Rooting for Strep

HellBoy may be having a nervous breakdown. Or, it could be just strep throat.

It all started a few months ago, when HB went from being a silent, peaceful sleeper to sounding like your uncle Bob after the Fourth of July barbeque—snoring, grunting, thrashing, and, at times, becoming apneic. Yes, we took him to the pediatrician, and yes, she recommended a consultation with ENT. However, an appointment with ENT turned out to be a precious commodity. While we were waiting, he seemed to get better.

Then a couple of weeks ago he had a volcanic vomiting illness. Then he had a second one, some five days later. Then he had a febrile illness—and by febrile, I mean that one afternoon the temporal artery thermometer flashed “HI” at us, and it hadn’t developed artificial intelligence and started saying hello—it was indicating that his temperature was above the upper limits of its range, which is to say, above 107. (It was TrophyHusband who obtained this reading. Since he’d done it while HB was sleeping, he figured that maybe the child had recently turned over and that he’d just measured the side that had been pressed against the couch. He turned on a fan and rechecked it a few minutes later and it was “only” 104.5.) His eardrums looked fine, and the fever went away after three days or so.

Then the snoring/choking/thrashing started up again. This meant that none of us were sleeping well, so everyone got kind of crabby.

All of this was followed closely by HB’s third birthday, which he thoroughly enjoyed despite the sleep deprivation. He got his heart’s desire: a real guitar, ¼ sized. He also got a lot of grandparental attention.

Finally Monday he had to go back to daycare, and immediately started his transition to Pre-K. (Pre-K!)

And started falling apart. By Wednesday, the teacher (his toddler class teacher; they've slowed down the transition) called us to come pick him up, which they have never, ever done before. His daycare is awesome; it takes something close to demonic possession for them to eject a child. His father took him Wednesday afternoon. I tried to drop him off Thursday morning, and he huddled on the rocking chair with me for thirty minutes, then burst into heartwrenching sobs as I peeled him off of me. I went to a meeting at work, then called daycare, and they said “Well … he’s a little better … well, actually, you’d better come get him.” When I got there all of the other children were frolicking in the playground, and he was crumpled into a ball on his teacher’s lap. He burst into tears when he saw me and sobbed, “I didn’t think you would come!”

Of course, I’ve also been fiendishly busy. I’ve been trying to spend every non-working moment paying attention to him—I have proof of that: my last entry was weeks ago! I didn’t even go running some days!—but I know he’s picked up on my stress, and he certainly notices when I don’t get home until 7 or 8.

HB looks exactly like his father, but his temperament seems, unfortunately, to be all me. This is the source of some guilt on my part. Should I have bred, knowing that my genome carries the code for some seriously messed up psyches? My brother went to school 38 days of first grade. He didn’t miss 38 days. He went for a total of 38 days. (Of course, that was immediately after my father died, but still.) And I hated being a child. This makes adulthood probably more enjoyable for me in some ways, but I still want HB to be happy being a kid. And lately, he doesn’t seem very happy.

Then yesterday was his three year checkup. I told our pediatrician the saga, and she said 1. Don’t pick him up early from daycare anymore and 2. His tonsils look hideous, let’s get a rapid strep test.

Of course his tonsils look hideous, I thought—they’ve been hideous for months. And he’s not complaining of a sore throat (not that he ever complains of anything, except having his will thwarted) and he’s not even febrile anymore. But sure, whatever. She said they’d call later in the afternoon, because the test had to be sent to the hospital for processing. (“Rapid strep” seems like a misnomer in this situation; “quickish strep” would be more accurate.)

No call came, which didn’t surprise me, since I knew he didn’t have strep anyway. I was able to cancel most of my obligations for the day and hang out with him, but then I had an awards dinner to attend.

This morning I took HB with me to a lovely baby shower. He was slightly subdued, which meant that he climbed into the host’s child’s crib and bounced on the mattress like a rabid kangaroo, used balloons as punching bags, took stages dives from the top of the couch and nearly took out the expectant mother, and ate cake, chicken nuggets, and a ham and cheese croissant. He also shared rather nicely, in particular allowing all of the other toddlers to take swigs from his sippy cup.

As I pushed him in his stroller toward my car, I noticed a text message on my phone from my husband: Just got a call that the rapid strep from yesterday was positive.

My first thought was, OK, that’s not even quickish strep, that’s glacial strep. My second thought was, oh god, he’s Typhoid HellBoy—all those kids who shared his cup! My third thought was, hey, maybe he’s not having a nervous breakdown—maybe the poor kid’s just sick.

I’m rooting for the strep.

I'm Here, Sort Of

The last time I was this frantic was when I was a resident in the ICU. I considered abandoning blogging, but I really don’t want to. I know I keep saying this, but please hang in there while I try to regain my balance. In the meantime, here’s an update:

Good news: I fired the temp assistant
Bad news: my old assistant still hasn’t come back, and it’s looking increasingly unlikely that she ever will
Good news: two of my associates in the outpatient offices had babies
Bad news: there is no one but me to fill in at the outpatient offices
Good news: I got a raise and a bonus
Bad news: I was given an offer I couldn’t refuse to take over as Medical Director of my outpatient office
Good news: I was relieved of several detested duties
Bad news: I have four months’ worth of unfinished work to get through
Good news: my parents are coming for the weekend
Bad news: TH is going away for the weekend
Good news: HB had a tiny growth spurt and grew out of his 2T overalls in time for his upcoming third birthday
Bad news: Nana is still convinced we’re starving him
Uncategorized: HB weaned himself (without ever learning any words for breasts)

I feel like I’m at a dead run from the time I wake up until I slide into bed, and sometimes all night long. But overall it’s a reasonably good busy.

And now I’m late for a meeting.

