sartorius

Blogging has changed a lot in the almost 13 years (!) since I started writing online, and I often think--particularly during this most recent long hiatus, when I was too busy to perform anything but the most basic of life tasks (see: job, performance of; family, keeping alive of)--why do I still do it? What is it, aside from perhaps the compulsive need for me to document the minutiae of my life, that makes me continue to write online?

It's not a business decision, certainly. It probably speaks to the direction that online media is moving these days that this blog is such an aberration--a more than decade-old blog that is almost completely non-monetized. I have my "real" job to thank for that--although it's been the job that has been the biggest obstacle to me writing often and regularly, it also allows me to keep all my writing projects, even the bigger ones, completely recreational. I think about that sometimes, how something ceases to be fun when you have to do it, and I am thankful that I have been able to have some very modest success at a hobby that really, I expected nothing more from than enjoyment.

But there's a little more to it too. There's an element to writing, like any activity, that you have to work at. If you don't write regularly, your brain freezes up. You lose fluidity. Stringing together sentences and ideas become laborious, painful; the end-product wonky, full of holes.

Why do I still continue to write here? Because in its own low-investment, low-impact way, each time I post something online, it's like a little exercise. Let me tell you a story, and see if I can make the words work. Let me try to build this wall of words and see if it will hold water. Believe me, I understand that keeping a blog is not nearly as high-minded as some of the "real" writing people do both online and off. But dashed off and conversational or not, it still works, you know? It's 13 years of writing exercises, archived in chronological order.

My first book didn't exactly blaze its way to the top of The New York Times bestseller list (another reason I'm thankful to have gone to medical school and to have the luxury of writing on the side--the stress of having my professional success subject to the caprice of the literary marketplace makes any day in the OR look like a walk in the park), but I do think I have another book in me. I think I would like, someday, to write a book about the practice of anesthesia. It's probably one of the most misunderstood fields of modern medicine, and also one of the most fun.

In my mind (a place where everything always works out perfectly) this book would be a combination of medical history--the Ether Dome, "Gentlemen this is no humbug," sort of thing, I love that stuff--interspersed with first-hand stories of learning and practicing anesthesia. Shine some light on what the hell it is exactly that we're doing back there, at the head of the bed behind the blue drapes. Help people know more about anesthesia than the labor epidural and the notion that propofol "killed Michael Jackson." I'd like to tell some good stories, and I think I have more to tell.

Anyway, someday I'll do it. Until then, I guess I'll just stay warmed up, and keep writing here.

*          *          *

(And now for something completely different...in which I erase all the lofty musing from above and just talk mindlessly about clothes.)

Now that I actually spend some time out of the hospital and out of scrubs, I have noticed that I can't find any clothes to wear. Wait, let me clarify. I have clothes. But I have too many clothes. Because it seems that my attitude towards wardrobe curation leans towards the "survivalist hoarder" end of the spectrum, and I literally (LITERALLY) have clothes from high school still hanging back there because what if I need to attend a "Reality Bites" themed party and I don't have anything to wear? (This is all the more pathalogic when you consider how many times I've moved since high school.) So what actually have is a messy closet packed full of clothes, none of which I actually wear, and which are actually interfering with my ability to find the small percentage of clothes that I do wear. FIRST WORLD PROBLEMS Y'ALL.

Anyway, I'm going through a major closet purge right now (I was going to say "diuresis" but I'm not really sure if that's a real thing that people say or if that's just a thing that medical people say--either way it brings up unpleasant images of hollow viscera evacuating), the goal of which is to have a closet where I could walk in, pick any two pieces of clothing, and have them match. I know this is extreme--not everything is meant to match with everything, after all--but look, I'm a busy lady, I don't have time to plan my little outfits like Cher in "Clueless." I just want to be able to grab stuff, put it on me, and know that they go together.

These are the things I actually wear:

• Red, white, navy, and grey. Yellow occasionally as an accent.
• Cotton knit tops. Preferably boatneck, 3/4 length sleeves. Stripes are a plus.
• The occasional button down, as long as they are soft and don't need to be ironed too rigorously.
• Sweaters, cardigans preferred.
• Skirts, A-line, knee length or shorter, certainly not longer. (This is not a slutty thing, it's more of a short people thing. Long skirts make me look like Momma in "Throw Momma From the Train.")
• Jeans, straight leg, dark wash primarily, occasionally white against my better judgement. (And this is not a "my ass looks huge" thing, it's an "I have kids" thing, and any light colored pants end up with stains and footprints all over them.

So, basically: nautical private school student.

In Atlanta it's warm enough that this getup can get me through most of the Fall into the Spring, with the exception of a few frigid weeks after Christmas where you actually have to bundle up--I have an warm but also exquisitely ugly yellow parka from L.L. Bean that will get me through that stretch. My goal right now being that I want to streamline my closet enough that I will have to put in next to zero through into what I'm putting on my body in the morning. Which is probably only one step up from being Charlie Brown opening up his closet to a row of identical yellow shirts with a single black zig-zag stripe across each one, but hey, I'm sure it made his morning routine very efficient.

Oh, and by the way: those brown shoes above. Please tell me about them, because I want to find them and marry them and make little shoe babies with them. (Brownie, Flopsie and Lacey, natch.) What are they called, does anyone know? And where can I find them? The picture above was from an Etsy vintage shoe sale (only $35!) under the heading "Dexter desert boots" but they were not in my size, which for the record is a 6 or a 6.5 American. You guys, THE SHOES. I realize that in some sense they are hideous and orthotic but SO AM I. Please and thank you.

