Lying Fallow ~ by Jay

I seem to have hit a dry patch. It's not that I've run out of ideas, it's just that when I try to put any of them into words, I end up erasing and retyping and erasing and retyping...not actually writing.

At the moment, I'm doing a load of laundry and emptying and refilling the dishwasher before I go upstairs and pack to go away for the weekend, and so the blog will continue to lie fallow for another couple of days. I hope to stop erasing and start writing again next week.

Conversations With my Daughter ~ by Jay

Mommy, you know that cake you baked last night?

Yes.

The one that was sitting on the counter?

{Mommy has a sense of foreboding} Yes?

The dog ate it. Good thing it wasn't chocolate. Then he would have died

{Mommy, through valiant effort, manages not to say "That would have been only fair".}

I Know I Need to Turn the Radio Off When...~ by Jay

....the local sports psychologist starts opining about "why the female psyche might be more advantageous (sic) for car racing".

Dude, there's nothing about the "female psyche" that I want to hear you tell me. Not.One.Thing.

What, You Can't Read My Mind? ~ by Jay

Of course you all know I'm thinking about posts - posts about women, free choice, the patriarchy, and porn; posts about this week in the office; posts about discharging patients from hospice; posts about my colleagues and their intermittent cluelessness. Sure, you know all that.

You mean you don't? I have to actually write them all out? Uh-oh.

At the moment I'm preparing to host friends for dinner and then lead services tonight, and head out for my mother's tomorrow morning. Sam and I are staying in a hotel, so I might blog over the weekend, or then again I might have something better to do. Either way, I'll be back home on Monday and should be back to regular blogging next week.

I'd wish the Americans out there a happy Memorial Day, but it's not really a happy sort of holiday, despite the beach trips and the barbecues. So I wish you peace.

Oseh Shalom

Oseh shalom bimromav
Hu ya'aseh shalom aleinu
V'al kol Yisrael
V'imru, v'imru amen.

Ya'aseh shalom, ya'aseh shalom
Shalom aleinu v'al kol Yisrael
Ya'aseh shalom, ya'aseh shalom
Shalom aleinu v'al kol Yisrael, v'yoshvey tevel, vimru amen.

(May he who makes peace in high places,
make peace for us and for all Israel,and for all the world,
and let us say, amen.)

Conversations with Acquaintances ~ by Jay

Why didn't you put a hat on that baby?

So people like you would have a reason to criticize me.

And Yet More On Uncertainty, Autonomy, Booze and Babies ~ by Jay

Is it "moralizing" to tell a woman that smoking causes asthma in children? If so, is that a bad thing? And is it wrong to try and give your baby the best in utero environment possible?

There are two separate issues here - at least. Let's tackle the last one first.

Is it wrong to try and give your baby the best in utero environment possible? No. Of course it's not wrong. It's every woman's right to do the best she can for her baby before and after it's born. I would never tell a woman she should drink during pregnancy. But there's a big difference between what we decide to do for ourselves as individuals and what society tells us we must do. The original article I quoted suggested that Australians should adopt a public health strategy of walking up to pregnant women in bars and telling them to stop drinking. That's not the same thing as giving women information to make their own decisions. That's making it public policy that women are supposed to be perfect, and deputizing everyone - not doctors, not nurses, but total strangers - to enforce the rule. That's treating women like children who misbehave in public.

For some women, the stress associated with trying to create the perfect uterine environment is in itself toxic - to the woman, if not to the baby. That's a lot of pressure to put on a woman: be perfect. Be perfect, or else. Be perfect, or your baby will suffer. Be perfect, or you're a bad mother before your baby is even born. And if you're not perfect, everyone has the right to shame you. More on shame later.

Now on to smoking.

Smoking and drinking are not the same thing. Smoking carries a health risk no matter how little you smoke, although the risk is greater for heavier smokers, while alcohol intake creates risk only at certain levels, and is probably beneficial in moderation. I counsel all my patients to stop smoking, and I do talk with them about the risks to their kids. It's a pretty far jump from what I said, which is that it may be safe to drink sparingly during pregnancy, to where the commenter landed, which seems to be on the square that says Jay thinks it's OK for parents to smoke around their kids. Maybe ze just meant to challenge my stand against drive-by moralizing, though. Let's look at that.

What, precisely, would we accomplish if we all walked up to smoking parents and told them they were hurting their kids? That approach assumes that the smoker didn't know, and it assumes that hearing such information from a stranger will help her stop smoking.

That's not how it works, though. Most smokers are aware of the risks to them and to their kids. They've heard about cancer and lung disease and asthma and increased ear infections. So why do they smoke? Great question. In fact, that's the question I ask all my patients: what do you like about smoking? Trust me, there's something they like about it. Smoking is meeting some need. They won't stop smoking until that need can be met by other means, or the costs of smoking start to outweigh the benefits, or both. It's not about information.

"Her right to smoke ends at her child's lungs". Well, I suppose so, but if we're really concerned about that child's lungs we need to help her parents stop smoking entirely, and one comment on the sidewalk isn't likely to accomplish that.

"Sometimes it's about the child". Yes, but how is the child helped when we shame the mother? Shame doesn't motivate change. It may drive behavior underground, but it doesn't motivate lasting change.

If we really care about the children, we have to care about the mothers. My understanding about helping people change comes largely from Miller and Rollnick. Here's what jumps out at me from that link: Motivation to change is elicited from the client, and not imposed from without. And it has been my experience - and the experience of others who have studied change - that shame impedes that process. Changing requires resolving our ambivalence about ourselves and our behavior, as well as creating new coping strategies. If we are using our energy defending ourselves against shame, against advice that feels like an attack, we have fewer resources to devote to the real work. We're too busy shoring up the castle ramparts to light a fire inside.

As Mama has pointed out in her comments, there is no consensus about abstaining from alcohol during pregnancy. Even as a physician, who has every right to give my patients advice about their health, I don't tell women not to drink. If we do - if we say good mothers don't drink during pregnancy and you should put down that glass right now, we are saying that women don't have the sense to make good decisions. If the woman in question isn't drinking a lot, we're out of line. And if she is drinking a lot - if she's incapable of controlling her drinking even though she wants to do the best for her baby - she needs a lot more help. Miller and Rollnick again:

The therapeutic relationship is more like a partnership or companionship than expert/recipient roles. The therapist respects the client's autonomy and freedom of choice (and consequences) regarding his or her own behaviour.

That's what works. That's what helps. If we really want to help the children, we need to look at our entire societal relationship with alcohol and addiction and we especially need to move away from the idea that addiction is a moral failing. We need to care about these women before they become pregnant. We need to behave as if women have value even when we're not pregnant.

There is more of a consensus about the risk of smoking but the same principles apply: shame doesn't work. Partnership does.

