High Level Conspiracy

Last week it snowed in Arkansas. A fair amount. Now when this happens in most states, it is a minor inconvenience, especially when it's under five inches. But when it happens in Arkansas, it might as well be a national disaster. Grocery stores are cleared. Schools are shut down for days. Getting to work is treacherous, since we just don't have the manpower/road equipment to deal with it quickly - I guess it would not be cost effective since it happens to us so rarely.

My kids had a couple of days out of school. They happily played with my sitter and neighborhood kids - sledding down our ideal vertical driveway and front yard, making snowmen, and brewing hot cocoa. A nice extended Christmas vacation. By the time I was off Wednesday, school was back in session, and I was glad because there was much on my schedule to get done. By the time I had carpooled kids to school, finished cling-on cases at the main hospital and a GI clinic, taken Cecelia (7) to her initial 2.5 hour orthodontist appointment (those guys are expensive! And clinics get to take snow days - they were backed up and we had a long wait), shuttled her back to school, grocery shopped, and headed back to the school for afternoon carpool - Cecelia to dance and Jack (5) to haircut - I was wishing I was back behind my scope. I'm telling you - this SAHM business can be as hectic as the craziest needle days on cytology.

Anyway, during afternoon carpool Jack loaded up first and we waited for Cecelia to get out of study hall. He bounded in excitedly, chattering on about his day, luxuriating in the novelty of having me do afternoon carpool. He was showing me all of his work in his folder, moving around the backseat like a spider monkey. Suddenly, he scooted up into the console between the two front seats and leaned toward me, conspiratorially.

He whispered, "Mom, I sneaked something. Want me to show you?"

I looked over at him, a little alarmed. "What did you sneak, Jack?" He hitched up his foot, exposing his ankle between his pants and sneakers. I didn't see anything, so I guessed, "Was it candy? Or a toy?"

He shook his head and smiled his wide grin - the one that always reminds me of an angelic devil. Still whispering he said, voice filled with pride and searching for approval all at the same time, as he peeled back one white cropped sneaker sock to expose another identical one, "No mom, look. It's double socks. I did it this morning. Isn't that sneaky?"

Even though I wanted to double over with laughter, I realized that was not what this moment called for. That is part of our mommy magic - to be able to suppress our mirth and take our kids seriously. "Wow, Jack. That is really cool. Did you think of that all by yourself? To protect your feet from the cold weather?" He looked at me an nodded sagely, pleased that I understood. "Uh huh! Exactly." He shrugged nonchalantly. "It worked."

I told him he was pretty smart, I never would have though of that. Truth be told, I am kind of impressed by this five-year-old's ability to sense the weather and what is needed. A little while back, I searched for weeks for Jack's fireman raincoat. This is one of the side effects of divorce that you don't really think about until it happens - stuff gets lost all the time in the shuffle back and forth between houses. You think your dryer is a black hole? Try your ex's house. Not to be judgmental - it goes both ways, but although he has strengths that I don't, I am certainly more organized. One evening, when my ex took the kids for dinner, Jack appeared at my door afterwards in the raincoat. I exclaimed, "Oh! Did Daddy find your raincoat?" He said, "No, mom. We were walking to dinner and I knew it was going to rain, so I went to Daddy's car and found it." Sure enough, five minutes later they were drenched in a downpour, and when they got home I peeled them out of their wet clothes, Jack's a little more protected than Cecelia's, and got them each in a warm tub.

The double socks continued throughout the week with as much stealth as day one. We were trudging through the yard down to the car every day - it became more slippery as the week wore on, and the driveway ice didn't clear until the weekend. On Friday, my sitter came early to get the kids to school so I could catch a plane to Atlanta for some much needed brother, sister, nephews, and brother-in-law time. I was amused to see this cosmopolitan city in more dire straits than us - they were just emerging on Friday from a week long slumber and ice continued to cause wrecks (not funny) throughout the weekend as cars were getting back on the roads. Before I left for the airport, I was giving my sitter instructions for Jack's show and tell and Cecelia's lunch. I told her the story about the double socks - it had been cracking me up all week. Sure enough, she texted me later that she caught him sneaking his double socks. I'll bet it won't be so funny in a few years when he is sneaking girls and alcohol. I'll be longing for these double sock days.

