liquid schwartz

Well howdy. Explaining why this blog hasn't been updated is only slightly more boring than reading the blog itself, but in short I had to give Grand Rounds last week, and since I couldn't work on Grand Rounds at work or while my kids were awake, basically every free minute I had up until last Wednesday was channelled into that presentation. Thankfully, it's finished! Now to resume my life of indolent goofery!

You may also be disappointed to know that I ultimately decided against using the "Exorcist" slide in the talk (Factor 1: too early in the morning, Factor 2: Catholic hospital) but it may please you equally or maybe even more that I did use this slide as an opener:

(He's his own best friend.)

*          *          *

As a brief and unsatisfying epilogue to the fractured (ho) story of Cal's clavicle, these following addenda:

Right before Thanksgiving, I reached out to the principal again, asking him if he could give me an update on his conversation with the school nurse after the incident. Given my background (and recall that I trained for two years as a pediatrics resident prior to anesthesia) I also offered to sit down with the nurse and work with her on a standardized medical policy for parent notification--if, of course, they wanted my help.

He responded...well, let me just copy and paste the body of his response email in its entirety.

"Thank you for contacting me regarding your concerns. Yes, I have communicated with the school nurse and the district supervisory nurse regarding the incident. Additionally, we have discussed and developed a plan for proper notification to parents."

(Signed, Pally Von Principal.)

Note, no actual elaboration of what this "plan" is, nor any perspective from this nurse herself. So...basically a deflecting non-answer, right?

Also (and I probably should have noted this in the previous entry so as to not seem quite as much like we are raising a doormat) the day of the injury, after he got home but before we went to the ER, Cal and I had a little talk about self-advocacy and appropriate responses. And I basically told him that grown-ups aren't always right. He had just finished reading "Matilda" a few months ago, so I referred to that a few times, how Matilda was oftentimes smarter than her parents and how Matilda's headmistress (The Trunchbull! The chokey! Oh man, I really love that book) was usually wrong. And that while he should obviously always be respectful of adults, if he felt strongly that something was amiss and that the adults taking care of him weren't taking it seriously, he should request to call his parents regardless. Then I quizzed him on our cell phone numbers. Then I crammed more Tylenol in his craw and tried to figure out his NPO status.

Anyway, all's well that ends...if not well, then at least eventually.

*          *          *

Well, now we're all caught up, but now I realize that I didn't actually tee up anything fresh to talk about today. But instead of pushing save and kicking this half an entry down the road like a tin can, I'm just going to slap it up with a promise that I will put up a real entry soon too. I do, in particular, want to write a little something about Nina, in particularly about her Girlness and Christmas shopping for her, and this strange feminist guilt I have about getting her real girly things. And then the strange feminist guilt I have about considering dolls and their accoutrement "girl things" because boys can play with dolls too, patriarchy! Though I wish that I could find that same stroller that Cal had when he was Nina's age, because damned if they don't just make everything in pink now.

(Above: Cal and some rando kid, circa 2006. This was back when we lived in Manhattan of course, so while such playground spaces and pocket parks came at a premium I would just like to point out how much more I prefer this kind of rubberized flooring to the default "mulch and wood chips" surfacing that seems to be the standard playground-issue here in Atlanta. It pushes up your minimum age to enjoy the playground by at least 6 months, between waiting for your kids to walk well enough and making sure that they're not going to eat all the wood chips when they do fall. Though high-fiber gluten-free diets do seem to be quite popular these days, don't they?)

prokinetic

Hello gadabouts! Sorry for the recent long-form radio silence, but my current schedule allows a few hours each week for generative activities, and two weeks ago it occurred to me that I was scheduled to give Grand Rounds to my department at the beginning of December. Am scheduled. Also, we don't technically call them "Grand Rounds," rather "Education Lecture" or (perhaps more to the point) "CME-Getting Exercises"; but I just continue to call them "Grand Rounds" for ease of reference.

Upon hearing that I was giving a lecture soon, and perhaps more thrillingly, that I would be giving my talk off a series of PowerPoint slides (well, Keynote if you want to get brand-specific), Cal got very excited, because--and I don't know if I've ever shared this particular quirk of his on the blog itself--CAL LOVES MAKING POWERPOINT SLIDES.

CAL

What are you doing? Can I help? Maybe I could make your slides for you!

MICHELLE

Well, maybe I'll pick a slide or two and you could help import the images or something, but a lot of it I think I'm going to need to do myself, because it's kind of technical. You know, science-y.

CAL

Like what?

MICHELLE

Well, like I have to look at a lot of scientific journal articles, and pick the information to present, and it might be a little complicated for you to understand at this point.

CAL

I can do that. What's the talk about?

MICHELLE

Well, it's about developing a standardized protocol for treatment of postoperative nausea and vomiting.

CAL

What's that? The last part, I mean.

MICHELLE

Postoperative...well, it means...sometimes after people have surgery, they feel nauseated, and they barf a lot. So it's about what kind of treatments we have to prevent barfing.

CAL

Your talk is about barfing.

MICHELLE

Well...kind of, yeah.

CAL

(Reverently)

Cool.

So anyway, my point being that the few hours I've had per week for generative activity has been shunted away from the blog and towards getting my barf talk together. Of which I've spent maybe way too much time deciding (between wading through RANDOMIZED CONTROLLED TRIALS and META-ANALYSES and CONSENSUS GUIDELINES of course) whether I should include this picture on one of the slides.

So...probably no, right?

*          *         *

Well, in other news from the world of Cal:

As some of you may already know, two weeks ago Cal broke his left clavicle at school. He's fine, didn't need surgery (as you can see from the film there is clearly a break but it is not displaced) and just needs to wear a sling for three weeks while avoiding cage-fighting for six weeks total. 

Cal's story is that he and a friend were playing tag at recess, when another kid ("A fifth grader," he told me ominously, as if that explained EVERYTHING) playing a parallel game accidentally tripped him mid-run, and down he went. And that's fine, these things happen, I'm certainly not blaming anyone (Cal, the fifth grader, any of the teachers) for the fact that Cal broke his clavicle, because that's what happens when you don't encase your kids in a Beanie Baby box and perch them on a shelf For Display Purposes Only.

I also don't blame the school nurse for not making the diagnosis of a broken clavicle when he reported to her office after recess, though--and I say this charitably--it was not a subtle diagnosis. Or...well, you tell me. A kid falls hard onto his left shoulder on the concrete of the school playground, a fall witnessed by his teacher, after which point his shoulders are asymmetric (like the left one is significantly lower than the right), he can't lift his left arm, and is crying about pain while pointing to the exact spot over his left clavicle where a clear angled deformity can be seen through the skin. Even so, I don't begrudge someone for not making that diagnosis, as clear as it may have been to me and anyone (including, may I add, the twenty or so elementary school kids who were shouting at me out the schoolbus window, "Cal broke his arm at school today!"). School nurse? Maybe more attuned to diagnosing disease of the infectious and rapidly-spreading variety than the orthopedic? Fine. I'll give you a pass.

But what I do mind? I do mind that fact that I didn't get a single call about Cal's injury--not one single call, text, e-mail, anything--and in fact did not know anything had happened until I picked him up at the bus stop and received him wincing down the bus steps, in tears, his friend carrying his backpack for him because even a fourth grader could tell Cal could not carry it himself. That the school nurse basically told him to walk it off and sent him back to class, where he sat for two more hours with a broken clavicle without me or Joe--both of us listed as emergency contacts and both of us never without our cell phones--getting single call so that could pick him up, check him ourselves, and cram in some Tylenol before taking him to the emergency room for a plain film to confirm what we could clearly see with our non-X-ray vision. THAT I DO MIND.