It's politically expedient to take the moral high ground, and say it's all about the children. But the approach we take in the US says it's all about the children, and the mothers are always responsible. It's up to us to create the ideal uterine environment and the ideal home environment after that. There's no discussion in the public health pronouncements about fathers, or about the corporations that make money with irresponsible marketing of alcoholic beverages and tobacco products. Nope, it's not their fault; it's not the lack of money for treatment; it's not the ineffective drug and alcohol education that kids get in school, when they get any at all. Nope, it's just the moms. And since we can't trust women to do the right thing it we explain complex uncertainty to them, we'll just have to tell them not to drink at all. That's so much easier.

If we really care about the children, we have to care about their mothers, and their fathers, and their entire communities. If we simply say "it's all about the children" and turn our backs - or our tsk'ing fingers - on women, then we reveal our own outdated attitudes about addiction. And we reveal ourselves as not being about the children at all, but always and simply about controlling the behavior of women.

A Small Interruption ~ by Jay

We now interrupt our series on booze and babies to bring you this episode of One Big Happy:

(click to enlarge)

Being treated like a girl is the worst thing that can happen to a little boy. This, we expected from the comics. But that last panel is - what? The intro to this?

More On Uncertainty, Autonomy, Booze and Babies ~ by Jay

The intersection of politics, feminism, medicine and public policy fascinates me, and makes me loquacious. What Bluemilk and Ariane covered in one post, I'm stretching out into at least three. This is part the second, with part the first found here.

Why is it that, at least according to one Australian public health researcher, Americans are more likely than Australians to chastise a pregnant woman who is drinking in public? Well, the Puritans sailed across the Atlantic, not the Pacific, but we're deeply ambivalent about the legacy we bear. We're the nation that passed Prohibition, and then glorified speakeasys and rumrunners. "Drink responsibly" is the aural small print in ads for beer that otherwise promote a culture of drinking too much, leering and pawing at women. Our public policy expects everyone to abstain completely until they're 21, and strictly segregates drinking into adult spaces - but our culture depicts drinking as a primary activity of adolescence. Not just drinking, but drunkenness.

We also use drinking as a marker for gender roles. Drinking is for men, sort of. Men try to escape from women so they can bond over beer, but women who drink - usually not beer - are particularly sexy.


So drinking is what men do when they're being irrepressibly young or what women do when they're being seductive. Pregnant women aren't allowed to be irresponsible, and they're certainly not supposed to be seductive. So the "alcohol is bad for babies" message gives a lot of people the justification to let their inner Puritan come out and tut-tut women who commit the cardinal sin of drinking a glass of wine while they are visibly pregnant.

I didn't have to deal with the tut-tuts, because I wasn't pregnant, but we do violate social norms - and I suppose the law - every Friday night when we give our daughter a sip of wine after kiddush. When she's in her teens, if she's interested, we'll give her a glass of her own. I started drinking sherry and wine with my parents when I was 15. My first mixed drink was a frozen whiskey sour that my grandfather poured for me at about that age. My family's pathologies do not include alcoholism, so no one ever got drunk at family events. Most people had one drink or two glasses of wine and that was that. There was nothing particularly thrilling about it, and so when I arrived at college - the drinking age was still 18 - there wasn't anything particularly tempting about alcohol. Besides, it didn't taste good at college. The beer was bad (room-temperature Budweiser? Feh.) and the mixed drinks weren't any better (although I did develop a regrettable taste for tequila sunrises when I was about 20).

I do not think alcohol is harmless, and I don't think teenagers should be encouraged to drink whenever they want to. But there's a big difference between a 12 and 19, and between a glass of wine at a family dinner and a bottle of vodka in the parking lot. Our current attitude towards underage drinking encourages the bottle-in-the-parking-lot. Everyone - or at least most people - wink at the law by the time the "underage drinker" is 20. And if you can wink at the law that says a 20-year-old can't buy beer, why not wink at a few others? So we breed cynics. We also make it harder for kids who are having a problem to get help, because they're underground. And if they're underground, they're more likely to get drunk.

Truly underage drinking - drinking on a regular basis before the age of 16 - is a strong behavioral predictor for abuse of or addiction to other substances. Alcohol is the real gateway drug. When we lump the drunken 13-year-old with the 19-year-old who has a beer on Saturday night, we lose the ability to address the deeper problem.

And when we condemn every woman who has a glass of wine while pregnant, we make ourselves look like overbearing moralists. We make it even harder for the women who really need to stop drinking. Carrie Nation lives, and she's waving her axe at you, if you're pregnant.

On Uncertainty, Autonomy, Booze and Babies ~ by Jay

Bluemilk and Ariane have posted about Australian media coverage of drinking in pregnancy. Apparently some public health officials in Australia aspire to reach the American standard of drive-by moralizing

“So, in contrast to somewhere like the (United) States where if you’re a pregnant woman in a pub drinking you might well have people coming up to you and telling you to stop drinking,” she said.

“That doesn’t happen here as much.” ….. (and further on in the article)

“The community is ready for a tougher message on alcohol,” she said.

“We have got to not only give them (women) the knowledge but we have got to somehow change their attitudes.”

RadicalMama, Bluemilk and Ariane are right that this is about controlling women. Of course it is; as Bluemilk points out, anything that references "the unborn child" is ultimately about controlling women. I don't know anything (well, not much) about Australian attitudes about drinking. Over here, "changing attitudes" is also about American puritanism about alcohol, our discomfort with uncertainty and malpractice insurance. And about making women completely and solely responsible for everything, good and bad, that happens to our kids.

How do I get all of that out of one quote on drinking during pregnancy? You'll see over the next few posts. Let's start with the uncertainty.

No OB in the United States will ever tell a patient that it's OK to drink even once. The official research position is that we can't identify a safe level. We'll never do a controlled study, so all our evidence is observational. And there's no question that fetal alcohol syndrome is real and tragic, and it doesn't seem to depend on steady intake. You know and I know that one glass of wine at week 38 won't do a damn thing to Baby; probably one beer at week 5 won't, either. But we don't know when the switch flips from "safe" to "unsafe".

OBs in my state pay annual malpractice insurance premiums that are more than I earn in a year. They can be sued for birth injury until the child is at least 21, so they will keep paying some insurance fees well after they retire. If docs say "don't drink", and they document that they said it, they can't be held liable for anything that might result from that drinking. This has nothing to do with science and not much to do with protecting patients, but it's how OBs have to think.

Even if OBs were able to honest with their patients, honest would include saying "I don't know". My colleagues aren't very good at that. We're supposed to be the experts, and we get to medical school in the first place by succeeding in an educational system that presents knowledge as absolute. You can't pass organic chemistry by saying "I don't know", or "I'm not sure", or "let's wait and see what happens". So when we get to clinical practice, and realize we can't know for sure - and sometimes waiting is the best thing we can do - it feels really scary.