Which form of Competition is Best?

Just came back from watching my daughter compete in ballroom dance competition. It struck me as a cross between a swim meet and an evening at the theater. I can’t decide if turning an art and a pleasure into a competitive activity is a good thing, or not. 

Which got me thinking about medicine, as most things do. Because what we offer is such a scarce resource, we inevitably select people who are, quietly or openly, highly competitive. Then we continue to rank them, in tiny increments, right through the end of training. At the other end, the money and perks that go with practice, or not, seem to play right into the same attitude. 

On the one hand, competitiveness has made my daughter a fine dancer, and my own competitive streak keeps me pushing myself to accomplish things I might otherwise not. But I do wonder if the drive, not only to excel, but to outshine, is a barrier to learning really important things—like the value of doing something for its own sake, or just being with our families, our patients, the people we work with. By the time my kids finished swimming competitively, they no longer could swim for fun. As a friend, I never learned to hang out; now I only seem able to be friends with people while I am doing something. And much as I try to be receptive with patients, I keep them and myself to a very tight schedule.

What bothers me most is that medical students are so conditioned to rely on their competitiveness for motivation, they can quickly become indifferent or hostile to anything that does not seem to have immediate value for giving them a leg up. The idea of studying anything because it is of intrinsic interest, or might someday be useful, seems to fall away quickly in the first semester of school, and may never return. Since it is especially hard to compete on the basis of creativity, which, by definition, confounds existing standards, this, too, seems to be systematically discouraged in our students. Creative problem solving is an essential element of practice, not just a frill. But to ask “how can we reward creativity?” immediately puts us back in the position of selecting, rating, and favoring, the same dynamic that fosters competition.

Resigning totally from a competitive environment—the ashram approach—never appealed to me. It always struck me as a paradox of people competing to show how anti-competitive they were. I just wish our education—the one we had and the one we offer—allowed us to allow ourselves to freewheel more, and enjoy it. As recent posts and discussions have highlighted, being present in our immediate lives—reading chicklit, not postponing everything in hopes of a future haven, or choosing family time over work--is an important counterweight competitiveness as the root of our motivation, and our rewards.

What It Feels Like for a Guy

*Editor's note: In the spirit of partner guest posts, this post was written by the husband of dr. whoo.

I’m not sure I am worthy of the title of Stay at Home Dad. I don’t have my children all day long every day.

My role to take on more of the domestic responsibilities began in fall of 2008. There was a combination of factors for this decision, but it was largely based on improving the quality of life for our family. Our oldest child had just turned four years old and our youngest, two.

With both of us working beyond full time, we were watching our children grow up in daycare and were limited to an hour or two each evening with them during the weekdays and the weekends were spent catching up on laundry, lawn, grocery shopping and million other items on the must do list. Exhaustion discouraged healthy cooking and exercise, and we ended up eating out or ordering in most of the time. I could continue to list all the reasons, but the truth is we should have done it sooner for fewer reasons. I never thought I would have anything but a long career of continuous development, but my wife had more time and money invested in her career and she was the bread winner. Besides, I have way more patience with children, and all other non-cat related matters.

It has been two and a half years since we made that decision, and it was the best decision for our family. Quality of life for everyone has improved tremendously. Cindy Lou is in first grade now, and we decided that Bean would benefit from the social interaction and academic curriculum at he gets at preschool. I take the kids to school, I pick them up (much earlier than we used to). I cook the meals and clean the house, albeit poorly I am told (seriously, how does dust accumulate so fast?). I pay the bills, clean the pool, and mow the lawn. I also do general repairs, minor plumbing and electrical work and you should taste my stuffed tilapia with white wine lemon butter sauce. During varying times of the day and evening, I work (as needed) to run my unintentionally non-profitable small business with 6 employees. I did get to take a paycheck last January (2010) so that’s good, right?

I now get a lot more quality time….err, snuggling/wrestling/tickling time with the kids which is unbelievably great.

