Shopping with Rose-Colored Lenses

I had another dentist appointment today. My upper teeth look human again, so that I can now toss my head back and laugh affectedly the way they do in bad commercials. I pre-medicated a bit for the visit (HATE going to the dentist), and then it went a little faster than expected, so I left feeling a liiiittle too good to get in the car and drive immediately. But hey, look — shops right near the dentist! With lots of pretty things to buy! And no HellBoy to distract me with his pesky screaming and thrashing.

It wasn't till I got home that I realized that everything I bought is PINK. Pink sweater, pink tank top, pink underwear, even some fuzzy pink flipflops. I almost bought a pink purse, but I didn't really like the shape, thank heavens. I must have increased the number of pink items in my closet by 500% today. Note to self: no more shopping under the influence. At least it was all on serious sale.

I still haven't made an appointment with my RE, but I will, I promise. I wonder, if my ovaries are indeed little dried-up husks, will I be devastated? Or will I be slightly relieved that I won't ever undergo another fertility procedure? I'm honestly not sure. But I agree, it's time.

At any rate, all of your comments definitely helped make me feel 1. appreciative about all that I have and 2. less embarrassed about feeling jealous.

I've been thinking about one of the comments that Bihari wrote:

I have several friends who are trying hard for children right now, and I really want to be a good friend to them through this, even though I have Mother Of Two stamped across my forehead. Any suggestions? I usually have just been keeping in mind that we all have our own set of losses and disappointments, and even if they're different, the experience of living through loss and disappointment per se can be the same, so that gives us a lot of common ground. But I could be full of shit. What say you?

Full of shit? Definitely not. In fact that's how I make myself feel better about someone else's fortuitous fertility: would I want her life? Everyone has some hard things to deal with. OK, this approach doesn't always work — there's one person in particular I know who has NEVER had ANYTHING go wrong in her entire life, in fact has had all sorts of wonderful things happen, and although she's a very nice person, I can't help it, I'm not a big enough person to be able to get past it. I know that people probably think that I've had it easy, too — I've got a great job and a TrophyHusband, we don't have to worry so much about money anymore, I've got a healthy baby. I even like my inlaws. Hell, I'm starting to irritate myself. But I have had some pretty crappy things happen to me in the past; I know what it's like to feel as if nothing will ever go right. And I think that loss and disappointment do indeed give you common ground.

As for specifics about talking to someone who's struggling with infertility when you yourself drop eggs like a hen and can get pregnant by shaking hands? Midwestern Deadbeat mentioned that she'd read Tertia's piece on how to be good friends with an infertile, and I think it is good advice. I myself was not/am not an especially touchy or bitter infertile (I think. Others may beg to differ). I've had worse things happen to me than infertility, and my experience was about a tenth as bad as some — it was only a few years of trying, I didn't have to do THAT many cycles of IVF, a lot of it was covered by insurance, and I didn't have any wrenching pregnancy losses, just one miscarriage of a "chemical" pregnancy — so I don't feel I'm able to speak for Infertiles in general. But I do have two pieces of counsel:

First, if someone is undergoing treatment, try not to take their bitchiness and/or craziness personally; it's not about you, and it will pass. Because those hormones make a person insane. I was never a PMS-er, and figured, how bad could ART be? Answer: really, REALLY bad. There were times when I would walk around in a white-hot rage for a week. I locked myself in a room during one vacation at my in-laws because I couldn't trust myself not to say something that would ruin my relationship with them forever. Seriously. TH had to bring me meals.

Second, there's a magic phrase that is always appropriate and that is guaranteed, if not to make an infertile person feel better, at least to not do harm: "You're handling this amazingly well." TH must have said that to me a thousand times, and while I sometimes doubted whether it was true, it always made me feel at least a tiny bit less psychotic. (Turns out it really wasn't true. Poor TH.)

