A Weighty Issue

I cannot describe how pleased I am that so many of you are heeding my call to wedge yourselves into your running bras and get out on the pavement.

But I am dismayed to see how many of you immediately started talking about your weight—that you wanted to lose some, that you did lose some, that you weren't losing any.

If you go back to my original post, you will see that never once do I mention weight loss as a reason to run.

Whaaa--? I hear some of you thinking. Why would I do something so unpleasant if I'm not going to get skinny?

Sigh. OK. I will tell you why you should later. But first let me tackle the topic of getting fat.

You probably already know that the country is experiencing an obesity epidemic. The majority of adults in the U.S. are above a healthy body weight. This in turn has caused an epidemic of Type 2 diabetes. And diabetes is the number one cause of 1) blindness 2) amputations and 3) kidney failure requiring dialysis. How great would it be if we could avoid all that? So doctors are desperate to find a way to get people to lose weight. Fat people are also desperate to lose weight, because even as everyone has gotten fatter, discrimination against fat people has not decreased at all.

So if everyone's on the same side, what gives? Why is everyone getting so big?

It's tempting to say that it's the fault of the fast food chains. And they do play a role, but I would argue a small one. The problem is multifactorial. There are several important differences between the U.S. now and forty years ago (or the U.S. and some other countries where people have not yet started to expand). First, people no longer have to move. Most people can now do their jobs by lifting only their fingers; correspondence, chatting, ordering, everything can be done by computer. (Being a physician is one of the few professions where we must keep moving — from room to room, down the hospital hall, to the front desk.) Second, people and jobs have moved away from the city centers, so almost everyone commutes by sliding their padded butt into a carseat and driving to a parking lot next to their job. People don't even expend the energy to shift their own car gears anymore. Third, food is now available everywhere, at any time of day or night. Not just at fast-food joints; everyone has a vending machine no farther than an elevator ride away from their desk, a 24-hour convenience store (with a parking lot) on the corner down the street from their house, and a huge refrigerator stocked with goodies.

Humans are genetically programmed to eat when we can and rest when we can, because we evolved during a time when if you passed up a meal or a rest stop, you were that much closer to being the weak one who got left on the rock to distract the saber-tooth tiger. (This programming is not uniform; some of us are jittery and jumpy and more easily distracted and tend to stay naturally slim. It was probably an advantage to a tribe as a whole to have a few people like this, so as to be able to alert the calm ones to danger and to run really fast if need be.) It probably didn't happen often that anyone got fat back then, but even if a tribe were so lucky, the consequences of this—premature death—were not, evolutionarily speaking, undesirable; these folks had already had their offspring, who cares if they lived to be 90? It's not just humans who are like this, either. I used to feel really sorry for birds in cages, because flying seems like such a wonderful thing, and they're being prevented from doing it. Then I learned that when birds live in a place where there are no predators on the ground, they give up flying. They get fat and lazy and waddle around, just like humans.

So when you pass up running and instead pull your car into the 7-11 for a Slurpee, you are simply heeding your DNA. That's right, it's not your fault. So quit feeling guilty; it's unproductive. But do realize that you are not in the environment your DNA thinks you are, and it's now up to you to adapt yourself.

It's been shown over and over again that if you put people into a controlled environment, calories in minus calories out equals weight gained or lost. No one is immune from this law of physics. What can't (yet) be measured, though, is just how hungry a person gets when they take in less than they put out, or how unpleasant a person feels when expending calories. You may suffer more when trying to lose weight than I would, I can't deny that.

Which brings me to the running thing. Simply running will not cause you to get skinny. Running more and eating less will. The running part is simple; the eating less, harder. But I'll give you a rough idea of what has been shown to be helpful (and in fact, I follow most of the rules myself):

1. Eat breakfast. People who put off eating until late in the day tend to be fatter.
2. Avoid simple sugars. This includes, but is not limited to, soda, juice (yes, even 100% fruit juice), candy, cakes, pies, chips, and white starchy foods. Simple sugars go down easy, then shoot your blood glucose up, which shoots your insulin up, which makes your blood glucose plummet, which makes you hungry. Hello, vicious cycle!
3. Make it a rule to stay away from the vending machines, the corner store, and the coworker offering donuts. Fast and easy snacks result in fast and easy pounds.
4. Don't keep bad food you can't resist in your house. What's that? You need to keep stuff around for your kids? Why on earth would you want your kids eating crap either?
5. Get enough sleep. Sleep-deprived people tend to get fatter; it's not known why.
6. EXERCISE. Exercise alone doesn't guarantee weight loss, but it does seem to prevent weight gain. Over the years, I have watched everyone I know slowly, slowly expanding, with the exception of those who get regular exercise.