I periodically get a little restless, and send my resume out to test the waters, but every time I get a bite I am forced to reconsider the consequences to my family if I return to the corporate world. Without fail, my decision is swift and clear as to what is best for our family, and that is to stay home. That is to say, stay available. Available for sick children and doctors appointments and field trips and household duties and whatever else needs to be done. My wife’s job as an OB/GYN is stressful and demanding enough, and I cannot help with that or relieve those responsibilities in any way. What I can do is almost everything else, that’s the goal anyway. In reality, she contributes a lot and always has a sense of when I need her help the most.

Anyway, I am unaware of any stigma and indifferent to prejudgments or misconceptions that others may try to attach to me. This works for our family and I am very proud and grateful for this arrangement. I used to think of it as me sacrificing my career for my family, but now I see clearly. We were sacrificing our family for our careers. We’ve both made the necessary changes to end that, and we are a happier family for it.

40 hours

40 hours. Some people put in 40 hours per week at work. It is 23.8% of an entire week. It is also the approximate amount of time I get to spend, in person, with my husband every week. Which makes 40 hours an allotment of time that has taken on new, precious meaning during the past 6 months while my husband has been stationed away from the family, a 6 hour drive (on a good day) away .

That 40 hours includes the time spent sleeping over 2 nights. It includes the time we attend to our own needs: work outs, showers, etc. It includes the time caring for the kids together, at gymnastics and swimming lessons. It sometimes includes the time I spend at work when on-service and covering a weekend. It is time that we are intensely focused on being together, of being a team reunited. It is time I can't wait for at the end of each week, and time that passes all too quickly.

I know this now: we will never take living in the same house, of falling into the same bed each evening, for granted again.

Making each week's 40 hours, from Friday, late at night to Sunday, early afternoon, that much more savored is the fact that soon,  in a couple of months, those 40 hours per week will become 0. 0 x 50 weeks to be exact, the amount of time that he will spend in Afghanistan in active duty. He'll have a total of 2 weeks of "R and R" sometime in the middle.

Working full-time and parenting 2 small kids with 1 on the way (6 weeks and 1 day to go before due date, but who's counting) has only been possible by lots of help at home. Ever since we had nannygate x 2 late last fall, my parents have basically moved in and are a tremendous help. They plan to stay well after I have the baby when another family member has committed to helping for several months. The new nanny search can wait until then.

Despite all of this madness, I'm remembering to count my blessings because they are many. To have retired parents willing to give up their previously enjoyed retired life to come live with us. To have a job which leaves me satisfied, happy, and not (usually) overworked. (Any overworking is my own fault and side projects I've taken on, not expected by my job). I have a wonderfully supportive boss who understands my family situation. I have a rock-solid marriage; we know that this separation and challenging 12 months ahead will only bring us closer. I have the world's best neighbors. We have fabulous friends who have helped so much already this year, both in their actions and their mental and emotional support. We belong to a wonderful church. So, now, 2 months before he is deployed, I am at peace and stand ready to face what comes my way.

One of my Christmas presents this year was a Philosophy set of products from their Amazing Grace fragrance line. If you're not familiar, Philosophy products come with smart names and little blurbs that inspire. The blurb on the Amazing Grace body butter I found especially resonant:

"how you climb up the mountain is just as important as how you climb down the mountain. and, so it is with life, which for many of us becomes one big gigantic test followed by one big gigantic lesson. in the end, it all comes down to one word: grace. it's how you accept winning and losing, good luck and bad luck, the darkness and the light."

My plan is to wear this and live this. Every day. It smells, well, amazing, and it might just help me through the months to come.

The Mythical Bright Light

When I was in my second year of med school, I had kind of a sobering moment:

One of my classmates had a boyfriend who had recently graduated from residency in medicine and had a job in a private practice. Back then, that seemed like the bright light at the end of a long tunnel: someday I would finish med school, finish residency, and then the torture would be over!

Except my friend was complaining about how her boyfriend was working harder than he ever had before. As the newest person in the practice, he took call every holiday and was at the office late every night. She then went on to tell me that this was "typical" of first attending jobs.

I wanted to throw up. So not only did I now have to get through med school and get through residency, I now had to put in my dues in my first attending job for god knows how long? When the hell did it ever end?

