Wednesday, December 28, 2005

From HellBoy with Love, A Broken Nose

I had fantasies of this Christmas being very relaxing for me. We spent the week with my parents, who are generally laid-back, fun, non-button-pushing types, AND my mom gets up early and is happy to watch HellBoy while we sleep. I figured that HB would be distracted by the new toys and the doting grandparents and the snow, and I would loll about reading the paper and drinking coffee and blogging.

Ha. This is what really happened: My mom did watch the monster every morning, bless her heart. But this meant that she was so worn out by the time I got up that she was basically useless for much of the rest of the day. My stepdad is good with somewhat older kids, but he finds toddlers irritating (and honestly, who doesn't?). He did read some books to HB, and take him for brief forays outside, but that added up to about 30 minutes a day. Then my mother would watch HB while TrophyHusband and I went for a run, which was also much appreciated.

This all totalled about 3 hours a day being off-duty (but really, who's counting? Me, that's who). Plus the 90 minutes of nap time, that left ten or so hours a day of trying to keep HB from destroying everything in the house. The toys were distracting for about ten minutes at a stretch. My folks had tried to childproof a little, but there's no way to childproof a Christmas tree, bookcases full of CDs and framed photos, nice furniture (when did they start getting nice furniture, anyway?), cats, computers, plants, etc., etc. And TrophyHusband needed to get some work done, which I tried to let him do because I felt a little guilty about dragging him to my family's for Christmas for a whole week.

And I had forgotten that HB really doesn't travel well. Not just the actual traveling part, though that is notably awful, but the being someplace new. So he acts out. A lot. My parents had friends over for Christmas dinner who've tried to get pregnant but couldn't, so they are half-heartedly contemplating infertility treatment. But HB put on such a show that night — screeching, running around like a rabid ferret, snatching clumps of fur from the cats' tails, chewing on crackers and spitting them out on the coffee table, pounding divots into the wood floors with his blocks — that at one point I turned around to see the wife with her mouth literally hanging open in shock. Later she said to my mother, "No way. I can't do it." So at least we've saved someone some money in fertility treatment, I guess.

Anyway. One of the things my mother did to distract HB while we slept in the mornings was to let him jump on their bed. Fun, right? Except that from then on we had to keep our eyes on him every second (instead of every other second), because he started climbing on all the furniture and trying to jump to his death. Then the other evening, I took HB down to our room to go to bed (my parents have a split-level, with the guest room downstairs). We were sitting on the bed, HB babbling and playing peek-a-boo with the covers. Suddenly, out of nowhere, he leaps to his feet and flings himself backwards. It was too dark for me to see what was going down until it was too late.

KER-ACK!! went my nose as his noggin made contact.

"FUUUCK!!" said I as I crumpled onto the bed, clutching my face.

When you break your nose, unless you're seriously drunk, you know it. The blinding flash of pain is usually enough to tip you off, but that sickening snap of the bone is unmistakable. I've done it twice before and had hoped never to do it again, but I've been afraid that HB would manage it one day. He's split my lip a couple of times and head-butted my nose, but never this bad.

No one heard me yelling for help, so I snatched HB under one arm and staggered to the foot of the stairs, tears streaming down my face. I could barely see, what with the tears, the pain, and the fact that I'd lost my glasses in the melee. HB was howling too.

"He broke my nose!" I yelled.

Much flurry and consternation, while I kept saying, "Just take him! Get me some ice! For god's sake, take him!" Finally HB was sequestered in the TV room with my stepfather and a Baby Crack DVD and I had ice applied to my poor throbbing nose.

After a few minutes I ventured to take off the icepack and show the damage to TH. "Er, I think it's swollen on one side?" he said nervously. Swollen? On one side? So soon? I went to look in the mirror.

It wasn't swollen. It was crooked. It was pushed to the side. I looked like something out of one of those awful domestic violence awareness videos they show to med students.

"It's displaced!" I wailed. "Yeah, I know," TH said despondently.

So then the conversation turned to whether I should go to the ER. Everyone else said yes, I said no. Because I know what happens to people who show up to the ER with a broken nose: first you wait, because a broken nose by itself will not kill you. Then once you get seen, they grill you about how it happened, because the real reason has to be domestic violence (thanks to the above-mentioned videos, medical personnel are now acutely attuned to this possibility). (In my case I guess you could say it was domestic violence, couldn't you?) Finally they take a look up your nose, poke around at the place it already hurts like a motherfucker, and tell you to go home and ice it and see a specialist in a few days. Because while you can put a nose back into place if you do it before it's too swollen to see what you're doing, nobody in the ER really likes to mess around with people's faces if they don't absolutely have to. So you go to the specialist in a few days, when you're finally feeling better, and they snap it back into place then. And I went to the ER the last time we spent Christmas with my parents, and I didn't want to make it a tradition.

"I'm not going to the ER," I said. "I have to fix it myself."

So I took two of some of the really good pain meds they gave my mom after her last medical procedure ("TWO? A half of one of those wipes me out!" she said. This from the woman who can drink a Cossack under the table, and has tried more drugs than any of her kids, I think, but whatever). Then I made everyone go into the TV room and watch some episodes of House that my odd brother had been insisting we HAD to see (because we're doctors, he said, but mostly because the main character seems to be channeling my brother). We all sat and watched (HB had miraculously fallen asleep on his grandpa's lap), me with the icepack on my nose, and I waited for the pain meds to kick in. From time to time I prodded at my nose and listened to it go "click-click" as it moved a bit. I tried to get the others to listen to it, because it seemed pretty cool to me, but maybe that was the medicine talking, because nobody shared my interest.

Finally I got up and slipped out and went to the bathroom and took a look, then put my finger up to the bridge of my nose and carefully puuushed and puuuuuushed and ... SNAP! It went back into place! I was so fucking proud of myself. Also a bit queasy, but definitely proud.

Now it's still not quite right, but that may be because it's swollen and a bit greenish. I can breathe just fine, and the bruising isn't hard to conceal. Besides, my cold sore and my weird hair draw attention away from my nose.

Friday, December 23, 2005

The Perfect Accessory for the Holidays

The feathered hairdo was in style when I was at the prime age for fussing with hair, i.e., junior high/high school. And it would have been one of the few hairstyles that my fine, limp hair could have sustained. But I am proud to say that I resisted. Partly because I always thought it looked dopey, but mostly because I HATE fussing with hair. I lack the playing-with-hair gene that every other woman seems to have been born with. I find it onerous to have to blow-dry my hair even in the middle of winter. I hate the feeling of styling mousse on my fingers. A visit to the hairdresser is about as appealing to me as a visit to the dentist.

Too bad, then, that my hair is a limp disaster when left to its own devices. I wore a crewcut at the start of college, but even this was too much for me to keep up. So for years and years and years and years I kept my hair in a ponytail. I would corral any handy person to trim it from time to time. This was ok while I was a grad student, a twenty-something editor, and a med student. But finally had to decide whether I really wanted to go into my professional life and my forties with a pathetic little gray-streaked rattail hanging off the back of my head. Because aside from my hair, I do possess some vanity. So I bit the bullet and started seeing a real hairdresser (damn, they're expensive!) and started with the cutting and the coloring and the styling products.

I actually didn't know how to do the most basic things. I tried a curling iron and promptly branded myself on my forehead. I tried the round brush to blow-dry it and got it so tangled up I almost had to cut it free. Eventually I did manage to gain enough proficiency to look reasonably put-together.

But. For some reason known only to the hair gods, whom I've clearly offended, the most recent cut I got — which seemed identical to the cut I've had for the past two years — has been giving me trouble. Specifically, unless I fix it exactly right, it looks feathered. And although I've noticed that this style seems to be having a resurgence, I still find it horryifying.

Yesterday my mother wanted to take me and AngelBaby to a holiday party where there would be people I hadn't seen in years. I was already despondent over the fact that just before our trip I sprouted the biggest, ugliest, This-Is-Spinal-Tap cold sore I've had on my lip in the past twenty years. You simply can't cover up those babies. Concealer just makes them look crusty and malignant. Luckily it's in the corner of my mouth, and if I smirk a little bit, it's thrown into shadow. But then my hair decided I wasn't going to be quiiiite self-conscious enough, and went into a Farrah Fawcett frenzy. I fussed and fussed, and finally my mother said, "We have to get going!" Which really made me feel like I was in seventh grade.

So I went, smirking wildly and repeatedly tucking my traiterous locks behind my ears. But did anyone even make eye contact with me? No, of course not. They only had eyes for AngelBaby, who loves a good party and networked like mad.

I disagree with those who say you shouldn't have a baby just to have a cute accessory. What else are they good for?

Monday, December 19, 2005

No Penguins, Just Squid

This weekend we had a long overdue date night, and finally got out to see a movie. This time I'm pretty sure the movie we saw, The Squid and The Whale, won't be co-opted by the religious right, unless they want to use it as a cautionary tale about what happens to little boys who swear and masturbate. I found it very funny in a painful way, but I was concerned that TrophyHusband wasn't enjoying it, because it's about people in NYC behaving badly during a messy divorce in the '80s, a situation close to TH's own childhood experience.

I needn't have worried. As we were leaving, I said, "Well, at least you know your parents' divorce could have been worse!"

