Five Words ~ by Jay

I asked Orange for five words to describe me and she obliged. She's off in Brooklyn now using more than five words - good luck, Orange!

The deal is she gives me five words that she associates with me, I write about each one and offer to provide five words for any readers who would like to do their own. If you're interested, let me know in comments and keep checking back - I'm at a conference and responses will be slower than usual.

So, back to me.

1)Mothering: To mother, mothering, motherly - all those words evoke nurturing, selflessness, advice-giving - these are all qualities that are present in many of my relationships, not just my life with Eve, and thinking about it now I see that I really want my mothering to be facilitative, not directive. I give less specific advice and direction than most of the parents in our circle. I am less invested in the outcome, in the specific behavior. Giving advice is easy; listening and encouraging Eve to make her own choices is much harder work, at least for me. I realize that I've been feeling a little less-than, a bit not-quite-a-real-mother because I don't manage my daughter's life in the same way as many of my friends, and I realize, looking at it squarely, that I need to let that go. Mothering is also offering comfort and unconditional love, and I do that - oh, do I do that. I may not have a biological connection with my daughter, but I can feel my love for her in my body, as well as in my heart and mind.

2) Feminism: Means never being able to enjoy a movie, a book or music on the radio. I've been listening to some old favorite mystery books on my iPod while I drive around. Lately it's been Dick Francis and J A Jance. I started reading Dick Francis' books while I was in high school, and his prolific days are long over, so it's been a while since I picked up some of these. Never mind the lack of women protagonists - I've been overwhelmed with the parade of virago wives, rejecting mothers, and manipulating sisters. There are brilliant and interesting women, as well, but all seem to have something lacking in their lives until Our Hero shows up and shows them what they're missing.

Jance is more complicated. I've been listening to her Joanna Brady series. Joanna is an Arizona county sheriff, and she experiences and stands up to repeated expressions of sexism. And in the later books in the series, she remarries and ends up with a guy who becomes the stay-at-home parent. Cool. But I've been immersed in these books one after the other, and noticed things that aren't obvious when you read one every year or so, as they're published. There are at least two books in which Jance writes about domestic-violence-that-wasn't, about men who are victimized by false accusations of abuse or who were "justified" in beating up their wives because the wives were such horrible people.

I know Jance and Francis aren't Kurt Vonnegut. They're not openly misogynistic. That's the point. Misogynistic ideas are so embedded in our culture and our literature that they show up, anyway, even from authors who are open in their admiration for and support of women's equality.


3)Hospice: What all medical care should be. Symptom-focused, relationship-centered, multi-disciplinary, home-based; open to negotiation of the goals of care with the patient's agenda given priority; acknowledging the emotional lives of the caregivers as well. It's a damn shame we only do this for people who are dying.

4) Solitude/downtime (you get so little!): Part of the reason I have so little is that it kind of scares me. I'm only just becoming comfortable with real solitude, as opposed to solitude with the phone or the computer or the TV. Some of the activities I schedule for myself are restorative - going to synagogue, drumming, being here at this conference. And much of my "real" life is restorative, too; I get a lot back from my patients, my hospice colleagues, my family....but I am feeling drained. This category gets an "under construction" sign.

5) Achievement: In my heart of hearts, I don't see myself as having achieved anything. Yes, I graduated from a fancy college, but I was admitted as a legacy. And besides, Sam was summa cum laude and I wasn't. Sure, I went to medical school, but not a very good one. Granted, I do good work as a doctor, but I'm not on a track to be the director or chair or chief of anything, and I haven't been able to sustain work as a clinician/educator. And of course, I am raising a child, but only one, and she's pretty easy, as kids go - no special needs, no sleep problems, no homework battles. I passed the boards, but I have an easy time with tests - it's not like I worked as hard as others did. Plus I have such advantages - no financial worries, supportive and encouraging parents, a husband who "helps". Who couldn't do what I've done if they had the start I was given?