The mixture of uncertainty and liability is stronger than a mojito, and probably more dangerous.

Photo Meme ~ by Jay

I'd never heard of a photo meme before, but I swiped this one from Mary.

The rules:

1. Go to http://www.photobucket.com/
2. Type in your answer to the question in the “search” box
3. Use only the first page
4. Insert the picture into your Blog.

So let's see what happens!

1: What is your current relationship status?

Married forever.













(I know it's schmaltzy but I do feel as if we were that young when we were married)

2. What is your current mood?

It may not be a mood, but "exhausted" is the answer.





(hmm, all the photos I like are very, very small)

3. What is your favorite band/singer?

I really don't have a favorite, but I'd say the one I've enjoyed the most consistently over the years is Paul Simon, and let's go retro.










(still small!)

4. What is your favorite movie?

Singin' in the Rain.
















(bigger!)

5. Where do you live?

In a stone house.








(it's actually our second stone house. Marry a geologist....)

6. Where do you work?

On the road (well, when I'm doing home visits, anyway)






(love that sky)

7. What do you look like?

Like I'm ten years younger than I am.










(so bizarre I couldn't resist. If you can't see it, it's Chuck Norris endorsing Action Jeans)

8. What do you drive?

A messy minivan.








OK, not that messy.

9. What is your favorite TV show?

Law & Order




(back to really small...)

10. Describe yourself.

Empathic.
















11. What are you doing today?

Having Shabbat.








12. What did you do last night?

Stayed up way too late.










13. What is your name?

Dr. Jay (and yes, I fiddled until I found the one I liked best)












Night-night, boys and ghouls.

The Parable of the Dripping Mug ~ by Jay

I'm throwing a travel mug into the trash, and I refuse to feel guilty.

I know, I know, what's the big deal? Just toss it and be done with it; no need to waste any emotion - not to mention the valuable time of my regular readers! - on such drivel.

I said this was a parable.

It starts with a mug I purchased a few years ago at the coffee counter in the grocery store. I was probably on my way to work, or headed off on a road trip, and we were probably low on mugs at the time. We each use one every day and we often leave them in our cars, so we usually have six or eight in rotation. And of course the ones we leave at meetings or hotels are always the ones that don't drip.

This one drips. It's OK if you're very, very careful, but most often I end up with coffee on my blouse. Maybe we switched the top with another mug, or maybe it always drips. Today as I mopped the coffee off my chest, I thought "I could just throw it out". Sure, it's a waste; sure, I spent money that's now going into the garbage; sure, it's one more thing in the landfill. But I don't need to walk around with coffee stains just to avoid waste.

Are you wondering about the parable yet?

Here's the lesson: I don't need to keep the clothes that don't look good on me, even if they fit. I don't need to keep the pair of shoes that pinch, even if they aren't worn out yet. And I don't need to make an effort to keep friends who show no signs of really understanding me and no interest in my life. Getting rid of things that don't work or don't fit used to leave me feeling like a failure for buying them in the first place. Stepping back from friendships still leaves me feeling a bit panicky, as if I have no right to make choices about my relationships but should be grateful that anyone deigns to talk to me. But I can breathe through that panicky feeling and remind myself that I'm no longer the dorky kid on the playground. I'm an accomplished and interesting adult who has the right to surround herself with people - and things - that make my life richer and more meaningful.

All that from a coffee mug and a stain on my blouse.

It Takes a Special Kind of Person.... ~ by Jay

....to be an elementary-school music teacher. We just tucked our excited girl into bed after the Spring Show, which was quite the extravaganza. The second, third and fourth grades each sang three songs, the band (fourth and fifth graders) and the orchestra (third, fourth and fifth graders) and the Chimes Choir performed, and ten kids read essays and poems they wrote on the theme of "It's a Wonderful World".

They did a terrific job. No one threw up, no one fell off a riser, they moved briskly from one thing to another - but those beginning musicians, oh my. The singing was lovely, and the Chimes Choir was actually beautiful music. But the band and the orchestra - wow. To be enough of a musician to teach music and play four or five instruments, and then to spend your days listening to beginning violin and clarinet players. For years.

Elementary school music teachers, I salute you. And since I can't post video of my daughter's concert, here's a taste of the genre

I Like Memeing Together ~by MPJ

I can rarely resist the opportunity to post my version of a meme Jay posts. So, I've taken her book meme and done it too.

Bold are what one has read, italics are for books one has started but not finished, but I rarely stop once I've started. The books I've stopped and started have all been post-kids -- and always because I've bitten off more than I could emotionally or intellectually chew on 2 uninterrupted hours of sleep a night. Go figure. Plus one I'm reading right now. I'll have to come back and revisit this list the next time I'm looking for a good book to read.

Jonathan Strange & Mr Norrell
Anna Karenina
Crime and Punishment
Catch-22
One Hundred Years of Solitude
Wuthering Heights
The Silmarillion
Life of Pi : a novel
The Name of the Rose
Don Quixote
Moby Dick
Madame Bovary
The Odyssey
Pride and Prejudice
Jane Eyre
The Tale of Two Cities
The Brothers Karamazov
Guns, Germs, and Steel
War and Peace
Vanity Fair
The Time Traveler’s Wife
The Iliad
Emma
The Blind Assassin
The Kite Runner
Mrs. Dalloway
Great Expectations
American Gods
A Heartbreaking Work of Staggering Genius
Atlas Shrugged
Reading Lolita in Tehran : a Memoir in Books
Memoirs of a Geisha
Middlesex
Quicksilver
Wicked : The Life and Times of the Wicked Witch of the West
The Canterbury Tales
The Historian : a Novel
A Portrait of the Artist as a Young Man
Love in the Time of Cholera (I'm in the middle of this now)
Brave New World
The Fountainhead
Foucault’s Pendulum
Middlemarch
Frankenstein
The Count of Monte Cristo
Dracula
A Clockwork Orange
Anansi Boys
The Once and Future King
The Grapes of Wrath
The Poisonwood Bible
1984
Angels & Demons
Inferno
The Satanic Verses
Sense and Sensibility
The Picture of Dorian Gray
Mansfield Park
One Flew Over the Cuckoo’s Nest -- I did see the movie though!
To the Lighthouse
Tess of the D’Urbervilles
Oliver Twist
Gulliver’s Travels
Les Misérables
The Amazing Adventures of Kavalier and Clay
The Curious Incident of the Dog in the Night-Time -- and I really, really hated it
Dune
The Prince
The Sound and the Fury
Angela’s Ashes : a Memoir
The God of Small Things
A People’s History of the United States : 1492-Present
Cryptonomicon
Neverwhere
A Confederacy of Dunces
A Short History of Nearly Everything
Dubliners
The Unbearable Lightness of Being
Beloved -- I was postpartum and knew what it was about and couldn't stand to finish it. I don't actually know why I even started.
Slaughterhouse-5
The Scarlet Letter
Eats, Shoots & Leaves
The Mists of Avalon
Oryx and Crake
Collapse : How Societies Choose to Fail or Succeed
Cloud Atlas
The Confusion
Lolita
Persuasion
Northanger Abbey
The Catcher in the Rye
On the Road
The Hunchback of Notre Dame
Freakonomics : a Rogue Economist Explores the Hidden Side of Everything
Zen and the Art of Motorcycle Maintenance : an inquiry into values
The Aeneid
Watership Down
Gravity’s Rainbow
The Hobbit
In Cold Blood : a True Account of a Multiple Murder and its Consequences
White Teeth
Treasure Island
David Copperfield

