back to school

I've enjoyed seeing everyone's back to school photos of social media these past few weeks, though they make me realize that I must be either one click off age-wise or else totally disconnected from current parenting trends, as I have never in my life taken a picture of my kid holding a sign (or if you want to get real fancy, a blackboard) broadcasting what grade they were going into. (Another trend that either came later or else that I just totally ignored was that thing where you put a giant sticker on the front of your kids' onesie telling everyone how many months old they are.) I mean, not that I don't take a picture of my kids on approximately the first day of school, because I do...kind of. But it just seems like there are so many things and rituals and accoutrement now. Like the child-rearing industry is slowly becoming the bridal industry.

But speaking of back to school...

Around the end of last year (right around, oh, say...Wednesday November 9th), I started thinking about how I could get more involved in healthcare on a broader level. I love my job and have no plans to stop being an anesthesiologist, but I also wanted to do something...else. Something more. Something less zoomed in, something a little more macro, something more policy and population-based. A broader way to help out. So what I decided to do was to go back to school and get a Masters of Public Health.

This was not an easy decision. Getting this degree is going to take a lot of time. It comes with a not-inconsequential monetary cost. I don't "need" to do it, and in most ways it's going to make my life a lot harder. It's not linked to any particular path for upward mobility or higher earning power, and I'm not looking to switch jobs. Almost no one that I'm close to understands why I want to do this, or thinks its remotely a good idea. (My parents seemed initially excited at the news, but then rapidly realized that I said I was getting an MPH, not an MBA, as they misheard. They were much less excited after that.) Oh, and also, I don't really have a really good specific idea of what exactly I want to do with this degree when (or if) I finally complete it. If I'm going to be totally honest, the only real reason I want to go back to school is because I want to learn more about public health, and can only hope that in the process of going through the coursework I'm going to find a useful, real-life way to marry this knowledge with my current career and find a good, real-world application for it. But I don't know what that's going to look like yet.

So anyway, that's happening. I've been accepted to the Mailman School of Public Health at Columbia, and will be starting their part-time executive MPH program next week. "Part-time" means I still will working my normal job, exactly the same as before. It also means a lot of remote work and an online curriculum, though once a month, for one long weekend (Thursday through Sunday, all day long), I will be flying into New York and completing my in-person classroom requirement. This, every month, for two years. We had an on-campus orientation in August. The first official day of classes is next week on September 14th. If I can get through this all without losing my mind, I'll be slated to graduate in August of 2019.

The time investment. The time investment is...a lot. I take it seriously. I work part-time at the hospital, but I have three kids (which is why I went part-time in the first place), and kids don't just go on auto-pilot. Doing this program necessarily translates into less time for me for them. It means more time in the evening spent in front of books, more than twice as many weekends I will be out of the picture, less flexibility for everyone all around. This was Joe's main objection to me starting this program. I don't think I'm airing any dirty laundry by talking about this, because he'd tell you just as easily: he doesn't think this is such a great idea. He's nominally supportive, and by that I guess I just mean he would never tell me explicitly not to do it. But for our family, I know he'd really rather I just...didn't. He doesn't see why we spent so many years getting to a point where our life was finally getting easier only to deliberately make it harder again.

But that was my exact thinking, only in reverse. We have three kids. Our youngest, Nina, just started kindergarten this year. I'm not saying our kids still aren't youngish (they are), or that they don't need me as much (they do, though the ways in which they need me are less about immediate survival and more about presence and guidance and...well, I guess I do all the food shopping and cooking, so, yes, maybe a little bit of survival). But it's a bit easier now. We have some breathing room. We have margins. What do you do with that elasticity? What else do you want to do? What's important to you? Is it about the luxury of empty space, or is it about the luxury to take on more? To do more with your life? What comes next?

Also. I finished residency nine years ago. Nine years into private practice. I love my current job, I love taking care of patients. It's the most rewarding, immediate, and intimate type of service I could ever hope to provide. (I know I'm supposed to say, "outside of parenthood" right here, but I won't. It's not that I don't think parenthood is important, I just feel it's a completely different thing.) But I feel like there's more I want to do. I just don't know how yet, so I want to learn. Because life is not lived in order to be easy. Life is lived to be worthwhile.