After he got back from the ER and we knew that he didn't need surgery, I wrote an e-mail to the principal to let him know about the situation. And again, I wanted to be perfectly clear what exactly it was that I was upset about. As a medical professional, I am more than aware about the perception of Asshole Patient Syndrome--namely that medical people sometimes expect unreachably high standards on their own medical practitioners, and can be, well, assholes about their own care or the care of their children. I reiterated that I was obviously holding no one to blame for Cal's accident (I think I may have used the phrase "these things happen" not one but three times in that e-mail, mostly as code for "DON'T WORRY I'M NOT GOING TO SUE YOU") and I again reiterated that while the fracture was quite evident, I did not hold the school nurse to the same standards of diagnostic acumen as an ER nurse or even a first year medical student. Fine. Maybe it wasn't obvious when it happened. Maybe it looked worse three hours later. Whatever. 

But I made a strong point that I was very dismayed (while, I hope, aggressively maintaining the mien of cordiality tinged with disappointment about the school's interpretation of in loco parentis) that although this was the kind of injury we should have been informed about, preferably close to the time it happened or at least at the point that he was in the nurse's office; we did not hear one word from the anyone at school even after that downward dog-shaped clavicle ambled off the bus in a miasma of osteoblasts and tears. In fact, if I hadn't e-mailed them, I probably would never have heard about the event, except from Cal himself. 

And frankly, we might never hear about it again. I just suggested to the principal, nicely (I thought) that he review with his school nurse what kind of medical events should trigger a call to a student's parents. He e-mailed back (addressing me as "Dr. Au"--I specifically did not make a point that Joe and I were medical professionals for fear that it would come off badly but either he knew that from our file or he saw it in my e-mail footer) that he would "look into it." And I can only assume that he has, since he hasn't e-mailed me back any follow up since. 

In the weeks that have followed, whenever I pick up Cal from school and walk by the administration, all of them know his face (or perhaps recognize his sling) and exclaim to him with bluff cheer, "HEAL UP THERE, BIG GUY!" and "LOOKING GOOD! FEEL BETTER!" But never, not even as an aside to me, has anyone ever mentioned any kind of addendum to our e-mail exchange, or apologized to me for not being contacted in the first place. Honestly, I don't even want an apology at this point for not being called, because that's somewhat beside the point. But some follow-up would be nice.

So my question is this: what would you have done in this situation, keeping in mind that I don't want anyone to be punished or lose their jobs or anything like that--I just want to make sure that no other kids break bones or have seizures or swallow chicken bones and have to sit writhing in class for two hours. Also: do you think that the fact that Joe and I are doctors makes any difference in a negative way, in the sense that it gives the impression, warranted or not, that we are holding the school nurse to unfairly high standards? 

Please to discuss.

car talk

I had to take my car in for some maintenance earlier this week. (Not the suburban kid hauler, I already took that one in a few months ago, this time it was the car that I usually drive to work, a 2005 Toyota Camry that we bought used about four years ago and which has been remarkably reliable since, despite the fact that I rear-ended it squarely with another car the very next morning after finally getting my driver's license.) I had a flat back tire after rolling over some kind of screw, and while one would think that changing out a flat tire and putting on a spare would be the end of it, apparently I still had to take the car in to get a real tire on (the spare is not a real tire? Why?), replacing the spare in my trunk, and getting the wheels realigned.

This is exactly what I told the car people to do, but for some reason they took the liberty of hooking my car up to the FREE 27 POINT DIAGNOSTIC ROBOT (note: I did not ask for the robot) and shortly thereafter came into the waiting room with the lugubrious mien of someone about to inform me that my car had rectal cancer. Because apparently my car also had a (something something) leak, which was important because the (something) fed water to cool the engine (something something), not to mention that the (something) was missing four (somethings) requiring the whole works to be replaced, not to mention that steering (something) was totally jacked up and in sum, my car was destined to explode into a thousand fiery pieces unless I shelled out $3,500 to get all that stuff fixed.

THREE THOUSAND FIVE HUNDRED AMERICAN DOLLARS.

Leave aside the fact that I just came in to get my tire changed. Also leave aside the fact that we bought this car used (though in excellent shape), so the total of the repairs proposed was more than a third of the price we paid for the car itself. Finally, apologies for the totally hackneyed "girls don't know nothing about cars" routine that I am personifying here--lots of ladies know a lot of stuff about cars, including how to change their own flat tires, but please forgive my stereotypical hand-fluttering in the face of impending automotive maintenance because I really, really know nothing about cars, INCLUDING HOW TO DRIVE ONE until about four years ago.

The mechanic left me with the price quote in that I'll let you have a minute to compose yourself way, saying that if I wanted to get everything fixed I would probably need a loaner to drive home so he would go ahead and get that for me. (He then added, with a tone of infinite largesse, that the loaner would be provided to me free of charge.) After unfreezing myself, I went to chase after the guy, because given that I had detected absolutely no problems with the driving and reliability of the car aside from, you know, the flat tire for which I came in, so barring any immediate safety concerns I would at least like some time to look over the diagnostic report and get a quote from a second car repair company.

Ten minutes later, he returned with the loaner. I told him that I'd like to hold off on repairs until we could get a second opinion. He looked at me for a beat, then called to the back workshop, where I assume my car was being fed through an MRI. "Yeah, the customer wants to hold off on the repairs. Uh huh. Oh. Really? Wow. Did you already...oh. OK." He turned to me. "They already started working on it. They took the water pump off the (something something) already."

"Already? Can they...you know, put it back?" More phone conferrals. The mechanic then told me that they could indeed put it back, but that I was lucky because they hadn't taken the (something) off the (something) yet, because (something something) antifreeze everywhere!

"I would like my car back please."

Any hour later, it was returned to me, with the new tire, which was the only thing I wanted changed in the first place. The following morning, Joe took the car to a AAA down the street from us, where they hooked the car up to a FREE 36 POINT DIAGNOSTIC ROBOT--nine more points than the other robot!--and found very little wrong with the car at all. (Joe brought the service list and the quote from the first place so he would know what to ask them to check extra carefully.) They replaced some of the missing (something somethings--like some kind of a bolt) and swapped out another (something that was dirty), but in all the bill totalled $500, which, while still a lot for a car that I wasn't intending to have serviced at all, is a far cry from the $3,500 that I was originally quoted.

And now here's the question for you. How much of it was bad luck of the draw at that first car place, and how much of it do you think is the fact that I (know-nothing-about-cars lady) took the car in to the first place, and Joe (know-little-about-cars-but-looks-like-he-does man) took the car in to the second place? Unfortunate happenstance, opportunism, or a little of both?

(Aside re: the post title. I love NPR as much as the next PBS-pledge-drive-canvas-tote-lugging-to-the-farmer's-market liberal, but there are two shows that I could never, ever get behind despite the fact that everyone else loves them dearly. One is "Car Talk." Those braying Boston accents! Why not just sharpen a pencil in my ear? And the second is "A Prairie Home Companion." Not only is it aggressively folksy, but it actually isn't funny at all, and you get the sense that the people in the audience will just laugh at anything just to show each other how cultured and good-humored they are. Bah!)

recalibrating

I know there's a touch of irony in adding this disclaimer given that I haven't updated this blog in, like, half a year, but: LONG ENTRY AHEAD.

There's a snippet of a cartoon I remember from my childhood--I can't remember if it was "Tom and Jerry" but if it wasn't it was in a similar vein--where a mouse is reclining in a hot tub. He's sitting back with his arms along the rim of the tub, maxing and relaxing as cartoon mice do, wearing that look of smug satisfaction he was prone to. (As an aside: I never liked Jerry. I always thought he was a real jerk to Tom, a cat who was just fulfilling his evolutionary imperative after all. Ditto Road Runner. Ditto those capering harpy kids that keep taking the Trix away from the rabbit. JUST GIVE HIM A BOWL, YOU ASSHOLES.)

So anyway, the mouse. He's enjoying the hot tub. He's relishing the water, the heat. But the water starts to get a little bit hotter. And a little bit hotter still. Suddenly it's not so comfortable anymore. Not hot enough that he wants to get out of the tub or anything, but just...hotter. He starts sweating. His fur starts getting a little frizzy (from the humidity, you understand). Then, finally, he turns around and notices the cat behind him, slicing onions and carrots to add into the now boiling water. (My memory of this part is not quite as clear, but the cat may have been wearing a chef's toque.)

