Wonkette on Cheney's Asia Trip

I almost choked when I read this: So That's Why Cheney Won't Return To America ... The article itself is also hilarious.

Enough procastinating! Time to get back to work!

Hives of another kind

Another picture of a building in my neighborhood that was recently taken down.

In today's New York Times, there's an article about vanishing honeybee colonies. Apparently, for reasons that are still elusive, bees just aren't coming back to their hives. This has great economic consequences, as many crops (up to 1/3) are pollinated by commercial hives.

Wikipedia's article on honeybees is full of fascinating tidbits. I didn't realize, for example, that honeybees were imported to the Americas by European settlers, and that wild swarms are actually "feral". Native Americans called the honeybee "the white man's fly". It's not clear to me whether there were any bees before Europeans got here.

In my back yard, come spring, I find bees, praying mantises, crickets, caterpillars and various unmentionable insects and animals. This little slice of nature in the middle of the city comforts me, but I wonder how many of the species are non-native. Does it matter?

city life

Continuity Clinic, Part 1

My next patients are from one of my favorite families. The mother is in her early 20s, with three children and another on the way. Despite her youth she is fiercely maternal, round and protective. Today I see the oldest, a five-year-old girl, and her two-year-old brother; the three-year-old girl is scheduled for next week, but she’s here, too.

There are no medical concerns about the oldest child, but her mother asks me about her behavior. Since her grandmother died last summer, she’s changed. More attitude, more moodiness. The girl’s mother is worried that she is still grieving for her grandmother. What should she do?

Turns out that with the death of her grandmother, the family has moved in with the mother’s new boyfriend, and that it’s now clear that mother and father won’t be getting back together. The father is still involved, but the girl sees him less and less. The mother is frankly overwhelmed by the three children, and, although she loves babies, is terrified about adding another child to the mix. In past visits we’ve talked about enormous energy bills and evictions. I don’t ask, but wonder, how the family is supporting itself. She doesn’t work and welfare is no longer generous.

One of the reasons we go into medicine, spend four years of college grubbing for A’s, waste our youth in more school and training, is that we love to solve problems. We are fixers of people. But how can I fix this?

How do you deal with a mother who has labeled her two year old as “bad” because he likes to get into things? Even the five year old says he is a “bad boy”. The three-year-old girl is also “bad”, but she climbs into my lap and wants to use my stethoscope. She draws me a picture and is touched when I take it. Where can I even begin?

I have 15 minutes to cover these questions, explain the ever-expanding list of immunizations, examine her, do developmental screening, and counsel about safety and reading. How could I possibly begin to talk about how she might be reacting to having a new stepfather? Explain how the mother should deal with it? Counsel her on how to deal with moodiness?

So I tell her that she should try to ignore the attitude, and should focus on the priority behaviors, that she and the boyfriend should both take individual “special” time out to spend with the child, that they should “catch her being good”. I ask the social worker to meet with the child to explore the question of grief. Reading this you may get the wrong idea about my methods. You may think that when I say I told her to focus on priority behaviors, I spent time coming to an understanding of what things were important to the mother, using what I learned to tailor the advice. That I spent time demonstrating what “catching her being good” means, that I probed the intricacies of the mother-boyfriend-father relationship. You would be wrong. All of my schooling, personal growth seminars, volunteer workshops, supervision, and reading have given me the right catch phrases. But any observer could see the distance between my words and her life.

I know this, and I don’t know how to change it. And I have to get to my next patient, and this family’s ride is almost here.

Snow Days

The snow has finally come, and, as usual, it is a case of be careful what you wish for. Snow brings snow days, which bring sledding, which bring every kind of injury you can imagine. Sledding into cars, being run over by cars, hitting trees, lacerating legs, fracturing skulls and many other bones; the list really is endless. The snow days also seem to lead to scalding injuries (hot chocolate, soup, etc.) and dog bites.


*This picture is actually from last year, as I haven't had much time to be outside taking pictures.

Baby, Let Me Follow You Down

Until I read this remembrance by David Hajdu, I didn’t know that Eric Von Schmidt had died. Mostly I know him from his influence on Bob Dylan, who says on his first album that he met him in the "green pastures of Harvard university". According to Dylan (at least in 1969), “He could sing the bird off the wire and the rubber off the tire, He can separate the men from the boys and the note from the noise. The bridle from the saddle and the cow from the cattle. He can play the tune of the moon. They why of the sky and the commotion of the ocean”. From Cambridge, where he lived, he also influenced many other folksingers, including Joan Baez, the daughter of an MIT physicist.

bats

There's a profile of Paul and Patricia Churchland, husband and wife philosophers, in this week's New Yorker. They are interested in neuroscience and questions about mind/body dualities. At one point, Thomas Nagel's essay "What Is It Like to Be a Bat?" is described. Nagel asks the reader to try to imagine what it is like to be a bat.

