"why, there's no basement at the alamo!"




I did a case today wherein the patient lost 11 liters of blood, and we ended up transfusing, in addition to assorted exogenous (read: donated by other people) products, 16 units of Cell Saver. The concept of Cell Saver, for those unfamiliar with the technology, is this. The patient is bleeding. The surgeons suck up the blood from the field into a special machine. When the blood in the container reaches a certain level, the perfusionists wash the blood in the bowl and spin it down. Then the anesthesiologist gives the blood back to the patient. Hence, cells are saved. Cell Saver. Ah, one of the few names in medicine that makes sense.

Aside from certain circumstances when Cell Saver cannot be used (soiled bloodstuffs, certain cancers that might get disseminated), Cell Saver can be a great thing. However, in a case like this where there is just so much bleeding, the practice starts to border on the absurd. Imagine this: We give the patient blood. They bleed it all out. We suck it all up and give it back to them. They bleed it all out. We suck it up and give it back to them. They...oh, you get the idea.

It actually reminds me of this quote from "Pee Wee's Big Adventure," a movie that I loved as a kid, and now appreciate as an adult as the first truly avant-garde art film of my (ill-spent) youth. "It's like you're unravelling a cable knit sweater that someone keeps knitting, and knitting, and knitting, and knitting, and knitting, and knitting, and knitting."

a table of one's own




I snuck out of the house early this morning and shacked up at Starbucks for a good six hours where I wrote. And wrote. And wrote. It was good. I was getting worried because I really haven't had a lot of time to work on the book since the holidays, and getting a look at my contract last week, while it made things all the more real and exciting, also got me feeling a little nervous because damn, I actually have to get this thing finished by July. IT WAS IN BOLD PRINT. But after putting in a good day today and falling back into the project, I'm feeling a little less worried. It'll get finished on time, and it might not even be half bad. (I hope. Oh please let it not be half bad. Or worse yet, all bad.)

However, after all that typing, I'm all typed out. So please excuse the insubstantial update. Above, by the way, is a picture of my writing camp at Starbucks. (The orange backpack is mine. It is huge because that's what I used to lug my breast pump to work in, and I just kept using it though it's probably much too bulky for everyday purposes.) I got there so early I even beat out the med students, who usually descend on the place and create little forts and tribal societies, buried amongst their syllabuses and Netters and whatnot. I even beat out the Work From Home Laptop set, who I was pretty convinced up until this morning lived under the condiment table when Starbucks closed for the night. That's right, Work From Home Laptop People, I beat you to one of the coveted big tables! Booya! For once, I did not have to sit next to the toilets! And I got a plug all to myself! MY VERY OWN OUTLET!

Oh lord, I am pathetic.

giving me the finger

(I usually don't tell stories like this, because as someone who deals in foul bodily succus all day long at work, I don't really find anything particularly disgusting about the excretia of young children. But this one was kind of gross, even for me.)




One of the many charming things about two year-olds is how few problems they seem to have, and how easy it is to fix them. For instance, I think I can break down Cal's daily tribulations into three main categories:

1. I Want Something (cookie, toy, dangerous pointy item) But My Evil Controlling Overlords Won't Let Me Have It.
2. Lo, I Have Hurt Myself.
3. I Am Overtired, And Therefore Must Waste More Of My Meager Remaining Energy Stores By Screaming.

The solutions to these problems are fairly apparent, even if they are illogical. For example, if Cal hurts himself, he requires (as many children do, I imagine) a kissing of the hurt body part to set things right. He firmly believes that this kissing really makes things better, and takes great pains to manipulate his face or hand or whatever injured part so that is aimed directly at my lips, therefore centering the healing vibes towards whatever invisible wound lies beneath. So of course Joe and I find this adorable, and I particularly relish it, because I know it won't be long before we as his parents will be viewed as USELESS and our kisses the equivalent of some cruel and humiliating punishment.

Anyway. So today Cal comes running up to me with his hand extended, saying, "My finger." He had been playing in the living room, so I assumed that he had banged his hand on something, sustained some sort of mortal crayon wound or similar. So of course, I bent over and kissed his extended index finger. Which I noted only afterwards was slightly brownish, and smelled like poop.

"Mama need to change the diaper," Cal added nonchalantly, about two seconds too late.

extortion

I got my New York State medical license in 2004.  Since that time, I've already had to renew my license twice, at $600 a pop.  I don't have to take a test to renew my license, or prove anything about my clinical acumen or outcomes, or really do anything related to medicine.  It seems that all I have to do is fill out a short questionnaire detailing the breakup of my time in practice, confirm that I have not been convicted of any felonies, and of course, send in a check to New York State for $600.  

I do not know what this $600 is for, or really even where the money goes when I send it in.  I do not know why my license expires every two years, when even my learner's permit is good for five years at a time.  All I know is that if I don't send it in, my license to practice medicine in this state expires.  So I have to pay up.  I have no choice.  This latest renewal also unfortunately coincides with my application for a Georgia state medical license, so, you know, there goes another $400.

This is the biggest racket of all time.   

i am talking about this again because i am clearly a glutton for punishment

Cal started his twice a week pre-preschool playgroup this Tuesday, and so far, he seems to be liking it. I mean, you know, he talks about "school" at home, and these stories aren't punctuated by tears or tales of midday throttlings by Thuggo the Abnormally Large Two Year-Old. So that's good.




I think what we mainly need to work on before he's actually ready for real preschool is the separation portion of the program, which is really why we enrolled him in this class in the first place. They try to allow the kids to do it gradually, and there's no absolute mandate that there must be no caretakers in the classroom by X point in the semester, so we're just sort of going with the flow and feeling out what Cal is ready for. For instance, Joe brought him the first day, and Cal was so instantly absorbed in all the toys and activities that when Joe got a page from the hospital 20 minutes into the class, he felt that he would probably be safe to step outside the room for a moment just to return the call.