It's Not Like My Toes Are Even Pretty

I have heard about three pregnancies in the last 24 hours. First, Angelina. Next, one of my students who wanted to explain why she's been MIA for some required exercises (she was vomiting in various bathrooms around the hospital, poor thing). Finally, one of my colleagues.

I have long noticed that some pregnancy announcements make me wince a little, and some do not. Angelina's, now, I feel irrationally happy over, maybe just because it's cool to think of two such gorgeous people combining genes, and maybe because she's certainly paid some dues (albeit with a fat checkbook). My student's, well, a tiny bit. Because I didn't have a guy who was willing to undertake parenthood with me at that stage in my life, even though I was already getting slightly long in the tooth (and I knew I couldn't do it alone).

My colleague's announcement was pretty hard to take. She's my age, and she sees outpatients in the same office as I do. She got married when I was in year three of my fertility quest, and she wasn't worried in the least about whether she could get pregnant — she used birth control for a while, even. Then of course she got pregnant two weeks after I finally did. (Which meant that we were out on maternity leave at almost exactly the same time, which just about shut down the practice — despite ample advance notice, none of the higher ups seemed to grasp what kind of problem this would be — but I digress). Recently I asked her if she thought she wanted another, and she said, maybe, sort of ... then she stopped her birth control again and had sex exactly ONCE, and now she's pregnant again.

I hate this evil finger of jealousy scratching at my back. I don't begrudge her this pregnancy, and I know she has a lot more to deal with than I do in life — she has a chronic medical condition that leaves her in pain and fatigued, her husband does almost nothing to help with their son or the house, and she's a really kind, generous person who has helped me often. And, I already have a fantastic (though hell-bent) baby myself, which a lot of people probably begrudge me. But it's hard to shake this ugly feeling. Jo wrote about it much more eloquently than I a little while ago.

It also makes me do something I hate to do, which is face up to my own desires and motivations. I have not made an appointment with my RE, despite knowing full well that time may have run out for me. I have not weaned HellBoy, despite knowing full well that nursing is probably interfering with any chance at fertility I might otherwise have. I become very adolescent about the whole issue. I'm still pissed off that I don't have the luxury of deciding how many biological children I want. I want to be able to ponder when would be a good time to have a second baby, without the incessant noise of the clock winding down making it hard to think. I'm finding this whole gig pretty overwhelming at times, and the thought of adding another baby to the mix sometimes seems outrageous. Not to mention the hideousness of infertility treatment. It would be nice to know that I could wait a couple more years to catch my breath.

I have a slightly ridiculous reason for wanting a second biological child: HellBoy looks almost nothing like me. He's got exact replicas of his father's cleft chin, distinctive nose, big brown eyes, even his long flat feet. The things that may have come from me are all pretty generic — straight fine hair, smallness, maybe his mouth? Probably his eyebrows? I mean, we're grasping at straws here. I joke sometimes that at the IVF center they finally got fed up working with my tough old eggs and just borrowed one from a nice young woman who resembled me. There's no easy way to prove this isn't true.* I coached my cousin's wife at the birth of their first child, and I was the first person to hold and dress the baby. I noticed right away that she had my cousin's toes, which are unmistakeable, and which I also have (maybe I'll post a picture sometime, but for now you'll have to trust me, these toes are better than DNA testing for tracking family connections). And I thought that was the coolest thing.

I want a baby with my toes.

So that's a pretty stupid reason, and yes, I realize that even if I had a second biological child it could be mini-TrophyHusband #2. I need to appreciate my incredibly good fortune in having HB at all (which I do, I do). I need to decide whether I want to get my butt to my RE and let them tell me if the door is really closed, because until I know that it's all rhetorical anyway. And then I probably need to wait a little while and talk some more with TH about what would be the best adoption scenario for us.

OK. Enough about me and my whining. Let's talk about lurkers, shall we? Because for de-lurking week, this blog is kind of a bust. Hundreds and hundreds of you, yet only one de-lurker ... why so shy? (You still out there, E?) Well, really, I'm not going to harangue anyone. I always hated my creative writing workshops where we were required to make comments. Some stuff was just crap, and the less said about it the better, and some days I felt like crap and didn't think I should impose that on the author either.