I've thought of that cartoon clip a lot in the last year.

But let me back up for a second.

If you've ever followed this blog with regularity in the past (though I'm sure with my sporadic updates I've winnowed that number down to only the die-hardest of die-hards) you've probably noticed that I haven't had the time to write much of substance since I went back to work after my maternity leave last September, and that I haven't updated basically at all since December. The reasons are all those that you could probably expect: busy job, three kids, and the responsibilities and duties associated therein. The explanations are always boring because everyone's reasons for being busy are pretty much the same, but to put it in medical terms: it's just a matter of triage.

It's hard to know where the tipping point was--though I have to presume that it was at least in part associated with the addition of our much-beloved third child into the mix--but at some point in the last year, things started getting hard. Not impossible, not un-doable, but subtly, Joe and I started to notice just how tight things were getting. Time was tight, at home, with the kids, with each other. Emotional resources were tight. Patience was less of a resource we could reliably depend on. The days and weeks started becoming these things that we were enduring, rather than living, let alone enjoying. Again, the imagery from an old movie comes to mind--inmates in a prison, grimly notching off yet another day on the wall of their cell.

I don't mean to imply that our life is a joyless dirge--far from it. We love our family, we love our jobs. Even working the hours that we do, we try carve out quality time when we can--long weekends, holidays, family vacations where they fit in. We bolus our family time because our basal infusion rate is so parsimonious, but we do make an effort to compensate. And we liked to tell ourselves that this bolus dosing was sufficient, and it worked...not well, but well enough.

But it didn't change the fact that over the past few years, and over the last year in particular, the feeling of our everyday lives becoming something that we were tolerating started to feel more an more pervasive. When you only see your kids for an hour or two at the very tail-end of each day, only to perform the most basic of maintenance for them (bath! brush teeth! yell at them for not taking their baths and brushing their teeth quickly enough because I'm tired and they're tired and everyone's tired so LET'S ALL GO TO BED AS SOON AS POSSIBLE) you start to feel like you're consisting on a diet of discarded crusts in an otherwise empty pizza box. Maybe you can piece together a life in these scraps of the day, but split between three kids, it's simply not enough time.

Joe and I have been discussing for years our long-term outlook for modifying (read: decreasing) the work hours for at least one of us to have more time with the kids, and for the longest time, our party line has been: soon. We're going to do it soon. "Maybe in a few years or so," was the stock phrase. But there was always the next thing. We'll think about it when I finish my fellowship. We'll figure it out it when I get more settled in my job. We'll do it if I make partner in my group. Later. We'll do it. But later. Meanwhile, time marches on.

Then: I was talking with one of my partners at work a few months ago. He has four kids, the oldest of whom had just turned eight. "I just realized," he said as we were chatting in the front hall of the OR, sidestepping a stretcher careening down the hallway from the PACU, "that he's eight. In another eight years, he's going to be in high school, driving, getting ready to go to college. Half my time with him is already done. I mean, they come home after they go to college and all, but you know what that's like. It's not the same. Half my time of having my son in my house is over already."

There feeling that I had after having that conversation was not unlike being wrapped in a piece of wet burlap and gently asphyxiated. Because Cal was turning eight too. Half our time raising our oldest son in our home was done, and not only had this particular calculus not ever occurred to me, but looking back, I can't say I really know where those eight years went.

Because see, we've always lived like this. Cal was born when we were residents. His entire life--and thus of course, Mack and Nina's entire life too--we've worked. Both Joe and I have worked our tails off. We're not residents anymore of course, and some of the specifics of our jobs have changed from year to year, but the fact of it is that we each work on average 50-60 hours a week, more if we're taking weekend call, and although we've been saying for years that we were going to try to get more control of our work schedules to put some more time into our family life, it hadn't happened yet. The decision point was always pushed off down the road. Later. Soon. Not yet. Someday. And now Cal was turning eight and I have no idea how time passed so fast.

If I'm going to be completely honest with myself I'm sure some of this particular grim inertia was also linked to a perverse macho pride. I've always spoken a lot about work-life balance in medicine and how these antiquated notions, about doctors functioning as around-the-clock automatons sacrificing their personal lives for the greater good, would have to evolve along with the rest of the world. But I think that in some ways I felt safe championing the choice for others to go part-time because I myself chose to work full-time. You do what works for your family, everyone's definition of work-life balance is different. But saying it from the vantage point of someone with three kids and still worked full-time herself felt like a secure platform from which to proselytize, like I was somehow above reproach from people who might accuse all part-time doctors of being lazy or uncommitted. DO WHAT YOU NEED TO DO; BUT AS FOR MYSELF, I AM DOING ALL THE THINGS.

And to be honest, we were getting by. It wasn't wonderful, but it was OK. We were surviving. Maybe we weren't "living our best life" to invoke an Oprah-ism (and I don't even know how I know that since I never even watched Oprah) but...day to day, we were getting by.

And then, the week before Memorial Day, our nanny of five years quit. With no warning, and giving zero notice. She just left one day and mentioned on her way out the door that she wasn't coming back.

Boom. Game-changer.

I'm not going to talk too much about the nanny thing because frankly, after probably the most stressful two months of our lives, I'm just over it. It wasn't even so much the issue of finding a new nanny--though that, obviously, was a huge part of solving our problems, at least in the short term.  But the larger and more important part was having to honestly evaluate our life, our choices, and just how much time we did indeed spend at work, away from our children. It was like turning the stark, faintly buzzing fluorescent exam light onto the fish-white underbelly of what kept things functioning at a level that passed as "OK" for the past five years. And what we realized was that: it really isn't OK. Having to outsource this much of our children's care--of our children's lives--to someone else, particularly someone who after five years could walk out on them without so much as a backwards glance...is not OK.

(This is putting aside the obvious logistical difficulty of finding a non-live-in person to work 50-60 hours a week. It's a tough sell to say the least. One suggestion, perhaps less helpful than most, was that we should just hire two nannies. To which my reaction was, if you have to hire two people to take care of your kids while you're at work, it's possible you're not spending enough time with your kids.)

So. Joe and I discussed and agonized and number crunched and evaluated. We talked to a lot of people. We agonized some more. And what's going to happen now is this: as of September 1st, I will be going part-time at my job. Joe and I would have been fine with either one of us working less, but because of the ways our jobs are structured, it makes more sense right now for the part-time working parent to be me. My new schedule will have me working three days a week, mixed in with my share of nights, weekend and holiday call. And my main goal for the other two days of the week? To do some of the things that I've never been able to do with my kids because I've haven't had the time. Simply to be around more.

I know this all seems unnecessarily melodramatic of an announcement to some, because plenty of people in a multitude of fields choose to work part-time. But for me, it is a big deal, because to be honest, when you're accustomed to following a prescribed path, swimming against the current for a change can be scary. And there are a lot of issues--job guilt, fear of resentment from co-workers or being perceived as less than fully committed to medicine, concerns about crippling my career potential--that I'm working through having finally made this decision. There's a fear of not wanting to let people down.

But that's it on the other side too, isn't it? I don't want to let people down. I want to do my job well. All my jobs. And I think that right now, I need to spend more time with my kids. Nothing's broken, I still love being an anesthesiologist, and the fact that I've worked full-time for the first eight years of parenthood wasn't the wrong call nor has it damaged our family. It's just that our choices then are not the same as our choices now, and when we have better options we owe it to ourselves to take them. We could be making more of this life. We could be doing better.

I'm not going to be there hovering in the periphery for every single second of my kids' lives, nor frankly should I be. But I'm looking forward to just being around more.

So that's what's going on with us. In most ways, it's really no big thing. But in other ways, it's the biggest thing.

thar's a snake in mah boots!

