Gratitude ~ by Jay

I am grateful for cancelled meetings and otherwise unscheduled days.*

____
* because that means I can get my actual work done during actual work hours, and see new admissions when they arrive instead of hours later.

Gratitude~by Jay

I am grateful for crisp fall days. (Sorry, Mama)

House of Cards ~ by Tigermom

It really does take a village to get anything done.

I have a village all coordinated and well planned out to get done what I and my family need in order to get through each day. I even have decent scenarios for emergency coverage.

But not for tomorrow.

Tigercub 3 is feverish and needs to stay home tomorrow, again.

Nanny asked for tomorrow off a month ago for much needed personal issues.

Tigerdad will be out of town all day tomorrow from sun up to long after sun down.

And I have a weird thing on my skin and managed to get a coveted dermatology appointment for tomorrow afternoon perfectly timed for after my patients and before I have to pick up the cubs at school. Why? Because their blessed school has last minute after school coverage available.

But only for healthy cubs. So who can look after cub 3?

Mother in law can only cover part of the day.

My mother cannot do any part of the day.

So what to do?

Cancel all of my patients, of course.

And take the cub with me to the coveted derm appointment.

Reflection for Yom Kippur ~ by Jay

The other day I sorted through some old photos and letters. I pulled them out because I’ve reconnected with some old friends, and got to thinking about what we were like all those years ago. When I sat down to write about transition, I found myself thinking back to those old changes – high school to college to medical school. Boyfriends to fiancé to marriage. Child to teenager to adult. Who I was, to who I am now.

What I’ve been doing lately could be called nostalgia, or a trip down memory lane, or a waste of time. I’d call it a life review, a term I learned from the chaplains at hospice. “Life review” is what people often do as they approach the end of their lives. Sometimes it’s internal, or even subconscious, coming out in dreams or delirious chatter. Sometimes it’s deliberate, as people pull out the old photo albums and tell their stories to their children and grandchildren, making sure that someone else knows where Grandma came from, and what life was like in the old days. Some lives are more difficult to review than others, as they are to live. But it’s almost universal, this impulse to look back as you come to the end.

So why am I doing it now? As far as I know, I’m not dying. Why look back?

Our chaplains have taught me that spiritual care at the end of life is about making meaning. They help our patients wrestle with the question “What’s important in life?” I’ve realized recently how valuable this process can be even in the midst of life. Teshuvah, in fact, requires us to make meaning, to wrestle with our values and reflect on how well our lives have matched our intention over the past year. We spend the month of Elul and the time of Yamim Noraim in life review, and then it is Yom Kippur, our rehearsal for death. Our tradition gives us a chance to think about what it would be like to make that greatest of transitions, and then to step back from the brink and act on what we’ve learned.

Nostalgia can be a trap. It’s possible to look back and see only how much easier and simpler life was, and how difficult and challenging it is now. When I look at pictures of the man I dated in high school, I remember the rush of feeling that comes with a first love, and it can be intoxicating. I could get lost there. Or I can look up and across the room and recognize that there is a greater depth of emotion and commitment in my marriage. Looking back has helped me appreciate the present, to connect the dots from then to now and feel whole. Teshuvah offers us this opportunity every year: to mark a transition from life as it is to life as it could be, to look back in a way that doesn’t keep us stuck in the past but helps us move forward into the future.

Gratitude ~ by Jay

I am grateful for the option to schedule blog posts, so I can post on Yom Kippur without posting on Yom Kippur.

Wishing an easy fast to those of you who are fasting, and a year of peace to all.

Gratitude ~ by Jay

I am grateful for my dishwasher.

Gratitude ~ by Jay

I am grateful for playdates.

Gratitude ~ by Jay

I am grateful for peaceful interludes and phone calls with old friends.

What Kind of Mother am I? ~ by Tigermom

I just got back from Back to School Night in our neck of the woods. And I serve as a foil tonight to Jay.

Background: Usually Jay and I come out just about in line on every issue I can think to name. Go ahead, try us out, we hit almost the same note on most issues.

