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Fun with Spring Fevers and March Madness

Last year I wrote about Why February is Hard for Pediatricians. I think, today it is time for Why March is Fun for Pediatricians. Why? The air is warmer, the flowers are bursting forth, I put my veggie garden in…the fava beans are getting tall. Spring is indeed here. But these aren’t my answers.

In medical school we were all faced with the challenge of choosing our specialty. Some of us knew from the beginning, some struggled with the decision. For me there was never any choice but Pediatrics. My reasons were a mix of meaningful and perhaps less so. Besides finding a field of medicine that is interesting and exciting, to choose well you also have to consider what social issue you are willing to confront. I found it much easier to help people parent than to help the same people confront their smoking and drinking habits.  I would rather be a child advocate than work to repair years of self-inflicted health damage.  The less weighty reasons for choosing Pediatrics? Easy: kids smell better. And, they make me laugh.

So in this month of spring fever and madness it seems that the sillies have come out in my patients! Enjoying their antics has made me very happy with the choice I made!

  • Last Tuesday one of my patients didn’t say much to me, didn’t answer my questions and drooled constantly; she spent our entire time together sucking on her toe.
  • As one little 5 y/o left I said to him “Bye, handsome!” He turned to his dad and said “see Dad, all the girls think I’m handsome!”
  • I had a well child check up with a 6 month old who giggled so incessantly every time I touched him that his parents and I started laughing with him; we laughed so hard we all had tears and I had to sit on my stool and take a break before I could focus on his exam again.
  • Yesterday, one of my patients was too busy to let me examine her. she had taken out my entire herd of plastic dinos and a book on dinos and was matching the plastic ones to the paper ones page by page. It took a while.
  • One father was irritated at his son who refused to let me look in his ears. The blackboard needed erasing…every single tiny bit of chalk needed to go. It was a slow process so, I gave up and got down on the floor to erase with him. When we were done we stayed there to deal with the ears.

What adult medicine doctor has this much fun with their patients? Then, there were some other kids….

  • One girl on Thursday decked me full-fisted in the nose when I tried to look in her ears.
  • Last week when I opened a boy’s diaper to examine him he looked me straight in the eye, smiled and peed full-stream ahead all over me.

Oh well, at least they smelled good?

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A Can of Beans

http://www.tate.org.uk/home/copyright.htm
Black Bean 1968 Andy Warhol

Something difficult has unfolded around here lately and when news got out a dear friend came by with a gift of a story. She told us about a day years ago when one neighbor heard the other had breast cancer. The well neighbor was shocked and saddened. She was at a loss and wanted to help; wanted to do something but, what? In a daze but motivated none the less, she grabbed a can of beans from her cupboard (perhaps we should imagine she was reaching for the chocolates?) and headed to her friend’s house. She rang the bell and as the door opened she felt suddenly a bit silly but, with a warm embrace she greeted her friend and said “I have brought you something.”

When those around us are suffering, when the news is bad, we often feel at a loss for words.  Or worry we will say the wrong things. And, all too often we do. I sat by the fire Sunday night talking about what people say and do in these moments. Some feel compelled to tell you their story.  When my brother-in-law committed suicide a few years back his brother had to endure story after story of other similar deaths. How painful for him to have to stand there suddenly supporting rather than being supported! Or, people would say how horrible it was that his brother had done this to him. Rather than lamenting how much pain his brother must have had to quietly suffer before death! When I shared my recent news with an acquaintance  she blurted out a question that was so absurd as to deserve my favorite of all snap comebacks: “Oh my! You actually said that out loud! You must be so embarrassed.” I of course did not think that fast and simply answered the hurtful question. Another friend of mine recently lost both of her beloved grandparents in the same month. She received many comments about how they had lived a long life implying perhaps that it was okay that they had died. Instead for her, the loss was stark and biting – not easier somehow because she had lived all these years with their love.

These examples brought me to think of an article I read last summer. In “You Look Great and Other Lies” Bruce Feiler writes well of “Six Things You Should Never Say to a Friend (or Relative or Colleague) Who’s Sick. And Four Things You Can Always Say..” It is absolutely worth a read. The tip that most sticks in my mind (perhaps because it seemed such a natural thing to say) is that it is hurtful to hear “You Look Great!” As if it is all about looks?

In the spirit of Mr. Feiler’s article and in the spirit of knowing that all of us mean well and want to say the right words let me add a few tips:

  • Learn to be comfortable with a moment of silence. As a physician and as a person who likes to gab I have had to cultivate this skill. When confronting uncomfortable topics many of us have a tendency to start talking – immediately and fast. Instead, pause, breathe and count to ten. While you do, you can gather your thoughts and the person you are with may have a chance to tell you more.
  • Simplicity is best. The briefest responses are often the most powerful. Try “My heart goes out to you” or “I love you and wish you did not have to face this.” Best yet for me was “I have faith in you.”

