Monday, October 31, 2005

The Kids Will Probably End Up Zen Buddhist

We went to the Episcopal church in town yesterday for the second time, and before you yawn and turn off your computer, let me tell you why that's noteworthy. The Tall Doctor is Christian Reformed (think upstanding Calvinist Dutch people); I am Catholic, but was raised Episcopal (God's Frozen People; Salvation Though Good Taste...yeah, I know). For the last few years we've been alternating churches: his Christian Reformed storefront congregation one week, my enormous local Catholic church full of plaster saints the next. And for a while, it's worked. But now the Rabbit is getting old enough to notice what's going on, and The Tall Doctor and I have begun to think about finding a place for the whole family, and we seem to be ending up right back where I started, with the smells and bells.

It isn't just the Rabbit. The Tall Doctor and I have been getting restless for a while in our respective churches, for a number of reasons. First off, there's the music, which any of you who've ever darkened the door of a Catholic church know is abysmal. Nobody in the congregation sings, and the people up front who are supposed to be "leading" the singing tend to play guitars veeerrry slowly and veeerrry quietly and warble away about being raised up on eagle's wings. Sometimes there's a flute. There's never any rousing organ music, and as to Orlando Gibbon and Louis Bourgeois (wonderful CATHOLIC writers of hymns), forget it. For someone who grew up knowing all four verses to everything in the Episcopal hymn book, and singing along with a belt-it-out congregation, this is a problem. (Yes, Episcopalians sing. Loudly. It's excellent, especially since you look at a typical be-hatted and be-blazered Boston congregation and think the last thing they're going to do is break into uproarious song. And then dammit, they do. It's moving and hilarious all at once).

For the Tall Doctor, ditto. He grew up singing all the great old hymns, and now the Reformed church is moving steadily Praise-Song-wards. There's a lot of drums and guitars, and a lot of white people singing spirituals, and a lot of music revolving around sentiments like, "My Jesus, my Savior, Lord there is none like You/All of my days/I want to praise/The wonders of Your mighty love." I mean, OK, there's nothing WRONG with it, but think about it. There's no one like the Lord? Yeah, true, but perhaps a little obvoius? Days/praise? Not a real fresh rhyme. "I want to praise"? Speaking for myself, what I WANT to do on Sunday mornings is sleep, and I'm not being flippant: hymns which focus so much on the singer's personal emotional experience make me leery, because God is rather more than my experience of Him. At least, I most devoutly hope so. So yes, The Tall Doctor and I have been struggling with that at his church.

Worse, at his church there are Worship Committees and Praise Teams. Once you've got a Praise Team, it's all over. Before you know it you have three middle-aged people standing at the front of the sanctuary holding cordless mikes, and it's just downhill from there, and I mean all the way down to Liturgical Dance. I've lived in India and Kenya, I'm all for women coming dancing up to the altar with the offering, but this is Iowa and we are not so much with the indigenous dance. Also, I grew up with the Anglican Book of Common Prayer, which is hard to top, and the earnest, heartfelt, in some ways praiseworthy attempts to reinvent the wheel which are going on in the Reformed church leave me cold and a little sad. Not least because it wastes energy, and because extemporaneous prayer ends up sounding repetitious anyway. (I once remarked on this to my parents, both of whom were raised Fundamentalist Protestant and are now Catholic, and they instantly chorused, "Dear Lord Jesus Christ, we just want to praise and thank You.")

And while the Worship Team issue isn't so great with the Catholic Church, I am not a cradle Catholic, and I am finding that it feels odd to try to bring my children up in a church which I joined at age thirty. It's still an opaque culture to me in many ways, and I don't want my kids to miss out on the heartiness of my own religious upbringing because I can't parse the subtexts of the Catholic congregations here. By which I mean, we've been at our current church two years and still know no one, and I'm not even sure why. It's kind of a closed society, and that's not so great if you have young children. Plus, none of the Catholic churches in town have a nursery, which essentially condemns every family with small children to missing most of church for, oh, about five years.

So...the upshot is, when you cross a Protestant and a Catholic, I guess you come up with Episcopal children. At least, I hope you do. Ours may be so confused that they wind up Zen Buddhist, and that would be terrible, because maroon robes would look awful with the Urplet's coloring. Salvation Through Good Taste, you know.