Two Medical Truths

Hearing stories like Snickollet’s makes everyone—including me—nervous. What if what happened to her husband happens to me? we ask. And then: How can I make sure that doesn’t happen to me?

The short answer is, you can’t. When someone comes come to me and says “I want to be tested for everything,” I try to explain that most dread diseases can’t be “caught early” and that it’s actually dangerous to be tested for things you’re not at high risk for, but I know that this isn’t reassuring.

The truth is scary. The truth is that any of us, no matter how healthy our lifestyle, can be struck down by something awful at any time. Most of us won’t, but there are no guarantees.

There are really only two things you can do to vastly increase your chances of living a long and healthy life, and neither of them is something that I can order a test or write a prescription for. Nor will they make the cover of any magazine. They are:

1. Don’t smoke

and

2. ALWAYS buckle your seatbelt.

I’m not saying that you shouldn’t exercise, eat healthfully, wear sunscreen, get a Pap smear, or be checked for high blood pressure. But honestly, worrying about any of those things when you haven’t taken care of the first two is like worrying about whether your underwear is clean while you’re stepping in front of a bus. (As for worrying about any of the latest health fads—don’t get me started.)

My advice? Do what you can to keep yourself safe and whole; do your best not to fret about what can’t be foreseen or prevented; and savor your time on this earth.

The 'Screw Interview

Because I said I would, I now answer these questions from thumbscrews:

1. You can travel back in time and visit yourself at [select all applicable] 10, 16, 22 and 30. What would you tell your various temporally-disjointed selves?

Amazingly enough, these are the ages where I had things pretty together (whereas 9, 15, and 21 sucked). (29 was pretty good.)

At 10: Get a photo of yourself in that red vinyl jumper. But not in the yellow patent leather shoes.
At 16: Don’t bother with the German. Learn Spanish.
At 22: It won’t kill you to suck up a little more often.
At 30: Just get it over with and get rid of him now.

2. If your drug of choice was an item which could be purchased at Home Depot for under $150, which one would it be, and why?

I’m not sure if this means something that really can be bought at HD, in which case, I don’t know, maybe a flat of flowers that could not possibly survive in my garden? Because hope springs eternal? If this means an actual drug drug, I’d pick E. Because happiness is nice.

3. You can reanimate and spend several hours (say, sharing some Batter-Dipped Choco-Cheesecake Nibblers at the local crap-on-the-walls chain restaurant) with one of the following individuals - which one would you choose, and why?
- A deceased relative of whom you were moderately (but not overwhelmingly) fond.
- A randomly-selected serial killer of moderate notoriety.

Definitely the relative; serial killers kind of bore me. I’d pick my paternal grandfather and try to get up the guts to ask him a) what possessed him to marry my grandmother and b) what my father was like.

4. Think of your most esoteric, potentially-humiliating sexual fantasy. Think of another, equally-odd (but completely fabricated) fantasy. Describe them both without identifying which is which.

For me, describing a fantasy in detail will ruin it. Therefore I give you no details, just:
a. Ordering someone around.
b. Being ordered around.

5. What is the typical prison sentence for the most legally-questionable act you've ever committed?

Prison sentence, probably ten years. More concerning to me would be license revocation. No comment on this one.

6. Think of the worst physical pain you've ever experienced (childbirth, ping-pong ball-sized kidney stones, atomic wedgie). Think of the worst emotional pain (depression, divorce, disaster). Think of the person who is closest to you in the world (child, spouse, sibling). You must decide whether they will suffer a comparable degree of physical OR emotional pain. If you choose the former, you will be required to inflict it yourself. If you choose the latter, it will occur without any involvement on your part. Which do you choose?

I could not possibly deliberately inflict physical pain on my child. So I guess it would have to be the emotional pain. Which was horrendous, but I have a feeling it will happen to him one day regardless; might as well get it over with.

7. You're granted the power to uncover the truth behind one very, very big secret of the modern age - who shot Kennedy? What the hell is the deal with celebrity Scientologists? You will not be permitted to share this knowledge with anyone, ever - it will be solely to satisfy your own curiosity. What do you choose to learn?

Did Bush truly believe there were WMDs in Iraq? I.e., is he just stupid, or is he evil?

8. While purchasing some plantains at Tienda Mexicano, you find The Lord. You discover that he is a cruel, arbitrary Lord, as well as one who has read entirely too many "Choose Your Own Adventure" books. He takes you outside, sits you down on the hood of his El Camino, hands you a can of Jugo de Coco and informs you that you will never see any of your current loved ones again. They will continue to live their lives, just magically sans any awareness of your continued existence. By way of compensation, you'll be allowed to determine your own natural lifespan. You may elect to die instantly, live to 120 or any option in between. What do you choose? Why?

120. I could think of ways to fill the time.

9. You are given the opportunity to sample human flesh. Your enjoyment of this unusual entree will not be the result of any amoral acts - the source of your Bruce Burger (Tim Tartare? Francois Filet?) will be an individual who has died of unrelated causes. Your consumption of said flesh will not be as a result of starvation, nor as a condition of some sick wager ("Take a chomp out of Lloyd's thigh and I'll give you season tickets to Six Flags Over Highly Unlikely Transactionville"). Yea or nay?

Nay, but not because of squeamishness about cannibalism per se; rather, I have a hard time eating any meat—even chicken can squick me out if I think about it too hard.

10. You are given a Memory Dustbuster. It looks like a regular Dustbuster, circa 1989. However, when held against the human skull, it has the ability to suck out specific memories. Like many small appliances, this one has gotten a bit finicky in its old age. It no longer removes single memories ... for each one which is removed, an equal-but-opposite second memory is also vacuumed up. You can suck out a particularly awful recollection ... however, you'll also lose a happy memory of comparable intensity, and you have no say in which one it happens to be. Do you use this device? How many times?