I know this is fucked, I really do, but when I start to think about owning some of my accomplishments I think "oh, Jay, you really should be more focused on who you are rather than what you've done". It is possible to recognize and appreciate one's privilege without discounting real achievement, and it is possible to be proud of one's work without being an other-focused caplitalist sellout. I'll keep working on it. And, in the meantime, I will hold on to those moments of gratification: the look in Eve's face when she sees me after I've been away. The patient who says "I always feel better when I come to see you". The hospice nurses who cheer when they find out I'm increasing my hours. The rare, elusive times when I feel truly at peace with myself.

Before I Leave ~ by Jay

Feminism in the funny pages?

Feminism in Herb & Jamaal?

Nah, can't be.

And yet....
Dialogue:

Math question #7:

If your father earns five hundred dollars a week, and your mother earns half as much, what does she have?

The same position in the same company.

Counting Down ~ by Jay

Nothing like a deadline to make me more efficient.

Flight out at 2:00 PM tomorrow. I remembered to make a rental car reservation (score! significant discount) but haven't packed; that's for tomorrow morning. I did download two new audiobooks to my iPod and sort through the unread paperback mysteries to choose a couple for the plane. Priorities, people, priorities.

I am in the home stretch of the long day - 2.5 hour meeting over, paperwork from yesterday completed, 2.5 hours of 7 hour office session in the books and I'm even caught up on my notes (thanks to a patient who didn't show up).

I can see the light and it's not an oncoming train.

I know that every time I say this it turns out not to be true, but I really do think posting from me will be very light for the next 10 days. I need this time for rest and renewal and reflection, and I'm almost there.

Things I Could Do Without ~ by Jay

Description: Two sets of fridge magnet words, one pink and labelled “Magnetic Girls Talk”, one blue and labelled “Magnetic Boys Talk”. The “Girls words include:

clothes, hairband, heart, love, sparkle, perfume, beads, necklace, furry, lipstick, ribbon, handbag, want, glitter, fairies, fluff, candy, flowers, wings, sherbet, bubbles, sweets, pink, make-up, skipping, magic, dancing, ballet, bunnies, rainbow, ladybird, lemonade, stars, sky, shoes, chocolate, doll, party, secret, diary, hair, jewels, princess, queen, tiara, ice-cream, teddy, music, sunshine, birds, butterfly, sugar, angel, diamond, cooking, friends

The “Boys” words include:

boots, glue, monster, scary, bones, racing, moon, helicopter, aeroplane, tractor, money, lorry, wizard, conkers, frogs, sticks, mud, dirt, spiders, snails, stones, bubbles, sweets, flags, magic, pond, string, grass, rugby, bug, dogs, caterpillar, cobweb, worms, dinosaur, dragon, bike, scooter, forest, treasure, climbing, swinging, skeleton, running, ghost, trees, swimming, lawnmower, treehouse, blue, football, chocolate, car

(lifted in full from Hoyden About Town. I'll write more of my own posts when I'm not working. Yes, I'm working now. Really.)

Conversations With My Daughter ~ by Jay

(after Mommy's pager goes off)

Mommy, are you on call again?

Well, I'm kind of on call all the time for some things.

Why?

Because it's my job, and people sometimes need to talk to me. I don't get called very often - most nights I don't get called at all, right?

Well, I suppose.

Besides, right now I'm on call for you.

I don't get that.

I'm here when you need me, right?

True.

You can call me and I come, right?

True. But not when you're not here.

Even when I'm not here, you can call me. You and Daddy are more important than any of the other people who call me.

That makes me feel good.

I Think I Love You ~ by Jay

If you are Teh Portly Dyke.

Seriously, I may have to change my sexual orientation, because any woman who can write this is so worth it.

Conversations With My Daughter ~ by Jay

(just when you thought it was safe to talk about the facts of life....)

Mommy, what does it mean to get your period?

When the uterus gets ready for a baby, the lining builds up with blood cells to help the baby grow. If no baby needs it, then the woman's body gets rid of that lining and starts over again. That means the woman has blood come out of her vagina. It happens every month.

So when that happens, you can have a baby.

Yes. Once a woman gets her period, she can have a baby.

But that only happens to grownups.

No, sweetie, it starts happening to some girls before they're teenagers. It will probably start for some of your friends in the next year or so.