Saturday, October 29, 2005

Random

Rabbit and the babysitter are reading in the living room.
Babysitter: I like the color on the living room walls. Did your Mama and Daddy paint them?
Rabbit: Me and Daddy--no, Daddy and I!--painted them.
B: Did your Mama help?
R: No, because she's little. And sweet. And she's a Mama.

Rabbit's chugging importantly around the downstairs, opening doors, drawers, and cupboards.
Me: What are you after, buddy? A snack? Or did you lose something?
Rabbit: No. I'm looking for GOODS!

A smell has pervaded the playroom.
Me: Did you poop?
Rabbit (cackling): No, it was just a fart.

One of the Rabbit's favorite CDs, of African music, is playing.
Rabbit: What's this song?
Me: It's called "Jambo Bwana."
Rabbit: Where did it come from?
Me: It's from Africa. That's a wonderful place far away that we'll visit when you're older.
Rabbit: Where did Africa come from?

Wednesday, October 26, 2005

The Coolest Thing About Me

I am square as a post: square as a book: square as a child's building block. I am so square I'm a cube. I am so Iowa-hausfrau that when I go out for drinks I talk at length about my kids' toilet training and tantrums, and I am so middle-aged that I wear quilted jackets and carry a Vera Bradley bag. I am a geek, a dork, a wonk, a total nerd. But still, I am cool: yea, cool beyond telling. For lo, I am friends with the coolest kids in the class, and their shine reflects upon me.

Yes, you, reading this: that's right, sit up straight, I'm talking to you. You writer-folk who are refugees from the worlds of law and business and theology and medicine: you hardworking mamas raising kids with love and wisdom: you midwives and oncology nurses and advertising executives and editors and businesswomen and teachers and vets and doctors and published authors--knowing you makes me feel like I've been asked to the sleepover of the season with all the most popular fifth grade girls. Like I've just opened the envelope and found that college acceptance letter--with a fellowship offer included. Like I've gone to the best bar in town and been accepted by the locals. Like I've been elected captain of the varsity field-hockey team. OK, maybe not that last, because who the hell WANTS to be on the varsity field hockey team. But you get the drift.

But just in case you don't, did I mention that I have the coolest friends? They--you--are odd and smart and funny and a half-bubble off plumb. They are so interesting that even when I'm at my dullest they just weave me into the brilliant Oriental rug of their own lives so that I feel part of a (gorgeous) pattern. They have worked in Haiti: in Pakistan: in San Francisco: in AIDS hostels and delivery rooms and on reservations. They speak Japanese, German, Spanish, French, Hindi, Italian. They have done the Santiago pilgrimage and written about it (in a book called Fumbling, which you should buy); they have picked blueberries on Nantucket and written about it (in a cover article for Saveur, thank you very much); they have rescued animals in Louisiana and written about it (www. pawsinthestorm.blogspot.com); they have thought of terrific stories about art forgery and written about it (Hibiscus Coast, from Penguin). They visit here from their own compulsively readable blogs. Some of them are experienced mothers of three; some are newly pregnant. Most of them can hold their liquor. One of them has stood up for me at BOTH my weddings, which I think you'll have to admit is going way beyond the call of duty. They are a motley crew, motlier (is that a word?) than all my past lives strung together, and they are, have I said it before? fiercely cool.

I don't know that I tell them this enough. So I'm telling them--you--now. Thank you, ya'll, for including me in the sleepover with all the cool kids. I may be dorky, but I am having the time of my life, and it's because of you.

Saturday, October 22, 2005

Meltdowns

Oh geez. It's Tantrum City here these days, and I know Rabbit's right at the prime age for them, but THEY ARE SO TEDIOUS! And the question of how to handle them on the spectrum from discipline to distraction is so ever-present! And it's getting cold out, so I don't have TIME to be getting both kids stuffed into winter gear every time we walk out the door, and deal with tantrums too! Whine! Whine! I think I'll have a tantrum of my own!

No, seriously, I need advice here, people. Rabbit has decided over the last two months that a) anyone coming to the house and picking up any of his toys is cause for dissolving into a puddle of noisy tears, and b) anyone taking a bite of any food he has designated as his own is ditto. He gets over it, of course, and by the end of whatever visit is going on he's dealing fine and playing and having a good time, but before that, there's these protracted scenes of snatching and weeping and wailing for "Thomas, I want THAT Thomas!" (and never mind that he has, like, four of the things).