But please do not run for the weight. Run because a fat runner is much healthier than a skinny couch potato. Run because it makes you strong. Run because it makes you happy in your own body, whether it's lumpy or flat, tall or short, square or round. Run because you'll live longer (and no, you won't wish you were dead, ha ha). Run because when you're out there running (as slowly as you can stand to, remember), you will have the experience of being alive in the world with your body doing what it was designed to do.

Watching Golf?

I'm thinking I should compile some of the responses on my last post to give to my students and residents so they can get some perspective on what patients and other clinicians think about the topic.

A couple of things I wanted to to clarify:

• Orange did not, in fact, spontaneously accuse me of having a stick up my ass. She simply agreed with me when I asked whether I did.
• Although I address my patients in a formal way, I don't think my manner with them is formal. I welcome—no, encourage—their input, laugh and joke with them, pat their shoulders. A few of them routinely hug me, and a couple have kissed me. (One kissed me on the lips once. An experience I hope is never repeated.) And despite my byline, I have never actually uttered the words "That's Doctor Mama to you," except in jest.

I haven't been on the blogosphere much lately because things are fraying a bit around the edges here. One of my colleagues called me this weekend to report that she was having weakness in her hand and leg, and her rheumatologist thought she should be admitted to the hospital, but what did I think? When I told her to get her butt to the hospital stat, she said, "But who's going to take care of the baby?" "Er, where's your husband?" I asked. "Downstairs watching golf on TV."

I ended up meeting her at the hospital and staying with her the first few hours. She's doing okay, but she has a pretty scary condition, and a lot on her plate. Her husband is being a father finally (with the help of his mother), but I'm not sure it will last once she gets home. She's talking about changing jobs to decrease the stress in her life. I wish she'd change husbands instead. I've been filling in for her as much as I can at the office; one of my mothers-in-law is staying with us, so TrophyHusband has help at home ... and I'm terribly, terribly grateful that this is pretty much the extent of what I have to grumble about.

You Can Call Me Doctor If You Want

Orange recently asked me if I ever tell my patients to call me by my first name. The answer is no, never. I don't call them by their first names, either. I call everyone "Ms." or "Mr.," unless they really insist, in which case I avoid saying their name at all. This is the only area of life in which I'm like this; for instance, the only adults I didn't call by first name when I was a child were my teachers, and I find it weird and hilarious when kids call me Ms. DoctorMama (or worse, Mrs. TrophyHusband).

I just feel that if I'm going to be poking and prodding folks in their most intimate places, I better make sure that they know I respect them first. (I do let a couple of old men get away with calling me Miss Firstname, but I still call them Mr. Thrombosis and Mr. Bad-Hip.) I especially dislike it when high SES white people call me by my first name; I feel like saying, Listen, you really don't want me to be your friend, you want me to be your doctor, so let's not muddy the waters, all right? I don't much like it when doctors I don't know personally call me by first name either. It's especially obvious to me when this happens because there are two ways to pronounce my first name, and people who don't know me usually pick the wrong one. Makes me feel like I'm being examined by a telephone solicitor. (I run into trouble with our pediatrician because she's a nurse practitioner; it feels absurd to call her Nurse, but double-standard-ish to call her by her first name.)

Orange says I've got a stick up my ass, but she also calls it "quaintly elegant" and "traditional." What do you think? Are you on a first-name basis with your doctor? Do you think it affects your relationship either way?

The Cat Came Back!

He waltzed in tonight, looking none the worse for wear, and in fact not even hungry. But he's not talking.

He would be in big trouble, but I'm too relieved to do anything but squeeze him and kiss him.