And at the end of the night, we may still on this issue as well.

Last week Tigerdad and I hosted 36 people for Rosh Hashanah dinner last and I had quite a week at work. (That's a post I have not figured out how to write about here.) And Tigerdad is gearing up for an out of town work gig that will be, at the least, tense and intense.

Add in a sick kid, three sets of music lessons, a tween with a new cell phone and you get the picture.

I never got around to calling the sitter to cover for tonight so I figured I was just scr#%ed. Then I thought of asking Tigerdad to sit while I went alone.

He was happy to have some home time.

I was happy to get out of the home time.

And a friend called to ask if we could watch her kid since her sitter baled.

So I got in some friend time on the way to and fro.

I took care of myself by getting out.

What Kind of Mother Am I? ~ by Jay

I am officially the kind of mother who doesn't go to Back-to-School night.

I've gone faithfully every year, kindergarten through third grade. I've sat in the overheated gym and listened to the same presentation about attendance and good nutrition and reading to your kids. I've dutifully processed to my daughter's classroom and sat in her chair. That part is fun - seeing her desk and her nametag and her artwork on the wall - but then the teacher starts to talk about what parents need to do for homework. Last year that was followed by several parents complaining that the math homework was too hard - for the parents, not the kids. But parents are supposed to go to Back-to-School night to show our interest and commitment. We don't want our kid's teachers to think we're the sort of parents who don't go to Back-to-School night.

Sam stopped going after first grade. Kids aren't allowed, and he knows the teachers anyway because he goes in several times each year to do science projects. Last year I came home sweaty and annoyed and he said "well, don't go". This year, when I looked at the calendar yesterday and groaned, he again said "Don't go". Then I read the handout Eve brought home and realized I wouldn't even get to go to her classroom because all the fourth grade teachers would receive parents in one room and review the fourth grade curriculum. In fifteen minutes.

I looked at the list of things I have to do this week: prepare to chant an aliyah I've never done before. Rehearse the Kol Nidre I'm chanting Sunday night. Get ready to lead services tomorrow evening. Organize the greeters for Sunday night and Monday's services. Check in with the new rabbi about any changes she might want in the set up for services. Oh, and go to work, where our inpatient hospice unit is nearly full and there are four families with major pre-existing interpersonal issues. We nearly had a fistfight in our parking lot last night.

Tonight I read through my Torah portion, recorded the Kol Nidre so I can listen to it as I drive, figured out my d'var Torah for tomorrow night, and had a lovely dinner and glass of wine with Sam while Eve practiced her violin (one benefit of getting home too late to eat with Eve). I will go to bed at a reasonable hour and get up tomorrow feeling ready for the day ahead.

Turns out that the kind of parent who doesn't go to Back-to-School night is the kind of parent who is taking care of herself.

Gratitude ~ by Jay

I am grateful for good red wine at the end of a long, difficult day.

Not Oprah's Gratitude Journal ~ by Jay

No, Orange, I'm not turning the whole blog into Oprah's gratitude journal.

I am wondering why I TiVo'ed today's Oprah show. Haven't watched it yet - will take a look when I head upstairs in a little while - but as soon as I heard it was Mackenzie Phillips, I set up the recording. I don't care so much about whatever family secret it is that she's going to tell, but I have always felt somehow connected to Mackenzie Phillips.

I can't have seen "American Graffiti" the summer it was released, because I was 13 and I had no social life, but I know I saw it in a theater - it must have been re-released at some point. And by that time I already knew Mackenzie Phillips from "One Day at a Time", which was one of the highlights of my life in high school. I loved that show. Valerie Bertinelli and I are the same age, but I found Phillips far more compelling. Julie Cooper did stuff - she ran away, she got involved with an older man, she argued with her mother - that her younger sister would never do and that I would never do, either, which is probably why I found her so fascinating.