I try different approaches. First I rule out tired/hungry/sick/overwhelmed, and fix those problems if they're present. Then, hitting or snatching or whacking is obviously subject to The Almighty Time Out, which does at least make an impression. If he's evincing not nastiness but just a complete inability to deal, I've been taking him into the living room, away from the situation, and sitting with him on my lap and letting him calm down, and then talking a little about sharing--in the "If you share with Tony he'll share with you," vein; nothing fancy. And I'll ask him what's wrong, too, to which there's rarely a coherent answer (I'm shocked--shocked!--that he can't parse his emotions yet). Often when he's had a cooldown period he does better--but sometimes not. We also often try changing the environment--going outside, going upstairs, introducing snacks, etc.--and again, that does work to some extent. Sometimes I ignore the whole thing, because the baby needs urgent attention, and Rabbit gets over it on his own. Sometimes we all lose it in one grand explosion. So yeah, we've tried various approaches, as I said.

I know none of your kids ever misbehaves, but if they DID, what works for you? I don't want to pound the poor kid flat, and if something else is going on with him I want to be sensitive to underlying issues--but I also want to set limits and enforce them, BECAUSE I'M THE MAMA, THAT'S WHY, and putting on the coat shouldn't have to be a fight every time. Sigh. Talk to me.

Oh, but in a lighter vein, I was getting ready to take a shower today and Rabbit backed up to the toilet, did a tremendous rasberry with his mouth, and announced, "I'm pooping. Now I'm flushing." Then he repeated the game about eight times. Toilet training is looking up.

Monday, October 17, 2005

Yogic Toddlers

I came into Bunny's room this morning and he was very carefully practicing Downward Dog Pose on his bed, clad in his footie reindeer pajamas. I know this was what he was doing because he told me so: "I'm doing Dog Pose, Mama!" He sometimes does yoga alongside me to my video, but now it seems I should be providing him with a mat for his room.

And also in the yogic vein, I was doing my video today in a snatched half-hour while everyone was napping, and as we inched our way into Forward Bend, the perfectly-posturing woman on the screen admonished me thusly: "Make the legs strong without force. Relax the spine without collapse."

Well, that would be the thing, wouldn't it, especially in child-raising. Strength without force: relaxation without collapse. Roll on, that happy day!

Saturday, October 15, 2005

What I Did Last Night

I really needed to go to work yesterday. I needed to leave town, alone, and go do something completely different from what I'd been doing all week, surrounded by people I don't see daily. I needed to submerge myself and think about things unrelated to me, or my children, or my shopping lists. I needed to use a part of my brain I only pull out on Thursdays and Fridays, and I needed to let the other brain parts take a break.

Work complied. I got there at one in the afternoon, I left at midnight, and I never stopped once in between. I saw thirty-three patients, and I didn't think about Iowa City once. It was as good as a vacation, except for the really rather impressive exhaustion which followed me home. That, and the smells, and the fluorescent lighting, and the doing-five-things-simultaneously...OK, maybe not so much with the vacation. But still, it was a needed change, and I feel I should give credit to the following people for getting my mind of me and the infinitely boring intricacies thereof. So, a shout out to:

1. The gentleman with the really impressive knee laceration who, when I asked him how he'd received it, said, "I fell off my stilts onto a lawn gnome."

2. The man who'd been rather badly bitten on his index finger. I said, "How'd that happen?" He said, "My wife."

3. The young man who came in with several cops on his way to jail because he was complaining of eye pain. The eye was fine, but his vision test wasn't. Perhaps the blood alcohol of 250 had something to do with that?

4. The gentleman with the elbow laceration who asked me out for a night of karaoke in Cedar Rapids after my shift. (I politely declined).

5. The youngster with a splinter embedded beneath his nail. Every time I came into his exam room, more, and bigger, and more malodorous relatives had appeared. I think I counted eight by the time he left. Where were they coming from?

6. The two year old who told his mother he'd swallowed some pennies. The Xray, fortunately, disagreed. Sighs of relief all around.