So forget I even brought it up. Carry on.

*No, of course I don't really believe this. Because they wouldn't give those nice fresh eggs out for free, now would they?

OK, But Let's Make It Quick

I warn you, I'm not very good at these.

10 years ago:
Trying to make it through my surgery rotation my third year of medical school. I got home at 9pm the very first day and burst into tears as I walked through the door. And I'm not much of a weeper. I was living with an older man, a scarily ambitious member of the intelligentsia who was the most self-absorbed asshole I ever hope to meet.

1 year ago:
Doing resident interviews. And I was on call one year ago tonight.

Snacks I enjoy:

1. Jelly Bellies
2. Peanut butter, straight up
3. Chocolate ice cream with peanut butter in it
   Can't think of any more. I don't much like snacks. I like breakfast and dinner, the rest is kind of a chore.
   

Songs I know the lyrics to:

1. Itsy-Bitsy Spider
2. Senor Don Gato
   That's it. I can't remember lyrics for shit.
   

If I were a (multi-)millionaire, I would:

1. Get a house with a parking spot
2. Pay off my student loans
3. Keep a nanny on call for when HB has a fever and can't go to daycare and for occasional evenings out
4. Visit Australia and New Zealand
5. Buy a house for my brother

Bad habits:

1. Candy
2. People magazine
3. Staying up too late
4. Sleeping too late on workdays
   
5. Blogging

Things I like doing:

1. Sleeping with the baby
2. Running
3. Reading the Sunday papers while someone else runs herd on the baby
4. Blogging
5. Sitting on the patio in the summer drinking drinky-drinks

Things I'll never wear/buy again:

1. Painfully pointy shoes
2. Alpaca anything
3. Heavy earrings
4. Plastic flip-flops
5. Nightgowns

Favorite toys:

1. My mac
2. My Scion XB
3. My Zach & Dani's coffee roaster
4. My white-noise machine
5. Froogle

I Swear I Didn't Drug Him This Time

Something strange and new has been going on in the DoctorMama household. Although the refrigerator is still empty except for limes, beer, and dozens of quarter-full containers of takeout food of indeterminate origin; although the floor under the desk in the study still has a faint yet evocative odor of pissed-off cat piss; although the plants continue their slow march toward death; although nothing else has changed, HellBoy is becoming AngelBaby.

I agreed to watch him by myself for three hours straight today. While this may sound laughable to those who are single-handedly juggling twins, puppies, and broken pipes, let me tell you, I was dreading it. I am not a wimpy person. I am even rather skilled at taking care of babies (I was an au pair in Switzerland, for chrissake!). I don't go down easily, but HellBoy can take me down. And he saves his really special moments for me alone. But TrophyHusband needed to get some important work done, so I took HB to ... the outlet mall.

I chose this because it's the sort of frantic place where an extra minion of hell is not especially noticed. Also because he's just finally grown out of his 12-month overalls and actually needed new clothes. I prepared as if going on a secret assassination assignment into the deepest jungle -- DVD player for the car, check; lollipops, check; binky, check; diapers, check; toy cell phone featuring Glinda the Good Witch chirping "I love you SO MUCH!" over and over until your ears start to bleed but at least it makes him happy godammit, check.

And then off we went. And I have nothing to report, except that I never had to pull out the DVD player in an hour total of driving (longest time by far); he SAT IN HIS STROLLER in the mall (I swear to god, he hasn't done that for longer than 15 minutes since he was two weeks old -- we've been using it as a shopping cart since then); he didn't cry, not even ONCE; he didn't require lollipops nor grab at my breasts screaming "DAT! DAT!", just politely held his hand out for veggie puffs and said "More"; and there was a crying baby in one store whose mother said, "Look, there's a good baby. Why can't you be a good baby?" And she was pointing at HellBoy!!!!