"What are you talking about?" he said. "My parents' divorce was worse. Way worse. In the movie, no one had to call the cops, and no one spit at each other, and they never played actual physical tug-of-war with any of the kids ... this looked pretty civilized! And the kid only drinks — nobody ended up in drug rehab."

I had sort of forgotten some of his worst stories. The weird thing is, he still maintains that he had a happy childhood, even though he doesn't remember a time when his parents weren't at war with each other. Makes me think it hardly matters what we do to HellBoy — he'll make his own interpretation of events anyway.

Then we went to a pub and had a nice dinner and a pint.

Now I've got too much to do before we have to get on a plane Wednesday, which I'm trying not to think about. I'm just hoping for one family holiday during which nobody vomits. And for a little free time to catch up on some good blogs.

Wednesday, December 14, 2005

How to Fix a Nosebleed

  1. First, you must be committed to the project. If you are not committed, just stop reading now and resign yourself to wandering around with wads of toilet paper trailing from your nose for the rest of the winter.
  2. An important thing to know is what causes nosebleeds. The vast majority of the time they are due to a combination of dry air, vigorous noseblowing, and most especially picking. Yes, you know you do it when no one's looking. Just admit it and let's move on.
  3. Another important thing to know is that what you are looking to do is create a blood clot in your nose and leave it there. More on this in a moment.
  4. OK then. When you feel that familiar warm trickle, the first thing to remember is, pinch. (Also that hydrogen peroxide will remove bloodstains from fine clothing.) Pinch the squishy part of your nose up as close to the firm part as you can. How hard to pinch? Hard.
  5. Next, lean slightly forward. This is so that the blood will pool at the dam you've created by pinching. If you lean back, it won't clot, it will just drain down the back of your throat and make you feel like hurling.
  6. This step is critical: Maintain the position for at least 10 minutes. Watch the clock. Do not cheat. It is boring, yes, but it's better than the excitement of mopping up more blood. (A trick: two tongue depressors taped together at one end make an effective nose-pincher, freeing up your hands and providing welcome amusement to onlookers who are annoyed about the blood everywhere.)
  7. After your time is up, you can stop squeezing and see if the bleeding has stopped. But DO NOT BLOW YOUR NOSE. This is torture — all you'll want to do is blow your nose — but you must resist. No noseblowing for the rest of the day. (And no more picking for the rest of the winter.)
  8. If the bleeding hasn't quite stopped, repeat steps 4-7 above.
  9. If the bleeding still hasn't stopped, move to plan B: nasal decongestant spray. Yes, we usually say they're worse than crack, but in this situation they are quite useful. They constrict blood vessels, and you can see how that could help. At this point you are allowed to GENTLY blow your nose ONCE to clear the way, then use one squirt of nasal decongestant spray. Then repeat steps 4-7.
  10. Still no luck? Repeat step 9.
  11. 99% of nosebleeds will be done way before this. If not, you can go to the ER and get nasal packing, which is basically a tampon shoved up your nose.
  12. You don't have leukemia.

Tuesday, December 13, 2005

Dr. Know-It-All

One of the things I love most about being a doctor is knowing things. One of the most important things one learns in medical training is how to "interpret the literature" — how to find studies that apply to a clinical question and then how to tell if a given study is any good (a surprising number of them aren't, or are only useful in a very limited way).

I also love sharing my knowledge. I've never been annoyed by friends and family members who ask me medical questions. Since I'm an internist, a lot of the things they ask are the same things I manage every day with my patients. And I'm very comfortable admitting when I don't know something.

But I don't want to become little Dr. Know-It-All. Sometimes when roaming around in the blogosphere, I come across descriptions of medical issues that seem either wildly inaccurate or possibly mismanaged, and I have to sit on my hands to not comment. For instance, I came across a mention of someone being treated for years with intramuscular antibiotics for "chronic Lyme disease." Although I know that this is essentially malpractice, it's none of my business, and I'm sure the comments of an anonymous stranger aren't going to change things anyway. But I hate thinking that someone else reading it will be misled.

There are a lot of murky areas in medical knowledge, and I enjoy reading educated debates about these issues. So much of what we once "knew" to be true has turned out to be wrong, wrong, wrong. Humility is a critical attribute for a clinician. But so is confidence, and it's a difficult balance to strike sometimes.

Wednesday, December 07, 2005

Hello, E!

Someone who knows me in the physical world has discovered my blog. (Hi, E! Welcome!) I figured she would eventually, since we read some of the same blogs, but I wanted her to stumble on my blog honestly — i.e. following a link she was interested in (or insulted by, as it turned out!). I knew she'd recognize me instantly, mostly because of the photo (which she took, I think) but also because I really do call HellBoy/AngelBaby those names, poor child. I haven't actually given out my blog name to anyone, however. TrophyHusband of course could easily track me down, because I talk to him about the blog (and leave my laptop lying around), but he's promised not to.

There's actually nothing on the blog that I wouldn't want TH to read (or haven't told him about), but there's something very therapeutic for me in having something that's just for me. Also, he is not a great secret-keeper, so he could leak the info inadvertently to someone I really wouldn't want to be reading it. I've seen a few good blogs go down in flames because they got outed to the real world. I don't want to have to be thinking about everyone's feelings when I write. And of course, although I don't talk about specific patients, I wouldn't want my patients to think I might talk about them, and I do say some non-complimentary things about patients in general.

Yet I do feel like I'm missing out on some things. It would be nice to be able to use the blog to keep up with far-flung friends, for instance, so I'm pondering whether to give it out to a couple of them ... would that be a slippery slope, though? Or perhaps I would feel pressure to change what I write about?

I guess I'll have to wait and see how it feels to have E around. She's very shy about commenting, so I'll have to encourage it if I want to know what it's like -- so, come on, E, drop me a line, why don't you?

Sunday, December 04, 2005

Ferberizing for Daytime

If you happened to be shopping in a large box store this afternoon and had your pre-Christmas reverie shattered by the protracted and unhearthly howling of a HellBoy, that may have been us, and I do apologize.

But allow me to explain.

I have not succumbed to pressure from others to "Ferberize" my child at night. I don't want to, and I don't need to. What I usually chirp cheerfully when the subject arises is, "What I really need is a way to Ferberize in the daytime!" Because while our nights have always been relatively restful, our days are not. HB is an "active" child. His daycare teacher says she's "seen a few babies who are as willful as he is ..." Our parents say that neither of us was anything near as crazy as our baby. Basically, he's hell on wheels. Which makes life interesting, but sometimes ... hard. In particular, going out in public with him is exhausting. Because while he enjoys exploring new things, he wants to do so on his own terms. And his terms do NOT include the option of riding in a shopping cart. Ever. For a long time it wasn't too bad, because he was usually willing to be carried through stores. Fatiguing, but good exercise. But in the last few months, even before he started walking, all he wants to do is get down and explore on his own.

We try to make it fun for him. We find a good spot where he's unlikely to break something — the towel section, say — and let him explore for a good long time. But inevitably he decides it's time to move on to the picture frame section, or the fine china, and when thwarted, he becomes apoplectic. Meaning, he howls, bangs his head on the floor or the nearest parent, kicks, and does the hooked-fish flop.

So today we did the usual — much playing, very little shopping, even a nursing break. But eventually we really had to get the the stuff we needed (halogen lightbulbs, which I happen to detest, by the way — they are the worst invention ever! Lightbulbs that are hot enough to blister you if you accidentally come near, and cost five times as much as normal bulbs. This is progress?). So TrophyHusband scoops HellBoy up and we start hightailing it through the store. Wailing and thrashing ensues. We try to trade cart for baby, since often he is willing to be carried if Mama is the one carrying him. But today he is insulted by the offer of my arms. So TH starts carting him out of the store, football-style.

"Wait!" I yell. He turns, perplexed.
"If he's going to scream anyway, he might as well scream while sitting in the damn cart," I say. "You remember I said we needed to Ferberize in the daytime? Well, this is it."
TH looks doubtful, but helps me to wrestle HB's kicking feet through the legholes and fasten the belt (thank heavens it was a nice new cart, with a good solid belt, not held together by fraying knots soaked in cookie slurry).

And then we had some fun. HB was FURIOUS. He was OUTRAGED. He clearly had murder on his mind. He screamed and cried waved his arms and kicked and bit the cart handle and turned purple. TH offered him his sippy cup, which he paused and held his hand out for — so that he could SMASH it to the floor! Oh, was he mad.

But I was thinking to myself, god dammit, every other mother in this country gets to shop with her child in the shopping cart. They're supposed to LIKE it. I've long since accepted that HB will never like his carseat, but come on — in the shopping cart, he's facing me, we're talking, he gets treats, he gets to see all the interesting people and beautiful products sailing by.

It was sort of like a near-death experience: I kind of detached and started to float away, watching the scene from above. I wiped his nose a couple of times, spoke to him soothingly but firmly, helped TH figure out which lightbulb might fit his office lamp, and rolled on. People parted like the Red Sea in front of us, but it was so obvious that this was a tantrum situation that I didn't notice any terrible looks. If there were any comments, I couldn't hear them over the howling.