Read, Unread, Unfinished Book Meme ~ by Jay

(meme pinched from Mim)
I haven't spent much time at LibraryThing, in large part because I doubt I'd ever leave if I really started. If I catalogued my books, I'd have to admit how many I own, and we can't have that.

So this is the list of the books most often identified on LibraryThing as owned but not read.

The instructions: Bold the ones you’ve read, underline the ones you read for school, italicize the ones you started but didn’t finish. Like Mim, I'm skipping the underlining - I can't figure out how to do it and honestly with some of them I don't remember if they were assigned or not. And I haven't separated the books I read for book club - don't know if that matters or not. They feel to me as if they were still assignments, in some way.

Jonathan Strange & Mr Norrell
Anna Karenina
Crime and Punishment
Catch-22
One Hundred Years of Solitude
Wuthering Heights
The Silmarillion
Life of Pi : a novel
The Name of the Rose
Don Quixote
Moby Dick (and yes, I was an American Studies/English major. Does Bartleby count? I finished that, and Billy Budd)
Madame Bovary
The Odyssey
Pride and Prejudice
Jane Eyre
The Tale of Two Cities
The Brothers Karamazov
Guns, Germs, and Steel (but I want to)
War and Peace
Vanity Fair
The Time Traveler’s Wife
The Iliad
Emma
The Blind Assassin
The Kite Runner
Mrs. Dalloway
Great Expectations
American Gods
A Heartbreaking Work of Staggering Genius
Atlas Shrugged
Reading Lolita in Tehran : a Memoir in Books
Memoirs of a Geisha
Middlesex
Quicksilver
Wicked : The Life and Times of the Wicked Witch of the West
The Canterbury Tales
The Historian : a Novel
A Portrait of the Artist as a Young Man
Love in the Time of Cholera
Brave New World (now this one I know was assigned in school, because I hated it and would not have finished it otherwise)
The Fountainhead
Foucault’s Pendulum
Middlemarch
Frankenstein
The Count of Monte Cristo
Dracula
A Clockwork Orange
Anansi Boys (I haven't even heard of this. Hmm.)
The Once and Future King
The Grapes of Wrath
The Poisonwood Bible
1984
Angels & Demons
Inferno
The Satanic Verses
Sense and Sensibility
The Picture of Dorian Gray
Mansfield Park
One Flew Over the Cuckoo’s Nest
To the Lighthouse
Tess of the D’Urbervilles
Oliver Twist
Gulliver’s Travels
Les Misérables
The Amazing Adventures of Kavalier and Clay
The Curious Incident of the Dog in the Night-Time
Dune
The Prince
The Sound and the Fury
Angela’s Ashes : a Memoir
The God of Small Things
A People’s History of the United States : 1492-Present
Cryptonomicon
Neverwhere
A Confederacy of Dunces
A Short History of Nearly Everything
Dubliners
The Unbearable Lightness of Being
Beloved
Slaughterhouse-5
The Scarlet Letter
Eats, Shoots & Leaves
The Mists of Avalon
Oryx and Crake
Collapse : How Societies Choose to Fail or Succeed
Cloud Atlas
The Confusion
Lolita
Persuasion
Northanger Abbey
The Catcher in the Rye
On the Road
The Hunchback of Notre Dame
Freakonomics : a Rogue Economist Explores the Hidden Side of Everything
Zen and the Art of Motorcycle Maintenance : an inquiry into values
The Aeneid
Watership Down
Gravity’s Rainbow (but I didn't understand it)
The Hobbit (Mary has just given me up for lost)
In Cold Blood : a True Account of a Multiple Murder and its Consequences (read most of it one night while I was babysitting when I was 14 and wow, was THAT a mistake)
White Teeth
Treasure Island
David Copperfield

Conversations with Patients ~ by Jay

Would it be bad for a person to take two aspirin every single day?

Aspirin in that dose is generally safe, but I don't think it would be a good idea for you because of your reflux.

Oh, it's not me.

Your husband?

No, my pig.

I'm sorry, I'm not qualified to offer you advice about your pig.

Well, the vet said he had arthritis and I should give him two aspirin every day. I've been doing it, but I'm starting to get worried about his stomach. Don't you think that's too much?

I really don't know anything about pigs.

But pigs are like people.

While It's Still Mother's Day ~ by Jay

This post reminded me of one of the things my mother did right.

No, that sounds worse than I meant. There are many ways in which I'd like to emulate my parents; they treated us as individuals, real people with opinions and ideas that deserved attention. My parents supported us financially and emotionally without trying to control us. At my father's funeral, my brother said "I was in my 20s before I realized that not all parents stand behind their kids the way our parents stood behind us", and he was right.

My parents were a team, but there were some areas that my father stayed out of completely. I never once had a conversation with my father about sex. I used to joke that one of the advantages of being an adoptive parent was that it allowed my father to preserve the illusion that I'd never actually had sex. My mother, on the other hand, talked about sex freely and openly. When I was 3 and she told me I was going to have a baby brother or sister, I asked how the baby got into her tummy, and she told me. When I was 9 and we saw the movie about menstruation in school, Mom filled in the stuff they didn't tell us, and she showed me the Kotex and Tampax and told me how to use them (way far in advance, as it turned out).

When I was 15, we had someone come stay with us for a few days. Darlene was 18 and her mother was an old friend of Mom's. Darlene's mother threw her out of the house because she found her birth control pills. After Darlene moved back home (thanks to my mother's intervention), Mom sat down with me and explained why she'd invited Darlene to stay. She told me that Darlene was right to use birth control. She said "Don't believe the people who tell you that girls in my generation were all virgins when they got married. Most of them weren't. And even if they were, technically, there's a lot of other stuff that happens besides actual intercourse, so they're just being hypocrites. You're not going to live the life I lived; you won't be married when you're 19. Daddy and I got married because we wanted to have sex, but you'll have other options. I hope you'll finish college before you get married, and I don't expect you to wait that long. I do think it would be better if you waited until after high school, but when you decide you're ready, come to me and I'll help you get birth control. Be smart about it".