Now I look at the show on YouTube and I'm amazed by how feminist it is. Every episode passes the Bechdel test. Anne Romano goes to college, starts her own business, works and tries and fails and sometimes succeeds. She has dates and boyfriends and long stretches in between. She notices and fights again the sexism in her daily life.

Where is this on TV today? Where is it in the movies? Where is it anywhere?

Gratitude ~ by Jay

I am grateful for loving friendship.

Gratitude ~ by Jay

Ariane's got a great idea. She's started asking her son Ben to name one thing he's grateful for each day, and has noticed it has improved his not-usually-happy demeanor. So she's going to try it to: one quick post each day with something she's grateful for.

Sounds good to me.

I am grateful to walk into work and be greeted by people who are happy to see me - not The Doctor, but me.

On Topic But Not On Time ~ by Jay

Mothers In Medicine had a Topic Day on Child Care, and they invited guest posts. I bookmarked the invite and fully intended to write a guest post - and here it is, days after the Topic Day, and I never submitted it.

Luckily, I have my own blog!

I've written about child care before. Eve started in an institutional day care when she was 8 months old. Before that, she had two babysitters: the teenager who lived next door who watched her for two hours once a week, when I had to leave for work before Sam got home, and a student of Sam's who was home with her own kids and watched Eve after Sam went back to work full-time.

I didn't consider a nanny. The idea of having someone in my home that much gave me the creeps, and I didn't want to stake my ability to do my job on one other person's reliability. I don't mind staying home with a sick kid, but I didn't want to use vacation days to stay home when the nanny was sick, too. I wanted a group daycare where a sick provider was someone else's problem.

One thing about being the last in your cohort to have kids: you gather a lot of information without really trying to. I knew the hospital daycare had a high staff turnover, and a long waiting list. I also knew that the local JCC daycare was well-regarded, and met the needs of several of my more anxious friends. Plus no Christmas stockings or Easter bunnies. Perfect. So when Eve was 8 months old, she started there part-time. Three weeks later, I quit my job - but I kept her in day-care two days a week.

Day care saved my life, or at least my sanity. I had no ambivalence about handing her over to other people. They did just as good a job with her bottles and her diapers as I did, and I had two days a week when I could be an adult and do what I wanted and needed to do. Nine months later, when I returned to work in private practice, I enrolled Eve full-time, even though I was only working 30 hours a week. She loved the JCC. She made friends, got to play with messy stuff we usually didn't have at home, developed better social skills at 2 than I've ever had, and had Shabbat every week. We had our issues with the preschool director and the food policy, but Eve was happy, and that was the most important thing. The JCC closed for Jewish holidays but otherwise they were open on school vacation days and snow days. Once, when we had the first six inches of a predicted two feet on the ground, I called to see what they planned. "We're thinking of closing", said the teacher, "but if you need us, we can stay here".

Eve started kindergarten and spent her afternoons at the JCC, across the street from her elementary school. It was a lovely transitional time, and she was happy to start first grade, and stay in the afterschool program. Day care was easy for us. She took swim classes at the JCC, and had religious school upstairs one day a week, and Sam or I picked her up early for piano lessons.

Now Eve is in fourth grade, and she has extracurricular activities three days a week, including a 4:00 PM dance class. She has more homework, and it's more complex. The afterschool program at the JCC is one room, and it's mostly kindergartners and first graders. And now I can't do any of the early pickups, which means that Sam would be stuck leaving work at 3:30 or 4:00 three days a week - not fair, and not really feasible. For the first time in nearly 9 years, we found ourselves wrestling with child care. I felt guilty for taking a job that made it impossible for me to participate in late-afternoon activities. Sam worried about what his boss would think - flexible is fine, but that seemed a bit much. Eve couldn't decided if she wanted to go back to the JCC or not.