And, don’t forget Feiler’s tip: don’t ask “How can I help?” There are few people who want to ask for help and in a crisis, few who know what help they need. Instead – just figure out how to help on your own. Bring dinner. Call on your way to the grocery store to ask for their shopping list. Send a note. Or, if all else fails you… bring a can of beans. Your support will be priceless.

Falling Back and Cleaning Desks

I have been feeling a wee bit overloaded these days. Overloaded in the happy-all-these-cool-opportunities are on my plate kind of way. But, also overloaded in the I-can’t-find-the-time-to-get-the-little-stuff-done kind of way. I am certain all of you know this feeling . My desk is more disheveled than I like. The winter garden (think fava beans) is not completely in. My pile of laundry needing to be folded is reaching epic proportions.

So on Sunday morning I woke up early to try to get a head start on my day. Maybe I was inspired by my European friend for whom daylight savings time started last week. He thought it was some how an inconvenience. I suffered pangs of jealousy.

Spring forward, fall back….

For me that falling backwards has been a mixed experience. In medical school and residency it was really quite the drag. At 2400 instead of being done with that calendar day of call, we had to start the hour over again. As a parent I am quite fond of gaining that extra hour of time. Now it represents a quiet house; an hour of uninterrupted catching up on the small stuff.

This Sunday I created my own falling back by getting up early and used the time to paint a really grubby bathroom. Ceiling done, wall edged, I was starting on the trim – happily painting away and listening to an NPR podcast on my iPod. I was also thinking about how great it was that to have this small piece of time and how nice fall daylight savings is. Maybe in a utopian world we could have a Parent Savings Day when all the children of the world slept for 24 hours while we parents got caught up. Then my reverie was broken by a sound outside the door and I opened it a crack. There was my lovely middle child with a huge happy-to-see me grin. I was deep into  my falling back and getting it done zone and all I could think was “Seriously?” Apparently I said it also.Oops.  #notgreatparentingmoments

p.s. : That podcast I was listening to was a collection of interviews called Desktop Diary reporting on

going into scientists or creative thinker’s workspaces and seeing how they work and what their desk looks like. The idea is that maybe some of the desks can tell us a little bit about the person.

It included the rather irritating desk of physicist Brian Greene who seems to think one thinks better with a clean desk. Hmmph. Now I need another early Sunday. Or, maybe I’ll emulate another physicist, Michio Kaku who said:

it’s pointless to have a nice clean desk, because it means you’re not doing anything.

Now, that’s more like it.

Bobbleheads, Packaging and Wise Career Choices

Sometimes life presents you with unexpected learning opportunities doesn’t it?

Last Thursday I went with my 12 daughter to see k.d. lang in concert. She needed to write a report for her band class on observations made while seeing a live music performance. We looked around for a local show and stumbled across the listing for k.d. lang’s show. It seemed perfect to me – my daughter could get her report done and I could enjoy some good music.

My daughter’s report had to list the instruments played, comment on sets and costumes.  Critique the music itself. She had to watch the mannerisms of the musicians (apparently some of the trumpet players in band move like bobble heads with each breath).

I hoped that there would be another lesson presented to her that night. A lesson of acceptance. In a review of k.d. lang’s singing, The Times of London declared:

It’s a quirk of the music industry that one of the sexiest, most sensual voices in all of pop music comes not from some raven-tressed siren in a glitter-dress but a middle-aged woman with a utility haircut and a penchant for male tailoring.

Exactly. I wanted my daughter to see that talent and success, wisdom and sexuality present themselves in all kinds of packages. Each worthy of her attention. I felt vaguely guilty for “using” k.d.’s concert as a teaching moment  rather than just an opportunity to listen to fabulous music but – so be it, off we went.

Turns out there was a better lesson waiting for us that night. As I watched k.d. on stage it struck me that although she gives this very same performance night after night it has not grown dull for her. Her songs soar, her feet skip and she smiles. A smile described in the NY Times as being the size of Montana, forms an invitation for us to join in the fun.

The next morning at work I was reminded that my job as pediatrician has some of the same fun worked into the routine. One 9 month old smiled so continuously and contagiously at me that I had to apologize to his mother for my own grin. An autistic boy with an uncontrollable fit of ticklish giggling while I was examining his belly made me give in to the giggles with him. How lucky k.d. and I are! And, what better lesson than showing my daughter that one’s work should feel at least in part, fun?

Lessons learned? Don’t be a bobble head.  Impressive people come in many packages. And careers should be fun. Choose well dear girl!

Two Patients: Trusting Intuition in Medicine and Life

Sick or not sick? This is the snap judgment all physicians make in the second they first view a patient. This is what they ask as they open the exam room door or pull back the curtain around the gurney. “Is this patient in front of me sick (in a way that means I need to act now to save their life) or not sick (ill but, someone I can patch up in some way and send home)?” Much of residency training is aimed at making sure young doctors leave with this skill finely honed. But, is it a skill or an innate talent that is hard to teach?