But girls that age can't have babies.

They can, and unfortunately sometimes they do.

Why?

Because they have sex.

Why do they do that?

Lots of reasons. People have sex because it feels good. When really young girls have sex, it's sometimes because they are looking for someone to love them, and they don't know any other way to feel loved.

But then they might have babies, and the babies would have to be adopted, and that would be bad.

It's a bad thing to be adopted?

Well, maybe not bad, but sad.

Are you sad that Laura arranged for you to be adopted?

I don't know. If she hadn't, then I wouldn't know you and Daddy, and I love you and Daddy. But I don't want to have to choose.

Choose?

Choose between you and Laura.

Oh, honey, you won't ever have to choose. I'm your mommy, and I always will be. And Laura will always be your birthmom. You won't ever have to choose between us.

Follow The Leader ~ by Jay

Paula at Anti-Racist Parent has certainly thrown me a curve. It's worth reading the piece. She makes a compelling argument against the idea of following a child's lead when you talk about adoption. I wasn't sure where she was going in the first part of the piece, as she describes arriving at a great new job, feeling unable to ask questions and having a boss who gives lots of nonspecific reassurance but no answers. Then she got to the punch line:

I must admit, I cringe just a little bit every time I hear an adoptive parent say they plan to follow their child’s lead when it comes to addressing the different aspects in adoption. Whether it’s talking about their child’s first family, integrating their child’s ethnic culture, addressing the subject of race and race consciousness, identity, loss, grief, feelings of rejection, fear of abandonment or resistance to trust, I can’t help but think what a tremendous burden it possibly might be on the child to have to be responsible to initiate and direct these kinds of conversations with their parents. . .the people a child looks up to, the authority figures and the ones who I believe should be behind the wheel.

Punch line indeed. I sure felt punched.

I do believe in following the child's lead. It's important to me that I check my own assumptions. I don't know what Eve's issues will be. I don't want to start reassuring her about something only to find out she's never worried about it in the first place. But Paula, an adoptee and adoptive parent, feels strongly that it's the parent's job to guide the conversation. And I have to recognize that my commitment to following Eve's lead is also a way to avoid the discomfort of these conversations. If she never asks, I never have to confront my own fear and grief, or - even worse - Eve's distress. Maybe this is magical thinking - if I don't bring it up, it will never happen; Eve won't feel angry and hurt or isolated or rejected.

Paula goes on.

Imagine being a child of 5, 8 or 12 years old and never having your parents approach the topic of your adoption other than saying things like “Be proud of the fact that you’re adopted”, “Being adopted makes you special” or “Other kids sure must be jealous of how lucky you are” without so much as an opening or opportunity to talk about the more complex and often times confusing aspects that accompany one’s status as an adoptee.

OK, wait a second. Maybe I'm not doing so badly after all. I don't think I've ever told Eve how to feel ("be proud") and I know I haven't said anything about other kids being jealous. Those comments close off conversation. We have tried to create openings and opportunities for her to talk about what she's feeling. We try to listen for the fears and the concerns, and respond when we hear them.

I agree with Paula that it is our job to make our family a safe space for these conversations. It's our responsibility as parents to give Eve the chance to process her feelings about her adoption. I know that no matter how skilled and well-meaning we may be, she may need to talk with someone else someday, and we'll help her do that. We'll face our own discomfort and grief when it comes up, and we'll keep going. I don't know if we're following or leading. In the end, I think we're all walking together.

I Know I Need A Break When.... ~ by Jay

....when I feel irritated with patients. Not just one patient - that happens - but repeatedly over the course of a day. I have my own hot buttons, and most days I can figure out that they're being pushed and take a breath before I respond. (Why I can do this with patients and not, say, with my mother remains an open question). But these days, these windy, short, dark days full of sinus infections and flu symptoms and gastroenteritis, these days I am short of whatever it take to manage my own responses, and I feel my irritation leaking out around the edges.