So we decided to experiment and advertise for a college student to pick Eve up three days a week - and Allie answered our ad, and our prayers. Allie is a college sophomore with her own car; she's smart and responsible and fun. She picks Eve up at school Mondays, Wednesdays, and Fridays, brings her home for snack and homework, and then takes her to her extracurricular activities. On Wednesdays, she brings Eve home from dance class, feeds her, and puts her to bed, so Sam and I can still go to drumming. Eve adores Allie. Allie adores Eve. Mommy adores the fact that Eve is spending three afternoons with a non-makeup-wearing, feminist-identifiying, very cool college student.

My life works again.

I love good child care.

Certified But Not Ready ~ by Jay

John and I are catching up. I was a college student the last time he saw me; now I'm a doctor with 20 years of clinical experience. That's quite a journey. And John is, as always, really interested. What was that like?

Everything I know about becoming a doctor comes from TV, so it must be wrong. Tell me about residency.

Tell me about residency.

I don't quite know how.

Medical school started out like regular school - classes, lab reports, tests, grades - and then morphed into this strange experience called clinical rotations. Clinical rotations where the teachers were interns a year or two older than I, and nothing I did was just for practice anymore - my notes were the notes on the chart, and my exam was the exam - sometimes the only exam. The level of supervision varied from the small suburban hospital where an attending signed every note to the large inner-city public facility where half the time no resident even saw the patient. At first nothing made sense - how did they know to give six units of insulin and not eight or twenty? Where did they get those articles they kept handing out? What in holy hell was multifocal atrial tachycardia?

For once in my life I managed to keep my mouth shut, listen and learn. I figured out how teams were organized, and what the stated rules were (call whenever you need help), and what the unwritten rules were (don't wake up the senior resident). I learned the shorthand and codes for various tests and diagnoses. By the end of my fourth year of medical school, I could manage six or eight patients on a medicine service - I didn't have all the knowledge I needed, but I knew how the workflow should go and I knew what tasks were most important. I felt competent and ready to be a doctor.

Then I started internship. I know I'm supposed to call it the first year of residency, but it was internship. Suddenly I realized I knew nothing. Nothing. I was the first person called for emergencies, the first person to see the patient, the one who started the whole clinical ball rolling - and I didn't know enough. I spent almost as much energy trying to cover that up as I did trying to learn and get my work done. My residency was pretty easy by the standards of the time*: every fifth night on call with a night float, so admissions stopped at 10:00 PM. We had to finish our work, which could often take several hours, but then we got to go home. Of course, on our ward rotations we had only one day off a month, and we did wards six or eight months of that year. And a normal, non-call day was 7:00 AM to 6:00 PM. Best learning experience of your life, said my father. I loved my internship, and I was on call every other night for a solid year. Want to do it again, Dad? No way in hell. It's your turn.

Internship ends, and I'm ready to be a senior resident, and once again be confronted with all the things I don't know. Some clinical, some organizational - how do you deal with a medical student who is not showing up? How do you organize rounds so everything gets done and everyone is heard? When, exactly, is it OK to wake up the attending?

And then poof! Residency is over, and I'm a fully-fledged, board-certified doctor. With an outpatient practice. I knew how to take care of deathly sick people in the ICU; I knew how to run rounds so they were fun and productive; I could go the ER with four consults at once and have everyone seen and orders written in an hour. But an office full of people with headaches and insomnia? What was I supposed to do with that?

I worked my nice, high-paying outpatient job for a week and then took inpatient call on July 4th and it was such a relief. Pulmonary edema I could deal with. Back pain, not so much.

My residency didn't have much outpatient experience - I think the assumption was that outpatient was the easy stuff, and we could learn as we went along. That first year out I learned that I had a lot to learn. I learned that continuity practice is an amazingly rewarding experience but requires a very different skill set from inpatient medicine. My residency prepared me to be an inpatient doctor - a damn good inpatient doctor, I will say - and the unspoken message was this is what's important. Here, in the ICU and the CCU and the cath lab and the chemo floor, this is where real medicine is practiced. Residents - particularly the smart ones, the ones who were headed for prestigious fellowships - didn't think much of outpatient attendings. Out of date. Not very bright. Really not on top of things.

