybe Mack in a few years) will be attending is actually supposed to be excellent--that school is, in fact, the reason we moved into this particular neighborhood in the first place. But do these things make me feel better? I little, I guess. But not totally.

Ideologically, I think that every child should have the right to a good education, that we need to direct more resources to public schools, that the public school system in the United States should, by all rights, be one of the best in the world. I don't believe that getting a quality education should solely be the purview of those who can afford private school. The fact that an education is state-funded doesn't make it a bad one, just as much as paying a lot for an education doesn't make it a good one.

But at the same time, want to know my first, knee-jerk response? It was: If this doesn't work out, there is no amount of money that I wouldn't spend to make sure my kid gets a good education.

It isn't about the money. Or is it? How do you separate out resources from environment? Why is it that the best public schools are usually in the most affluent neighborhoods? And wherein do other, non-monetary resources come into play? There was an example in the article of a parent who talks about how she was just blindsided that her child, despite passing all standardized testing indicators, was actually performing way under grade level, and the first thing I thought was: how could you not have known that? How can you not know what your kid is doing? How would you be surprised to find out that your kid can't read? Can't do math? Isn't performing at grade level? I wouldn't think you'd be blindsided by that; I'd think you, as the parent, would be the first to know.

So in this case, as is the case with just about everything in the world, it is about money, but also...it isn't. It's about the rest of the picture. My kid spends seven hours a day at school, ten hours a night sleeping. It's what one does with the other seven hours that make the difference.

(And before people get upset, let's not equate emphasizing academic success with a joyless childhood. I have two little boys and I know kids have to unwind and have fun in order to grow up happy, so I'm by no means promoting seven straight hours of grim academic drills, cram school-style. I'm just saying is that as their parents, we have more perspective than anyone else the extent to which our kids can achieve, and also as their parents, it is our responsibility to help them get there.)

Anyway, Cal's starting first grade in a few weeks. And Joe and I are going to be right there. We'll see what kind of work he's doing, see what kind of homework he's bringing home, see what kind of progress he's making. We're going to work at home, and then we're going to work a little more. And I think that'll be just as important--probably more so--than what school he goes to or what teacher he has or whatever summer reading list they're sending home.

And make no mistake, I think all schools most certainly have a tremendous responsibility to their students. They should, and they must. But along with that, let's not let institutional reputation, test scores and a grades give any false reassurances, or absolve us as parents from the responsibility of picking up the slack.

miscellaneous etcetera

2011-07-14T16:17:00.002-04:00

I was trying to figure out why this week felt so interminable, when I remembered that I was on call this weekend, so instead of two separate weeks, I'm living through one endless mega-week. Like a monobrow, there was no line of demarcation. And since I didn't have a weekend to take care of all my odds and ends, I started off my week behind, so now I am tired.

But first things first. The winner of the guerilla marketing campaign (and the pack of awesome ultra-fine-tipped gel pens, along with a signed copy of my book) is Julia Blue, who's ingenious book cross-promotion on Facebook impressed both me and my editor. Julia, e-mail me your address, and I'll send those out.

(Speaking of mailing things out, if you have not received your pre-order bookmark yet, don't worry, you're going to receive your bookmarks, and many of you have already. It's just that I actually got, like, ten times the number of e-mails than I had initially anticipated, so I'm just very, very slowly hand-writing the notes and addressing the envelopes and mailing them all out in between other pressing tasks I have to do, like going to work and raising my kids. International pre-orders will probably ship out last, just because those are the only ones I actually have to take into the post office for air mail. Everyone else, be patient, they'll all get shipped eventually, even if it kills me. THANK YOU. Unless it really does kill me, in which case: avenge my death.)

Uh, where was I?

Oh yes, it's been a long week.

* * *

OK, so tell me what you think about this. Cal's starting a new school this year for first grade. We just found a copy of the summer reading list for rising first graders. I'll just put part of it up here, see what you think.

On-Grade Level:
1. Arthur Series
2. Biscuit Finds A Friend, Alyssa Capucilli
3. Brown Bear, Brown Bear, What do you see?, Eric Carle
4. Dr. Seuss Beginning Reader Books
5. Franklin Series
6. Frog and Toad All Year, Arnold Label
7. Frog and Toad Are Friends, Arnold Label
8. Sheep in a Ship or Sheep in a Jeep, Nancy Shaw

A little more challenging:
1. Alex and the Terrible, Horrible, No Good, Very Bad Day, Judith Viorist
2. Berenstain Bears Series, Stan and Jan Berenstain
3. Click, Clack, Moo: Cows That Type, Doreen
4. If You Give A Mouse A Cookie, Laura Joffe Numeroff
5. Little Bear’s Visit, Else Holmelund Minarik
6. Sheila Race the Brave, Kevin Henkes
7. Strega Nona Series
8. The Best Nest, P.D. Eastman
9. The Very Hungry Caterpillar, Eric Carle

OK, so look. I like these books too. I'm not saying my kid is some kind of super-brain, because he's not. But really, these are the books that he's supposed to be reading for first grade? "The Very Hungry Caterpillar" is a nice story, don't get me wrong, but is it really considered "a little more challenging" for a class of six and seven year-old kids?

Am I nuts? Am I going Tiger Mom on this list? Or do you think these books are too easy too? Seriously, be honest, because I can't even tell. I'm trying to figure out how much of it is just the fact that there's a range of books for all kids in the class, and how much of it is the fact that it seems like the expectations for our first graders is--look, I'm going to get flak for this, but I'm just going to say it--sadly low.

I'm not saying that I expect school to take the place of parents pushing (that word is so loaded, let's say "encouraging," because it sounds nicer although my meaning is the same) their kids to reach their full potential. But I guess my fear is that if this reading list is a preview of the expectations for our first graders, school's going to be combination of mind-numbing boredom and then hours of meaningless busy work in the form of infinite homework assignments designed not to reinforce any actual learning, rather to fulfill some kind of meaningless quota.

I mean...OK. Frog and Toad are very cute, and I love the fact that they are friends. But people, really. I mean, "THE VERY HUNGRY CATERPILLAR," for chrissake?

* * *

Mack's enjoying school so far, even though the transition of actually being dropped off at school all day, coupled with a week of Extreme Togetherness (my new reality show) while we were on vacation for a week has turned him into some kind of Momma's Boy monster. (MOMMA'S BOY MONSTER is the working title of my horror film screenplay. Alternate title: THE CLINGER.) The biggest problem with him right now is quite simply that he's two years old, and while Cal waited until he turned three for the worst of his behavioral tics, Mack has apparently been reading all the child development books and has seized upon the terrible twos with gusto.

I know it's a developmental phase, and that he's right on schedule, but seriously, watching him and his 720 degree changes of heart in under 30 seconds is vertiginous to say the least. And it's just hard to keep up with exactly what phase of the I love you / I'm angry at you / I need you Mom, every second of every day, I must only breathe your exhaled air / NO MOM GO AWAY I DO IT MYSELF cycle he's on at any particular moment.

Kid's lucky he's cute is all I'm saying.

* * *

Oh, and I'm not going to plug every last public thing I do excessively, because it's all on this page and you can just look at it at your leisure (or not), but I just wanted to share this one interview I did with Greg Berg on WGTD-FM, because Greg is a great interviewer who listens as much as he talks, and whose reading voice made the excerpts of the book sound much, much better than if I had read them myself. Is there some NPR master class that teaches people how to talk good? Because I'd sign up for that in a second. And then I would narrate Ken Burns documentaries all freaking day.

Hope everyone's having a good week.

colonoscopy face

2011-07-07T20:04:00.001-04:00

I tweeted today that someday, I want to make a video of all the faces that doctors make while they're doing colonoscopies. Our GI colleagues are as talented as they are brilliant, but as we all do, they sometimes make some funny faces while they're working. And since I'm almost always standing directly across from them, I get to see the full spectrum. Here are a few favorites.

We love our GI colleagues, and I hope that I look as cute when I'm making my "concentration" face as they do. (However, as I know I likely do not, it's a lucky thing that I'm wearing a surgical mask 75% of the time.)

pecking order, level 2

2011-07-06T13:35:00.001-04:00

So I joined my anesthesia group three years ago, which makes me the most junior member of my practice. And as such, I have had the Junior Person Desk.

I took that picture my first day of work. (See on the chair my old OR sneakers, which have since disintegrated from overuse/dry gangrene--I have a new pair of the same sneakers now, but in fuschia. OR sneakers should always be a color on which blood will not be visible. My brief stint with khaki sneakers lasted all of two days for that very reason.) Anyway, it's a perfectly fine desk, but the shortfalls of its location reflecting my status in the pecking order became readily apparent the first time I sat down.

It's right next to the door of the break room. Hell, my desk practically was the door of the break room. And it seems like a small deal (because obviously, in the global sense, it is), but...it's a really high-traffic area. Also, usually that door is closed. So every time I sat at my desk, people would open the door, and it would slam right up into my chair. Or people would forget the combination to get in and out of the break room, and I'd hear them beep-beep-boop-BZZT entering the wrong code and then struggling to puzzle out why the door wouldn't open, so eventually I'd just stand up and open it for them. Or occasionally folks would forget pieces of debris on my desk, just because...I don't know, the garbage can was too far away. Oh, a half-eaten bagel and a chewed coffee stirrer, a present for me? THANKS GUYS!

A number of people in my department have rotated through that particular desk location over the years, and the universal agreement is that, given the option, one should decamp as soon as possible. The good thing is that, as an anesthesiologist, I rarely have reason to be sitting at a desk anyway, but sometimes I do have to sit and write something, or return a call, or, you know, fluff my paperclip collection. And in those moments, I hated having The Junior Desk.