I hope this isn't a foreshadowing of what it will be like when HellBoy is a teenager and stays out past curfew. "You are in big trouble, young man ... oh, sweetie, I'm so happy to see you, can I fix you something to eat?"

I'm Not the Weepy Type, But

GoodCat is missing, and I've been on the verge of tears all day.

We let the cats go out on the back patio, and they climb around in the no-man's land behind the houses on either side of us, but they've never left the block. I knew when we decided to let them out that we were running the risk of losing one of them, but it made them so happy, and somehow when I imagined one of them going missing, I figured it would be BadCat, which would not be the worst thing in the world from my perspective (he's TrophyHusband's cat, and he has ... issues). But GoodCat is such a sweetheart.

Add to this the fact that a couple we really, really like just got job offers in another state, and that I'm on the rag, and I'm kind of a mess.

GoodCat is the one at the top of this picture:


If you've seen him, let me know.

Dropping Balls

Today I saw a patient I haven't seen in four months. The last time I saw him, I ordered some bloodwork because he has hypertension. And one of the things I discovered in that bloodwork was diabetes. Which is a good catch; hypertension plus diabetes is a deadly combination, and requires careful management.

Problem is, I didn't catch it. I signed off on the bloodwork and had it filed. So he's been walking around untreated for the last four months.

Another confession. Last month, I saw a patient I had been treating for chronic back pain. At his previous visit, I'd started him on a pain reliever we sometimes use when anti-inflammatories aren't cutting it but we're nervous about going to opioids. This medication worked very well for him; he was quite pleased, and wanted a refill.

Problem is, I had overlooked the fact that this patient had a contraindication to starting this medication: a seizure disorder. I don't know how I overlooked this; it's his ONLY OTHER PROBLEM BESIDES BACK PAIN. I nervously asked him, "Have you had any problems with seizures?"

"Funny you should ask," he replied. "I've had two seizures since I saw you last, after not having any for two years."

You might be thinking right now, wow, DoctorMama is one of those BAD doctors. Why should I listen to anything she says? And I sometimes feel that way too.

I can tell you that I graduated with honors from a good medical school and I trained in a top-notch residency program. I got excellent board scores, and I keep up to date. I teach (and learn from) medical students and residents.

None of these things guarantees that I'm a good doctor, of course.

I can tell you that patients like me, and recommend me to their friends and family. No one has ever sued me (yet). I've never killed anyone, or caused them irreparable harm that I know of. My patients' blood pressures and blood sugars are better than the national norm, even though their socioeconomic status is well below average.

None of these things guarantees that I'm a good doctor, either.

And none of these things kept me from making those errors.

I know I don't make a lot of mistakes, and I know that everyone makes some. But I'd rather make none. Yet I don't know how this can be achieved.

Looking at the first case, there is a system meant to keep me from making such errors: abnormal results are flagged with an asterisk on the lab sheet. Thing is, every abnormal result is flagged, even ones that clinically make no difference. I sign off "abnormal" results as normal all the time. The only system that differentiates the abnormals that matter from the ones that don't is my fallible brain.

In the second case—the guy with seizures—there are a couple of places that the contraindication might have been spotted. First is my PDA; I often look up medications on the electronic database, and under this medication it clearly says "caution if seizure history." Thing is, I look up only the medications I'm unsure about or unfamiliar with. Which category does not include this particular medication. I KNOW you have to use caution if there's a seizure history; I just didn't THINK about it at the time. And if I were to look up every single medication I prescribe, I couldn't possibly see the number of patients I do (which isn't all that high to begin with). The second place this mistake could have been caught is at the pharmacy; the computer there might have flagged this medication as a problem, given that the patient was also filling prescriptions for anticonvulsants. And perhaps it did, but you've seen the printouts from pharmacies—they're pages long, and include every possible contraindication and side effect. Who can take those seriously?

The patients themselves could have helped prevent these mistakes. The first patient never called to ask about his results; if he had, it would likely have prodded me to take extra care when signing off—though again, no guarantee—and the second patient could have asked if the new medication would interfere with his seizure medicine. But neither patient is the type to do that, and besides, that's not their job. It's my job.

Bottom line is, I dropped the ball, twice.