I don't want to be the sort of doctor who treats "good patients" differently. I want to give each person the best of myself. I do realize, rationally, that people who call me and say "I've had a cold for a day and a half and I have to be better by tomorrow, so please call something in to get rid of this" are under a lot of pressure and probably can't afford to stay home, put their feet up, and drink tea for 48 hours. Rest and tea would probably do them more good than anything I can prescribe, but their lives don't allow them to stop and take care of themselves.

Ah, look, here's an insight. Right now my life isn't allowing me to stop and take care of myself, or so it feels to me. Sam is away and won't return until after Eve is in bed tomorrow night. I usually work until 8:00 on Tuesdays, so when we found out about this trip I changed my schedule. I have no openings in my schedule until the end of March, I've used up 8 of my vacation days for Jewish holidays, and my productivity hasn't been great lately, so I didn't want to just cancel four hours of patients. No problem - I'll move them to Thursday. Except...on Thursdays I have hospice team meeting at 8:30 AM, meaning I will work straight through from 8:30 AM until 8:00 PM. I'll have an hour between the end of the meeting and the beginning of my office hours, and I'll need to drive to the office, get something to eat and catch up on paperwork. Then I need to clear off my desk before I go home, which means I'll be in the office until 11:00 PM or later. No wonder I'm irritated.

The good news? The desk-clearing off is necessary because on Friday I leave for a conference, my annual faculty development conference, my chance to reconnect with other docs who see things the way I do and to rediscover my confidence as a teacher and facilitator. To catch my breath. To slow down and reflect and feel safe.

There, I feel less irritated just thinking about it.

The Good Patient ~ by Jay

You never want to be an interesting case.

An interesting case is a diagnostic dilemma. Symptoms that can't be explained, organs that don't do what they're supposed to, blood vessels that veer off course. Abnormalities that doctors find endlessly fascinating.

The problem with being an interesting case is that you are a case, not a person. If you're lucky, you'll find a doctor who understands that you are a person with a disease, and who can help you understand and cope with the consequences of your compelling pathology. If you're really lucky, you'll find a doctor who can do that and treat your symptoms, too, even if she can't address the underlying causes.

It's bad enough to realize that you have to be lucky to get a doctor like that. Unfortunately, it's not just luck; it's also privilege. Doctors don't just like interesting cases; we also like good patients. Being a good patient isn't the same thing as being an interesting case. Being a good patient has nothing to do with pathology and everything to do with behavior.

Good patients don't annoy the doctor. Good patients are on time for their appointments (even if the doctor routinely runs an hour late), take their medicines as prescribed, appear well-groomed no matter how they feel, respond to their disease with courage and a sense of humor, have insurance (in the US), tolerate pain like a good little stoic, and don't directly challenge the doctor's expertise. Good patients make the doctor feel good. Good patients don't whine, complain or ask for anything inappropriate.

Some of us may behave like good patients because of our personalities, but it helps to be appropriately socialized. If you grow up with little or no access to decent health care, spend hours waiting in understaffed public clinics and are routinely treated as if you are worthless, you are not going to learn how to be a good patient. In the US, that means if you're white and at least middle-class, you have a far better shot at being a good patient, especially since you're then likely to look like the doctor and not activate as many of the doctor's latent prejudices. If you're poor or a person of color, you're going to have a hard time proving you can be a good patient.

By now you may be wondering what sent me off on this particular rant, or perhaps you're nodding your head and saying "I bet Jay read that article in the New York Times Magazine this morning". "What's Wrong With Summer Stiers?" takes us inside the Undiagnosed Disease Program at the NIH. The program enrolls patients with (surprise!) undiagnosed diseases and brings them to NIH headquarters in Bethesda, where they are examined by a cadre of specialists. The unit is attempting to identify heretofore unknown diseases by combining cutting-edge clinical medicine with cutting-edge basic science. It's a very cool idea, and of course the most accessible way to write about it is to follow a patient through the process. Summer Stiers is, indeed, an interesting case. Summer Stiers is also a good patient. NIH, it seems, is looking for both.