In med school, I learned to be a med student. In residency, I learned to be a resident. It was only afterwards, out in the clinic with my patients, that I learned to be a doctor.

On The Brink ~ by Jay

I should learn how to schedule posts - that last spate of six in two or three days could have looked like a week's worth of blogging!

It's been a good week so far - busy but rewarding at work, and busy with good things at home. Three nights out - an evening of food and music with friends from work, an evening at a very nice beer and food dinner (Belgian beer - amazing stuff) with Sam and friends, and then an evening just with Sam. Our living room renovation is mostly done, just in time for our annual erev Rosh Hashanah extravaganza tonight. My mother is in town, staying at a hotel (with Eve as her roommate, much to Eve's delight) and on her way over to plot a kitchen campaign with me. Brisket, kugel, chopped chicken liver, black beans with saffron and oranges for the vegetarians, and lots of yummy side dishes and dessert contributions from friends.

L'shanah tovah - a sweet New Year to all of you. May you find health, peace and joy.

Time Travel ~ by Jay

Last week I found John again.

John was my first boyfriend, but that doesn't even begin to explain the depth of our relationship. John asked me out when I was 14 and he was 16, and I was too scared of my own feelings to manage the relationship. I broke up with him after a couple of weeks, and he was angry, but he didn't go away. He just - hung around. He asked me to dance, and splashed paint on me when we were working on sets, and came to visit when I worked at the library. And then, over a year later, he asked me to his senior prom, and I went. And my life changed. Only two sophomore girls went to the senior prom; overnight I left the category of Weird Kid and entered a different social stratum. And overnight I changed from the girl who only went out at night to babysit into a 15 year old dating a college freshman, who picked me up in his Camaro three or four nights a week and took me to parties and fireworks shows and restaurants and rock concerts.

I loved him, but I don't think I appreciated him. John adored me. He thought I was beautiful, and he loved that I was smart, and he wanted to sleep with me but never asked again after I said "no". We dated for two years, and we ended it when I was a senior because we were starting to pick at each other, and we wanted to remain friends. I dated other guys, but never felt that deep, intense connection - until I met Sam. The first night we went out we stayed up all night talking, and after he left I realized it all felt familiar, because he was like John. Sam had the same kindness and integrity and loving honesty, and even some of the same mannerisms and way of knowing the world. They're both deeply curious about the physical world. They're systems thinkers and engineers and introverts. They're tinkerers and builders and lighting designers and men of their word. They are the only men I've ever really loved. How does a girl get that lucky twice in a lifetime?

Meanwhile, John and I stayed in touch for a time and then drifted off, as people do. He married a college classmate, and ex-girlfriends are just kind of awkward when people are newly married. I moved, and he moved, and - life happened. For 20 years, I've wondered where he was and hoped he was happy. I've wanted to tell him about music he'd like, or a show I saw. I wanted to know that someone else remembered things the way that I did. John was my best friend for two years of my life, and I missed him.

I don't know why I looked for John on Facebook last month. I don't know why he was on my mind. I looked, and I found him, and I friended him - and even over Email, that connection is as strong as it ever was. He's still married, and I'm still married, and that's not going to change, but reconnecting with John has given me back a piece of my past, a piece of myself. John remembers my father, and the way my father was with me when I was a kid. I don't have much extended family, and very few friends from childhood. Sometimes I feel as if my real life started the day I got to college, and the time before that was a dream, or something I made up. But now John pops up in my Email inbox, and makes fun of the words I use in Lexulous, and tells me I should check out a jazz guitarist, and I feel as if I've come home.

So lucky. So blessed.

Renewal ~ by Jay

We are coming to the end of Elul, the beginning of the Days of Awe. Rosh Hashanah starts Friday night. Elul is traditionally a month of reflection, a chance to consider our actions over the past year and ask for forgiveness. Each year I plan (or hope) to have a true Elul practice of daily thought and prayer. This year, like every other, my intentions were swamped by the day-to-day realities of life and I found myself moving through Elul as I do every other month, juggling work and home and family and recreation, sleeping less and eating more than I should. I've stepped in as acting chair of the ritual committee and we have a new Rabbi (who has a broken ankle and can't drive or stand). And yet I don't have the rushed, irritated feeling with which I often approach the holidays. I'm not anxious.