And honestly, once I decided to go ahead and do this thing, part of me was really tickled and excited about the idea of going back to school. It's been a long time. And I like school. I like learning. I like knowing things. I especially like knowing things that I feel I should know already. I've been doing some pre-reading for some of my classes, and there are so many things I'm learning now--about healthcare economics, policy, the history of Medicare and Medicaid--that I can't believe I hadn't been explicitly taught before. And the fact that I'll be back at school right where I started, at Columbia, on the health science campus...I just get a kick out of returning "home." (Columbia friends: the School of Public Health is located in the old Psych Institute, next door to the new Psych Institute, two doors down from our first year prison dorm rooms in Bard Hall. That was a grim little block wasn't it?)

So anyway. That's what's new with me. How have you been doing?

ch-ch-ch-changes

This blog, from the beginning, has been a journal about change. I started writing here in the year 2000 (though some of the older Homestead archives have since been eaten, believe me, they went alllll the way back, and yes, there was an Internet then) and from the beginning, it’s been a chronicle of ∆x/∆y. Medical school. Marriage. Residency. A different residency. Parenthood. Moving to the South. Every year was something big and something new and oh hell, how are we going to do this now and the constant, underlying theme through it all was change.

At the time I kind of petered out on the blog (and know that I never really intended to step away entirely, but the slow fade just kind of…happened) part of it was that the rate of change had slowed. Things were calming down, and we were settling into our lives in a way we’d never had a chance to before. Joe and I were both attendings and in stable jobs. Our kids were getting older. We bought a home and lived in it for a while. There were days with patients and nights on call and parent teacher conferences and summer camps and carpool lanes. And while things continued to be busy, they also became shockingly normal. Calm. Maybe even a little bit boring, though I mean that in the best possible way. It just felt, though, that in this journal about change, there wasn’t much left to write about.

I don’t think I feel that way anymore. There are a lot of ways to view this post-Trump ascension world we live in now, but I don’t think I can say anymore that life ceases to change. But neither can I continue to insist that it is boring, so...there's that. I think a lot of people—regular people, normal people, people like me—have a lot of energy and a renewed sense of civic responsibility in the face of this new administration, but often if feels difficult to know where to channel all that energy, you know? What do we do now? Where do I put all this? How can I help? How do you do stuff?

Look, I’m just a dumb doctor. I do what I know how to do. I work with patients. I help people individually in sometimes big but usually small, concrete ways. I speak the language of medicine and science and research and data. My campaigns are waged at the bedside, or in the operating room. I’m not a politician. I’m not a legislator. I’m not a lobbyist. I’m not a judge. I don’t know how that world works, or the avenues into it. But I want to change that. I want to learn. Then I want to do it. And I don’t want to do it alone.

I’ve done a few things since Election Day. These are just very small things, things I know how to do, in order to chip in, help shore things up, fix things, and teach my kids how to do the same. But it’s not enough. These things are important, but they are also too small. I know it takes thousands of little drops to fill a bucket, and I want to keep on adding those drops, but I’m ready to start doing more, and I just need to figure out how. So now we’re going to start, and we’re going to do it together.

Here’s a small list of some of the things my family and I have done since November 9th. It’s not a complete list (there are probably some things I don’t quite remember, I didn’t write them down or anything), but I also didn’t talk about it much on social media either, because my instinct was always that anonymous good works are the best kinds of good works. However, now I think the need for collective action and coalition building supersedes those instincts, and also, more than ever, we deserve to know that we’re not alone on this. So, an incomplete list.

• Donated money to Planned Parenthood.
• Donated money to National Public Radio and the Public Broadcasting Station.
• Donated money to the National Parks Service.
• Volunteered at Hands on Atlanta making holiday gifts for veterans at the VA. (The kids helped with that one.)
• Sponsored a needy family for the holidays through Families First Atlanta—a mom, kid, and grandparents. The dad had been deported earlier in the year.
• Signed up with the Clinician Action Network.
• Signed this petition to fight the repeal of the Affordable Care Act.
• Donated to the DNC.