Well, you know, I wasn't there, but I am told that what happened when Cal looked up and realized Daddy was gone was what we euphemistically call "a meltdown." Well, I guess that's not much of a euphemism. Luckily, the incident didn't seem to do too much harm--he was still excited about going in today, and our nanny says that he had a good time. So, you know, we'll work on the separation bit.

Though our prime intent for sending Cal to the pre-preschool is so that he will eventually crush the USMLEs (um, kidding and whatnot), they seem to be a good job of accomplishing our other prime intent, which was to get him used to a more structured classroom environment, with a teacher, set activities, and rules. You know, because usually we let him run wild in a lawless environment like we're on HBO: NO LIMITS. Not really. But it's nice for him to have these little activities and tasks, like hand-washing and group snack time, and he has enjoyed showing off his new skills at home. Like today, the kids learned about drinking from a regular cup, not a sippy cup or a covered cup with a straw. I myself have rarely allowed him free reign over an open cup, because hey, I have enough stuff to clean, but as Cal told me at dinner, all it requires is "two hands" and for one to "do it slowly" and "be careful."




He is taking to outside instruction so well I am going to suggest to the teachers that the next addition to their curriculum should be how to use the Swiffer.

the underwear drawer

It does not count as age-inappropriate browbeating if I tell you that we're trying to toilet-train Cal, does it? I figure it's either that, or I'll start getting notes from people cavilling, I CAN'T BELIEVE YOUR TWO AND A HALF YEAR-OLD ISN'T TOILET TRAINED YET, GOOD LORD WOMAN, WHAT ARE YOU THINKING, MY TEN MONTH OLD HAS SUCH EXCEPTIONAL BLADDER CONTROL THAT HE CAN PEE IN A VERY SMALL SHOT GLASS FROM ACROSS THE ROOM! So anyway, between the two extremes, let's just call it even.

So yeah, we're trying to toilet train Cal.





So far, he has been pretty good about keeping himself dry for an hour or so in underwear before bathtime in the evening--the timing of such extended diaperless tightrope acts being timed to minimize the fallout from an errant urine stream or two. He can hold his pee for a while, and he can pee on the potty when the mood seizes him. But to say that he's anywhere close to being toilet trained is a vast overstatement at this point.




He does seem to like his new underwear, however.

i owe you one book




After my day on Monday, it was kind of a nice respite to be in a room doing anesthesia for eye surgery today. As I tell my patients, nothing in medicine is free of risk, but at least compared with yesterday, I was slightly less concerned about my patients trying to die on me.  Which is good.

In other news, I got a look today at a near-final draft of the book contract that I'll be signing with my publisher.   Ah yes, the book.  I know I haven't talked about it much, since Joe's fellowship match in Atlanta got me all stressed about having to move to a place where I have NO HOME and NO JOB and NO CHILDCARE and NO GOOD PUBLIC TRANSPORTATION, but yes, I am still making good progress on writing this book.  This is probably not much of a surprise to anyone, so I'm not afraid to tell you that...I don't really know much about the finer details of literary contract-speak. For instance, who even knew it would take so long to cobble together a contract? Who knew it wasn't just a single piece of paper reading "I owe you one book" that I would sign with an X? My understanding prior to this was: I write a book proposal. Some publisher decides they like the book proposal. I write the book. The book gets published. The end. Nowhere in this (admittedly simplistic) understanding of the process did I ever conceive of terminology like "foreign language rights" or "mass market editions." Also, there are stipulations in the contract with respect to audio versions of the book, and some part in there about large print and Braille editions. Ah so.

So anyway, I am reading through this contract, but I find that I am having to Google, like, every fifth word. It reminds me of that part in "Ramona the Brave" (I'm not sure if this is the exact "Ramona" book that I'm remembering, but whatever, the one I'm talking about is the one where she's scared of the gorilla in the nature book. And where there's a hole in the side of her house that she and Howie jump through. Remember? Yes.) where she's trying to show off to her babysitter that she can read, but she doesn't know all the words, so she just kind of makes a buzzing sound in her head and skips over those parts. "The Publisher shall be entitled to BZZZZZZZZZZ and BZZZZZZZZZZ the rights granted in this BZZZZZZZZZZ, in whole or in part, upon such terms as BZZZZZZZZZZ, and the Author shall earn a share of BZZZZZZZZZZ as set forth below (see section B subsection (ii)." Dammit, Jim, I'm a doctor, not a...contract...parsing...type-person.

Luckily, my agent seems quite expert and appears to know exactly what she's doing in these negotiations, so I will continue to let her do just that. And I will give anesthesia and continue to Google things, and hopefully, pretty soon, we will have a finished contract, which I will sign with an X. Huzzah.

you take the good you take the bad

I knew today was going to be a challenge (see: two Peds open heart cases back-to-back), but what I didn't know was that I was supposed to be carrying the Peds Trauma and Peds Arrest pagers today too. You want to know an wholly unpleasant way to find out that fact? Be working in the OR, getting your patient settled before going on bypass, when a nurse wanders in, thrusting the pagers towards you. "Dr. Au, one of the anesthesia secretaries said you're supposed to be holding these pagers today, and that one of them just went off." Whee!

I don't know why someone who is actually working in the OR is somehow also supposed to be available to field the arrest and trauma pages (this just builds in a critical delay--I had to page my attending to handle my patient on the table while I grabbed the arrest bag and went running down to the ER to attend to a patient who, for the sake of anonymity, I will call Stabby McKnife) but hey, things can't always make sense, can they? That would make things too easy.