At the end of a recent clinic day I had just two patients left. I walked into the first room and inwardly groaned. This one was sick. However after hearing the history I started second guessing myself; it all sounded very reassuring. And, as we are also taught in medical school – the history is 90% of the diagnosis. Maybe I could treat and send this one home for the night? However, I had a gut sense, a hunch, that home was the wrong place for this child. That snap decision of sick won me over and I was right. The child was sick.

The next exam room held a child who I immediately felt was fine; not sick. But, the more I listened to their story the more I worried. There was some real potential for hidden danger. Then I was left wondering – how much of a workup should be done on this well-appearing child? Since the history had given me cause for worry, labs and a CT were done to prove that this child was indeed, not sick.

Later I commented to a friend on this sick vs. not sick judgment we make. He pointed out to me that likely this is based less in instinct and more in hard facts that are processed by our minds before we notice the processing. He felt that in a blink of an eye, on a subconscious level, I connected the dots I observed:  reassuring history or not this patient was sick!

Perhaps but, I have met well-trained, intelligent doctors who struggle with this talent of intuition. In medicine the hard facts are obviously of tantamount importance but, our instincts need to complement our intelligence. Malcolm Gladwell wrote in his book Blink: The Power of Thinking Without Thinking:

 The key to good decision making is not knowledge. It is understanding. We are swimming in the former. We are desperately lacking in the latter.

Another friend of mine is in the process of making a life-changing decision. His sister challenged him by asking how he could make such a choice with barely any evidence of it being right? He explained that it felt right, that his gut told him it was right, that to make this choice made him feel like he was returning to home. Gladwell might say to his sister that:

our world requires that decisions be sourced and footnoted, and if we say how we feel, we must also be prepared to elaborate on why we feel that way…We need to respect the fact that it is possible to know without knowing why we know and accept that – sometimes – we’re better off that way.

In his 2005 commencement address at Stanford, Steve Jobs spoke in large part about trusting one’s intuition both in career and in love.

you can’t connect the dots looking forward; you can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future. You have to trust in something — your gut, destiny, life, karma, whatever.

I wonder what Jobs would make of this concept of the balance of science and intuition that physicians face with every patient?  In our personal lives it is clear he felt trusting our gut was the way to go. He left those Stanford graduates with wise words:

have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary.

 

Sublime and Surreal; A Birthday Vocabulary Lesson.

I walked to my car a few nights ago on my birthday and was stopped in my tracks by something in the atmosphere there on the street. It was twilight; the sky an electric blue and the trees and houses nearly black silhouettes against the sky. The street light stood as a golden guardian. The only sound out there in those few moments was a rustling of the leaves in those dark trees caused by a gentle breeze.

It was distinctly dreamlike. Surreal even. It was exactly as if I were standing in Magritte’s painting The Empire of Light II.

Earlier in the day I had been hiking on the bluffs over the ocean with two friends. At one point along the trail we paused. They were chatting, I was breathing. I looked up to see the most fabulous sky. There is no other way to put it but to say it was “sky blue”. That bright light blue that can be bought in a tube. There were fluffy clouds in cartoon-character shapes floating by. Standing there I again felt I could  have been standing in a painting: Magritte’s The False Mirror. It transformed my hike into a sublime experience.

These moments began a vocabulary lesson at dinner last night.

Surreal:

marked by the intense irrational reality of a dream

Sublime:

of such excellence, grandeur, or beauty as to inspire great admiration or awe

The rest of my birthday weekend continued the theme. A spa massage: sublime. Practicing the massage techniques I had “learned” on my 10 year old and savoring the feel of his strong little body: sublime. Apricot almond birthday cake: sublime. Fighting an hour-long, block-wide nerf war, girls against boys, with my kids and their friends: surreal.

Yes, having the ultra-pacifist mom shoot her kids repeatedly aiming to “kill” was indeed surreal. But, it was also such a sublimely fun hour capping off an at times dreamlike weekend.

An Accident, an Artist and a Poster

Several years ago I was driving along the north coast of California. As I rounded a sharp, cliff-lined bend I came upon an accident scene. A girl in her early 20s had been riding her bike and was hit by a semi-truck. The truck was long gone but a gaggle of well-meaning good Samaritans was at the scene. I joined them reluctantly (not wanting to stall my journey and put my own kids at risk as they waited by the roadside). As I walked up and assessed the scene I hoped to see that all was well and that I could quietly leave. But that wasn’t to be, I was needed. When I saw this I told the small group that I was a doctor and remember now the relief this brought to all of them. Imagine their fear, there on the coast with this wounded girl and help a long time coming.