"Insofar as I can imagine this (which is not very far)," he wrote, "it tells me only what it would be like for me to behave as a bat behaves. But that is not the question. I want to know what it is like for a bat to be a bat." The purpose of this exercise, Nagel explained, was to demonstrate that, however impossible it might be for humans to imagine, it was very likely that there was something it was like to be a bat, and that thing, that set of facts-the bat's intimate experience, its point of view, its consciousness-could not be translated into the sort of objective language that another creature could understand...But if the bat's consciousciousness-the what-it-is-like-to-be-a-bat-is not graspable by human concepts, while the bat's physical makeup is, then it is very difficult to imagine how humans could come to understand the relationship between them.

The impossiblity of imaging the interior life of a bat, while at the same time being able to understand the biology of the bat is used as an argument for a special status for consciousness, and against the ability of neuroscience to completely understand it. For some, this is an argument for a fundamental mind/brain duality. The Churchlands strenously disagree, and I'm inclined to second them. The fact that we can't fully imagine what it's like to be a bat is not that informative. If we weren't faced with the fact of bats themselves would we be able to imagine them?

[Looks like there's no online version of the New Yorker article. Sorry.]

Ice Hymenoxys

Here's another winter picture. From digging, by way of apartmenttherapy, one of my (many) frivolous indulgences.

Snow

I wish it would snow. Snow is one of the consolations of living away from California, but this year the weather keeps teasing me. I know that in other places they are drowning it it, but I've missed what little we've had. Here's a picture from last year.

Strawberry eyes and carrot nose - it's a little exhibit of how our economy has changed from the days of Frosty, when snowmen had to make do with coal and buttons.

Giant Squid

Inspired by one of Errol Morris’s First Person segments, I went looking for information on Giant Squid and stumbled upon this trove of images that are in the public domain. They are not organized well, but some are quite interesting. Here is another:

A very special day

Most of the time work at the hospital comes closest to Scrubs. Occasionally, like last night, it is similar to an episode of ER. (Apparently the combination of Monday and cold weather makes many teenagers want to drink draino.)

Today was straight out of an ABC after school special. Or maybe one of those movies they show on Lifetime or Oxygen.

Step 3

Partially because I am cheap, but mostly because I am lazy, I have put off taking USMLE Step 3 until now. Studying has made me realize how much I've forgot, but, I swear, I don't think I've ever heard about some of these things. Some examples:

• I vaguely remember VIPomas from medical school, but glucagonomas? And who knew that 67-90% present with migratory necrolytic erythema?


• Drusen, apparantly, are refractile deposits that can occur in the optic nerve head. (And there is an unrelated syndrome: drusen of the retina)


• Shouldn't I know by now that epiphora is the medical word for tearing? It's a nice enough word, but why do we need another word when we have one that is specific and not vulgar?


• A pinguecula, helpfully, resembles a pterygium. Actually, it turns out that both of these nodules on the conjunctiva are common.

As might be apparent, I know virtually nothing about the eye. It might be because I spent 1 1/2 days in medical school on ophthalmology. I don't think that any of these things will be on the exam, but the words are beautiful, no?

Update: Drusen were indeed on today's exam.

Red Tide

I find myself now, at 30, surrounded by people and things of my choosing, feeling nostalgic for an evening 16 years ago. Perhaps it is not strange, as I stand looking out on a gray sky and a gothic prison, that I think about a beach bonfire. It would have been late summer, when the tourists and the fog were both lifting. In the hills, a dry wind would blow off the oak trees and fields, bringing a smell of warm straw. A neighbor, a girl who seemed, even then, to be anorexic, invited me and drove me in her Turbo Volvo, of which she seemed inordinately proud. I don’t remember her name, but I do remember her telling me that her mother said, “women are like flowers, every time they have sex they loose a petal.” At the beach football player types and their girlfriends, a group I barely knew, drank beer surreptitiously.

Although I had lived on the central coast of California all of my life, I had never seen the waves lit up the way they were that night. It was as if the Milky-Way had fallen into the bay. In small groups the boys stripped to their shorts and dove in the shimmering water, leaving glowing trails. They swam around the point to a cave in the cliff, accessible only through an opening under water. Shivering and boasting, they dried themselves by the fire. Walking at the reflective edge of the sea with the moon reflected dozens of times on the waves, I felt that if I died then, it would be alright.