But these are tiny actions, and not nearly enough. Lately it has been suggested to me that one means of political action is, quite simply, talking out loud. I mean, after a fashion. Via the Internet, on social media, ways in which ideas can be shared widely and communities built broadly. I know this is not a new idea at all—it's pretty much Twitter's entire modus operandi, at this point—but I never felt that it was as satisfying talking about doing stuff as actually just shutting your mouth and doing the stuff. But I think what I'm learning now is this. Sharing ideas is activism. Talking to people is activism. Starting the conversations and keeping them going is activism. And then we'll get to what comes next.

Anyway, this blog. I'm still just a doctor. This has always been a small platform focused on the minutiae of daily life, and will continue to be for as long as I can remember my Blogger password. (Hey, shut up, it's hard sometimes.) But the world is bigger than any one of us, and it's also up to us to take responsibility for all of it.

Now, to what you've all actually been interested in.

Cal is eleven now, and in the seventh grade. I know many of the people who have been following this blog since time immemorial remember when Cal was just born, and it's impossible for you to believe that he's in middle school. Don't worry, I feel exactly the same way.

Mack just turned eight a few weeks ago, and is in the second grade. He only recently stopped making a weird face every time I tried to take a picture of him. This photo was taken before that particular skill was mastered.

Nina, she will insist on telling you and everyone in earshot, is A Big Girl. She also insists on dressing herself sometimes, as you can clearly see, but has luckily tried to cut her own hair only once. She is four and a half years old, and in Pre-K.

Joe is 42 now and in the one millionth grade. No, but really, he's doing well. I'm not going to talk too much about his work, because that's probably pretty boring, but he's great at what he does, and it's an honor being on his team. Probably the most important thing you can do in life is choosing the right co-pilot, and somehow I lucked into a good one. I'm not a perfect person, and I have more flaws than I can reasonably enumerate. But whatever good I've done, and continue to do, is due to and in the service of these guys right here.

Anyway, this is just a brief mic check, and a post it note on the wall to say...I'm here. I hope you are too. So let's start talking. Let's get to work. Let's do this thing.

Discuss: What social or political actions you and your family taken, if any, since the election, and why? I understand that we don't all have the same political leanings, and I respect those differences. I live in the South, after all, I am accustomed at this point to having smart people disagree with my political views and having it descend into a slap fight only 50% of the time. (60% tops.) But the goal is the conversation, after all. In the end, the campaign of change has to be one of hearts and minds. So let's start here.

kafka-esque

I was in the kitchen cleaning up after dinner this weekend when Mack walked into the room, looked up at the ceiling, and froze.

MACK

Mom! Mom!

MICHELLE

What? What?

MACK

(Pointing)

Look!

I looked up at he ceiling, where he was pointing, and there, just hanging out upside down, was this giant cockroach. The kind that we used to call "water bugs" in New York, and that some people call "German cockroaches" or Southern regionally, "palmetto bugs." I would post an illustrative picture here, but when I did a Google image search for "giant cockroach," I basically DIED OF GROSSNESS, which is an actual fatal medical condition. Truth.

I have a phobia of roaches. I mean, I know everyone hates roaches, but I really, really hate them, mostly because I grew up in an apartment in Manhattan and roaches were just everywhere. See, in New York, it didn't matter how nice your apartment was, or on what floor you lived, or how scrupulously clean you kept your living space. If you lived in New York, you had roaches. Period. Sure, we had all sorts of traps and devices to foil them--your standard roach motel, sprays, little strange blobs of poisoned bait we would smear in various strategic locations.  My friends in school swore by this kind of crazy roach killing "chalk" that you could only buy in Chinatown (somehow the notoriety of this chalk hinged on its seemingly underground and illicit nature, like, "You need roach chalk? I know a guy...") with which you were supposed to draw with on the inside of your cupboards. The mechanism supposedly being that when the roaches crawled over the chalk lines they would die, or melt, or combust, or something. But we never got this poison roach chalk, mostly because I was worried that we'd kill first the roaches and then ourselves with what must surely be some highly toxic shit. Like a suicide pact. WITH ROACHES.