Furthermore, anyone looking for evidence that I am projecting my own fashion sense (or lack thereof) onto Nina need look no further, because: mea culpa. Likely in a year or two she'll be clamoring for only the tackiest taffeta/polyester/princess shit, so I'll inflict my questionable aesthetic while I can.

OK, back to work.

boy meets world

Cal started fourth grade about a month ago, which would usually be my cue to say, "Can you believe it?" but every time I say something like that I think about that Tig Notaro bit and feel a little bit stupid.

Anyway, fourth grade. It's going pretty well so far, at least academically, but I think we've entered the age where we really need to start watching his friends and keeping on top of their activities and interactions. And while this all would likely be true regardless of the existence of Minecraft, it sure doesn't help.

For those of you blissfully unaware (meaning you know no kids between the ages of, oh, say 5 and 21), Minecraft is a video game, and to call it a generational obsession would be understating things somewhat, like calling Pol Pot a pretty mean guy. I agreed to get the game for Cal because it seemed innocent enough--basically an open-world action adventure game, building things with blocks, resource management, that sort of thing--and more to the point I didn't want him to be some sort of out-of-the-loop freak if every single other kid in his class was playing this game and he wasn't. I know, I know, if all your friends jumped off a bridge, etcetera etcetera, but since he's a year or two younger than his classmates we try to be particularly sensitive about allowing him the social tools to be one of the gang more easily. Because if we didn't let him play Minecraft? He'd be, like, THE ONLY ONE. And I just hate to think about him being the pop culture equivalent of the kid whose parents don't let him eat sugar, and brings, like, unsweetened carob cakes in for his birthday, you know?

So anyway, we let him play Minecraft (which he's only allowed to play on the weekends--we still have rules and standards up in here after all), he plays it, he loves it, everyone is happy. And every time I pick him up from school all he wants to talk about is MINECRAFT and everyone's special strategies in MINECRAFT did you hear about the newest thing in MINECRAFT? And William? Told me that there's a mod? That you can put Star Wars skins on your MINECRAFT server? And also one time? Thomas was building a house and two creepers snuck up on him but then he used his leather armor and threw a sheep at them and then he fell into a trap in the nether? And it was SO FUNNY!

(I'd like to think the game makes more sense than this but suspect that it doesn't.)

Except one day I walked by when he was playing Minecraft and I noticed that there was this scrolling chat box open at the bottom of the screen, with these other randos talking to each other while they were all playing. (I'm no video game enthusiast, but I think there are similar things in most video games that you play cooperatively with people online, games like "Call of Duty" and of that ilk). Those of you familiar with such games probably won't be surprised to hear this, but the back and forth taking place in this chat box? Awful. Terrible. Slurs! Swearing! INCORRECT SPELLING.

"Cal," I spluttered, "what is all this going on at the bottom of the screen?"

"Huh?" He looked down. "Oh, I didn't see that. I'm not really sure. I think that's other people that are playing on this server. It's my friend Archibald's* server, he invited me to join when we were sitting together at lunch last week."

"OK, but who are these other people? Do you know them? And why are they saying all these terrible things?" For lack of any other better solution, I just covered the chat box with my hand.

"Oh, I don't know. I guess they're Archibald's friends. Or other people that joined his server anyway. I haven't really been looking at it. What are they saying?"

"NOTHING. They're saying NOTHING. But can you turn this screen off? Hide it in some way? Or better yet, why do you have to play on someone's server at all? Can't you just play by yourself? Play by yourself and do something peaceful, like build a diamond...zombie...hut...or something?"

So anyway, Cal turned the chat function off, and then we had a talk about not playing with people online unless he really really knows them personally and he's preferably in the same room as them. I also said he was never allowed to have the chat function on again, ever, because: INAPPROPRIATE.

He's still young and relatively naive, so I know this is just the beginning. And while I'm obviously not going to be a super-paranoic about the use of the internet and social media (see: this page you're reading right now, and the existence thereof) I am a little apprehensive, despite the fact that we have a pretty tight lid on his screen time and computer habits and who he spends his time with outside of school. Because what's it going to be next year? Or the next? Or even forget the computer--what are he and his friends talking about in person at recess? In carpool line? At their sleepover parties?

(Yes, you're right--they're probably talking about Minecraft. Because Hayden? Said one time? He got a pile of gold? But then a zombie came and fell into this lava moat that he made around his house? And then someone hacked into his server and stole his diamond armor! It was epic!)

Cal is eight years old now, which is the age that most kids start to form stronger and stronger ties with people outside of their families. So I have to let him do that, but it's hard not to worry, because even though we know his friends and know their parents, that act of sending your child out there into the world can feel like feeding a lamb to the wolves. Because we can't always be there, and we can't always filter, and can't always catch the chat box before they see it and cover it with our hand. We just can't. That's what raising a child is: getting them ready so that they will be OK without you.

In my mind Cal is kind of a low-maintenence child, in that's he's old enough now to fend for himself and his personality is generally allergic to trouble-making. (He's actually kind of a people-pleaser to an almost unfortunate degree, in that even the hint that he's transgressed in some way makes him start to get teary and apologize--at school, anyway.) But nonetheless, I'm glad that I'm going to have a little more time to spend with him now, not just in spite of the fact that he's older and becoming more independent, but because of it.

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* Not his real name, OBVIOUSLY. I actually have not ever met this kid before but I have encouraged Cal not to play on his server anymore because aside from the obvious reasons I detailed above, apparently he regularly stays up until midnight playing Minecraft on school nights and what parent lets their nine year-old kid do that? 

a more perfect union

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

Why yes, yes I do.

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

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

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

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

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

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

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

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

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