We have a new anesthesiologist joining us next week. Everyone is very excited. We're excited to get our new colleague, but I in particular am excited because, in order to make room for our new colleague, two of our part-time physicians are now sharing a desk space, thereby freeing up physical room for an extra person in our department. And a few weeks ago, I got a note that said that, if I wanted, I could get first dibs on the free desk, moving on up in the desk lineup and clearing off my Junior Desk for the new guy. I made my move today.

Welcome to the practice, Dr. K! And, all kidding aside, I hope the desk will be as good to you as it has been to me. I'm not one to ascribe talismanic properties to things randomly, but it's been a very lucky three years for me, and I'm open to the fact that it might be because of the desk as much as anything else.

(I'm still moving to the new desk, though.)

cutting the barber's hair

2011-06-30T18:20:00.001-04:00

I'm sure everyone is pretty well sick of hearing about our vacation by now (yes, everyone loves to hear about a fun trip, but after a certain point it does veer into that "endless slideshow at your grandparent's house" territory--not that I don't love an old school slideshow, mostly because I like to push the big button and I like the sound it makes when the slide cah-chung advances in front of the lamp), but in this final post of our vacation week, I would be remiss to not talk about the Bluefields staff that made our vacation so special.

So look, for real, I felt weird about having so many people around whose sole purpose was to make sure that we had a nice vacation. I know that's the whole reputation of this place, that it takes exquisite care of its guests, but having so many people around to help felt...I don't know, like putting on airs. When we go on vacation, we take care of our own kids, carry our own luggage, corral all our own little pool toys at the end of the day, fend for ourselves, you know? Being waited on makes us feel a little spoiled.

I remember when I first started working at St. Joseph's down in Atlanta (everyone knows where I work now, right? It's on all my press info now, no real point in keeping it some big secret anymore) right after I finished residency, and I was just in the habit of doing everything myself and getting and assembling all my own supplies, because...well, because old residency habits die hard. This principle can be generalized to our entire lives. I was worried that they'd be sitting around watching me and I'd be watching them and we'd smile at each other awkwardly and it would be Awkwardville, the capital city of the state of Awkwardia. Because we're just folks! We don't need a headman and a cook and a nanny and guy who sets out beach chairs for us! Hey, bellman, gimmie that thing! How about I'll carry it for you!

And I'll not lie, even now, at the end of the week, it still feels a little weird, because Joe and I are very used to taking care of other people, and not so used to people taking care of us. But the staff here is so warm and so helpful and so present, but in the most seamless, unobtrusive way possible, that quite honestly, it stops being very very weird and starts to become...well. Let's just put it this way: it's always nice to be so well cared for.

One of the ways that we notice it the most is that when you travel with young kids, there are a lot of little details that you have to worry about. Packing beach bags. Lugging towels. Rinsing out sandy swimsuits and hanging them to dry afterwards. Procuring and transporting a reservoir of snacks and drinks to bring with you. (Right now, at home, I have a diaper bag crammed full of used little Ziplock baggies with crumbs in them which have been used for this very purpose.) Planning meals--where, when, how, and what. Trying to spend time with one kid while supervising your other kid who is trying to go kamikaze over the side of the pool. You know, nothing bad, nothing difficult, nothing that any parent doesn't do all day, every day, but just...things. The little things.

And that's the magic of this place, and the staff here. The little things. The little, little everyday things. Like: OK today. I'll just tell you about today.

Today we went down to the beach. We went down to the beach with our beach bag and our towels, but we forgot to bring our little sand toys. Before we could even say anything--before we even realized that we'd forgotten them, it seems--Kerri Ann came down with a pile of buckets and shovels for Cal's sand castle, and then very unobtrusively left us alone to our family time. Later on, we came back up from the beach to the pool (I know, I know, such a tough life, look, I HATE ME TOO), Rosemary magically appeared with these little tiny grilled cheese sandwiches for the kids to eat, because lunch wasn't going to be until a little later and she thought they might be hungry. (They were.) While the kids were in the pool, I came back to the house for half an hour, and while I was inside, Rosemary stayed outside with Joe and the boys, just to be available as an extra hand by the pool, since Mack can't swim, and Cal sometimes thinks he can swim a little better than he actually can. At lunch, Dwight made strawberry banana smoothies for Mack, because he loved them the first day he was here and Dwight knows that he's been asking for "that pink drink" basically every day since then.

Or like this: our first day here, after our walk down to the beach, we came back to find that our suitcases had been unpacked for us. A few days later, I found a folded piles of clean kids clothes in the closet, fresh from the laundry. We're going to have a suitcase full of clean clothes to take back home with us. This has never happened before, ever. It's also allowed us to travel so much lighter, because usually, for Mack, if we're going to be somewhere for 7 days, I'm packing, like, 21 changes of clothes. I am not exaggerating. (Kid's a mess.)

Or like this: yesterday, someone came to get us in the front yard to tell us that "the donkey is here." There's this donkey that lives nearby, and when there are kids staying at Bluefields, sometimes they have him come over to give rides. And the donkey wears a wreath of flowers and little hat. WHICH IS AWESOME.

It's things like that. The little, little things. Things that make this family vacation a real vacation for everyone, and about someone taking care of those who are usually taking care of other people, like that old riddle of who cuts the barber's hair. It's not about being overly programmed or not even about having someone else take your kids off your hands for the whole week. We don't want that. When we're off from work, Joe and I want to be at the bottom of a dog pile of kids. But it's about a vacation from the little things, and making new, lasting memories of the big things that are important.

We're leaving here Saturday morning, and I'm going to take a little break from blogging for the rest of my vacation until we get back to the ATL. But from me and my family to Bluefields and theirs, thank you so much for taking such good care of us this week. We will never forget our first time here, and can't wait to come back.

community

2011-06-29T17:52:00.005-04:00

I know I said I was going to talk about the incredible staff here today, but I decided that we're going to do that tomorrow instead, because today I'm going to talk about the Bluefields Basic School.

One of the things that appealed to me when I was originally doing research about Bluefields was the fact that, perhaps unlike some of the larger hotels and guest houses here, this family-run resort really seems invested in the local community. Aside from the fact that they employ so many people from the town to work at the resort, they also give back quite a bit to the community in other ways, and one of the ways is in funding the Bluefields Basic School, a local early childhood education center for three, four and five-year olds in the area.

One of the things we really wanted to do when we came down was to visit and help support the school, and we were so pleased that they weren't yet on summer vacation, so we could actually meet the teachers and the children. Given that Joe and I are in healthcare (duh), we were particularly interested in earmarking a portion of our contributions towards something related to early childhood health and safety. As one concrete example, some of the contributions from Bluefields and friends of Bluefields have gone towards subsidizing healthy and fresh school lunches for the kids, some of whom don't always get a chance to eat breakfast before school each morning.

Another reason we wanted to go visit the school, and perhaps a more selfish reason, is just for the sake of keeping perspective in check. Joe and I are very lucky people, our kids are incredibly blessed, and we're having an unforgettable family vacation. But part of vacation to a foreign country should be learning about the community you're visiting, and we thought that spending some time at the school would be a interesting and familiar way for Cal to do just that.

Plus, did I mention how adorable these kids are?

That little one, there, in particular, mounted quite the charm offensive. After I took that photo, she magically extracted camera right out of my hands with the force of SHEER CUTENESS and took all those pictures below. Kid's got talent, right?

Anyway, everyone loves being on vacation, but it's also nice, when being taken such good care of by a community of people, to be able to give something back. Learn more about Bluefields Bay and their local community initiatives here. And thanks so much to the Bluefields Basic School for letting us visit on their last day of school! Have a good summer vacation kids!

out and about

2011-06-28T22:10:00.002-04:00

Our first full day here, we basically let the kids run the beach-pool-beach circuit to their heart's content, and the fact of it is that if that's all that we did during our week here, they'd be perfectly happy. But starting on Monday, Joe and I wanted everyone to try one new activity per day. Because new activities are fun, and, to be honest, our kids aren't exactly known for their easy acceptance of new things.

Our first activity was snorkeling. A local guy with a boat (his name was Herman) picked us up at our beach, rocketed us twenty minutes along the coastline to a coral reef, where there were a billion pelicans just sort of hanging around, waiting for fish to jump into their mouths like Nigel in "Finding Nemo."

It was...not a total success. Cal has gotten fairly proficient with the snorkel in the pool, but something about the combination of having to drop out of a boat and having some slightly choppy seas kind of freaked him. So he came back in the boat after about five minutes.

Joe gamely pushed on for about ten minutes after that, but then he started getting claustrophobic (truth be told, he's not the world's best swimmer) and the rest of us in the boat were getting fried in the sun, so we headed back right after that. Yes, we are lame, but even for me, who didn't end up getting to snorkel at all (Mack wouldn't let me out of the boat), the jaunt along the coastline and the view alone was worth the trip.

Today we took a day trip to see some crocodiles on the Black River, and visited a local waterfall formation known as YS Falls. Part of what Bluefields does for these trips is provide a van and a driver, arrange a local guide for the falls, and pack a full picnic lunch to eat there. (We had fried chicken, fresh banana bread and vegatable curry--so, you know, not a stack of PB&J, though I would have gladly eaten that too.) It was really fun. All the local interest without any of the attendant logistical stress. Really lovely.

This was a side trip that we consider going on just with Cal, because it was a little of a drive to get to both these locations, and we just weren't really sure whether or not Mack would have more fun hiking to a waterfall versus staying at the pool for the day, bobbing in his life vest like a cork. (Apparently it's much more fun than it sounds.) Every cottage at Bluefields is very fully staffed, which includes a full childcare, in any permutation that you might need it (stay with one kid while you take the other kid out to do something special, stay with all your kids while the adults go ~~get potted at~~ learn fascinating trivia about distillation at the Rum Factory, sit in the house while the babies are sleeping so that you and your spouse can have a nice candlelight dinner on the beach, what have you). However, ever since Mack started preschool three days a week he has had the worst separation anxiety, and given that we were on a family vacation, I just couldn't stand to get him all worked up. We were here to be together, after all. So we brought him along.