Nope. Maybe I would’ve at the time, but they’re part of me now.

11. The Enormous Glowing Sphere of Influence Equation: how many of the following events have occurred in your life for which you've felt personally responsible? By this, I mean that the event in question would definitely NOT have occurred were it not for one or more conscious decisions on your part. Do NOT include events which were confined strictly to your professional life - thus, lawyers/doctors/matchmakers/executioners/etc. should use their discretion on this one.

- Marriages - 2
- Divorces - 0
- Births/adoptions – 2 (yes, I only have one child, but I’m counting the baby born to a patient for whom I prescribed the medicine that starts with V and ends with A)
- Deaths – nonprofessionally, 1 (helped my mother say the right things to get them to let my grandmother go a little earlier than she might otherwise); professionally, many … I am proud of how many people I’ve helped to die in the presence of their loved ones with as few tubes jammed into them as possible. All of them would have died anyway, but it would have been days or weeks later for most, and years for at least one.
- Involuntary commitments (mental institution/rehab/prison) – 0, but it should have been 2 (one rehab, one prison)
- Relocations of over 1,500 miles - 0
- Ascension to a level of fame/renown/power sufficient to interest/impact more than 10,000 individuals – I was going to say 0, but I have had at least a slight influence on the lives of many patients, students, and residents. That number is in the thousands, I guess.
- Change in income level of +/- 50% - 2
- Formal adoption/renunciation of religious faith (or other organized belief system) – 0. Never had it, never will; I don’t think I’ve discouraged anyone else, however.

12. An exercise in writing, randomness and self-reflection (when commenting/posting, only include item "C"):
A. In exactly 25 words, describe the thing you're proudest of.
B. In exactly 25 words, describe the thing you're most ashamed of.
C. Combine the odd-numbered words from A. with the even-numbered words from B

Graduating account the a of finking medical on class, a I pal quit France job summer done was courses without knowing I I not succeed.

Bad In-Law Karma

I shouldn’t be writing this for two reasons:

1. I am already so behind at work that even going in to the office for several hours yesterday (Saturday) and NOT blogging, I didn’t catch up, and tomorrow I start a week “on service,” which unfortunately does not mean I get serviced; it means seven days seeing patients in the hospital while continuing to do the rest of my job, which means someone is going to be suffering, and mostly that someone is me, though I fear more than a few patients may be feeling the pain too.
2. Whenever I bitch about my in-laws, I get an image in my mind of all the things HellBoy’s future partner will say about me. In-law karma is going to bite me in the ass.

But anyway. This is what was supposed to happen this morning: When HellBoy woke up, TrophyHusband was to whisk him into Nana and Papa’s room and they’d let us—particularly me, since I guess I seemed a mite cranky yesterday—sleep in. I would rise several hours later, rested and maybe even bearable to be around, and certainly not likely to write an ungracious post about them.

This is what actually happened:

6:45 am. HB wakes. TH whisks. I roll over and even manage to pick up the thread of my dream, which had something to do with edible handkerchiefs.

6:47 am. HB is climbing on my head.

6:48 am. TH is attempting to peel a howling HB off my head, explaining that Nana apparently didn’t understand that HB can open doors.

6:54 am. TH succeeds. The howling travels downstairs. I roll over again, but the dream has fled.

6:56 am. Howling.

6:57 am. Howling.

7:03 am. Howling.

7:05 am. Sounds of television (usually forbidden during daytime) echoing up into my bedroom.

7:20 am. I give up and come downstairs and turn off the television.

7:21 am-7:40 am. Howling.

etc.

I suppose I could have sedated myself at that point, but although I am generally a big fan of Better Living Through Chemistry, the idea of taking a sleeping pill in order to sleep late seems a bit much.

Then there was breakfast, which involved Nana making 1) pancakes 2) an enormous mushroom cloud of blue smoke and 3) piles of dirty dishes. During the eating of said breakfast, the following conversation took place:

NANA: Eat the pancakes, HB! Eat the yummy pancakes!

HB: I want to eat butter.

NANA: You know, when he comes to our house, he eats a lot more!

ME: Really. [Subtext: Nana truly believes that I do not feed HB enough, and that this is the cause of his small stature, rather than that he might have inherited some short genes, for instance from her side of the family, where none of the men stand above five four.]

PAPA: That’s true! I think it’s because if his cousin is there, it’s like a competition. Are you going to eat that pancake? [Note: Nana also loves to tell stories about how Papa’s mother used to feed him raw eggs when he was a child to try to fatten him up. Papa is now of Shrek-like proportions. For some reason this is supposed to inspire us.]

NANA: Maybe it’s like with Annie and Jasmine. H__ can never get Annie to eat at her house unless she cooks her something really special, but when she brings her to our house and she gets to eat next to Jasmine, she’s fine!

ME: Are you saying that H__ has an anorexic GOLDEN RETRIEVER?

TH: [laughing so hard he starts weeping and wheezing]

HB: I want to eat whipped cream.

Putting One Foot in Front of the Other

Some very enlightening comments on my last post. I meant to follow up on that post earlier, but I got blindsided this week. I was in a fantastic mood at the beginning of the week, because my assistant was finally returning (her replacement still cannot reliably transfer a phone call, page someone, or revise a Word document). I was peppering! all my emails! with exclamation points!!!

Then I got a call from my assistant.

Her OB put her on disability for another month at least.

For severe postpartum depression.

I feel like a gigantic asshole for not realizing this. She hadn’t told anyone, but the signs were there. It’s sobering to realize how blind I can be (and how much in denial). I’ll go visit her this weekend, and I sent her flowers. She’s getting treatment.

I’m panicking about how I’m going to make it through the next month, and terrified that she’ll never come back. I’m now trying to plow through the mountain of stuff that I had been putting off doing until she came back.