When I was 16, my life changed literally overnight when I went to the senior prom with John. Before that I never went out except to babysit; that summer I was gone four or five nights a week, going to parties and concerts and amusement parks and hanging out with college students. John and I were together for two years, and about six months into the relationship, my mom asked me if were having sex. I said "don't be ridiculous" and she said well, you clearly care about each other, and it's natural to wonder and to want to. I said "Are you going to tell me not to sleep with him?" She said "Would that change anything? I trust you to make the right decision for yourself. I do think you should wait, but not because I think you need to be married. When you do have sex, you're going to enjoy it. It's wonderful. And you won't want to go back to a relationship without it. So if you stop seeing John, when you start seeing someone else, you'll move more quickly. That's natural. But you should realize that you're making a decision not just about the guy you're with now, but the next guy as well".

I didn't sleep with John. I don't know if it was my mother's advice, or my own knowledge that high school was simply a way station and my real life was out there waiting for me, and I knew John wasn't going to be part of it. But the next guy I did sleep with, my freshman year in college, and like good little overachievers we planned the whole thing. A month ahead of time, I went to the college infirmary and was fitted for a diaphragm. As I'd promised my mother years before, I called her up to tell her about it.

She answered the phone and I said "guess what I did today?" She listened for a minute and then said "I'll call you back" and hung up. Very odd. When she called back an hour later, she was laughing so hard she could hardly talk. Turns out that when I placed that call she was entertaining the Hospital Auxiliary at tea. There were 50 women, all very Proper and all older than she, in her house eating off her good china. My mom was open with me but she didn't see any need for everyone else to know about it.

Thanks, Mom. Thanks for answering my questions when I read John O'Hara at age 12 and for bringing Fear of Flying home when I was 15, and then going out to dinner and leaving me alone with it. I hope I can do as well by my daughter.

In Which Mommy Can't Go Home Again ~ by Jay

I was blessed with books when I was a child. My parents and my grandparents and my great-uncle and even friends of my parents bought me wonderful books. Not just marvelous stories, but beautifully illustrated editions that are a pleasure to look at and read even now. When my daughter was about a year old, I read "Make Way For Ducklings" to her, and it was one of the happiest moments of my life. She has her own copy of "Ducklings", a gift from a Bostonian friend of mine, but I read to her from my book, just as I had always dreamed I would.

Last month my mother brought another stack of books when she came to visit. I thought my dancing daughter would snatch up the book of ballet stories, but her favorites are the two Babar the Elephant books. I loved Babar at her age, and I was delighted to read them to her - especially delighted because I don't get to read to her all that much these days. She usually reads to me. But the Babar books are printed in cursive and she can't read cursive yet.

Unfortunately, I don't love Babar as much as I used to. It's not just that Babar's mother is killed at the beginning of the first book, but there's something very odd about the relationship Babar has with the Old Lady. Never mind that she's only ever identified as the Old Lady, which is disturbing enough. (If you haven't read the books, Babar is captured in the jungle and taken to the city, where he escapes and is befriended by the Old Lady). The Old Lady takes him home, buys him fancy clothes (bespoke tailoring, no less) and gives him plenty of money and his own car. Um, what?

Tonight we read the second book, which starts when Babar and Celeste leave on their honeymoon. Their balloon crashes on an island where they encounter savage headhunters. Stereotypical racist images much? They are rescued by "Mrs. Whale", who gives them a ride on her back. A remarkable exception to the ubiquitous images of males as heroic figures? Nope. Mrs. Whale leaves Babar and Celeste on a reef while she goes underwater to eat and forgets about them, because she is a "giddy, thoughtless creature". Oh, good, we have misogyny to go with the racism.

Sigh. Maybe I can go back to "Make Way for Ducklings", although, come to think of it, there's a lot of Irish-police-stuff in there.

Time to go down the list in the Feministe Feedback comments for children's books I can read without feeling nauseated.

Bah, Humbug ~ by Jay

I'm not the first person to shudder at the pink-ribbon frilliness now associated with breast cancer. Barbara Ehrenreich wrote about the breast-cancer subculture in 2001, after her diagnosis and treatment, and she of course said everything far better than I could. I always feel somewhat Scrooge-ish when I find myself irritated by yet another pink product and yet another opportunity to consume for the cure. But at least it's always been my choice - I can ignore the marketing and skip the pink ribbons and latex bracelets and special cocktails. Today I found myself swept up in pinkification without even the option of refusing.

We went to a baseball game. Innocuous enough - a minor-league game on a pleasant May Sunday. They had a Mother's Day promotion, of course. Pink hats. Pink hats that trumpeted a local breast cancer treatment program. The team wore pink jerseys, and there were pink ribbons everywhere. Survivors spoke and people cried and all was sweetness and light, and money flowed.

Sorry to be un-pink, but what exactly does being a mother have to do with breast cancer? Is breast cancer now the signal experience of being female? Is every event that involves women going to co-opted by the pink-ribbon brigade? Just because I have a uterus, I must be a soldier in the fight to preserve the breasts.

And it does seem to be mostly about the breasts, not so much the women. Breast cancer is not the most frequent cause of death for women in the US - that honor goes to cardiovascular disease. It's not even the most common cause of cancer death - that's lung cancer. (We've come a long way, baby.) Yes, I know people think breast cancer is a scourge of young women but it's primarily a disease of the elderly - although old women, as we all know, are not sexy. Who cares about the removal of sagging, wrinkled, septagenarian breasts? It's perky young ones we really care about.

I don't want people to assume that because I'm a woman and a mother that I will fall in line behind the pink-ribbon-bearers. I don't want to buy a tote bag for the cure. I don't want to focus on the cure at all. I want to look at the serious underlying threats to women's health, to the environmental and economic and educational problems that reduce women's access and increase our risk of disease. I want to ask questions that won't sit well with the corporations that sponsor the pink-ribbon events. I want to think about health as it affects all women, not just the ones who look pretty in pink.

Health is a feminist issue. Access to care is a feminist issue. We need to extend our concern, our interest and our money to all women, not just the ones who look pretty in pink.

Conversations With my Daughter: Daddy's Turn ~ by Jay

{Daddy is trying to figure out the directions on a birthday-present knitting gadget}

These directions are terrible.

{reproachfully} I'm sure someone tried their best, Daddy.

Conversations with Patients ~ by Jay

What brings you in today?

Just my usual visit, every six months.

What's on your mind?