Anyway, it turns out my concerns, much like my pre-trip concerns about the weather, were misguided. Mack napped in the van on the way there and the way back, and he loved seeing the crocodiles, loved boating down the river, went apeshit about swimming near the waterfall. It was really special.

(I will admit that there was one part during our waterfall excursion where Mack got a little bit of water in his mouth and I leapt towards him in slow motion, shouting, "Nooooo....GIARDIASIS!" But that aside, I was able to pretend that I had not gone to medical school and was, in fact, a normal human.)

Anyway, the activity level of this vacation has so far been just right. There's enough to do outside of the villas that you could actually be programmed up to the gills every single day for the week that you're here, but no one is Cruise Directing you, telling you via bullhorn that you should be participating in karaoke up on the Neptune Deck. It's just very self-directed and whatever you want to make of it. If you want to take a day trip or two (or five), poof, it's arranged, and there's the driver outside your door with a wicker basket of food and a cooler of drinks the following morning. Or, you could spend the whole week lying on the beach and by the pool, doing your best impression of a sea sponge--and that's totally OK too. As the staff here has told us repeatedly, "No problem mon, it's your vacation."

Which leads me to the topic for the next entry: the staff. Which is a fact that, to be totally honest, I felt kind of weird about before we came here, because, what do you mean there's a staff for each house? What if we're used to taking care of ourselves? We're not demanding, we don't need stuff. We don't want people to be waiting on us. So are they just going to stand there, like, looking at us? It's going to be weird, right? Totally weird.

Short answer: yes, it's a tiny bit weird, but it also stops being weird after, like, 20 minutes. And then you realize that it is AWESOME. We'll talk about it tomorrow.

grub

2011-06-27T22:08:00.008-04:00

You guys may remember our summer family vacation last year to The Tyler Place, which is a wonderful family spot that everyone on the planet seems to love unabashedly, but for a number of reasons, was just not quite for us. Tyler Place really emphasizes fun for the entire family, but there's also quite a lot of separation of children's and adult activities, which is probably great for people who spend a lot of time with their kids at baseline, but want vacation time to be a vacation from all aspects of their everyday lives, including having to cater to a lot of child-centric activities.

I'll be totally honest with you when I say that Joe and I feel like we don't spend enough time with our kids as it is, and the last thing we want when we're on a hard-won family vacation is to spend a lot of time away from them. So when we were planning our summer vacation this year, we deliberately looked for a place that was low-key, a little more free-form, and allowed for a lot of family time and activities that we could do together. And after some extensive research (OK, I'll admit, when it comes to vacation planning I usually do most of the research and Joe's job is to vote yay or nay--usually yay by the time I'm done making my case because as a writer I can be very persuasive) we found Bluefields Bay.

I'm telling you all this partially to give you a little more information about the Blogging from Bluefields program, which I had mentioned in a few earlier entries but had not gone into too much granular detail about because, to be totally honest, it's the kind of thing that can kind of make people write mean anonymous messages to you. But I was making the reservation for our annual summer vacation, talking with the owners, when I mentioned to them (they are very friendly, and the entire resort is family run) that it was going to be a perfect time for a vacation, because it was going to come about a month and a half after my book release, so we'd probably be due for a little quality family time right around then. Talk of the book begat talk of the blog, which ultimately led to a collaboration with the Blogging from Bluefields program, meaning Bluefields is absorbing a portion of the cost of our trip here. I know. I know. I HATE ME TOO, GUYS. But let's be clear about this also: they don't dictate content, and they don't edit what I write. Probably the only thing that's appreciably different is the immediacy and extent of my writing--I'm blogging while on vacation, in other words, instead of putting up one big entry after I get home. Otherwise, it's just a matter of sharing our experiences, which, lord knows, I do more than enough in our normal lives anyway. Anyway, I just wanted to make that all transparent.

OK. So. The food.

Joe and I don't take big trips all that often, but when do make travel plans, I find that although part of us would prefer to stay at smaller, independent hotels or B&Bs, taking kids along for the ride makes us lean towards staying at, like, Le Gigantic Chain Hotel because if all else fails (exhaustion-provoked self-destruct sequence or similar), there's always the hotel restaurant in the lobby, or in case of absolute implosion, room service to save the day. When we visited Atlanta during our pre-residency graduation blitzkrieg during the February of 2008, we made the mistake of staying at a hotel without any kind of food situation save a vending machine, thinking, perhaps, that we could always find food off-site. But traveling with a two and-a-half year-old and having to plot every single day where and when and how we were to find meals for a whole week (between daily job interviews, meetings with realtors, and preschool tours) was, to put it simply, THE WORST.

Let's cut to the chase. You don't have to worry about food at Bluefields. Ever. All meals are included. All snacks are included. All drinks are included, and yes, that includes booze drinks. (I'm no lush, but despite the limitations of being an Asian lady, I will occasionally partake in a booze.) Not being a food blogger or anything even remotely close, I'm a little out of my element when it comes to talking about cuisine (though, for a better food blog, may I recommend Ginger and Scotch, the new and frankly fabulous food blog launched by an old high school friends), but look, a picture is worth a thousand words, so let me just show you what we've been eating the past few days.

Breakfast: saltfish and ackee for the adults; french toast with bacon and scrambled eggs for the kids. (Not pictured, the mound of fresh tropical fruit at the table. Very nice.)

Lunch yesterday and today: spicy beef crepes with fries; a local spicy fried fish with rice and veggies. What kind of fish? I don't remember. WHAT DO I LOOK LIKE, AN ICTHYOLOGIST? On second though--don't answer that. (It tasted good.)

Dinner last night and the night before: don't ask me to remember what it all was. Though I do remember eating it all.

Each house has its own chef, who plans your meals with you in advance. They told us when we arrived that they could make special food for the kids if we wanted--of the mac and cheese, chicken fingers genus--but I told them I usually preferred Mack and Cal to eat what we were eating, so that's exactly what they've been getting. Of my two kids, Cal is the pickier one--he's far more likely than Mack to eschew a dish just because of the consistency or the sauce or some kind of specific spice that he deems "weird"--but I think he's been so hungry from all the activity and the food has been so good that he's basically been clearing his plate at every meal. And Mack...well, when it comes to eating, I don't much worry about Mack.

All meals are served in your accommodations, by the way, so no schlepping around. So special and wonderfully intimate, particularly for a family that rarely gets to eat its meals tout ensemble. Our cottage is a little smaller that some of the others so there's no formal dining area, but this is remedied by the fact there's actually a separate oceanside pavilion in which all our meals are served, just one short flight down from the main house. It's steps from the pool and steps from the beach, and that, as my kids will tell you, is alllllll right.

So, there you are. Food? Diagnosis: DELICIOUS. And now I will leave you with a picture of some local island drinks, and Cal's oceanside toast to his new favorite beverage, Ting.

Tomorrow I'm going to talk about some family-friendly activities, both locally and off-site. For example, tomorrow we're planning to take a short day trip to hike to a waterfall, where we will swim and have a picnic lunch. AQUAROBICS. Don't forget to follow along with my Twitter feed or look to the Flickr set for my iPhone photos, and I hope you're all having a good week.

the digs

2011-06-26T22:43:00.005-04:00

So, as promised, the accommodations. The accommodations here...are pretty sweet.

There are four other villas here which vary in size--some can accomodate up to 12 guests, which seems like it would be fun for large or multi-family groups--but as we are terrible introverts with no friends apart from our two kids (how much you think we're kidding basically depends on how well you know us), we elected to book Cottonwood Cottage, which is a two bedroom lodging with its own small pool, right above Bluefields Beach.

Kids don't really care about the view, but there's a killer view out every window, and it's just a few short flights of steps down in order to see that view up close and personal. It's a public beach, but it's incredible how private it feels when you're down there. I think there was one other family down there this morning, but they left mid-morning for their flight back to the States, and after they vacated, we were the only ones down there.

Kids also don't care about the furniture and stuff like that (and to be perfectly frank, neither do I, really) but even a philistine such as myself could appreciate the attention to local historical detail and the interesting architectural flourishes, like the hexagonal-shaped rooms to maximize ocean cross-breezes, and the high wood vaulted ceilings. It's pretty neat, honestly.

To be totally, totally honest, here were the things I really cared about infrastructure-wise before I came here. First, was there wireless internet? (Yes.) Two, was there air-conditioning? (Yes, but you're not spending that much time indoors, so who cares.)

Which brings me to the main point that I love about this place, which is that everything is incredibly convenient. Want to go to the beach? Walk down the stairs. Want to go to the pool? Walk across the front yard. Want to eat? Turn around and there's someone trying to shove food and drinks directly down into your gullet, though in the most charming local way. Guys, I ate breadfruit chips today! I thought they were saying "grapefruit chips," and was silently puzzling, 1.) how they could possibly chip and fry a grapefruit, and also 2.) why the grapefruits on this island tasted like potatoes. The chef, so friendly, and probably sensing my confusion through supernatural means, ran straight out of the kitchen and put this in my hands, proceeding to tell me about at least five local breadfruit dishes and how they are prepared. Like I said: absolutely charming.

I am taking a lot of pictures (obviously), and the ones from my iPhone I'm loading up to my Flickr account as I go, because, to be honest, there are a lot of pictures. You can follow along here, I will add new pictures day by day as we go so I don't have, like, fifty skrillion photos to upload all at once when we get home. Here are some of my favorites from today, but check out the full set if you have some time to kill, you can never see too many pictures of my family in various stages of aquatic submersion.

