Atheists do Advent. Again.

Homeschooling is awesome.

Just had a fantastic curriculum-spanning conversation about anatomy, cubism, and map projections. Two dimensional representation of things is HARD. I have so much to learn about maps. And anatomy drawing. And both of the religions that permeate this house. They are all imperfect pieces of the truth.

But it got me to thinking about work, and home, and change and, well, Advent.

This time of waiting for God to bust everything open. The pleasant anticipation of cute, harmless babies. Everyone loves babies.

And any parent can tell you that the arrival of a baby changes everything.

It's been a while now since I've done any office family medicine. This year is all about the acute care. Same problems, different perspective. But I was thinking this morning about the number of times in a week that I ask people to do utterly ridiculous things.

Lose weight.
Quit smoking.
Stop drinking.
Exercise more.
Reduce stress.

Good and obvious things that few people disagree with in general. Healthy living is good. Like babies. (Aren't they cute!? Oughtn't they not stick their fingers in wall sockets!?)

And I suppose it is slightly less ridiculous/more possible to ask those enormous things in the context of a long-term relationship with someone who is coming to see me as a family doctor. And it *seems* less ridiculous to say these things at a moment of extreme change and upheaval - say, when someone learns they are pregnant, or right after a first major heart attack. But really, I am asking something no less bizarre/impossible than "leave everything behind and follow Jesus".

Who really has the ability to *do* that? What right have I to even suggest such a radical new direction for a life that isn't mine? To suggest that people upend their lives completely and go in a whole new direction?

The way that we eat and move is so deeply a part of who we are. It is really a re-imagining and a new start to a whole life to ask these things of people. I might throw in a comparison to "rebirth" here. Changing something so fundamental as food/activity/habits puts everything else at risk of changing too. Career, relationships, living situation - are all tied into the seemingly innocuous and unambiguously good plan to just "quit smoking" or "lose weight". Quitting smoking/losing weight is good! Like babies are good! And it can turn your life as inside out as having a baby come into it. (I mean, there are differences. obv. You can gain back the weight. Babies can't be returned)

And lots of folks avoid both clinics and the God people out of the belief that the only desire of medicine and religion is to control them/make them feel guilty about not doing "the thing". That we are bad people if we smoke instead of pray. And that prayer and teetotalling are inherently miserable and unpleasant. I wish I could erase that particular myth. Because religion is FUN. It feels good. And being able to move, and breathe, and sleep also feels good. Really, no guilt, mostly pleasure. Come play!

Yes, it really might mean quitting your job, selling your car and house in the suburbs, divorcing your wife and grabbing your own health and life by the short and curlies and making something entirely new and terrifying. Maybe it will be easier than people think, owing to the skills gained from a stable childhood, or the resilience that comes from having lived through war or immigration.... or, I suppose, harder, maybe even for the same reasons.

And you are going to die anyway, whether you do it or not. And you might get killed by a drunk driver as you are biking to work. Your diabetes/liver failure/lung cancer may still kill you. But between here, and death, you have just one chance to be really alive. Why not take it? Why not inhabit this temporary body fully? Why not live well in this body, within loving relationships, in a community that grows goodness? In God's world? It's kinda awesome. It's not perfect, but it's its own reward really.*

And I know I don't know much. Not about medicine, and certainly not about religion (though considering how much of both I do around here, I really wish sometimes that I weren't so much of a generalist).

So, I turn things upside down, and see what falls out. I will invite more love and more children (and more religion) into my life. I will wait and see what surprises are in store. And I will continue to invite others to turn away from suffering and towards hope. As ridiculous as it is to think that a baby could change the world. Or that a 55 year old diabetic hypertensive smoker might lose 50 lbs. But I will just choose to act as if it's possible.



* I remain suspicious of doctors who jog. I tend to trust fat doctors who smoke. And other atheists. Because I'm contrary like that.

on being bi

Posts that have been fermenting for a while...

News:
1. not dead
2. Still a resident
3. The kids are still cute.




Last fall, I was back in my former large city, ingratiating myself with the powers that be at the job I really wanted the mostest, and trying to psych myself into writing an application for said job.

It felt so good to be back in the town I had spent most of my adult life, in the hospital where I had done so much of my medical training, surrounded by so much that was nostalgic and familiar. Eating the food I liked, bought from local fruiteries and restaurants. Prescribing the drugs that made intuitive sense (Medical culture being just slightly different everywhere, that "obvious" cocktail of Vanco/Timentin or Haldol/Ativan/Benedryl being a "rather unusual choice" somewhere else) and all the while missing my family like crazy.

