The Race Belongs Not To The Swift…

But to those who just keep effing running.

Sorry to mangle Ecclesiastes, but this is how I feel lately, for many reasons…

Yesterday afternoon, Hubby took Babygirl on the Target run, and Babyboy and I found ourselves with a few hours of free time. Unscheduled time with only ONE kid doesn’t happen very often. I asked him what he wanted to do.

“I want to go for a run in the stroller… to Boston.”

Yes, we live near Boston, but not THAT near. And, he was serious.

Babyboy has been extremely focused on maps, and where we live in relation to just about everyplace… especially Boston. Plus, he’s enthralled with the buildings and highways of the city. For weeks, it’s been Boston this and Boston that. He’s even become enamored of the band by the same name. (Can I tell you how many times you hear “More Than A Feeling” before going nuts? More than you’d think, actually. I’ll take Brad Delp’s frenetically angelic vocals over The Wiggles any day.)

So, lately when we’ve gone for runs, he’s wanted to run to Boston.

Now, I love to run. I’ve run three marathons, but, those were well over a decade ago. When I got pregnant for the first time, I didn’t move, I ate everything, and I gained sixty pounds. I worked very hard to lose some of that weight, but then… in my second pregnancy, I gained fifty pounds. My first attempt at running after Babygirl was born… Well, suffice to say, I described myself in a post as “a mooselike creature in ill-matching baggy pants and her husband’s rain jacket toodling up the hill like a manatee on land“.

Since then, I’ve just been working and working myself slowly back up to where I was pre-pregnancy. So, I take the kids on runs. We have two jog strollers, a single and a double (both free to us: one was a gift, the other a hand-me-down). This summer, I’ve been pushing my limits in distance while simultaneously pushing either one or both kids in one of these baby joggers.

It helps to have an unrelenting trainer in Babyboy. A few weeks ago, I had planned an easy run with him… But Babyboy spurred me on. Every single time I tried to turn around, he freaked out.

He would repeatedly scream, “I want to run to BOSTON!” and start throwing himself around in the stroller, to the point of almost tipping it over.

Though I had had absolutely no intention of doing so, we just kept running. We ran down to the train tracks, along the river, and then under the highway, to a park literally right next to the major artery of the city.  The park’s proximity to the highway and the views of the city on the distance apparently satisfied Babyboy’s Boston sensibilities. He was thrilled… and so was I, actually.

I was thrilled because I hadn’t run that far since before he was born. We were both thrilled, because it’s a really beautiful park that we had never been there before: an urban reservation, oddly quiet and yet at the same time, it feels safe. We’ve never run this without also running into other baby jogger runners, people walking their dogs, and random picnickers.

We’ve done this “Boston” run several times now…. and again yesterday. I tried to turn us around at several points, more because of the time than anything else, but Babyboy wouldn’t hear of it. We did the “Boston” loop, he was happy, and I logged in a 7.5 mile run, with a jogger stroller.

7.5 miles with a baby jogger… Take THAT, Lance… You wouldn’t have needed the steroids if you’d had my son as a trainer!

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Back In The (Teaching) Saddle

 I’ve signed on to help teach firstyear medical students how to interview patients. It’s been few years since I was involved in any teaching; five, to be exact. As soon as I found out I was pregnant with Babyboy, I decided not to re-up my involvement in a course teaching empathy to thirdyear med students. I loved the course, and I enjoy teaching, but it was one of the many things I dialed back when I had my babies.

And good thing I did. We’ve only been reliably sleeping through the night within the past year. I would have ended up in the loony bin if I’d tried to keep teaching on my list of responsibilities, with little little kids at home. I often have patients who come in with grave concerns about their memory and concentration abilities. In many cases, these are thirty- and forty-something working mothers of young children. My first question- “How much are you sleeping?” often yields the diagnosis. Hello, chronic sleep deprivation. It is a form of torture, after all.

Anyhow, now that my brain is reasonably functional, I decided to look for an opportunity to get back into teaching. The same week that I was thinking about it, an email went out to all the faculty, asking if anyone would be interested in joining the first year interviewing course. Hello, coincidence. I blocked out my Wednesday mornings and jumped in.

So here I am, into Week 2. I have to say, I am duly impressed. It’s a four month course, approximately two live hours per week devoted to practical skills building, on top of a load of readings, write-ups, and reflections. These first sessions are all about building rapport and using basic techniques (open-ended questions, continuers, silence) to obtain a good patient history.