Next, we're going to talk about the food. FOOD. Mack has some opinions, and he'll share those with you tomorrow.

touchdown

2011-06-25T21:36:00.002-04:00

Well, after some delays (clearly not weather-related, mostly just secondary to "equipment issues,"--like, hello, we don't want to worry you, but the plane might stop working in midair--we made it to Bluefields Bay, Jamaica. At least we didn't have it as bad as these guys.

(Full disclosure: I originally took to above picture to tweet about the sad state of etiquette in the culture of modern air travel, because: really? No shoes? Feet on the seats? Playing a Nintendo DS all loud? Also, not pictured: her boyfriend SLEEPING ON THE FLOOR, pronated elbow pictured visible above, to the left. But then I remembered that there were some fairly significant storms in Atlanta yesterday evening, and that perhaps they were still delayed from that, and anyone delayed more than 12 hours and who has to spend the night at the airport can do whatever the hell they want as far as I'm concerned.)

Aside from our (relatively insignificant) delays, the flight down was fine. There was the moment, during our descent, when I obligingly turned off all electronics to be in compliance with FAA regulations and Mack threw an absolute tantrum because he wasn't finished watching his episode of "Walking with the Dinosaurs" (he's two, it happens, though because of the spectacle of it I felt in that moment like Worst Mother Ever--the fact that he was watching a BBC documentary should have helped but IT DIDN'T) but otherwise, aside from the fact of the travel itself, our trip down here was fine. We were picked up at the airport by Percy, a driver from Bluefields, transported along some very interesting terrain on the way to the Southern end of the island (among the sites we passed was a local funeral, with the full procession including a white and purple pall-beared coffin passing maybe six inches from our starboard window--Cal didn't ask and I didn't say anything) but we made it to our destination intact and greeted, charmingly, with strawberry smoothies and a beautiful view of the ocean.

So far we've only been here about, oh, four hours, but...I think we're going to have a good week.

The kids love it here. Cal, in particular, loves the Ting Soda (pictured in the picture below--NO IT'S NOT BEER), which is a local grapefruit-flavored soft drink. I wouldn't have thought that Cal would like anything grapefruit-flavored (he'll eat stuff with strong flavors and all--our latest triumph has been chicken curry--though he's definitely set in his ways when it comes to his culinary tastes) but everything seems to taste a little better here.

As I mentioned yesterday, we're participating in the "Blogging from Bluefields" program, so I'll probably be updating here fairly frequently. Though, as a medical person, I'll probably doing things rather systematically, because, you know, REVIEW OF SYSTEMS, GUYS. Tomorrow, I'll be talking about our accommodations. Sneak preview: they're pretty nice.

Hope everyone is having a good weekend.

summer vacation

2011-06-24T15:41:00.003-04:00

So! We're leaving on vacation tomorrow. Jamaica. Bluefields Bay. We've been planning this trip for the past nine months. The kids are looking forward to it. The bags are full of beach and pool stuff. We got all those little tiny sub-three-ounce sunscreen bottles from the travel section at Target. We told Cal there will be fishing and sea kayaks and snorkeling. And we told Mack we will be taking an airplane there. (That seemed to be enough to get him going.)

I've been checking and checking and checking the weather report since earlier this week, hoping that this forecast would change (after all, I told myself on Monday, we were still almost a full week out! So much time for the clouds to dissipate!) but at this point, I may have resigned myself to this picture:

Look, I know it rains in the Caribbean all the time, so maybe it'll just rain once or twice a day, like, during the kids' naps, and...after it gets dark. Right? Right? And, as Joe pointed out, a 60% chance of rain means a 40% chance of not rain, right? RIGHT? (You nod now.) Look, it's not like I need it to be sunny. I don't care if it's not sunny. The sun and its mutagenic rays! Do not want! I just don't want it to be, you know, the penultimate scene in "Back To The Future" where the lightening bolt strikes the clock tower. (In this scenario, "the clock tower" is code for "my children.") Because Cal has been training for snorkeling on the beach, and if the ocean is going to be unswimmable, I sure don't want to be the one to tell him.

But weather aside, we're so glad to be going anyway. That's the other piece of the work-life balance equation that doesn't get talked about too much, because it seems too obvious, but--you need to take vacation. A real vacation, not that kind of vacation where you just stay in town and catch up on errands and tell yourself how much you don't need to relax. Not that, but a vacation where you actually leave, go somewhere, and take yourself away from all the little distractions that take you away from spending time with your family.

We got some fairly sobering news this week, as you may have inferred from Wednesday's entry. A child in Mack's nursery school class passed away unexpectedly after a brief illness, which is unspeakably tragic. And it's that kind of news, that strikes so suddenly and unexpectedly and so close to your heart--like a tree that falls down in a storm, sparing your own house but demolishing that of your neighbor--that makes you realize all the more that you need to cherish what you have. So this vacation in particular, which falls during a point in our lives where Joe and I are probably the busiest with outside obligations than we've ever been (and yes, this includes residency) is going to be about happiness and thankfulness, loving our kids and making the most out of the time we have to spend with them. Even if we're wearing rain ponchos and playing Monopoly indoors for an entire week.

We will be staying at Bluefields Bay Villas and as we are participating in their "Blogging from Bluefields" program, I will actually be updating fairly often this week with lots of pictures and updates. Make sure you're following my Twitter account if you aren't already, because, you know, The Twitter. (Insert social media techno-jargon here.) Hopefully we'll be getting wet only intentionally, and pouring out a bottle of Red Stripe on the sand for our homies in abstentia.

See you there!

the great wall

2011-06-22T20:54:00.002-04:00

You would think that for doctors, who work with life and death issues every day, the issues of our own frailties or the tenuous line between health and sickness for our own families would be, if not accentuated, then at least more immediate than to those who, say, do investment banking for a living. But the strange thing is that despite our easy familiarity with human mortality, it is not the case at all that we are able to readily apply these scenarios to ourselves. We see patients who are sick or even dying on a daily basis--sometimes patients who very much remind us of ourselves, our spouses, our parents, our kids. But it's just a constant stream of other people. And seeing so frequently that it happens to other people, more than anything, starts to make you feel unconsciously like it's always other people, that it could never happen to you, or to those we love most.

Two years ago, when Joe was hospitalized after an acute bout of viral myocarditis (from which he has since totally recovered), the experience was not so much of concern or apprehension--though, of course, there was plenty of that too--but more than anything a feeling of disorientation. We were in an ICU. It was morning. Morning work rounds were underway, and even through the closed door, I could hear the scrum moving from one bed to another, emitting a low hum of recited numbers and medications and therapies that, even just partially overheard, sounded wholly familiar. But I was inside the patient room now instead of outside like I usually would be, and Joe was lying in the bed beside my chair. The environment was familiar, but the context was completely strange. What was I doing here? Why wasn't I outside at the nursing station, checking labs, writing orders? Why was Joe wearing a nasal cannula? Why was he the patient? How could this be happening?

Some of the experience of being a doctor involves being close one instant and yet distant the next. It sounds strange, and sometimes patients interpret the emotional boundary as coldness, but in many ways, maintaining a distance is necessary in order for to be able to do the job well. I am warm with patients, as familiar as I need to be, but in my mind, I set up barriers. Sometimes there are things that I don't want to know. Sometimes there are things that I don't want to see. Taking care of patients is wonderful, an honor, and yet sometimes, the things we know threaten to tear you up from the inside, in small, insidious ways when you least expect it--like tiny shards of ground glass you didn't even know you'd swallowed.

Because sometimes things happen and you can't set up barriers, because they're too close, or happen too quickly. And that's when it's hard. And those are the nights you come home to your family after work and you hug them a little bit tighter, a little bit longer. And your kids think you're crazy and start running around, shouting about whose turn it is to throw the Frisbee, that they're ready for their evening snack, and asking if they can watch "Kung Fu Panda" for the umpteenth time because they haven't watched any TV at all today, not even a single second.

Then they ask you about your day. And that's when the barrier comes up again, as you force a smile and sneak in another hug before telling them that your day was fine, just fine, thanks for asking.

malice

2011-06-21T18:31:00.005-04:00

Well, if you haven't seen this yet, it's not for lack of me telling you about it, that's for sure.

Again, I wish we'd had more time to talk about an issue that clearly could have filled up the whole hour and then some, and I don't think I've ever spoken in public at any point in my life and not wished afterwards that I'd been more eloquent, but...it was fun. I hope it sparks a lot of discussion, and I hope that people outside of medicine can try to empathize, even just a little bit, with the bigger issues at play.

Since I've started writing outside this blog a little more (see most recently, my stint writing for Psychology Today, where my motto has pretty much been go big or go home, at least in terms of picking highly polarizing topics), I've been struck by how much people seem to really dislike doctors. As a modern medical trainee, I never grew up thinking that I would be loved or revered as a doctor--I just wanted to do my job and take care of people, and if they wanted to thank me for it, fine, I appreciate being recognized, but the approbation was besides the point.

Still, I'm really taken aback by some comments I've read, not just in response to my piece, but just responses to doctors and their choices in general, that makes me wonder how this sentiment of generalized antipathy towards the medical profession, doctors in particular, has evolved. We've all gotten used to hearing blanket statements towards other professions ("All politicians are crooks" is probably the most common) and I have to say, some of the blanket statements I hear lobbed back and forth about our profession (that's we're lazy, that we're arrogant, that we don't care about people, that all we want to do is earn a buck or a million of them) seem to be treading awfully close to that territory. How did this happen? Do these stem from specific bad experiences that patients have had with particular doctors, or is there something else, something more pervasive and societal, that have not only knocked doctors off their historic pedestal, but put us in the same box as scoundrels and opportunists?