Undoubtedly the scariest call I've gotten from work happened this Thursday, when the director of the chess club that Cal attends after school called that afternoon to say that Cal never showed up, and did I know where he was?  (I was at work and of course freaked out because OMG MY BOY IS LOST.  Long story short, Cal just forgot it was chess club day and so missed the bus that was to take him there--we tracked him down ten minutes later patiently waiting in the principal's office for someone to pick him up.)  So yes, that was scary.  But the second scariest call from home I received the day after that, when our nanny told us that she came home from school pickup to see two large copperhead snakes sunning in our driveway.

Joe and I pulled in from work at the same time, and there were no snakes visible, sunning or otherwise. Joe went peering by the back door to see if the snakes were hiding under this storage unit we keep there for balls and frisbees and assorted outdoor detritus, and said, "I don't see anyth--" before jumping back in the air about three feet.  Because there was this:

I don't think I realized that I was scared of snakes until that day.  I knew I was scared of cockroaches--growing up in an apartment in New York made me more than familiar with that particular evolutionary success story--but I honestly can't say I've really seen a snake that big outside of a zoo, behind a guardrail and an information placard and a thick, reassuring layer of plexiglass.  But now, peering out from the inside of my house at the venomous snake chilling outside, I can confirm that yeah, for sure, I'm afraid of snakes.

I mean, LOOK AT IT.

LOOK AT THAT FUCKING SNAKE!

(Borderline related: did anyone who got the iPhone 5 on release day have any input as to its improvements when it comes to low-light photography?  As someone who lives in a low ceilinged ranch house with not enough windows, I am interested.  Please weigh in if you're in the mood!)

Anyway, I looked at it and screamed girlishly. Then we called the kids to look at it and they did not seem particularly perturbed (or indeed even that interested), though I gave them both a stern talk nonetheless about if you see a snake don't go near it, it doesn't want to hurt you but it could bite you if it gets scared (I left out the part about tissue necrosis and the potential need for serial debriedments and fasciotomies because WHATEVER, TMI).  They shrugged, glanced and the snake through the window again before going back to their Legos.  But I could not be so blase about it because the snake, OMG the SNAKE.

About half an hour later the snake slithered away under some shrubbery along the side of the house, at which point we could see that the tip of its tail was a little squashed from our nanny accidentally running over it with her car when she first pulled into the driveway.  We noted where the snake was headed as we had already called A Snake Guy (I believe his official title was "Wildlife Removal Specialist") to come by and check our property the next morning, and wanted to give him a little help in finding what might be the nest, or as I called it, Snake HQ.

I was on call this weekend, so when I walked to the car Saturday morning (down a poorly lit driveway that my mind inconveniently imagined to be PAVED WITH SNAKES) I did again see one snake lying there in the middle of the driveway, not moving.  I didn't know if it was the same snake as yesterday and frankly I didn't care--I hurriedly got into my car (which was probably teeming with SNAKES) reached into my bag (also stuffed full of SNAKES) and started the engine (ditto SNAKES).

The Wildlife Removal Specialist showed up later that morning while I was at the hospital, and though I wasn't there, Joe said that he got rid of that one driveway snake (it was the same snake from the day before, already dead, probably from the inadvertent tail squishing--and it was inadvertent, because even though none of us like snakes and even though the snake could bite our kids/dog/selves, I don't think any of us has the stomach or cojones to kill a snake), sprinkled some "granules" in the high-suspicion region by Snake HQ (purportedly a repellent of some sort) and put down two glue traps that looked for all the world like the ones I could buy at Home Depot.  Total bill: $230 for half an hour of work.  He did not find a nest or any other snakes in the area, though it's not clear to me how hard he looked--half an hour in an area as dense with ground cover as our yard doesn't seem like a whole lot of time to spend combing the premises.  And the glue traps were covered with leaves by that evening, so it's really uncertain how effective those are going to be.

(This is probably a good point to tell you guys that I'm quitting my job and becoming a Wildlife Removal Specialist.  They have a higher hourly rate than I do and they don't have to pay malpractice insurance.  All those years of medical training wasted, but whatever, sunk cost.)

So that's that.  But what bothers me now--what really bothers me--is this: our nanny said that she returned from school pickup to find two copperheads sunning on our driveway.  Two.  One of them got accidentally squished by her car, and that's the one that we found, and that the wildlife guy removed.  (YOU GUYS HE DIDN'T EVEN KILL THAT SNAKE HIMSELF.  $230?  Really?)  But the other one we never saw again.  So in all likelihood, we may still have a large and extremely poisonous snake still hanging around our property.  He could still be in our yard.  He could be hiding under my car.  He could be calling me on the phone and oh my god, get out, the call is coming from INSIDE THE HOUSE.

So basically we have to move now, right?

internal monologue of the not-quite-good samaritan

There are two left turn lanes off the exit of the highway that I take to work. Usually I get to work so early that traffic of any kind is not a problem, especially on the local roads, but this morning, there seemed to be an awful lot of brake lights and lane changing on this one short span. I was in the right lane, everyone ahead of me seemed to be changing into the left lane to bypass something that was apparently obstructing traffic up ahead. As I got closer, I saw that there was actually a stopped car up ahead. A car that was braked at the intersection, not moving despite the fact that the light was green.

Because of my position in the line, I pulled up right alongside the car. I figured it was probably some kind of breakdown or engine problems, thought I thought it was odd that the car would be stopped in traffic without any hazard light turned on. But there was a guy inside the car, alone, sitting in the driver's seat. He was sitting up, leaning up against the back of the seat with his eyes closed, and he wasn't moving.

Well, shit.

First thing I thought was, cardiac arrest. I craned my neck more. Was he breathing? Hard to say. He definitely wasn't moving in any way that I could make out through my car window. He didn't looked slumped over or anything obviously ominous, but who falls asleep at an intersection, for chrissake? So clearly, he was dead.

Shit.

I should get out and see if he's OK.

Well obviously he's not OK, just look at him.

He had an MI. No, wait, he had a stroke. A hemorrhagic stroke. No, wait, a ruptured aneurysm.

Could he be sleeping? Who falls asleep off the exit of a highway?

OK, I've got to get out there. Ew, I don't want to touch a dead person. I don't want to do CPR on a dead person. I don't even have any gloves.

Get a grip, woman, you're a doctor.

But...ew, dead people.

I have to go out there. Is that safe? Am I going to get hit by another car? What's going to happen to my car? Now both lanes of traffic will be blocked. People are going to be mad. There's going to be honking. I hate honking. Why do they honk so much here?

OK, I've got to go see if he's OK. Shit, I'm going to be late for work. What cases do I have this morning? I have to start that CABG, don't I? Oh, and I have that shoulder replacement too, now I'm not going to have time to block that patient before we go back. I have to call the OR front desk. I hate being late for work.

But who cares if you're a little late for work, there's a dead guy there! Anyway, we're right around the corner from the hospital. You'll just get in his car, drive him over to the ER...wait, what if I don't know how to drive his car? What if it's a stick shift? I should call 911. Yes, 911. That's what people do.

JUST GET OUT THERE AND CHECK ON HIM, ASSHOLE.

I put the car in park. Just as I was reaching for my door handle, the guy in the other car, apparently not dead, opened his eyes and drove off. So I would like to say that I was in the process of doing the right thing, but honestly, since he never gave me the chance, I'm not so sure.

exteriors and interiors

Hey guys, thanks for all the nice comments on that last post. Funny thing about a blog--I don't know any of you, but you really did make me feel better. I do recognize that this topic has the potential to devolve into some sort of negativity spiral no matter how civil a group we all are (and I do honestly think that I can claim some of the most rational and level-headed readers on the internet--and believe me, I have seen a lot of internets!) so I just decided that the easiest way to keep the peace (we'll call it an NSAID move) is just for me to not talk anymore about the book cover issue beyond what's going on now and what's happening next. But thank you, thank you, THANK YOU all for your wonderful words and support. It has meant a lot, probably more than you know or than I can express.