This could be temporary, I realize. My nose only just today stopped making a weird clicking noise when I scratch it. But if it keeps up, I'm going to have to look around for something else to bitch about. And I'm going to have to find another way to get my upper-body workouts if I'm not going to be heaving a thrashing toddler around for hours every day.

Nose Update: My Modeling Career is Over

Under pressure from TrophyHusband, I went to see an ENT guy today. (Who has an unprotected wireless network from his office, bonus!) He looked at an old picture of me, then wrestled with my nose a bit (ouch), and finally said that it looked like I had done a reasonable job resetting it on my own (thankyouverymuch!), but yes, it was probably still a tad out of joint (no surprise to those who know me), and if I wanted he could put me under anesthesia and yank it around some more. I joked that my modeling career is pretty much over at this point anyway, which he laughed a little too heartily at, in my opinion. Anyway I said thanks but no thanks.

Now I'm off to the dentist to get the first two of seven fillings replaced. At least they'll be swapping my metal fillings with white ones, so even though my nose is less lovely than it once was, my mouth will lose some of its Terminator appearance.

I Guess I'm Not the Patient Whisperer After All

I aspire to be — or to at least appear to be — the kind of nonjudgmental doctor that patients can tell anything to, and from the kinds of hair-raising things I've been told, I'd thought I was succeeding. But I recently discovered that there's a very common concern that none of my patients have ever asked me about.

When I took my current job, I took over for the only male doctor in the practice. He had collected a patient panel that included a lot more male patients than the other doctors, which I was glad about, because I really enjoy seeing men. Not that I don't like seeing women, but women tend to go to the doctor more often than men do, and it can get a tad boring.

I had to work at gaining the trust of some of these men, and more than once a patient would halt in the middle of telling me his story and say, "It's a little strange to be telling this to a lady doctor ..." which was my cue to bring up the topic of impotence (or ED — erectile dysfunction, the euphemism du jour). Heck, I'd ask about it even if they didn't seem like they had something they were getting flustered about. (My favorite answer of all time: "Well, yes, doctor, I have been having some trouble with my, you know, with my — direction." Which was actually true — he wanted the direction to be up instead down.)

But recently a man joined our practice, and I noticed that several of my male patients started showing up on his schedule. I wasn't shocked; I knew that these patients had always wanted a male doctor. But I was a little disappointed that I hadn't been able to keep them, given my simply breathtaking skills at patient rapport.

The other day I mentioned to my new partner that he was leaching all the testosterone out of my patient roster. "Well, you know there are things that men just won't tell a woman doctor," he said.

"No, they ask me for V*agra all the time," I said.

"Oh, not about that," he said. "There's something that I bet no male patient has ever asked you about, yet it's one of the most common concerns men come to me with."

"I doubt it," I said. "Try me."

"That their p*nises are too small."*

And I had to admit that he had me there. Though I have heard many, many penile concerns, that has never been one of them.

This has left my doctoring self-esteem a tad shaken. How could I have been missing this major thing? One of my favorite parts about being a doctor is being able to reassure people. And here all these guys have left my office feeling, well, inadequate, and unable to tell me about it. I mean, I knew that men worry about this, but I didn't realize that so many of them think it's enough of a problem that they should see a doctor about it.

And I'm not sure I'll be able to include it in my review of systems. "Do you have any constipation? Diarrhea? How's your urination? Any problems with erections? And — how about your johnson? Feeling cheated? Under-peckered? Got a wiener instead of a brat?" At least my partner told me what to say if I ever do get this complaint: "Too small compared to what? You've been watching porn, right? Well, you need to remember that those guys are in the top 1 to 2 percent of the population. The other 98 percent look about like you do."

Which is not at all what women are taught to say in private life ...

*Trying not to attract too many folks who will be very disappointed if they find me popping up in their Google searches.

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.

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?

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.

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.
    

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.

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?

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.

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 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.

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.