Then something interesting happened. HB started to pause in his crying to make these short, ear-shattering shrieks. At first I was horrified — it sounded like someone was stabbing him in the gut. But after each scream, he would stop and WATCH me to see my reaction. It was hilariously obvious that he was playing me. So I just quietly said "shh!" and stroked his cheek.

And after a few minutes, he just — stopped. He took a deep breath, looked around, picked up the cookie that had been offered him long before, and started to chat with me. Well, as best he can — our conversations mostly consist of exchanges like, "Ball!" "Yes, those are nice balls, aren't they?" "Chair!" "Yes, there's a chair." "Og!" "No, that's not a dog, that's a horse."

We went through checkout like a NORMAL FAMILY, baby gnawing on a cookie in the seat of the shopping cart. Before rolling out the door I offered him his coat, which he cheerfully let me put on him.

This may sound pathetic, but I have never gone grocery shopping alone with HB. I once took him to Target by myself, but I knew TH was meeting me there, so it doesn't really count. Because you can't shop while carrying a 23-pound, fighting mad toddler.

A whole new world has been opened to me.

Saturday, December 03, 2005

It's Better to Be Safe Than Sorry — Isn't It?

When deciding where to spend their professional lives, doctors are faced with a basic decision about the type of patient they wish to see. It breaks down like this:

Type 1
Highly educated
High SES
Type 2

Of course this is a gross oversimplification, and many patients are a mixture of the two, but as a generality it's pretty accurate. Most doctors will say that they prefer to see a "good mix" of patients, but that's hard to achieve; Type 1 patients don't feel comfortable in offices where Type 2 patients hang out, and vice versa. In addition, when most doctors say they want a mix, what they really mean is that they want mainly one type, but with a smattering of the other thrown in to keep things interesting.

Me, I love taking care of the Type 2s; the Type 1s can drive me nuts. I can't stand having to explain to a Type 1 why this or that test or treatment isn't indicated, but I adore cajoling Type 2s into getting the tests and treatment they desperately need. And I'm good at it. I do have a mix of patients, mainly because people know that I have relatively fancy credentials, and therefore assume that I must be a Type 1 doctor.

Now, it seems to me from my web travels that the vast majority of people on the blogosphere fall squarely into the Type 1 column (the commenters more than the bloggers). If there's a test for something, everyone should get it. Because it would be absolutely terrible for someone to have a medical condition that isn't diagnosed and treated, right?

Well, not necessarily. I think of it as being kind of like the justice system. In the U.S., we'd overall prefer to let a few guilty people go free than to ever imprison an innocent person. In China, the opposite is true (at least from what I've read on the topic). Both systems have their pros and cons. We're horrified to hear about the innocent people imprisoned, possibly tortured, and put to death in China (or at least I am). But I bet they're horrified to hear about people being raped, tortured, and murdered by criminals who were released because of a lack of evidence. In both instances, innocent people suffer and die.

In medicine, testing people for illnesses that they are unlikely to have results in, essentially, false arrests and convictions; people suffer side effects of the tests themselves, and side effects of treatment for a something they may not even have, or if they do have, might never have harmed them. But allowing illnesses to go undetected will result in some people suffering from the illness itself.

There are many studies that examine this very thing, the cost:benefit ratio of a given test or treatment. It's tricky, because you have to put a price on priceless things — health, life — but it can be done. From studies such as these come recommendations about who should be tested. But what you'll find if you compare recommendations to actual practice is that the Type 1s get way more done to them than recommended, while the Type 2s get way less.

For instance: my mother is 65 and in a monogamous (er, I assume) relationship of 25 years. Yet every year, year after year, she gets a Pap smear done. When her risk of cervical cancer is zero. Why does her gynecologist keep putting her up in the stirrups? Well, for one thing, her insurance covers it, but more importantly, her gynecologist probably assumes that my mother expects and wants it. And because, well, yes, her risk is probably zero, but it's better to be safe than sorry, right? Right?

But what would happen if my mother had an abnormal Pap smear? More tests and procedures. Possibly endangering her. And definitely wasting a lot of resources. All for nothing, because if she had an abnormal Pap smear, it would be because of a test error. Who still dies of cervical cancer in this country? Yes, the Type 2s. Because they don't have insurance, or if they do, they don't have doctors who take their type of insurance -- or they don't have doctors, period.

The same thing goes for all the healthy people who get cholesterol tests every year. Or diabetes tests. Or, like my father-in-law, a stress test. The amount of money that is wasted on this kind of nonsense is truly shameful. If my mom could donate her Pap smears even every other year to someone who isn't getting them, a lot of good could be done. (I get a Pap smear every three years. Unfortunately I haven't found a way of donating the ones I don't use.)

There's an annoying saying in medicine that you should treat every patient as if she were your grandmother. I would phrase it a little differently: you should treat your grandmother the way you treat all of your patients, because all of your patients should receive not "VIP" care, but appropriate care.

Thursday, December 01, 2005

I Don't Know How

December 1st: AngelBaby's 18-month birthday. My uncle's 75th birthday (good god, that can't be right). An ex-boyfriend's 41st birthday. Also Blog Against Racism Day, I've been told.

Problem is, I don't know how to blog against racism.

I grew up in a liberal college town, but on the poor side of town, where almost all of the black people lived. At my elementary school, half of my teachers were black, and more than half of the kids. The principal was black. We learned about MLK Jr. and Rosa Parks and Malcolm X and Muhammad Ali. I actually didn't know that black people were a minority until I got into junior high and had only two or three black kids in my class. (I went home and told my mother they were segregating us, causing much consternation and confusion, fortunately sorted out before she tried to contact the school or the newspapers.)

But despite living in a mixed neighborhood, I can't really say that I mixed. The black kids wouldn't play with the white kids. This is how I remember it, anyway. I had friends who lived in all-white neighborhoods who would sometimes talk about how awful racism was, etc., and I hardly understood what they were talking about. Where I lived, the black kids were in charge, and they didn't let the white kids in. I don't recall this being hurtful; it was just how it was. Some of the black kids were pretty tough and would threaten to beat white kids up after school, but they never actually did, to my knowledge. I was called "honky" a few times.

My best friend in junior high was Chinese, which seemed like another type of white to me. My first sort-of boyfriend was also Chinese, come to think of it. My mom had a black boyfriend for a while. I liked him better than some of her boyfriends, for what that's worth. My freshman year of college I had a black roommate. I hung out with her some, but again, it was hard to mix. At the dining hall, she always ate with the rest of the black students. I was allowed to be there too, but I definitely felt out of place. We drifted apart after freshman year.

Twenty years later, I work in a very racially mixed institution, with an unusual number of African-American doctors and students (as well as Asian and East Asian and Spanish-speaking and white). And my family is a little mixed now: my husband's stepdad is African-American, and my sister's son (who was adopted) is Korean/white. Our son attends a mixed daycare; his best friend is biracial. I live in a mixed neighborhood, though not a very mixed block -- you have to go two blocks over before the ethnic makeup starts to shift, along with the house prices. And somehow now I'm much more sensitive about racism than I used to be. Maybe it's because most of my patients are black and poor. Maybe it's because I was in the minority as a child. But it's come to the front of my consciousness in the past few years much more acutely than it ever did before, and it makes me very angry, and I don't know what to do about it. I remember the OJ case, and how glad I was about the verdict for the sake of the nation, but how angry most of the white people I knew were. My husband and I have talked about adopting an African-American child, but I worry. I know I'd notice every time she was slighted in some way. And our society is still so very divided -- would she be essentially forced apart from us eventually?

I have been encouraged by the words of good people. But I haven't a clue how to blog against racism.

Wednesday, November 30, 2005

The Lawyers Won't Help, But This Might

There's been a lot of talk here and elsewhere about callous, mean or stupid doctors. An article in the Times today has a pretty good discussion of the topic. They also provide a link to a site where patients can rate their doctors.

I have mixed feelings about the rating site. I think it's a great idea in general, and I believe it has the potential to change physician behavior. However, it's not at all clear that it's reliable in any meaningful way. First, you can't tell who is managing the site (and whoever it is, they don't proofread carefully). Second, the site allows advertising, which makes me suspicious. Third, it doesn't appear that they vet the ratings at all. I tried it out by rating one of my doctors; I was able to do this without creating an account, and my rating appeared instantly. There is a way to flag ratings or listings you feel are suspect, but since it's entirely anonymous, there's no way to tell if someone has, for instance, padded his or her own rating. (No, I didn't rate myself.) Finally, I expect the site will be heavy on the doctors that serve the educated (and in my opinion overtreated) patients who have easy access to the web. Most of my patients won't have the opportunity to make use of it.

But it's a start, and perhaps will help doctors start thinking about whether they are being good instead of whether they might be sued.

Tuesday, November 22, 2005

Shh, He'll Hear You

HellBoy is starting to talk more, but his pronunciation stinks. The other day GoodCat wandered into the living room and HB started his usual "AT! AT! AT!"

"HB, can you say 'CAT'?" TrophyHusband asked.




Just then the cat started to do what cats are wont to do, and TH, getting bored of the lesson, said, "Can you say, 'The cat is licking his balls'?"

And HB shouted, "BALLS!!!!"

He also calls spoons "poon." We're going to start getting dirty looks at daycare if we're not more careful.