It will probably be a little while before I’m blogging much.

BUT: I’ve been seeing a lot of maggots on the running path now that the weather’s better, and that makes me happy. Keep it up, everyone, and don’t forget to keep it slow!

Anyone have any good running reports to share?

Roundheels or Prudes?

I have a lovely single friend who graciously allows me to enjoy vicariously her romantic exploits (and gave permission for me to discuss this topic here). She’s a hottie who is not afraid to (very safely) explore her wild side, and she’s ticked off a number of conquests that are on my fantasy list (e.g., bike messenger, guitarist in a rock and roll band, various other sullen slacker stereotypes). The other day she was recounting to me a romp with someone new, and remarked that this fellow was unusual in that he’d asked specific permission to proceed at every step along the primrose path. Although she certainly appreciated his courteousness, this had the effect of interrupting the momentum somewhat. It wasn’t as if he was asking to do anything freaky, she pointed out. It was more that he seemed to be expecting her to call a halt to the proceedings at any moment, and was surprised (though grateful) that she did not. And come to think of it, many of the men she’d enjoyed had displayed a similar “Wow! What a wonderful surprise!” reaction to her favors. Which made her start to wonder if she is unusual. Do most people call a halt before going All the Way? And if so, when? And for crying out loud, why?

I was of no help here, because I’ve encountered a similar “surprised but happy conquest” situation a number of times (including with TrophyHusband). I have never started making out with a guy without following the experience through to what I believe to be its natural conclusion. This is because I would never swap spit with someone I was not willing to swap other bodily fluids with (or pretend to—condoms always, everybody!). So we got to wondering, are we easy? Or are we overly picky? Do lots of people make out with someone they aren’t that into, or do lots of people hold back even when they’re hot for someone?

We went to the closest authority for more information: TrophyHusband. As a man who is very experienced in the ways of the swinging single world, we figured he’d have a reasonable sample size to be able to give an opinion. The question we posed to him was: “Did most of the women you made out with ask you to stop at some point?” (His sample being limited to women.)

His answer was a rueful “Oh yeah.” He was unable to put a number on it (years have past since those times, after all), but estimated that it was certainly the majority of the time. He said that where things were halted varied widely, though there was perhaps an above-the-waist/ below-the-waist trend. He had no answer to the why question; he said no one ever explained, they just said, “Okay, that’s enough!”

So, are my friend and I roundheels, or prudes? For those of you who don’t finish what you start, why? And what makes you decide when to stop?

Embrace Your Taste (and I Reserve the Right to Disagree)

In my last post, I singled out one of the paintings displayed on our cruise for ridicule, and this engendered some questions as to why, essentially, I was being mean about that particular work.

My mother is a painter and was an art teacher; she is also alarmingly frank. She is incapable of saying “How nice!” about a work of art that she thinks is bad. The first time she was at my mother-in-law’s house, my MIL grabbed her and said, “I want to know what you think of this print we bought!” and my then-fiance and I each made an audible gasp of horror. (Miraculously, my mother liked the piece.) When we were children, if my siblings or I drew a picture, we never expected my mother to say “Honey, that’s beautiful!” and hang it on the fridge; instead, we got a critique. This is not to say she never liked the things we drew. She let us know when she approved of something as well as when she didn’t, and why—though she still wouldn’t put anything on the fridge; she finds that practice abhorrent. (My husband recently put one of HB’s finger paintings up on our fridge, and I flinched. I let it stay—for now.)

So I was taught from a young age to look at things in a visually critical way, to figure out what I liked and what I didn’t, and to try and articulate why I felt the way I did. In other words, I was schooled in the development of taste. This is not to say that my mother ever insisted that there is one absolute standard for good art; I was always aware that there were pieces that a lot of people liked that she didn’t, and vice versa. (The argument over what should be anointed as Great Art and go into museums is beyond the scope of this entry.)

Why do I detest this painting? Yes, it has some good qualities. It is fairly proficient technically; aside from the hands, the figures are well rendered. The sole of the woman’s left foot is particularly nicely done. Yet when I rounded the corner on our cruise and was confronted with this piece, I recoiled (and sent my husband back to take pictures of it). Why? There are a number of reasons I can articulate, though many I probably cannot.

• The coloring is monotonous and not pleasing.
• The overall composition is ungainly. The eye is not led around the figures but rather gets an impression of a triangular clump of body parts. The phrase “beast with two backs” comes to mind.
• The positioning of the figures is awkward; it seems forced. It is obvious that this was not done from live models, as it would not be possible for the models to maintain that pose for much longer than it would take to make a snapshot, and indeed it looks as if this was drawn from a photo rather than life. There are reasons to draw something rather than photograph it; for one thing, the artist gets an opportunity to walk around the models and get a real sense of where things are in space and how gravity acts, and to use this to inform the piece in a way that a photo cannot. I could imagine a painting of two nudes in an awkward position that I would appreciate—if it was obvious that the painting was meant to display the awkwardness of human coupling.
• There is a coyness to the hiding of all the naughty bits that is irritating—reminiscent of the opening scene in Austin Powers, which is funny but not beautiful.
• But the thing that really gets me about this piece, I think, is the obvious idealization of the figures. What is the purpose of this piece? If it’s to display the beauty of the human form, I’d like to see a real human form. If it’s to titillate, it should be sexier. This piece is like soft-core porn: offensive to some, yet not getting anyone off—the worst of both worlds.

Of course this is all subjective. Most simply, I find gazing at this picture viscerally unpleasant. Other people must not, or it wouldn’t be hanging there (though I am willing to bet that a lot of people wouldn’t like it).

The bigger question is, is it okay to mock a work of art? I say, of course it is. Someone went to the trouble to create it for public display and someone else went to the trouble of selecting it and hanging it in the hopes that yet another person would buy it. This means that it is being offered up for judgment. That’s the point.

