T-Shirtte Shoppe

Is this about what you had in mind? Microfiber, in girlie or unisex style:





































First one goes to Victoria. Victoria, if you'd like to claim your prize, send me an email w/ a place to mail it and your preferences re: style and size (doctormamamd is the name and gmail is the place, and don't forget the "md," someone else stole plain "doctormama"). (Will that circuitous address decrease the spamming, you think?)

My Hair Doesn't Work, and T-shirts

Upswing underway, I’m fairly sure. I am looking forward to things here and there—for example, I am really pleased that I get to meet up with a fellow blogger tomorrow. (Caution: if you let your location slip and it’s anywhere near me, I may hunt you down. I have made several of my best friends this way. I’d link to them, but then my own location would be obvious.)

Mignon noted the diversity evident at HB’s preschool. That this does make a difference was illustrated yesterday evening: I was sitting on the front stoop with him and he started trying to put cornrows in my hair. “This won’t hurt, but it will pull a little bit,” he said. “You twist it and twist it, and then—Mama, your hair doesn’t work!”

I am addicted to your running success stories. I really have to make up some shirts to send to folks with the best stories. If I do, what should they say? “At least I’m running”? “Another Maggot”?

And if you’re looking for something funnier and spicier than what I’m up to (not a very high bar, I admit), check out Feral. (Warning: if you’re at work and your internet access blocks “inappropriate” content, her page may not open.)

It’s Not You, It’s Me

You’d think I’d recognize the signs earlier by now:

Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

depressed mood most of the day, nearly every day
markedly diminished interest or pleasure in all, or almost all, activities
significant weight loss when not dieting
psychomotor agitation or retardation
insomnia
fatigue or loss of energy
feelings of worthlessness or excessive or inappropriate guilt
diminished ability to think or concentrate
recurrent thoughts of death

It’s always such a weird relief to realize what’s going on—like when you’re driving around lost and suddenly spot a landmark you recognize: I’ve been here before, and I know the way back. I have increased the dose of one of my medications on my own but have an appointment with my psychiatrist soon.

Probably the worst part of it is what a fraud I feel like when I’m counseling students and residents.

TH has not hung up his shorts (nor stopped shaving his legs), but no races in the near future and no discussion of two-wheeled conveyances. My father-in-law has donated a TiVo, so the Tour can be watched without me having to keep HB quiet.

I am running, and that feels good.

There are still things that make me feel happy. Things like this comment from Victoria:

Please count me as one of your success stories. In January, I was completely sedentary, obese, & suffering from pretty serious arthritis pain in my hips, as well as meralgia paresthetica & near-crippling referred pain from a bulging disc in my back. The orthos told me there was nothing to be done about the hips until I got old enough for a replacement (I’m only 42). I had a couple of steroid shots in my back for the disc pain, but they did nothing. The spine ortho was talking about surgery. My PCP told me that weight loss would help—but how can you lose weight if you’re in too much pain to exercise?

Then, I slowly decided to start trusting your advice that it’s ok to run even if you’re in pain. This is contrary to what the orthos were telling me, but then, they really weren’t helping me, and I knew something had to change. … I knew I had to lose weight to stop that pain.

So, I trusted you. I started running, very, very slowly (so slowly that my dog was walking on the uphill sections of our runs!), only half an hour at a time, only every other day. Running itself isn’t burning many calories, but there’s something about being active that makes every other challenge in life seem more manageable. It made me feel optimistic, and powerful.

I made a strenuous effort to lose weight. Since the beginning of the year, I’ve lost 35 pounds. I’m now “mildly overweight” instead of “obese.” Everyone keeps commenting on how different I look. But the most significant change—the one that nobody can see—is that I have NO PAIN. My hips feel tender when I run, but the rest of the time? No meralgia at all. No referred pain from my disc at all. And no arthritis pain at all (except a little bit during & after runs).

This is incredible. I would say I have a 95% reduction in my pain. Back in December and January, when the pain was at its worst, nobody was giving me any hope that I could recover from my pain. … I was panicking—I felt like a decrepit old lady with no hope. I was in so much pain that I couldn’t work. I was taking Vicodin every day, and feeling stoned all the time, and still in too much pain to think about anything else. Sometimes, I couldn’t even carry on a simple conversation with my husband about what to have for dinner because all I could really focus on was how much pain I was having … Now I am pain-free and I feel like I’m in charge of my life and my health.

I am convinced that there’s something about exercise itself (not just the weight loss) that helps my body manage pain.

Anyway, what is so incredibly helpful about your website is not only that you tell us not to be afraid of pain and not to give in to it, but also that you set really strict limits on how much we can do. In the past, I’ve always, always overdone it, gotten injured, and become discouraged. Now, doing only half an hour every other day, I have had no injuries. And I also have no excuse not to exercise. If I feel like having a glass of wine in front of the t.v. instead of going for a run, I tell myself, “Oh, come on, it’s only half an hour.” And I go.

I think of you every time I go for a run. I think you would be so happy to see what a difference your advice has made in my life.

And things like this picture of HB, HAPPY at daycare, sent unsolicited by one of his great teachers:



Note the evidence that he now chooses his clothes himself: (green) socks with sandals.

Mamas, Don’t Let Your Babies Grow Up to Be Cyclists

So I get this email last week:

From: TrophyHusband@midlifecrisis.com
Subject: racing sat and sunday combined race
Date: June 17, 2008 1:12:38 PM
To: DoctorMama@overextended.edu

There is a mid day fri short part (home in time to pick up HB no problem). Sat 9am start to 2 hour race (so leave here @ 7ish, then back by @ 1-2). Sunday early start and 1 hour race...home by 10am. Would figure out some reasonable time to catch up on sleep.