I have not seen this in my particular practice, I should say. I like to think I have a good rapport with my patients, and while I know everyone thinks its easy for anesthesiologists ("you just put them to sleep,") the fact of it is that we have to inspire the most amount of trust in the least amount of time, so patient relations is key. I also would like to underline that I don't particularly want to be put up on a pedestal (it's really only in the past few years that I've even become comfortable in being addressed with the honorific--if people call me "Michelle" I'm generally much more at ease), and regardless of how society views doctors, it's still an honor and privilege to serve our patients. But it's there's definitely a change in the role of doctors in society, and as much as I've been talking about the changing face and culture within medicine, perhaps there's just as much of a change in relating to us from the outside.

Why do people hate doctors? I mean, I kind of hate my dentist, but you know, not really--I just hate the reasons I have to go see him. But he's a good guy, doing his job, and I don't think he's a criminal or anything. Wherein does personal experience bleed into societal expectation? At what point did Norman Rockwell's country doctor become Alec Baldwin in "Malice"?

Thoughts?

tell me more

2011-06-20T17:44:00.006-04:00

Today's round table for "Tell Me More" was a lot of fun. Of course, with only 17 minutes of alloted airtime and 4 panelists (Dr. Siebert and I were joined by Dr. Randi Hutter Epstein, medical journalist and author of "Get Me Out of Here"; and Dr. Laura Ment, Dean of Admissions and Professor of Pediatrics at the Yale School of Medicine), there was barely enough time to scratch the surface of the issue, but scratch it we did. Scored it, in fact.

Given the time constraints, there's always things that you wish you'd gotten a chance to say but didn't (though I'm particularly grateful that I didn't say something I wish I hadn't--as sometimes can happen, see: my oral board prep sessions #s 1, 2, 4 and 6), but of all the things we didn't get a chance to touch on, here's the one thing I wish I'd said most of all: it's about choices. The choice to do and be what you want. The choice to become the Dean of the Medical School. The choice to become the Chair of the Department of Cardiothoracic Surgery. The choice to cut back on clinical hours so as to spend more time with one's family. The choice to do good, and "above all, do no harm," in the way that seems best and most appropriate for each individual and those they care for. All talk of indebtedness and societal obligation aside, the mark of an advanced society is the freedom its constituents, and what I really want, above all, is for ability for doctors--yes, even doctors--to make any of these choices, and for these choices to not be so polarizing as to have to inspire a national debate.

Segment will air on "Tell Me More" tomorrow (trimmed for length), and the full roundtable will be available online. Thanks to all my intelligent and insightful colleagues for the rousing discussion, and to the lovely Michel Martin and NPR for getting us all together.

the padres

2011-06-19T21:01:00.002-04:00

Happy Father's Day to one of the best fathers I know.

You will also be pleased to know that Cal has ranked him very highly.

Also, totally unrelated (well, I guess kind of related)--I will be participating in a roundtable discussion tomorrow on the NPR show "Tell Me More" with Michel Martin. The springboard for this topic will be an Op-Ed that ran in The New York Times last week (surely you've seen it), and one of my co-panelists on the show will be Dr. Karen Siebert, the author of that essay. I'm fairly sure that the rountable itself will not be live, but I also expect it will play in the near future, and I know the show also has a podcast that I can direct you to once the segment goes up. If you have any opinions (as I do) about the role of working parents in medicine, you probably won't want to miss this one.

grand canal

2011-06-14T19:48:00.002-04:00

I went to bed last night with the start of an ache in one of my upper right molars. Nothing terrible, but it got worse overnight, occasionally waking me up from sleep, to the point that I realized that I might need to go in to the dentist post-call on Thursday in order to get it looked at.

By early this afternoon, the pain was, shall we say, exquisite. It was like a ball of flaming nails inside my head. It hurt so much I couldn't even think straight. And I knew I was to be on call all day tomorrow, in a job that requires above all that I can think critically and pay attention and be able to make big decisions in a split second without being distracted by the fact that my mouth felt like it was going to freaking explode. It could not wait another two days. So after work, I made an emergency appointment with my dentist, and soaked a gauze pad with lidocaine to mash on my gum over the tooth. (Pathetic topical attempt though it was, it kind of worked, enough for me to drive to the dentist's office anyway.) My dentist, who very nicely carved out a spot for me in his schedule, took one look at my tooth, took one look at me, and promptly did a root canal.

So, that was my afternoon. Well, that, and the fact that I found out, while I was in the dentist chair waiting for the calcium hydroxide (or whatever that stuff is that they use) to exercise its bacteriocidal action on the inner workings of my molar, that my response to Dr. Sibert's Op-Ed in the Times this Saturday was quoted in The Wall Street Journal online. So I guess this day wasn't all bad.

tripping to the light linktastic

2011-06-13T19:20:00.003-04:00

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

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

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

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

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

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

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

oh my stars, another giveaway!

2011-06-11T16:35:00.003-04:00

Long-time readers may be aware that this site is not run for commercial purposes at all (that is to say, I don't run any outside ads) though as a citizen of the planet Earth I do interface with commerce from time to time and as such will occasionally talk about businesses or products that I find particularly delightful. I am also aware that I have turned a good many of you onto becoming drooling, mindless zombie addicts of a site called JetPens, which features stationary products from Asia, and...well, I'm sorry, but it's not going to get much better. (I myself have a relapsing remitting course of the disease.)

A few days ago, Brad from JetPens e-mailed me and said that he'd noticed that I, you know, enjoyed JetPen products (to put it somewhat mildly) and wanted to send me some samples to try out, as well as a gift to pass on to my readers. I said, hmm, I don't know, I don't really have strong feelings about pens and stationery and nerd stuff like that but OH OK FINE SEND 'EM OVER. I told him that much of my readership was medical, and as such, my interest were pens that were precise, smudgeproof, in colors reproducible by photocopy, and preferably retractable. He sent me a few, and to be honest, I haven't really tried the others yet, but that's because the first pen I grabbed was this one.

THIS ONE:

OK, so before you tell me, let me save you the time. I KNOW IT'S PURPLE. That's the one he sent me, so that's the one I'm showing you. It comes in other colors too, so don't, you know, freak out yet. There's more freaking to be had a few paragraphs down. Anyway, my childhood pediatrician wrote with a purple pen through the entire decade I was with his practice (I believe it was a purple Pilot Precise V5, now that I think of it--funny that I can remember that, but I DO) so, you know, it's a legitimate choice. My pediatrician was a delightful gay man with a diamond earring who practiced out of an office in Greenwich Village and who smoked cigarettes in his office--sometimes while we were sitting there, holding his ashtray for him--so I'm not saying it's an orthodox choice, but I loved my Pediatrician and I love purple pens so there you go.

Anyway, let's get down to brass tacks. It's called the Pilot FriXion Ball Knock Retractable Gel Ink Pen in 0.5mm point. Why does it have so many parts to its name, like a member of British royalty? UNCLEAR. But it's a gel pen. It's retractable. The ink is waterproof and (I read somewhere) "alcohol proof." It writes well. But let the pen speak for itself.

Holy shit, guys, it's an erasable gel pen! I DIE. I'd had erasable pens in the past--they were something of a fad when I was in, oh, I want to say the fifth or sixth grade. But this erasable pen is nothing like those sad, sticky, ballpoint pens of yesteryear with their unweildy grey gum erasers packed onto their readily displaced pen caps. First of all, the ink is phenomenal. Smooth, dark, rich, no globs. Just like the best gel ink pens. Secondly, the eraser is amazing. It's not like a pencil eraser at all--it doesn't leave all those little eraser bits to brush away. I think the erasing process actually works by friction (oh, I get it...FriXion! Ah!) and it's the heat produced by the eraser rather than rubbing off bits of ink and paper itself that make the line disappear. But it does erase, and it erases well, as you can see above. How does it work? Do I look like some kind of scientist? I don't know. Therefore, it is MAGIC.

OK, now for the bad part. First of all, I'll probably never use this pen at work, because, well, I don't think you should write anything in the medical record that could be erased. It doesn't erase just from touching it, mind you, but it's possible, over time and with a lot of rubbing, that the line may fade. So that's one. But remember, I work at a hospital--if you don't work at a hospital, or if you use pens for anything that's not archival, I really don't see any problem with it.

Secondly, I think that it is somewhat temperature sensitive, due to the aforementioned erasing capability. I think that if you subject the erased ink to temperatures below - 10 degrees Celsius (14 degrees Fahrenheit), the erased lines may reappear. But that could actually be kind of fun--I'm going to do an experiment later on and write a Super Secret Spy message for Cal that he can expose by sticking it in the freezer. It'll be like Freaky Freezies--remember those gloves with the designs that would appear when you went out in the cold? Anyone? The '80s? Yes well...they were cool. Also, for the opposite reason, they don't recommend you leave the pen in a hot car, or on a tar roof in the middle of the summer or what have you. These are all limitations, yes, but for most people, under most normal working circumstances, it is a really, really cool pen.

And, you know, I would give it away to you, my readers, only Cal has claimed it for his own, and therefore I have to give away this other thing, which is even better.

I have waxed rhapsodic about the Uniball Signo RT UM-138 pens before (I believe Brad noted that they were "my favorite," which is pretty close to accurate), and he sent along this 8 pack in all colors to give away to one lucky reader.

You may have noticed that I had to substitute a black Pilot G2 in 0.38mm point for the original black one that came in the pack, because SOMEONE (I suspect Cal) got into this pack before I could and now I can't find the black pen. But I think I have a new black Signo RT UM-138 lying around somewhere from a previous JetPens foray, so if I find one of those, I'll sub it back in.

I'm also going to throw in, because it's going to be fitting for the rules of the giveaway, one free copy of my book. It's OK if you already bought a copy, you can give it to a friend, because you're just that generous, and, might I mention, good-looking. (I would like to point out, of course, that July 1st fast approaches, and there may well be no better gift for the new intern or resident in your life than this book, which many are calling "the new 'House of God'.") How can you qualify for this fantastic giveaway? I'm so glad you asked.

