I Write Letters ~ by Jay

Dear Insurance Company,

I am in receipt of your request for further information so that you may process my request. Unfortunately, I have no idea what I requested or for whom.

In order to process your request for more information, I will need the name of the patient to whom you refer.

Thanks ever so.

Sincerely,

Dr. Jay

Conversations With My Daughter ~ by Jay

Time for bed, sweetie. You have a big day tomorrow.

What big day?

You have your orchestra concert.

Oh, that. That's not big. It's just a concert.

So what would be big?

Moving.

Things I Could Do Without ~ by Jay

Blog-comment spam in Chinese (at least I think it's Chinese, and I have to assume it's spam).

Traffic slowdowns for no good reason. It's like a mystery with no denoument. Plus it makes me late.

The Suite Life of Zack and Cody, which I was forced to watch by my own promise to Eve that she could watch the Disney channel if one of us watched it with her. Parenting theory: you watch the objectionable stuff with them, and then you have a reasonable discussion about what she likes and what you see. Parenting reality: child looks at you as if you're daft and says "but I just like it! And it's just a show!" and then refuses to have any further conversation.

Having to make polite conversation with people who say "but don't you think everyone who lives here should at least try to learn English?" as if a) it's just that easy and b) there's no cost or loss involved in the learning and c) non-English speakers simply aren't trying.

Racist, self-important police officers who threaten people, especially black people, just because they can, and the people who defend them.

Seems Like That Should Be Obvious ~ by Jay

I receive an Email asking if I am available for a meeting at any time on Tuesday.

I respond by saying I am available from 8:30 AM to 11:30 AM.

I receive another Email saying "We already have a meeting set up for 1:30 PM. I can't tell from your previous response if you are available at that time".

Is there some way I could have been clearer?

I am available between 8:30 AM and 11:30 AM. In this time zone, at least, 1:30 PM does not fall between 8:30 AM and 11:30 AM.

Is there some meeting-schedule-convention that I don't understand? Do some people keep their real available time a closely guarded secret, unlockable only by the correctly worded request?

I must be missing something.

Women's History Month Quiz ~ by Jay

I love memes and I love quizzes, so here's a combination! Deborah Siegel, over at Girl w/ Pen, is trying to start a little infectious blog quiz. If you've got one, paste these questions and add one of your own, then post it up at your blog so we can spread the knowledge.

1. In 2009, women make up what percent of the U.S. Congress?
A. 3%
B. 17%
C. 33%
D. 50%

2. How many CEOs of Fortune 500 companies are female?
A. 12
B. 28
C. 59
D. 84

3. Who was the first First Lady to create her own media presence (ie hold regular press conferences, write a daily newspaper column and a monthly magazine column, and host a weekly radio show)?
A. Eleanor Roosevelt
B. Jacqueline Kennedy
C. Pat Nixon
D. Hillary Clinton

4. The Equal Rights Amendment was first introduced to Congress in:
A. 1923
B. 1942
C. 1969
D. 1971

5. Who was the first African-American woman to win the Nobel Prize for Literature?
A. Phyllis Wheatley
B. Alice Walker
C. Toni Morrison
D. Maya Angelou

6. What percentage of union members are women today?
A. 10%
B. 25%
C. 35%
D. 45%

7. What year did the Griswold v. Connecticut decision guarantee married women the right to birth control?
A. 1960
B. 1965
C. 1969
D. 1950

8. In what year was the American Medical Women's Association founded?

A) 1972
B) 1881
C) 1915
D) 1980

Scroll down for the answers.





ANSWERS: 1:B, 2:A, 3:A, 4:A, 5:C, 6:D, 7:B, 8:C

(via)

No, Really? ~ by Jay

From my medical headline Email this morning:

NEW YORK, March 24 -- Politics, not science, led the FDA to delay approval of the emergency contraceptive Plan B and when the agency finally did okay the morning-after pill, politics dictated the access it allowed.

Filed under "ya THINK"?

And let's pay particular attention to this paragraph, toward the end of the piece:

The Bush administration, which was vocal in its opposition to abortion, was opposed to FDA approval of Plan B, but framed its opposition as a safety concern.

Because of course PREGNANCY is entirely safe. No woman ever becomes ill, or dies, or is disabled, or has to spend six months in bed because of pregnancy. No safety issues there. Nothing to see. Move along now.

