Archive for the ‘Family’ Category

Classic rock music lovers who think they don’t like poetry, and literary purists who think they don’t like popular music, may have been equally baffled to hear that Bob Dylan is a winner of the Nobel Prize in Literature. As an unrepentant English major, I’m delighted.

I can’t remember a time when Dylan’s music wasn’t a part of my growing up, from the rebelliousness of the anti-Vietnam era to the bittersweet maturity of “Tangled Up in Blue“, my all-time favorite.

When you think about it, any time you listen to a song — a current popular hit, a 1950’s oldie, or a centuries-old ballad like “Greensleeves” —  you’re listening to poetry, only with a tune. In ancient times, before most could read or write, people turned stories into poetry and sang them because rhyme and melody made the stories easier to remember and retell. Much of rap music is poetry (often crude, but still poetry) with complex use of rhyme and assonance, and the musical element reduced to a backdrop of pounding rhythm.

Poetry set to music can convey any and all human emotion. Love, of course. Jealousy — absolutely. Just pick a musical genre, and there’s a hit song about jealousy. In pop music, Taylor Swift’s “Blank Space” lets her revel in her psycho side. In country music, Carrie Underwood graphically explains in “Before He Cheats” what can happen when a woman wants revenge on her faithless lover, and takes it out on his car. And the still-creepy “Every Breath You Take“, the 1983 classic rock hit by The Police, blurs the fine line between devotion and obsession.

Then there’s the universal human experience of grief. There was a time when every parent expected to lose a child, or more than one, because children often died from pestilence and poor sanitation. When my daughter Alexandra died unexpectedly at the age of five months, I couldn’t decide which was worse — thinking that I wouldn’t survive, or being horribly afraid that I would.

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Nothing brings out the mama lioness in me more than seeing one of my cubs not being treated as well as I think it should be.

Recently I had the unusual experience of accompanying my oldest daughter into an unfamiliar hospital for a minor surgical procedure. Now this daughter isn’t exactly a cub — she’s a full-fledged adult, with a master’s degree in health care administration, a husband, and two small boys of her own.

But as I watched the OR team prepare her for surgery, I started to feel like an odd combination of a mama lioness and a secret shopper. To the staff members who came in and out of the hospital’s preoperative area, it was clear that I was simply the family member in the corner, and they probably figured I had little clue about what was transpiring. Meanwhile, I was taking in every detail. Some tasks were performed excellently — others, not so much.

The hospital where her surgery took place is a small community hospital on Long Island. It enjoys a location where Jerry Seinfeld, Christie Brinkley, and other wealthy New Yorkers maintain lavish homes for weekend and summer holidays.

My daughter was instructed to arrive at 6:30 a.m. Her procedure involved an initial stop in radiology, to be followed by the actual surgery. As a veteran of hospital life, I questioned whether radiology even opened that early, but we had no way of checking. So we left her house at 5:25, driving carefully on dark, icy roads with fresh snow, and lining up for a 5:40 a.m. ferry ride from her home town so that we could arrive at the hospital by 6:30.

The good news — a valet met us at the hospital door and whisked away the car, so we had only a moment to savor the 20-degree weather and the harsh wind that made it feel colder. My daughter was promptly escorted to a private room to change clothes.

Hurry up and wait

A nurse gave her an insulated paper gown with two openings to connect it to a wall-mounted forced air warming unit. This, I thought, was a wonderful thing. Where I’ve worked, we had forced air warming blankets in the ORs but the hospital wouldn’t spend the money to put them in the preoperative areas. I thought of Tina Fey, playing an immigrant from Albania in a Saturday Night Live spoof of the HBO series “Girls”, and imagined her saying, “In my country, we do not have such things.” Within minutes, my daughter’s gown was hooked up to the warmer and she was feeling much cozier.

Then we waited.

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Did it ever occur to some of today’s physicians that many people work awfully hard and complain a lot less than they do about “burnout” and “work-life balance”?

Did it ever occur to them that “work-life balance” is the very definition of a first-world problem, unique to a very privileged class of highly educated people, most of whom are white?

Every day, I go to work and see the example of the nurses and technicians who work right alongside me in tough thoracic surgery cases. Zanetta, for instance, is the single mother of five children. She leaves her 12-hour shift at 7 p.m. and then faces a 60-mile commute to get home. She never complains, and unfailingly takes the extra moment to get a warm blanket for a patient or cheerfully help out a colleague. When I leave work, I see the gardeners who arrive in battered pickup trucks and mow lawns in the Los Angeles summer heat for slim pay and no benefits. I can’t imagine these people wasting time worrying about work-life balance. They’re too busy working.