In neither instance did anything terrible happen. The first patient doesn't take his blood pressure medicines, and wasn't very interested when I told him that he has diabetes. (I did tell him that I had missed it on the last bloodwork; he wasn't very interested in that, either.) He may surprise me and do a better job controlling his diabetes than he has controlling his pressure, but a delay of a few months is not going to make a difference anyway. The second patient didn't hurt himself when he had his seizures, and he doesn't drive. (When I told him of my mistake, he was just upset that he couldn't keep taking the pain reliever. I prescribed him opiates.)

Some doctors are resentful of systems designed to keep them from making mistakes (and worse, of patients or family members who question them). I'm not. It's really scary to have someone's health or life depending on my imperfect mind, and I wish I didn't have to fly without a net so much of the time.

How's It Going, Maggots?

I got an email today that almost brought a tear to my jaundiced eye:

Subject: Thanks, Sarge!
This running thing, it is addictive. This is the first time in my Krimpet-fueled existence that I have exercised FOR FUN. And, after less than a month, I can already see my body contouring a little bit. It's a slow but very gratifying process; sort of like ordering a car in the mail and having a new piece arrive every few days.

It made me so goddamned proud. And it got me wondering how the rest of you have been doing. Are you remembering to take it S-L-O-W? Especially in this heat.

[Updated to add: and if you want to find out what happens if you don't follow the instructions, look here.]

A few other heat-related tips:

• Go with the wind the first half of the run, so that when you're coming home you have the breeze to help cool you off.
• Remember that drinking too much water isn't good for you. Eat a little something salty (unless you have high blood pressure) and drink a glass of water before you head out, and then have a glass of water when you're done. And sports drinks don't do much for you.
• Think it's too hot to run? Well, it's not. Get your butt out there.
  

I'm With the Band Now

I have to round in the hospital and take calls this weekend. The prospect is making me intensely crabby, so I'm laying low.

HellBoy, however, has been in a great mood ever since I broke down and bought him his one true heart's desire: a GIT-ar.























This thing makes him so happy, it's frightening. What's weird is, he's never seemed like a particularly musical kid. I think he must already know the secret: the guy with the guitar can always get girls, even if he sucks at playing it.

Build a Better Mousetrap and Your Daughter Will Become a Slut

Good news: the FDA has approved an HPV vaccine. This means there now exists a vaccine that prevents cancer (not to mention abnormal Paps and the followup treatments that have the potential to impair a woman's fertility). What a great invention! What a marvelous advance! What a wonderful opportunity to improve the condition of women in the world!

Except, wait. Apparently some people believe that this isn't a good thing at all. Because, don't you realize, the threat of death by cervical cancer is one of the things that keeps good girls from, you know, doing it. HPV shouldn't be vanquished; it's a wonderful, natural chastity belt!

This got me thinking about other useful inventions in an entirely different light. Because once you start to really think about it, many other seemingly helpful and benign things might also have the potential to make sluts out of innocent girls. For instance, here are a few products that I have been singing the praises of that on second thought could lead a maiden down the primrose path:

• Softpaws. Now, these are a terrific invention. They keep people from having the tips of their cats' fingers guillotined, they help save furniture, and they look adorable. But if you examine it carefully, this product may not be so innocent. Think about it: what kind of pets do unmarried women tend to keep? That's right, cats. And soft-hearted young women are less likely to sign their kitties up for declawing. But this means that they have to keep a close eye on Mrs. Fluffy or risk ruining the nice afghan they've crocheted for the hope chest. But once they've slapped on a set of Softpaws, they can go gallivanting off into the night worry-free ... and soon they're fallen women.
• Champion Double-Dry Seamless sports bras. Once I discovered these, I wanted to pitch all my old running bras. These don't chafe, don't pinch, keep you cool, and most important, eliminate The Bounce. What more could a girl want? Well. I don't think I need to tell you that anything that makes it more comfortable to run around in public half-naked is a one-way ticket to losing your precious flower.
• Puffs Plus (or other lotion-impregnated tissues). How did anyone survive before these were dreamed up? Two blows with regular tissue, no matter how soft, and I already have the beginnings of two scaly red stripes running from my nose to my upper lip. Besides being uncomfortable, this is unacceptably geeky, and I have enough geeky tendencies to want to avoid any more. In addition, using these for wiping my son’s nose means that he has no bad associations with the project and I don’t have to chase him across the room. You may dislike the oily residue left by this product; you may have accidentally used these to attempt to clean your glasses and been left with temporarily smeared vision; but these are small objections to what would seem to be a benign and helpful product. But Puffs Plus are actually risky to the chastity of young girls everywhere, becauseonce you start thinking about things that are dry becoming lubricated, well ...
• Odor Xit. On account of BadCat, I looked long and hard for a product like this, and almost despaired of finding something that actually worked. I don't know what's in it, and I sure don't let HellBoy take swigs from the jug, but I love, love, love it. But how could this stuff turn good girls bad? Well, remember that single girl with cats? Even once she's got the Softpaws on Snowball and Sooty, there's another line of defense keeping her virtue intact, and that is her anxiety over the fact that her modest efficiency apartment with the cute bubble shades and doilies has an unfortunate and distinct odor of cat. Odor Xit, by eliminating the evidence of elimination, means that this nice girl will feel less inhibited about bringing men up to her place. And we all know what those filthy men want.
• Dermablend. This stuff is designed to cover up scars and tattoos and other Angelina-type inconvenient marks, but it rocks as a blemish cover-up. I've never come across something that covers pimples so effectively and lasts so long. Dab this on in the morning, and you're worry-free the rest of the day. You might think that this is no more dangerous to a young girl's virtue than any old makeup (which certainly can be problematic in itself), but you'd be wrong. Here's what happens: thirteen, fourteen and fifteen year old girls who try to conceal their pimples in an attempt to pass as being much older are often betrayed by the premature failure of their coverup product, and are thereby saved from deflowering by guys who really believed they were over eighteen, man! With Dermablend, the deception will not be revealed until it's tragically too late.
• Marsona white noise machine. My life was immensely improved by one of these devices. No more kicking poor TrophyHusband all night, no being woken up by the skateboarders heading down the street for their midnight extreme boarding. Perhaps sleeping peacefully in one's own bed seems unlikely to result in a girl's downfall. True, if you're talking about the girl. But what if it's her mother who uses it (as is most likely, after all)? This is clearly a recipe for disaster. Because if a girl knows her parents can't hear her climbing out her bedroom window, what's to stop her from doing so? Next thing you know, she's servicing all the boys on the block while her parents slumber on unawares.
• Braun Silk-Epil Epilator. I adore this thing. I expect that women of a hairier phenotype find it less dreamy than I do, but I've always been a total clod when it comes to shaving; I cannot avoid cutting myself. This baby yanks the hair right out by the roots, like waxing but without the mess. Sure, it's not entirely painless, but it's a lot better than those early prototypes, the sadistic Epilady contraptions. You might think you know where I'm going with this—that a girl who feels sleek and hairless will also feel sexy. Perhaps true (and certainly suggested by the picture), but the real problem with using this product lies in the fact that is is painful (especially when used in the bikini area. You could go full Brazilian if you really had the guts, but I don't recommend it). And once girls get used to facing up to the pain of depilation, the next step is losing their virginity. Because if fear of cervical cancer is keeping women from having sex, fear of the pain of popping your cherry must be a pretty potent deterrent too.

What wonderful underrated inventions have you adopted? And do they encourage bad behavior?

The Diaper Dyslexic

Some time ago a friend of mine discovered my blog, and said that she hoped I wouldn't feel like I had to censor myself if I ever wanted to complain about her. Now, she happens to be wonderful—kind, generous, brilliant, gorgeous—and I not only would trust her with my life, I did trust her, with mine and HellBoy's, since she was the one who dragged his ornery person into the world. So I said, "Don't be ridiculous! Why would I ever want to complain about you?"

Well, I'm afraid it's happened. Sweetie, although I do appreciate you putting up with HB's antics last night, and giving him a bath, and reading him bedtime stories, blah, blah, blah ....

The diaper tabs, they go in the front.

If you put a diaper on backwards, cosleepers will find themselves in a rapidly spreading puddle at 4 am. And if you wake HB up to change his pajamas and the bedsheets at 4 am, he is not ready to go back to sleep. He is ready to par-tay.