Well, I've been having some pain in my hip. It hurts terrible sometimes, feels like I can't even put weight on it.

Sounds pretty uncomfortable. When did that start?

Oh, about three weeks ago. Seems like it was right after I cleaned out the gutters and repaired the roof. Guess that wasn't such a good idea.

Maybe not.

After all, I am 87 now. Sometimes I still think I'm 60.

No We Can't ~by MPJ

This is cross-posted at my blog.

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Photo credit: Photo by tgbusill

Four years ago, I listened to Obama speak at the Democratic Convention. I listened to him say there were no red states or blue states, just the United States, and I wanted to sing for joy. Here was someone who was speaking my truth. I wanted us all, conservative and liberal, to stop bickering, get along and work for the good of the country together. Amen!

That all sounds nice, of course, but four years in, I'm starting to see what I really meant by "united." By "united" I meant: I want to be in power so that you will have to pay attention to me and I can stop having to pay attention to you.

I meant I wanted conservatives to stop stereotyping us liberals as "elitist." I wanted them to listen to what I was saying (and by "listen" I meant "agree"). I wanted them to respect my views (and by "respect" I also meant "agree").

What I didn't want was to listen, really listen, to what conservatives and evangelicals were saying. I didn't want to respect their views. I didn't want to stop stereotyping them as greedy capitalists or uneducated buffoons or religious nut jobs or racist, sexist, homophobic monsters, at least not until they "listened" to me. And when they listened to me, they would change, because I was right. After all, all reasonable people would be liberal if they stopped to really view the evidence and the facts and think about things. All they needed was education, a little exposure to the truth.

I was thinking of this in light of the e-mail exchange I had with Laurie (a woman my husband was friends with and acted out with in his sexual addiction), who denied that anything inappropriate ever happened between them. Had I been confronted with this denial several years ago, I would have presented her with all of the evidence at my disposal. I would have tried to prove to her that her reality was warped, that she was delusional, and I would have done it with a fierce and frightened passion. I'd be fighting like a cornered animal, because reality seemed so tenuous and fragile, so mutable. I'd hold on to the facts as the one solid piece of wreckage adrift in a wild, roiling sea.

I admit, I still did, to reassure myself, go back and check the dates, the words, the photos, the e-mail messages. I wrote it all out. Juxtaposed her truth with mine. (I'm not that fixed yet.) But in the end, I let it go. I owned my truth, gave her hers and didn't send copies of all the evidence for her elucidation. And I was able to say sincerely, to myself and to her (see above, re: not that fixed yet) that I was glad I was able to state my truth and she was able to state hers. And they're both valid.

She and I don't see the past the same way, but that's ok. What she feels is what she feels. What she has experienced is what she has experienced. Where she is is where she is. What she knows is what she knows. And it's not my job, even if it were possible, to make sure that she confirms my reality for me. To respect where I am, I have to respect where she is.

So, as I was listening to Obama's speech last night, to that same uplifting message that used to inspire me, I found myself thinking, "No we can't." No we can't come together and get things done as long as we all believe everyone else is wrong. No we can't as long as we think no one has the right to feel or believe differently than we do. No we can't as long as we think that if they "saw all the facts" or "had a real relationship with the one true God" or "knew there were no weapons of mass destruction" or "really understood the Bible the way I do" or "knew how harmful fossil fuels were to the environment" or "realized what would happen to the economy if we rolled back Bush's tax cuts" or... No we can't as long as we think we hold the keys to the only door to truth.

Liberals and conservatives, Christians and Muslims and Buddhists and atheists, men and women, black and white and every shade between, poor and rich, all contain people who feel unheard and who are unhearing, all contain people who think they know it all, all contain people who think the world would be better if there were no more differences. It's not politics or gender or race or religion or class that divide us: it's our own inability to accept and respect that other people are where the are. It's our own inability to acknowledge that they have and hold their own realities and truths as deeply and desperately as we have and hold our own. It's our own inability to accept the things we cannot change, change the things we can, and know the difference between the two.

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Late addendum: Of course, I can't even contemplate how much more acceptance I'll need before I'm anywhere near spiritual enough myself to stop saying, "George W. Bush is a dumbass." ;) We're so doomed.

In Which I Expect Too Much ~ by Jay

Hello?

Hi, is Mr. Sam available?

Who's calling?

The State Democratic Party.

Mr. Sam isn't home right now. Can I help you?

Is this Mrs. Sam?

No, this is Dr. Jay, but I am Mr. Sam's wife. Perhaps you need to adjust your script.

Conversations With my Daughter ~ by Jay

We had an assembly about smoking today.

Oh? What did you learn?

Smoking is stupid.

Why is that?

It gives you bad breath and it kills you.

Ah.

So only stupid people smoke. If you tell people smoking is stupid, then they'll stop.

Well, it's not quite that simple.

Why?

People smoke because they like it. Sometimes very smart people smoke. Mostly they know it's bad for them, but it's hard to quit.

Do you know people who smoke?

Sure. A lot of my patients smoke. {Mommy avoids mentioning that the beloved grandmother used to smoke, but guesses this will become obvious the next time we look at old pictures}

Do you tell them to stop?

I try to help them figure out how to stop, sure. But how do you think they'd feel if I told them they were stupid?

I think they'd feel bad.

Right, and I don't want to make them feel bad. Feeling bad won't help them stop smoking; it might actually make it harder.

I don't ever want to smoke.

And I hope you don't.

What She Says ~ by Jay

"She" is Portly Dyke, and she blogs over at Shakesville. Which I think I will have to add to my regular reading (and when will I add that? Dunno. Maybe instead of showering. I kid, I kid).

But back to Portly Dyke. She has a post up which is just the best damn thing I've ever read about the pernicious impact of heterosexism and homophobia on all of us, even on a woman who lives in a diverse and welcoming town and came out years ago. Read it.

How fucked is it to say her town is "welcoming"? Like it's some kind of badge of honor that in your community gay men are less likely to get beat up on the street and lesbians might be invited to the PTA Mother's Day event. "Wow! We treat gay men and women as if they were actually people! Yay, us! We deserve a cookie!"

Too bad it doesn't work the other way around. I'd prefer it if we labeled non-welcoming communities and organizations for what they are. There would be normal communities, and there would be bigoted towns. You choose.

Back to Success ~ by Jay

I've been pondering our discussion about success and achievement. I realize that for me it's the process, not the product, that matters. And it matters who I am as I start and pursue whatever it is I choose.

Let's go back to that image of the wall. If climbing the wall would be meaningful to me - the actual climbing, the physical act - then climbing it is successful no matter what's on the other side. But if I feel I am lacking something essential, climbing the wall will not restore what I am missing.