The girl ultimately did well and, is not the point of this story. Instead her accident formed for me the basis of a happy accident of acquaintance.

Every year on Labor Day weekend my family travels that same coast road and in the town we stay in is a yearly art show. The year after the accident I was touring the show, which is held in multiple studios, homes and galleries. As I walked into the seaside home of one painter I was surprised to be greeted by her with a gushing of enthusiastic greetings and thanks. She had been there at the scene of the accident the previous year,  and remembered me. From this serendipitous meeting has come a nice acquaintance based on yearly trips to see her and her art.

This year on the usual day that I tour the show, I was tired and feeling a bit more introverted than usual. I was tempted to walk by her house and out to the beach to sit alone. Instead, I talked myself into heading in and by doing so, reaped the benefits of making the effort. Her art is astoundingly beautiful. Her plein air paintings have evolved to be increasingly and delightfully abstract. They show planes of space defined by thickly laid paint and a powerful use of color. For me they are as if Rothko has come back with a palette knife to paint landscapes. She and I enjoyed a long conversation about art started off by my asking who she is most influenced by. We looked at books of hers and discussed style, color and method.

Our conversation brought to mind a word that has come to mind several times lately: process.  In the sense of it being:

a natural phenomenon marked by gradual changes that lead toward a particular result – the process of growth

One of the paintings my friend showed me connects to this sense of appreciating process. It was by Paul Wonner, depicting two men sitting together. There is great feeling in the abstract strokes of color that blurs their faces but, leaves feeling intact. Perfect in a way. And yet, Wonner chose to leave obvious drips of paint across the canvas, even on one man’s face. Obvious imperfections decisively left. Why?

Process used in a psychological sense can mean taking the time to work towards becoming a better version of our selves. To generate this evolution though one needs enough self-reflection to be able to say “Look! This is how I did it – this is how I changed!” In viewing Paul Wonner’s painting of the two men it seems the drips were left as an indication of his process. They are leading us to see the gestures, the spaces, the feeling. He is saying “Look! This is how I did it – see my broad brush strokes, see my drips?” He was perhaps, asking us to look at how his beautiful painting evolved. He may have been asking us to see that the drips on his painting are part of the process that generated the emotional meaning held in its planes.

I saw a poster on a city street this week that said:

“art is not a moment; it is a process”

Indeed. Art like life, is best when it involves a process of evolution and observation.

What I Learned From a Patient Yesterday and a Tree Today

As an addendum to my post: Why Make Art? A New Answer Arises, Stitch by Stitch, I want to let you in on what the crocheted tree made me think about.

First though, I need to start with a really cute three year-old. She came to see me yesterday with her mom and big brother. He was actually the patient, in for an earache or rash or… something. But when I opened the exam room door his sister completely stole the show. She had big blond bouncy ringlets, gorgeous blue eyes and a great smile. She was very proud of herself, and for good reason! She had chosen absolutely the most stunning (blindingly?) outfit I have seen in a month. It was a great sundress with polkadots and flowers in one color palette and twisty hair ribbons in another. The shoes, obviously, were pink. Her ensemble made me smile and it made us both happy.

What we wear has power. We’ve discussed this concept often in my house. Several years ago we had a good friend whose teenage son chose to dress in goth (or emo) attire. Black everything, lots of piercings, unusual hair. My kids found him scary-looking.

I encouraged them to be open-minded and non-judgemental. After all, how you dress is nowhere near as important as how you act, right? If he avoided drugs and alcohol (check), if his grades were good (check), if he treated the people around him with respect (check) then, what did it matter what he wore?

But we decided around the dinner table that how we dress does matter. It can either open or close doors. Dressing in a way that closes figurative doors does not seem wise for a kid headed to college or to the workforce. An obvious point, or perhaps a bit of parental brainwashing on my part.

Another point came to mind today. How we dress also affects the feelings and mood of those around us. Dr. Brain Vartabedian makes this point in part, in his blog post Doctors with Purple Hair:

The argument is always the same: ‘I can be a good doctor with purple hair.’ Of course you can.  But this isn’t about you. …A career built on the privileged relationships shared with patients requires consideration of what will make them most comfortable.

In my closet today I surveyed the muted array of clothing colors with a certain sense of boredom. No happy polka dots and clashing ribbons for me. Sure, I could dress to make the parents of my young patients trust me. But where was the happy-inducing outfit? I stood there wondering why adults can’t dress more like three-year old children. Why couldn’t we dress like crocheted trees, decked out in cheerful stripes from head to toe? And in doing so make everyone around us a bit better off. Think of all the happiness that would follow us around through the day!