Anyway, so there was Stabby McKnife, and there were the two open heart cases, and then, at the end of the day, there was an arrest in the ICU, which--hell, anytime you have an arrest in a critically ill child, things just aren't pretty. I left work two and a half hours late and when I got home, Joe tells me that he absolutely MUST watch football tonight because Ohio State is in the playoffs (or whatever) so could I please take care of Cal's emotional, bodily and hygiene needs for the rest of the night, because blah blah blah football. FOOT. BALL.

Anyway, enough with the computer, I have to give Cal his bath. And then I have to DIE.

but what i really love about you is your mind




The problem with taking Saturday call is not so much the call itself, as the aftermath. I got home this morning at 8:00am, slept for three hours, and then went with Joe and Cal to the playground so that I could at least spend some with my family this weekend. Now it's 7:00pm, and I am back in the ORs early tomorrow morning, doing two back-to-back Pediatric open heart cases. Next weekend I am off, but that seems very far away right now.

Starting the work week at a deficit makes me feel not unlike a zombie, lurching from one task to another in search of tasty delicious human brains upon which to feast. Brains! BRAINS!

So I am a little tired is what I'm saying.

saturday on call




There's nothing like having your name pasted over the paper towel dispenser in the PACU to make you drunk with power.

deconstructed turkey

Cal brought home a folder of stuff yesterday, culled from the past few months of his art class. The below I suspect was some sort of "assemble a turkey" project from Thanksgiving, involving felt cutouts, feathers, googly-eyes and the like.




Either that, or this is a much more avant-garde class than advertised, and they took the kids out to the highways to create studies in roadkill.

yes, it's january 3rd, what of it?

Christmas was so nice that I'm having a hard time thinking about taking the tree down.




Anyway, why can't we just keep it up year-round without being labeled eccentric cranks? You know, as sort of an alternative decorative light source? Some people have chandeliers, others have Tap Lights, we have this Christmas tree.

neither desperate, nor a housewife




Is it some sort of a rule, or just a stereotype come to life, for mothers-in-law to feel that daughters-in-law don't do enough around the house?

As a medical resident with a two year-old child, who leaves the house at 5:15am every morning and gets home anywhere between 5:30pm that evening and 9:00am the following day, I have to say that most of my time is pretty much booked with raising my offspring and, you know, being a doctor. In the hospital. Where I work when I am not at home. Also, sometimes I try to write this book that I'm working on. Just a few small activities to occupy my day, you know. Unfortunately, this leaves me relatively little time to sew my own drapes, or turn old drapes into clothes, or whatever paragon of wifely virtue it is that I may be held up to.

I think this impression that I don't do enough housewifery is innocent, a holdover from another generation and another set of duties and expectations, but I would be flat-out lying if I said it didn't bother me a little. There are the larger feminist implications of it first of all. And then there is the knee-jerk reaction wherein I rail (quietly), "What, do I have to be good at everything?" Anyway, it's 2008 already, isn't this supposed to be The Future? When can I get me one of those robot maids and a self-cleaning home? Not to mention a car that folds into a briefcase?

Really, I think what clinched it is that Joe did the laundry yesterday when I was post-call, you know, having worked for TWENTY-FOUR HOURS STRAIGHT the night before, and the fact that I wasn't on hand to pair my own socks make me look kind of bad. Damn you, dutiful new-age husband!

And therein ends my obligatory holiday season family psychodrama. Feel free to share your own. Otherwise, as you were.

(Obligatory addendum: May it go without saying that I love my in-laws, they are the best, so helpful, so supportive, will be staying with us for a month helping us with our transition to Atlanta, super-duper people. Yes! The best! I didn't need to say that did I? Well, yes, I probably did. I! LOVE! THEM! But I do not love dusting.)

happy new year

On the whole, I can think of a lot worse things I could be doing at 11:58pm on New Year's Eve.






But I can think of a lot of better things, too.

Happy New Year. May 2008 be all that you wish for it to be and more, and may your nights on-call be less busy than this one.

the holdout




Here it is, the one soda machine in the hospital that still only (ha, "only") charges $1.50 for a 20 oz. bottle of soda. (All the other machines in the hospital charge $1.75.) I'm not sure why this one is the holdout, but I suspect that since this machine is located in an unlit closet somewhere deep in the Pediatrics call suite, the soda company has forgotten that it exists.

it should be noted that none of the polar bears were drinking coke







Joe's parents were meeting up with some friends for lunch today, so Joe and I took Cal to the zoo. Really, the die was cast after a series of tactical missteps yesterday.


Misstep #1:


(Everyone standing next to the elevator, en route to the Transit Museum)

JOE'S DAD
Cal, are you ready to go to the zoo?

CAL
Zoo! To see animals!

JOE(Whispering)
We're going to the Transit Museum.

JOE'S DAD
I mean trains! Not the zoo! We're going to see trains!

CAL
(Hopefully)
Go take the trains to see animals?


Misstep #2:


(Leaving the transit museum, walking through Brooklyn Heights searching for lunch)

JOE'S MOM
I'm starving. Where are we going to eat?

JOE
The restaurant's just a couple more blocks this way.

JOE'S MOM
I'm dying. We'd better get there soon. I could eat a cow.

CAL
(Panicking)
No cow! No eat a cow!

JOE'S MOM(Covering)
No honey, we're not going to eat a cow.

JOE
No, we're going to eat a couple of cute bunnies.

MICHELLE
And then if we're still hungry, maybe we'll eat Cooper.


I hate to see what's going to happen when he realizes that chicken nuggets are made of chicken.

pluggery




If you ever needed another excuse to go to Brooklyn Heights, here's one. The New York Transit Museum. Really fun, hands-on exhibits, some great old-timey pieces of history, and to top it all off, the whole museum was built into an old decommissioned subway station. So cool. (Full photo set here.)