But anyway, despite the traps and bait and sprays and no chalk, we still always, always had roaches. I'd go to the kitchen at night for a glass of water, steel myself, and turn on the kitchen light. And there they were, most skittering away, but some brazenly continuing to sit on the kitchen counter looking at me, because they knew (surely they knew) that I was too horrified of their crunchy exoskeletons to kill them. Little baby roaches. Full-sized regular roaches. The occasional waterbug (I realize this is technically incorrect nomenclature, I don't think they were aquatic because if so welcome to tonight's nightmare) which were all the more horrifying for the little details writ large for anyone to see, even at a distance. I mean, they're all gross, every last part of them, but for me, somehow those big hairy legs were the worst part of all.

Anyway, I have to stop describing now, because I'm getting all sweaty. Ugh. Roaches.

In the South, it seems that the larger varieties of cockroaches predominate, and there's always a point in the year, I think because of the heat? Or because of some kind of breeding season thing? That they decide to come indoors. I don't know how, probably through the vents or something, but there's always a few weeks, usually in the summer, that we have a few roaches in the house every day. We find one on the wall of the bathroom. One in the closet. One year I found one on Mack's bed (he wasn't in it THANK GOD--at least I don't think he was, unless it was a Gregor Samsa-type situation) just feet up, dead. It's been a strange summer this year--really rainy and relatively cool--and so even though it's September now, I guess the roaches have decided that now is their time to strike.

So:

MACK

(Pointing at the roach on the ceiling)

Argh!

MICHELLE

Argh!

MACK AND MICHELLE

Argh!

MICHELLE

Mack! Get Dad!

MACK!

Yeah! Dad! Dad will kill it! Dad will punch it! DAD!

MICHELLE

DAD! HELP! DAD!

CAL

(Walking in from the living room)

What's going on? (Looks up) Argh! DAD!

JOE

(Running in from upstairs)

What? What happened? (Looks up)

Oh. I thought there was a fire or something.

MICHELLE

I wish there was a fire so we could use it to KILL THAT ROACH.

JOE

I'll kill it. Here, give me something.

MICHELLE

If you try to kill it while it's up on the ceiling it will jump down and land on you! 

Or worse, what if it's one of those flying roaches? THEY FLY.

JOE

(Holding up a vegetable cutting board)

Here, can I use this to kill it?

MICHELLE

Why...what...you...that's a cutting board. We put our food on there.

JOE

I'll wash it off!

MICHELLE

But why of all the things in this whole house could could possibly use to kill a giant insect 

would you use a cutting board? Find something else! Something disposable!

JOE

I said I'd wash it off!

MACK

(Pointing)

Argh! It fell!

MICHELLE

It fell? Where did it go?

MACK

I don't know.

(NINA, not really sure what we're all screaming about but excited to partake, 

proceeds to walk under the ceiling where the roach had been, laughing with her mouth open.)

MICHELLE

Gah!

(Scoops up the baby)

Look, it's like in that Iron Chef America, where Bobby Flay jumped up on his work station to "raise the roof" like a douchebag, and Morimoto was pissed because Bobby Flay didn't respect his cutting board by getting his shoes all over it, and it was a chef's ultimate dishonor. So my point is: you're worse than Bobby Flay.

JOE

OK, I'll use this thing.

(Holds up one of the baby's board books)

MICHELLE

SOMETHING DISPOSABLE.

JOE

Where is the roach even?

MICHELLE

Argh! It's right there! On the smoke hood, like, two inches from your head! 

It's looking right at you!

JOE

(Shrieks girlishly, smacks the roach with a mini legal pad of scrap paper)

MICHELLE

Did...did you get it?

JOE

Yep. (Holds up a ten-inch cockroach* by one of its filamentous antennae.)

I would have washed it, you know.

MICHELLE

Well, next time why don't you kill it with your toothbrush, and wash that off.

Anyway, there is no point to this story, except to say that roaches are disgusting, and if anyone has any of that special Chinatown killing chalk I will take some of that right now. THE END.