7. The little old lady who'd stitched her finger into a seam with her sewing machine. The needle had gone all the way through her nail, through her finger, and out the other side. She stopped the machine and pulled the needle out with tweezers. By herself.

8. The three year old with a sore wrist. "What happened, hon?" said I. "The dog pushed me off the sofa," he informed me.

9. The man who made me lose a bet. As I headed down the hall to see him, the nurse said, "You'll never get out of there in under fifteen minutes; he'll talk your ear off." "Ah," I said confidently, "I can shut anybody up with nonverbal signals alone: learned that in private practice where I had, like, six minutes to see each patient." Twenty minutes later I came out of the exam room with my tail between my legs. Taking a history from this guy was like trying to swim under Niagara Falls.

10. The young man who'd spent a year in Iraq already and who, with two years of National Guard service left, was almost certainly heading back next year. When I said, sheepishly, "This sounds corny, but thanks; a lot is riding on y'all's backs, isn't it?" he said, "Well, I just do what I have to." He wasn't being self-deprecating; he really meant it.

I love my job. I do. And the above is largely why.

Wednesday, October 12, 2005

I Lay It All At Thomas The Tank Engine's Door

You know how some days just flow? How you can get both boys up and dressed and fed and the kitchen cleaned and everyone out the door right on time, then meet up with the rest of the playgroup and drive out to a pumpkin patch? How the weather can be seventy and sunny, the air crisp, the corn rustling in the fields? How you can have stories read to you in the pumpkin patch, then play in the corn bin, go for a hay ride, and play on a wooden pirate ship/jungle gym, all with smiles and gales of laughter? How you can ride home in the sunshine with two drowsy boys clutching pumpkins in the back seat and The Sound of Music on the CD player, and feel blessed beyong belief?

Well today wasn't one of those days. Monday was--in fact, Monday followed the above itinerary pretty much to the letter--but today was not. Today was I Am Two-and-a-Half And I Am Now Making Up for All the Tantrums I Haven't Thrown Yet And I'm Going to Do It in the Library Day. And not in a laugh-about-it-later way, either. Trains were thrown, small children were shoved, screams were screamed, resounding "No!"s were shrieked. Not a pretty picture.

You know what I mean. There's the times your kid's being difficult, and you can sort of raise rueful eyebrows and make bemused faces at the other mothers as you remove your weeping child from the scene of the crime, thus demonstrating that while you're aware your kid's being a pain, you're also dealing with the situation in a gentle-yet-firm, detached-yet-loving manner and you know everyone else in the room's been there too. They can then raise their eyebrows back at you, evincing understanding, sympathy, support, and fellow-feeling in a heartening way, and you can at least salvage something from the situation. THEN there's the time's your kid's shoved someone's adorable toddler and grabbed her train, and pitched a fit when you made him apologize, and thrown yet another train when you hopefully allowed him back to the train table, and that last train has hit someone in the ear. And when you've cracked down and removed your child from the play area he's turned into a war zone, he shrieks and continues to shriek, and writhe, and weep, and beg, and plead, as you buckle him into his stroller. And the other mother's look at you with that mixture of smugness (MY kid didn't do that today) and pity (Poor thing, what a difficult child) and annoyance (My kid was having a nice time until YOUR kid showed up) and totally legitimate outrage (Your kid hit me in the ear!). And while you're removing your preschooler from the scene of the crime, you can feel your barely-repressed rage bubbling away, clear for all to see, as you try to keep calm, sequester your embarassment so it doesn't govern your reaction, and summon your last shreds of patience and common sense. You feel like any minute you're going to start HISSING. You know, the Supermarket Hiss.

And on top of, or more accurately underneath, all that, there's the questions raised by this perfectly normal, expected, developmentally appropriate two year old behavior. (See? See! I retain my perspective! Look, oodles of it, just lying around here waiting to be used!) The question of how to set firm, consistent limits, yet respond flexibly to this particular child in this particular situation. The question of how to help him control himself without my controlling him too hard in the process. The question of, is there anything else going on right now (earache; Mama's new job) that could be underlying this behavior. The question of how not to over-react and get dramatic while still making an impression so the kid doesn't do the same thing every time he encounters a Thomas the Tank Engine train table surrounded by toddlers.