In order to feel successful at whatever I do, I must accept myself wholly and fully as I am now. If I feel that I am less than, more achievement won't fix me. I will simply be me, still less than, but with one more credential.

If I am fine as I am - if I am truly content with myself - then I can look at each new option and evaluate it on its own merits. I can think about the process: will I enjoy the work? Will I find meaning in the doing of it? I can also consider the goal: what can I do differently once I complete this? I will take the certification exam for Hospice and Palliative Care in the fall. Will I be a better person once I pass? No. I might be a more educated and better-informed physician; I certainly will have expanded professional options. That's valuable to me. But it won't make me someone else, someone more worthy of my own love.

The challenge is to love ourselves, in the fullness of our imperfections, and accept both what we are now and what we can be. Then we can ignore all the voices telling us what we should do and choose those paths that are truly ours.

Conversations with Patients ~ by Jay

So at your last visit we talked about your husband's drinking.

It's been better. He's been home more and he hasn't driven drunk with the kids in the car since the last time I was here.

I'm glad. I know I suggested you consider AlAnon. What did you decide? Did you call them?

No, I didn't.

Can you tell me about that?

I didn't see how me going to AlAnon would help my husband stop drinking.

Dr. House, I Presume ~ by Jay

Two of our commenters on my Medical Errors post (one new one - hi, Ann Thrope! Any relation to Mis?) mentioned the TV show House.

Here's how Hugh Laurie's own website describes his character

The misanthopic Dr. House loves to solve the mystery of his patient's ailments without the mess and tediousness of actually having to interact with them.

From what I've seen (which is only ads, I have to admit) the man uses shame as a teaching tool and is revered not in spite of but because of his rudeness. He's brilliant! He's honest! He's quirky! So what if he treats people as if they're at best interesting lab specimens? And more often as if they're not worth his time?

Why would I watch that? I spend part of my professional life dealing with the consequences of that behavior - patients who are afraid I'm going to yell at them, colleagues who think it's acceptable to berate my staff on the phone or intimidate the residents into cowering submission, family members and friends who want me to know JUST HOW RUDE the orthopedist was at their visit last week, patients and family and friends who need me to explain their test results to them or translate what they were told about their medication, since their other doctor couldn't be bothered to actually talk to them. Or listen to them. I spend another part of my professional life helping residents and doctors learn how not to be Dr. House, since lousy communication skills make practice more frustrating and less rewarding and, ohbytheway, markedly increase your malpractice risk. And helping people learn to communicate is a lot more difficult if they think "brilliant doctors" behave like House. They can't look like Hugh Laurie, but they can act like him, by God.

And then there's one more thing: imagine a woman behaving like that. Go ahead, I'll wait. Got it? Somehow I don't think she came across as brilliant and quirky and sexy. I bet she looked shrill and bitchy and opinionated. She wouldn't be promoted, or revered, or looked up to, no matter how brilliant she was. She would be "counseled" and sent to remedial instruction and relegated to a dead-end job and maybe even eventually fired.

If you like it, great - enjoy. But that's one medical show I avoid not because it's wrong, but because it's too close to being right.

The Dilemma of the Reform-Minded Parent ~ by Jay

Today Sam and I answered the questionnaire about the gifted program at our daughter's school. Filling out this form is the first stage of getting her enrolled in the formal program. The questionnaire was three pages long, requiring both numerical ratings (on a badly designed Likert scale) and free-text comments. Several of the questions used educational terminology that I didn't really understand. Sam works with districts and teachers who are implementing science standards and new curricula, and knows the jargon - luckily for us, I guess.

Our school district is what the state euphemistically calls "challenged". 70% of our students are eligible for free lunch, which means their families live on or near the Federal poverty level. 25% of the city's population is Latino, with their children concentrated in three downtown elementary schools. Our daughter attends the whitest, wealthiest elementary school in the district, and of course her school has the best test scores - we're in the top ten schools in the state. Why "of course"? Because standardized test scores of the kind mandated by NCLB correlate with race and socioeconomic status more than they represent teaching skill, student achievement or anything else they purport to measure.

Why public school? Because it's ten blocks away, and the JCC and its afterschool program are across the strees. Because we can use the potential tuition money to buy her books and travel and other things we wouldn't be able to afford. Because we believe in public education. If passionate, involved parents opt out of the public system, it won't improve. Because there is no perfect alternative. The Jewish Day School is far too Orthodox and conventionally Zionist for our taste. The Christian schools are, well, Christian. The nearest Quaker school is 30 minutes away in the wrong direction. The "elite private schools" emphasize a drive for social status and wrongheaded academic rigor that we find counterproductive. Because we want her to experience the diversity of the world she lives in, and to understand how lucky she is to have more than enough money, food and clothing. And I know that's sinking in. Last year she came home with a permission slip for a field trip. When she handed it to me and said "Mommy, this is in English. It's only in English. That's not fair. What about the parents who don't speak English? What about the Spanish parents? They won't be able to read it and maybe their kids won't be able to go". That's my kid.

But my kid is in a system that uses testing and tracking in ways that Sam and I find at best counter-productive and at worst racist. Ability-group tracking is a bad idea; it hurts low-performing students far more than it helps their high-performing friends. In districts like ours, tracking will cluster white kids in the "higher" tracks and Hispanic kids in the "lower tracks". Labeling like that can be impossible to undo. But we can't change the district - at least not right now - and we do want our daughter to enjoy school, and be challenged. So we've agreed to have her pulled out for Extra Group Work, the name they give to the pre-gifted program, and we agreed to have her tested this year for the formal gifted program. Hence the jargon-filled questionnaire.

Never mind the absurdity of trying to explain our kid in multiple choice. Yes, she's creative and inquisitive, but she's also shy and sometimes overly compliant and fearful of correction. Yes, she reads above grade level, but doesn't seek out "challenging and complex texts". Is she a good problem-solver? Well, how tired is she? When was her last meal?

But mostly I was stunned at the complexity of the questions. I am sure there are kids in her district who are as smart, creative and thoughtful as our daughter, but who have parents who don't read above a third-grade level themselves, or who don't read English at all, or who have to work two jobs and don't have half an hour to fill out a questionnaire. Parents who might not understand that this program is free, or might be afraid there will be more homework than their kids can do. I'm much more literate than the average American-born native English speaker; if some of these questions were confusing to me, I imagine they would be confusing to almost everyone else.

So here we are, knowing our daughter will benefit from a flawed system that would not pay nearly this much attention to her if she were seen as her birth-mother's daughter and not ours, knowing that some of her friends will be denied this program even though they could get as much out of it as she will. We are painfully aware of the privilege this represents, and the oppression it reinforces. But holding her out of the gifted program won't fix the system. So we'll send the form back into school and hold onto our belief that she will grow up to help repair the inequity herself.