Saturday, November 19, 2005

And Some of My Best Friends Are Lawyers

Seems like I've been reading an awful lot of comments on other blogs lately in which the prevailing sentiment is that doctors are stupid and evil. Whenever someone has a story about some medical treatment that went wrong, usually in fertility treatment or childbirth, there are a bunch of comments insisting that the blogger should call a lawyer.

These comments leaves me feeling frustrated and a bit depressed. For the obvious reason, of course, but also because I think they illustrate a basic problem in healthcare in this country. There's this notion that if all doctors do their jobs right, everyone will be cured/get pregnant/give birth easily without drugs/have a healthy happy baby who sleeps through the night and never spits up.

There are few great doctors and a few bad doctors, and lots and lots of average doctors. But there is no doctor who will do the right thing all the time. And even when doctors do everything right, things will turn out wrong sometimes.

If things don't turn out perfectly, people often want to sue. But lawyers will not take most of these cases. Lawyers will only take the cases that will result in large monetary verdicts. These cases are the ones where someone is either killed or permanently physically damaged. The younger and cuter the patient is, the bigger the verdict.

So what does this system create? First, an environment in which doctors are afraid to admit when they have done something wrong, and therefore do not have any opportunity to teach others how to avoid mistakes. Second, a healthcare system that puts huge resources toward trying to avoid the outcomes that result in the largest awards -- efforts that are focussed on the minority of patients -- and little to no resources toward basic improvements that will benefit the majority of patients.

Take childbirth, for instance. An injured or dead newborn, whether the result of bad medical care or just bad luck, can result in an enormous jury award. The typical argument in these cases is that if the mother had received more aggressive medical care, the outcome could have been avoided. The obvious result of this is that OBs are under intense pressure to be aggressive all the time. Meaning, they quickly pressure women into induction, forceps, c-sections. They know they will not be successfully sued for bullying, but they could be sued for being gentle.

A lot of women turn to midwives because they know or sense this. Which can work ok, but midwives are also under pressure: they must quickly turn care over to the OBs if things start going south. And a doctor who suddenly has to pick up a tough case from a midwife, a doctor who doesn't know the patient or the whole story, is going to be even more aggressive than usual.

In the meantime, all of the things that can make childbirth in a hospital frightening, isolating, and frustrating are not addressed, because there's no money in it. There's no lawyer who will sue a hospital for arbitrary rules about visitors, for surly and overworked nurses, for failing to do everything possible to ensure breastfeeding success. And there's no insurance company that will reimburse hospitals for any of those things either.

I'm not defending bad doctors or crappy hospitals. I've been through my fair share of them myself, and it's awful. I do believe that sometimes suing is very appropriate. But I wish that everyone who is angry about the ways things are in healthcare right now -- and we should be angry -- would start thinking about what will actually make things better, and the answer is not to call a lawyer.

Monday, November 14, 2005

Interview Season

They're here. November through January is resident interview season, and they appear like a flock of black-suited birds migrating for the winter. I interview four in a row every interview day, and although we've only had two days so far, they're already starting to blur together. Same clothes (conservative), same hair (ditto), same questions ("How are the fellowship opportunities here?" "What changes are in store for your institution?") I desperately search their personal statements for something interesting to talk about, but I find the same statement every time:
I walked through the doors of [name of free clinic / institute in a developing country / hospital in a bad section of town] with [appropriately humble emotion]. I was faced with [appalling scene of human hardship / touching scene of expected death / inspiring scene of personal courage]. I knew then that I wanted to [help others / make a difference].

When I was [
age between 10 and 20], my [rather distant relative] fell ill with [not especially concerning illness]. Watching [him / her] suffer made me realize the impact of illness on others.

During my medical school career, I have volunteered at [
a free clinic / a highschool to talk about contraception / an elementary school to tutor youth]. This has taught me the vital importance of [giving of oneself / feeling grateful for my position in life].

I will never forget the face of my first patient to [
call me "doctor" / ask me to hold their hand / die]. I hope I will always remember the important lesson this taught me about [trust / empathy / death].

Ten years from now, I see myself as a practicing physician who is also involved in research in some way and who teaches students and residents, but I will never forget the feeling I had that first day I walked through the doors of [
name of free clinic / institute in a developing country / hospital in a bad section of town] and really [felt like a doctor / understood what it means to be human].

Afterward they all send the same thank-you note, as they were instructed to do by their medical school. So how can I be expected to keep them straight? How I wish they would leave their hair long, wear a purple suit or a nose ring, talk about politics or a broken heart or religion or the kids they hope to have. I know it's scary for them -- for the ones with so-so academic records, anyway -- but it makes me sad to see them so conformed.

I know there are some medical students reading this. When you go on your interviews, give me a break. Wear green -- or at least gray or brown. Ask, "What do you love about your job? What do you love about your life?" And if the above is your personal statement, throw it away and start over. It's not so hard -- just talk. Tell me what makes you you.

ADDENDUM: jgt asked,
My husband is making the interview rounds right now. They're told over and over that the majority of attendings are conservative folk and that anything that makes you stick out is more likely to tip the scales against you than for you.

Do you think you're less conservative than the average attending?

It depends on the specialty. In most surgical specialties (General, Plastics, Ortho, Urology, Ophtho), yes, they're relatively conservative, for doctors anyway. (In my unscientific investigations, doctors in general are more socially liberal than those in other professions, but surgeons tend to vote Republican whereas the non-surgical types are more often Democrats.) Peds, Family Practice, EM, and Internal Medicine are all fairly liberal groups, and Psychiatry is waaay out there groovy. (I'm not sure about Neurology and Dermatology; OB/Gyn is a mixed bag.)

Am I less conservative than average? Oh yeah -- I'm pretty much a lefty -- but a majority of my colleagues do agree with me on issues like abortion, the war, same-sex marriage, universal healthcare.

I certainly wouldn't advise anyone to try to be deliberately wacky to try to stand out from the crowd -- that's sure to backfire -- but hiding what's interesting about you seems like a bad idea too. What I'd do if I were on the interview trail today is try to get the interviewer talking first -- ask about a picture on their wall, maybe -- and get a sense of what they're like. If you have anything in common, start talking about that, and everything is easy after that. I love talking cats, kids, running, travel, photography, art, politics ... it's easy to get me going on any of it, and I'm not a very schmoozy person. Other colleagues would love to talk about cooking, sailing, biking, gardening, dogs, oh, I don't know. But if you don't start talking about something like that, you'll end up talking about how your worst quality is "my perfectionism!" and getting asked dumb questions like, "if you had to be the only doctor on a desert island, what two texts would you bring?"

The folks I remember clearly from last season were: the professional guitarist, the guy who drove ATVs during his every free moment, the guy from Ireland, the woman who had a baby the same age as mine (and was worried about even mentioning it in interviews), the guy whose parents immigrated to the U.S. and picked crops to get him through college, the almost certainly gay guy who directed an a capella choir with a cute name, the nine-months-pregnant woman, the professional surfer, the woman in a short skirt and spike-heeled boots ... if there'd been a juggler, I'd certainly have remembered him. And at the rank meeting months later, it wasn't hard to call these people to mind, unlike the rest of the plodding masses.

Friday, November 11, 2005

The Human Binky: The Downside of Cosleeping

I had to stay at work until 9:00 last night for my "leadership" course ("Goal Setting" and "Attitudes for Success" were the topics last night. My Goal = Endure This Class; My Attitude = Truculence). HellBoy was still awake when I got home, of course, since our bedtime routine is: mama nurses him until he falls asleep. That was fine -- I was happy to be able to at least see him. But starting at about 3am, he decided that he couldn't sleep unless one of my breasts was in his mouth at all times. I don't know if it's related to my being gone last night, but I hope so, because I can't take too many nights of that. It would be one thing if I had long floppy dugs that I could just sling over to him on demand instead of tiny compact ones that necessitate much contortion on my part. My neck is stiff and I'm feeling groggy.

An another subject, you know what there should be a word for? You know how when you have to pee for a really long time but don't, and then finally you go, and for about a half hour after you go your bladder feels all happy to be empty? It's more than relief. There should be a word for that happy-empty-bladder-feeling.

Monday, November 07, 2005

I Know I Should Love Them All the Same, But ...

There are patients I enjoy, and patients I enjoy less. Oh, who am I kidding, trying to be all PC. There are patients I can't stand. I have something of heirarchy when it comes to how much I like patients. I think most clinicians do, though the order can be very different.

At the top are the smart patients. Not educated, smart. They can be smart and follow all my directions, or they can be smart and ignore everything I say. I don't care. In fact sometimes the latter are the most interesting. I have one patient who smokes two packs a day and coughs and wheezes like a sick cat. I tell him to quit smoking, and he tells me, "Now you know I'm not going to do that!" But he doesn't ask me to fix his cough. He just comes to chat, and I love to chat with him.

Next are the crazy patients, provided that they aren't dangerous crazy. I didn't used to mind dangerous crazy, but one punched me in the face once and split my lip, so I'm a little more careful these days. (He wasn't my patient, by the way -- he was just walking by me in the psych ward and didn't like the looks of me.) (I always feel compelled to add this. Otherwise I'm afraid everyone will think I'm just annoying as hell and that I make my patients want to punch me in the face.)

Next are the dumb patients who do what I say. Boring and a little scary, these people.