I'm thinking we need a handy rhyme to help you memorize diaper orientation, so that when you are faced with your own (eventual) new one's bare butt, you'll be ready. You know, something along the lines of righty-tighty, lefty-loosey.

How about:

You put the tabs in back? You must be smoking crack.

(You know we love you, and that I'm only teasing, right? Have a great time surfing. We'll miss you. Send postcards.)

Hellish Boy

HellBoy/AngelBaby is turning two soon. I know I complain about him a lot, so in honor of his birthday (and in case he ever learns to read and stumbles across this blog), here are:

10 (Relatively) Good Things About My Boy

1. While he's still doing ... that, he refers to nursing as "milk please," which is convenient when we're out someplace and I'm not in the mood to get into a discussion of the pros and cons of Extended Breastfeeding. I can just say cheerily, "Sure, you can have some milk when we get home!" (I've semi-deliberately refrained from teaching him any words for the equipment; his phrase for breast is "milk there." He'll also say "switch sides," which I think is rather polite.)
2. He has not gotten more hellish. I've noticed that some easygoing babies become rather less so when they become toddlers, and their parents are left flatfooted. HB hasn't gotten easier, but at least we're in shape now. And the more he can do and say, the happier he is. Which is awfully nice, since he used to spend so much of his time in a fury.
3. He's a good sleeper, provided he's not in his own bed.
4. His sentences are in pretty decent working order, and include the depressing "Mama pager answer it"; the informative "HellBoy make a mess"; and my personal favorite, "Dog penis touch it" (he did).
5. He can be bribed with candy, but he doesn't eat it. He will stay strapped in his carseat gazingly lovingly at a lollipop for long enough to get across town, then trade the lolly for a slice of tomato.
   
6. He loves to take medicine as long as he can drink it from a little cup, first rolling it between his palms like a lush about to take a shot.
7. Being so small, he wears out many of his clothes before growing out of them, which is economical. He also doesn't require large quantities of food.
8. He can spell his name. (He believes he can write it too, but unless you're a connoisseur of performance art/interpretive dance, it's not recognizable.)
9. He likes to pee in the potty sometimes. And only peed on me once tonight.
10. I had been worried about his tendency toward violence, but he's become quite gentle—with babies, animals, flowers, books, his mother. In fact, he appears to be becoming something of a pacifist.

Class Report

I went to an overpriced, overrated, and patriarchal university that was a spectacularly poor fit for me. (I happily got credit for AP tests and managed to get out in three years.) I knew only a tiny fraction of the people in my class, I remember even fewer, and I remain in touch with none. Yet when I recently received my class report, I was mesmerized. I am fascinated by what people choose to say to sum up their lives so far.

The really cool people never say anything about themselves, of course. I dutifully sent in the requested info: my address, job title, and the names of my husband and son. Since I enjoy reading this stuff, it seemed unfair to say nothing about myself.

Of the people who chose to write something, almost all wrote about only those three things: job, spouse, and children. Now, the form requested that information up front, so it makes sense that most people would assume that's what they're supposed to write about. But it seems terribly incomplete, especially after reading blogs. Of course there's a space issue, but I think that most of my favorite bloggers would be able to come up with a couple of paragraphs that could provide some insight into their souls. (I couldn't, but then who said I was one of my favorite bloggers?)

The descriptions of the children made them seem interchangeable. Most three-year olds mispronounce words in cute ways. Most six-year-old boys have an obsession with some category of toy. Most twelve-year-olds play soccer. All children "keep you young but make you old!" I was sobered, however, by the number of people who had sad stories to tell. One classmate has three children who all have autism. Another lost her second pregnancy to a fatal neurological disorder and her third to uterine rupture (followed by a diagnosis of metastatic cancer in her husband). Another had a two-year-old who died of a brain tumor. These latter stories made the breezy descriptions of the boringly normal children seem callous, though I know they weren't meant to be.

A surprising (to me) number of people married young and stayed married to their original spouses. Many had sweet things to say, but some of their comments distressed me. For example:

I'm still married. That's saying something, isn't it? After so many years, I observe that one must work hard at a marriage relationship, and one must be committed. I have found that love is a decision, not a feeling. Effort does seem to pay off.