When I was doing inpatient rotations in residency, I noticed that my attendings never left work before I did, and actually, were often there later than I was (except on call). I started to have a bad feeling that the bright light at the end of the tunnel was all a myth, and that by entering medicine, I had resigned myself to working hard for the rest of my life.

I do think that, in general, attending physicians work very hard. I know there's going to be some dermatologist who comments something like, "Hey, I work only two afternoons a week, I love my job, and I make half a million dollars a year!" And that's awesome for you, really, you bitch. But I think even physicians like myself, who work part-time and have fewer hours, work pretty hard while at work. And physicians who work full time in private practice generally work their asses off.

The bright light is not entirely a myth. At least as an attending, you earn more money and get to do something closer to the job you want to do. But then again, how many people end up with their dream job right out of training, especially in this economy? I think it's to be expected that you'll need to spend a few years putting in your dues. I think it's a myth to think that you just need to get through seven years of training and then you'll be on easy street. After all, there's a reason Physician ranked only 83 on CareerCast's list of the top 200 jobs of 2011 (I seriously thought we were going to be after the guy who cleans the urinals or something).

I guess my point is that if you think of medical training as something horrible you need to get through before you end up with some cushy, high paying job, maybe you should rethink medicine. I don't think it's a good idea to postpone your life until "the hard stuff" is over, because it might not be over as soon as you think. Or ever.

But as usual, I welcome dissenting opinions. Do you work your ass off as attending? Or did you get a cushy, high paying job straight out of residency?

Doctor chick lit?

I always used to read a lot as a kid, but when I started med school, I decided that anything I read ought to be medicine-related, so I pretty much gave up on reading for fun. ("What, you mean reading Robbins' Pathological Basis of Disease wasn't fun??") But in my last year of residency, I was sufficiently bored that I decided to open myself back up to fiction again.

I'm mildly embarrassed to admit it, but I LOVE chick lit. I don't know why, because I hate fashion and flowers and jewelry and everything else girly. But I love these books. It's especially shocking because I used to be SUCH a little book snob when I was a teenager, and I'm sure I would have mocked Older Me mercilessly for reading a book about a woman who helps her quirky ghost great-aunt find a lost necklace (bonus points if you know what book I'm talking about).

But I don't have anything to prove anymore, so I'm going to read what I want, dammit. I recently discovered a list of the ultimate top 100 chick lit novels and noting that I've already read and enjoyed 7 of the top 10, I've decided to make it my mission for 2011 to work my way through the list. Come on, who's with me?

But you know what bugs me about chick lit? How come none of the female protagonists are ever doctors??

Seriously! On that list of 100 books, you'll find women who are lawyers, teachers, PR reps (a popular chick lit career), i-bankers, and basically tons of great careers. No doctors. There are no chick lit books about doctors.

Why the hell not? There are lots of doctors writing memoirs. There are lots of thrillers written about doctors. (I used to be a big Robin Cook fan, until I realized the villain was always Evil Managed Care.) There are tons of TV shows about doctors, some of which involve doctors hooking up a lot (Grey's Anatomy). There are comedies about doctors (Scrubs). So I don't know why female doctors can't be the protagonists in chick lit? The Devil can wear scrubs, can't she?

You can probably tell this really bothers me. Why can't someone write a novel about a female doctor who's riding on a plane, ends up telling all her secrets to the cute guy next to her, then it turns out he's her new boss and also she has a shopping addiction? What's up with that?

I am legend.

I am RH+’s husband (Mr. Positive?) and a stay at home father. Recently I’m a hot topic. Yes, I heard tings (said in my best De Niro voice). Here’s a bit more about myself…

• I don’t mind being called “the wife” or “Mr. Mom” or “Daddy Daycare” or when someone says “Oh look, daddy’s day out. Giving mom a break today, eh?”
• I cannot find a stay at home dad’s group in my city with google. Thus, I have no social interactions. And no prospects.
• This life chose me; I didn’t choose it.
• Circumstances left me with no job, so I’m just watching the kids for a while.
• I wear mandals. All the time.