Here's hoping that the Obama administration puts science ahead of politics and women's health and agency ahead of misogyny and slut-shaming.

Conversations With Patients ~ by Jay

(Or, sometimes it's nice to have good news)

The last time I saw you was just before the surgery.

Yes, and I was a wreck. Wasn't I a wreck? I was so worried.

I can understand why.

But it was fine. It was completely fine. They got it all out, and I don't need chemo or radiation. The surgeon was wonderful, the nurses were nice, and I feel great.

I'm so glad to hear that!

And you know how I've always been really anxious?

Yes.

I'm not any more. I'm not anxious at all. It's like I was worried all my life that something awful would happen, and it did, and I survived - and I can't believe the relief.

You look much more relaxed.

I haven't taken any Xanax since I came home from the hospital. I don't know - maybe this won't last and in a month or two I'll need it again. But right now all I feel is happy and grateful.

Conversations with Patients ~ by Jay

I need to ask you some questions that may be embarrassing. I ask every teenager these questions.

OK.

Do you smoke?

No.

Drink alcohol?

No.

Use anything else?

Like what?

Pot, pills, coke.

Well...sometimes.

Sometimes?

You won't tell my mom?

No, I won't.

Sometimes I have soda.

Soda?

You know - soda. Like Mountain Dew. Promise you won't tell my mom?

I promise.

Teach Your Children Well ~ by Jay

Those little J. Edgar wannabes were so cute!

Labels ~ by Jay

Does it matter if women identify as feminists if they are working toward what I consider to be feminist ends?

From Deborah Solomon's interview with Sandra Day O'Connor in today's NYT Magazine:

Do you call yourself a feminist?
I never did. I care very much about women and their progress. I didn’t go march in the streets, but when I was in the Arizona Legislature, one of the things that I did was to examine every single statute in the state of Arizona to pick out the ones that discriminated against women and get them changed.

So do you call yourself a feminist today?
I don’t call myself that.

Is there a label you prefer?
A fair judge and a hard worker.

I understand that O'Connor isn't setting that up as a binary. Of course it's possible to be a fair judge, a hard worker and a feminist. Part of my brain says it doesn't matter what label O'Connor chooses; the work she did in the legislature and the role she played on the Supreme Court have helped to reduce the impact of sexism by some measure. This is one of the reasons I really dislike this one-page interview feature: no follow-up questions, no exploration. Just pithy little sentences edited to make Solomon look smart.

I wonder why O'Connor prefers not to identify as feminist. It's clearly not for the reasons Kat is frustrated with younger women who believe we're in a post-feminist age:

What I don’t understand is a refusal to commit to the cause of women’s equality in any small way. A refusal to acknowledge that while one’s own circumstances may seem devoid of sexism or oppression (and to this I’d raise an eyebrow), we still have so much farther to go before all women can say this. A refusal to care about the needs of those women less fortunate than us, simply because we have health insurance, can afford birth control, would have access to a safe and legal abortion (and the funds to pay for it), God forbid we should ever need one, and have held the right to vote for almost 90 years.

O'Connor knows, better than I do, how far we have come, and I suspect she also knows how far we still have to go.

Labels are funny things. I know what I mean by "feminist", and I also know I have more in common with some women who reject that label than with others who choose it. I may be better off buying food that is grown with pesticides by a local farmer than a pepper that's labeled "organic" but is shipped 3,000 miles and packaged in plastic by a company owned by ConAgra. It's time for me to start looking underneath the labels at the true impact of the actions represented.

Or Else ~ by Jay

Over at The Second Road, Mary wrote about being a healthy person. She said

The truth is a lot of my “healthy” actions aren’t very different from what they used to be. While some do look very different (I don’t check phone records anymore or fish through pockets for receipts), in many other cases some of my healthy new boundaries can look a lot like my unhealthy old attempts to control. But in coming at them from a place of faith and balance — in letting go of the outcomes and trusting myself and others — they feel different, to me and to everyone else around me.

and something went "ping" inside my head. I've been musing about the difference between an ultimatum and a statement of needs. It feels coercive and controlling to me to say "do this or else", and yet I want to be able to state my own needs. What's the difference between "or else" and "I need"?

Mary has it right. The difference is letting go of the outcome. When I say "or else", and the other person doesn't change, then I'm stuck. I've made the other person responsible and if they can't do what I ask, the outcome won't be what I want and I have no other recourse. There's no answer to "or else".