I mean, what the fuck? I read this entry to TrophyHusband and said, "I'd kill you if you wrote this way about me." "You shouldn't care if I said that," he said. "You should be upset if I felt that way."

This reminded me of how several people pulled either my husband or me aside at our wedding to tell us, very soberly, something along the lines of "You should know that marriage isn't a party. Marriage is hard work."

The spectacularly poor timing of these pronouncements aside, we both found this to be a bizarre way to look at things. We have always "worked" at not taking each other for granted, saying please and thank you, and considering each other's feelings. But the reason we knew we wanted to be married was that none of this felt like work. So it became an inside joke for us—"I feel like having Indian food tonight." "I was thinking Chinese." "Work of marriage!"

Things were harder once we had a baby, but the work has been more to try and figure out how to spend time with each other while working full time (and that's a work in progress). I've had to work at remaining pleasant despite fatigue and stress (not always successfully), but that's in general. There have certainly been ... challenges, but they've always seemed to be about one thing at a time, not about the marriage as a whole.

Our suspicions about the reliability of the "work of marriage" advice have been borne out in that everyone who gave it is now divorced. This past weekend we celebrated our fifth anniversary, and we asked each other, "Does this feel like work?" And we both said no.

Are the folks who talk about the Work of Marriage just in bad marriages? Or am I misunderstanding the concept?

And if you had to, would you be able to sum up your life so far in a couple of paragraphs?

Listen Up, Maggots

I'm gonna make runners out of all you sorry recruits. (At the request of thumbscre.ws.)

This is all you need:

• Comfortable running shoes
• Supportive bra (if applicable)
• Half an hour every other day (NOT every day)

Here's the secret knowledge:

• Running is different than walking. Yes, walking can be good exercise, blah blah blah. The difference is that with running, there is that marvelous fraction of a second when you break free of the earth's gravity and are floating in air. Then you come crashing back down. You cannot cheat on this, unlike with walking, which easily becomes ambling for most folks.
• Everyone makes the same mistake when starting out: going too fast. When you start, you need to go SLOWLY. So slowly that you could probably walk faster. So slowly that you will feel humiliated if you see anyone you know.
• Do not worry about (or even calculate) your speed or distance. Measure yourself only by time.

That's it. Put on the shoes, go out the door, and start running as slowly as you can bear to go. In the beginning, you might only be able to run for ten minutes of your half hour. Don't push it. Walk the rest. Over time you can SLOWLY increase the amount of time you're actually running until you're doing it the whole thirty minutes. If you actually do see someone you know, pretend you're just finishing an epic twelve-mile run: fake that you're "shaking it out" and dramatically wipe the sweat from your brow.

(As for stretching, meh. It's never really been shown to do much. I do a few yoga-type stretches and some ITB stretches (especially #3) beforehand, but if I'm in a real rush, I skip them.)

You will need to figure out if you're a morning runner, an evening runner, or a fortunate bi. I have never been able to run in the early morning, which is too bad, because it means double showering on weekdays. My favorite time to run is about 4 pm. During the week I have to go at 6 pm or so, but as long as I have a snack beforehand, I manage.

The following are NOT good excuses for not running:

• I don't have time. Me neither. But I do it anyway.
• I'm not athletic. Why do you think you have to start slower than an arthritic sloth? In fact, former athletes probably can't use this program. They can't wrap their minds around the concept of no longer being competitive.
• My boobs are too big. Strap those puppies down. I admit I'm not the best qualified to comment on this, but some of my best friends are well-endowed runners, and they manage with industrial-strength bras. When I went running with a new and impressive lactation rack, I found the double-bra method effective.
• The baby cries in the running stroller. So does mine. Sometimes I bribe him with candy; sometimes I leave him home with his father; sometimes I let him cry. But I still run.
• I'm too fat. If you can walk, you can probably run. Not as fast or as far, but you're not measuring speed and distance anyway. And don't worry about what people might think (unless you live in L.A.). When I see someone of large proportions out running, I want to cheer them on.
• It's too hot/cold/rainy/snowy. Oh, suck it up. (Also suck on an inhaler if you have asthma like I do.)
  