These students don’t know any actual medicine yet, but the whole point of this course is, they don’t need to. They don’t need to be clinicians at all to efficiently yet empathically elicit a coherent story from a fellow human being. As a matter of fact, it may be better that they don’t know any medicine, so we can drill in the basics of bedside manner before these kids hit the floors for real.

I really can’t recall receiving any formal instruction in the clinical interview during my med school years. (Anyone from our alma mater reading this? Am I just blocking something out?) I can’t recall much formal instruction on this in residency either. (Of course, I don’t recall much from residency, in general. Hello, sleep deprivation… And unhealthy coping mechanisms… Didn’t make for nurturing the brain cells.) I did voluntarily participate in a course like this one as a clinical research fellow. I found the course exceedingly helpful, revelatory, even. But that was in my eighth or ninth year of training, and it was a choice.

And so I marvel that these newbies get this course. My job is to find them patients to interview on the floors, prepare them a bit, observe the interview, and then provide constructive criticism on their interaction as well as their write-ups. There’s some other stuff thrown in there as well, but that’s the gist of it.

Last week, it was with a bit of a shock that I realized these patient encounters are their very first. They have never, ever before in their entire, gunner, straight-A premed lives sat face to face with an actual live patient before this. Of course, it makes complete sense. They just moved here and started classes this month. Duh. But it struck me how special it was to be a small part of that first, precious, innocent encounter.

*And let me clarify- Yes, I was shocked to realize that these were their very first patient encounters, because they did so well. Far, far better than I would have at that stage, myself. I continue to be duly impressed.

I’ve also noticed how much I’m taking from the course. In my own clinic, I’ve become hyper-aware of when I jump in to the patient’s history. Do I tend to cut people off before they’ve finished? The research show that it takes attendings about 23 seconds before they interrupt the patient. Is that me? Lately I’ve been trying hard to keep my trap shut and let the patient talk. Silence.

And, I’ve realized that I’m not actually very good at using open-ended questions, continuers, and summary statements (like, “Let me make sure I’m understanding what you’ve told me. The pain started three days ago after you lifted that fifty-pound bag of birdseed, and then you went to the local urgent care center?”) I know I can benefit from these lessons as much as my students, and, I venture to say, I think many of my colleagues could, as well.

As far as these first encounters being special, innocent, and precious: The research is very clear that as we march through our medical training, our empathy drains away. We tend to become jaded, cynical, and insensitive. There’s been a huge push for med schools and residencies to teach empathy, which really means, to help trainees hold onto that empathy they had in the beginning. But, it’s incredibly difficult to do this given the structure of training being what it is, i.e., hellish. Many residents become bona-fide burned-out, after only a few years on the job!  I’ve lived this, and I know: these first encounters are special, innocent, and precious.

Ah, nostalgia… 'Actually, you're my second patient if you count that cadaver in med school.'

*These last few paragraphs were added in response to a medical student’s critique. See below commentary.

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An Open Letter To My Fellow Commuters

I have promised my patients, colleagues, friends, family, neighbors, and everyone that I will never personally attack anyone on this site. But I reserve the right to shame anonymous members of the general public for their bad behavior.

I’ve been taking the train (the Boston subway line is affectionately nicknamed the “T”) to work for a few months now, and I feel the need to speak up:

To the healthy, young, lazy- ass folks who do not offer their seat to the elderly, disabled, or hugely pregnant: I saw you sprint for the train and then muscle your way through the crowd to that last open seat. I highly doubt that you are nursing some occult malady and that you really need that seat. In addition, your physique leads me to believe that you would benefit from the modest core workout that standing up on the train would afford you. So, how about get up off your well-padded duff and let the frail osteoporotic woman with the grocery bags/ the pale guy with the crutches/ the nine months’ pregnant lady with cankles sit down?

To the folks that drop their trash on the floor of the train: Seriously? There’s recycle bins and trash cans all over the place at every stop. You can’t hold on to a lousy candy wrapper for long enough to throw it where it needs to go? And how about get a digital newspaper subscription? It’s 2015.

To the folks that bash the T: Yes, it’s infrastructure is antique and the technology is outdated. But they’re doing the best they can on a minuscule budget. If you think you can do better, I believe they’re hiring… Meantime, lobby your representative to vote for more funding to upgrade the transportation you ride every day.

To the guy spouting obscenities on his cell phone: You may be engaged in a personal conversation that is so emotionally charged as to justify your judicious use of F-bombs, but we do not need to hear it. Please keep that sh-t in your mouth. If you are unable to control yourself, either call your b-tch back later or get your motherf-ck-ng ass off the train.