* Only very slight exaggeration

the chamber of secrets

Cal did two weeks of "Danger Camp" this summer (basically a summer day camp program based on this book) and came away with it not only with the requisite mosquito bites and tie-dye T-shirt, but also with an enduring passion for spying, ciphers, espionage, and general subterfuge. It's all highly contagious, and while Mack will deny this to his last breath he idolizes Cal beyond all measure so whatever interests Thing 1 has rapidly become the interests of Thing 2.

Separate and mostly unrelated: we currently live in a three bedroom house, which while by New York standards is an embarrassment of bedrooms (and square footage), means that under current occupancy patterns, we have neither a guest room nor a room for Nina to decamp.

THEREFORE (and this is where the two threads come together) we are working towards the goal of consolidating both boys into the same room. We already have a bunk bed in Cal's room so we're halfway there (it's even a twin over a full so that Mack will be, what, 50% less likely to end up on the floor?) but even so, it's a transition that is sure to be met with some resistance, at least initially. So we're selling the idea by billing these new shared quarters as the SUPER-DUPER BOYZ HANGOUT ROOM. Jazz hands! And one of the ways that we thought we could make the room cooler? By building a secret clubhouse inside of it.

Cal's room has three small closets, the middle closet of which has a lofted crawlspace, about two and a half feet wide, thirteen feet long, and maybe four feet high. We'd been using this space to keep a variety of larger items that we had nowhere else to store (as we have neither garage, basement nor attic space); things like our Christmas decorations, moving boxes, an old set of doors from the laundry room, what have you. We still have no place to store these things, and in fact, all these things are kind of sitting out in the family room now until we find a better place to put them. But lack of storage aside we figured screw it, let's just empty out the crawl space and turn it into a clubhouse. A SUPER SECRET RAD CLUBHOUSE FOR BOYS. No Homers allowed!

The first thing we had to do, after we emptied the closet out, was change the light fixture. Being a closet, all it had was a single bare bulb hanging from the ceiling with a pull-chain cord, which was obviously hazardous, what with the risk of anyone walking into the burning bulb with their face. So we took out the light fixture, capped it off, and put in an outlet instead. (I say "we" but when I say "we" I really mean the electricians did it and I watched, encouraging them with the thumbs up sign and offering beverages for their troubles at annoyingly frequent intervals.) After the electrical work was done, we vacuumed and washed the floors (and I apologize for the lack of any really good "before" photos because you have to understand, it's basically a railroad car-shaped space, there's really no room to get a good shot) and got to work decorating.

One thing that Joe really wanted to put in there was a full-wall panel of dry-erase board. A dry erase board that size (about four feet by six feet) would easily cost more than a hundred bucks, but we did it on the cheap by going to Home Depot and getting a panel of fiberboard with one side of white shiny coating (not sure what the coating is but it is smooth and slick, like melamine) and getting it cut to 48 inches, which was the length of the wall on one side of the clubhouse door. The whole panel of fiberboard cost something like $12.99, and after getting it cut, we ended up with two fairly large pieces of whiteboard material--I still have to find a home for the second piece, because I guess I'm too much of a cheapskate to throw it away. The only drawback to this is that the dry-erase board isn't magnetic like some of the more expensive "real" whiteboard options, but in the big scheme of things and especially given the price differential, I don't think it's a big deal.

My big contribution was the lighting. Mainly the concern was safety. Joe had wanted to install one of those recessed can lights up in the ceiling, but I just kept having visions of the kids burning their heads or their hands on the bulbs, as the ceiling really is very low in there--Cal can't even stand up straight without his head grazing the ceiling. Another issue is that as a closet, the ventilation in the clubhouse space isn't very good. We already put a fan by the door to move some air in there and I have talked to the boys about leaving the outer closet door open, because as an anesthesiologist I am somewhat paranoid about CO2 rebreathing. (That scene from "Apollo 13" where the astronauts have to make that new CO2 filter out of, like, a sock and some duct tape? THE STUFF OF NIGHTMARES.) Anyway, my point to the lights is that anything incandescent would heat up the space quickly. I originally thought about a string of low wattage Christmas lights, but then I found these:

Tape lights! (Not "tap lights". TAPE lights.) They're LED and energy efficient, bright, cool to the touch, and super-easy to affix, as they are literally backed with 3M tape so you can just stick them up wherever you want. And best of all?