And, if I dressed as a tree at least my patients would approve. Maybe I need to go shopping. ©

Inspiration (or how to break the silence of a slump)

At times I want to write and find my muse quiet. At times I have ideas but no talent. I am learning the solution: when struggling to write – read. I find that as I read newspaper articles, others blog posts, books (more and more non-fiction these days) ideas come to me. From somewhere deep in my brain nuggets of ideas from here, or there, from this source or that, bubble up and coalesce. Then often without real planning, I sit to capture the ideas and the threads that connect them and out flows (at last) a more or less coherent piece. It isn’t that I am borrowing other writer’s work (a friend ask if it wasn’t hard to be so moved by other writing that I actually more or less copied the author’s words or style). Instead, when reading I try to think beyond the words on the page to the connections in my own experience. I find inspiration not an example to follow.

The man who does not read has no advantage over the man who cannot read.

-Mark Twain

What you are today and what you will be in five years depends on two things: the people you meet and the books you read.

-Twila Tharp

I’m off to read.

Language Matters

Language matters. The words we choose can have far-reaching impact on those we interact with. This is arguably more true in medicine than in any other field.

Ryan Madanick wrote a recent blog post on the use of descriptor terms used by physicians in patient’s charts. He felt that the use of phrases like “is a very pleasant 52 y/o woman” or “is an unfortunate 16 y/o boy” is inappropriate. I agree. However, in response to this post one reader commented that he felt Dr. Madanick was nit-picking. He isn’t.

When I see such comments in colleagues’ note I wince. I was taught well by attending physicians who appreciated the power of language. I was taught to leave judgements like “pleasant” and “unfortunate” out of my notes. I was even taught not to use the ubiquitous term “complains of “or complaining of” (as in Mrs. Jones is a 43 y/o woman who complains of stomach pain”). When I was a medical student I had a trauma surgery rotation. The attending during that time was a wonderfully dynamic and caring man. One morning he brought his wife to rounds to listen in (this was pre-HIPAA). Afterwards he asked her what she thought of the experience. She was outraged. Outraged by our use of language. The patients who needed us most were “unfortunate”, “demanding” and “complaining”. Those we liked were “pleasant” and “stoic”. Those we did not were “difficult”. She asked how pleasant, fortunate and stoic we would each be if we were stuck in the trauma unit after a  car accident left us unable to walk or, a bullet to the chest left us struggling to breathe pain-free? She volunteered that it was likely we would all be pretty darned demanding and complaining.

These words aren’t only judgmental and fault-finding, they are dangerous. Dangerous in their tendency to narrow our thinking. I had an experience early on that made this point loud and clear to me. Before seeing a patient one night I was handed the chart by a nurse who asked if I knew the child. I did not. She went on to tell me how difficult the parents were and how the kid was a “frequent-flier”. I glanced at the chart before seeing the child and read a few notes all with comments about this “unfortunate” child and her demanding parents. Several days later I learned that after seeing me, and returning to another physician she eventually presented to the ED in extremis. I sat down alone and went back over my visit. The only error I could find in my care was one of perspective. I entered her room biased. Biased by descriptive words used by the nurse and found in her chart that should not have been used. Did I miss her diagnosis because she was in my office too early in the disease process? Or did I miss it because I was viewing her as a complaining frequent-flier with difficult parents?

When we enter into care for a patient we need to approach them as if they are a tree of possibilities. The choices of diagnosis and the decisions around care should be narrowed not by our own bias and judgment but by careful medical thought. To speak of our patient’s with critical descriptors is not only rude but it is medically dangerous; doing so hurts them, and leaves us at risk as well.

Balanced Lives – with gratitude

Two weeks ago I sat in an open air cafe in Istanbul lazily eating mezes or appetizers, drinking dubious Turkish wine and talking with my godmother. What a gift! As we sat and chatted the conversation turned where it usually does between two doctors. Boring anyone around us, we always seem to find a way back to the days of our training, trading war stories from the hospital days.

In this case my paltry stories were truly weak compared to hers. Her training was Herculean. She graduated from the University of Virgina medical school sometime in the early 60s as one of two women in her class, did a residency and fellowship in the South Bronx and has just recently retired from a career as a hematologist. Her hours were brutal (every other night for every year), her education never-ending. If every minute out of the hospital is indeed education lost, she lost little. Except sleep. Among lots of riveting tales of patient care challenges, there was one striking personal story. Late in her residency she was at last granted three days off for Christmas. On Christmas Eve she drove from New York to Virginia but became terribly lost on the familiar drive because of a haze of illness setting in. She arrived on her parents’ doorstep at 2 AM exhausted and feverish only to sleep through most of Christmas and drive back to NY the following day. When she returned to work an attending noticed how ill she was and sent her for labs that ultimately revealed mononucleosis. This was thrilling to her – two weeks of enforced time out of the hospital! Who cares how ill she was – there was freedom and sleep before her!