When I say "I need", that's the start of a conversation. The outcome may be the same, in the end; the other person may not be able to meet my needs. But if I've identified them as my own needs, then I may be able to figure out how to meet them. Ah, a paradox: by giving up my attempt to control my partner, I have regained control of myself.

"I need" can also start a negotiation. We can open the door to a common understanding. We can explore the meaning of an action. "Or else" suggests that the action has only the meaning I assign to it. I know impact matters. When someone uses an anti-Semitic phrase, I am injured even if that wasn't the intent. In intimate relationships, I want to think about the intent. It helps me to understand that Sam needs time alone, and that his retreat to the garden or the basement isn't about me. That insight changed the impact of his actions. I need social contact, but Sam doesn't have to provide it.

In Judaism, we say "we do and then we believe". We act, and from that action comes our faith. Mary turns this on its head. From her faith comes the action, and in the action is health. And once again, she has explained me to myself.

Things I Love ~ by Jay

Patients who bring their babies in to see me

Baby feet, in adorable little baby shoes.

Playing peek-a-boo with babies and small children I don't know in supermarket check-out lines and restaurants.

Watching the older children at shul play gently and affectionately with the current crop of toddlers.

The look on a small child's face when I hand her a tongue depressor to play with.

Not having to wake in the middle of the night to feed/change/settle a baby.

Empathy ~ by Tigermom

So sometimes at work, I see a patient who has been terribly wronged. Wronged by a parent, a significant other, a stranger, a trusted confidante, you name it I have heard about it.

The person is often profoundly hurt, scarred, and has or is working on ways to integrate the experience into how they see themselves.

And in truth, the person is always reworking how to integrate the experience at different times of their lives. They think they have it figured out, where it all fits, they may have found a really good hiding place for the experience, the emotions, the implications for the time being at least.

They may have found a truly healthy place for it all. But inevitably it comes back out at another time, maybe at a time when there is another stressor or time of vulnerability.

Then sometimes at work, sometimes just the next hour, I will see someone who has perpetrated a terrible wrong. A wrong against a child or a significant other, a stranger, confidante - you get the idea.

And that person, the one who perpetrated the wrong, is often profoundly hurt, scarred, and has or is working on ways to integrate the experience into how they see themselves.

And that person also spends a lifetime putting the experience into context in their life. What does it mean? Where did the behavior come from? How do I function after the hurt I have caused? Is there any way to make things right? Or at least tolerable?

The irony is not lost on me that in one day I might see both people wronged and perpetrators. But in the room, with each person, I feel the person I am with is both a victim and a survivor.

Getting Ready ~ by Tigermom

My test is over, I have caught up on laundry, gathered my tax information so the time is here, time to think about what we need for our big family trip.

My biggest concern is that everyone have the right combination of appropriate footwear. Not too many pair of shoes, not too few, but just right. Sturdy sandals, for sure, light hiking boots too, and the third is the mystery. Sneakers? Clogs? Flip flops? I will have to scour everyone's closets to make sure I get it right.

Luckily I love shoes.

Quiet Sunday ~ by Jay

Cleaned up the bathroom after Eve sprayed it with water from the shower head, which she managed to reach the first time but couldn't put back in its holder.

Spent an hour in a committee meeting during religious school, then spent 20 minutes trying to figure out who was supposed to take the art supplies home. Decided to take them home myself.

Got halfway home when Sam called to tell me the religious school director called and said I'd left my laptop bag in the building. Did not want to go back, so Sam arranged for my bag to be left at the front desk for later retrieval.

Took Eve and her friend to Target to pick up a present for Ari. Ari's birthday party was this afternoon but I'd forgotten about it until Ari's mom mentioned it last night in her Facebook status. Thank God for Facebook. Explained that no, we were not buying an R-rated movie for Ari, who turns 9 today. Decided on a Star Wars Lego set and a lightsaber.

Got home from Target and discovered that I'd been given the envelope but not the birthday card. Handed Eve and friend, who needed lunch, over to Sam and returned to Target, where I decided to just buy another card rather than stand in the 10-person-long customer service line.

Got home again and ate my own lunch while the girls played on the Wii. Wrapped presents, made Eve stop playing the Wii and write out the card, took girls to the bouncey-bounce place for the party. Signed release forms and left them a phone number in case of "injury or other emergency". I had never been to the bouncey-bounce place before and was awestruck by the sheer scale of the inflatables.