They change color! They even have flashing and strobe effects, which is not my favorite setting (I kept waiting for someone to start seizing in there) but the kids certainly enjoyed pushing all the buttons. I mean, no kidding, right? THERE ARE BUTTONS? WE MUST PUSH THEM. Anyway, we got two sets of 16 feet each, which was enough to go around the entire clubhouse once with a few feet to spare. We actually like these lights so much we ordered another two sets to rim the bunkbed with, so the kids could use them as reading lights in bed. (See also: the awesome factor.)

We rounded out the room with a berber carpet remnant we had lying around from carpeting the bedrooms when we first moved in (coincidentally the one strip we had was almost exactly the dimensions of the clubhouse space--we just had to lop off a few inches in width to make it fit), two beanbags from Target, a few superhero posters, and a world map from National Geographic. Et voilà.

The name of the secret club, by the way, is SECRET CLUB MOM AND DAD NOT ALLOWED (S.C.M.D.N.A. for, uh, "short") and after surveying the finished product, Cal and Mack promptly kicked me out, which I consider a successful end-result.

Hope you're having a happy Labor Day weekend!

straddling

I had to take our minivan to the dealership for a physical (I don't know--what do you call it when you have to take your car in for a visit to the car doctor? A well-car check? I plead ignorance and this parenthetical is now threatening now to take over the whole intro) and at the dealership they have honest to god carrels in a room off the waiting area, like a damn library. On one hand--how great! A quiet area with a desk and a chair and a power outlet to get some actual work done! And on the other hand--how long do you expect that I'm going to be sitting here, exactly?

Well, nothing like a stretch of captivity to force you to update your foundering blog. Ahoy hoy.

Last week was my last week of working full-time. My first "official" week of working at a 60% schedule is actually the week of Labor Day, but I had this week fortuitously scheduled as a week off from almost a year ago, like I planned it this way the whole time, for transition. It's not so much a vacation as purely a maintenance period for our family (MAINTENANCE! That's the kind of car visit I'm at now! Le mot juste!) meaning yesterday I took Mack to the dentist and tomorrow I'm taking Nina for her one year well-child check and now I'm here looking at a wonderful hubcap display and wondering if I should get purple under-light effects to make our suburban splendor-mobile that much more splendid. I mean, it seems excessive and yet this pamphlet makes such a compelling case for them...

I am so excited to enter this next phase of being more engaged or at the very least present for my out-of-hospital responsibilities, but I acknowledge that various internalized cultural attitudes have been a little difficult for me to shake. Namely, I find that I really have to check myself from being too defensive when people talk to me about my part-time status. 

JOE

(As we are engaged in high-level strategy talks about managing yet another week of juggling 

call schedules, OR and clinic times, childcare, meal timing, and after school activities)

Man, this is hard. I can't wait until you start slacking off at work a little bit.

MICHELLE

SLACKING OFF?

JOE

I mean...not slacking...I mean...you know what I mean! Working less! Working less at the hospital!

MICHELLE

THERE IS NO SLACKING INVOLVED HERE. NO SLACK. 

ALWAYS WORKING! HARD WORKER ME!

Or possibly this:

CO-WORKER

So, you're going part-time, huh? Sounds nice.

MICHELLE

(Cautiously)

Yes...

CO-WORKER

Gotta go be mom. I get it. I wish I could do that.

MICHELLE

DO YOU THINK THIS WAS AN EASY DECISION OR SOMETHING?

BECAUSE IT WASN'T! NOTHING EASY! EVERYTHING HARD!

CO-WORKER

Uh...

(Starts backing away, feeling for the doorknob)

And also:

RANDOM PERSON

Hello--

MICHELLE

(Pointing)

AND YOU! I'LL HAVE YOU KNOW THAT I HAVE AN EXCELLENT WORK ETHIC.