I was not too upset about this email, because I have been trying to have a Good Attitude. I have also been practicing saying No at work (which is pretty hard, as it turns out; one thing I had to say no to three times. Someone also went out early on maternity leave, and the system has been stressed yet more. But if I never waste ANY time—no blogging, no lunch break, no chitchat—I can make it happen).

No problem! I say. I have been trying to arrange a date night for some time, but I will simply work around these parameters. I find an early movie and line up the babysitter for Saturday night.

Friday night I confess I do occasionally glance resentfully at our new kitchen cupboards, which despite my discomfort that they even exist in all their bourgeois glory, are really cool. The resentment arises from the fact that I am not allowed to restock them because I developed a rotator cuff injury from emptying the old cupboards in record time at 10pm on a Sunday night after HB’s birthday party because TH forgot that the workers were coming the next day. TH has promised to restock them, but hasn’t found the time. Which is cool, I’m in shape, nothing wrong with my legs, I can run up and down the basement stairs: need salt …. down … up … need a spatula … down … up … need a measuring cup … down … up …. etc. No problem!

Anyway, Friday night cannot involve cupboard restocking, because before each and every bike race there are hours of arcane preparation involving not just a bewildering array of greasy bike parts but much consulting of the computer, rearranging of the car interior, phone calls, etc.

Saturday morning I have a really lovely time with HB. We eat breakfast on the patio, then I pay some bills while he plays relatively quietly and only shoots a plane at my head once, then we go downtown to put the change in the coin counter at the bank as per his request, then we wander around and have lunch. At noon my cell rings: it’s TH. Maybe home in 2 hours? As long as I get my run in and we get to our movie, I say.

HB and I head home. Phone rings at 2:00. TH: Maybe home in half an hour? Oh, and I forgot to mention, I invited Jack and his mother over for a playdate this afternoon. They’ll be there any minute.

Fine! No problem! As long as I get my run in and we get to the movie in time!

Jack and his mother arrive. I don’t know her, but she seems very nice. I neatly avoid having to say her name, since I can’t remember it, if I ever heard it at all. (I am THAT mother at daycare, the one who doesn’t know anyone’s name.) HB and Jack play in the wading pool. I find out that Jack is on “the Spectrum,” which is why he always has a tutor with him at daycare. I tell his mother that I just thought it was because he could already read so well that they gave him a reading tutor. I don’t think before I say this, and I hope afterward that it makes her feel good. I tell her that I worry about HB being a bully. She tells me that she gets daily reports on how Jack interacts with all the kids, and HB is NOT one of the bullies. This makes me feel good. Everything is good! No problem!

TH finally arrives at about 2:45, and I run upstairs to change into my running things, leaving the play date to him. I go for a glorious run. When I get home, the play date is still in full swing. I remind TH that we have to leave by 5:00, and our guests take their leave. I take a shower. I ask TH if he has fed the neighbor’s cat yet, which he volunteered to do over the weekend. He has not.

We make it to the movie in time! My dinner is a cheese stick and a beer, but that’s OK! As long as beer is involved, it counts as dinner to me. No problem!

I have chosen Iron Man, because it seems like a no-lose proposition. I am willing to watch Robert Downey Jr. do just about anything—he is, after all, on my List—and I figure TH will be happy with the gadgetry and the explosions. We haven’t been to a movie in a YEAR. We used to see a couple of movies a week.

I enjoy myself immensely. I could have done without RDJ’s overly precise facial hair, but compared to TH’s shaven legs (and the unavoidable resultant “hair shorts” effect), well …

As we exit the theater, I smile and point out a little girl who is yawning and stretching in her father’s arms. “Wouldn’t it be cool to have a kid who would sleep through a movie?” I say.

“It’s PG-13 FOR A REASON,” TH hisses. He then launches into a rant about how they should ban torture scenes in movies, and a laundry list of other complaints about the movie.

Now, we have a problem.

“I’ve been looking forward to this all week,” I say. “And you’re ruining it for me.” (I feel like such a trite asshole for even saying this. Then I feel mad that I’ve been turned into a trite asshole.)

He did apologize, and he didn’t go to the last part of the race on Sunday (though partly because it would mean waking up at 4 am and because he’d been “shelled” on the Saturday portion, I believe), and he did restock the cupboards.

But I’m still feeling bereft.

He used to make me laugh. He used to watch my back. He used to talk about subjects other than how to avoid razor burn behind his knees.

Do I have to change his nickname?

Maggot Q & A

Q: What about knee pain? My knees have dull, generalized pain ... my knees swell … Any opinions on the running is bad for your knees if you have bad knees theory?

A: Running really isn’t bad for your knees. It can make them hurt, sure, but it doesn’t cause destruction. Football players, who run explosively while carrying 300 pounds, destroy their knees. Runners don’t.

The most common cause of knee pain in runners—especially women runners—is something called “patellofemoral syndrome,” “chondromalacia,” “runner’s knee,” and some other terms I forget. There’s a reasonable description of it here. It’s not dangerous, but it is annoying and painful. The best treatment seems to be strengthening your quadriceps; those little knee sleeves with cutouts for the kneecaps might help.

ITB syndrome give you pain along the outside of your knee; stretching that band helps that one.
After 2-3 months of retraining, most of these problems are solved.

My basic rule: If running is clearly making a problem significantly WORSE, you might not want to do it. Otherwise, go ahead.
______________________

Q. I have LESS pain now than before I started exercising regularly. WTF???????

A: You know that line in Apocalypse Now, “I'm here a week ... waiting for a mission ... getting softer … every minute I stay in this room, I get weaker…”? Every day you spend babying yourself is a day you get weaker. No matter what might be wrong with you, you’re not going to get stronger sitting on your ass. Not that I want any Maggots going on homicidal missions into the jungle, but if you get off your ass, you will feel better.
______________________

Q: Side cramps. Any tips to help avoid this? Sometimes it gets so bad that I can't finish the run and even sometimes run for a few days after that.