My book (along with, you know, the front part of the book) was supposed to go to press this week, so obviously there's something of a time crunch in coming up with a new cover. I think we've eked out an extra week to get our affairs in order, but obviously, at this stage, for something this important, two weeks isn't a hell of a lot of time to bounce ideas back and forth. I'm told that they have taken the original designer of my book cover off all her other projects so that she can just work on this, and only this, until we have a satisfactory end product. I have a few ideas myself, but of course, as I mentioned (I think in the comments) I as the author don't actually get final say on what my cover looks like, as it's ultimately more of a marketing decision. But I still have ideas.

Originally, after I heard the news, I started really blue-skying it and came up with a number of ideas--ideas that I still think are pretty cool. (One in particular involved an all red cover with line drawings in white and a sort of copperplate font...well, whatever.) But in the end, I came to the realization that while the new cover had to be different, it probably shouldn't be too different, because I want it to still be instantly recognizable as the same book that it was before. I spent six months building momentum behind the old cover image, I shouldn't have to throw all of that away. Anyway, it's ultimately out of my hands, but I had some ideas, and I e-mailed my editor a couple of Photoshop-generated cover composites, for what little that's worth. Anyway. We'll see.

So.

Hey, so we went back to see that house today! I was a little bit nervous about going back (firstly because I thought I might have romanticized things out of proportion; secondly because it is inhabited by what looks like an older childless couple who have a collection of many many ceramic knick-knacks balanced on top of the skinniest, most delicately balanced display pillars I have ever seen, and we were there with two kids with a penchant for acceleration--never has the term "bull in a china shop" been more accurate) but it was fine. It was more than fine. We're seeing four more houses tomorrow a little closer to our current neighborhood, perhaps more to convince ourselves that we are not rushing into anything more than any actual interest in seeing these other homes. But after that, we may be in the position to make an offer. It may not be the offer than the owners want, and they may well say no. At the very least they will parry back, and we may bat things back and forth for a while, like cats. But after that...well. I'll let you know what happens after that.

Joe and I have often remarked that, considering what boring people we are, we have a lot of exciting things happening to us, and we feel very fortunate that we have so many good people who and interested in coming along for the ride. Endpoints are never certain, but as long as we are in good company, we can have fun on the way there. So thanks for that.

regular law-breaker

Ira Glass and I agree on one thing--well, probably more than one thing, but this thing in particular--that the best place to listen to a radio show (or podcast) is in the car while you're driving. This is a somewhat new development for me, as anything related to driving is; most of you are probably aware that I got my first driver's license a little more than a year ago (October 19th, 2009, to be absolutely precise, after failing the road test once the month prior) and while I am somewhat more comfortable driving now than I was then, I still would not classify myself as a good driver. I am probably a better driver than your average teenage hotrod, but it's the very thing that makes me a better driving--that is to say, a surfeit of caution--that also makes me a worse driver. Anyway, I always try to be very careful. I signal my turns even in empty parking lots. I never pick up my phone while in the car, or else I pull over before answering. I have a GPS in the car that I have programmed to avoid all highways, giving me the directions from Point A to Point B only via local roads. When I see other people driving like fucktards (which is basically every fifth car), I tsk tsk them in rue.

But I do like to listen to podcasts in the car.

It wasn't that long ago that I couldn't listen to anything in the car, because so much of my concentration was focused on the actual task of driving. No music. No conversation. I dreaded having the kids in the car with me, not only because of that fear of having all my eggs in one basket (that basket being the car), but because no matter how much I explained that they had to shush, Mommy was driving, she had to concentrate, the endless monologue and stream of questions from the backseat only increased in volume.

However, I've been driving for a while now, and 95% of my driving takes a well-worn circuit between home, work, and, on occasion, Cal's school, so I'm a little more comfortable with the act of driving, at least along these routes. When I'm going somewhere new, the old rules apply (no radio, no music, no talking) but on routine drives, I will listen to a podcast or two, or occasionally sing along to music. Singing and driving at the same time! Who knew this day would ever come.

Anyway, I used to plug my iPod into the auxiliary input port of the car so that the podcasts could play through the actual car speakers, but for some reason, this stopped working, and then subsequently, I lost the auxiliary cable hookup anyway. So then I was putting my iPod on the dashboard and playing it through the actual iPod speakers, but I don't have to tell you how this turned out--tinny, muffled, and I could barely hear anything anyone was saying. So, as a final solution, I plugged in my earphones and put one earbud in my ear for the drive. The other ear was free to, you know, receive ambient sound. I did have a vague notion that this was probably not the safest thing (you know, having something in your ear while operating a car) but I rationalized that it wasn't any different than having a Bluetooth earset for hands-free phone answering, which I'm pretty sure is allowed, if holding the actual phone up to your ear while driving is not.

Anyway, I was driving home in this fashion the other day (carefully, on the right side of the street, at the speed limit) when I pulled up alongside a police car, which had stopped, waiting to turn into a gas station. We passed by in slow motion. I looked at him. He looked at me. I passed on by. He made a U-turn. The next thing I know, I saw flashing blue lights in my rearview, which I'm pretty sure is some kind of indication that you're in the deep end of the shit pool.

"Is something the matter, officer?" I asked all politely, knowing already what this was going to be about. He asked me for my license and told me that he saw that I was driving with headphones on--did I know that wasn't allowed? I said that I didn't realize that (though it made perfect sense), but that I'd only had one earbud in. Then I forced myself to stop talking, because what did I think I was going to gain from making excuses to a police officer? Just smile and nod, dumbass!

The police officer (who was very nice, by the way, and had a very charming Irish accent, like a cop out of a damn movie about the 1950's) then stopped, and asked me, "What kind of work do you do?"

"I'm a doctor."

He looked at my scrubs and nodded. "Next time, don't drive with earphones." And then he let me go without a ticket. I'm not sure me telling him what I did had anything to do with him deciding to let me go without a citation, but I guess I'll never really know, even though that's not going to stop me for feeling vaguely guilty about that possibility.

And no, I'm not going to drive with earphones anymore. In either ear.

baby it's cold outside

So as those of you who follow my Twitter stream may be aware (and if you aren't, why not, at the very least there are links to some very detailed Lego pictures as well as my thoughts about creamy pumpkin soap--not soup, soap) the furnace in our house--that is to say, the house we are renting, not a house we actually own, thank god--made it apparent that it was not up to actually producing any meaningful degree of heat right at the end of last week. Unfortunately, this was on Friday night, past the point that any furnace repair company would deign to come check things out, freezing temperature and young children be damned. So this weekend was one of piecemeal heating solutions, consisting of strategically placed space heaters and many layers of Cosby sweaters. One good thing is we discovered there was actually a second furnace up on the second floor (who knew?) which had shut off for the past two years but did actually work, and was enough to at least heat the kids' bedrooms overnight, though not sufficient to heat up the rest of the house, where everything else (TV, toys, master bedroom) is. So, southerly latitude nonwithstanding, it's been pretty cold up in here.

One of the furnace people who came by to inspect the unit told us that the problem was that whoever had installed this furnace--and it's brand new, installed just a few months ago--put the whole unit in wrong, something with it needing to be leveled correctly something something condenser drainage something something reinstall the furnace ONE MILLION DOLLARS. And then, for some reason, some other guy came by today with the landlord, tinkered with something else apparently very minor, and now we...kind of have heat again. So I'm not really sure how he fixed it or what he fixed or if he even fixed anything at all or if it's going to last, all I know is that I no longer have arctic puffins roosting in my bedroom, and I'm no longer worried that my kids are going to run headfirst into the space heater and get Waffle Face. So that's good.

(Also, if you followed my Twitter stream, you would have seen the alarming pictures of me trying to make a brisket--yes, ME, I know!--which actually turned out pretty well despite best efforts to simultaneously cause massive conflagration as well as indigestion. Rest assured that though the meat looks strangely darkened around the edges in the middle photograph, that is merely an artifact of Hipstamatic, not what it actually looked like; I do love my family and want them to live.)