Hmm. Wonder why that is? I haven't carved out time to journal or read or learn Torah. I haven't been to services more often than usual. I haven't even been listening to Jewish music on my iPod.

But I have been attending hospice team meetings four times a week. Each of our meetings starts with a thought for the day from our chaplain, and lately people have been adding to what the chaplain reads with reflections of their own. Last week, one of my home visits was interrupted by a nun who had come to give communion to the patient and his family, and the sanctity of the moment spread over me like a pool of sunlight. Today our chaplain called me about a long-term patient, lost in his dementia, who seemed more distressed than usual and kept saying "I'm Jewish. I'm Jewish. Is he Jewish"? My prescription is a CD of High Holiday music, which I just finished burning.

My spiritual life is no longer partitioned off into my evenings and weekends. I can bring all of myself to my work - heart, brain and spirit - and in return I can find teshuvah in a conference room or at the bedside. My life is whole.

Adonai has renewed my days, as of old.

Revealing ~ by Jay

Anyone who writes a memoir has to make choices about what to reveal and what to keep private. I'm sure that when Peggy Orenstein wrote Waiting For Daisy, about her "quest to become a mother", she thought carefully about what she was doing. Unfortunately, the most revealing sentence in her latest New York Times article is one she probably didn't think about at all.

In What Makes a Woman a Woman?, Orenstein recounts her fascination with Caster Semenya, the African runner who was forced to undergo gender testing after an unexpectedly good performance in the World Championships. That's the question that was asked about Semenya, and for Orenstein it carried echoes of her diagnosis of breast cancer at 35. She was advised to have her breasts and ovaries removed for preventive purposes, and the idea made her worry that she would no longer be a woman.

I began to fret: without breasts or hormone-producing ovaries, what would the difference be, say, between myself and a pre-op female-to-male transsexual? Other than that my situation was involuntary?

Involuntary. Orenstein didn't choose to have cancer. And she must be saying, in contrast, that transgender women (let's get the terminology right, even if Orenstien didn't) have chosen their own status. And the subtext is, of course, that trans women aren't actually women.

Orenstein goes on to write about the inexplicable brew of hormones and socialization that make us who and what we are, and the power of our own sense of ourselves as male or female. She concludes with this

My guess, however, is that it’s(....)something that transcends objectivity, defies explanation. That’s what I concluded about myself, anyway. Although I have, so far, opted to hang onto my body parts (and still wonder, occasionally, if I would feel differently were, say, a kidney or an arm at issue), I know that my sex could never really be changed by any surgeon’s scalpel. Why not? Perhaps because of the chemistry set I was born with, one that Semenya may or may not share. Perhaps merely because . . . I say so. And maybe that will have to be enough.

It will have to be enough, and it will have to enough for all women, including those who are born in nonconforming bodies.

Shanah Tovah ~ by Jay

It's that time of year, and even the Muppets know it

Safety Is as Safety Does~ by Jay

So I was going to write about this article in the New York Times, but echidne said what needed to be said. Kids are less likely to walk to school because we're all worried about stranger abduction (especially of pretty blonde girls) and - shock! surprise! - it's the mothers who are now responsible for driving all those children about and held in the contempt of society when we don't.

Worth repeating: echidne's response to a police officer who informs a mother that she "endangered" her son by allowing him to walk a mile to soccer practice:

I wonder why that officer isn't keeping the streets safe so that children can walk to soccer practice.

I wonder, too. echidne gets at this: we can let the social fabric go to pieces because the women will be there to drive their children through the unsafe streets when there's no money for school buses, and women will be there to homeschool their children when the public schools fail, and otherwise expand the definition of "mother" from relationship to a more-than-full time job, because of course we're all terrified of what will happen if our children are out of our eyesight.