Oddly, I do not seem to have answers to these questions. The only options in child-rearing, however, seem to be either to crawl under the bed with a bottle of vodka and drink myself into oblivion because sometimes I'm going to do things wrong and damage these amazing beings in my care, or to assess the damage and carry on as best I can because option one seems somehow overdramatic. Or maybe there's a third option which involves just a little vodka? I think that would be best. Vodka, and some more pumpkins, because they were a big success.

Monday, October 10, 2005

Circles? More Like Stonehenge

I was reading away happily in Vogue this evening--yes! I love Vogue! It's gorgeous to look at, you can't tell the ads from the editorial pages, and they take fashion SO seriously that they compensate for the entire Midwest, where sweatpants are fashion--anyway, I was reading away, and ploughed unwittingly into an article on some new under-eye injection, not Botox, which banishes the bags. Hmm, thought I, banish the bags? Wouldn't that be nice. Because I don't just have dark circles under my eyes, I have jonesing-for-my-next-fix stains. I have lines, I have sag, I have bags, I have crepe, I have xanthelasmas (those strange little cholesterol deposits in the skin), I have wine-dark frigging seas. The rest of me looks no more than my age, but my eyes? Centurians for sure.

I don't remember when it began to dawn on me that the way I looked wasn't just fatigue, or winter, or bad hair color, or lack of makeup. I'm not sure quite when I realized that I looked the way I did BECAUSE I WAS GETTING OLD. But at some point after thirty-two--after India, actually; the subcontinent did me in, physiologically speaking--I began to understand that I'd hit my peak a few years earlier and it was going to be downhill from here. I was never going to look twenty-one again. Hell, I was never going to look thirty.

Which gave me pause. Gives me pause. It makes me spend more than I should on (the hilariously tactfully named) Estee Lauder Resilience Lift Moisturizing Cream, and search out the perfect "day cream" (aka spackle), and spend a few more minutes before I go out the door messing with the lipstick. It makes me spend the odd five minutes daydreaming about having someone inject chemicals under my eyes to give me a few more years of dewey youthful freshness.

Wait: no it doesn't: I can pretty much say categorically that I never want anyone injecting things under my eyes. I never want anyone lifting my butt, or tucking my tummy, or microlipo-ing my thighs. Expensive cream is where I draw the line, because it's fun and makes me feel good, and sure, it's encouraging to me and the people who have to look at me all day. But after that, it begins to feel more like ducking mortality than like maintenance.

I'm going to get older. Eventually I'm going to die. This sucks, on so many levels. However, it's pretty much a non-negotiable, so I'd rather experience it than pretend it isn't happening. At least, so I chant to myself when I catch an unanticipated glimpse of myself in the morning mirror and have to stop myself from rearing back in fright.

So far, the experience is sort of fascinating. For instance, I think women in their forties gain a sort of beauty unavailable to women in their twenties, and I look forward to seeing if maybe I get a little bit. Also, I find it liberating to look as though I might know a thing or two (Ha! If only they knew!) so don't mess with me. It's good for my vanity to let go of defining myself too much by what I look like, and it's probably good for my soul too, though I'll start with the superficial stuff, thank you. I mean, it's embarassing to be thirty-eight and still functioning on said superficial level, but a girl's gotta work with what she has, you know? Really, the only thing I miss is that annoying twenty-year-old energy which let me stay up all night and still function well the next day. Now that I have kids, I realize what that was about.

So I'm looking decidedly middle-aged, and the bags under the eyes are impressive, and I can't really scoot out of the house relying on that dewey youthful freshness any more, but I'm still grateful to my body. It's done two marathons, two kids, two year-long stints in India and Africa, and almost three years of interrupted nights. I just can't see putting botulism toxin or anything similar into it in an attempt to make it look the way it did twenty years ago. I might get it a massage, though, to make it feel better.

And a haircut. And some nice hair color, because I don't even want to know about the grey hair. I just don't want to know it.