May I suggest, though, that you skip the gift shop at the end if you have kids. TRUST ME. You may play the logic card, telling them that they have enough train crap at home without buying yet more, overpriced train crap--but they will not ever, ever believe you.

christmas part deux

So. Joe's parents are coming into town today to spend the tail end of the holidays with us, and provide us with some babysitting tomorrow night so that Joe and I can finally go out for dinner to celebrate our respective good news (the book deal for me, the fellowship for Joe). Plus, Cal gets the benefit of having two people around who have an insatiable hunger for ALL CAL ALL THE TIME, including endless iterations of the I-push-the-trains-this-way-you-push-the-trains-that-way game. Lovely.




Public service message! So long as your kid is old enough and does not have a burning urge to know what marbles taste like, a cheapy plastic marble run will keep them entertained for hours. HOURS. I mean, I suppose you could get the nice fancy wood one if you're all sophistimacated, but I assure you that gravity works the same and you will be much less distraught if your dog chew it into mulch. (For example.)

so this is how he has so much energy




MICHELLE
(Drinking coffee)

CAL
(Gesturing to cup)
Cal have some?

MICHELLE
No, honey.

CAL
Want to hold it and drink some.

MICHELLE
No honey, this is coffee, and coffee is for mommies and daddies, not for Cal.

CAL
Want some.

MICHELLE
You have your own drink.

CAL
(Looking intense)
Want some. NEED SOME.

MICHELLE
Woah.

maybe we'll put this picture on next year's holiday cards




The OR. Where we keep the Christmas tree up all year long.

(In the same spirit, it also should be noted that the leg holders for certain cases in the lithotomy position are called "candy canes.")

happy holidays





And a good time was had by all.

"could you describe the ruckus, sir?"

Wow, who knew people had such strong feelings about Magna Doodle?

Anyway, so yesterday was kind of a slow news day, which is what usually happens when I decide to just post a video clip from our extensive home movie files. Incidentally, I was deciding between the "Learning to Read" clip and this other clip I have of Cal opening an early Christmas present, which happened to be a big box of Dum Dum lollipops. But then I thought, that would be two candy-eating videos in a row, thus inviting excoriation from people kindly and pityingly informing us DON'T YOU KNOW CANDY IS BAD? So the reading clip it was. And now you know...the rest of the story. 

It is pointless to note (though watch me try!) that Cal asks to "play numbers and letters" the same way he asks to play trains or puzzles, so really, it's not a big deal, and if he's having fun, we're going to let him guide us. But I'm sure that if I say that, somewhere in someone's mind is the voice of an overly mascaraed pageant mom explaining how little four year-old Kayleigh just LOVES dressing up in a midriff-exposing rodeo outfit and being judged while shimmying with a lasso to the music of Dolly Parton.

Well anyway, I think discussion is healthy, and all I have to say is that we're lucky that we all have the right to have our own children and screw them up as we please. Joe and I want to let Cal start to be comfortable with words if he's having fun with it, other people don't think it's appropriate, so they don't. Doesn't much matter to me--in fourteen years they'll all be locked in a library, Cal for bringing a flare gun to school, your kid for duct taping someone's buns together in the locker room, and they'll have a grand old time talking about life and love and how much they hate their parents.


* * *

Well now, that dispensed with, I'm going to move on to another topic. So surely you know by now that we will be moving to Atlanta in July, and as part of the adaptive maneuvers I have to make for this move, I have to learn how to drive. Yes yes, the sacrifices we all have to make. I really don't quite understand why it has taken me this long to learn. I've had my learner's permit for about ten years, and I've taken several courses with trained instructors and whatnot, so theoretically, I'm as prepared to drive as any numbskull teenager. However, the key difference is that they want to drive, whereas I really do not. I blame one failed road test my senior year of college (wherein this Massachussets DMV guy told me that I "could kill someone"--I which I think was probably excessive, I just didn't realize that a small side street was two-way and was driving in the middle of it instead of on the right) and subsequent scarring experiences in the name of my growth and driver's education, like that time Joe forced me to drive on the highway in Connecticut. I have PTSD from that one. So at this point, getting my driver's license is somewhere next to booking an appointment at the dentist for multiple extractions. At some point, it needs to be done, but this won't prevent me from pushing it off as long as possible.

My newest fantasy is this:




See, in the fantasy, I would still get my driver's license, but I would get to and from work on this. A scooter. It would be very Euro and also, I would not have to drive a car most of the time. It would be like riding a bicycle, only BETTER and COOLER. Additionally, scooters are more energy efficient and we would spend a lot less money on gas, but I would be lying if I didn't tell you that these were secondary concerns to the fact that I just hate cars and want to avoid driving one at all costs.

Obviously, I would have to drive sometimes. I would have to drive Cal around occasionally, and I don't think he could balance on the handlebars of the scooter very well. (I am kidding, of course--though I did see someone riding a bike down the streets of Manhattan with a helmet-less kid positioned just as described, and it was very scary.) But it would be a nice option for the day to day, and for running short errands, wouldn't it? And then I could take my baguette and copy of Le Monde out of the underseat storage smoke little brown cigarettes while commiserating with my Left Bank compatriots, "Oui, l'amour."

Of course, I could also end up under in a crumpled mess under a 12-wheel Kroger truck, but look, just let me dream a little bit. I'm moving to Georgia. Retreating into my rich fantasy life is how I'm coping with reality right now.

surely these skills will come in handy





I post this as sort of a motivational tool, because if Cal can learn to read, surely I can learn to drive.

feeders and growers




I find it very cute, not to mention fitting, that the theme for the Neonatal ICU at [Children's Hospital] is "The Very Hungry Caterpillar."

the hot zone

Man, that pig generated more comments than the preschool thing! To those made uncomfortable by our party foodstuffs, I offer two things. One, this cute bunny! (image credit)




Two, this piece of advice: do not go to Chinatown. Seriously. There are things that you will see in those restaurants and butcher windows that will make you unhappy. Delicious things.