I have never been good at getting myself to just sit and write. So I took a break from the Grad Skool Appliance process to go get some coffee. I wanted just a big, crappy cup of coffee with enough caffeine that I could then muster the necessary butt-to-chair for writing. (Say whatever you like here about stimulants and ER docs and their/our attendant neurology. I have found. my. people. That is all)

Seeking caffeine, I stepped out into the most vibrant and diverse and familiar neighbourhood in the city of my 20's .... And couldn't find a Tim Horton's anywhere. Lovely little cafe's, all the fanciest espresso drinks and beautiful terraces on which to sip them. Old Italian men watching sports, legions of hipsters behind their macbooks, trendy young parents enjoying the last few months of freedom chatting while breastfeeding their infants. But I just needed a coffee. Preferably cheap. And there was none.



Now I am as annoyed by people (including myself at times) who travel and then eat at McDonald's as the next person. But it wasn't so much homesickness as the sudden feeling of being un-homed. I realized that home was 2 places. That I was both from that lovely and exotic and sophisticated city where I lived for nearly a decade, as well as being from this very much smaller, far less fashionable, uncomfortably WASP, college town where I have grown deep roots in just 3 years. And in that moment, I felt like I was neither. Neither really from here nor really from there. Neither place fit. I didn't fit.

And I was reminded again, that being bi means just that. Both, and neither. Not an identity unto itself usually, but belonging in two places, and not in any. And I was reminded again of how very uncomfortable that can be. How difficult it is to contain multiple selves, how the desire to belong is so strong at times that it is easier to deny a part of ourselves than to continue to be outsiders.

There are good parts too of course. No one doubts the utility of being bilingual, the added perspectives of those are bicultural, the possibilities for relationship and family that emerge from bisexuality, the uniqueness and nuance that are necessary when we are our full and complex selves.

But it isn't always easy, and once I am two (or more) things I can never go back to a simple belonging. Of knowing my place with confidence.




And I am both proud and worried about raising my children in this space between spaces. In my world, my home, my family - where the rules and mutability of gender, sexuality, and religion give them more places to be bi- than to just belong.



I got the job, and now I have to pack up and move.
Again.
So, in a few months, we will all go to the city. Changed forever by the time in this small town, and not at all as the family who left. Our family is larger, messier, older, richer and deeper. For most of us, it will be a "going to" and not at all a "going back."

I try to put the focus on the awesomeness of being both, many, or any. I try to build belonging everywhere. And I am working on celebrating more, giving more things names, marking more occasions. And loving as hard as I can.

We will have our own coffee pot too, and I can look forward to leaving the house each day with the largest cup of coffee that I can carry into the world, caffeinated for whatever may come.

weeping in the courtyard

I hope to hell that this is the last thing I will ever write about love and commitment. The very idea makes me squirmy. So I will phrase it as advice. If you care about someone enough to visit them in hospital, and the doctor asks who you are, have a bloody answer. Even if it's not exactly right.

Acceptable answers could include:

I am her: boyfriend, ex-husband, roommate, partner, lover, friend, boss, drinking buddy, teammate, colleague, dog-walker, parole officer. . .

But take just 2 seconds to give that relationship a name. Names make things real. People deserve names, and relationships are all we really have. I know that one word is not enough to describe everything between you. I don't need to know all that is. Lie to me if you need to. But suck it up, and put that person and that relationship ahead of your desire to be liked/respected/understood by a total stranger.

"Her. . . I, uh, live with her. . . Her common-law . . . whatever, I guess".

I am so so sorry lonely woman. Lonely woman who is so sick and so pleasant and young enough to die. And probably will die soon. You deserve to be loved better. Your "whatever" is a lousy jerk, and he is letting you down yet again.

And that shit makes me cry.

weird nights

Back in the emergency department. love it there.

I had to visit the ER for myself yesterday. It was the first time I've ever pulled rank in a medical encounter. I am well conditioned to wait in line-ups. But I was sick and needed to get better before I could go back to working. And I made it in and out of the department (including seeing a medical student and having the staff look things up on the internet) within 20 minutes. Efficient. Maybe that will go a way toward making hospitals here look better. (You can look up the average wait times around these parts here ) which you might note are currently abysmal.

Night shifts are my favourite. Last night's moment of good clinical judgment: (mind the exclusion of the many many things I certainly missed). A girl came in with a complaint of something that sounded vaguely muscular. On a hunch, I discovered a mummified object in her nether regions. I wish I could share more of the story, but the leap from "my muscle hurts" to "can I have some forceps please?" really was as unlikely as it sounds.

As much as "I know my own body" makes me want to roll my eyes sometimes, I am equally amazed by the capacity of folks to engage in serious denial and utter cluelessness about their physical state.

I realize that I am leaving out a whole lot of context here, but the interaction got me to thinking about a mentor of mine in medical school. (The same woman who hugged my head and spoke on this panel). I ran into her at a conference a while ago, and she had some brilliant things to say about borderline patients:

"So much of the challenge of interacting with borderlines is about power and powerlessness. Their history is about people taking away their power. Interactions with these patients are about them determining if you are just another person going to take their power away, or if you are going to let them keep it and use it themselves. At the same time, they are unsure if they are worthy or capable of handling their own power, and they try to set it out for you to take it".