Last are the dumb patients who ignore everything I say. God how I hate these folks. I have one guy who is cheating on his wife and keeps coming in for STD's and wants me to give him pills to slip to his wife in her food. (No, of course I don't give them to him!) (Should I?)

The other day I saw a woman who is five feet tall and 300 pounds. She said the same thing that 99.9% of really fat people say when the subject of weight comes up:

"I don't know why I keep gaining weight. I don't eat anything."

Now, this statement in itself is not the dumb part. Like I said, 99.9% of people say this. But I have a stock response that works 99.9% of the time:

"You may be right, and it's not fair, but however much you eat, it's too much for you."

Most people will nod sadly on hearing this. And it's not a line on my part; hyper people who jump around all day and jiggle their legs until the person sitting next to them on the couch screams "Would you cut it out?" can eat a lot more than serene folks. And most of the people on the planet are the product of generations of surviving starvation -- that Pack It On gene is powerful. I do practice what I preach -- I exercise, I don't drink soda and juice all day, and I try to avoid eating a lot of junk -- but I know that I have it easier than many people. For a lot of people, telling them to eat less is like telling them to breathe less. Especially in our society, with a Starbuck's and a McDonald's on every corner.

But this woman wasn't buying it. She stared at me for a long, long, moment, and said,

"No, I don't eat too much."

I was flummoxed. Finally I said, "Well, why do you think you gain weight?"

"Because there's something wrong. You need to do tests."

OK. A lot of people think thyroid disease can make you gain weight. And it can. But it can make you gain 15, 20 pounds, max. Not 180 pounds. But she didn't even think it was her thyroid, because her thyroid had already been tested multiple times. She believed that there was some other condition that was making her gain weight and that I hadn't tested her for this condition because I was either incompetent and didn't know about it, or evil and deliberately withholding it from her.

Oh, and I also needed to do tests to find out why her back hurts. And her knees.

I'd like to think I treat all my patients equally, but I know that's not possible. I have a pretty good poker face, but I'm sure my expression was less than entirely nonjudgmental and empathetic as I tried to explain to her that I was not withholding some magic treatment for obesity from her. And I offered her pills for weight loss. I don't mind doing this. They don't work very well, but I'm happy to have people try them. But she didn't want that. She wanted to know what was Wrong.

It reminded me of those plants -- you know, "Magic Plant! It Grows On Air!!!!" She could be a "Magic Human! She Absorbs Fat from the Atmosphere!!!!"

Wednesday, November 02, 2005

Only Ghosts Need Apply

This being our first year in our house, I wasn't sure how much candy we'd need for Halloween. So last week when I saw our neighbor from two doors up the street, who's been here forever, and whose house was decked out in Halloween-themed decorations, I asked her. And something kind of strange happened.

"Ah ... er ... well, for years we did ours on the Sunday before Halloween," she said. "But I'm not sure what the plan is this year ..."

I was confused. Halloween before Halloween? She explained that there is a tradition on our block to have Halloween early, just for our block. And then many people turn off their lights on the 31st.


It took me a minute. What would be the benefit in this? Well, your kids would only go to houses of people you sort of know ... but wait, you could do that just as well on Halloween itself, right? So the only benefit is, you wouldn't have to answer your door for the people who aren't on your street. And what, you might ask, is the difference between the people on our street and the people, oh, a couple of blocks over?

Exactly. Our neighborhood is racially mixed. Our street, not very.

I'm kind of slow. I didn't actually figure it out until after our neighbor left, but once I did, I was livid. And embarrassed to be living on this block. It's not the kind of thing one asks when going to an open house. And there were Kerry stickers all over the place. But I can't say that I didn't know about the general paleness of our neighbors.

Fortunately our neighborhood has a listserve, which we consulted. We found that we weren't the only ones who felt that this was racist, and everyone -- at least, everyone who was willing to post about it -- agreed that they would indeed be doing Halloween on Halloween. Still, on Sunday, there were some kids on our block going door to door and some people answering the door with candy.

But on Halloween we sat on our stoop with beer (for us) and candy (for the trick or treaters) and you know what? We had a blast. There were a lot of dark houses on the block, but also a lot with their lights on, and lots of people sitting on their stoops, and it was a big party. (The neighbor who told me about the Sunday thing was out on her stoop too.) AngelBaby had a ball watching the parade of kids. I only had to chase after him once, when he fell in love with a dog and wanted to follow it home. We took pictures of the kids, and even printed a few pictures on the spot to give to them -- it was like some corny TV ad.

This is what some people were afraid to open their doors for. And this. And this.

Friday, October 28, 2005

The First Hit Is Free, Then You Have to Pay

We flew across the country last week so that I could attend a conference and TrophyHusband could spend time with some college friends who have a five-month-old little girl. This trip posed a challenge: How to survive six hours in an airplane with HellBoy?

On the trip out, we made use of:
  • puppets
  • a beachball
  • soap bubbles
  • breasts
  • candy
  • dvds
  • singing
  • books
  • friendly stewardesses, and
  • many, many, many trips up and down the aisle
On the trip home, we made use of:
  • Benadryl
Yes, I drugged my baby. Despite my general belief in Better Living Through Chemistry, the idea of doping my child for my own convenience has seemed less than savory. But this time I realized that it was not for my convenience, it was for my sanity. And for my marriage. We don't tend to keep score in our relationship, but there's something about spending hours locked in an airplane with a maniac toddler that really gets a person watching the clock. OK, I've been making funny faces for 4.5 minutes. That means you have to chase him down the aisle for 7 minutes. Because it's harder to make funny faces, and you run faster anyway. So I bought the clever melt-in-your mouth children's Benadryl ("Children under 6: consult a doctor." Check!). He gobbled it up and asked for more. I felt like a pusher.

However, my guilt didn't last long. It would seem that HB has inherited a hardy liver from his mother. Because although he did settle in for a nap about 45 minutes after his dose, the nap didn't last much longer than his usual one, at which point he awoke, extra rested for his next assault. And then we entered some turbulence. The stewardess, who was either very rules-conscious or just sadistic, insisted that the seatbelt sign applied to HB as well, and he had to be strapped into his carseat.*

And then his DVD player, which apparently was not designed to survive being repeatedly hurled to the floor, broke.

How bad did it get? So bad that we actually had notes passed up the aisle with suggestions from other passengers on how to make him shut up. And I couldn't blame them. I actually hoped someone might have a good idea. But really, all he wanted was Out. Of. This. Frickin. Seat.

There was no evidence that the Benadryl had any lasting effect whatsoever. And when we got home he wouldn't go to sleep until 11:30. I guess next time we slip him some Xanax, or on second thought, take it ourselves and then offer it around the plane.

*This highlights the weird double standard about babies and airplanes. If they're under two, they can sit on your lap. Ah, they'll be fine, just hang on to 'em. We tend to get a seat for HB anyway, since we risk bodily injury if we try to control him within the confines of our two seats. But if we buy him a seat and bring his carseat, then they get all official on our asses. First they have to check if the seat is Approved, and then they make him sit in it. WTF?

Saturday, October 22, 2005

My Breasts, or, When Are You Going to Stop ... THAT?

I entered motherhood committed to the idea of breastfeeding, and fully prepared for how much it can, well, suck. I knew it would be difficult and painful -- never mind what some rabid BF advocates say, I'd seen enough women go into it with the best attitude and support possible reduced to cringing, weeping wrecks to know that it can be really, really hard.

And it was. First the (unfounded) terror that my milk would never come in and my baby would shrivel away -- or that I would weaken and give in to the evil, evil formula supplementation and prevent my milk from coming in.

Next the (well-founded) fear of the pain. I hoarded the Percocets prescribed after my "crotch c-section" and used them prior to evening nursing sessions, which for some reason were the most painful. (Yes, I exposed my baby to narcotics. Also to alcohol, caffeine, cow's milk, and cabbage. And he's fine. Well, crabby and tiny, but fine.) I remember TrophyHusband holding the baby until he got fussy, then suggesting timidly, maybe he was hungry? He can't be hungry! I just nursed him! Figure out a way to calm him down! Sometimes I felt like I was constantly being chased around the house by my husband, the squalling baby held out in front of him like the masthead of a ship.

Then came the WWF breast-wrestling matches -- it took weeks for my "let-down" to get coordinated, during which period of time each feeding session began with the baby latching on, then letting go and howling in frustration, latching on, howling, over and over and over ... I timed it, and the average length of time it took for him to start really nursing was 20 minutes. Average. Sometimes it was 40 minutes. Including middle of the night feedings. And each feeding lasted about 45 minutes, which meant I was nursing or trying to nurse approximately 26.5 hours per day.

Finally it all clicked, stopped hurting, went smoothly and efficiently.

It was right around this time that people started asking, "How long do you plan to keep doing ... THAT?"

Geez, people. I just finally got the hang of it! Was what I wanted to say. What I really said was something along the lines of, well, it's recommended for the first six to twelve months, yadda yadda. But really I had no clue. I sort of figured it would, as we say in medicine, declare itself. He'd wean himself, or he'd start biting, or I'd get sick of it.