I've been doing promotion for my book. And I'll not lie to you: it's hard. Book promotion is one of those things that involves lots of time and energy and connections (and, let's be honest: money), and as a first-time author, albeit with a lovely and hard-working team behind me at my publisher who are doing a wonderful job, getting the word out about a book when you're not a Big Name can be difficult, especially in a choked summer market. To be honest, it feels at times like wearing a sandwich board reading "WE BUY GOLD" in the middle of Midtown Manhattan next to a Sbarros as everyone rushes by avoiding eye contact. There might be more that I could be doing, or should be doing, but the thing of it is, writing and this book is not my sole career. So there's only so much time I realistically can spend, you know, pimping myself.

I've been thinking a little bit about guerrilla marketing, which is to say modes of marketing that involve unconventional and imaginative (and often interactive) devices rather than just, you know, a pile of cash to buy ads or shelf space. Nowadays, I'm sure that using social media could be a big part of that kind of marketing approach. So. Here's the dizzle.

Think of some novel and imaginative way to get the word out about my book, which, in case you haven't been paying attention, is called "This Won't Hurt a Bit (and Other White Lies)." If you're doing something online, do try to link to a site that sells the book, and/or the book website. DON'T SPEND ANY MONEY TO DO THIS, I'm not telling you to go broke, I just want your help in trying new approaches and new avenues. Also, don't break any laws. (No murder, you guys.) The aim is to not just to increase awareness of the book, but to get people to want to read it.

Use your blogs, use your Twitter accounts and Facebook, make a funny video on YouTube, whatever. Just don't make it so that people are less likely to read the book after your efforts, you dig? So do some novel publicity, something new and different that we haven't seen before, and then tell me about it. You can e-mail me, with a link or a picture (preferred, so I can keep better track), or you can tell me on Facebook or Twitter. (I am @scutmonkey on Twitter, and I friend all comers on Facebook, so go ahead, just ask.) I will look at all the entries, most likely share them, and pick the most effective one by...oh, you want to say July 11th? That's a month from now, that gives you enough time, right? The winner gets the pens and the book and a personal thank-you note from me on my personal embossed stationery, which is something that I have now because I am a grownup, dammit.

Spread the word! These pens need a good home! Also the books, think of all the poor, orphaned books out there that need nice warm shelves or night stands to sleep on! WON'T SOMEONE PLEASE THINK OF THE BOOKS?

Go! Fly! And thanks!

here, there, everywhere

2011-06-08T21:48:00.003-04:00

So look, a couple of things.

Remember how I have that blog on Psychology Today now about the human face of medicine? I have a new piece up about the vaccination debate and why I take it personally. I would love to have you read it and comment, regardless of what side of the debate you fall on. (If you have a direct comment about the piece, please comment on the Psychology Today site itself, so they can see that people are reading and don't think I'm some kind of a dud whose writing generates zero interest.)

Secondly, I am on call tomorrow. Again! And then the following morning, I will have two radio interviews, one with Dr. Mehmet Oz for his radio show on Sirius, and the other with Greg Berg on "The Morning Show" on WGTD-FM. Only don't get too excited, because both interviews are taped, not live, so I'll need to let you know when they are actually going to be, you know, audible. However, the fact that they are taped will increase the likelihood that they can edit out anything stupid I might say post-call, so really, it's for the best.

it puts the lotion in the basket

2011-06-06T16:46:00.002-04:00

Mack's first day of school went well. I don't quite have the stomach for these kind of drop-off situations, but luckily I go to work very early anyway so that's my excuse. Joe was the designated bad guy, and he said that while there were some tears and low-level leg-clinging in the morning, by the time I picked him up this afternoon Mack was in a good mood and very chatty, which I can only assume is a sign that he had a pretty good time.

The teachers said he didn't nap at the designated naptime though, so we're doing this now. He'll be down for the next three hours, I predict.

(This is a very low-light photo and all Mack's sheets happen to be green, which is why it looks like I'm Jame Gumb stalking him with night-vision goggles in my Kill Basement.)

I was on call all weekend and it looks to be a pretty busy week, but our internet has been down intermittently so I just wanted to take this quick window of functionality to throw something up on Ye Internet and say hi. Hope you guys had a good weekend, and that your week is starting off right.

the cat's in the cradle

2011-06-02T21:06:00.001-04:00

My baby is starting preschool on Monday. MY BABY IS STARTING PRESCHOOL ON MONDAY.

Cal I was a little more worried about when he started school. Cal is shy. Cal is deliberate and reserved, which, in the caveman world of preschool, translates more to getting squashed on. And Cal can be stubborn as hell about change.

But Mack is ready. This kid is ready for school. He was ready months ago. Not that there's not going to be some transition (I still don't think he quite understands that the "school" part of school involves actually leaving him there all day) but he's going to love it and he's going to make friends and he's going to thrive. And honestly the only reservation I have about sending him on Monday is the fact that he's my baby, my little baby who was born just yesterday, so it seems, and I'm just not quite ready to let him go.

psychology today

2011-06-01T20:39:00.005-04:00

You may have already seen this, but I have a new writing gig on Psychology Today, and as my first post, I put up a piece that I've been noodling around for a while, about work-life balance during residency. If you haven't seen it yet, take a look.

It doesn't totally surprise me, though I guess I'd be lying if I didn't admit that it surprised me just a little, the reactions I got to the piece after I posted it. There are some measured responses, some balanced responses, but also some responses that make me realize: wow, some people really feel a lot of generalized antipathy towards doctors. And that makes me kind of sad, I guess. I don't deny that it's a privilege to go to medical school, or that it's a privilege to take care of patients, but I wish...I don't know what I wish. Maybe I just wish that criticisms lobbed towards doctors didn't automatically lead with the assumption that we are all terrible people with icy, cold hearts made of cash registers and human tears. Or that we all drive Lexuses.

(And, for the record, though I feel partially like I'm losing ground by even bringing this up--neither Joe or I drive a Lexus. I myself drive a Toyota Camary that we got from a used car dealer, whose cosmetic imperfections compel perfect strangers to stop me on the road in order to harangue me about body work.)

I put the piece up to talk about the fact that a profession born out of humanism sometimes fails to use humanistic principles in dealing with its own trainees--trainees who are largely idealistic and hardworking and wanting more than anything else to do good. And yet many of the comments I got sort of went in another direction, almost like an airing of grievances about the whole of medical profession itself. So. Three things.

One: I'm really glad I wrote the book I did. If for no other reason to humanize the practice of medicine to the outside, and to let people see what it's like, really like, to be a young medical trainee who, like all young medical trainees, got into this profession not for fame or fortune or the promise of a champagne fountain in their two-story foyer, but simply in the interest of trying to do her very best, for her patients and for her family. Many, many of the people who have read my book already are involved in medicine in some way, but now, more than ever, I'm determined to bring it more to a non-medical audience.

Two: I have no problem with getting comments opposite to my own viewpoint (so long as they are not gratuitously vitriolic), because that's the value of having a system which encourages open discussion. So I really hope that, for this piece and future pieces, that I get even more discussion, on all sides, and that the culture of those discussions is as well-conducted as the ones we've been able to have on this page. Do you have any thoughts about the piece? Why not weigh in?

Three: I'm delighted to have started writing online for Psychology Today, because I'm excited to bring the topics that I care about to a wider audience. The focus of my column on PT is the human side of the medical profession, and I can already see that we're going to have a lot to talk about. So what should I talk about next? I have some ideas, but you guys tell me: what do you want to read about?

sink or swim

2011-05-30T14:35:00.010-04:00

Hope you're having a good Memorial Day weekend, everyone. As we enjoy our holiday, of course let's not forget our brave men and women in the armed forces, without whom this beautiful summer weekend with our families and loved ones would not be possible.

In the States, Memorial Day marks the official start of the summer season, and this makes me realize that the idea of summer, to someone in or recently departed from academic medicine, is very different from the idea of summer held by the rest of the population. For most, summer means school's out. Summer means vacation. Summer means sunshine and barbecues and leisure. But for the eight years that I was in academic medicine (I'm leaving out the year that I was a first-year med student, since first-years usually get their summers off, though they usually spend the time doing something unbearably earnest), summer meant one thing: new beginnings.

The Gregorian calendar begins in January, and most schools from elementary to university begin somewhere in the neighborhood of August/September. But in medicine, the new year always begins towards the beginning of the summer. One chapter ends, another chapter begins.

During the summer, usually on or close to July 1st, everyone in academic medicine moves up a peg. Third year med students become Sub-Is. Interns become residents. Residents become new attendings. New people come in to fill the spots vacated. Everyone is in new roles, figuring out what they're supposed to be doing. Want to know why the conventional wisdom is that you should never be admitted to a teaching hospital in July? That's why.

Here's an excerpt from my book that I was thinking about today, and after the excerpt I'll tell you why.

A sub-internship, or “Sub-I” (as it is known to those of us who cannot get through a sentence without acronym or abbreviation) is basically the training bra of residency. It is a pre-requisite for graduation from medical school, consisting of a month where we assume the patient load and care responsibilities of a first-year resident (or “intern”), albeit with the increased supervision and support required by logic and law. It is a dress rehearsal for the real thing.

In one sense, being a Sub-I the logical progression from being a third year medical student. See one, do one, teach one is one oft repeated credo of academic medicine, and after a year of watching residents in action, it seems due time for us to start “doing” on our own. Sounds reasonable enough. However, the reality of the transition from third-year med student to Sub-I is more like being lifted dripping from a knee-deep wading pool in which beach balls and foam noodles lazily float, and thrown headfirst into the churning ocean, your only instructions being to keep your head above water and not die.

So. Cal learned how to swim today.