Or look at what it’s like to work in one of the world’s top restaurants. Edward Frame, now a graduate student in social research, described his first job in a Michelin-starred kitchen for an article in the New York Times.

“I worked in a small alcove, connected to the dishwasher,” he wrote. “Glass racks came out, I wiped away any watermarks or smudges, and then, just as I finished one rack, another appeared. This went on for hours, like some kind of Sisyphean fable revised for the hospitality industry. By hour two my fingers hurt and my back ached. But I couldn’t stop. The racks kept coming. Slowing down never occurred to me. There wasn’t time. I needed to make it nice. I wanted to make it nice.”

Let’s face it—a lot of people have jobs much worse than being a physician. Apparently, they don’t expect to be coddled or to receive much sympathy about their rate of burnout, or their lack of “work-life balance”. Nor do they expect that workplace expectations will be altered just to suit them.

I can’t imagine having the gall to complain about how tough it is to be a physician when all you have to do is open your eyes and see what’s all around us:  people working incredibly hard, making far less money than we do, and then returning home to face the responsibilities of family life, child care, housework, home maintenance, and everything else.

We—physicians—thankfully can afford help with these tasks. The Medscape Physician Compensation Report for 2015 reported that the average compensation for a primary care physician was $195,000 and for a specialist $284,000.

When I was a new faculty member making an instructor’s salary right after residency, it’s true that I didn’t have a lot of take-home pay left after I made monthly payments for student loans, private pre-school for two children, housecleaning help, and a full-time nanny to provide transportation and after-school care. The full-time nanny was essential because a child with a bad cold or an upset stomach needs to stay home, and a physician can’t drop everything to stay home too. These were investments that my husband and I made because we felt that being a physician is important work.

But in medicine, the prevailing wisdom today is that the rigorous culture of the past needs to change—along with the expectation of dedication to duty, long work hours, and stoicism—because it’s all just too difficult and we risk getting burned out.

Now Stanford University has started a new “time-banking” program designed to ease pressure on faculty physicians and basic science professors. As admiringly described by reporter Brigid Schulte in the Washington Post, the program allows faculty members to “bank” hours that they spend on uncompensated activities such as committee work and earn credits to use for support services at home or work.

Dr. Gregory Gilbert, an emergency physician who was the poster child for the Post article, used his credits for delivery of meals to his home, housecleaning services, and employing a “life coach” to help him “find better balance in his life”.

Wait just a minute. I’m sure that Dr. Gilbert is a good person—a divorced father trying to be a conscientious physician and spend time with his children. He must be a smart guy if he’s on the faculty at Stanford. Do you mean to tell me that Dr. Gilbert couldn’t figure out how to order food delivery and arrange for housecleaning before Stanford came up with this program?

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Dr. Margaret Wood, who chairs the Department of Anesthesiology at Columbia University Medical Center, has published a wonderful article titled “Women in Medicine:  Then and Now“, in the journal Anesthesia and Analgesia.

I think I speak for many of us in admitting that Anesthesia and Analgesia doesn’t occupy a prominent place on my bedside table. Many readers may have missed Dr. Wood’s article. That’s a shame, because it isn’t just about anesthesiology, and speaks to issues in medicine independent of specialty or gender. Here are some of my favorite passages about lessons she learned over the course of her long and successful career:

“1. It is important to have a passion for what you do if you strive for excellence. If you have that passion, then the efforts do not feel like a sacrifice and “burnout” is not an issue. I cannot imagine that Virginia Apgar spent a single moment talking, thinking, or worrying about burnout.

2. The current fashion to complain about “life balance” can be self-destructive; however, pacing oneself is critical. You can have it all, just not all at once. The Chairman of Anatomy gave the inaugural lecture to my incoming class of medical students. His thesis was that as a physician/medical student you could have (i) an active time-consuming social life, (ii) a family, and (iii) a career, but to be successful you should have no more than two of these at the same time. I believe this to be true and have followed this advice since.

3. Women should be careful not to fall into the trap of feeling entitled to special considerations or engage in special pleadings. Our patients want their physician to be the best, whatever his or her sex. There is no room for a physician of either sex who is less qualified or less committed because of outside responsibilities.