• I can’t make small talk at parties because “I’m a full time dad” is a conversation killer.
• Surfing the internet all day keeps me busy most of the time. The rest of my time goes to Wii.
• I don’t cook well and can't operate the simple machinery stored in the laundry room.
• I’m a failure in the corporate world.
• I can’t look at your MIM website without secretly wishing there was some MIB tie in.

• My right thumb tingles a bit.
• It’s all bon bons and soap operas…and NASCAR.
• Sometimes I feel like I’m shirking my role as financial provider and that my role as homemaker is less significant.
• Grocery shopping is challenging enough, adding small children to the mix makes every outing an adventure.
• I don’t like sports.
• I’m homeschooling my kids, or should be.
• I am the post modern trophy wife.
• I’m an introvert. Or an extrovert.
• My wife wears the pants, but sitting around in my underwear all day isn’t so bad. Someone bring me the remote. Stat!

Hey, stereotypes exist for a reason, but that doesn’t make them right about individuals. Only one of the above statements is true about me and the guys I hang with. (I’ve got a tingly thumb…don’t ask why.) Most of the list are outright lies, some are exaggerations, a few are truly myths, and still others are simply artifacts of times past waiting on society to finally bury them (if the last hundred years have taught us that men and women are equals, then so be it). One thing is certain: a new beast has entered into the public mythology—into our shared societal consciousness—a new superstition entering the unassailable fortress of forever. I am a stay at home dad. I am legend.

So that’s the screw-you-part where I say all your stereotypes are bogus. Oh, and the last line is from the book (which turns, big shock, out to be not much like the Will Smith movie), starting with “a new superstition.” I didn’t make that crap up, just the crap before it. The real-me-part is that although I was raised in daycare and turned out justfinethanks, I always envisioned having my wife raising my kids. Marrying in our early 20’s, we waited 8 years into our marriage before the time felt right to have our first, so we were already on our second house and somewhat financially stable (as opposed to my own parents who were married in their teens and constantly argued about the little money they had). With RH+ in residency making the same salary as me, and with potential to make “doctor money” in a few years, it seemed like staying home fit me best. I tried it and liked it. We had to tighten our belt a bit, with the exception of upgrading to a DVR with the cable company (commercials can bite me). Otherwise, the high cost of daycare and gasoline, plus a favorable mortgage refinance equated to literally ¾ of my salary. RH+ picked up 2 moonlighting shifts per month (affectionately known as “sleeping for dollars” except for the one time she was everyone's hero, but she can tell the rest of that story…). Anyway that stuff plus our conservative lifestyle enabled us to go down to one salary with minimal pain. It was worth it. Totally.

I’m now part of a dad’s group, so I can share some perspectives from other fathers as well. I highly advise prospective full time dads to google yourcity + “at home dad” (use quotes) or check Meetup.com to find a group. It’s cool to talk sports, politics, diapers, and watch the moms groups wince when we arrive at the park only to often complement us as we leave the park. Dads who made a conscious decision to stay home and parent are much happier than those who lost their job and are watching the kids while looking for another job. This is no different than a guy unhappily working at the burger joint while looking for employment in his career of choice. Dads I know who actually took a significant net pay cut to make the deliberate choice they thought was best for their family are happier for it.

I can’t say being an at home dad is for everyone. I do know that everyone should try to have a career that they love. I love being a full time dad and find it to be an easy gig most of the time. This is also no different than a guy thriving in a career that he loves.

As a full time father, I know my son better than anyone. Sending him to kindergarten last year was really tough because his life story now had experiences that I was not a part of, chapters that I did not help write. Now that we have our second son, my decision to stay at home is reaffirmed as the correct one. He’s just started to toddle. Watching him try to mimic big brother at 14 months old is hilarious, its awesome, its frightening, and totally confirms exactly what I’ve always said: better raise your first kid right so he’ll do a good job with the rest. Here’s hoping that I did. And if I did not, well I have only myself to blame.

Great Expectations

"I always wanted to build model planes," he said, wistfully examining the partially finished one on the table. "My father would not allow it. He collected stamps, so we collected stamps." - King George VI in The King's Speech.

Of all the dialogue in this outstanding movie we saw on New Year's Eve, this gave me sudden pause.