More echidne

I don't think anyone decided that it would be time for American parents to start reallyreally fearing strangers abducting their children, but that's how the way those cases are treated works out.

No, no one decided consciously that this should happen, but as Susan Douglas and Meredith Michaels point out in The Mommy Myth, it's no coincidence that fears of abduction and sexual abuse became pervasive in the 1980s, just when it had become accepted for mothers to work outside the home and when the idea of government support for daycare was a viable political option. Backlash much? You will notice that we've completely abandoned the idea of subsidized daycare.

Ironically, it's the children who live where streets are really less safe who are more likely to walk to school. We live in the white, wealthy fringe of a poor school district. We have some car windows broken every now and then and the occasional burglary, but essentially no random crimes against people. We actually have tree-lined streets with nice sidewalks. There are no children walking to school in our neighborhood; there's a line of minivans headed down the street instead. But downtown, where the trees are fewer and the sidewalks broken and stained, where a nine-year-old was killed by a random gunshot in June, more than 70% of the children walk to school, mostly by themselves.

We've made it our business as parents to keep our children safe, and we shrug our shoulders and turn our backs when other, less privileged parents can't do the same for theirs. It's not fear of abductions that keeps me up at night; it's anger and frustration at the classism and racism of our society, which in the end will do far more harm to far more children.

Conversations With My Daughter ~ by Jay

I'm glad it didn't rain yesterday, so we got to go out on the playground at recess.

You thought Danny was going to chase you, right? What happened?

Oh, he chased me.

Did he catch you?

Nope.

Did you have other people running with you?

Yup. Mercedes and Didi and Lori and all the girls. And Dylan.

I thought Dylan was with Danny.

He was, but now he's with me. It was so funny, Mommy. One time when I was running I looked back and there were, like, 15 people behind me in a triangle, all following me. Danny only had about seven, because Dylan and Randy ran with me instead of with him.

So they never caught you.

They never even got close.

Now What? ~ by Jay

Sometimes I wish the ride to school were a little longer. We get in the car, and Eve starts talking, and I want to keep driving to prolong the conversation.

And sometimes I'm relieved to pull up to the front door and let her out, so I can catch my breath and figure out what I'm going to say next.

Today's conversation:

Mommy, remember Danny?

He's the boy who liked you, right?

Yeah. He still likes me. He's going to chase me at recess today.

Oh?

He'll chase me, and his gang will help.

Well, your gang will help you, I bet.

I don't have a gang.

You have a group of friends you play with at recess.

That's not a gang. That's a group.

What's the difference?

A gang is cooler. You know, they say "wassup". Stuff like that.

Oh.

But you're right, my friends will help me.

What happens if he catches you?

He stands in front of me and doesn't let me go by. And his friends stand there, too. But last time I looked at Dylan and I said "oh, please, please, let me go by" {bats eyelashes, cocks head, wiggles} and he did. So easy.

What would happen if you didn't run?

He chases me, Mommy. I have to run.

But he can only chase you if you're running. What if you just ignored him and did something else?

But I like running. I run fast. It's fun.

I'm glad you like running, and I'm glad recess is fun, but it doesn't sound like fun to me for a group of boys to stand around you and not let you through.

Oh, they'll let me through. Don't worry, Mommy.

At which point she picks up her backpack, climbs out of the car and heads out into the day.

And I drive off, thinking what the hell do I do with this? Am I reading too much into kids running around the playground? It's true that boys have been chasing her - literally - around playgrounds and gyms since she was 3. But I can't get rid of the image of my daughter in the middle of a ring of boys, wiggling her hips and batting her eyelashes so they'll let her out.

Now what?

Unexpected ~ by Jay

When I became Hospice Medical Director, I also became the Medical Director of our home care agency. This week we had our quarterly Advisory Council meeting, and at the end we reviewed proposed new policies - including our policy on reducing medical identity theft.

What?