Medical Errors ~ by Jay

No, not the real kind. The fictional kind. The kind that keep me from watching any medical shows on TV since "St. Elsewhere", and incite me to throw novels across the room.

1) The denoument of a mystery in which a murderer confessed all while on a ventilator. Ventilators require a tube to move air in and out of the lungs. That tube traverses the larynx, which most people call the voicebox, and travels directly between the vocal cords. When there's a tube between the vocal cords blocking air movement, there's no talking. Hence no confessing without a pen and paper.

2) The teenager on Knots Landing who developed end-stage renal disease requiring a transplant. Why did she develop kidney disease? Well, they explained, "she was run-down. You know how kids overextend themselves". Oh, and after her transplant? No acne or weight gain or nasty facial hair growth from the anti-rejection drugs, and apparently no low-salt diet; in the hospital afterwards, someone brought her Chinese food.

3) The second-season opener of The West Wing during which people stood outside an operating room in street clothes watching their friend in surgery. People, the entire operating room area requires scrubs. Plus they don't let people watch surgery. It's not a spectator sport. And after that surgery, Bradley Whitford wakes up - after having a collapsed lung and a lacerated pulmonary artery repaired - in a bed with one IV, oxygen by nasal cannula, and no chest incision or chest tube visible. I don't have time to list everything wrong with that scene.

4) The survival rate when anyone has CPR on TV: 75% survive the arrest and 67% survive to discharge. Reality? Extremely optimistic reports of survival in out-of-hospital arrest are up to 30%. More likely it's below 10%. And "survive" does not mean "recover".

5) The crucial plot point of Anna Quindlen's "One True Thing". The mother dies of ovarian cancer - but no! An autopsy is performed that shows she died of a morphine overdose! Did the sacrificial daughter do it? The philandering husband? You can read the book to find out who done it. I finished the book but I was muttering to myself the whole time. There is no way a woman who died with metastatic ovarian cancer would have an autopsy by the medical examiner. The doctor would sign the death certificate and that would be that. Even if there was an autopsy, toxicology tests don't show the level of morphine in a patient's bloodstream, just presence or absence, and this woman was taking morphine. So a) no one would look and b) they wouldn't care if they found it.

6) All those scenes of closed chest compression on M*A*S*H. Open compressions - actually opening the chest and directly squeezing the heart -work better than closed and were widely used in World War II. The surgeons in M*A*S*H were in a operating room. They would have opened the chests. Besides, successful closed chest compression was first reported in JAMA in 1960. The Korean War ended in 1953.

Phew. I feel better now.

Any budding writers out there? I am available to make sure you don't irritate me if your work is published or produced. Really, it would be so much better that way.

Whoops, Missed It! ~ by Jay

Photo credit: Photo by PinkCakeBox on Flickr

Two Women Blogging is a year and three days old today!

I just looked over some of our first posts, and I was surprised to see that it took a month before I wrote something with a "feminism" tag. What was I thinking?

We started this because I wanted to blog but was afraid to do it myself. Mary, who had started her own blog a few months earlier, was willing to take on another at my request. Which meant that I knew at least she was reading those first few posts of mine. Along with Orange, of course, who'd been nagging me for months to start a blog.

I'm glad I'm doing it, and I'm glad I'm not doing it alone. I feel that I've been welcomed into a warm, wide circle. There are some faces I knew before (Mary and Mama and MomVee and a few of our non-blogging commenters) scattered among the new friends in our growing community. I've learned a lot about writing and politics and families and relationships and life in Australia and even a smidgen of HTML.

It's still a thrill to see comments on my posts. You all make me think, and you help me grow, and you've welcomed and appreciated me. Thank you - and here's to another good year.

Conversations with Patients ~ by Jay

On average, how many drinks do you have in a week?

Oh, I dunno. Most weeks I go through 3, maybe 4, cases of beer.

Does this ever cause a problem for you?

Well, not for me.

For somebody else?

Yeah. The judge - now he has a problem.

Which judge?

The judge who took away my license after my last DUI.

What I Love About Being a Hard-Ass Parent ~ by Jay

It's so easy to give your kid a special treat.

When you're as mean to your kid as Sam and I are, she isn't allowed to eat in front of the TV. So when you make an exception and allow her to have a bowl of pretzels and a drink while she's watching a DVD with a friend, all of a sudden it's a Really Big Deal, and a Very Special Occasion.

When you make her go to bed at 7:30 even when it's still light out and even though EVERY OTHER SECOND GRADER IN THE WORLD GETS TO STAY UP UNTIL AT LEAST 8:00, then it's very exciting when she gets to stay up until 9:00 for a sleepover.

Poof! You're the Magic Parent. Just like that.

Who Do You Trust? ~ by Jay

I wonder what it is about TV and print information that automatically gives it credibility. In some cases, recommendations from ads on TV or filler pieces in Parade Sunday magazine seems to be more important to my patients than what I say.

I suspect some of it is the Voice of Certainty. Allopathic medicine is not an exact science. (There is no such thing as an exact science, but that's a post for another day.) I am honest with my patients about uncertainty. I say "I don't know" over and over again. I explain the way diagnosis works - we think of a list of things that might explain the symptoms, and then we do testing or further examinations and one by one we check things off. Nope, not that; nope, not that one either. Often we end up at the end of the list and all we've said is "Nope, none of the above". So that's good news - your nausea isn't caused by liver cancer or gallbladder disease or pregnancy - but it leaves me saying "I don't know" again. And I warn them of the potential side effects of the medications I prescribe.

Complementary health practitioners, on the other hand, can be much more certain. Chinese doctors will take your pulse and look at your tongue and tell you, with great assurance, precisely what is wrong and precisely what you need to do to make it better. "Drink this tea and you will sleep well". That's very different from my "Take one of these for a few days and see how it goes. And let me know if you find it gives you a dry mouth or you start to feel constipated".

There are a few studies suggesting that the doctor's confidence level and prediction of recovery has an impact on patient outcomes, or at least on the patient's assessment of their recovery. I always tell people with colds or other respiratory illnesses to call me if they don't feel better in a few days, and that used to be the last thing I said as I walked them out to the counter. Now I say "You can call me if you don't feel better in two or three days, but I think you'll be almost back to normal by then". I want my final comment to be positive.

I started thinking about this today, about where people get their medical information and how they evaluate it, because of something a patient said. I'm used to patients bringing in clippings from the newspaper or printouts from websites, or the name of the medication that their neighbor took last year when she had the very same thing. But today I had a new experience. My patient said "My lawyer told me that I should tell you to change my blood pressure medication. He takes FancyMediCapsule, and he says it's better than what I'm taking".

And I bet the lawyer was absolutely certain about that.