“This is an absolutely great case,” {the lead researcher} said. It had everything he was looking for when he first helped design the program: documentation of her long, perplexing history and the likelihood that she was suffering from something entirely new. He was also impressed with the patient’s good disposition and coping mechanisms, which at the time he knew about only because of how Robert Pinnick, her primary-care physician, described her in his introductory letter. “We appreciate your interest in helping us make a diagnosis in this wonderful 31-year-old woman,” Pinnick wrote, “whose indomitable will to survive and always positive and pleasant attitude make her case not only tragic, but intriguing and a joy to pursue.”

What is that makes Stiers a good patient? Well, she's positive and pleasant (despite chronic pain, complete disability, daily need for peritoneal dialysis and a disease that defies diagnosis). Then the reporter talks with the patient.

When I first spoke with Stiers..., I could tell what it was about her that captivated Gahl. She was soft-spoken, with a lilting, little-girl voice, and even when she was telling me about the devastating series of physical breakdowns that have afflicted her, there was nothing complaining or self-pitying about it. Only once did she give a hint of her frustration, when she mentioned being told earlier that day that her phosphorus numbers were high, always a concern on dialysis. “They don’t know why it is, since I’m doing everything they tell me to do; I’m eating just what they tell me to,” she said. “That’s kind of what my whole life is. I follow directions — I’m a good little follower, I do what I’m told — and this happens anyway.”

She's a good little follower. That pretty much sums it up. The intimation of her childlike, dependent demeanor ("soft spoken", "lilting, little-girl voice") tells us even more about what a good patient is supposed to be if that good patient happens to be a woman (and just in case we weren't sure she was a woman, the article opens with the line "Her breasts are beautiful". Because even when we're deathly ill, it's important that we remember we're supposed to be hot).

The article also gives us an example of a bad patient, or at least someone who was assumed to be a bad patient. It happens this was a bad parent; the patient herself is only 2, and we accept all sorts of behavior from two-year-olds. Not, it seems, from their parents.

When the Undiagnosed Diseases Program’s first pediatric patient, 2 1/2-year-old Ragan Thursby of Florida, was admitted in October, Gahl said he thought he recognized the signs of parents who would go too far, to the point of pursuing every diagnostic option, spending money they didn’t have and shortchanging Ragan’s healthy older sister. Gahl later realized that he was wrong. After the first day, Ragan’s father sought out Gahl to demarcate his own bottom line: his unwillingness to put his daughter through needless pain for uncertain benefit. At that point Gahl decided it must be Ragan’s mother who was driven, without limit, to find a name for Ragan’s profound developmental delay, no matter what the emotional and financial toll. But the week at the N.I.H. seemed to shift priorities in Ragan’s mother as well. “I’m finished now,” she said at the end of the week. She was at last ready to turn over the search for Ragan’s mystery to the N.I.H scientists, she said, and was heading back home to Tallahassee to do what Gahl suggested: to continue to fight to provide Ragan with the best local services she could; and to take a breath and just love her little girl.

Go too far. Because he knows, this man who has four grown and presumably healthy children, just how far is too far to go in pursuit of a cure for your profoundly ill two-year-old. How wonderful that she was able to turn her child's future over the experts and go home to do what mothers do best.

In the paragraph before the description of Ragan's parents, the article does acknowledge that the patients who present to the NIH Undiagnosed Diseases program are a self-selected group. The author calls them courageous and single-minded in one breath, but also "slightly desperate". Galt himself disapproves of those who want "diagnosis at any cost", which is curious, given that he has created a government organization designed to offer just that.

No, that's inaccurate. The program isn't about diagnosis. The goal of the Undiagnosed Disease Program is knowledge. They seek to learn from the tissue and DNA and medical travails of these patients so they can increase our understanding of the molecular and genetic basis of disease - not to help these patients, but to provide better care for patients of the future. They do try to attend to the current needs of their contemporary patients - Summer receives acupuncture treatments and instruction in guided meditation for pain control. She's getting excellent medical care at home, and I'm not criticizing the use of complementary therapy for her pain. Summer herself seems to value her role as a source of information, of help for the future. But then she would. She's a good patient.

This I Like ~ by Jay

Since I can't figure out how to embiggen, you can read the whole thing here.

Plugging Away ~ by Tigermom

Studying hard for my board re-certification exam. Brain feeling fried. Getting anxious as the days count down.