60 posts in 60 days, day 2: going viral

So, Joe's heart. What happened was this.

About three weeks ago, Joe had a cold. All of us, of course, ignored it, because the fact of it is that Joe always has a cold. I'm not sure why, whether or not this is a testament to his delicate constitution or to my insurmountable immune defenses, but while we both work at hospitals and both live with two preschool-aged kids, he catches everything, and I catch nothing. So Joe had a cold, sniffling and coughing and what have you, and there was nothing much more to say about it than that.

Though, apparently, there was.

Three days into his cold, Joe started noticing some palpitations. He describes them as feeling weird, occurring first at night as he was trying to fall asleep, like strange jolts to his body that shook the bed. He tried to ignore them, but they were getting more frequent and he was feeling shitty, and after his surgical cases one Wednesday afternoon, he asked one of the anesthesiologists to run an EKG on him and hook him up to some monitors, just to see what was going on. This was in a series of cryptic and alarming texts I got from him while at work:


Getting an EKG.

Pulse ox reading 95% on nasal cannula.

Having lots of PVCs, P waves look funny.*

(* If those letters and words mean nothing to you, don't worry about it, the long and the short of it is that all indications pointed to the fact that something with his heart was fucked up.)

I texted him back, basically telling him that he needed to go to the ER postehaste and force them to get an echocardiogram, because it sounded like he might have a viral myocarditis. So he did, and they did, and...he did. ("I knew it!" I crowed triumphantly over the phone when Joe confirmed the diagnosis, after telling me how others in the ER were pooh-poohing his concern, with some sentiment that an echo might be overkill. But then I kind of realized that this wasn't an academic discussion and this wasn't "guess the diagnosis" on rounds, this was my husband, and the ridiculous knee-jerk triumph of being right kind of gave way to dread.) So anyway, they admitted him to the cardiac "progressive care unit," put him on telemetry, and that is how Joe ended up in the worst place in the entire universe: an ICU in an academic hospital at the beginning of August.

I know I'm going to get such shit for saying this, since I was a resident, like, yesterday, but the intern who rounded on us? Was probably fourteen years old. She was lovely though, and adorably flustered. I remember that feeling so vividly, how much as a medical student or a junior resident we would all just hate having a patient was was a doctor. There was that dread, that sense of embarrassment that I was never quite able to hide. I might be able to fool my other patients into thinking that I knew what I was doing, but the patients who were medical professionals? They knew how inexperienced I was. They knew that I was an impostor.

This is probably also a good point to make note of the fact that as patients, we were exceptionally privileged in terms of the kind of care that we received. As a two MD household, one of whom actually worked at the hospital where he was admitted as a patient, we know that people treated us a little nicer, checked in on us a little more often. We had a little more access to information. When it came to the issue of visiting hours, people looked the other way. When it was time for us to go home, the discharge protocol was accomplished with probably the most expediency I've seen in an academic hospital. But the fact of it is that regardless, being a patient is just a terrible, terrible experience. No matter how much you know, you will feel helpless. No matter how much you can do, you will feel powerless. And no matter how much you try to reassure yourself, there is that lurking dread in the back of your mind that the worse case scenario could and may occur. In this sense, being an overly knowledgeable patient may actually be worse. And as much as being a doctor helped to understand what was going on, there were moments when I would have gladly put out of my head the patients I'd had with a history of myocarditis who were on the UNOS list for a heart transplant. Ignorance can be bliss.

Joe, luckily, was never that bad off, and our hopes are that the odds are on his side and that in the next few months he will get better and better, his myocardium remodeling and his cardiac function returning close to his baseline. But until then, he's taking a handful of meds--some of which aren't a terrible idea for him to be taking anyway (hard to find a thirty-something year-old cardiologist these days who isn't already on a statin) and some others which we hope he can wean off eventually. And not to be hopelessly glass-half-full about things, but this may be something of a blessing in disguise, forcing us to take a good hard look at ourselves and make some lifestyle changes that have been long overdue anyway. We're trying to cook more, eat healthier, and while Joe is still restricted from any major physical exertion (I've been doing most of the heavy lifting around here, which is even more hilarious than it even sounds), I'm sure at the end of the six month convalescence period, he will be more than happy to step it up on that front too. Sometimes it can take something like this--frightening and vivid, but hopefully with no long-term implications--to scare you straight.

But that aside, what I learned from this experience is that the line between ourselves and our patients is a very, very thin one. Curiously, being exposed to sick people day in and day out has something of a distancing effect. I take care of patients in some degree of heart failure every day, but I never think of it in terms of my own life. The more I take care of patients with myriad medical problems, the more it can seem like heart disease and lung disease and freak accidents are things that happen to other people. But they're not. It can happen to us. It can happen to our spouses, our parents, our friends, our kids. We like to think there is a line dividing us and our patients, but one day when you wake up and find that you are the patient, you realize that line is just wishful thinking, a protective measure that exists only in your own mind.

It's true that doctors make the worst patients, but in another way, we also make the best patients. Having seen the good, the bad and the ugly, and having more of a sense now how fine the divisions are between, we will do what it takes to get things right. Having walked through the trenches for years among those who have not been so lucky, we appreciate what we have, and we temper our attitude towards the sick people in our care accordingly, from those days and weeks and months that the word "patient" were not a them, but an us.

let no one say this has not been an eventful year

OK, OK, but before you get all piqued at me about not posting, quick pop quiz. Which of the following things happened in the four months since my last substantial post?

1.) Random stray gunfire came in through our window one night
2.) I took the Anesthesia written boards
3.) Joe was hospitalized for three days in the cardiac ICU
4.) We found a new rental in a less bullet-y neighborhood and are moving in five weeks

All of the above, my friends. All of the above.

First thing: I reposted those two entries I redacted a few months ago, here and here. There, now everyone knows what I was cryptically referring to in my penultimate post before that video with Cal and the driving dogs. We got a bullet through our window. No one was hurt, but really, a bullet through our window? That is excessive drama by any standards, and I am a decidedly undramatic person. Despite the sweeps season-like air that the incident lent this blog, I took down my posts about the bullet shortly after posting it because Joe didn't want his parents (read: Mom) to know about what happened until we were out of our current living situation (lest she worry unduly), and I found that since I couldn't talk about the bullet and I couldn't really talk too much about work and since I couldn't talk about XYZ other topics for a wide variety of reasons (ranging from general discretion to topics just too boring to write about), I realized I couldn't think of anything to blog about. One week became two, became a month, etcetera etcetera. The more you stay away, the more you stay away. Anyway, barring any further upheaval to cap off the year (perhaps alien abduction would be a fitting coup de grace), I will resolve to do better. Perhaps I will do what I did last year after I fell off the wagon for an overlong period of time. 30 posts in 30 days, that kind of thing. Anyway, we'll see.

Oh yes, Joe in the ICU. That was about two weeks ago. Short answer: viral myocarditis. Long answer: I will try and get a blog entry up about it sometime soon, both about the general experience and about the dual advantage/terror of being a healthcare professional hospitalized for a potentially serious condition. He's out now and doing better of course, or I wouldn't be talking about it at all. Call me superstitious, but I'm a firm believer that talking about bad things makes them come true.




Cal and Mack are both doing well. Cal started school a few weeks ago. He is in Pre-K this year--after some stunning-to-the-teachers (though not stunning to us) gains in the social arena during the Spring semester, his teachers decided not to pursue the issue of retention, and though he still is the youngest kid in his class this year, he's basically normalized himself amongst his peers and is just acting like a regular kid--talking and playing and laughing and running around, as opposed to sitting on the sidelines with the teachers chatting about numbers and scowling evilly about this kid or that kid breaking the rules. (Among other things little-old-manly, Cal loves pointing out and imposing rules on others, sometimes in less than adorable ways. My little mid-level manager.)

And Mack?




Mack is delicious.