4. Women no longer need to “prove themselves” against the sea of doubters who dominated medicine 40 years ago. Fortunately, we are now past that point and such doubts, are I hope, antediluvian. Women are where they are today, however, because many of us felt that demonstrating that women really could “do it” was a moral imperative and one to which we were fully committed.

5. Parents need to manage their work and family responsibilities to ensure that both receive their full attention. This will often mean ensuring that they have excellent childcare to allow them to have the confidence to focus on work when that is required. This may be expensive, but it is a critical investment by both parents in their family’s future. Successfully raising children is a joint responsibility of both partners; what is critical to women is also critical to men, and vice versa. Women starting out on this journey can be assured that it is possible to raise well-adjusted children in a home in which both partners have challenging and successful careers, provided there is a true partnership in the family.”

Is Dr. Wood a curmudgeon, or perhaps a dinosaur? That could be, but I find her honesty refreshing.

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Of cats and termites

How an eleven-pound cat precipitated domestic chaos and delayed surgery

Termites are endemic in southern California, and we’ve had spot treatments several times over the years at various sites in our house where little piles of sawdust have appeared as evidence of termite activity. Finally it became clear that the termites were winning and more aggressive treatment was in order: tenting. This is the process of hoisting a big, brightly-colored tent over the whole house and putting an end to the termites with a poisonous gas called Vikane, or sulfuryl fluoride.

Tenting is a major project. All food and medicine has to be put in special non-porous plastic bags, sealed tightly with tape. All the people, animals and plants have to be evacuated. Natural gas must be turned off. The house is sealed in the tent for 24 hours, then aired out with big industrial fans. On the third day, you can go home.

The fumigation was scheduled to begin on Monday. Over the weekend, we put the food and medicines in bags, or most of it anyway. I arranged for our three tabby cats to be boarded at the vet. Our dog-walker agreed to board Milo, our 100 lb. Rottweiler-mix dog, at her house. My husband Steve complained continuously, as though I had bought bags of termites and sprinkled them around the house on purpose to annoy him.

On Monday morning Steve and I both went to work, to our day jobs as anesthesiologists, and I came home at 11:30 to take the cats to the vet and hand off the dog. The exterminators were expected to arrive between 1:30 and 3:30 pm. I had the presence of mind to lock all three cats in the family room before I went to work. Now my task was to get all three into their carriers and off to the vet.

Going three rounds with Tigger

I decided to tackle Tigger, the five-year-old male, first. He is strong, sinewy and sleek, and we’ve nicknamed him the “stealth cat” because he is very good at eluding capture. I thought he would be the biggest challenge to put in the carrier, and I was right.

Round 1. I caught Tigger, shoved him into his carrier, and tried to hold him down while I zipped it up. He turned into a writhing yowling clawing dervish and fought his way out.

Round 2. I think he got out even faster that time.

Round 3. Met the definition of insanity, as I hoped for a different outcome from the same sequence of actions. Same cat, same outcome.

I considered my options, and decided to get Joe and Tabitha into their carriers and drive them to the vet. This, I thought, would give Tigger time to calm down. Joe is a placid 17-year-old senior cat, and while he doesn’t like to go anywhere, he can’t be bothered to put up much fuss. Tabitha is a 10-month old kitten. It took some doing to catch her, and she was very unhappy, but she was still too small to win the contest. I drove Joe and Tabitha to the vet and came back home. As I came in the house, I caught a brief glimpse of Tigger, still locked in the family room. I put some more food in bags and waited for Krys, the dog-walker, to arrive and help me with Tigger.

1 pm: Krys arrived. We discussed the plan to put Tigger in his carrier. Only problem: we couldn’t find Tigger. We looked all over the family room and kitchen. We searched in the coat closet, under furniture, and behind the washing machine and dryer. No Tigger. It was as if he had evaporated. Milo (the dog) at this point was becoming anxious, trotting around after me and panting, sensing a disturbance in the force. I decided it would be best to let Krys and Milo leave.

1:30 pm: A fair amount of stuff still needed to be put in bags, but I couldn’t find the cat anywhere. Rising anxiety. I called my husband. A veteran of married life, he recognized the tone of desperation in my voice, and promised to come home as soon as he could arrange coverage. Cat clearly more important (for the moment) than heart surgery.

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