None of which occurred. And once the early hurdles were over, the rest didn't really bother me. Breastfeeding in public was never even the slightest issue. I've never been shy when it comes to exposing body parts, and it certainly didn't bother me to haul out a boob for a crying baby. And I've never noticed anyone appear to be bothered by it. Once when I was sitting in a public park I realized that several people were staring at me, but then I looked behind me and realized that it was a cute cat pouncing on leaves that was drawing everyone's attention. It didn't even faze me to do it in front of TrophyHusband's 80-year-old grandfather. I figure, if it makes someone uncomfortable, they can look away, and if someone gets off on it, well, I'm glad to spread some happiness in the world. There was one episode at TH's work Christmas party where AngelBaby kept popping off to look around, causing me to spray milk onto adjacent guests, but mostly it was all good.

Well, I'm remembering now, pumping at work was occasionally a hassle. I have my own office with a door that locks and my mornings are flexible, so usually it was ok (though time-consuming and messy), but one night I had to stay late so I pumped an extra time, and suddenly I heard a key turn and the door flew open and there I was, breasts laid bare, the two trumpet-like pump flanges protruding from my chest and the machine going runk-runk-runk, facing the kid who cleans the offices at night. He still averts his eyes and won't return my greeting when I pass him in the hall.

Then AngelBaby turned one and I found myself wandering around in the world of Extended Breastfeeding. It appears that without realizing it, I have become an official member of the wacko-hippie-crunchy-holier than thou CULT. At least according to some of those who stopped breastfeeding earlier. And my mother. AB is small for his age, so it's not always obvious that I'm nursing a walking, talking child, but when he toddles over, climbs into my lap, straddles my legs, yanks up my shirt and bra yelling "NUR! NUR! NUR!" and displaying his mouthful of teeth, it can cause quite a stir.

So how long am I going to keep doing ... THAT?

I still have no clue. It's so easy, and so useful -- nothing fixes a pissy mood or a smashed finger faster, and when he's being HellBoy, my boobs are the only weapons I've really got. There's no up-side to giving that up.

So how bad would it be, really, to send breastmilk care packages to my son at college? I know FedEx can ship frozen stuff.

Monday, October 17, 2005

How I Became a Doctor

Mine was not the typical path to medical school. In my family, we weren't raised so much as allowed to grow up. What pressure there was, was to be creative. My mother was an artist who taught school to make ends (approximately) meet, and I always got more praise for my artistic endeavors than my good grades. (My father was a violinist who worked as a statistician to make ends meet, but he died in a motorcycle crash when I was five.) I didn't do more science classes than absolutely required. Instead I took English, French, German, creative writing, art, music ... and I decided to major in creative writing in college.

Yet all along I was fascinated by medical subjects. Really fascinated. Weirdly fascinated. I guess it started after I had a nervous breakdown at the age of fourteen following an ugly period involving a sadistic live-in boyfriend of my mother's. I developed major depression accompanied by panic attacks and anxiety, and the main focus of my anxiety was that I was dying of some dread disease. (I'm not sure why this made me so anxious, since I also wished that I would die.) It's a good thing the internet wasn't around yet, because I could have whipped myself into a nonstop frenzy looking at all the paranoid sites that exist today. What I did do was read every medical article I could find in every magazine and newspaper I could get my hands on. The nervous breakdown finally ran its course (for the time being) and the evil boyfriend left (for good), but my medical article addiction remained.

After college I got a nearly free ride to get an MFA in creative writing. It was there that I first began to realize that the creative life might not be the one for me. Because while I loved writing a really good story, I only managed to produce something I considered to be really good once or twice a year. The rest was crap. I also got fed up with the workshops. After a while I just didn't feel like commenting on yet another semi-autobiographical story of awakening. (I did make my best friend in my MFA program, and her approach to writing -- as hard work she could do for hours, days, weeks, months, years on end without much return -- made me realize that mine was dilettantish. She did ultimately become a published novelist, richly deserved.)

I went to work as an editor of technical writing, while trying to keep writing fiction on my time off. I really liked my job, but the part I most enjoyed about it was getting a project that I could dig into and know that I could finish. I began to realize that I have a hard time with delayed gratification when it comes to work. I like to know that I've done something useful every day. Creative writing is far from that kind of work. You can measure the number of words you write each day, but the chance of them being useful in some way is dauntingly tiny. Not that fiction isn't useful -- it has enlightened, encouraged, emboldened, and educated me in many ways over the years -- but I had no faith that most of what I produced would be of use. Partly because the chances of being published are slim, but also because as I said before, most of what I put out seemed like crap.

I joked from time to time that I had missed my true calling, because medicine is not a particulary good hobby. But I never seriously considered going to medical school. It seemed absurd. It was absurd. To do it, I'd have to figure out a way to do all the premed requirements; then take the MCATs; then apply to med school; then if I got in, spend four years in med school followed by at least three years of residency and then possibly fellowship. I was terrified of the idea of spending the next ten years of my life on something so grueling. I'd never been someone who could skimp on sleep; how on earth could I survive being on call? And wasn't I too old?

When I was 27, some messy painful stuff happened having to do with a man, and I found myself feeling depressed again. One day I started wondering, How did I get here? This is not my beautiful life. So I asked myself, All right, where is my beautiful life? And I thought, I wish I'd gone to medical school. What about all the objections above? Well, I thought, so it's ten years, but it's not ten years of prison. It's ten years of living, just doing something different and harder. And if I wait any longer, I'll just be older. Around the same time I inherited some money -- not a ton, but enough to let me quit my job and take premed classes for a year. Which I did.

It was pretty terrifying at first. I didn't do a prepackaged postbac year -- too expensive; I went to a state school as a special student and waitlisted myself on all the premed courses I needed. My schedule was like a complicated jigsaw puzzle. And I was rusty. I got a 39 on my first physics quiz, which made me hyperventilate. But taking all the premed courses together was actually very efficient; once I figured out how to study for one, the methods applied to all of them. And I did figure it out. Eventually I totally kicked ass on every subject.

When I interviewed at medical schools, I was worried that they'd be puzzled by me and the path I'd taken to get there. As it turned out, they loved me -- they were bored of seeing the cookie-cutter 21-year-old premeds who had never gotten a chance to do anything interesting in their lives because their parents had pushed them into medicine. And when I started med school I found that I had a real advantage over those kids. I'd already spent a summer bumming around Europe -- three summers, in fact. I'd already had my fill of waiting tables and writing fiction and hanging out and generally living the slacker life. It didn't bother me to buckle down; for me it was a refreshing change. Especially refreshing was learning something real rather than pondering the abstract.

There were some drawbacks, of course. First was the money. When I had to sign the documents to borrow the first $25,000 for the first semester, I cried. Second was the time commitment. It was indeed hard, and it left me with little time to develop the rest of my life. For instance, I didn't deal with getting rid of the boyfriend with the messy painful issues for several years, during which time my biological clock started winding down. Third was the way it transformed me. In many good ways to be sure, but I did lose some of the things I liked about myself. I'd always had a phenomenal memory, but now I no longer could remember many details of my life. I actually forgot entire events ever took place. And I was no longer as able to be supportive of other people.

Am I glad I did it? Absolutely -- it really is my beautiful life much of the time. I am so suited to being a doctor. I've always been curious about the inner workings of other people -- both physical and mental -- and medicine gives me license to actually poke around and take a look. And I found TrophyHusband during residency, which was such a stroke of good luck I could hardly believe it -- I'd pretty much resigned myself to being single, since I'd rather be single than be with someone just to get married, and I was a terrible judge of who might be right for me.

I do regret that I didn't do it slightly sooner. I urge others who are considering med school to put it off a little while, because I think being older and having more life experience was tremendously helpful, but seven years was a bit longer than I needed.

People often ask if I still write fiction. I don't. I keep waiting to see if I'll ever feel the need to express myself in that way, and so far I haven't. But clearly I feel a need to express myself in some way, because here I am.

Sunday, October 16, 2005

Oh Boy, Here We Go: The CIO Missionary

My sister-in-law has a son who is six months younger than HellBoy. He's also already two pounds heavier (we get his hand-me-downs). He's a fat, blond, happy happy happy baby. Put the two of them next to each other, and HB looks like a worried gnome.

Until now, our styles of baby raising had been fairly similar -- breastfeeding, some cosleeping, lots of carrying around. But the two babies' temperaments are very different -- I've never actually seen PerfectCousin cry, while on bad days HB uses screaming as his main means of communication.

But my SIL hasn't been getting much sleep, and last week she tried letting PC cry it out. As it often does, it worked within two days, and now he doesn't wake them up at night. I'm truly happy for them; I'm glad she is no longer so sleep-deprived.

But now SIL is proselytizing for the CIO method. She's calling us up every other day insisting that we have to do it too. "I just want you to get sleep too!" she says. I've told her that in fact I feel quite rested most days, and that the main person in our house who needs to have improved sleep habits is me -- I've always tended to wake up in the middle of the night and wander the house waiting to feel sleepy again. (Despite having been a CIO baby myself.)

I've never told anyone they shouldn't use CIO, and I don't think I project an aura of disapproval, either. I don't think it's evil. I just don't want to do it with HB. So why does everyone want to convert me? I'm starting to know how smokers feel.

Wednesday, October 12, 2005

The Talk

TrophyHusband and I had The Talk the other night. The Talk about whether we want another child, and if so, where to get one.

We agree that yes, another child is theoretically something we both want. So far so good.

