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.
Wednesday, December 28, 2005
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?
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.
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
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.)
- 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.)
- If the bleeding hasn't quite stopped, repeat steps 4-7 above.
- 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.
- Still no luck? Repeat step 9.
- 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.
- 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.
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?
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.
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:
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.
| Type 1 Suburban Highly educated White Healthy High SES Overtreated | Type 2 Urban Undereducated Non-white Sick Low SES Undertreated |
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.
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.
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