RANDOM PERSON

Aha. Huh. Well, as I was saying, "Hello, and welcome to Target."

Anyway, sorry world. Obviously I am having feelings. It's like I'm all messed up on my Erikson's stages. Instead of "Generativity vs. Stagnation" I've regressed back to "Identity vs. Confusion." (Also, can we all acknowledge that the fact that I even remember any of this from second year med school psych is pretty fucking impressive? OK, not so impressive, but notable at least.)

I don't know why I default to the defensive--maybe I need to prove to myself and everyone that I'm not "slacking off" or "opting out" or taking some slow boat to Shangri-La. Not that anyone has implied that, I think it's pretty clear that going part-time at work amounts more to scaling back on one type of (rewarding, highly-paid) work and scaling up on another type of work which is both unpaid and elicits a less direct, calculable form of appreciation. Not that I need my head patted constantly, but I think many of us have experienced the Moebius strip that is the endless cycle of keeping a three-kid household running smoothly, and how the loss of old workday landmarks can make things both easier and harder.

I know I'm probably stomping all over the landmines with this but just hear me out, I'm sitting in the backroom of a Toyota dealership waiting for them to finish checking my brake fluid or god knows what else so this is a bit of a rush job. I realize that my defensiveness is just part of my natural adjustment to our new situation (see also: guilt at bringing home less bacon than I was before, particularly after many years of being the primary or equal bacon...herder) but this all makes me happy that I have the option to partially scale back as opposed to having to make a binary choice to be all in or all out. The identity loss I'd have without some career focus would definitely be traumatic, and I think that this option, the part-time option, might allow me the best of both worlds. That's the theory anyway, and hopefully once I see that, I'll stop alternately taking everyone's head off and showily doing one-armed push-ups to prove that I'm JUST AS POWERFUL AS I EVER WAS.

(Psychological problems! I has them!)

*          *          *

I was going to write some more stuff here, but in the interest of just getting this up and saying BLOG UPDATE: MISSION ACCOMPLISHED I'm going to save that for next time. My goal in general, by the way, is for there to be a next time more consistently, and to do a little more writing in addition to the other thousand things that I've been neglecting in the past year. And now I have no idea how to end this  entry so I guess I'll just put in this video of Nina lurching around because didn't you hear, she's a toddler now.  Unreal.

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.

indian summer vacation

The way Joe and I schedule our lives we end up planning most of our family vacations more than a year in advance, and around the Spring of 2011 we made plans to rent a cottage in Jamaica for summer vacation the following year. Well, turns out that despite my neurosis about planning things well ahead of time, you actually can make plans too far in advance, because it turns out we were a little busy this past July. Luckily, the rental place was very nice about allowing us to reschedule once we told them the reason, and so we took our family summer vacation and moved it to a week in the fall. To this week, as a matter of fact.

It actually doesn't take that long to fly from Atlanta to Jamaica, but we did have to take a car to a shuttle to a monorail to a plane to a van, so it ended up being a fairly grueling trip for the three kids. Luckily we now have no other plans for this week other than to hang around and let the kids beach and pool themselves stupid.  So you know.  Vacation.

We invited my parents to come along with us for the trip too, because it's nice for the kids to be able to spend time with them, and also (selfishly) it's nice to have another two sets of eyes around to make sure no one's playing with anything dangerous/inadvisable/flammable.  Here are each of them holding the only remaining grandchild who will agree to sit on their laps.  In the picture on the right, Nina, like Kuato, wants you to open your mind, Quaid.

(I should also note that my dad came into town one day early so that Joe could do a blepharoplasty on him, which is why his eyelids still look a little bruised.  He would also want you know to know, however, that he got this done only because his lids were drooping and obstructing his vision, and not for purely cosmetic reasons.  Now, I don't know nothin' about no oculoplastics, but I do know that doing a good blepharoplasty is sometimes a tricky and subtle business--particularly on Asian people--but even just three days post-op, I have to say that Joe did a really amazing job.  First off, my dad can see better, so already: success.  But as someone who has been looking at my dad for my entire life, I also have to say that even this soon postop, he also looks really good and natural and himself, which is important.  So good for him, and less good for, you know, Kenny Rogers.)