If we all follow these simple guidelines for basic civility and decency, we can all enjoy a much more relaxing and even enjoyable commute to the hospital.

And try to smile, too!

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Honey, I’ll Be Late Home From The Office…

I work part-time, and I rarely miss our kids’ dinner and bath time. But Mondays are my afternoon clinic days, and not only am I usually leaving well after the afternoon rush hour, but my commute has been longer of late.

I’ve been walking to the closest trolley stop a mile away, instead of driving to the train station with the big parking lot. It takes me longer to walk to the little trolley, switch at the first station, and take the train in, but the walk is sooo lovely, it’s worth it. I enjoy the quiet time, and the scenery. There’s a big hill with a view of the city in the distance, and huge stately homes with neat landscaping, leading to our quaint town center and the antique trolley line…

This Monday I had a bit of a hectic afternoon, seeing my own patients while also covering prescription refills/ patient questions/ urgent results for my colleagues who are away. (It IS August…) But,  I was able to wrap it up by a little after six p.m., not bad! And I speed-walked to the train line across from the hospital.

As I entered the station, I saw that my train was just arriving. I swiped my card, burst through the gates, bolted for the stairs, took two at a time all the way to the top, weaved around the slow walkers, called to the conductor who was leaning out of his window (and I’m SURE he saw me), and I made it to the doors of the first car…. Just as they closed. I mean, these doors shut in my face.

This is why I usually don’t run for the train. It’s just so humiliating to make that very public physical effort, and miss it anyways. When I’m a passenger, I always feel a kind of entertained pity for the fool that tries to catch the train, and fails. You know when people do that and then they kind of pretend that they weren’t really trying that hard in the first place and don’t really care…

Well, everyone on the crowded train who saw me sprint in my black work dress and sandals got a good show as I yelled at the conductor:

“Really? Seriously? I’m right here.”

He just calmly slid closed his little window, and there went the train. 

Soooo. Anyhoo… I did the only thing I could do. I pulled out my phone and buried myself in my Pinterest feed, pretending I didn’t give a hoot.

I waited ten minutes for the next train. All went fine until the switch for the trolley. At the trolley, there were a number of attendants assisting a man in a wheelchair who needed to get onto the trolley. This involved setting up a folding lift and slowly, carefully raising it up so he could roll on. It was an impressive little engineering feat. It took some time. The poor man apologized profusely to everyone and anyone on the trolley. I was the only one who said, “It’s OK, sir! Don’t worry.” From the looks of my fellow commuters, I’m not sure they felt as obliging.

By the time I got to the fun part, my peaceful walk, it was almost eight o’clock and the mosquitoes were out in full force. I fairly trotted up the hill and down the hill and up our street and home…

The kids were fed and clean, and also jumping up and down on the living room furniture, yelling nonsense words and giggling hysterically. Hubby was understandably flustered. I herded them right upstairs and got full swing into bedtime. The kids eventually succumbed, but it took a looong time…

Hubby and I finally sat down to dinner together at nine-thirty p.m. He’d prepared it all earlier: Grilled garlic shrimp and baby peppers over arugula salad, with a homemade lemon- parmesan dressing, by the way. Go Hubby!

Honey, I’ll be late home from the office more often…

 

 

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Latest on MiM: When The Patient Brings Presents… Or Punishment

Me reflecting on an interesting week, and some common doctor/patient dilemmas, on the Mothers In Medicine group blog: When The Patient Brings Presents… Or Punishment

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I Saved My Kid’s Life…

But my poor choices put him at risk in the first place.

It was a gorgeous summer Saturday morning. I had originally planned to leave Babyboy with Hubby and take Babygirl with me to visit a friend and her new babies. But, Hubby had a number of broadcast assignments at the stadium, and he had to leave early.

So as I ran around the house doing laundry, preparing food, cleaning dishes, potty-cheering, dressing the kids, and cleaning kitty litter, I wondered what to do with the unexpectedly free morning:

We need groceries… It’s a beautiful day… I’d love some exercise… Hey! Let’s walk to the little grocery nearby! I’ll take the kids in the double stroller!

The kids were very good all morning: they used the potty, they ate breakfast, and they didn’t pummel each other. I felt good about taking them on a little outing.

The kids thought it was a great idea. We got our shoes on and headed out. I pulled the double baby jogger stroller out of the garage.