Left Eve and friend at the party and went to GiantOfficeStore to buy folders (ran out of blank folders when I reorganized the filing system yesterday; that was Big Fun). Stopped and picked up my laptop bag. Returned to the party because Ari's mom is one of my closest friends and stood for an hour - no chairs - while everyone bounced, slid, boxed and ran around. Then we all ate cake and ice cream. I can see why they don't feed them until they're done bouncing.

Brought Eve home and listened to a barrage of questions about we're going to do next. It was 3:30 in the afternoon. I hadn't planned "next". Eve and Sam went for a bike ride and I actually had 20 minutes for a phone call with a friend.

Then we had an hour of computer time, after which Eve asked to go out to dinner, I said "No, Daddy bought food at the store", Daddy revealed that he actually hadn't purchased one of the main ingredients for the dish we'd planned to make and we decided to go out to dinner anyway. Had a nice dinner. Sat next to an extended family dining with about six kids: two babes in arms, two preschoolers, two school aged/tweens. They were having a great time, kids included, and it was fun to watch, but I was also aware that I was grateful to be able to look at babies and not take one home.

Went out for ice cream afterwards (yes, that's twice in one day, but Eve starts the Big State Test in the morning and we felt a treat was in order) and sent Eve off to bed when we got home. Lately she wants to read to herself (currently Michael Phelps's autobiography) while we sit on her bed. Tonight she asked to lean on me and have my arm wrapped around her. I had to turn the pages of my book with one hand, but it was worth it. She's also now singing the sh'ma by herself. My growing-up girl.

Then I had a chance to finish my book (Murder in Greenwich Village, a paperback mystery), watch the end of an Antiques Roadshow repeat on TiVo and do tomorrow's New York Times puzzle. I'm on call but so far (knock on wood) the beeper has been quiet.

And it was, really, a quiet Sunday.

New Rule ~ by Jay

Minimum age for my patients to die is 97.

No more people younger than I am. No more mortally ill people with children Eve's age. No more dying people being tended by their parents.

97. OK, maybe 85, but that's as low as I'm going.

Conversations with Patients ~ by Jay

Ms Smith

Dr. Jay, I need a new order for my mammogram. The one you gave me is for a screening mammogram, and I need a diagnostic mammogram.

I looked over your results from last year and you're due for a screening mammogram, not a diagnostic mammogram.

But my insurance won't pay for screening tests. They'll only pay for diagnostic tests.

That's a shame, but they will look at my records and if I order a test that's not indicated, they'll refuse to pay for it, anyway.

Then I guess I just won't have a mammogram at all.

Ms Miller

I had to pay for my mammogram this year, and I'm really annoyed.

What happened?

Well, you remember they saw a shadow on the right breast?

Yes, and they were able to convert the screening mammogram to a diagnostic mammogram so you didn't have to come back again, and it was fine. I thought that would be a relief.

I was relieved until I got the bill. My insurance pays for screening tests without any copay or deductible, but for diagnostic tests we have to use our deductible - and it was January - and plus they only pay 80%. So the screening mammogram would have been paid for in full but I'm still paying off the diagnostic one - and they didn't find anything, anyway!

I can see why you're upset.

So don't even bother giving me another order form. I'm not having any more mammograms.

My Little Red Story ~ by Jay

Orange dropped me a link to My Little Red Book in comments. I hadn't heard of it, despite the fact that the NYT Book Review arrives (with the rest of the paper) every Sunday. I read the Book Review section maybe once a month (!) and that wasn't my week. Once I figured out that Orange wasn't talking about some odd scrapbooking kit, I trundled off to Amazon to check it out - and immediately ordered it.

My Little Red Book is a collection of stories about first periods. I'm usually skeptical about books by prodigal teenagers, but this one works. Rachel Kauder Nalebuff, now 18, started collecting stories for a high school project after hearing her mother's and grandmother's recollections. Kauder Nalebuff trusts her storytellers and her subject, and the reminiscences stand on their own with only a gentle comment from her now and then. It's not a taxing book to read; I started it last night and finished it after dinner. It's not surprising to know that many women felt shame when they first menstruated, but it is striking to see that shame resonate for pages at at time, across generations and on different continents.