My experiences as a medical student and resident could not have been more different. Although I trained before there was any attention to national limits on resident work hours, I certainly did not have every other call at all, let alone for years. I managed to insert a pregnancy into medical school, one into residency and much to the chagrin of my now-colleagues, one the first year I graduated. I did not have to become ill to find a balance in my life (although I may have been equally sleep deprived thanks to the 3 kiddos).

I just finished reading a thought-provoking post by Doctor Chris Porter. He wrote of the need to shift our mentality or thinking about hours worked in the hospital. He felt it benefits our profession to be accepting of a balance of hours in the hospital (learning more medicine) with hours out (nurturing our families). How true. I am a product of the shifting tide of thought. I am also made very grateful to those pioneering sorts that went before; listening to my godmother talk made me even more acutely aware of the gifts they gave us today.                               ©

 

 

 

 

 

Addendum: Dr. Porter has another wise post on his blog site: On Surgery, “The Part-Time Doctor”. In it he states “Openly planning to balance work life with family life is mature and admirable”. Hear, Hear!

Fava Beans: Slow, Dangerous and Tasty

I am having trouble getting these people I live with to appreciate fava beans. What on earth is their problem? For me, favas have a prodigious quality; they fill me with wonder. This family of mine and a few good friends, seem to think I am a bit screwy.

I plant fava seeds in September, maybe October. The summer crops are finished and pulled out to the compost pile, the winter garden is planted. Most of it is meant to be eaten through the winter; chard, kale, parsley, broccoli, onions and more. But, I fill in wherever possible with fava seeds. They germinate, sprout in the fall then are sort of dormant in the winter as we eat all those cruciferous veggies (my family complains some here also). Then, in the very beginning of spring the fava plants wake up and take off for the sky – easily hitting a height taller than me. Many people plant them as “cover crops”; they are nitrogen-fixing plants and renew the soil, nourish the compost. For this purpose they are plowed them under or composted this time of year. But I wait. Wait until those pods are hugely pregnant with beans. Then some random day in May I recruit helpers to haul out the plants and find all the pods (they are by then about 9 in long and swollen with about 6-8 beans). We then take the pods into the house and begin shucking them, forming more compost and a surprisingly small pile of beans. These beans are next briefly dipped into boiling water to blanch them and loosen their skins. After diving them into an ice bath I start shucking each bean out of its whitish covering. “I” because by then I have usually lost all my helpers who somehow do not see the beauty of this process.

Then with my shockingly small pile of bright green beans, I can cook dinner. I usually get two meals out of a harvest. My favorite two recipes are a ragout with sausage, favas, tomatoes and papardelle and, mashed favas and mint as a bed for halibut. Both yummy indeed but, both more delightful for the celebration of the passage of the seasons and the miracle of growth. Eating them creates a zen-like experience. It becomes one of those times when you pause, breathe in and really taste the food on your tongue.

Briefly though, there is a danger to eating Favas. People with the X-linked recessive hereditary disease Glucose-6-phosphate dehydrogenase deficiency can develop a fatal hemolytic anemia after eating favas. People of African, Middle Eastern and South Asian descent are affected most often. It could therefore be surprising to hear that favas are most commonly enjoyed in theses very parts of the world. The theory behind this is that the condition of “favism” offers a protection against infection against malaria.

Slow, nourishing, dangerous and tasty… How could you not be awed by these beans? Indeed, it seems one other person around here “gets” them. For mother’s day I was given a poem:

Dear Mom,

You are as exciting as radishes, as pretty as flower.

You are as spicy as peppers and you always have thyme to help me.

You are worth the work like fava beans and as sweet as blackberries.

Worth the work? Me? Hmmm.

Vulnerability, Becoming a Better Doctor and the Beach.

I like to keep a separation between my workday and my home life. It is created by a walk to my car and a 20 minute drive home. During this time I think, create and often, ask myself how I can be a better doctor tomorrow. Lately, I have been thinking the answer lies not in reading more books or journals, timely license renewal or peer review. The answer it seems, lies in feeling my own vulnerability.

I had a patient this week who was perhaps, a bit challenging. I was overloaded, behind, late. She was not doing what her parent and I needed her to do. Frustration started to enter the room but, as I sensed its arrival I stepped back (literally) and looked at my patient. Then, it hit me. She wasn’t trying to be non-cooperative (that horrid, judgmental, doctor term); she was feeling vulnerable. Scared, hurting, feeling… at a loss. Being ill or hurt makes it hard to be brave, strong and – cooperative. The more time we physicians have the “opportunity” to feel this vulnerability, the more we become able to feel what our patients and their families feel.