The problem is where to get this child. Options include:
  1. Go back to the ART clinic and see if another few go-rounds with IVF yield anything.
    Pros: Might get another bio kid, resulting in a matched set; no arduous adoption process.
    Cons: Much less likely to work now than last time given my age; the time, energy, and cost; pregnancy; birth; the cold sweat and palpitations I get remembering the needles, the probes, the walking around throbbing with rage at anything and everything when my estradiol level goes above 1000.

  2. Donor eggs.
    Pros: TrophyHusband's mensch-y genes; no arduous adoption process; get a baby from birth.
    Cons: End up with a hard-to-explain half-matched set of kids; cost; pregnancy; birth.

  3. Adoption.
    Pros: Could choose the sex; no pregnancy; no birth.
    Cons: The whole arduous process; cost; not having the baby from birth; and, where to adopt from? The open-adoption circuit is out -- I watched my sister go through that and I know I couldn't take the uncertainty. So that leaves non-white babies. TH's stepfather is African-American, which makes this question even more delicate in our family. I'm not sure I'd be able to watch one of my children be discriminated against. But would we seem racist if we chose to adopt internationally?
Ever since the topic came up I haven't slept; I just lie awake watching these questions dart around my head like crazed weasels.

Thursday, October 06, 2005

I'm Hiding Out Over Here

Holy cow are things heating up over at the Leery Polyp. I didn't comment, partly because there are too many words there already, but partly because it doesn't seem like a discussion that includes people like me. I haven't read all of the comments (I don't have time for a third full-time job), but from what I saw, the discussants fell into two camps: the I Gave Birth Through My Vagina Without Drugs and I Am Proud camp, and the I Couldn't Give Birth Through My Vagina and I Am Hurt that You Are Proud camp.

Where's my camp? The I Gave Birth Through My Vagina With Drugs and Had a Terrible Tear and Still Am in Pain and Wish I'd Had the Damn C-Section but Really Don't Mind if You're Proud camp?

From the research I've done, in the days before modern medicine when women gave birth at home without drugs, very few women died. But a lot of babies did, or were damaged. Birth plans are really for the mother, not the baby. Yes, babies born by uncomplicated vaginal births with minimal drugs do very slightly "better" at the beginning, but this effect is small and transient. And babies born by complicated vaginal births do much worse than those born by c-section, and these effects can be large and permanent. And it's very hard to predict which way things will go. (I've always been intrigued by the stories of girls who give birth in secret and then go back to the prom -- how do they have such an easy time of it? But one of my best friends is an OB, and she's seen several such mothers after the births. She said usually the perineum is a wreck after these deliveries, and extremely hard to repair.)

Women who sense that OBs are resistant to their birth plans are usually correct. But this is because if the result of a delivery is not a healthy baby, the OB is the one who will be blamed/sued/devastated. Hardly any of my students want to go into OB now; it's not worth it.

But I'm way too chickenshit to post this over at Jo's.

Wednesday, October 05, 2005

The Center Cannot Hold

So despite the stealth ibuprofen, AngelBaby did get a fever, and was banished from daycare. His illness has a domino effect:
  • Our dinner with the people from New Orleans had to be postponed
  • TrophyHusband has to stay home with AB, and had to cancel his Thursday 6am deal
  • I have a plausible excuse for skipping the leadership class
Note that these are all actually good things. Too bad AB has to suffer for them. He'll have a good time with his dad at home, though. I, on the other hand, am up in the middle of the night again, this time with a scratchy throat and gritty eyes, cursing that little fomite. I'll take something and eat some ice cream, and I hope to fall back asleep soon ...

Friday, September 30, 2005

Weekly Wrap-Up

AngelBaby had his 15 month check-up this am, and we found that:
  • He remains in the 5th percentile for weight
  • He remains in the 10-25th percentile for height
  • His head remains in the 75th percentile
He looks like a Blow Pop.

The nurse practitioner has been concerned because he's had fluid in his ears at every visit, plus two ear infections last spring. But we took him for a hearing eval a couple of weeks ago, which he passed with flying colors, so we thought the issue was settled. But today she noted fluid again (no, really?), and wants to check with ENT about tube placement.

I think this could be described as elective surgery for nurse practioner distress. We're not biting.

In other news, I've been talking with my brother's girlfriend and her dad almost daily. Her mom has a pretty bad cancer, it turns out. They're wonderful people. Of course. Sucks.

In more other news, I'll be on call from 4:30 pm today until 8:30 am Monday. Fortunately one set of TrophyHusband's parents are coming for the weekend to pitch in with HellBoy. I am very lucky in the in-law category.

Wednesday, September 28, 2005

How to Succeed in Co-Sleeping Without Really Trying

I never thought I'd be a co-sleeper. In fact, I didn't know it even had a name. I'm pretty sure I used to be one of those childless people who are shocked -- SHOCKED! -- to hear that people sleep with their babies.

Then HellBoy arrived.

At first he was all AngelBaby. I had him in a little sidecar bassinet, which worked well enough. He slept a couple-three hours at a time, woke to nurse, and went back to sleep. He was so light (5lbs 14oz at birth) that it was nothing to pop him in and out. Plus, I needed to arrange myself elaborately with the nursing pillow, the glass of water, etc., etc., so there was no chance I could sleep through it.

Then he got a couple weeks older, and started to protest at being put back in the bassinet. But I was terrified that I would smother him if I kept him in bed. So I just nursed him more often. And got more and more sleep deprived.

Finally I did it -- I let him stay next to me (with a roll guard to help prevent smothering). And he was soooo happy. And I got sooooo much more sleep. But I felt sooooo embarrassed about it. So I did what I usually do when I feel uneasy: I studied the issue. I learned that this had a name, and fierce proponents and opponents, and some (crappy) data -- but basically that it was a perfectly reasonable option. Meanwhile, I got addicted to the extra sleep, and to the nice feeling of a cuddly baby in bed. TrophyHusband was perfectly happy to have the baby there, so that wasn't an issue.

Then we learned how to nurse lying down, and it was all over. NO WAKING UP TO FEED THE BABY. SLEEP!!! I was the best-rested new mother on the planet. But oh, the reactions from other people. The horror -- the horror! It was actually kind of fun to taunt people with it. I took the baby in to work to show him off, and the first question everybody asked was, "How's he sleeping?" To which I would reply, "Oh, he sleeps great. Just wakes up to eat and goes back to sleep ..." at which point the listener would be smiling happily, until I added, "... of course, he sleeps with us." Three-quarters of the time the smile would morph into a look of alarm. "Oh, you can't do that!" was the typical response. "Why not?" I'd ask. "Because ... because ... eventually he's going to have to learn to sleep by himself!" was the best that anyone could come up with. OK -- so he can learn now, or he can learn later. I pick later.

But I still felt strangely ashamed. I'm still not sure why -- perhaps because I was taking the easy way out. But it just felt so right for us. Plus, our two enormous cats slept with us every night, and it seemed absurd to kick the baby out of bed and then turn around and invite the cats up.

Finally one night I sat up and said, "We're getting a king-sized bed." TrophyHusband immediately recognized this as a turning point, because up until then I had always viewed king beds as an outrageous excess. No one needs that much room! Which is kind of funny, because I really need my space in bed -- I'm always shooing TH, aka CuddleMonkey, away from me.

So now here we are, over a year later. Our typical routine is that around 8:15 pm I sit and nurse AngelBaby until he rolls over and falls asleep, then I put him in his crib. TH and I get to have the bed to ourselves (plus a cat or two) until about 1 am, when the baby wakes up and hollers, at which point TH fetches him into bed. Then we all sleep happily until about 5, when the baby wakes up to nurse a little more. Usually after that he sleeps till 7 or 8. And we all feel pretty rested most of the time.

Does AngelBaby need this, or do we? I think it's both. He's an intense baby; he never fusses, he becomes apoplectic. So we have to choose our battles. But also, we work full time; I feel comfortable having him in daycare, but when I'm with him, I want to be really with him. And he's not a cuddly baby most of the time, so it's gratifying to have our fill of snuggling, even if it's while he's asleep.

Works for us.

Sunday, September 25, 2005

Now I Know How It Feels

The other evening, while TrophyHusband was making dinner and I was distracting HellBoy from playing with knives, TH's cell phone rang. I took over stirring the pasta while he went to answer it. You should know that I have a little problem with telephone phobia. I get anxious when speaking to someone I can't see. So TH will often let me in on his phone conversations by repeating whatever is said and then passing along my comments. (Another post sometime re this.) But this time, he got a funny look on his face and sort of wandered away, out of easy earshot. By straining my ears and picking up HB to keep him from whining, I managed to pick up something along these lines:

"... very narrow staircase ... 15 months old ... jerry-built ... cats need to be able to get through ..."

And I quickly figured out that he was talking to someone about installing baby gates on our staircase. So did I think, oh, how nice that he's taking care of this? No, what I thought was, that cheating son of a bitch.