I have never felt ashamed of having my period, but I've never told the story, either. And I do remember being told to make sure the boxes of supplies were behind something else on my closet shelf, and I remember being rebuked for leaving some sign (don't remember what it was) in the bathroom because "it will make your brother uncomfortable". Even at 14 I was offended at the idea that I had to hide for his (imagined) comfort.

I'm writing this for the girl I was, and for the girl my daughter is growing to be, and to mark International Women's Day.

My mother told me I'd start late - she had, after all, and she assumed those things ran in families. Maybe they did. I don't honestly know how late I was compared to the other girls in my class, because we never talked about it. I was taken for my first bra at 12, but then nothing else happened for what seemed like an eternity. Like many of the girls in My Little Red Book, I'd read Are You There God? It's Me, Margaret, probably shortly after it was published. Margaret uses pads with a belt, and I was sent to summer camp with a supply of pads and belts at age 11, but within a year the belts had been replaced by panties with a plastic crotch and elastic straps to hold the pads. I had a box of pads and two pairs of panties. They sat in my closet for a long time.

I'd always been a weird kid. I was socially and physically awkward, and feeling like the Last Girl in the World to get my period added to but didn't really change my sense of myself as Different. I didn't know what to do with my hair (that didn't change until I was over 30) and hadn't started to wear makeup. I didn't have very many friends, and we never talked about puberty. One of my closest friends had a cancerous tumor removed when we were 12; the treatment damaged her pituitary (yes, I knew what that was when I was 12) and she never physically matured. So even if we'd been inclined to discuss it, we wouldn't have, for fear it would upset her.

Every now and then I'd find myself with kids who didn't know me and thought I was a Normal Girl, and they would talk about cramps and PMS and ohmygod I wanted to die when I saw the stain on my jeans. I just listened and didn't say much. If they thought I was one of them, that was fine. I knew better, but I wasn't going to out myself.

The summer I turned fourteen, I gained weight and my body changed. I'd always believed I was overweight; now I had the hips and butt to prove it. I started wearing clothes a size or two larger than my mother. I actually needed the bra - but still, no period. All I wanted was to get my period - but at home, please, and not at night. I had to buy all new clothes for school that year because everything was too small, and I couldn't buy junior sizes. I didn't much like most of the clothes. I remember what I wearing the day I found blood in my panties at school (of course it was at school) - a navy blue stretch pantsuit that was already a little too small. I had to go to the nurse's station and get a pad, and I was sure everyone could see it.

I called my mother and asked her to come pick me up. It's the only time I can remember her refusing. I walked home, and for some reason we had the conversation out on the front stoop. I suppose my brother must have been home - I don't know why we were sitting out there. Mom gave me more pads and made sure I knew how to use them, and she kissed me and cried a little. I know she told my father but he never said a word about it. Ever.

There's a history of vaginal malformations in my family, so I was instructed not to use tampons until I'd had a pelvic exam. After one round of the plastic panties, I decided that was enough and in a week I had my first pelvic exam and Pap smear - and the gynecologist showed me how to use a tampon. Mom gave me one of those little plastic cases to carry tampons in my purse, and I didn't use a pad again until toxic shock reared its head. That was my first year in college. We'd been given Rely tampons (the brand associated most closely with TSS) in our Welcome to College goody bags. I had light flow and tended to wear a tampon all day, so I was well and thoroughly wigged out, and abandoned tampons completely unless I was swimming, in which case I put a tampon in and removed it as soon as I was out of the water.

My mother menstruated until I was in college, so when I started I felt an alliance with her that I can't really explain. The memory of that transition is powerful. Eve, at 9, shows no signs of impending puberty while I, at 48, am experiencing hot flashes (along with persistent menstrual cramps, which seems unjust). Sometime soon I will finally clean the leftover wipes and diaper rash cream out of the closet in Eve's bathroom and replace them with pads and tampons. Not an alliance, so much, as a passing of the baton. I trust it will still be a powerful moment. I promise that if she asks me to drive her home from school, I will drop everything to be there.

Coming Up For Air ~ by Jay

The conference ended at 6:00 PM today, and I'm finishing my packing before heading to the closing party. I've kept up with my Email, but there are 390 posts in my Google Reader. Gulp.

If you responded to the Five Words, please drop me a link in comments. I don't want to miss those but I'm afraid I may wipe out my whole list of unread posts in a moment of decisiveness.

Travel tomorrow, first full day home on Saturday. Can't wait to see my daughter's face, and sleep - ah, blissful sleep - in my own bed with my own husband.