Maybe I should not take vacations. I seem to end up worse for the wear after many of them. Hawaii the first time found me in preterm labor and complete bed rest at 20 weeks. Scary then, but now he is 15 and perfectly fine. Hawaii again led to a ruptured appendix and way too much time in a hospital bed. Most recently, a sparkling San Diego day disintegrated into an explosion of pain as my skate slipped on a patch of poorly placed sand. I was left immobilized for a handful of weeks and am now facing a ridiculously long period of rehab. Each of these beach-side mishaps left me stranded, forced to slow down and experience the world as many of my patients have had to. I felt acutely vulnerable. Pain. Needles. Limp. Weak. Dependent. All of this bringing to mind an often quoted passage:

“Did you ever say yes to a pleasure? Oh my friends, then you also said yes to all pain. All things are linked, entwined, in love with one another.”

“What does not kill me, makes me stronger.”

– Friedrich Nietzsche

Yes to vacation? Then risk yes to… learning. For I have found during each stint with vulnerability my skills as a physician do become stronger. But maybe on my next trip (in June with my mother and Godmother in a faraway seaside city) I can take a holiday… not just from daily life and work but from learning?

Classic Tales: Pelicans, Pennies and Pain

I am reading a book now that has got me thinking. It is The House on Mango Street. The jacket cover tells me that I ought to find it important; perhaps a classic. A classic? What exactly is one? My sixth grade English teacher snarkily informed us that a classic was just a book our parents had been made to read so they felt compelled to set us to reading. I came home and told my mother (a classics-lover if there ever was one) and I do believe this may have been one of the three times I have seen her really mad). I chatted with a friend the other night about this concept of “classics”. He felt that often a classic was simply a book of overblown reputation. Perhaps he and Mrs. Snarky were on the same page?

I took little english in highschool and none in college. Yes, none. So now I feel at times left out of the dialog. I try to catch up by reading the “classics” that I hear referred to, their names tossed around like ping-pong balls by those in the know. I read Shakespeare when riding the Muni to and from work one winter. Read all of Jane Austen at some point. I devoured Anna Karenina and The Age of Innocence kept me awake until 2 AM when I reached the horribly frustrating ending. I read classics to understand what all the hoopla is about; to be on the collective conversation. It seems to me that usually the classics are dubbed such for a reason. They are classic indeed.

The style of The House at Mango Street is interesting. It is written in very small chunks. Disjointed chapters with tantalizing titles telling, piece by piece the story of a girl’s youth in a poor Chicago neighborhood. It was a hard read; perhaps I was in the mood for a book with a plot? After one bout of trying to connect with this respected book I lay in the dark thinking about it. Then the magic of it hit me.

I also seem to experience life in disjointed moments of clarity. The days are filled with so much routine that is the punctuation that stands out. Our lives don’t have a plot really, they don’t have the suspense of a good novel. We move through the routine of life from moment of sharp juxtaposition to the next. So a book written in small chunks of observation, is a commentary on our routine lives – small offerings to be pondered and thought about. Bit by bit.

My night-time thoughts proved true in the morning. As I moved through my day it wasn’t the connecting pieces that struck me. Instead I would tell you a tale (much like that unfolding on Mango Street) of small moments. My 9 year old’s joy over finding he could buy a big basket of shells for the scant money left in his pocket.  Laughing at my children as they worked to count every pelican that soared overhead for days after their aunt offered to pay them a penny a pelican. She had no idea how observant they can be! The incredible pain of falling hard when least expecting it. These form the stories of our lives and these stories are often the ones worth considering classic.

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Spring Has a New Name

Sure, every mom does lots of laundry. I too do lots of laundry. It used to really bug me. I would try different systems of managing the endlessness of it. My sister-in-law swears by an only one day a week system. No laundry for 6 days did sound like a dream come true….problem was that the seventh day was hell.

It is the folding that really kills me. I don’t seem to be able to stay on top of it. My best friend suggested her trick: don’t. She hucks the load of clean laundry on her bed and the kids sort through and grab their own stuff and…stuff that in their drawers. My mother was horrified when I tried this; she straightened their drawers and folded every thing in the house for the whole week she visited.

I came to peace with the laundry some time ago. I decided to try a zen-thing with it. Tried to focus on the moment, to feel the cloth as I folded. Enjoyed the peace of the laundry room alone. Started listening to NPR podcasts to get me through. I developed a nifty system of organization in my laundry room. It was, as they say, all good. For a while. Then, spring hit.

Spring came last year and involved one baseball player, one softball player, one lacrosse player, two swimmers, five skiers and a new puppy. Wet towels, muddy pants and smelly socks piling up day after day threatened to take me down the path to insanity. How is a mom supposed to keep up with spring in the laundry room? Well, I think I found an answer. Make that three answers, a boy, a girl and their brother.

Spring has come again. I call it Laundry Season. This time it involves three lacrosse players, two swimmers, the ?dog and five skiers. Yesterday one of them came to me and asked what setting was right for his lacrosse pads. Cool.

Oof!

I am still reading The Creative Habit by Twila Tharp, I am motivated by Doctor_V  but, I still haven’t gotten out of bed before the sun to write. What a struggle this creating a writing habit is. I write for fun, I write for pay, I write to get better at writing but, increasingly it is hard to carve the time to get the job done.