But just got off the phone with a doctor mom neighbor friend who totally understands my angst. What soothing peace a friend can give who has been there.

Off to a ladies' Oscar night party after I cram another hour of facts into my head.

Jay, just finished the end of life/palliative care questions. I did respectably on them.

Conversations With My Daughter ~ by Jay

Mommy, we worked on our state projects today.

Oh?

Yes. I got to use the computer to look up facts about Florida.

So what did you learn about Florida?

(recites the population and the names of several famous Floridians)

And the state bird is the...the...hummocky-bird.

Hummocky-bird? Do you mean hummingbird?

No. Hansock bird?

I never heard of a hansock bird.

No, that's not right. Hocking bird?

Mockingbird?

That's it!

Still Waters ~ by Jay

Haven't been blogging much lately. The stories in my work that are alive for me right now are so particular that I can't figure out how to change them without being false to the people involved, and to myself. I've been working harder than usual - it's flu and cold season, and there are a lot of organizational challenges everywhere right now. And every time I think about blogging about feminism or culture or politics, I feel overwhelmingly angry.

Zuska wrote about anger recently. I should update my blogroll to include Zuska; she's a smart, savvy feminist scientist with a wicked sense of humor. Zuska commented on a disagreement between two other bloggers, and ended with this

Me, personally, I'd like to see a lot more chicks in touch with their Inner Pissed-Off Woman, spouting off, making people uncomfortable. It's good for all of us.

I'm completely in touch with my inner pissed-off woman. She's alive and well and shrieking her head off in here. My inner pissed-off woman feels assaulted by nearly every magazine, billboard and movie trailer she sees. She doesn't want to hear anyone else talk about Nadya Suleman, unless it's Melissa McEwan, because the tidal wave of hatred and misogyny is pissing her off even more. My inner pissed-off woman does make a lot of people uncomfortable, including me.

I want to get out of touch with my inner pissed-off woman. I want to be able to respond to the world by facilitating discussion, not shutting it down. When I'm angry, I can be funny and smart and insightful and articulate, but I'm not open-minded. Anger feels like performance - it's declamatory, not conversational. Maybe my discomfort with other people's discomfort is the result of years of femal socialization and all the rest is just rationalization, but the way I act when I'm angry feels as if it violates many of my core values. I value connection and dialogue. I believe that change happens when people really listen to each other, and move beyond labels and assumptions.

When I blog, I can sometimes channel that anger into a post that does start a conversation. I'll have to think about that. Perhaps when my anger is more focused, I can express it here in a way that allows people to respond. Perhaps the distance in this medium reduces the impact of my intensity. Perhaps I shouldn't, in the end, be all that worried about what makes other people uncomfortable.

Lots of questions. Lots of anger. Lots of tired. Thanks for hanging in there while I work to sort all this out.

American History XX ~ by Jay

Mommy, that's from the Declaration of Independence.

{reads}
We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain inalienable rights, that among these are life, liberty and the pursuit of happiness.

Mommy, why does it say "men"? Aren't women equal, too?

Where are all the shrinks hiding? ~ by Tigermom

I practice in a major metropolitan area in the age of phone books and the internet. There should be no problem tracking down a good psychiatrist in private practice whose name I KNOW.

But it is hard. And I am a people person, a reach across the aisle, making connections kind of doctor.

I love playing geography with people. You know, "Oh, you are from x? I don't suppose you know so-and-so. She trained at x around the time you did." And it is not that hard to make real connections. Connections that help me find resources for myself, for my patients, for my colleagues. Connections that help them find resources for themselves, for their patients, for their colleagues.

This week a patient called me I would have loved to see. But my office location did not work for the patient so off my mind went to work, working to find just the right fit psychiatrist for the patient. A one person mental health referral service. And I am glad to be one since it is so hard to track people down and imagine the challenge for someone ill to do so. My first idea person is full, but he called me right back with two other names and phone numbers of really good doctors to whom I would feel great referring.

So that patient will benefit because I knew who to call.

But I work for an organization that wants to add another doctor and someone suggested a psychiatrist who is really good by reputation. And I have had some exposure to the person and agree that he is good.