But anyway, I guess in some sense I was lucky to be on call last night, because there was so much food left over from the party that I didn't even have to worry about dinner. The roast beast had long since been reduced to shreds, but there was still some chicken and tortilla chips and salsa, stuff like that. There were also two gigantic tubs of pasta salad sort of sitting there looking contemplative, but after some thought I steered clear, because I was a little suspicous of something with high mayonnaise content sitting out at room temperature for eight hours. Heaven forbid I get food poisoning and then have to deal with some emergency.

The thing that made it a little less than ideal to be on call yesterday was that Cal's been a little sick lately. Nothing major, just a lot of congestion and coughing. A text message exchange between me and Joe last night, while I was in the OR.


JOE
Cal has a fever, 99.1 axillary, and slapped cheeks. So, parvo it is.

MICHELLE
OK. How's he feeling?

JOE
Fine. Gave him some Tylenol mixed with juice.

MICHELLE
He's about 15 kilos, so...(tapping on calculator) let's say 7 ccs?*

JOE
I gave him 5 ccs.

MICHELLE
Lowballer.

JOE
He feels fine.

MICHELLE
Good. Oh, and stop slapping our son's cheeks.


This morning, I'm not completely convinced that Cal does indeed have parvo, since he has no rash on his body that I can see, but it hardly matters, since there's nothing different that I'm going to do about it anyway.

* No matter how many years may have passed since my days as a Pediatric resident, I cannot stop reflexively calculating oral Tylenol and Motrin dosages. It's like a tic.

roast beast

I have been to a lot of work midday holiday parties in my time, most of the cookies-and-punch variety.





However, seeing a suckling pig in the Anesthesia lounge was a first.

inflation




Hey, we just found out yesterday that Cal got in off the waitlist for one of the pre-preschool classes, so now he can attend twice a week instead of just once. Huzzah! Never have I experienced such a sense of accomplishment for something that required absolutely no merit or effort on my part, or on the part of my child. So starting in January, Cal will be starting preschool prep. Perhaps I will get him a little blazer with a crest, à la "School Ties." And then he will stand outside his dorm, under the weight of the pelting rain and his classmate's bigotry, and shout, "COWARDS!" (No, I never actually watched that movie, but I saw the commercial, which told me more than enough.)

See, I think the thing with the Manhattan preschool thing is like what happens at Mardi Gras with the beads. (Backstory: I went to Mardi Gras in New Orleans my senior year of college with some friends, because I figured that it was the last time I would have to do so before having to eschew such youthful debauchery for the stethescope and white coat set. And let me tell you, that was not a wholesome scene. I'm glad I went and was able to see it, especially before Katrina and all, but man, you do not want your kids running wild there at that time of year.) What I didn't really understand upon first arriving in New Orleans was the whole bead thing. You are aware, of course, that during these parades at Mardi Gras, people hurl strings of beads at the gathered throng, both as general spectacle, to attract a crowd, and occasionally as reward for showing your mammaries and nethers. What's the big deal? I asked myself. They're just these crappy plastic beads! Why is everyone killing each other and humiliating themselves for these stupid two-cent plastic beads?

I'm sure there's some sort of economic principle that illustrates this, or perhaps it's as simple as peer pressure in high school. But when everyone else wants something very badly, it insidiously elevates the value of that thing in your eyes too. Because by the end of our four days in New Orleans, I wanted the beads too. I did not go "Girls Gone Wild" for the beads, nor did I steal or cheat for the beads, but certainly, if someone was throwing beads, I wanted to catch them. They were pretty colors and shiny. Beads. It was like hypnotism.

There was a hierarchy of beads, of course. Lowest on the hierarchy were the little beads, mostly in strings of green or gold or purple, that probably came in gigantic bulk bags of five hundred. These were tossed about indiscriminately, and we soon tired of their ordinariness. Then there were the bigger beads, the different colored beads, the beads shaped like multifaceted disco balls. These were the superior beads, sought after. Finally were best beads, the coveted beads, the beads that required effort, that came with stories. These beads I got off a guy on Bourbon Street who was dressed like the Mayor of Munchkin City. These beads I got from that parade with all transvestites. These beads I got from some guy who was so drunk he stared intently at the front of my shirt, plaintively requesting that I "let those things breathe." The strange thing was that there were beads all over the streets and parade routes, literally scattered on the pavement and along the sidewalks, some even of the very nice variety, but no one seemed remotely interested in those. It's like they completely lost value once they hit the floor. The more difficult something is to get, the more people want it, and the opposite seemed to be true as well.

In a way, this is what happens in Manhattan with preschool. Those more rational among us rightfully point out that preschool is just basically a holding pen for two year olds to draw on their own faces with marker and exchange viral scourge, so why the big scene? Why the applications and the interviews and the first round admission letter brouhaha? Do we really think it means something, aside from being (in the case of the extremely elite preschools) an indicator of status? Do we really think it ensures the kids' future success? THEY WEAR DIAPERS AND EAT THEIR OWN SNOT. But the strange thing is when you're in the scene, and everyone around you is in the scene, even those who don't buy into the hype start insidiously to believe in it.