He's going to be six in about two months, so he's definitely not, shall we say, precocious in his mastery of water survival tactics. He had all the requisite skills to swim, but mostly he's just been kind of nervous around the water. Didn't like to put his head in. Didn't like to be in the pool without a flotation device. Worried about getting water up his nose. Worried about sinking. I don't think he quite trusted, despite a number of increasingly scientific demonstrations about human tissue and buoyancy, that he would float. Being a bit of a late swimmer myself, I remember that feeling well. But I also knew from my own experience that all it would take was one moment--one leap of faith, or more accurately a second of forgetting his own doubt--for him to realize that yes, he was going to be OK in the water after all.

It's med school graduation season now, of course, and I hope it doesn't sound disingenuous (because it is quite simply the truth) that I often think about the crop of newly minted practitioners joining us in the real world. And look, I don't have any good advice, I'm new enough at the game that I'm still trying to figure things out for myself. But there's going to be a moment for all of you when you look up and realize that you're doing something that you didn't think you knew how to do. That something you practiced and practiced and practiced somehow, likely while you weren't paying attention, became automatic. That in the recesses of your brain, you actually knew something, remembered something, that will help an actual patient in your care. It's that moment--the leap of faith, the forgetting of your doubt--that's going to make you realize something that you're only being told now and may not quite yet believe.

You're a doctor.

Welcome to the team.

these are all good questions

2011-05-29T20:04:00.004-04:00

CAL

What is "Ribs Et-cuh?"

MICHELLE

Oh, that says "Ribs Etcetera," it's a sign for a barbecue restaurant.

CAL

Why does it have a pig on the sign?

MICHELLE

Because that's the kind of meat they serve at the restaurant, honey.

CAL

They serve pigs?

MICHELLE

Well, you know, different kinds of meat come from different animals. Like remember,
how steak comes from cows, and how chicken comes from, uh, chicken?

CAL
Yeah.

MICHELLE
So the meat that comes from pigs is used to make a lot of things,
like bacon, and ham, and ribs, which is one of the things they serve at that restaurant.

CAL

Oh.

(There is some silence.)

CAL

So how come the pig is smiling?

MICHELLE

Uh...

more text message exchanges in the two doctor household

2011-05-27T20:20:00.001-04:00

JOE
How's it going?

MICHELLE

Good. Finishing a case now. You out of the OR?

JOE
Yup.

JOE
Totally nailed a big cosmetic reconstructive case today.

MICHELLE

You should really use sutures, not nails.

JOE

D'oh!

hoarders

2011-05-26T15:05:00.002-04:00

There's this stroller that Joe keeps getting after me to put on Craig's List, because all it's doing is taking up space in our house, and neither kid has used it for the purposes of transport in the past year and a half at least. Atlanta, unlike New York, is not a real stroller-intensive city. There is occasional use for a stroller, like at the zoo or something, but on the whole, Atlanta is so car-centric that it's not like New York, where everyone has their one-hand-fold umbrella stroller that they carry, kid and all, up and down the subway steps. Especially now that Mack is older, he really doesn't need a stroller, unless we're doing a lot of walking, which, as I think I just noted, just doesn't happen in Atlanta, unless you're the kind of person who just walks to and from places for no reason at all. (Yes, yes, I know, "exercise.")

I don't want to sell the stroller. I resisted selling it before we moved, and now that we actually have moved and the stroller is just becoming more and more obsolete, I'm still resisting selling it, though I really can't come up with a real sound reason why. It's a good stroller. We got it when Mack was born. It's a double stroller, the kind where you can put one bigger kid in the front and one smaller kid in the back. It's a narrow profile, so it's good for cities or supermarkets. It's a nice bright green color, so it's highly visible to oncoming traffic and to satellites in outer space. But it's pretty much strictly ornamental at this point. No one uses this stroller. It's just sitting there by the front door, holding a pile of winter jackets. If we sell the stroller, we could use the money we get in exchange for goods and services.

But I still don't want to sell the stroller.

See, the thing is...we have two kids. I love my two kids. I really can't imagine having a third kid, nor, honestly, can we really afford it at this point, time or money-wise. But. But. When I think about selling this stroller, selling this perfectly good double stroller, I keep thinking, "But if we have another baby, we can put the baby in the back and Mack can sit up front!" Are we trying to have a baby at this moment? Not even close. But might we, at some point, decide to have a third kid? I think I'm more open to that option than Joe is at this point in time, but I think we'd both agree that we won't rule anything out. But given that, given the possibility, wouldn't getting rid of this stroller, this perfectly good double stroller with an infant attachement in the back, be kind of a waste?

Yes, I know I can sell the stroller so it's not sitting in my front hallway taking up space. I know that if and when we decide to have another baby (and by no means is this a foregone conclusion) we can just get another stroller. Think of the stroller technology as it might be in the future! They might have strollers that hover and steer themselves! Also, robot nannies! So I should just sell the old stroller we have, right? The double stroller into which Cal can't even fit anymore. Which Mack wouldn't even deign to sit in at this point. I should sell this perfectly nice stroller, take the money, and use it to buy some school clothes for Mack or a new lunchbox for Cal or something that we really need.

But I still don't really want to sell the stroller. Make of that what you will.

on dreams

2011-05-25T09:25:00.004-04:00

The night before I return to work after having been on vacation, I always have an anxiety dream about anesthesia. It's something that I hoped I would outgrow, and I guess I have to some degree, since for the entire first six months of my anesthesia residency, I had anxiety dreams about anesthesia every single night. Most of these dreams had to do with the standard things that residents are anxious about--I had dreams about machine malfunctions, patients sitting up on the table in the middle of surgery, leaking canisters of volatile anesthetics that rendered me unconscious before I could reach the machine to turn it off. But some of the dreams I had early on were completely nonsensical, like the one where I was at an airport and I was called upon emergently to resuscitate a sea lion. Why was I in an airport? Why a sea lion? If this implies anything unsound about my state of mind, please also remember that I also had a young infant at the time, and the very fact that I was even able to sleep deeply enough to dream was a triumph in and of itself.

So anyway, the dream I had Sunday night was that I had to put a thoracic epidural in my own grandmother. To what purpose it was unclear, but I do remember having to sit her up on the OR table and prep her back with Betadine while explaining to her in Cantonese what I was doing. Aside from the construct, it was actually a very realistic dream, and when I woke up, I had to orient myself for a few minutes to decide whether or not my work day had ended or whether it was just beginning.

What anxiety dreams do you have about medicine? Have they changed over time? I would like to think that they will, or that I might at least at some point in my life be able to go on vacation without having to count on one full night of tossing and turning and dreaming with a pulse-ox tone backbeat. But it's been more than 15 years since I last took a math class, and I still regularly have dreams about showing up for the big calculus final having not attended a single lecture (it's always something where I forgot that I registered for the class, and didn't realize it until the Add/Drop period had ended), so I don't have real high hopes that my medicine anxiety dreams will ever fully go away.

the life aquatic

2011-05-22T16:33:00.003-04:00

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

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

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

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

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

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

That is all. (Thanks, Veronica!)

you guys!

2011-05-18T12:40:00.007-04:00

I flew back into Atlanta early Tuesday morning, on a 6:00am flight out of Logan. It had been a while since I had been in Boston (I actually don't think I'd been in Boston or even anywhere near it since college, which seems like it should be that long but was, in actuality, almost twelve years ago), but aside from the weather being ridiculously cold and dreary, it was exactly as I remembered it, including the automated voice on the Red Line on the T which informed me that "Charles/MGH" was the next stop for, like, three stops in a row.

The book events, all of them, were great. I had conferred with a few friends in the writing business beforehand about the very fact of doing any live book events, and one of them in particular (my friend from high school Deanna Fei, whose book is out in paperback now) told me that she had been told that one is not a "real author" until they have a book reading at which only two people show up, and one of those two people is the author's mom. So I had some real fears that this might happen to me, and that I would just be crushed because, you know, I just spent six days away from my kids in order to do all this stuff.

But you guys! You guys really made it worthwhile.

This was the turnout at The Coop in Cambridge on Monday. It was a great venue, and it was actually the only venue at which they set up a podium with a microphone, which was perfect, because after the other two events and doing all those radio interviews, I was kind of starting to lose my voice. I can't help it, I'm not much of a projector when I talk, usually I'm using my dulcet tones to soothe, like Smoove B.

The book tour (short as it was; I wouldn't have minded going to more cities, and maybe in the future I will, depending on how my schedule and how things with the book are going) was so much fun. Even the smallest event, which was in Philly, drew more than 20 people, and even if one of those people was clearly there primarily to eat cheese and drink free wine, he was at the least very attentive, and if I may say, his large beard was magnificent.

It was fantastic to meet so many readers, of course--and I was impressed because some of you guys have been reading for a long time, I had more than a few people come with their old copies of Issue #1 (and only) of Scutmonkey Comics, very old skool. (Fair warning: clicking that link may cause cortical blindness. White font on a black background with hot pink accents--mistakes were made.)

But what was really amazing was to have the chance to connect with the many, many old friends that I picked up along the way. In the course of my six days on the road, I caught up with my family, and some of my oldest friends from high school, college, med school and residency. Guys, I had dinner in Boston with my old Orgo professor and my old pre-med advisor, and we talked about our kids, like I was a grown-up person or something. It was like "This Is Your Life, Michelle Au" Blew my mind.

And I think that's what I got out of the book tour most of all. The events were a blast, and I can only hope that it's going to help the book get some buzz or traction in this busy summer market (speaking of which, my book makes a pretty awesome graduation present, if you happen to be choosing between my book and, like, Betty White's new memoir) but most of all it reminded me of how lucky I am to have so many amazing people in my life, and that where you've been is just as important as what comes next.