A: This problem plagued me for years. A “stitch” doesn’t even begin to describe how painful this can be. I figured out that I could usually avoid it by—yes—starting slowly, but it wasn’t until I finally learned what it was that I could really fix it. For most people, this is, basically, a cramp in your diaphragm (no, not the birth control device, the thin flat muscle under your lungs that helps you breathe and gives you hiccups). It comes about when your breathing and your stride don’t mesh well, and can be prevented/treated by focusing on your breathing. For me, it works to breathe in step with my feet. Doesn’t seem to matter which foot, but choose one and breathe in or out every time that foot strikes. If you’re already cramping up, slow waaay down while you do this. And if you give yourself a good 5 or 10 minutes of starting slowly, it seems to help a lot. I still have trouble every now and then if I forget to start slowly—happened yesterday, in fact.
______________________

Q: Any comments on treadmill vs. road running?

A: I say, however you can do it, do it. There’s running and there’s not running. Running = good. That said, I imagine that if you run exclusively on a treadmill, there are a lot of muscles that are used in traversing uneven ground that are left underdeveloped. I find it fun to get on a fancy treadmill every now and then just to see the numbers.
______________________

Q: How do you deal w/ the guilt? (I'm running, therefore I'm not at the work or with the kids.)

A: Do you feel guilty about brushing your teeth? About going to the doctor? About eating dinner? About taking a dump? About washing your clothes? You get the idea. I have felt this twinge, but then I realize that this makes me SO MUCH BETTER of a mother/person that I should feel guilty if I don’t do it. I tell my son that it’s something I have to do to be healthy and feel good.
______________________

Q: Any advice for running with a group?

A: I have run solo for much of my running life, but I think groups can be great if you stick to a few rules: 1) No discussion about when/where/if. It happens every week at exactly the same place and the same time. Maybe no one else shows, but so what? If you spend a lot of time figuring out schedules etc., it breaks down quickly. 2) Resist competition. If you want to run next to someone, figure out who is naturally faster and then spend the next five minutes with the faster person running far BEHIND the slower person, until the pace is established.
______________________

Q: Am I just buying the hype from the shoe companies or is there a real benefit to replacing my shoes?

A: If your feet/ankles start to hurt, you probably need new shoes. I used to resist this, but after years and years, I’ve found that if I get good shoes from a real running store (i.e. NOT the sneaker store at the mall), my feet feel a lot better. If new shoes don’t feel good, take them back and get different ones. A real running store will exchange them even after you’ve run in them. As for replacing after a certain number of miles—I don’t know, probably not a bad idea. I just replace mine yearly.
______________________

Q: I noticed that no one ever talks about fat people running.

A: That’s because my advice is the same for the very small and the very large: Go SLOW. Focus on time, not distance. Get good shoes and a good bra. You will, sadly, have to spend more on your bra and maybe your shoes than a small person does, and it is likely that you will be slower for longer. But there is no reason you can’t do it, and boy do I give you credit: if you strapped 130 pounds on me and told me to hit the trail, I would have a VERY hard time, if I could do it at all. You’re working harder than anyone else, and you should feel proportionately prouder. I also direct you to the most excellent Jul.
______________________

Q: Do you have any advice for running in the morning?

A: Ugh. I am an awful morning runner myself, for two reasons: 1) I am soooo much more stiff in the morning that I have to be really careful or I end up hurting something and 2) I’m not really in need of stress relief until the end of the day, so the reward of running is much less. So I’m probably not the best person to ask about this. But that hasn’t ever stopped me from dispensing advice: I don’t do it without some cereal and coffee first.

Maggot Tricks

Now that spring is here, the running paths are getting pretty crowded. I don’t mind; I love seeing you maggots finally getting out there. You’re looking good, you really are. A couple of you still need a little more support up top, and a few of you are still trying to go too fast, but I’m proud of you all.

Some of you may be wondering, after you’ve gotten comfortable with slow and steady, what’s next? Well, here are a few tricks to try:

• Focus on form. Put your shoulders back, tuck your butt under, and pull your gut in. This will feel better, look better, and build up those core muscles in the proper position.
  
  
• Relax. As you run, think about letting your hands relax, then your feet. Hard to describe, but you’ll see what I mean if you try it.
  
  
• Add time. At the end of your run, if you’ve still got jump, do an extra little loop around the block, the park, the penitentiary, whatever.
  
  
• Add speed. I know, this violates my second rule of running, but if you’ve mastered the slow, you’re allowed to try a little bit of the fast—but only at the end of your run, in a tiny little burst.
  
  
• Listen. This sounds a little groovy, but a neat thing to do every now and then is to try to focus on each and every sound you come across as you run. (Yes, this necessitates shutting off the ipod, but it’s good for you once in awhile.)
  
  
• Smile. Smile in encouragement at all the other maggots you see, and smile at the non-maggots, so as to prevent them from saying to each other, “Did you see the rictus of pain across that runner’s face? That’s why I never run.”

Any questions (that haven’t already been answered)?

Full(er) Disclosure

Re: my backside. Yes, I have an awesome ass, and yes, sometimes this knowledge sustains me in times of trouble. Thank you for the nice feedback; it did cheer me up. I wish I could promise that you too will get one from running, but mine is a genetic gift; I perhaps will maintain it longer by running, but I had it before ever I stuffed my feet into clompy Nikes.

But I also have a great stomach, which is something running can foster:



BUT. As anyone can plainly see, I lack a rack. In that picture up there? I’m wearing a padded bikini top. This state of affairs is more than fine with me – I love not needing a bra – but it does lower my overall hotness quotient. When I’m out running in warm weather, I don’t get hoots and hollers until after I’ve gone past someone and they’ve gotten a look at my hinder.