But now, despite all the essays and interviews and transparent efforts at parental one-upsmanship, we won't even be attending preschool in Manhattan at all. We're moving to Atlanta for the next two years, and by the time we get back, Cal will be ready to start kindergarten, which we can hopefully attend at one of any number of excellent public schools in the area. Though I don't know if we're just fleeing one scene and diving into another--for that week we're going to be in Georgia, we have had to line Cal up for five preschool interviews which, each institution insists are mandatory. Wow, flying into to town for a preschool interview, a new benchmark of ridiculousness has been set. As long as the other parents don't start talking loudly about how poor private jet service has gotten these days, and does anyone know how to get a red wine stain off from leather seating?--we'll just keep our heads down and try to somehow try get Cal near a microwave so he can read off the numbers.

i want candy





For the Cal fans among us. Caught on video at last, my scandalous parenting style! Watch as I feed my child copious amounts of chocolate, allow him to play with the microwave, keep him from head butting my pelvis with further chocolate bribery, and can't even elicit a "thank you" for my efforts. (Not pictured: the part where I give him a bath in the washing machine. Springtime fresh!)

the book of job

How does one apply for a job, anyway? I'm not talking about a residency or a fellowship--that application process follows a very specific structure, and I'm down with that. But I mean a real job. A job Out There in the Real World. In my elaborate fantasy life, it would be like the world's shortest one-act play.


MICHELLE
Hi. I am smart and a good work person. You give me job now, please.

EMPLOYER
Why?

MICHELLE
Because I need it.

EMPLOYER
Well...OK. Also, would you like some money?

MICHELLE
OK.

(FIN.)


However, I believe there is probably a little more to it than that.

After some amount of procrastination (I wanted to do these things, but somehow the very thought of it just made me so tired--anyway, I got out late from work many days this week) I did the following. The first thing was to pull my CV out of moth balls and give it a polish. I erased some old things (I figure no one needs to know my volunteer work in college anymore) and put in some new things, like, oh, MY TRAINING AS AN ANESTHESIOLOGIST. Secondly, I pulled up the Google Map of Atlanta, and wrote down all the little pink squares--I mean hospitals--in around and far from Academic Medical Center. Finally, I Googled the name of each hospital (seriously, what did we do before the Internet? Would I have had to go to the library and ask for a phonebook of Atlanta, Georgia? Probably yes.) and wrote down the addresses and phone numbers of the anesthesia groups staffing each hospital.

I lost my will to live before I could proceed any further, but the next step will be calling all these places and sending in my CV. And then telling them that I am smart and a good work person and that they should give me a job now, please. Everyone keeps telling me that the anesthesia job market in Georgia is good and that I'm a good resident coming out of a top residency program so I should just relax, to which I respond, "What makes you think I'm not relaxed? The face that I no longer have any fingernails with which to CLAW MY OWN FACE OFF? I'M RELAXED!"

(Can I have a job?)

prep school

So we recently enrolled Cal in this class at our local kid's playcenter. It is billed as a two year-old playgroup cum preschool preparation class, where kids go in, have circle time, story time, science time, crayon-eating time, what have you, and get used to being around other kids, listening to a teacher, the whole preschool environment. Emphasized is the "gradual separation" component to it (which is the main reason we signed Cal up--some kids jump into new situations with gusto, but he's more of the type that goes into his legwarmer impersonation and starts begging to leave), where week by week, the kids get used to being alone with a teacher and the other kids, away from the primary caregivers. What the hell, he's been taking music and art classes for more than a year now, this will be an extension of the same, and anyway, he needs to do something in the winter, since it's so cold outside.

It's a 90-minute class, and I tried to get him in for the twice-a-week program, but it seems like we were a little behind the curve in signing up, and I could only squeeze him in once a week, on Wednesday.


MICHELLE
Could I get on the waitlist for one of the other classes?
In case a spot opens up, so he could maybe go twice a week?

EMPLOYEE
Sure. We have additional two year-old classroom time on Tuesdays and Fridays.
Which class do you want to be on the waitlist for?

MICHELLE
Doesn't really matter. Can I put him on the waitlist for both?
We'll take either, if someone drops out.

EMPLOYEE
OK, I'll take care of that. (Typing noises) OK then, Cal's enrolled for Wednesdays,
and he's on the waitlist for both Tuesdays and Fridays.

MICHELLE
Great.


After I hung up, I realized: we have put our son on a waitlist for a preschool prep course. We are now officially ridiculous.

behold, the internet is useful!




Thank you all so much for you comments and e-mails (and Facebook messages!) regarding our impending move to Atlanta. You have no idea how much your insights help. Probably the only thing more difficult than planning a wedding from afar is trying to get Cal into a school, find a job, and figure out a place to live from afar. Maybe I could deploy some wireless robot to meet with realtors and interview with anesthesia groups and preschool teachers in my stead in Atlanta while I work the remote controls from up here. But with my luck, the robot would becomes sentient and turn evil, and then I'd really be starting things off on the wrong foot.

Anyway, I have to spend some time this weekend getting together a list of contacts and sending off my CV. Ideally, because of Joe's call situation (he will be holding the Oculoplastics call pager every day for two years straight--it is home call, and hopefully he won't get called in that often, but man, I've taken home call before, and that pager is like a noose around your neck) I will not be looking for a "partnership track" job. Doesn't really make much sense, given that we won't be there for the long-term anyway, and really what I would love, if I could find a position like this, is a "day player" anesthesia job. You know, more of a Monday through Friday, no call, no nights, no weekends or holidays kind of thing. Seems reasonable to expect there will be jobs like that out there, since a lot of anesthesiologists want to take call and do overtime because there are substantial financial incentives to working those extra hours. Anyway, we'll have to see what's out there. 

It occurs to me that this just may be the first "real" job I've applied to in my entire life--you know, a job that's not volunteer work, not part of some academic obligation, a research grant, a summer fellowship, stuff like that. My first real job. I AM ALMOST 30 YEARS OLD. Talk about delayed.

Anyway, there have to be plenty of patients who need anesthesia in Atlanta. And I am more than ready to provide it. So, no more drinking whisky and biting on a stick before getting your leg sawed off.* It's time for the good stuff.