And is it okay to criticize another’s taste? Well, yes, sometimes. If my mother had disliked the piece my mother-in-law showed her, I don’t think she should have said, “Ew, that sucks,” as that would be criticizing my MIL’s taste to no purpose and therefore impolite. But if my MIL had asked my mother’s artistic opinion on a piece my MIL was thinking of buying, then telling her she didn’t like it would be honest and right.

It doesn’t seem any different from, say, music. I’m sure you know and love people who enjoy music you can’t stand, and you’re willing to tell them that, yet you do not love them any less for it. I, for instance, cannot abide jazz, though it does not make me respect someone less for enjoying it. Some people are embarrassed by their own taste in music, which I don’t get. If you like something, you like it. Same with art. Embrace your own taste.

So, if you happen to enjoy this piece of art, I don’t think you should be ashamed of that fact. But I also think you should know that if you go on this cruise and buy it, there are a significant number of people who will recoil when they see it on the wall of your boudoir.

A Supposedly Fun Thing

Even before I read David Foster Wallace’s A Supposedly Fun Thing I'll Never Do Again, I was never tempted by the thought of going on a cruise. But this was before I found out that it was one of the few vacations that includes free daycare (with the exception of the grandparent “vacation,” but the easy grandparents were unavailable, and the exhausting ones, well, we did that last year).

Free daycare is great—if your child consents to participate. It can even be great if your child does not consent, provided that the daycare workers do not page you fifteen minutes into your idyll telling you that no, he has not “settled down,” and please come get him NOW, before he contaminates all the happy toddlers.

So, a cruise with a two and half year old stuck to one’s leg is probably different from a childfree cruise. But the ships still seem kind of hideous, I’ll bet. I don’t think my dislike of the artwork would have been any less keen, for instance. I would also wager that having the main shore stop cancelled due to high winds would not have been any less annoying. Perhaps more so: I know for a fact that the couple who had planned to be wed on shore—and had waiting guests and attendants who had traveled by air—were more upset about missing their own wedding than we were about getting on an actual, not perceptibly moving beach.

But there were some good moments. Sitting on the balcony reading the first novel I’ve finished in months while TrophyHusband was in the pool with HellBoy (who had a fabulous time, once he was sprung from the horrors of ship daycare); running on the track some thirteen stories above the blue ocean, uphill as the ship tilted one way, then downhill as it lurched back; sitting at the bar sipping a drink while HB stood transfixed by the string quartet for a full half hour. And I actually didn’t think much about work at all.

But I just found out that my assistant is getting an extra two weeks of maternity leave. I keep reminding myself that her baby probably needs her more than I do, but it doesn’t feel like he possibly could.

And yes, I am a bit compulsive about sun exposure, why do you ask?

Rules to Blog By

Whether the original Trainwrecks site was harmless or evil (which I do NOT, NOT, NOT want to discuss—I’m very bored of that topic), it served one useful purpose for me: it gave me rules to blog by. Until its demise, I was a little afraid to check my “came from” stats, waiting for the day that the telltale “trainwrecks.net” would appear. So I scoured their site, looking for blog behaviors that were most likely to trigger a trainwreck pile-on. Some things weren’t too hard to avoid; I’m not about to run off with someone else’s spouse and brag about it, my pets are all neutered, and I’m not running any financial scams. Other things I wasn’t about to stop doing even if I was risking a trainwrecking; I wasn’t going to wean my toddler just because some people think extended nursing is disgusting, and I won’t say that my husband is anything but outrageously wonderful, because it’s the truth—but there were a few things that I thought might be good for me to keep in mind. Here are my Rules to Blog By:*

1. Welcome dissent. Introducing a controversial topic without expecting readers to have some ideas that differ from my own would be foolish, and would deprive me of opportunities to have my own viewpoint evolve. This relates to the next rule:
2. Never delete comments (unless they are dangerous—i.e., could reveal my identity, or consist of hate speech). Having dissenting comments deleted really ticks people off. (I haven’t yet been tempted to delete a comment I didn’t like, but I think I need to keep this rule in mind just in case.)
3. Do not insult readers. If someone misunderstands me, I will err on the side of assuming that I phrased something poorly rather than that the person is stupid.
4. Do not complain about something over and over, yet reject all suggestions for improving the situation. I admit this is occasionally hard to resist.
5. Do not post pictures of your kids—unless they’re really, really cute. Obviously, I wrestle with this one.
6. Do not brag about something under the pretense of complaining about it. For example, I should not say “The problem with having a child who is toilet-trained early is that they yell embarrassing things in public restrooms like ‘No touching the poop, Mama!’” If I’m going to brag about my child being toilet trained, I should just say “My kid poops on the potty, and that rocks.” Except that would violate the next rule, which is
7. No talking about poop—unless you are funny enough to pull it off. Which I’m not. This last statement may look like a violation of the next rule, but it’s not.
   
8. Don’t put yourself down in the hopes of having readers disagree with you. So please do not argue with me: I am not funny enough to tell a worthwhile poop story. If I am looking for validation, I will ask for it; if I get insults instead, I will remember my final rule:
   
9. Don’t take it personally. A good rule to follow in life as well as in blogging, and hard in both worlds.

*Please note that I am NOT saying that all of these things are necessarily wrong, nor that everyone should follow my rules; these are simply the things that I might be tempted by and want to avoid.

What’s Got My Knickers In a Twist

As I alluded to previously, I’ve been a little stressed lately. The reasons are pretty boring, but just so that everyone knows it’s not you, it’s me, this is what has had me staying awake nights:

• I have a new boss. I do not yet know if he will be a bad boss or a good one, but he’s new. I do know that he’s more focused on “the bottom line” than the prior boss, and this could work against me, because much of what I do—teach and mentor—is not accurately reflected on the bottom line.
  