The kids interrupt. The “dog” barks. The cell phone rings. The house phone rings. I ought to exercise. My hair grew. The garden grew. My neighbor is all kinds of fun. All kinds of excuses. But dear reader, the biggest distraction is this computer! Email (on 4 different accounts, don’t ask), Facebook, Twitter. The NYTimes and LATimes on-line. Love Wikipedia! Need to check to see if I have comments here to respond to. How many people looked at my blog today?…  Oof! How, when we write for a living on the computer, do we turn it off to write?

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The “Dog”. What is your theory?

Late one night in January last year the kids came running in the front door thrilled with a fuzzy new find. Percy was an abandoned, dirty, matted and very hungry 2 month old puppy of indeterminate breed.  We tried all the usual channels but, no one ever claimed him. Puppies, it turns out, are a bit of work. We (read that as: the grownups in the house) were thrown into a cycle of late night runs for the backyard and endless rainy walks saying (on the advice of a well-respected puppy trainer) “Do it, Percy, Do it” to train him to defecate on command.  As if. I started searching for recipes that would separate the meat from all that hair. No luck. It has since then been pointed out to me that I did not actually have to keep the critter that perhaps, I should have told my three beaming children “No”. Right. You try.

Everyone likes to give us their theories about  what exactly, he is. Portuguese water dog? Something-a-doodle? Bijon frise? The cat thinks he is a cat. He thinks he is …comfortable here.

 

 

 

 

 

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Connections and Bonus Questions

I just read “18 Stethoscopes, 1 Heart Murmur and Many Missed Connections” a fabulously written article in the New York Times by Madeline Drexler. She tells her story of being a model patient – a person with a medically interesting “finding” who is asked to help teach medical students. These “patients” are examined by small hoards of inexperienced medical students who have little knowledge, little skill and varying degrees of innate bedside manner.

I was fortunate enough to go to a medical school where we began examining patients – real and staged ones – from month one. I still remember many of these people well; more clearly perhaps, than those I cared for in my sleep-deprived haze of residency. As Ms Drexler describes, I am certain that back then, I too was filled with awkwardness and overtaken by my interest in the examination findings at the cost of expressing empathy.

There is one that comes to mind now. He was a model patient for my final exam in a class on physical examination. I think he might have been the bonus “question”. I had studied hard. I was tired. He was in a room behind a door I nervously opened to find the answer to what exactly was different (medically speaking) about him. There in the room, on an exam table sat this young man. He may have been 25 or so. Dark haired, bespectacled and calm. I approached him and began the work of examining his body for a “finding” of sorts. Heart, lungs, abdomen… all depressingly normal. Mouth, neck, ears…getting closer. Then to my joy I found “it” and remember well the thrill when I did. There was a big part of me that wanted to say ” Woo Hoo! I did it”! Ms. Drexler describes this reaction in other students:

“This was a student who is not uncaring or unkind,” Dr. Treadway told the class. “But in that moment she did something all of us do all the time: she was so engaged with the problem that she forgot about the person who had the problem.”

I had a favorite attending doctor in medical school. Everyone else was scared of him. I looked up to him. Sure, he asked the hardest questions and embarrassed me at times. I stood tall with the knowledge he was doing this to make me better. And, when I watched him with patients and parents I saw that all of his sternness evaporated; he became the most caring doctor in the hospital. He asked, as Ms. Drexler reminded us to do, about how it felt to be stuck there as patient or parent. When he was talking with a family it seemed that perhaps, time had stood still. He had no where else to go, nothing else that mattered more than the people in front of him.

I think of this man often. He motivates me still. And, what I know now after all these years, is that I am still learning. Every visit with every patient I strive to become better at listening, interacting, understanding. I reach for the ability to make them feel that time has stood still in that room with them. I am not there yet but – reading Ms Drexler’s words and remembering my attending’s gifts help me feel that I might, just might get there some day.

P.s.: The answer to the bonus question was prosthetic eye.

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Shoveling Snow

Just a brief note of contemplation:

It has been a long and stressful stretch of work. Extra hours filled with lots of sick children both at work and, at home. I have been feeling the imbalance that for me occurs when my mind works overtime and my body doesn’t get out the door to work at all. So, today I was happy to be at last moving more than thinking.

I find a certain solace in repetitive brute work. Hiking steadily uphill with a big pack. Mowing the grass with a hand mower. Digging a big hole in the sand. Shoveling snow. You might guess I problem solve, create or brainstorm while grunting. No, I just completely relax. Completely zone out and… refill the tank.

Now, after first a bout of shoveling followed by a long walk in the snow, I sit, calm again. Ready maybe, to face the week ahead. Oh, its only Friday? Ahhh, good. More grunt-work tomorrow.