But now, I can’t help wondering, were even the innocent things we loved poisonous? Bioluminescence is the official word for what I saw that night, and tiny organisms called dinoflagellates cause it. These algae can cause a variety of fish and human ailments, including paralytic shellfish poisoning. Red tides off the California coast have become more common since 1991, when I first saw them, the increase attributed, at least in part, to increased agricultural runoff and warming of the ocean. They have been associated with fish and bird kills, and small outbreaks of seafood caused illness. Although periodic climate variations may have played a part in that year’s bloom, and the glimmering I saw might have been from one of the harmless varieties of the dinoflagellates, more likely that magical night was an early sign of global climate changes to come. And so I think about how easy it is to conflate beauty and “goodness”. I ponder danger, youth, and the limits of aesthetics as I watch the trash-strewn alley, the prison and the gray sky.

[Picture from Wikipedia's artice on Red tide.]

Ronald Mallatt

On the way to Home Despot today, I heard the tail end of This American Life. The profile of Ronald Mallatt, who recently wrote a memoir, was wonderfully strange: a boy whose father dies when the boy is 10 becomes obsessed with building a time machine so that he can see his father again. This obsession rules his life; eventually he becomes a physicist, specializing in black holes, but still secretly holds onto the idea. Finally he comes clean, and writes a scientific paper that relates to time travel. Although the reviews of the memoir all talk about how inspirational the story is, for me it brought up questions about how we define sanity, and about the uses of madness.

Reminded me a little of Fast, Cheap and Out of Control.

Being a patient sucks.

Being a patient sucks.

This is probably not news to most non-doctors, but since I’m a doctor, and as such, tend to avoid medical care at all costs, I rarely see it from the other side. There are many reasons that we avoid going to the doctor: pride, feelings of invincibility, lack of time, to name a few. But by not experiencing it firsthand, we can forget the fact that being a patient really sucks.

I’m not even talking about the doctor’s appointment. I found aspects of my recent trip to the gynecologist to be pleasantly regressive; it was comforting to be cared for, and to not have to make the decisions, even if parts of the interaction were disturbing. Like the Native-American-inspired semi-abstract 3-D wall sculpture of a vagina from which a baby’s head was emerging in his consulting room. And there was the off-handed mention that he had once had a patient just like me who turned out to have cancer. Not that he thought that I had cancer, no, no, that case was so unusual, and he probably would see only a couple more cases like that in his career. Cancer? That wasn’t even in the top 10 things I thought could be causing my problems. Not something that had showed up in my literature searches, and certainly among the possibilities that I had stayed up worrying about. Did he mention this to all of his patients? Or was he nervous because I’m a resident? Come to think of it, he did seem nervous. Maybe it was because there was a vagina on the wall?

No, it’s wasn’t the doctor’s visit. And, cancer-talk not-withstanding, I wouldn’t even call myself sick, so I can’t speak to the obviously suck-y aspects of illness. What has driven me to tears of frustration is dealing with getting the studies that the doctor ordered. I showed up for an ultrasound after 3 hours of sleep to find that the requisition hadn’t been faxed in, delaying the study for another month. I tried to get my blood drawn during a break but was unable to because the doctor had used a prohibited abbreviation, even though it was clear to everyone what he meant. Always, always, the doctor’s office is closed. The office staff is patronizing, instructions are vague, and the bureaucracy is inflexible. And I am doing this at the hospital where I work, all the time wearing my ID badge that says C, MD. I can’t imagine what it is like for my patients, whose parents sometimes have marginal literacy, who have real illnesses, who don’t have the resources that I have. And so, I vow to be more understanding. After I finish fuming.

When I was a child I wasn’t much for dolls. Stuffed animals, some, but actual baby animals, no, and dolls even less. I wasn’t the kind of girl who imagined her wedding and then imagined her children. As I became a teenager, I embraced a more radical feminism, and the thought of becoming a wife and mother seemed even less probable. In college, for one of my co-op’s yearbooks, I was asked about my plans for marriage. My answer was concise: Ha!

A few short years later I fell in love. We moved in together. I spent afternoons and evenings with our neighbors’ children, who were toddlers when I moved there. Alexi, the eldest, would come over when I came home from classes or clerkships, and we would read or draw for a while. Then, on many nights, she would help me cook, spinning the salad, and sit wordlessly with us through dinner. My closest cousin also had two children during that time, brilliantly charming to my biased eyes. Watching one, 3 or 4 at the time, while my brother had surgery, he asked me solemnly, “Will they have to cut off his head?”