• My new boss likes to have 7 am meetings.
  
• So far there have been two 7 am meetings at which my presence was requested. I was 20 minutes late to BOTH of them.
  
• My assistant is out on maternity leave, right in the middle of a HUGE project, and her replacement is astonishingly helpless. Examples:
  
  • She does not know how to revise a Word document. I couldn’t figure out how she kept introducing new errors into documents I was giving her to correct until it dawned on me that she was retyping them.
  • She does not know how to find a “sent” email. She sent me an email announcing that there was a room change for a meeting. She did not tell anyone else about this room change. When someone asked where they were supposed to be, she asked me to send her the email she had sent me.
  • She does not know how to page anyone. If you dial the numbers for her, she does not even know that you should stay by the phone to wait for the call back.
And on and on. I am spending most of my time doing her job these days. This is not an exaggeration.


• When I was expecting a rejuvenating couple of days last weekend, my in-laws showed up with—surprise!—my sister-in-law and her infant and her two-year-old in tow. Eight people, three of them under age three, in 1300 square feet, with one shower. Then the grandparents ditched everyone and went shoe shopping for hours. Somehow I spent most of my weekend babysitting the four-month-old.
  
• Tuesday I broke out in an itchy rash from my neck to my ankles. It turned out to be a systemic reaction to an antibacterial ointment, but I spent a terrified couple of days thinking it was one of my antidepressants. (It was bacitracin, by the way, and about 30% of people who use it for any length of time can become allergic. Interesting fact: bacitracin got its name because it was originally isolated from a bacteria grown from a wound from a girl named Tracy.)

There’s more, but you get the gist. Some of it’s better already (this weekend is much more relaxing, and the rash is almost gone) and some of it will be better very soon (my assistant returns in two weeks), but if someone in cold-weather running gear runs past you in the next couple weeks muttering “Serenity Now,” it’s probably me.

Why Ask Why?

Humans are wired to constantly search for causes for (and solutions to) every problem. This is probably our most useful adaptation, but it can lead to certain difficulties, especially for doctors.

Take flu shots, for example. It has been shown conclusively that flu shots do not give you the flu. (They couldn’t give you the flu due to the way they’re designed, but people went and did studies on it anyway.) Yet there are many people out there who swear that flu shots give you the flu. Why?

Flu shots are given during cold and flu season. A certain number of people will come down with an upper respiratory infection in any given week. If one of those people happened to get their flu shot that week, it’s easy to see why they would assume that the shot was to blame. Forever after, they will attest that flu shots give you the flu—and will probably convince a few other people of the same. Trying to argue against this is nearly futile. I attempt a preemptive strike with every flu shot I give, telling them that the shot won’t fully protect them for about two weeks, so they could still catch the flu in that time, but I’m not sure how well this works.

Trying to bring on labor is another example. Studies have shown that NOTHING works to bring on labor, with the exception of the drugs used for formal induction in the medical setting. Castor oil? Doesn’t work. Having lots of sex? Doesn’t work. Scrubbing the floor on hands and knees? Doesn’t work. Nipple stimulation? Doesn’t work. Acupuncture? Doesn’t work. Ankle massage? Doesn’t work. Walking/jumping? Doesn’t work. Stripping the membranes? Doesn’t work. Primrose oil? Doesn’t work. Raspberry tea? Doesn’t work. And so on and so forth.

But wait! I can hear a lot of you (probably most of you) thinking. My doctor recommended having sex, and it worked for me! My best friend used castor oil, and it worked for her! My midwife swears that several of her patients have gone into labor after drinking raspberry tea! I know these things work!

But think about it. No matter what, every pregnant woman eventually goes into labor. And whatever thing she did just beforehand will always be credited with doing the trick. Therefore of course all of these things have “worked” for some people. But when they’ve been formally studied—having fifty pregnant women do nothing while another fifty twiddle their nipples, for instance—the rate at which they go into labor is exactly the same.*

Birth defects are yet another example. I was talking with a pregnant friend recently about how nutty everybody gets about pregnant women doing anything—taking medications, drinking coffee, having a little alcohol, lying on their backs. This hysteria seems to be getting worse and worse. Partly this is just part of the whole trend toward fetishizing pregnancy, I believe, but partly it’s because of the way birth defects occur. There are only a few things that are known to cause terrible birth defects—thalidomide, oral isotretinoin, and a couple other uncommon things—but even if you don’t have exposure to one of those, there is a 2-3% risk of major birth defects. And when one of these spontaneous defects happens, of course everyone starts wondering what caused it, and remembering every cold tablet and cup of coffee and hot bath they took during pregnancy. If you do a retrospective study looking at birth defects, the mothers of babies with defects always remember more exposures to everything than the mothers of healthy infants. But if you do a prospective study, following people through their pregnancies and documenting exposures, there’s no difference between those in which defects occur and those in which they don’t.

If something happens often enough—a colicky baby being fussy, for instance—it’s easier to figure out (by trying a lot of things that don’t consistently work) that nothing you do causes it or cures it, and it just needs to be waited out. Relatively rare things that can occur randomly (getting pregnant, birth defects, most cancers) or that inevitably end with time (pregnancy, a chest cold) are the things that really lend themselves to myth-making about causes and solutions.

The belief that every phenomenon can be explained and every problem solved is a wonderful thing much of the time. It’s great when someone with diabetes understands that eating carbohydrates causes their blood sugar to rise or that taking their medicine brings it under control. But it’s frustrating when someone can’t accept that doctors don’t have the solutions to everything. (The doctors who can’t accept that—and there are many—are even more frustrating.)