(*I think it may be prudent to add here that this is simply a reference to the Atlanta civil war scenes in "Gone With the Wind," not some preconceived notion on my part that the South is somehow backwater. And I'm sure if you bite on sticks for anesthesia, they're very nice sticks, made from the wood of peach trees, whittled and trimmed by beautiful maidens. OK then, as you were.)

hotlanta




There's no pulling one over on you guys, is there? I thought that the peach drawings were but a tantilizing clue, but as it turns out, the news was TOTALLY OBVIOUS. Well, as many have guessed, the big news is that Joe matched in an oculoplastics fellowship in Atlanta, and we will be moving there this July. To live. For two years. In Atlanta. Which is in this state called "Georgia." Which is far away. And not New York. At all.

I am feeling somewhat conflicted about all this.

On one hand, it is a good thing. Joe matching in a good program at a very big academic medical center is undeniably great news. He has been in the process of applying for plastics programs for about two years now, so to finally have some payoff on that is a relief. After he didn't match this past spring, we almost immediately started the process of applying for some other 2008 plastics positions outside of the spring match, in addition to starting the ordeal of getting our ducks in a row for the 2009 match proess. This is a not insubstantial amount of work, complicated by the sort of weary cynicism that accompanies any large burden of work for which you are not assured any results at all.

So while matching at this program in Atlanta is great news on one front, I have to be honest that for both of us, receiving this news yesterday that the deal was done evoked an emotion just short of happiness. On one hand--he landed this competitive fellowship! He will get excellent training! Great surgical cases! Good news for his career! Huzzah! But on the other hand, we are basically giving up absolutely everything else. I had a fellowship spot at [Univeristy Hospital] for next year, and I will be giving that up. My family lives in New York, and we will have to move away from them. We have housing, childcare, a network of people up here, and when we move, we will be saying goodbye to it all. From that point of view, the scales look a little...uneven. We always said that because Joe's fellowship was so difficult to get and such a great opportunity for him that wherever he ended up matching, we would just pick up and go, but...man. This had better be worth it.




I have to admit in moments of self-pity that I feel a certain 1970s Hillary Clinton-esque martyrdom. I mean, this fellowship that I signed up for would have been good for my career, for my professional development, and my department chairman had discussed with me the idea of staying on at [University Hospital] as faculty afterwards. So why would we automatically move to accomodate Joe's career? Was there a certain latent sexism on both our parts to presume that this should happen? Why move for him and give up everything else, as opposed to staying for me?

Well, it's not so simple, is all it comes down to. Obviously, landing an oculoplastics fellowship is really, impossibly tough, even for the most qualified candidates, so to turn down a good situation when it is offered to you is just short of huberis. And I could always come back and reapply for the Regional fellowship if I so wanted. I could always apply for a faculty position at [University Hospital] after Joe's fellowship is completed. These are reasonable options, and these are opportunities that would be available to me even after some time. But a good oculoplastics fellowship on the other hand is a rare bird indeed. You just don't turn a good position like that down. Another one may never come along.

In addition, despite my initial reflexive reaction to uprooting our entire lives for this fellowship, it's not just about Joe's career. Compared with some of the other fellowships that we've looked at, this one offers (supposedly--this from Joe, who is clearly trying to sell it to me) a better quality of life for its fellows. He will be able to spend more time with me and Cal, have shorter hours, less intense call. And after he's done with his fellowship, he will hopefully also be able to have a better lifestyle overall. Again, better hours, better income, and more importantly, he will be happy doing the kind of surgery and practicing the kind of medicine that he enjoys. I have, several times in the past, told Joe to just forget plastics, do general opthalmology, practice part time and stay home with Cal the rest of the time, leaving it to me to bring home the bacon. I was only partially kidding. But for Joe, it's not so much the income as it is the work. I mean, yes, we need to put food on the table, but in the end, he needs to be doing the kind of work that makes him happy.

In addition, in the big scheme of things, Atlanta is a pretty nice place to live. We applied to worse programs in way more far-flung places. I'd much rather live in Atlanta than a lot of those other "cities" (I use the term loosely), where the corn maze and the world's largest ball of twine are central attractions. My cousins lived in Atlanta (well, Alpharetta, which is one of the suburbs) for a good many years of my childhood. Atlanta is doable. I can handle Atlanta. Of course, you have to understand that I have lived in Manhattan for the past 29 years of my life, so this all will not come without some period of adjustment.

So, we have a lot to do before then. I have rescheduled some vacation time, and in February, we're all going to fly down to Atlanta for a week to try to get some shit done. We have already submitted applications and scheduled five preschool interviews for Cal, we are researching the real estate market, and I will have to start applying for a job. Lots to accomplish in one week. This is where the audience participation part of things play in. Some of you may know Atlanta. Some of you may actually even live there. Some basic questions:

• Where should we live? I know the traffic in Atlanta is completely unreasonable because everyone drives, because the mass transit system is just not as robust or reliable as the one that I am used to. We want to minimize our commute time, obviously, and we have applied mostly for preschools near where Joe will be working. (Should I say where it will be? Are people going to stalk him? I think it should be obvious to anyone who actually knows Atlanta--it is the big Academic Medical Center. Starts with a E. Yes? OK. Stalkers, ho!) We were thinking of Decatur. Is this a nice area for families? Is the rental market reasonable, or do we have to buy to get anything good?

• Any dirt on any of the local preschools? We are pretty familiar with the names of most of the ones in the area, but of course, we don't have the benefit of insider knowledge, so all we do is assess whether or not their website looks good before applying. It does not have to be super fancy, we just want a school with good teachers and nice families, and a facility with a minimum of tasty lead pain chips. More towards the preschool end of the spectrum and less towards the daycare end preferably, though I know sometimes those lines are blurry.
  