(You’d never know that belly once housed a fetus, would you? I was an absolute freak when I was pregnant, keeping a death watch out for stretch marks—mainly because my mother has truly horrifying ones. When I went into labor and realized I’d escaped without getting any, I kept babbling to everyone involved in the admission process that night, “I didn’t get stretch marks!” They all smiled politely while secretly adding me to the list of Most Self-Centered Laboring Women Ever.)*

Re: BadCat. Not to worry, he’s been the recipient of all that modern veterinary medicine has to offer, and then some. I would love to have him on antidepressants, but even the vet has acknowledged that he cannot be pilled. Even if one is so foolish as to pay $64 for specially compounded liver-flavor liquid medicine to squirt down his throat, he forces himself to vomit it back up. I did not know that there was such a thing as a bulimic cat, did you? He is unmoved by Feliway. Our lovely vet has agreed to supply us an injectable anti-inflammatory medicine. It is not approved for more than one-time use, but injections are the only way to go, and when he’s feeling stiff and arthritic, he’s worse than usual. We have our house arranged something like a ship, fully swabbable.

He’s actually a very loving, curious cat who has never injured anyone who was not trying to pill him. I got him from the shelter when he was seven years old and near-unadoptable due to his slow-to-warm personality and his obesity—he was so fat he had to lie down to eat. (We trimmed him down by seven pounds.) He’s behaving himself this week … and HellBoy has finally learned that if he throws a tantrum, BadCat may pee on something beloved, e.g. HB’s fireman costume, his spelling computer, his guitar case … not a bad tantrum deterrent.

Re: HB. It finally occurred to me in a rare moment of clarity that the thing I need to work on with him is his anger. He is who he is, every strange inch of him, and I love him, but the ability to control his anger is something he must develop in order to become a successful person and a positive force in the universe. I know he can do it—I’ve watched him turn his mood around on a dime—so rather than stress about his personality, I’ve been focusing on pointing out and then not tolerating the ugly outbursts. For instance, “I know you’re mad at me for not letting you take a shower with me, but if you stand here in the bathroom yelling and screaming instead of going to your room to do it, we’re not going to Target.” And so far, IT’S WORKING, PEOPLE!

Re: the snake. Yes, it is a reticulated python, and no, I didn’t pull it from the ocean. The story is much less interesting than that: the poor creature was being pimped by the beach photographers who take pictures of drunk tourists with monkeys, toucans, and snakes and charge mucho dollares for the resulting prints. My stepdad snuck this shot in with his own camera, but I did the honorable thing and ponied up the money anyway. The python seemed pretty happy; he had a huge rat-shaped lump in his midsection.

Re: the bicycles. No, it’s not a phase—more like an old flame. TrophyHusband was on a cycling team in college, but turned to running in medical school as it’s much less of a time and money suck. Then I came along. But over the past couple years he’s been plagued with a strange toe injury (in my opinion brought on by running too fast when he wasn’t running with me), and couldn’t run, so his thoughts started to stray to his old love. He was already using a bike for commuting (and for taking HB to daycare), but then he started going on some group rides, then he bought a better bike, then a real racing bike, then he joined a team, and before I could say “Tour de this, buddy,” I started getting emails like this one:

From: TrophyHusband
Date: Wed, Sep 5, 2007 at 3:22 PM
Subject: quick-ish ride tonight ...

... with my guy friends....80-90 minutes, meeting 6:15 if I can (hopefully) make it (so shorter than usual thurs ride).

And I was like, when did 90 minutes become “quick”? Who are these “guy friends”? Where’s my TrophyHusband? Waaaah.

I’m happy for him, really I am. And I know I have no real right to complain. But damn, he loves those bikes. Sometimes I feel like this woman.

Re: the job. Oy vey. The less said the better right now.

One sort-of nice thing coming up next weekend: I get to go stay in a hotel room for TWO nights all by myself. (I have to give a presentation that I’ve not yet prepared, but I’ll figure that out somehow.)

*Note: NOTHING prevents stretch marks. There is NO magic cream or potion. Strangely, they seem to occur more in women who have their first pregnancy at a younger age – I guess infertility can pay off in unexpected ways. (That photo was at 30 weeks; it got even weirder looking from there.)

Bikini 'n' Snake

Now that I’ve drawn you in with that title, I will take advantage of your attention to complain:

I once read somewhere that a lot of working women say that a good thing about working is that even if things aren’t going great at work, there’s always home to escape to, and vice versa. But what about when nothing seems to being going right anywhere?

I used to love my job. Adore it. But for the past year or so, I often hate it. I really don’t know what to do about this. Today I had my first (near) panic attack in years. I just got back from vacation to get some very bad news at work. Then today I was busy busy busy and got to the cafeteria just before it closed, only to discover that they were out of grilled cheese sandwiches, OH MY GOD, NO GRILLED CHEESE, and there was nothing else I wanted to eat … and suddenly I felt like I just couldn’t take it. And I don’t even particularly like grilled cheese sandwiches.

Then there’s home. Something I haven’t blogged about at all because I really hate to whine about him is TrophyHusband’s relatively recent obsession with cycling. LATELY ALL HE THINKS ABOUT IS HIS FUCKING BIKE(S), there, I’ve said it.

Then there’s HellBoy being hellish. While he was out sick, his usual bud Justin started playing with Jack instead, and now they won’t play with HB, which makes HB come home in a fouler mood than usual, which, trust me, is saying a lot. He is so ill-tempered, this kid.

Then there’s BadCat, who has escalated from peeing on things that are not his litterbox whenever he’s mad to defecating on things that are also not in the litterbox category. He is also half blind now and looks like he’s giving you the evil eye all the time:



So it feels like everything kind of sucks. Many nights I fantasize about checking into a hotel all alone.