So how to contact the doctor?

He is not listed in the phone book.

He is not listed on Google.

He is not listed on a variety of medical web sites with a current phone number.

A colleague gave me an email address for the doctor, but he did not respond or the email is out of date.

How do patients find this guy?

I don't get it.

You either have an "in" or you are sh@#$t out of luck.

That Feels Good ~ by Jay

I appreciated all the nice comments when I announced that I'd passed the Boards. I spent a lovely half-hour that morning calling people and kvelling, and then I plunged back into my daily life.

My mother called me Thursday evening and said "So how does it feel?" I don't know, Mom; it feels like a Thursday. The euphoria had passed.

Yesterday the Hospice Medical Director sent a broadcast Email to the hospital network with the news that all three of us had passed, and ever since then I've had a steady stream of pats on the back coming in to my Email box. I know he sent the Email because we're trying to establish an official Hospice and Palliative Care Program, and the announcement supports our case. He didn't send it to make me feel good - but I'm feeling good anyway.

It's nice to know the Chairman of Medicine and the Director of Education and the Physician in Chief think I did something worthwhile. It's nice to be appreciated, and congratulated, and noticed. Maybe I shouldn't need the recognition, but I'll stop second-guessing myself for five minutes already and just - enjoy.

Mmm.

Conversations With My Daughter ~ by Jay

Look, Mom, I have magnets for my locker! One says "Girl Power" and the other says "100% Girl".

I see that. What does it mean to be 100% girl?

I don't know. Maybe it means you're not half boy. Or maybe it means you're not a girl with a tail - half girl/half dog.

Fallen Idols ~ by Jay

First Michael Phelps and then Miley Cyrus. Let the lamentation begin. The idols have fallen. Why must our role models always disappoint us?

Because our "role models" are people - in this case, very young people who have lived bizarrely circumscribed and over-analyzed lives.

I am not particularly distressed that Michael Phelps smoked pot, and it wouldn't bother me one bit if my daughter knew about it. Miley Cyrus's thoughtless racism is more dangerous than Phelp's bong, and Eve is a lot more interested in Miley Cyrus than she is in Michael Phelps, but if she sees the photo and asks about it, she'll survive. If she asks her parents, she'll learn something about racism and about compassion. That's not a bad thing.

The problem isn't that our idols do stupid things. The problem is that we have idols in the first place, and that we expect them to teach our children how to live. Eve won't smoke pot just because Phelps did, and she won't make racist jokes just because Miley Cyrus makes racist jokes*. She will make her own choices, and her own mistakes. Eve's life will be what she makes of it - and I'll be happy when she realizes that the life of a teen idol is not perfect.

It's OK for famous people to be, well, people. To be human. To make mistakes. Our children can learn more from the mistakes than from any pretense to perfection.
_____
*What Miley Cyrus did (making slant-eyes in a picture with an Asian friend) was racist. This is not open for debate. Her intent may not have been racist, but the gesture clearly was. Please don't bother explaining otherwise in comments.

Where's Jay? ~ by Jay

Buried under a mountain of paperwork.

Haven't even started the taxes yet, but am in the midst of preparing for a faculty development course I'm coordinating...and a chart audit of my hospice charts. I have fallen way behind on my hospice notes and have been frantically catching up.

Ah, for a real, functional EMR that would provide all the basic info...no, I should be grateful that I can at least type these notes, because if I had to write them by hand, I'd be in agony right now from writer's cramp.

Back to the salt mines. I promise blogging to come - someday.

I Passed! ~ by Jay

The Hospice and Palliative Care Exam.

Phew.

Ten Random Things About Me (As a Mother) ~ by Jay

As I deal with the lingering effects of my cold, an onslaught of work and preparation for Eve's birthday party, I've been ignoring many other things, including this blog. Mama rescued me from blog-guilt with a meme she invented. Thanks, Mama!

1) Like Mama, I don't like sitting on the floor to play kid games. This doesn't come up very often anymore since my daughter is now 9, and I know I'm supposed to be sad that she doesn't want me to play on the floor with her, but I am instead relieved.