Anyway, so we're here.  Cal's having fun swimming, Mack's having fun bobbing, and Nina's having fun lying in a variety of shady spots and looking at the ceiling fan in the bedroom.

I suppose there might come a time where our travels might not so reliably involve going to the beach.  Just probably not anytime soon.

Vacation!

a picture is worth something something

A wordless entry for Joe's birthday (well, mostly wordless), because really, what else is there to say?  Well, except that the kids chose the cake flavor (radioactive strawberry) and the frosting colors (myriad).  COULD YOU TELL?

Happy birthday, Joe!  You're one of the good ones, and we love you.

Edited to add: not achieved through some sort of crazy photo trickery, but indeed those birthday candles are burning with different colored flames. (The effect probably would have looked more dramatic with the lights out, but oh well, maybe next time we'll have our party at night or, at the very least, not in front of a window.)  I figure there must be some sort of inorganic additive in the filament--Chemistry wonks can probably help me with this--but the kids thought it was pretty awesome.

more on hand wounds

Thanks for the input, guys, though I wish now that I had solicited your advice on how to more easily peel ginger (with a spoon?  Really?  And it doesn't just turn it into a mush?) BEFORE slicing a sliver of my damn finger off, not from the arguably more bloody world of the retrospective.  This is why I can't have nice things.  Like, you know,  fingernails.

Also, one commenter noted: "Wasn't there some big debate over bagel slicers at one point and now this? Is that irony I smell?"  (Click on the link to read the debate itself, but for the lazies, briefly: Joe had this bad habit of holding his bagels in his palm while cutting them in lengthwise directly into his hand, and I had a problem with that, especially given that he's in a profession where hand tendon injury could be catastrophic.  For instance, a minor to moderate hand injury would not necessarily end my career as I know it, but it could almost certainly end his.  However, you will be gratified to know that after that last discussion more than a year ago, Joe doesn't cut his bagels employing the "hand taco" method anymore--or at least he doesn't do it in front of me.)

Well, here's the difference as I see it.  I slice a lot of vegetables with a vegetable peeler.  This most recent event I would classify as an accident.  Accidents happen.  For example, I try to be cautious at work, but sometimes accidents still happen, like, say, needle sticks in the OR.  But accidents happening despite best precautions is different than habitually unsafe practice--like recapping non-blunt needles by hand, or sloppy sterile technique. (This is no one in specific, by the way, just a few easy everyday examples I can think of).  Or, to bring it out of the hospital setting and back into the kitchen where it started, let's say slicing bagels using your palm as the cutting board, or rubbing raw chicken all over your countertops.  My point being, I would say it's the difference between cutting yourself in the kitchen (it happens to everyone) versus setting up a situation where cutting yourself is much, much more likely to happen.

So no, that's not irony you smell.  Just the smell of human flesh and ginger cooking in a delectable mélange.

*          *          *

Oh, and by the way, not that I wish you pain, but if you happen to have cut your hand and if you also happen to work in some kind of germ zone (or at least in a job where you have to wash your hands a lot), here's a great and truly occlusive bandage that will hold up for, I kid you not, a good couple of days.  

I got a six pack of these for the winter season (A.K.A. the "I'm washing my hands so much and the weather is so dry that my hands be cracking everywhere" season) and between me and Mack (Mack is a great believer in the curative power of Band-Aids, even without any actual visible injury--he prefers to prophylactically laminate himself) we are putting them to good use.  They're a little more expensive but seriously, they are worth it for high-mobility areas--as mentioned before, they are truly occlusive, they really stick well, and don't tend to get all sodden and ooze off like the more traditional model.  

Now everyone go get injured!

break Joe's website

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

MICHELLE

You need a professional website.

JOE

I do?

MICHELLE

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

JOE

What is an "Internet"?

MICHELLE

Let me...just do it for you.

So we made this:

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

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

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

MICHELLE

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

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

JOE

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

MICHELLE

(Pause)

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

JOE

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

MICHELLE

No reason.

Thanks guys!

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

as time goes by

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

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

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

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

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

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