We are technically creditors: we bill for our services and allow people to defer payment. The FTC now requires all creditors to have such a policy. If you live in the US and you've recently been told you'll have to present a picture ID at your doctor's visits, this is the reason. We need to confirm that you are actually the person who has insurance.

So the FTC spent money and time developing the rule, and we spent money and time developing a policy to follow the rule, and medical practices and hospitals will have to add staff hours to make sure they document that they've followed the rules.

What if everybody had insurance?

What if there were no incentive for medical identity theft?

What if?

Empathy ~ by Jay

Sometimes I wonder about my colleagues. Why do we maintain patients for days and weeks in the ICU when we know they're not going to recover? Why don't we just sit down and talk with the families instead of dodging them in the halls? Don't they know that there's no ethical difference between discontinuing a treatment and choosing not to start it in the first place? We all learn that in first-year ethics.

Today I had to leave the ivory tower and enter the real world - the world of ventilators and continuous hemofiltration and infections requiring four antibiotics and the dominos of liver, kidneys, heart failing one by one. The world of children who are not ready to lose their mother - are we ever ready? - but also can't stand to sit in the ICU any longer and watch machines pump air in and out of the inert form on the bed.

And it is different than not starting. It's agonizingly different. Choose not to use technology, and you are letting nature take its course. Choose to discontinue the technology, and you are choosing the day someone will die.

If there's a harder choice on this earth, I don't want to know what it is.

Even when I know it's the right thing, even when I can see the pain and suffering in the face of the patient, it's hard to put pen to paper and write those orders. Not all the orders - it's easy to stop the labs, stop the other medications, cancel the Xrays - but it's been 23 years since I did it the first time and it hasn't gotten any easier to write the order to remove the ventilator.

Today I realized, as my hand hovered over the chart, that this is where my colleagues get stuck. This is hard, and sad, and it must feel wrong. It must feel like we are colluding with death and disease. Maybe we can wait. Maybe it will get better. There's always a chance. And so on it goes, day after day, because it's just too painful to stop.

I have always seen the suffering of the patient; today I glimpsed the suffering of the physician in a way I haven't before. This is my own pain, and perhaps I was blind to it for the same reason my colleagues turn their faces away from the tears of the families - because it just hurts too much. We all want to relieve suffering, and sometimes we get lost in our own distress. We retreat into jargon and distance and busy-ness; we shrink from connection for fear our own wounds will be opened.

I put pen to paper and write the orders because I believe the ethical precept, and because I have empathy for the patient's suffering. Sure, it's hard for me, but it's so much harder for the daughters and the sons. And I realize now that I can have empathy for my colleagues, too, and compassion for myself. I've been avoiding other docs the way they avoid the families of their ICU patients.

Physician, heal thyself. Physician, forgive thyself.

On the other hand ~ by Tigermom

Tigerdad had this interaction with the same babycub last night:

TD: "Hey, dude, I see you have some dirty clothes on the floor. Can you put them in your laundry basket before we read?"

BC: "Sure Dad."

TD: "Thank you BC."

BC: "You do not need to thank me. I should be thanking you for reminding me!"

Whew.

Out of a Tigercub's mouth ~ by Tigermom

Overheard:

Baby Cub, "You and Tigerdaddy are different."

Tigermom, "Oh yeah? How are Tigermommy and Tigerdaddy different?"

Baby Cub, "Weeelll.... you clean the kitchen yourself and Tigerdaddy makes us clean the kitchen."

Uh oh.

Things I Could Do Without ~ by Jay

Apparently there's a new cleaning product that can clean Multiple Surfaces. Wow. To demonstrate the unbelievable awesomeness of this amazing substance, someone thought it was appropriate to lock a woman in a glass box.

I particularly love her objection. She doesn't say "Hey, you bastards, you locked me in a box!" or "How dare you expect me to clean this room?". No, she says "I have to pick up my kids. I don't ahve time for all of this". Because if they'd just done it earlier in the day, locking her in a glass box would have been just fine.

Need to clear my palate with a little Sarah Haskins.



Ah, that's better.