Saturday, October 08, 2005

Practicing To Be A Nurse

I wish I could draw for you the confusion on patients' faces when I bust into the exam room, announce, "Hi, I'm [Long Weird First Name], I'm the nurse practitioner," and proceed to sit down and start taking a history. My name is one they've never heard before, they don't know what the hell a nurse practitioner is, and they're entirely unsure of why I'm all acting like a doctor if I'm NOT one. "Hmmm," I can see them thinking as I swing briskly into my routine, "she's who? She's practicing to be a nurse? Is that kosher? When will the doctor come? Then again, she sure acts like a doctor, and there's those flattering Smurf-blue scrubs and that nice, reassuring white coat, and that big old stethescope, so maybe I just didn't hear right. I've been waiting a while already; I guess I'll just run with it and see if something better comes up later. My luck, to get the practising nurse whateversheis." And they sit up and get on with telling me about how the box cutter slipped and went right into their palm, or the other car ran into their rear bumper at a stop light, or whatever.

The surprising, and honestly rather nice, thing is that most of the time that brief, confused look is the only blip caused by my nurse-practitioner-ness. The patients talk (and talk and talk and talk): I treat: end of story. I can count on one hand the number of times in my eleven-year career I've had someone say, "I'm sorry, but I'd rather see a doctor,": seriously, it's only happened four or five times, and not in any kind of pattern. When they do, of course, I just tell them that's fine, and escort them into another exam room, and gleefully go off to tell whatever physician I'm working with that they now have another patient, sorry, nothing to be done about it.

I'm not sure why this is. Some of them may have heard of an NP: some may decide they heard wrong and I'm the doctor after all. But I think most of it is expectation, the phenomenon of people seeing and hearing what they expect to see and hear. I come in, I'm wearing the clothes they expect a doctor to wear, I do the diagnosing and treating they expect from a doctor, so they sort of block out the nurse practitioner part of my introduction, and I become Doctor Whoshe to them. Even when I worked in Family Practice and had patients I'd seen for years, and to whom I'd painstakingly explained the difference between an NP and an MD--even then, my patients all called me Doctor. When I carefully re-explained--"No, Mrs. Runs Close to Lodge [actual Lakota name; I used to work on a Rez], I'm a nurse with a master's degree--they listened, then said, "Yeah, OK, but Doctor Whoshe..." Sometimes they'd even give me what they considered the ultimate compliment; "You know, you're almost as good as a doctor!"

And I'd thank them, because it would have been tacky to snort with a combination of amusement and despair. Despair? I hear you cry; I get the amusement, but whence the despair? Well, because after eleven years I am weary of being a cypher, a medical platypus, an enigma. I am weary of explaining myself, and of having to adapt to a different role with each different job, and of being referred to as a "midlevel provider" (which sounds like I'm a drug dealer who specializes in only moderately awful drugs--pot, say, instead of crank). I am tired of making less than half of what The Tall Doctor makes. I am, in short, a little burned out on the whole FNP role, and am ready to make a traitorous confession.

Which is, predictably, that I wish I'd gone to medical school. I go to work in the ER now, and what I want to be doing is working up the sickest patients, running the traumas, intubating and putting in central lines and making the hard decisions. I don't glamorize it--hard decisions suck--but I want it. I want that scope, and freedom, and flexibility. Also, the cash would be nice.

Don't get me wrong: I love my job, and I don't intend to stop learning, and it's not like I think I'm just too, too smart and above it all and am wasted as a nurse. No, no, I cannot even tell you how much I don't think that. It's more that I chose not to go to med school for all the wrong reasons, and that bothers me enormously. I didn't want to spend that long in school, I was scared of all the science, I feared the years without sleep (to which I say now, ha! I have two sleepless sons and it's not like residency where at least you get to sleep through SOME nights). I didn't want to make the committment to such an overwhelming (as I saw it) job. And, to be fair, when I decided to get some sort of higher education in medicine, I'd just spent a year in Africa working in rural health programs and doctors didn't figure much there--the nurses did everything, and since I wanted to do overseas medicine, I figured nursing would be the thing. And I knew I wanted to write as well, so I wanted a job that would pay the bills but leave me some brain around the edges to put words on paper. So I applied to Yale's three year direct-entry FNP program and crossed my fingers. And here I am, and a lot of the time I wish that, professionally, I were somewhere else.