I wish I had a better way of explaining this to patients. Sometimes when people ask me “Why did I get this disease?” I’ll answer, “Just bad luck,” and they look at me like I’m crazy. I suppose if I were religious, I could answer, “Only God knows the reason,” but 1) I’m not, 2) my patients might not be either, and 3) even if they are, it could be an annoying thing to hear (“I’m sure God has a reason for why you had this miscarriage!”).

How do you deal with things that can’t be explained?

*UPDATE: OK, I should know better than to use an inflammatory example such as this. I say the following in a comment below, but I’ll add it here too: the induction of labor example was meant mostly as an example of a perfect setup for fallacious beliefs to take hold. Yes, there are studies here and there that suggest that a couple of these things might increase the odds a little bit of delivering earlier (though several of those studies were actually done in conjunction with oxytocin, so I’m not sure that you can count them). But having looked at the evidence, I’m standing by my assertion that none of those things is worth having anyone put themselves out in any way to do, because if they work at all, the effect is teeny-tiny. Remember, negative studies mostly don’t get published, so if there are a few weakly positive studies—or positive weak studies—chances are very good that there are at least a few unpublished negative studies.

I’m not saying that everyone should be induced medically by any means; I think too many people get induced as it is, and if we just waited until babies were done gestating we’d have fewer c-sections. I also think childbirth has been overmedicalized in general—I even think that the evidence supports the superiority of (supervised) homebirth in multiparous women. But the things that I see heavily pregnant women doing to try and bring on labor just seem miserable, and the amount of advice they get about it could give anyone a headache. (Which doesn’t help bring on labor either.)

And yes, I’m having a wretched day, and week for that matter.

My Breasts 2, or, Haven't You Stopped that YET?

Yes, I’m still doing THAT. Yes, he is two and two-thirds years old. Yes, the end is in sight.

I have discovered that after a certain point, most people no longer ask if you’re still nursing. I’m not sure if they assume that no one could possibly still be nursing a child who is toilet-trained, or if they assume that I am out of my mind and will never wean him so there’s no point in asking, or if they’re too horrified even to ask, but the questions have pretty much dried up. Heh.

Until recently, I was fibbing a little about how much he was nursing, just to keep people off my back, I guess. People would say, “Oh, he still nurses a little at bedtime?” And I’d answer, “Something like that.” Which was only a lie if “something like that” doesn’t include also nursing 1) first thing when I got home from work 2) 4:30 in the morning 3) 7:00 in the morning and 4) pretty much all day on weekends.

The weekend days were the first to go, soon after his second birthday. It was getting so that Mondays I’d have to wear an industrial-strength bra to rein in two very confused and pissed-off breasts by late afternoon. He tolerated this restriction pretty well, so I moved on to: the 7:00 am snack, which was making me late to work almost every day. That change made him cranky, but he was cranky in the mornings regardless (this has changed since I, the über-dork, got a sunrise clock—but more on that another time).

We were stalled there for a while; the habit of insisting on nursing the second I walked through the front door seemed unbreakable. Then something unexpected occurred: he learned that Weaning Happens.

I’m not sure if I thought that he already knew this (I had cut him back, after all), or if I thought it was too esoteric a concept, but it surprised me.

It happened one evening as I nursed him after work. I said, “You’re a lucky little boy, you know.”

“Yeah,” he said, and went back to the fount.

“Not every little boy gets to nurse, you know,” I said.

He paused for a moment, considering this. Then he started to list every toddler he knows who nurses.

“Sydney nurses,” he said.

“You’re right, she does nurse.”

“Baby Jake nurses,” he said.

“Yes, he does,” I said.

“Lucas nurses,” he continued.

“Actually, no, Lucas doesn’t nurse anymore,” I answered.

He stopped and stared at me in shock. Then his face crumpled up. He buried his face in his hands and started sobbing.

I realized that up until then, he assumed that some kids nurse, and some don’t. He hadn’t understood that it would someday stop, poor kid. I had just rocked his world.

“It’s ok, it’s ok!” I said, hugging him. “Lucas drinks milk from a cup now! He likes it! He’s happy!”

“Yeah,” he said, tearfully and doubtfully, and went back to the supply that he now knew to be endangered.

For the next few days, anytime anyone mentioned Lucas, he would announce, “Lucas drinks milk from a CUP!” But more significantly, he started to ask for milk in a cup. Up until then, he had always refused to drink milk from a cup unless he was at daycare.

The evening session disappeared not too long after that. I noticed that he also became less clingy; he’s not as unhappy to let go of me now that he doesn’t see me as a human binky, I suppose.

I had worried that the 4:30 session would be hard to quit, because he could find the goods on his own, after all (he has a toddler bed, which he stays in for a couple of hours before making the trip to our bed). But a couple of times I woke up enough to stop him and offer him a cup of milk I keep on the bedside table. This pissed him off at first—once, after refusing it, he actually went to the trouble of sliding out of bed, getting the cup from the table, flinging it across the room, then climbing back into bed—but he usually settled down pretty quickly. Soon, of course, he quit waking up at all.

Yes, people, I had to wait almost three years for my child to sleep through the night. Point and laugh if you will. I’m not ashamed.

Now the routine is, nurse for about two minutes, then drink some milk from a cup, then lie down and go to sleep. And that’s the only nursing we ever do anymore (ok, ok, I admit it, last weekend when a tile floor smacked him in the face and he got his first-ever nosebleed, my instincts took over and I yanked up my shirt. It startled him into stopping crying, too—he looked as if money had started to rain from the sky. Later he half-heartedly asked for it again, but didn’t seemed shocked when I said, no, only for bedtime).

I think we’ll hang here for a little while. No sense in rushing things, after all.

I’ll Show You a “Little Pinch”!