2) I am more concerned about Eve's exposure to violence in the media than sex. When she's a teenager, I'll be more comfortable with her seeing porn than "Pulp Fiction".

3) We tried to entice Eve to go downstairs and watch TV on her own on the weekends instead of waking us up. (This is more about Sam and me as parents, but I'm leaving it in). We told her she could watch whatever she wanted as long as we didn't hear her. We were disappointed that she never actually did it.

4) I worry that I expect my daughter to be too independent. She can do a lot of things for herself and I'm always surprised when we run into something she can't do. Sometimes I don't believe her the first time she asks for help.

5) If it were up to me, I'd let Eve have as much screen time as she wanted.

6) I wish Eve wanted me to brush her hair. When she was little, she hated having it brushed and so we mostly didn't. Now she does it herself and doesn't want any help. I would have loved fussing with her hair.

7) I am the soft touch in our house.

8) I'm glad I waited to have children. I would have been a resentful, miserable, angry mother in my 20s or early 30s.

9) I have never minded leaving Eve with other people. I've happily handed her over to the day care, various baby sitters, synagogue child care, her grandparents and a variety of other people. I worry that this proves I am essentially unmaternal.

10) The most important thing I've learned in the last 9 years is that my child will show me how to be her mother if I can slow down and really listen to her.

I hate cancer too ~ by Tigermom

Honest to whoever is up there in Heaven, I was about to write this post when I read Mama's while I procrastinated writing mine.

One of my best friend's, Catharine (not her real name), is dying. She has metastatic breast cancer in many of her bones and has been in pain for a good long time.

She is a therapist and we met many years ago when she referred me a patient. And then another and then another and then another. The professional experiences we have shared have been deep and strong.

And we would have these life changing conversations on the phone. It was years before we actually had a brick and mortar meeting. I had little children and we lived a distance away. We had to describe ourselves to one another so we would know each other when we had our first lunch. Our patients thought it funny that we knew each other so well, but not what the other person looked like.

She shared much of her life's hardships and joys with me and I with her. She introduced me to her closest friend and colleague who then became one of my closest friends and colleagues. Her background is in many ways very different from mine, but she made it easy for me to ask her questions and not feel awkward. I so appreciate that and she enlarged my world so much for that.

Her gift though was not just how she made me feel, but really how she made her patients feel. They all have known her deep commitment to them as whole people: their physical, emotional, and mostly spiritual selves. She was not afraid of their deep scars and traumatic pasts and presents. She bore witness and helped them make sense of their travails while building a hopeful and healthy future.

And she has shepherded them still throughout her illness. She did not have chemo after her surgery and so no one saw outward signs that she was ill. But she let them in little by little teaching them about illness and death and how to care for oneself in the process. As her bone pain has gotten worse and she was less able to make appointments, she did tell patients of her challenge. They appreciated the knowledge and the time she gave them to process out loud with her how to cope, how to cope when she would die, how to make this all right, that the person who helped them through their unthinkable previous losses was now going to leave them as so many before had done.

The patients have been talking to me all year, almost concerned for me, "Did you know that Catharine has been ill?" And crying in my office as they talk about what they will take with them from the therapy work with Catharine and grateful.

I just happened to call Catharine today about a tragedy that had befallen one of our patients when she told me she is leaving our town next week. Catharine's original home is far away from here and she decided when her mets were diagnosed that when the time came, she would move back to be with her mother in their far away home. We barely managed a professional conversation about how was her friend handling the impending departure, how was her mother handling the news, about catching that one patient up to date who had not seen Catharine for years, when I dissolved into sobs and tears and cried about how much I would miss her.

She lost it too, my rock did and I tried to hang on by asking if she had my email, could I send it off to her so that she could write while she was away. Like a desperate grab that email would reach to Heaven.

I hope it does. I will write to Catharine every day.

Conversation With the Patriarchy, 1986-present ~ by Jay

This is Dr. Jay. I'm calling in a prescription for Patient Soandso.

{details of prescription given}

OK, we'll have that ready in about an hour. Can I have your name?

Dr. Jay.

And the physician's name?