• This is something of a long shot for any of my colleagues down there, but--any good anesthesia practices in the area? I am obviously going to send my CV to the Academic Medical Center, and cold call some of the other places that might use private groups, but any extra info anyone can give me would be much appreciated. You can e-mail me, if you are with an actual group, I will even send you my CV and all that stuff. Finally, the world will know what I got on Step I of my Boards. I know you've been waiting.
  

• I'm going to have to drive, aren't I? (This was not a real question, more of a rhetorical "woe, woe" lament.)

• Recommendations on a good Pediatrics practice would be appreciated. We're going to have to set up some stuff for Cal, obviously. I would prefer if the practice was affiliated with the Academic Medical Center just for ease of access, but if you know someone who's really stellar and in a non-academic private practice, I will take that too. Ditto on a good OB/Gyn or vet for Cooper.

• What if we don't have any friends? What if no one likes me? (This, again, is not a real question. I also used to ask myself these things before going to summer camp.)

So anyway, obviously a lot of big changes going on around here, mostly good, some traumatic but still good in that growing-stronger-through-change kind of way. Clearly, you will hear way too much about the process of relocating from New York to Atlanta in the upcoming months. I know, it's everything you never wanted to know and wouldn't ever think to ask. You're welcome.




We're moving to Atlanta.

watch this space

More big news today. Very big news. No, still not pregnant, but the news is life-changing all the same. Sorry to be a tease again, but I literally cannot think of anything else to post for today, and yet there are certain people that we have to share this news with before posting it here. But believe me, I will tell you, and tell you soon. Because lord knows we're going to need some help with this one.




Get ready for a change.

this was ill-advised



I'm sure this fills some sort of need in the Oscar epic-laden December feature film field, but...have you heard the world clamoring for a Run DMC-themed computer animated remake of "Alvin and the Chipmunks"? I myself have not.

christmas came early this year




While Cal was napping yesterday, Joe built this little Lego railroad metropolis for him out of his old tracks and our sizeable Duplo stash.




Man, compared to this, the actual presents that we got him for Christmas look pretty lame. Alphabet workbook and new socks, anyone?

eye'll be home for christmas




A Christmas tree set up in the window of this LASIK factory in our neighborhood. We have long suspected that this is not quite the most professional bastion of medical practice we've ever seen (case in point: the procedure room is in front of a floor-to-ceiling window deliberately in full view of pedestrian street traffic, right next to the giant plasma screen TV and scrolling multicolor Times Square ticker advertising the good doctor's services), but in case these was any doubt, let's take a closer look at these ornaments.





I mean, I could see how that might be cute and all, under the right circumstances, but given the whole Vegas-style office picture, I think they may have chased away their two remaining possible patients.

the very hungry caterpillar




Ordered Cal the chicken teriyaki at this Japanese cafeteria place near Union Square today. Didn't expect it was going to be quite that big, obviously.

like a real doctor

Good day at work today. Well, good day for me, the resident, but not a good day for the patient. Strange how often that happens. Anyway, it was a day that I was scheduled for some relatively routine Gen Surg cases. Big cases, mind you, but nothing too crazy. The surgery was well underway when I hear the sound that will make any anesthesiologist look up and stand at attention--a prolonged slurping noise emanating from the field. I peeked over the drape, looked at the contents of the suction cannister, and motioned to the circulating nurse. "That blood in the fridge? Get it in here now." 

Two hours, five liters of blood loss and one slow-motion code later, we were stabilized and wheeling to the ICU. It was very...I don't know. Satisfying. It may be gruesome to think of that word in connection with one patient's bad outcome, but there it is. To be able to deal effectively with that situation was profoundly satisfying. There are the ordinary days, and there are the bad days that you screw things up and for days suffer with recrimination and self-doubt. But then there are days like today where you think, "You know what? One of my patients tried to die on me today, and I didn't let them."

I hear the sentiment a lot, mostly from medical students and bitter surgical residents, that they would never do anesthesia because it's so boring. Well, let's separate that out, here. Maybe you would never do anesthesia, the same way that I personally would never do...oh, say, Psych, or Ortho, because, you know, personal preference. But let's not let people undermine the work that we do by calling it "boring." Some of the scariest, seat-of-my-pants moments in medicine I have experienced as an anesthesia resident, and honestly, I am not an adrenaline junkie--I don't gamble and avoid roller coasters--but I can testify that this kind of medicine is thrilling. It's like, all that stuff you read about physiology, and pharmacology and hemodynamics in your textbooks? It's all happening RIGHT HERE right in front of your eyes. And it's really something to be on the front lines of that. I don't know. It's just fun. 

There's a lot of stuff that you do as a resident in any specialty you can barely argue you need a medical degree for. Tons of scutwork, papers to fill out, patient transport, transcription and dictation of lab values, some purely clerical, mindless stuff. But real anesthesia, the front line acute care medicine, makes me feel like, for lack of a better explanation, a real doctor.

I know that no one understands what anesthesiologists do, people don't look at what we look at and don't see the things that we're constantly, even unconsciously attuned to. And of course, people resent us for this that and the other thing, and while sometimes that annoys me, most of the time I'm OK with it. Because I know what I do. And my patient in the ICU will wake up later tonight because of what I do. And that, friends, makes me feel pretty damn good.

branded




I was wearing this sweatshirt over my scrubs this morning when one of the anesthesia techs stopped me.


TECH
Is that your husband's name?

MICHELLE
What? (Looking down) Oh "Spence"? No!
No no no! That's the name of the high school my sister went to.

TECH
Oh.

MICHELLE
What, you really think I would wear a sweatshirt with my husband's name
printed in giant letters across my chest? Please.

TECH
Well, you know, that's why I was like, damn.