OK, I've got a ton of catching up to do right now, but more soon. And thank you again to everyone who came to my book events, it really meant a lot to me to see you all there. Don't forget, people in the Southeast, I still do have one more book event tomorrow evening, 7:00pm at the Atlanta History Center. Information can be found here or here, RSVP to reserve a spot, or you can buy tickets at the door.

the hometown crew

2011-05-12T15:26:00.000-04:00

The book event in NYC last night was...well, take a look.

The event was awesome. I was a little concerned about attendance beforehand, because it was a Wednesday, and a little early for some people getting off work, maybe a little late for others. But the turnout was fantastic, we pretty much sold out all the books in stock, and the discussion afterwards was really good. Thanks for coming out, New York!

(Philly, are we going to be having some fun too? Come on then! I'm a little anxious about Philly because it's the city that I begged to have added to the tour but also the only city where I've never actually lived or gone to school. But Philly is such a great medical town and so close by that I just couldn't image passing up the opportunity to meet some of you in person. So...see you tomorrow? And bring your friends! All 500 of them!)

Before the book event I swung up to Washington Heights to visit with some folks and visit the med school. You know what? It's exactly the same. Kind of grim, kind of imposing, with a lot of people in white coats walking around. Feels like I never left.

I would have taken more pictures but there were so many people walking around that I probably would have gotten plowed down if I tried. Luckily, some assiduous readers helped me out with this one:

(Thanks, Valerie L.!)

Anyway, I'll be heading to Philly tomorrow, where I'll be spending some time with my old friend Tammy, who has the distinction of being the person who convinced me to switch from Peds to Anesthesia in the first place. We're going to the famed Mutter Museum (of Medical Marvels?) before the book event that evening, and if you don't think I will live-Tweet that shit, then obviously you don't know me at all.

Finally, a few more pictures of the book out in the wild. Thanks to everyone for sending them in, I can't fit them all in this entry, but I picked a handful that were fun.

In honor of the first scene in the book, which some of the morning radio interviewers from today laughingly said they deliberately avoided talking about in great depth (heh) in case some of their listeners were still eating breakfast. Thanks, Sangeetha!

Here we are, atop the CN building in Toronto, which is apparently the tallest building in the Western Hemisphere. Lofty! By the way, reminds me of this: On Old Olympus's Tower Tops, A Finn and German Vied At Hopps. Quick, what is this mnemonic for? And why do I still remember it? Ah, the sticky and sometimes random power of memory. (To be clear, yes, I do still kind of need to know this, and the mnemonic helps.)

Monkey see one, monkey do one. Now we just need a shot of the monkey teaching some other monkey how to suture banans. IT'S THE CIRCLE OF LIFE.

Finally, this last one (thanks Mingle!) is for Cal and Mack, who both LOVE "Angry Birds," which Cal can play with some skill, although Mack mainly just slingshots most of his birds backwards or straight into the ground. Which is a good segue to point out that the book is available in all e-book formats now! Instant gratification, ho!

Thanks, everyone. See you tomorrow in Philly, and then on Monday in Cambridge. Surely there will be some sort of yard nearby in which to park your car.

pub date

2011-05-11T11:49:00.001-04:00

I had mixed emotions as I headed for the airport this morning to start the first leg of my book tour. I'm happy that the official publication has finally arrived of course, and the idea of doing publicity is kind of exciting, in the way that novel things are exciting. But another part of me is kind of sad, leaving my kids for six days. I know six days isn't a hell of a long time, but that's all relative. And for a two year-old that lies in bed every night clutching a hank of my hair, brushing the wisps against his cheek while murmuring, "Hair...hair..." it might seem like an awfully long time.

(Does that sound creepy? He's a baby. Not creepy. But if he was a grown-ass person, yes, kind of weird.)

Even as a resident, I never spent more than 36 hours away from my kids (well, singular "kid" at the time), and the first time I spent even more time away than that was a few weeks ago when I went to Iowa City for 48 hours. So this is...a longer trip. Six days.

But I really wanted to do this and I think it's important (or at least, I hope it is) to do some in person events in big medical cities and at least start to thank some of the many, many readers that are generating good word of mouth for the book and making sure that it's going to be a success. So let's make it count! Come on out to the book events, tell your friends, drag along your relatives, whatever. Or else I'm going to have to tell my kids that I spent six days away from home in order to sit on a series of folding chairs in various bookstores while pretending to check my email.

See you guys at the Columbia University bookstore (116th and Broadway, thereabouts) at 6:00pm tonight, and for a drink and some giant haggis-looking burritos at The Heights afterwards. And if you're in Philly, join us for the event this Friday the 13th at the Penn Book Center. FRIDAY THE 13th. Like I said before, I can't promise that the reading won't prevent you from being crushed by a falling piano, but IT MIGHT. Not worth the risk either way--just go to cover all your bases.

Oh, and you know the book has finally gone live for the Kindle and the Nook, right? Oh good. Also, the bookmarks giveaway is officially closed, thanks to everyone who e-mailed me and who pre-ordered the book before today. I'm working on getting those bookmarks out in a timely way, but there are a lot of you guys, and that's a lot of notes to write and envelopes to lick. But never fear, I'll get them all to the post office eventually.

radiolucent

2011-05-08T20:08:00.000-04:00

Hey everyone, hope your Mother's Day was swell. And thanks again for all the great photos you've been sending me--I have them all saved, but I'm going to preempt them for this series, which I received from Bea, Eve, Jess and Tony, some of my old friends from med school. They got quite into the spirit of things, as you can see. AND I LOVE IT.

Here is my book getting a mammogram. Or rather, my book as a boob.

And here Natalie, a patient care assistant, demonstrates that reading my book can make getting a mammogram a slightly less unpleasant experience.

Tony, my old med school classmate, poses in the CT scanner with his copy.

And Bea, who's actually in the book (she's the one who compares med school to being in the army) gets a brain MRI while reading. Now if only it was a functional MRI, so we could see which areas of the brain light up. (My guess: the hippocampus, and the amygdala. Neuroanatomy humor, hey-ooooo!)

This one I thought was super-cool: my book in the MRI coil. See how the suture needles are attracted to the MRI field, and are getting dragged into the coil? I get really paranoid about that every time I have to administer anesthesia in the MRI scanner--I keep having this vision that my pen or something is going to shoot out of my pocket into the coil and stab someone.

Hello, other authors. Have you had your books examined under fluoroscopy? Pity. IT IS AWESOME.

Luckily, the scan came out clean. Radiolucent as the driven snow, baby.

Bea was right, by the way. Med school is like the army. I mean, there's no actual warfare (for the most part), but you're working hard and going through some physically and psychological hardships with the same group of people for four years, all while charged with a greater sense of purpose. And it really affects the quality of the relationships you form with people during those four years. I met my best friend in med school--later, I married him. There are friends I have from med school that I know I'll keep in touch with my entire life. Because we've been through the fire together and emerged intact. We did it together. And most importantly, we had fun.

Anyway, that's something I want to convey to people who are pre-med right now, or in med school, or going through residency. It's hard, but you have people around you, and you're doing it together. Don't forget to have fun. Because that sense of fun is what's going to carry you through, and it's what's going to meet you on the other side.

Thanks, Bea, Jess, Eve and Tony! I admit, getting that photo montage from you guys made me tear up a little bit, and I am not a person who habitually tears up at stuff, with the exception of "Toy Story 3," because good lord, I'm human after all.

* * *

Hey, do you have a radio? Do you live in the Southeast? Well then, listen to me on the radio tomorrow! I will try not to embarrass anyone! First at 8:20am on KFRU-AM out of Columbia, MO on the David Lile Show, and then at 9:35am on WRVC-AM out of Huntington, West VA. (The website for WRVC-AM does not seem to be displaying correctly on my browser, but maybe it's just me?) It's live radio for both shows, so watch it in the same spirit that you watched that live episode of "30 Rock," 50% out of actual interest for the topic, and 50% for the bread and circus and the excitement of me slipping up and saying something irrevocably dumb. I LIVE TO ENTERTAIN YOU.

Also, let me point out that I added a meet-up for after the NYC event this Wednesday at the Columbia University bookstore. So after the reading, let's say around 8:00pm, we'll meet at The Heights, which is about a five minute walk away. It's a nice place and they have a nice rooftop bar, and yes, yes, I know, it's a Wednesday and you have to get home to study (or whatever)...but have have to eat anyway, and it's not like we're going to keep you out all night and get you wasted or anything, just stop by and relax with some harmless pleasant nerds. It'll be pleasant and I guarantee that taking a few hours off on one night will do more for good for your brain than studying all the rest of the entire week.

I'm shipping out bookmarks in the middle of next week. Even though the book is widely available at this point, I did say originally that the bookmark giveaway was for all orders prior to May 11th (which is the "official" publication date), so that offer still stands as is. You still have a couple of days to get your free bookmarks and a personal note from me, so if you were waiting for some reason, go ahead an order the book and then e-mail me to let me know you did! I will mail you one bookmark for each book you order prior to Wednesday, so yes, if you order ten books, I will mail you ten bookmarks. Need I also point out that it makes a wonderful graduation gift? Much better than a polyester stuffed bear wearing a mortarboard, I can tell you that right now.

mother's day 2011

2011-05-07T16:16:00.001-04:00

Hey everyone! Happy Mother's Day!

Cal made me a card this card at school.

Here's what was inside.

At first I thought he wrote that I was "3D," but then realized that he wrote that I am "32." Well, both are technically correct.

This was a little off. I'm not sure if he wrote that I weigh 15.5 or 155, but just for the record, the latter puts my BMI at almost 150. Time to lay off the donuts, shorty.

Mother's Day is a little forced for my taste, and I would never mandate that anyone celebrate it, especially for my own sake, but since it is almost Mother's Day and the occasion presents itself, I would like to say that there's no better present than these two boys.

And if only I had some arms, I'd hug them both.