It is not, after all, too surprising that much might be expected of a king's child. Great privilege is accompanied by great expectations. How difficult it must be to live such a life, especially in the age of ubiquitous media. I feel a certain pity for Kate Middleton, whose life can certainly never be normal again. I actually wept in the theater for King George VI and his terrible predicament.

What a compelling depiction this was of the effect a tyrannical parent can have on a child. Ultimately, George V admitted the respect he had for his second son - too little, too late.

Throughout history, a certain personality type has been attracted to a throne. Genghis Khan, Elizabeth I, Julius Caesar... none of these was a gentle or shy type. I believe many surgeons share this same super-Type A personality. I recognize it in myself. Without some such traits, it is difficult to get through training and be successful in this field.

Rulers must not show weakness; they must appear confident at all times. They must relish control and enjoy making decisions that affect the lives of real people. So it is with surgeons (and some other specialists) as well. The OR is very like a small kingdom in many ways.

It can be difficult sometimes to moderate those personality traits at home with family. Clearly being so Type A has its advantages, but there can be a dark destructiveness to it. King George VI evidently knew that well.

I can understand his father, George V. As a successful monarch, he must have wanted his children to be just like him. Anything less would imply failure on his part to produce equally successful offspring. He must have felt the need to control his children's development as he controlled everything else. When he could not correct their flaws, he felt disappointed, frustrated, even betrayed. He could not countenance failure.

I admit that I have felt shades of this. I suspect I'm not the only one. Like many surgeons, I have always been successful at most things; I have never really had to face a major failure. I have generally been able to make things happen the way I want them to. Raising a child, however, is different.

My son is the most precious thing in my life. My greatest wish is for him to ultimately be happy and successful. I know he is not me; I don't really want him to be. He is a different person, and that's a wonderful thing. I would never push him into a field he didn't love - yes, including medicine. Nothing could change my love for him.

Nonetheless, I have found my Type A side struggling at times. Two things have bothered me the most.

He is not a straight A student. He has the ability, but he just is not motivated to accomplish this. I tell myself that he is just 12 and that B's and C's are OK. He may buckle down as he matures. We make sure he gets his work done, and we try to help him study for tests, but he's just not interested. He would much rather play hockey or watch ESPN. This is so frustrating to me... and I can't understand it. At a visceral level, I can't imagine not having the drive to be top of the class.

Worse, he hates to read. Loathes it! Even before he was born, I dreamed of reading together with him. I imagined sharing the books I have loved all my life, laughing and crying with him over the pages. I know now this will never happen. It may sound silly, but this is possibly the biggest disappointment I have ever known. But I can't change him, make him love something he doesn't.

None of this sits well with the controlling part of me. At times, I'm tempted to yell my frustration at him, force a book into his hands, take away his sports. Obviously, I tell myself, that wouldn't be fair, and it would only make him resent me. Type A or not, I don't want to be King George V, dictating what my son will and will not enjoy, will and will not do.

I've been mulling over the reasons that scene moved me so. I think it had something to do with recognition, and with fear.

Kings or physicians, our children are the most important part of us. We want so much to see the best of ourselves in them. We work so hard in part to give them the best opportunities to build a satisfying life for themselves. We know only one route to success and happiness, the one we have walked ourselves. We fear that their differences from us may spell difficulty for them, or even failure. Where they fail, we feel that we have failed.

Further, we crave a lasting bond with our children, one that will connect us through the years and the inevitable separations. Subconsciously or consciously, we try to cultivate similar tastes and interests, ways to understand each other better. The love comes naturally; the mutual understanding is harder. We fear loss and loneliness.

My biggest challenge may be letting my son grow into a different person without trying too hard to interfere. I can't change my surgeon's Type A-ness, and I can't change him. Nor can I change my hopes for his future. Perhaps my New Year's resolution should be to interest myself more in the things he naturally enjoys instead of yearning to make him over in my own image. I should focus less on my own disappointments and more on the joy of who he is. Truly, there is so much to be joyful about.

Since the time of Dickens and before, parents have had Great Expectations for their children. Let us have the wisdom to recognize our own fears and shortcomings, and to temper those expectations with purely unselfish love.