I know I have to let go of that, of course. At thirty-eight with two tiny children and a novel in process I just don't see squeezing in, oh, ten years of prerequisites and med school and residency, and if I'm not going to do it, I should just shut up about it. I have a wonderful part-time job, which pays well and keeps me learning and once in a blue moon makes me feel like I'm doing that elusive good, and I am grateful for all that. I just need to figure out HOW to let go, how not to spend all my time at work wishing I were more the boss lady, less the drone. It seems like a waste of emotional energy to get frustrated every time I walk into the ER--so I need to figure out how to learn some of the things I want to learn, and let go the rest, I suppose.

I think it boils down to balance again: how to let go of some dreams without packing in on all dreams entirely. Robert Frost has a wonderful poem called The Oven Bird, which ends, "The question that he frames in all but words/Is what to make of a diminished thing." And there's that moment at the end of "The Umbrellas of Cherbourg" where Catherine Deneuve's character, all grown up and married, runs into the character of her first love, now himself grown and married to someone else, and the music comes up with the theme from their youthful love, and they look at each other and turn back to their families, and that yearning, hopeful music is still playing as they drive away into their lives. All that loss, and yet all that strange gain in unexpected places. I was listening to a recording of The Sound of Music in the car with Rabbit the other day, and found myself in tears, because I played Maria (yes! yikes!) in my high school production, and hearing those songs brought me right back to being seventeen and that sense of infinite possibility, that exciting sense of your own potential for who-knew-what, which gets at least diluted by thirty-eight. (And for more and better talk about that, read Funny Pathetic--there's a recent wonderful post there). Or maybe it's just that you're so fucking tired by thirty-eight that The Sound of Music can make you maudlin?

In the meantime, while I find the elusive balance, I would like to come up with a better job title than Nurse Practitioner. I mean, could that be a clunkier, less informative title? Come on, people, I have faith in you: I want you to come up with a sexy, fabulous, accurate-yet-compelling job title for those of us whose professional life consists of dressing like a Smurf and draining abcesses. The comments section awaits your suggestions: there will be prizes for the winners. Go to it!

Thursday, October 06, 2005

Penguin Suit, Duck Feet



These are The Tall Doctor's size 14 1/2 feet in his new orange fuzzy lounge-around socks. I think they look strikingly duckish, or perhaps penguiny.

Rabbit has a new fuzzy sleeper, too: bright red with black and white penguins flapping happy flippers all over it. He trots around, very serious and important about his new "Seuss Suit," which is our term for all footie pajamas, since the first few he had were all striped and what with his bottom sticking out behind and his tummy in front, they made him look like a little Dr. Seuss critter.

The Tall Doctor is a wonderful Daddy, gentle and firm and kind and funny. He understands that a guy needs his tools, so he lets Rabbit play with the paint rollers, and that a guy needs time away from the womenfolk, so he takes Rabbit (and now Urp) away on Saturday morning expeditions to the barber and the airport and Macdonalds and Ace Hardwear and Menards. He makes pancakes and corn bread with Rabbit, and lets him help in the tool shed (doing what? I have no idea). Rabbit adores him, and Urp vibrates and becomes incandescent and drooly with joy when he comes home from work. As do I.

Anyway, seeing The Tall Doctor's new socks and the Rabbit's Seuss Suit in close proximity when I got home from work this evening made me realize that actually, The Tall Doctor is an emperor penguin. Yes. One of the largest brands his species has to offer, and the most selfless of parents, cradling his tuft-headed child on his great, big, orange feet as the winter closes in and Mama makes her way home from work.

Sunday, October 02, 2005

Patients Lie, But Charts Don't--Or Do They?

One of the hard things about my job is that it generates stories which I really, really want to post, but which do not belong to me. I'd love to quote conversations I have with patients, or give excruciating details about nasty pathologies, or dissect just how a certain patient has made me crazy, but I can't, because that exam room is legally and ethically sacrosanct. The stories I hear in it are not mine to tell. I can tell stories with composite characters, of course, and talk about generalities, but specifics, not so much. People are so vulnerable when I see them--at least, I certainly feel vulnerable when I'M being a patient--and I don't want to betray their trust. So that's why you don't get the really juicy stuff here, and why my medical posts tend to be a little abstract.