So let's jump back into it, shall we? Or hell, I'll do you one better. Forget 30 posts in 30 days. It's 60 posts in 60 days this time around, baby. This is called "penance." And lord knows we have enough to catch up on.

redacted

Had to take down the last two blog entries (if you read them, I'm sure you'd recall, they were somewhat memorable) at Joe's request, because he didn't want certain people who read this page to worry. And worry they would. So poof. Ignorance is bliss.

Anyway, that's that. Don't worry, you're not crazy, they really were up there, and you really did read them, I just removed them. Maybe we can talk about it more later when the dust settles. I have some strong opinions about this matter, as you may have guessed, and have been angrily shaking my fist at Charlton Heston since.

commence freaking

While I was certainly concerned last night, it was dark, I didn't ever see for myself the bullet hole, nor its proximity to where we were sleeping with the baby. Then, when I got home from work this afternoon, I took a look.

Now I am freaking out.

"he hates these cans!"

At 11:58 last night--I know the time exactly because I looked at the clock when I heard the sound--there was a small, tinkling crash in our bedroom. It sounded like a light bulb had exploded, or that a Christmas tree ornament had shattered, both sounds which were somewhat improbable, as light bulbs are not in the habit of exploding spontaneously, and even we've had our Christmas tree down since...uh, March. "Did something break?" I asked, looking around. Joe got up to investigate, telling me to stay in bed with the baby, because I didn't have any shoes on and he didn't want me to step on any glass.

He looked around the room, picked up something off the floor. Then he went downstairs for what seemed like a long time. I figured he was looking for the broom. When he finally came back into the bedroom, broom-less, he came up to me and pressed something small and cold and metallic into the upper part of my arm, so I could feel it. "I found this on the floor."

"What is that," I asked. "A penny?" I couldn't see, it was dark.

"It's a bullet," he answered.

There are these moments, few and far between, thankfully, where the cognitive dissonance between what someone is telling you and what you are seeing are so different that you just can't understand quite what's happening. There I was, in bed, holding the baby, who was nursing contentedly and making little snuffly sleep sounds. And there was Joe, holding up the bullet that had just been fired through our bedroom window.

"I've called 911," Joe said. Cal was fine, sleeping in his room. His little toddler bed is up next to the window, just in the room next to ours, but thankfully, due to his truly acrobatic sleeping habits, he had since relocated to the bigger, queen-sized mattress that we also keep in his room for guests, which is set farther back by the door.

"Where did the bullet come in?" I asked. I was still confused. Were we really talking about a bullet being shot through our window? Like, from a gun?

"I don't know, but I'm not exactly going to go up to the window and start looking around now," answered Joe. "Stay up here with the baby. Don't get up. I'm going downstairs to wait for the police."

I will tell you, I lived in New York for 30 years, and never once had I been near gunfire, nor had I called 911 once. (Well, there was that one time in med school, but that was an accident.) I've been in Atlanta for less than one year, and already we've called 911 twice, and had a bullet come through our bedroom window. What gives, Atlanta?

Anyway, the police came, looked around, and Joe brought them up to the bedroom, where they found a small bullet hole through both the outer screen and one of the bedroom windows. The angle of the bullet holes lined up such that it seems that the bullet was traveling on a downward trajectory when it entered the room, and was moving at such a low velocity afterwards that it bounced off our squishy upholstered rocking chair and ended up on the floor, next to the changing table. So likely some idiot was shooting his gun in the air, probably even at some distance from our house, given that neither of us remember hearing an actual gunshot. Clearly some people don't believe in the axiom that what goes up, must come down. Maybe they think that bullets travel up so high that they burn up in the stratosphere on re-entry, like some damn meteoroid. Or maybe they're not thinking very much at all.

Mack and Cal thankfully slept through the whole thing (the police were very nice about being quiet, even when they were upstairs), and Joe and I eventually went back to bed after cleaning up the glass and changing our sheets, which had some shattered glass strewn about. But I still can't shake that feeling of cognitive dissonance. A bullet landed in our bedroom. Where our baby was sleeping. Next to the room where our other baby was sleeping. And the person who shot it likely has no idea, nor is he in the least bit sorry.

Anyway, we're all a little tired this morning.

snakes on a drain

As I had sort of implied with that earlier post, we have been having some problems with our downstairs toilet. (How weird, to have a "downstairs toilet." How weird to have stairs. Anyway.) Nothing broke per se, the toilet's not overflowing, there's no leak, the toilet just won't flush. I don't know if its a function of water pressure or too much toilet paper or someone's formidable and apparently capacious bowels, but it has been clogged for several days, defying attempts at clearance ranging from flushing again to plunging to The Old Coathanger Trick to being chemically challenged with Drano. At some point, we sort of called the code and Joe suggested that maybe we needed to call a plumber to snake the toilet.

"No!" I insisted, jiggling the coathanger into the toilet's murky depths, "It's fine! Just flush it again!"

Anyway, I called a plumber.

First, I called our building management as a courtesy to ask if there was a preferred plumber that they wanted us to use. However, as with every other occasion that I have called building management for any kind of problem (see also: SILENT BUT DEADLY, when we thought we were being killed by a gas leak from our fireplace), my call went directly to voicemail. Fine, I tried. So I looked online (apparently there is this very informative and useful site called Google.com! Write it down! I'm saying that as a joke but my mom actually e-mailed me once with a note to that very effect--e-mailed it, in fact, to my Gmail account) and found some plumber in our neighborhood that was called something enticing like, "Budget Plumber" or "Affordable Plumber" or whatever, something implying that they were cheap. So I called the economy plumber and explained the problem, asking them if I could make an appointment for them to come by tomorrow. Oh, and by the way, barring any unforseen complexities (a bezoar of toilet paper the size of China, perhaps), how much did they estimate it might cost to clear the blockage?

There was some rustling as the lady looked for her price list. "Well, if it's a simple [hmmm], and there's no [hmmm] to the main [hmmm], as long as the [hmmm] is confined to the [hmmm]..."

(Fifteen minutes of plumbing talk later, she said that it could be around $135.)

A HUNDRED THIRTY FIVE DOLLARS FOR YOUR EXTRA-LONG COAT HANGER POKING? I felt like I was going to have a stroke. But what can you do? It's like calling a consult at the hospital. Sometimes you don't want to go through all the trouble, and it's not anything you couldn't do yourself, but what are you going to do? You need the experts and their special toys. So anyway, they told me that the plumber would be by the next day, between 10am and 2pm (note the convenient and small time frame--that won't fuck up your plans for the day) and hung up.

About an hour later, I got a call back from building management. "Hey, got your message, and yeah, there is a plumber that we like to use who does a lot of work in the building. It's called Super Duper Plumbing [or whatever, I can't remember], here's their number. If you can, be sure to ask for Eric."

"Super Duper. Eric. Got it."

"ERIC!" the building manager repeated, somewhat frantically. She had a real boner for Eric, evidently.

Now, let me ask you this. If your management company has a SPECIAL RELATIONSHIP with a specific plumbing company, if they throw all their business towards this one group, wouldn't you expect that reciprocally, some sort of special discount should be applied for residents of this housing complex? I mean, that's just my understanding of how the world works. You scratch my back, I'll scratch yours. You snake my toilet, I'll...flush yours. I don't know. Stay with me here. I called Super Duper Plumbing, made an appointment, asking for ERIC (they tried to give me Steve instead but I said no way, Corky) and then called back the economy plumber to cancel.

However, after canceling with the first plumber, it occurred to me that I never asked Super Duper Plumbing for an estimate. So I called back, they hemmed and hawed, and fifteen minutes of plumber talk later, they said that at bare minimum, it would probably cost $235.

TWO HUNDRED AND THIRTY FIVE AMERICAN DOLLARS TO SNAKE OUR TOILET. I mean, I know that these are troubled economic times and all, but I was under the impression that numbers still carried some meaning.

So then I cancelled my appointment with them too. And then I was going to call back the first plumber to re-set up the original appointment, but I was too embarrassed, like I had jilted them or something and now I was crawling back on my hands and knees begging them to clear the detritus of our human waste from our poor, pathetic downstairs half-bathroom.