Do you still want to see me in a bikini holding a snake? Here you go:


Proof of the mysterious unpredictability of phobias. I know, I’m wearing the same dumb shirt and hat as in last year’s picture. Same bikini too. At least HB got upgraded to a Superman suit. And even if everything is falling down around my ears, baby’s got back.

Me and My Big Head

Being a physician is for the most part a humbling experience. You think you’ve figured out the key to helping a patient control her hypertension, and the next week she gets admitted to the hospital with a pressure of 230/110. You don’t even think of asking the sweet grandmother about substance use, and she has a stroke from smoking crack. You reassure a chronically complaining patient that her shortness of breath is nothing to worry about, then find out that her oxygen level is low enough to qualify her for home oxygen. I shouldn’t be using the second person; I did all of these things.

But every now and then, you—I—hit one out of the park and feel like a freakin’ genius.

The other day, another attending was supervising the medical residents in the outpatient office when she pulled me away from my own charts.

“You like Derm stuff,” she said. “Maybe you can figure this out.” It was a very young woman who had what the attending and the residents thought looked like bad psoriasis—but it had happened very quickly and in some unusual areas, including in the places where she’d irritated her legs by shaving them dry.

I swept into the room, which was now filled with several residents, a student, and the poor girl, who was sitting on the table clad only in a gown. A red, angry-looking, scaly rash was spread over her elbows, her wrists, her abdomen, her knees, and down her shins. In many places, the rash was in the form of small round patches.

“Mm-hmm.” I said. “Tell me: did you recently have strep throat?”

“Last month!” she said, her eyes widening. The residents literally gasped. “It was culture-proven,” one of the residents said.

“Yep, that’s it,” I said.

“What?” they all asked.

“Guttate psoriasis,” I tossed off casually. “Happens after a strep infection. What’s on the legs is the Koebner phenomenon.”

Now they think I’m The One.

I won’t tell them just yet about the guy I said could go home who went to the ER instead and ended up in the ICU, intubated, in a hypothyroid coma.

You Are [INSERT WORD HERE]

Your words are way more interesting than mine. To amuse myself while propping up a febrile three-year-old (who, having finally exhausted the orifices from which noxious liquids can be discharged, is all better), I categorized your words into several groups (and arranged them in alphabetical order – no, my word isn’t “compulsive,” why do you ask?):

Tough Stuff
I was interested to see that this is the largest group. If you find your word in the list below, you don’t break under pressure. What doesn’t kill you makes you stronger, etc., etc. I aspire to be here myself, but I’m really not:

Alive
Assertive
Bitch
Brave
Driven
Feral
Fierce
Impossible
Incorrigible
Independent
Intense
Persistent
Relentless
Resilient

Happy
If you find your word in this category, your theme song is “What a Wonderful World,” especially as sung by Israel Kamakawiwo’ole. We need more of the likes of you:

Content
Fortunate
Happy-go-lucky
Hopeful
Joyful
Loved
Optimist
Positive
Satisfied

Sad
Is your word here? You’re not in a good place. No silver linings for you; life is one big ugly cloud. Your glass is half-empty – or maybe even bone-dry:

Barren
Broken
Disgusted
Hopeless
Jaded
Overwhelmed
Pessimist
Worried

Noncommittal
If your word is here, you have trouble deciding, though you may be charming while you ponder:

Conflicted
Curious
Distracted
Eclectic
Neurotic
Shy
Trying
Undecided
Work-in-progress

Wise-ass
This is the category for those who don’t want to follow stupid rules. You make your own rules, and if you want to have three words instead of one, you damn well will:

Bad Attitude
DILLIGAF (“Does it look like I give a fuck?”)
Friendly Cranky-Pants
Nagging
Shoot here
Smart-Aleck
Smartypants
Whatever
Witchy
Yeah, yeah, whatever

Generous
Not too many people fall into this category, more’s the pity for the rest of us:

Compassionate
Listener
Mommy

Artless
No pretentions here; you are what you are:

Fresh
Genuine
Jennifer
Kosher
Loquacious

Pragmatic
The realists:

Curious
Inquisitive
Realistic
Thoughtful
Sharp-Eyed

It is the last group into which I fall, because my word is:

PRACTICAL

Boring, right? But accurate. This essential aspect of my nature explains many of my choices and actions in life. It’s why I was much better suited to being a doctor than a writer. It’s why I can’t stand spending money on fancy cars or cosmetics or wedding dresses. It’s the backbone of most of my advice to others (“What is it you hope to achieve in this conversation with your ex?” “In deciding what you want to do with the rest of your life, think about what will make you happy to be doing every day”). It allows me to remain Zen-like in the face of “difficult” patients (getting upset will only hurt me, after all).

Being incorrigibly practical has its downside. For instance, it makes it hard to dream big. I hate the interview question “Where do you see yourself in ten years?” because I have a hard time imagining my perfect future. This seems sad. I do save like crazy for retirement, but only because I am following the rules, not because I have any specific plan for what I’ll be doing with the money. Being practical made infertility treatment uniquely awful, because I had a very hard time wrapping my mind around doing it when each procedure was more likely to fail than not. And occasionally my aesthetic sensibilities are pitted against my pragmatism. I learned the hard way that I can’t live in an ugly place no matter how much money I’m saving, but I am feeling very conflicted over our current plans to replace our hideous but relatively new kitchen cabinets with ones that yes, will function better, but mainly will look nicer.

Have I miscategorized? Anyone want to change their word?

What's Your Word?