See, I wield all the power tools in our house. I install shelves, fix faucets, replace electrical outlets -- and put up baby gates. We have a 100 year old rowhouse with a narrow staircase that has a lovely carved newell post set at a slight angle to the stairs. This created a bit of a problem when it came time to install baby gates. Most gates were too wide for the space. In addition, there was no way to fasten the latch to the slanted newell post without damaging it in the process. And, we had to make sure that BadCat would be able to get by (he's too big and clumsy to leap over). So a couple of months ago I spent most of a hot and frustrating day fashioning a solution to the problem. And I think I did a beautiful job, if I do say so myself, but you be the judge:

I realize that we can't allow HB unsupervised access to these contraptions, but then we can't allow him unsupervised access to anything.

So I start following TH around, making angry faces and gestures. Finally he hangs up and confesses that he had seen an ad for someone who custom-babyproofs houses and had wondered whether there was a better solution for our stairs.

He was cheating on me.

I did get some satisfaction from the fact that the guy told TH that it sounded like I had already come up with the best way to do it. "Jerry-built" indeed!

TH says that he now realizes he can't get away with anything.

Tuesday, September 20, 2005

Making Amends, and Walking

I have made amends. I put four Choco Tacos in the staff refrigerator and an anonymous note:
Soon thereafter an addendum was written below my note:
Thanx U Rock!
So I think I've been absolved. And I do feel much better. Apparently somebody has been stealing Snapples too, but I swear I didn't do it this time.

AngelBaby decided to become a true toddler yesterday -- he started walking for the hell of it, rather than as a party trick to amuse us. More things to worry about now, but I'm overall glad about it -- his knees are a fright and his hands get filthy because he insists on crawling on the sidewalk. And now he can move up to the toddler room at daycare. Right now he's the oldest kid by far in the infant room. 15 months old, and already held back.

Sunday, September 18, 2005

Those Penguins Sure Have It Tough

TrophyHusband was really lobbying for the penguin movie, while I was holding out for the Aristocrats or Broken Flowers. In the end, the babysitter was a little late, so the only movie time we could catch and still have dinner was the penguins. Dinner was great. But as I expected, the movie is littered with the fluffy corpses of baby penguins. There were penguin babies dying of neglect and predation and 100 mile per winds at 80 degrees below zero and because their mothers get Jawed by a terrifying leopard seal (who knew there was such a thing as a terrifying seal?). I'm glad it wasn't the first movie I ever went to while leaving AngelBaby with a babysitter. Movies should really have ratings based on the circumstances under which one should not see them. Case in point: I went on a first date to see Happiness. We got through the first half of the movie ok because we'd done tequila shots at the bar next to the theater, but as the alcohol level in my blood sagged I began to realize what a terrible mistake I'd made. Mostly in the choice of date, but the movie was a problem too. So Happiness would be rated NFD (No First Dates). The penguin movie would be rated NAFTP (No Anxious First-Time Parents). And most action movies would be NALMSS (No Annoying Literal-Minded Spoilsports), so I wouldn't be allowed in.

Thursday, September 15, 2005

I Am the Choco Taco Thief

I have already managed to do two really spacey things today that may have bad consequences.
  1. The tech support guy left a message saying he wanted the fancy digital video camera I checked out months ago back. I was supposed to be using this for taping student conferences, but I just haven't managed to get around to it. And when I looked on my shelf for the camera, it was gone. I have no idea when it disappeared or how. And he is one of those horrible noodgy people who will be absolutely hysterical about this for months.

  2. There is a conference that I am in charge of that takes place every Thursday at 11. Everyone in the department is supposed to come to it. Today at 12:15 I realized that I DIDN'T GO TO MY OWN CONFERENCE. My department chief did, though!
So now I'm off to see patients. Let's hope that I don't kill one of them with my ineptitude.

(And the other day I had to stay late and I was starving and I found a Choco Taco in the staff fridge and ate it ... and today there's a huge sign on the fridge bitching and moaning about how someone stole the Choco Taco. I didn't own up to it. I just snuck away. I am a space case and a Choco Taco thief.

If the person who owned the Choco Taco reads this, I can only say: It tasted good.)

Update: The hysterical noodgy tech guy just came by and found out about the missing camera, and said ... "Oh, don't worry about it. Maybe someone borrowed it, or maybe not. I'll get you another one!" He recently started dating one of the administrative assistants in our office, so the only thing I can think of that is making him so relaxed is, maybe he's finally getting some? Whatever it is, I'm not complaining!

Wednesday, September 14, 2005

Why I Call Him GoodCat

Impatience with Patients

I'm on call tonight. That means I have to keep my pager on until 8:30 tomorrow morning and answer pages from: outpatients from 10 different doctors; nurses at 2 nursing homes; and residents at the hospital who are admitting patients. I only have to do this a couple of times a month, plus about every seventh weekend, but it can be a real pain in the ass. My least favorite calls:
  • Calls from the lab about stat results. Usually the results are just mildly abnormal. The tech always asks if I want the patient's home phone number, and when I say "No" in a really bored voice, they ask how to spell my name.
  • Calls from the nursing home about new admissions. They have to read every order to me over the phone so that I can verbally ok each one. This takes a long time and I don't know the patient from Adam's off ox and have to keep myself from reading a magazine while the nurse blathers on and then I realize that I may have just ok'd a lethal dose of laxative.
  • Calls from patients trying to scam narcotics. Actually I don't mind these so much; it's kind of fun to hear what they have to say when I tell them no. Except when they're really agreeable and mournfully say they'll just call their usual office in the morning. Then I feel like a mean asshole.
  • Calls from patients who have a sore throat and/or cough and their doctor "always gives them antibiotics" and "it takes care of it right away." There's no winning with those folks. I have to either try to explain to them that their illness is viral and isn't helped by antibiotics (which is almost never successful because I'm basically telling them that their usual doctor is wrong, wrong, wrong), which takes forever, or I just take the easy way out and order the antibiotics even though I know it's the wrong thing to do. Then I feel like a wimp.
  • Calls at 4 am.
  • Calls from patients in the emergency room wanting me to speak to the People in Charge so they won't have to wait so long. Because they must have something much more serious than the other fifty people already waiting.
On another front, the tiles are going up in the bathroom today, so we're that much closer to living in the modern world again. You might think with all of this that we're getting a really fancy bathroom, with a heart-shaped Jacuzzi and a Japanese toilet that weighs you and checks your stool for blood, but actually it's as simple as can be. Except that TrophyHusband researched shower fixtures for days and toilets for weeks, and we'll have a shower control that automatically adjusts the hot & cold water for you and a toilet that only requires one flush. This last thing is very important to TH. I had no idea it was such a problem. Everything must go down and stay down with one flush. I don't know what he's putting down there -- all our junk mail? bricks of maryjane? small woodland animals? -- but whatever it is, it apparently puts up quite a struggle.

Monday, September 12, 2005

There Is a Water Service Which Will Solve an Agony

I had noticed that someone already had the website, so I went to investigate. Turns out it's a Korean OB/Gyn's address. I used the handy Google translator, and this is what it came up with:
There are to women and is not a place which is an obstetrics and gynecology certainly it will not become it is a place which is necessary but it wants hiding, when it distinguishes the place which is shy the place where the women of most good season dislike most because of point rightly it is an obstetrics and gynecology hospital.
It is like that but it uses a recently internet and it does not distinguish a confidence not to be, it stands but as much as there is a water service which will solve an agony and there was a water service which will find the medical treatment knowledge which is necessary and. Is caused by with the medical treatment knowledge which it is knowing but by mistake and there is also a case which ruins the health of the oneself with the own diagnosis which set it calls rather ... the agony which it will not be able consultation of cool solution and disease it led in order to everybody wild side more nearly, this space polyvalent good season it prepared. Thank you.
I haven't a clue what all that means, but I would like to try the water service which will solve an agony, and the doctor seems like a pretty fun guy:

The weird thing is, the photos at the top are of white babies. What is it he's promising, anyway?

Saturday, September 03, 2005

Why I Call Him TrophyHusband

It started as a joke, because he's six years younger than I am. He's also cute, in an intellectual/hipster/crunchy way. But mainly, he's much nicer than I am.

For instance: in the middle of all the craziness with having to get out of our house, he made time in his day to go and donate blood. Now, I know a lot of people donate blood, but I don't think anyone has had to work harder to do so than TH. A long time ago, before they had figured out how to test for HIV, my husband went to donate blood and was faced with a bewildering questionnaire. He's very smart, but he tends to over-think things, and he answered one of the questions wrong. Not wrong as in he was actually at risk for HIV; wrong as in he misunderstood what they were asking when they asked about his previous sexual contacts. (Let's just say that he had sowed some pretty wild oats, and that he's geographically challenged and didn't know exactly where in the world sub-Saharan Africa was, and ... oh, never mind.) So they politely told him thanks but no thanks. He was astonished, but didn't argue. But then the next time he went to donate, he found out that he was on the Blood Donor Blacklist. That's right, they will ban you for life if they think you might be tainted.

Now, many people (including me) would have said, phew, don't have to feel guilty about not donating blood anymore! But not TH. No, TH went on a campaign to clear his name and be allowed to donate blood once more. Which was NOT an easy task, let me tell you. And one fine day, he received a pardon and was restored to Approved Blood Donor status. And he has tasty and useful Type O negative universal donor blood, so they now want him a lot.

Of course, I got annoyed because it meant that he was spacey for the rest of the day and wasn't quite as useful as he usually is. But that's because I'm not nearly as nice as TH.