And then Joe got home and asked if the toilet was fixed and I said, "Funny you should ask that," before telling him the whole story about the cheap plumbers and the building manager and Eric and TWO HUNDRED AND THIRTY FIVE DOLLARS!!! Which is why I cancelled their asses!

"TWO HUNDRED THIRTY FIVE DOLLARS?" Joe panicked, completely skipping over the cancelling part. "WE CAN'T AFFORD MANY MORE PROBLEMS LIKE THIS!" This is usually his cue to start his gloom and doom pre-tax season financial projection, which--OK, I know, alright? I know times are tight, and some expenses inopportune, but do you and CNN need to point out how it's the End of Days every single minute!? It's not like I'm over here stuffing fur stoles and hundred dollar bills into the toilet, causing it to clog! I DIDN'T EVEN WANT TO CALL A PLUMBER, WE HAVE TWO OTHER TOILETS THAT ARE WORKING PERFECTLY FINE, I JUST WANTED TO KEEP POKING AT THE TOILET WITH A STICK.

Anyway, we soon realized that while we probably are not qualified to handle the nuances of fixing, say, a cracked water main, or even necessarily a leaky faucet, the act of jamming something down a toilet to break up whatever unspeakable substances are clogging it does not amount to rocket science, and that they sell toilet snakes (or "augers," for you fancy folk out there) at Home Depot for, like, $30. And so...



And now, we can flush our toilet.

(And the point of my telling this story was...what? Hilarious domestic antics? Appreciation for the plumbing arts? The revelation that someone in our house may be taking prodigiously huge shits or using an unholy amount of toilet paper, possibly both? An attempt to sabotage any chance I may have of ever becoming Surgeon General? Take your pick.)

first week home, first 911 call

So Mack is one week old, and I think we're all doing well. Cal so far has made the adjustment as smoothly as one could expect (in that he acts like an insane person, but the insanity is typical three year-old stuff and indistinguishable from the insanity manifested before the baby was born) and Joe is back at work doing Those Things He Does. Speaking of which: THANK GOD for Joe's paternity leave. Oh man, if we could have a househusband full-time, that would just be solution to all life's problems, because Joe single-handedly kept this place afloat that first week. Not only was he completely available to Cal while I was hobbling around, alternately incapacitated by fatigue and my most non-adorable sutures and a variety of not-appropriate-for-discussion postpartum indignities--he did almost all the cooking and cleaning and handy-manning that one could reasonably accomplish in a week. Really, the only thing he didn't do was the biologically improbable, barring a prolactinoma in his pituitary the size of Kansas.

Ha! Medical humor! How much do you love it?

(Crickets.)

Anyway, I remarked to Joe over the weekend that we might want to get a carbon monoxide detector for the house. They were actually required in New York (or at least I assume so--one day about two years ago our super showed up at our door, shoved a carbon monoxide monitor into our hands and instructed us in his inimitable nasal Queens accent to affix it somewhere near the kitchen before stalking away, screaming something into his walkie-talkie). But there is no CO monitor in our house currently, and as I had been having some headaches ever since we started using our gas fireplace, I just wanted to make sure we had our bases covered. So anyway, we got the detector yesterday morning. After some cursory exam of the packaging (some terror-inducing clipart of kids sleeping while ODORLESS DEADLY FUMES closed in around them), I pulled out the detector, plugged it into the wall close to the fireplace, and walked away.

It started alarming about a minute after.

I pushed the reset button quickly (just to turn off that deadly piercing shriek before we all went deaf), and thought to myself that I shouldn't panic, it could just be a startup alarm, to show that the detector is working. After resetting, the alarm was silent. The little green light was on, showing that the detector was sampling. I headed into the kitchen to make some lunch.

And the alarm went off again.

I repeated the reset process, but the third time the alarm went off, I figured we needed to do something about it. First, I cut off gas flow to the fireplace. On the back of the alarm were printed instructions that if carbon monoxide was detected, we were to: 1.) Open all the windows in the house, 2.) Move outdoors, and 3.) Call 911. I did the window thing, bundled Mack up and moved him next to the open doors leading out to the courtyard of the complex, but when it came to calling 911, I balked. Call 911? Really? Wasn't there a building supervisor I could call? Or a local fire department hotline? Everyone was fine. Was it overkill to call 911?

I called the building supervisor. Voice mail. I looked online to see if I could find the the contact info for my local fire station. After finding a number that seemed plausible, I called in and explained the situation. Whoever it was that picked up the phone was very nice, very responsive, but after every sentence I said, she put me on hold, and then there was a pause of about 15 seconds before she came back to ask me the next question. Address? I told her. Please hold. Click. Doo dee doo. I put my jacket on. I poked Mack, who was still alive. I thought about hyperbaric oxygen chambers. The gas flow to the fireplace had been back on for six days by this point.

The lady at the fire department came back on and told me that she was sending someone over. "But next time, you should just call 911. That's why I kept putting you on hold. Everything you were telling me, I was relaying to the 911 dispatcher." Oh. Three minutes later, I heard sirens. I peeked out the window and I saw a firetruck--a full, huge rig--tearing down the street in front of our house. Did I do that? Were they coming here, or is there another, actual fire? Two minutes after that, there was a knock at the door. When I opened it, there were no less than ten firemen standing out in the hallway.

It kind of reminded me of a code in the hospital, actually. Probably a third of the time there's a code called (usually in the case that a patient has arrested), the code is a false alarm, and what really happened is that someone just fainted, or had a dip in their vitals, or disconnected one of their monitors while making a run for the bathroom, making everyone think that they died. In the hospital, the cavalry shows up to every code called, but once they see that it's a false alarm, most of the people leave.

After about a minute, seeing that no one was passed out or engulfed in flames, half of the firemen went back to the truck. The others went around the kitchen with their carbon monoxide detectors, examined the stove, poked at the fireplace. I felt sort of sheepish for some reason, and kept apologizing and rationalizing, even though I know that I only did what I should have done and the fire department were just responding as they are supposed to--but I just felt embarrassed, like I was making a big hysterical fuss. Anyway, I explained the whole thing--the out-of-commission-for-several-years-only-recently-reactivated gas fireplace. My headaches. The new CO detector that basically started alarming the second we plugged it in. One of the firemen was examining the detector itself, which was now making intermittent staccato shrieks. "Was it alarming like this?" he asked me. No, I told him, when I called, it was making a single, steady alarm. "This thing is acting weird," he remarked.

Anyway, in the end, the firemen blamed it on the monitor, saying that sometimes they can malfunction, and that there may have been a buildup of schmutz (my paraphrasing) on the detector mechanism causing it to false alarm. In any event, they did not detect any carbon monoxide with their own detectors, but that, to be safe, we should keep the gas flow to the fireplace off until it could be checked. In light of my headaches, which prompted the whole purchase of the CO detector in the first place, they asked about Cal and Mack, if they've been having headaches or acting different. I said that we'd only had Mack home for a week, so I wasn't really sure what "different" would be for him, but he seemed perky enough, and that Cal was feeling fine. "Good," he said, "you're probably OK, then. It's like canaries in a mine shaft. The smaller ones will feel the effects first."

Anyway, the firemen--who were all very nice, by the way--trundled out after about ten minutes, and after letting the house air out for another ten minutes (I was taking no chances), I closed all the windows again, examined Mack again for signs of carboxyhemoglobinemia (what, you don't have a carbon monoxide oximeter on your eyeballs?) and put another layer of clothes on him, because without the fireplace, the house was getting downright chilly.

I actually have a ton of work that I need to do during this maternity leave, including but not limited to 1.) studying for the Boards, 2.) working on my manuscript, and 3.) possibly getting my GA state drivers license. I gave myself a week "off" before jumping into the fray, and though that week ran out yesterday, I really, really didn't feel like doing anything.

So anyway, if nothing else, I had a great excuse for blowing the day off.