You might be surprised to learn that medical professionals are some of the most needle-phobic people around. You should hear the whining in the line for the flu shots every year: “Which nurse looks like she hurts you the least?” “Is it a big needle?” “I hope I don’t faint!” Not to mention the ones who just avoid their shots. “But don’t you have to stick needles in people all the time?” you may be wondering. Well, yes. Into other people. Most (though not all) needle phobics don’t have too much trouble with a stranger’s blood or pain; it’s our own we’re concerned with. I have an (untested) theory that needle phobics may in fact be drawn to medical careers; there’s an aspect of phobia that involves deep interest in the object of fear. It’s invested with such power in your mind that it becomes fascinating.

There are different broad types of needle phobia (that site I just linked to is pretty good, by the way); I had a combination of the two most common, vasovagal and associative. The vasovagal type involves the symptoms typically associated with phobias: nausea, rapid heart rate, sweating, and a drop in blood pressure, resulting in lightheadedness and even fainting. A tendency toward becoming vasovagal seems to be just the way some of us are made, and usually we have more than one phobia to contend with. (A couple other phobias of mine are spiders and phones. I did have a fear of public speaking, but overcame this in quite a different fashion — maybe I'll tell that story too one day. Snakes, heights, and mice bother me not at all, so you never can tell.)

“Associative” needle phobia usually develops from an unpleasant experience with needles in childhood (whether your own trauma or something you witnessed). Mine probably started when I had two separate episodes of scarlet fever that necessitated very large injections of penicillin into my butt. They held me down while I screamed and fought. (Not the best way to go about it, one would think; I hope this isn’t a typical pediatric procedure anymore.)

From then on, anytime I knew in advance that I was going to have to get a needle of any kind, I would live in anxiety for days. Those who suffer from needle phobia often avoid necessary medical testing and treatment (some avoid pregnancy solely for this reason). I usually made it through, but not always, and I definitely delayed my infertility workup due to this. I vividly remember the days before my first bloodwork, wondering how I was ever going to be able to get through ART. That blood draw went ok, but the relief I felt after it was “It’s over with! Never again!” rather than “That wasn’t so bad!”

The first time I had to have an injection at home, I premedicated with an anxiolytic (the good stuff), but I was still so tense that I put my husband through a good half hour of “OK! — No, wait! Wait! — OK! No no no!” It ended with me in tears, though the injection was eventually administered.

Then I learned the first trick that helped me. It’s a simple technique for overcoming vasovagal reactions. Most people make the mistake of trying to relax as much as possible before and during the experience, but it turns out this makes things worse, because it allows your blood pressure to plummet, and makes your symptoms more severe. Whereas if you cross your legs hard and clench your fist on the side opposite the injection or blood draw, you help maintain your blood pressure, and then you don’t feel woozy, and the cycle can be (temporarily) halted. (Take care not to make it look like you are about to punch the phlebotomist; they can be touchy about this. I actually pinch my thumb really hard between my other fingers, and scrunch up my toes.)

The next trick I learned was visualization. Most people have categories of pain: some pain is ok, some is scary, and some is actually good. Everyone’s different, of course, but some examples of good pain might be: tweezing a stray hair; lancing a boil; popping a pimple; getting a tattoo; bikini waxing; digging out a splinter; having a newborn latch on to tender nipples … you get the idea: sudden pain that serves a worthy purpose. If you can pretend that the needle stick is actually one of the “good” pains, it seems to hurt much less.

The technique I learned that was most helpful for the “associative” part of the phobia was re-associating the procedure with something good instead of bad. What helped me the most for this was focusing on the goal: a baby. At the last infertility clinic I went to, they had pictures of patients’ babies up on the wall facing you as you had your blood drawn. Some people were offended by this, but if I could find a really cute one and focus on it, it went much better: it’s for a baby! Ouch! Not so bad!

A technique that helped with both aspects of my phobia was distraction. When my husband had to give me deep intramuscular injections of progesterone in oil—with the BIG needles—he developed what I called his “patter”: he would think of an interesting story to tell me, and right when it was getting to the good part, WHAM! he’d stick me. Sometimes he’d forget to talk (an amazing lapse, if you know my husband), and I’d have to yell “Patter! Patter!” as I lay on the bed with my pants down.

And finally, a great treatment for most phobias is habituation. This can be hard to achieve with needle phobias—playing with needles is not generally practical or savory. But infertility treatment was just what the doctor ordered, ha ha. Intramuscular injections daily—hell, twice daily, why not? Blood draws, let’s see—let’s do them every other day, just in case! It’s not clear why habituation works, but after a few days of this, most phobic people just chill out. (You will rarely see a really ill needle phobic in the hospital. Rather, you will see them, but you won’t realize they were ever phobic.)

The one thing I wondered was whether I would be back at square one once infertility treatment was done with, because habituation often fades if the stimulus isn’t continued. But not too long ago I came down with strep throat, and realized that rather than take pills for a week, I could just get a shot in the butt. I looked at the syringe beforehand, and it was the biggest, longest, fattest freaking needle I had ever seen. In addition, the quantity of liquid was prodigious, and was a disturbing milky white color. I gazed at it for a moment, then said, “Eh, stick me!” and dropped trou. It was only later, as I was limping around the office, that I realized that this was the very thing that had triggered the whole problem in the first place. And I finally felt cured.

Since

I'm sick (again) and in the middle of a shitstorm at work (again) and my precious assistant just went out on maternity leave (not again, and the baby is adorable, but I am near helpless without her), and I'm working this weekend.

These are my excuses for this short post. I have the needle phobia one half-written, so that'll be out soon.

But today, one really cool thing happened: my son correctly used the word "since" in a sentence. This reminded me of how I once worried that I would be sad to see him leave babyhood behind. When in fact oh my god am I glad to leave his babyhood behind. Babyhood kicked my ass. He was a real HellBaby, but as a toddler, while he's still intense, he's a lot closer to the norm (if the norm encompasses channeling Bono, that is).