But Babyboy refused to get in it. “I’m not a baby anymore. I can ride my bike to the store,” he insisted, and he pulled his bike out.

Oh, goodness, I thought. I’m not sure.

I wavered. He’s just starting to ride. He’s very tentative. We have to remind him to look both ways to cross the street. He rides so, so slowly…

But then I thought… We have taken him on many rides around the block, and even to a playground that is actually much farther than the grocery store. And, he rides so, so slowly.

Babyboy put on his helmet. He was totally, completely, 100% determined to go no other way than on his bike.

I made the call. I kept thinking about how he’d ridden his bike all the way to that playground about a mile away, and he was fine…I said, “Okay!” and got out the single jogger stroller for Babygirl.

And we were fine, for almost the whole way. He rode slow. Painfully slow. He wanted to stop and examine every street sign, sewer cover, drain, cigarette butt… I realized it was going to take us forty-five minutes to go a quarter of a mile.

He was very good about stopping at every street crossing and looking both ways. He struggled with pushing his bike across the street, and managed to catch his legs on the pedals and get scratched a few times, but overall, it was uneventful…

Until we were almost there. We had to cross one more street, a busy one-way double-lane route. I wasn’t worried about it, because it’s a heavily used crosswalk with a traffic signal. All we had to do was press the cross button and wait.

Babyboy approached the crosswalk slowly, so slowly. I was a few feet behind him with the stroller. Babygirl asked me a question and I leaned down to listen.

Then, it was everything all at once; and yet also, in slow motion.

A car honked, tires screeched-  Holy shit

Babyboy was riding right into the crosswalk, into traffic. He wasn’t looking either way, only staring directly ahead at the grocery store across the street.

I screamed, “Stop, stop, stop!”, let go of the stroller and leapt and grabbed and pulled him by the back of his shirt, pulled him right off the back of his seat. The bike wobbled and toppled onto the road. Two lanes of traffic dead stopped.

Babygirl had kept rolling forward and hit a parked car, I didn’t see how hard. Her snacks were spilled, but she seemed okay, was calling for me and asking, “What happened? Mommy, what happened?”

Some people on the other side of the street trotted over. “Are you okay? That was really scary.”

Babyboy seemed stunned, but he was fine. I was…  just sick, sick to my stomach, with that mix of fear and adrenaline and shock and, more than anything, overwhelming mortification.

What the hell had I been thinking, letting my five-year-old kid ride his bike on these busy streets? 

“We’re fine, we’re fine, thanks, appreciated…” Somehow, I brushed Babyboy off, gathered the bike, the stroller, and, walking the bike now, we made it across the street. All the cars were still stopped, waiting.  The pedals caught Babyboy in the legs again as we walked, and he collapsed on the sidewalk, crying. I wasn’t too far from that, myself, but wanted to get the heck out of there. I hugged him and again, thought:

What the hell had I been thinking, letting my five-year-old kid ride his bike on these busy streets?

But, when he was cheerful again, we somehow made it into the grocery, and picked out a few key essentials for dinner. I let Babyboy choose the main course (swordfish and mussels, FYI, and he ate extra helpings of both later that evening!). I let both kids choose produce, in an effort to make the whole trip a happier one, and erase that ugly experience.

Of course, we weren’t going to try to ride back. We would leave the bike at the store and he would walk back if that’s what we had to do. But, I first called my mother, knowing that she’s rescued us from many a jam… And she rescued us from this one, too. She lives nearby, and she drove to the store in her SUV and got us. The kids were super-excited to see her. The change in plans was very interesting to them, and, probably, a huge relief as well. We crammed the stroller and the bike in the back, and she took us all home.

Thanks, mom!

I had originally been planning on taking the kids somewhere else more fun in the afternoon, but, I felt completely wiped out, depressed… morose, even. I kept re-living the whole thing. I felt edgy, nervous, irritable. I found myself snapping at the kids, and then giving them big spontaneous hugs. Crazy. I’m losing my shit. I finally texted Hubby to just get home. Just get home.

When he pulled up, the kids and I were in the backyard. I told him the story, and then just cried, cried and cried. We said a prayer of thanks…

And we’ll only be riding in empty parking lots and on paved trails for a long, long time.

 

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I Studied For The Internal Medicine Boards On The StairMaster- Blog post at NEJM Knowledge+

I’m very excited to have my first blog post up on the New England Journal of Medicine’s Knowledge+ Blog, titled I Studied For The Internal Medicine Boards On The StairMaster. True story!

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