• I can't afford the equipment. Really, the shoes and bra are all you need, and they don't have to cost a lot of money. You don't even need a jogging stroller; I used a regular stroller when I first started running again and just ran on smooth pavement. Babies like to be jostled anyway.
• I'm too depressed/headachy/chronically under the weather. Running will fix all that!
  
• Joggers are dorky. Oh, like you're so hip? I've seen you going to the store for Ben & Jerry's wearing those droopy pants and that stained t-shirt.
  

The following may or may not be good excuses for not running:

• I have a bad knee/hip/foot/back. As long as running does not actually make you hurt more, it should be fine to do it. I have found that as long as I only run every other day, I remain injury-free.
  
• I'm pregnant. Some people can keep running when they're with child. I was not one of them.
• My neighborhood is too dangerous. Can you drive somewhere? Can you get a running buddy?
• I hate running. If you give the above regimen a real try — say for two solid months — and you still hate it, ok. But if you just think you hate it, it's probably because you've always tried to run too hard and fast.

Let me know how it goes. Maggots.

(Update 2012: For more, here are all the running posts, or check the sidebar to the right for "Running FAQs/Maggot Files")

Tagged As A Weirdo (6 Things)

1. I like the smell of B.O. Both that of others and my own. Unfortunately I have never gone out with anyone who agrees with me on this matter, so I am forced to maintain personal hygiene. I do enjoy traveling in developing countries.
   
   
2. I have nonopposable thumbs. I can only flex the first joint of my thumbs about 15 degrees, so unless I also bend my pinky/hand, I cannot oppose them. I am less evolved than a chimpanzee.
   
   
3. But I do have outrageous facial muscle control. For instance, I can close each eyelid independently of the other. I don't mean winking—I mean closing each eye in an entirely relaxed fashion while keeping the other completely open. I can also wiggle my ears (in tandem and independently); raise my eyebrows alternately; wiggle my nose; and fold my tongue into the shape of a clover. I have not found a use for any of these talents beyond entertaining drunk people at parties.
   
   
4. I do not watch TV. Not for any moral or philosophical reasons—I just never get around to it. I've never seen Gray's Anatomy, Desperate Housewives, any of the reality shows ... how do people have the time? I think I must be less efficient than everyone else.
   
   
5. I have never made out with anyone I did not also have sex with. I find tongue kissing more intimate than intercourse, so I could imagine having sex without kissing, but not the other way around.
   
   
6. I will not wear navy blue. It depresses me.

... And All I Got Was This Stupid Bag of Granola Bars

On the final leg of our epic journey home, I was forced to answer the dreaded call for A Doctor On The Plane. And I do mean forced, because TrophyHusband, being a much more generous soul than I, volunteered me. (He's a physician too, but since the problem wasn't related to his rather specialized field, I was offered up.) I was the appropriate person, since the patient was a little old Puerto Rican lady having an anxiety attack, nearly indistinguishable from dozens of my own patients. She had some cardiac risk factors, which made the situation a little more worrisome, but she refused aspirin and nitroglycerine anyway. She did allow me to take her blood pressure, reassure her, and administer a chill pill. And my payment for my noble effort? A bag full of all the leftover granola bars the attendants could find. (Well, that and a bag full of the leftover beer.) No free tickets.

It was very odd to try to be the doctor while wearing dirty slides that displayed my chipped and peeling pedicure, grubby drooping jeans, and a T-shirt with toddler smearings on the shoulders. Although I'm a fairly sloppy dresser in private life, I tend to dress rather formally when I see patients—starched white coat, nice shirt, etc. I feel a twinge of disapproval when I see doctors wearing jeans on weekends or students or residents not wearing ties. I realize that this is rather old-fashioned of me, and perhaps ridiculous, but I think that at least some of my patients expect their doctor to look the part, and it seems disrespectful to do otherwise. On the other hand, my white coat does present a barrier of sorts between me and the patient.

What does your doctor wear? Do you think it matters?

Speaking of attire or lack thereof, and not in support of any worthy cause (the way Orange's rack display was, for instance), here is a gratuitous cheesecake shot of me with AngelBaby in the swimming pool:




















It's the picture that I will look at in twenty years and think, you know, I wasn't too bad.