So, abstract this: the other night I had a [heavily disguised here, composite, name changed] patient who broke down in tears while I was talking to her, and when I made my empathetic face, said that she was at our hospital instead of the other hospital in town because she'd recently seen her medical records at the latter institution, and "how do you think it makes a person feel to see 'morbidly obese' all over the chart? When a person's doing her best, and never eats anything, and walks for miles and miles--how do you think it makes her feel?"

Well now. That IS a question, and I'm not being facetious here. How would I feel if I read my medical records and saw how an outsider had observed me? If I picked up a chart and saw, in some anonymous physician's writing, "irritable as all hell," or "cellulite-plagued in the nether regions," or "stuck-up, smart-alecky, fast-talking know-it-all who rarely actually knows what's going on." I think it would hurt in a very particular way, mostly because I'd be seeing something I knew about myself, something I want to change, confirmed by an outside source whom I respected at least a little. I think it would make me feel that everyone in the office or hospital where my records were kept was in on the opinion--in on the joke, really. It would make me feel awful.

And of course, if I were obese I'd have the added issue of having my pathology show on the outside. I mean, when you walk down the street your diabetes or hypertension or dysfunctional uterine bleeding or congestive heart failure doesn't show to the casual observer, but when you're struggling with weight, it's so bloody obvious to everyone. And by weight, I mean the kind of weight that's considered technically "morbidly obese," like one or two hundred pounds overweight. To have to enact what is essentially a private struggle in the public arena must be excruciating at times.

So yeah, when this patient saw her chart, ouch. And yet at the same time, honest charting is essential in medicine, because without it crucial information gets lost and patients do not get good care. When I pick up a patient from another provider, there's nothing I appreciate more than being able to look back at the last few entries in the chart--be it paper or computerized--and see exactly what problems this patient has, what's been done about them, what's worked and what hasn't. When I see "morbidly obese" on a chart, I DON'T actually think, Loser. What I think is, diabetes, hypertension, cardiac disease, joint disease, etc. etc. In other words, I think about the pathologies I need to have in mind when I see this person, so that I can give her good care. And really, "morbidly," just indicated she is a certain percentage above (way above) ideal body weight, so is more likely to have the aforementioned problems. In fact, that little word "mordibly" which so upset my patient is actually a good example of the kind of precision in language which makes for efficient and accurate charting--which in turn makes it sting when you read your own chart.

The acronym soup is completely baffling at first, of course: the first time I opened a chart in nursing school, I couldn't read a word of it. It was like being handed Dostoevsky in the original Russian and being told, "Summarize this in one paragraph." "83 y.o. F s/p ORIF L femur p MVA," read the first line I tried to decipher (fourteen years later I still remember it, it made such an impression). "IV D5NS c 20 K @ KVO" read another line, and "MSO4 2 mg IV Q 2" another. I nearly walked out of the hospital in despair. Nearly, but not quite, because the word salad fascinated me, and I wanted to learn how to toss acronyms with abandon myself. So I got myself a book titled (no kidding), "Medical Abbreviations: 10,000 Conveniences at the Expense of Communication and Safety," and I went at it.

And of course as I went along, I learned that the strangeness of the language actually has a point, that point being to communicate exact information quickly and in a standard format. When I write down a patient's history, or present it to a colleague, I do it the same way every time, and so do they, and so do doctors in Mongolia and Niger and Bhutan. History of Present Illness: Past Medical History, including drugs and allergies: Past Surgical History: Family History: Social History . This means that (theoretically, and actually often in practice) incredibly complex situations can be described with fair efficiency, and comprehended pretty quickly. And that's a good thing.

Except sometimes the patient gets lost in the efficiency, and, drunk on accuracy, I forget that "morbidly obese" is a wounding and stigmatizing diagnosis for someone to read. I have to remind myself continually that there's a person behind the tightly-packed acronyms, someone whose story transcends the concrete documentation of proven pathology. I have to remember all the hard-won medical formats, of course, because they let me function and provide care, but I also have to remember that they are indeed only "Conveniences at the Expense of Communication and Safety." I have to think about "how a person would feel if she reads 'morbidly obese' all over everything." And then I have to proceed with caution. It may be unpleasant to remember that I, too, can be described by acronyms: it is definitely unpleasant to remember that knowing how to wield them doesn't make me resistant to my own pathology. But I think it's essential. Otherwise ALL my patients will be in tears, and THEN where will I be?