I may have spoken a little too early about having extra time. My Big Talk (which went well!), then a Saturday “retreat” for work (silly me, I didn’t realize that “retreat” meant “long-ass meeting” – though I guess I should be grateful that there were no falling-backward trust exercises), and some bumps in the road with the new colleague (e.g., a patient declaring “I never want to see that doctor again in my life”), and the month has veritably flown.

But! It could have been worse. I have had some great runs, I have not been ill, and today – today I tackled our “to be filed” pile of papers. I was a little shocked to realize that I hadn’t filed anything for about fifteen months, but never mind that now – I am now up to date. It’s frightening, how happy I feel about this. I keep stopping at the door of our office/guest room and peering into the formerly overflowing, now empty baskets just to bask in the overwhelming sense of order and accomplishment.

Anyway, what I really wanted to post about was this: a couple of months ago one of my residents and I saw a patient who had a tattoo over his heart that read (in the usual Gothic lettering so popular with tourist-trap tattoo shops):

Depressed

Talk about truth in advertising. Naturally we got to talking about what one word we’d choose if we had to get a tattoo to describe ourselves. One resident thought his would be something along the lines of “Calm.” Another resident’s should be “Ebullient,” we all agreed. An attending who was passing by said hers should be “Skeptical,” but we argued with her on that; she’s actually kind of gullible.

So if you had to have one descriptor tattooed on you, what would it be? It has to be true most of the time, and something that those who know you well would agree is apt.

I’ll tell you mine after you all tell me yours.

Under the Wire

A few weeks ago, I was chatting with one of my very first Maggots, someone I ranked up near the top of my Successes list, when she said something that made my blood run cold:

“So I’ve been running regularly for a year and a half now, and I never want to stop … even though I’m no good at it.”

“Say what?”

“I just kind of suck at running. I still can’t run for the whole half hour.”

I was stunned. Here I thought I’d taught her so well, and she’d been ignoring my second edict:

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.

“You idiot! You’re going too fast!” I said. She looked skeptical. So I slapped her upside the head and told her to start doing it right. And now she can run the whole half hour.

She’s a stubborn sort, but it made me realize that I must not have emphasized this point enough.

SLOW DOWN.

IF YOU CAN WALK YOU CAN RUN, AS LONG AS YOU’RE GOING SLOWLY ENOUGH.

Am I making myself clear?

Someone asked if I ever get in a slump, and the answer is, of course – especially during the winter, and especially if I’ve been sick and off my schedule. The one and only solution is to put on my shoes and get my ass out the door. Once I’ve got that first run in, the next one is exponentially less painful. So far this winter it’s happened twice in a row, and it was really annoying to have essentially wasted my first couple of getting back to it runs.

I really hate winter.

Christmas was okay. We had it here for the first time ever, and it was less onerous than I expected to put up a tree. HellBoy was pretty angelic, for him. Chanukah probably helped soften him up. (Yes, we do both. And by “we” I mean me and the rat in my pocket.) My stepdad did crack everyone up when he declared that he’d found HB’s theme song: Tom Petty’s “I Won’t Back Down.” HB himself agrees that it’s appropriate, and learned the words after hearing it twice – not that the lyrics are particularly complicated. (Petty doesn’t seem nearly as convincing singing it as HB does.) (Get this: lately HB’s been staying up later than we do. We tell him to stop jumping on our heads and go play in his room, and he goes … somewhere. Not for very long, and he can’t unlatch the gate to the downstairs, so I don’t think he can do much harm.)

My folks came here, which was pretty nice. My parents don’t usually push my buttons, partly because I’m a tad insensitive and my mother is a tad ... vague. However, my mother does have this way of looking at me that I know means “I’m worried you’re too busy.” I know the look means this because from time to time she actually says “I’m worried you’re too busy” when she looks at me that way. And I am, but – where to trim things down?

Here’s a start: we hired a new physician who starts this month, and I gave myself a 20% lighter clinic schedule. I didn’t exactly get permission to cut back my schedule, so we’ll see how long it takes before my bosses notice. Then we’ll see what I’ll do if anyone does notice …

Here’s to less guilt in 2008.

Picky, Picky

It’s been a while since I’ve done an advice post. So, inspired by a few inquiries from friends, I bring you the following public service post.

Are you a face picker? Are you obsessed with removing every little imperfection in your complexion? Do you spend a half hour at a time sequestered in the bathroom, up against the mirror, scanning every inch of your skin, imagining defects if you can’t actually see them? Do you inevitably make things worse, leaving yourself with an angry bleeding crater where there was nothing before but a slightly tender little bump? Do you promise yourself you’ll never do this again, only to be back at it the very next day?

I’m here to help.

I’ve known a lot of you. Under times of stress, I’ve joined your ranks. I’ve see many patients, almost always young women, with the telltale red marks fanning out across their cheeks. It’s never their reason for the doctor visit, and I know how painful it is for them when I bring it up, uncovering their shame. But there are things that can help you, if not stop, at least minimize the carnage.