I decided to become a pediatrician, in part, because it seemed like it would have a better lifestyle for a family. I waited a year to graduate from medical school so that my new husband and I could move together across the country. When it came time to choose a specialty, it became apparent that my plans to have a career that focused on international health would be difficult with a family. After much agonizing I chose a specialty with a much easier lifestyle. So many decisions, both large and small, were made on the assumption that I would become a mother. We even had a plan, unspoken at first, finally agreed upon explicitly, to have a child at the end of my residency.

And now, every month goes by with another negative pregnancy test. Every period becomes a betrayal. I find I cannot even speak of it without tears. Even though, on a theoretical level, I know that there is overpopulation. Even though the world seems like an unpromising place to in which to bring a child. Even though I know that even in the best of circumstances having a child makes people more unhappy, is difficult for the marriage, is hard on the body. Even though I’ve seen uncountable instances of the worst of circumstances, where a child destroys everything that the parents used to call life. Even so, I can’t imagine not having a child. The easiest thing is to not think about it too much, but even that can be hard. Many of my classmates, on the same biological timetable, are pregnant. One is adopting because she and her husband have tried for so long. At work, I’m surrounded by babies, some with grandparents only a bit older than me. It’s still relatively early, and I try not to get discouraged. Anyway, it’s foolish to believe that we can chart out our future. So I keep waiting.

Southbound on the Northway

I took this blog’s title from the name of a town in New York. As I was recently driving home from up-state New York, I was impressed by the poetry of the exit signs. Together, they amounted to a kind of “found” poem.

Round Lake, Burnt Hill
Suffern
The Oranges
Winters Run

The names reflect a certain sensibility of the founders.

Street Fight

Watched Street Fight last night. I strongly recommend this movie, which was nominated for an Oscar for Best Documentary. It is about the 2002 mayoral election in Newark, a city with similar problems to the city where I live. I expected it to be interesting because of my experiences here, and because it is an inside look at an election, but as the film progresses, the outrages build. A reminder of how fragile democracy is.

It also begins to explore self-defeating beliefs of some poor African-American communities; I think we may see this again in the upcoming election with respect to Barak Obama. Is he really black, and so forth.

Metaphors

Between subdivisions and cornfields lies the pond. The ice comes together like tectonic plates, groaning as it shifts. Samuel Beckett’s face comes to mind, lined and furious, and I think that’s how I’d like to grow old. (Is that possible for a woman?) The frozen mud crunches under my step. I approach the edge. Put a foot on the surface to gauge its strength. It shudders and creaks. Cracks propagate out. I push harder and harder. Suddenly the ice gives, my foot falls and water splashes up my leg. The noise and cold are surprising, exhilarating. It’s not that I don’t like my nice warm socks…


I head home.

Urgent Care

Recently, one of the other residents called me in to help out with a laceration repair on a 3-year-old boy. It was a small cut on his chin, and she had already numbed it up, but she needed some help holding him down. We have a tool called a Papoose, whic is a straight jacket with a bowling pin shaped hard plastic surface – it straps down the child’s body, his arms, and his head, but is really no match for a strong 3-year-old who wants to move his head. We put him in the Papoose, I leaned over him to hold down his face, and the other resident draped his face.

Like all children, he did not like having his face covered, and he began to object. He started with the simple:

“No
Stop
Get me up”

Then:
“I’m going to pee on y’all”

I had no doubt that he would. She started to put in the stitches, which he not seem to particularly notice compared to the trauma of being held down. He continued to call out, moving through the other phrases toddlers say:

“All done
All done
Bye-bye
Bye-bye”

Then the most heartbreaking for me, also common:

“I’m sorry, I’m sorry, I won’t do it again, I’m sorry”

Meanwhile, his brother and father lounged in the corner, laughing at “the little man”, and telling him to be quiet. He continued through several more rounds of the above phrases for about five minutes, as my co-resident finished the repair. Finally, though, it was too much, and he brought out the last tool:

“GET THESE MOTHER-FUCKERS OFF OF ME”

I was impressed that it took so long for the big guns. Such restraint for a 3-year-old.

bad for the clothes

Robert Frost on his theory of writing:

“A sentence is a sound in itself on which other sounds called words are strung. You may string words together without a sentence-sound to string them on just as you may tie clothes together by the sleeves and stretch them without a clothes line between two trees, but – it is bad for the clothes"

From Christopher Benfey's review of the new Notebooks of Robert Frost in the New Republic.