Rules to Pick By

• Don’t think you’ll be able to stop through willpower alone. Habits like this—nail biting, hair twirling, face picking—are notoriously hard to break that way, at least in the long term. You need a strategy.
• The simplest trick of all, yet the one that is most resisted: Wherever it is that you’re doing it, switch the light bulb for one of exceedingly low wattage. When you can’t see the “problems,” one of the triggers is gone. Stop arguing about this one. Just try it. You can always switch the stupid bulbs back again.
• Get a face care regimen, and stick with it. It doesn’t really matter much which one. Most of them are based on one of four ingredients: benzoyl peroxide, retinoids, antibiotics, or salicylic acid. Some are over the counter, some are prescription. They all work ok, but none of them work overnight. You need to give a product at least a month to see if it agrees with you. (This is probably why the Pr0@ctiv system is successful. Although it’s just benzoyl peroxide, it gets you to buy into the regular use for a month thing. You can get similar “systems” for much less at the drugstore.)
• Consider investing in one of those electric pimple-zappers. These are pricey, but can be worth it. They ostensibly work by heating the blemish, and are meant to be used on the deep painful kind of blemish. This may or may not be effective at curing the pimple, but is definitely effective at hurting like hell. This is psychologically quite useful, because it gives you something serious to do. Take that! You can think as you hear the zap and feel the pain. If you can transfer your compulsion from picking—which is especially counterproductive with this kind of pimple—to zapping, you may be able to short-circuit the impulse to try and “fix” it by squeezing.
• When a pimple is healing—whether you picked at it or not—it usually flakes. Do NOT pick at these flakes with your filthy fingernails. Get a flat-tipped tweezer, and remove the dead skin with those. And don’t peel the skin back—pull forward, to pull off just the dead part. Scraping at the skin with your fingernails will grind bacteria in, and then you’ll get all sorts of nastiness.
• In fact, never scrape at your skin with your fingernails ever. If you end up with a blemish that MUST be manually removed—you know the ones I’m talking about, the kind that you avert your eyes from if you spot one on a stranger and wonder how on earth their loved one let them leave the house like that—do NOT pick at it with your fingernails. Use a washcloth, a cotton pad, almost anything but your fingernails.
• If you should end up with something on your face that is bleeding—which should only happen if you’ve ignored one or more of the instructions above, but whatever—I have a neat trick for stopping the bleeding in time for you to get to work. Remember how I said you should never use decongestant nasal spray for decongesting, but you can use it for a nosebleed? Well, you can also use it for other kinds of bleeding. A few drops on a bleeding wound constricts the blood vessels and stops the hemorrhage.
• Never use antibiotic ointments on any wound, but especially not on the face. About a third of folks who use these for any length of time develop a contact allergy to them, and the result looks just like an infection. So you keep putting the ointment on, and make the allergy worse, and put even more on, etc. … plain Vaseline is good for wounds, but use sparingly on your face, since if you spread it around, it’ll make you break out more. A tiny dab will help keep a lesion from looking quite so crusty.
• When you need camouflage, Dermablend is amazing stuff. Unfortunately it’s almost impossible to figure out which shade is best for you on line, which really sucks. If you can find a store that sells it, that’s probably the best way to find out, but I’ve never had the guts to approach one of those white-coated cosmetics ladies at the department stores myself. I’m not sure what I’m afraid of, but it has something to do with the thought of someone peering at my skin under bright lights and then gasping in horror. My skin is ok, but they’re paid to make you think your skin is only fit for a freak show.
• Try to remember that the vast majority of blemishes do not contain anything that has to come out. Yes, there is the odd whitehead or blackhead that can be easily removed, and very rarely an exceedingly ripe pustule that can be released, but most of the time, thinking that there’s something there that you can get out and thereby fix the problem is the path to madness, and to the wreck of a perfectly nice complexion.

Answers and Updates

Just got done with an enormous project and a sticky personnel issue. So it’s back to the rest of life.

Re: $
Q: Why, exactly, are you sending HB to private schools?
We live in a city where the public schools are unfortunately very bad. Not “bad” as in the SAT scores are lousy—bad as in kids get shot at in school, and teachers have been so assaulted so severely that they end up crippled. If we lived somewhere where the public schools were so-so but safe, I’d send HB there; I’m no snob. But we are very committed to city living. And I’m hoping we’ll find a school that will be a good, granola-ish fit. No prep schools for HB. He can stay where he is through kindergarten, which is another two years.

Re: Running
Q: How do you run once the sun sets so early?
Find a well-populated and well-lit path, and wear a reflective vest.

Q: What's the best way to cool down? A hot, lukewarm, or cold shower?
My favorite thing to do is to wait to shower until I’m actually chilly, then take a hot shower. This is a rare luxury, however. If I have to shower soon after a run, I take as cold of a shower as I can stand. I have the unfortunate capacity to continue to sweat for hours. I have this patch between my shoulder blades that is like the core of a nuclear reactor.

Re: Driving
Q: Care to share your thrifty driving techniques?
It’s called hypermiling, and here’s a site that explains it. I always thought I was not an aggressive driver, but turns out, boy was I was wrong. I used to get 27 mpg in the city, and after only my third tank of using many of these techniques, I’m getting more than 32—which is higher than the rating on my car. It’s really fun, too—it’s a challenge. Some people take this to extremes. I’ll admit to squealing my tires a bit coasting down the parking garage if I’m leaving late and no one’s around, but I’ve never drafted an 18-wheeler.

Re: HellBoy
He’s been SO much easier lately. Because I’ve been calmer? Because he’s getting older? Because I’ve been even more careful about picking my battles and sticking with no if that’s what I’ve decided? Because he’s started telling us exactly what he wants us to say when we’re playing with him?* I really have no idea. But the amount of time he spends angry and crying is dramatically decreasing. Hallelujah indeed. (By the way: yes, that song appears in Shr-k. In the movie, John Cale sings it, but for the CD, they used the Rufus Wainwright version. HB prefers John Cale, though he does like other Rufus Wainwright songs—his favorite is Across the Universe, which for a long time he called “Nothing’s Going to Change My Worm,” and would explain, “Because my worm is perfect!”)

*Sample script:
HB: I’m John Cale. (aside:) Say, “Here comes someone who knows the words to Hallelujah!”
ME: Here comes someone who knows the words to Hallelujah!
HB (walking slowly onto the “stage”): Now I’m going to play a song that was written by Leonard Cohen. (aside:) Say “That’s my favorite song!”
ME: That’s my favorite!
HB: No, no, say “That’s my favorite song!”
ME: Oh, sorry. That’s my favorite song!”
Etc.

$

Such an uncomfortable topic for me. When you grow up poor, money takes getting used to.

I was told back in the spring that I was probably going to get a raise, but I didn’t hear anything else until recently, when my new contract showed up. The raise was nice, and nicer was that in my next paycheck, I got something extra: back pay—my raise was back-dated nine months, to the beginning of the year.

So I ran right to my checkbook and took care of one of my higher-interest student loans. This is what I’ve done with every influx of cash I’ve had since starting a “real” job five years ago, and yet it was only recently that my student loans got below $100,000. When we married, TrophyHusband and I were in debt for about a third of a million, with no assets to speak of aside from our degrees. His loans are being whittled away by a program for physicians who devote their time to research (research being much less remunerative than clinical work, the government tries to lure folks into it this way). Mine I’m chipping away at—$1300 a month, plus extras. I’m also putting the maximum into the various retirement accounts available to me, as is TH; the Alternative Minimum Tax rakes us over the coals every year; and of course there’s daycare. So our bank account isn’t enormous.

But we don’t have to worry. It is highly unlikely that we will ever have to worry again, at least not the way I worried growing up. After my father died, we had no income; my mother had three kids and no degree. I was placed in Head Start. We lived in a tiny apartment—we owned the house, but rented out two-thirds of it. We had an old car that broke down a lot. I wore a lot of hand-me-downs. I had two Barbies, while my friends had dozens (though I don’t recall wanting Barbies, or any toys really; all I ever wanted was books).

I didn’t really mind any of that. It felt normal to me. And I wasn’t truly deprived; I did have music lessons, and our local Y had an awesome array of classes priced on a sliding scale—I took pottery, trampoline, gymnastics, magic, swimming, even horseback riding. I mostly made friends who didn’t have much more than we did; the richer kids just seemed to live in a different world. But I did hate the worry. My mom was not good with money. Bounced checks were routine, every single month. There were always stores we couldn’t shop in because her name could be found on the handwritten list above the cash register: DO NOT ACCEPT CHECKS FROM THE FOLLOWING … Having people show up to cut off the gas or electric was not uncommon (though I learned that if you tell them you have a sick baby, they rarely actually do it). We lived in the poorer section of town, and when I went to junior high, I had to ride the “bad” bus, where you risked getting assaulted if you tried to sit in one of the tough kids’ seats, and sometimes even if you didn’t. A couple of times I went home after school with friends from one of the fancier suburbs, and I was astonished at how nice their buses were. I did whatever I could to avoid my bus—rode my bike, begged a ride, even walked the three miles.

Finally, when I was about twelve, I said to my mother, “This is ridiculous. We shouldn’t be bouncing checks. We should only spend what we have.” This was when I found out that a) my mother was unsure as to just how much money was coming in and b) didn’t really know how to balance a checkbook. So I sat down and figured those things out, put us on a budget, and took over the finances. I didn’t let my mother go to the grocery store without me, because she was liable to throw all kinds of pricey crap in the cart instead of the perfectly good store brand stuff. And it was a beautiful thing—no more bounced checks, and I finally knew just how much I could spend on new shoes for school. As soon as I could earn a little money babysitting, I did it as much as I could (in fact, I was regularly sitting for a family of three boys under 4 from the time I was twelve—no wonder I didn’t want to have kids too young). In high school, I saved enough money to pay for all of my own stuff, plus get myself to Europe two summers in a row. (My mother eventually married my stepdad, who is a perfect balance for her—he’s so frugal that he has been known to pour cheap wine into expensive bottles for her, and she can’t tell the difference, so everyone is happy.)

Frugality has a hold on me that I’m not sure will ever loosen. Oh, I’ve relaxed some—we go out to eat a lot, we take a vacation here and there, I get my family nice gifts for birthdays and Christmas, and I’ll buy myself fun stuff every now and again. We give a lot of money to charity. GoodCat recently had to have some teeth pulled out, and when they said that they could pull out two extra that looked iffy for about $60 more or wait and see, meaning it could be an extra $500 down the road to redo the sedation, I let him keep his teeth. But I’ve never bought a fancy car (I drive a Scion; TH almost exclusively rides his bike and will probably sell his car soon), we resisted our real estate agent when she suggested we look at the biggest house we could qualify for (three times as much as the house we bought), and the most I’ve spent by far any item of clothing was the $300 I dropped for my wedding dress. We never carry a credit card balance. Our house has one and a half bathrooms and two and a half bedrooms, no garage. I almost never buy my son clothes that are not on sale, and I certainly buy him nothing from any boutiques. His equipment is all of the good-enough brands. I recently learned how to drive my car so that I get more than 31 miles per gallon in the city, and this pleases me enormously.

Right now I tell people that I’m cautious with money because of the student loan debt, but there’s more to it than that. Buying things that cost a lot when you can get something much less expensive that works just as well just seems, well, stupid if you don’t have much money, and immoral if you do. My in-laws redid their kitchen using a special kind of granite that had to be imported from Brazil. It looks no better than the home-grown stuff, but cost something like five times as much. This just seems wrong to me. But then, I guess we don’t really need to live in a 1300 square foot house either. We didn’t have to use real tile when we redid our bathroom (though we did have to redo it; it was crumbling to pieces and flooding the downstairs). And one of these days I am going to have someone out to repair all the holes in the plaster …

Anyway, what I really meant to talk about when I started this is, I have no idea how to raise my son when it comes to the whole money thing. I feel very uncomfortable about the fact that he will be in such a different position than I was. He’ll be going to private schools pretty soon. When he asks for money, I won’t be able to say “we don’t have it” honestly. I’m not sorry that he won’t have to scrub other students’ toilets in college like I did, but I also don’t want him to be like the rich kids I hated. Or did I just hate them because they were rich?

I can already see some of the ways I’ll be mortifying HellBoy when he’s a teenager ...