"Life is chaos, and cutting is concrete".

I am hopelessly broken, and there is no way out. Will you rescue me?

Which, secretly, is a big reason I love the emergency department. I do love the excitement of emergent stuff, the procedures, dealing efficiently with simple problems, and shuffling the long and complicated off to medicine. But I also love the people who use the emergency department as their way of handing crisis. Who can't really manage to keep things under control and deal with problems during business hours, the drug-seekers, and the chronically suicidal. There is something raw and compelling and honest about people in crisis. Sometimes, especially compelling when crisis seems to follow them everywhere. I can't bear that level of suffering in my own life, it's too difficult to meet directly even in an office practice, and it was so, so draining as a therapist. But in the emergency department, when I know that I will walk away in a few hours, I can find compassion. Even though I know it is never enough, never good enough, and won't change anything in the long run. But truthfully, NOTHING in the emergency department is going to change things in the long run.

Time is also the privilege of being a resident, I know that if departmental "flow" and actual sick people become part of my responsibilities, I won't have time to spend with people whose problems have more to do with bad things that happened years ago, and very little to do with whatever brought them to the hospital at 2am. . .

In any case, my creepy "find" garnered me a bit of good will from the nurses, which made for an infinitely more pleasant night.

Vegetarian dilemma

I'm taking a little class for a couple of days. Yay! I like school. I love multiple choice tests. And it sort of counts as working. 'cept there are no real people with sad stories.

Refreshing.

It's a class that teaches the things I think I may need to know, but won't have time to read about and figure out on my own when the time comes that I need to know them.

I.e. if I need to know about antibiotic doses, I can turn to my trusty small machine or any number of books or another doctor and figure them out. Same for pretty much everything else. Except in dire emergencies, people can wait a few minutes or days until their doctor is sure about something.

But for those dire emergencies, I figured I should take the class *before* I need to know it. So, I'm getting up early to learn how to put in emergency airways and chest tubes, and to diagnose the things that kill quickly.

I am not alone in my belief that these skills really ought to be learned by trying them out. The first time I tried to put in a chest tube as a medical student, I didn't push nearly hard enough, and didn't get it past the ribs. That really sucked for the person whose chest I was poking at, who then needed more poking by the resident.

The idea of this class is to try it out a few times, so that when I need to do this on another real person, I'll get it right on the first try.

But how to practice? This course has traditionally offered pigs, or rescued dogs as test subjects. The animals are anaesthetised, and theoretically feel no pain. Certainly less than that poor old lady with the collapsed lung who was the test subject for my first crack at this skill.

The course, as offered in this town to about 15 MDs/year, would use 4 pigs (or dogs). At the end of the day, the animals would be "put down".

Now, I eat no bacon. And was a little squicked out about the pork part of the day. But lots of people do eat lots of bacon. I have personally met several people who tried the At.kin's diet at some point. I also know that pork sales were pretty depressed in this part of the world this year, and that several thousand pigs needed to be destroyed.

I also know that being able to put in a chest tube will make me a more useful person. It will certainly save someone else from unnecessary pain and possibly death/disability.

(I have also mellowed/sold out enormously since I was 16, and feel only the slightest twinge of guilt for planning to practice exclusively downstream medicine btw, so take this as you will)

I was perfectly willing to drink coffee, don gloves, and swallow hard to get through the pork product part of the day.

And I will admit that I was also *quite* relieved to find that the day was going to be entirely plastic people.

That is, until I heard the story of how that came to be.

See, there is only one company that makes plastic bodybits that are certified realistic enough to teach this course to doctors. They sell their product to make money. And they cost a LOT of money. They also have lots of expensive disposable plastic bits. They are close, but not quite like the real thing. They are closer to people than pigs in some ways, and not as close in others. And did I mention that they cost a LOT of money?

The thing that I have a hard time with, is the manner in which these bodybits are marketed. Although it is apparently perfectly legal, the company collects the name of institutions and physicians who are teaching the course, the dates of the course, and provides them to activist groups. They rely on the earnest altruism and free time of idealistic undergraduates and other concerned community members to pressure the doctors and institutions to stop using live animals for the class. Pressuring the program to buy the only plastic bodybits approved for use -- from themselves.

Which has the other side effect of raising the future cost of the class, which will make it expensive enough that my residency program will no longer cover the fee. Leaving future trainees to either suck up the (substantial) cost of the class, or graduate from training without having learned these skills.

Sketchy.

I'm not sure if I feel even dirtier than I would had I been covered in pig grease at this juncture. yuck.

(also, for the record, I did have to pierce chicken legs this afternoon, so in some ways, I feel like I got the worst of both worlds)

playing doctor

I went back to work, and the baby turned 1. I have nothing intelligent to say about work yet. Addictions are still popular. So is unprotected sex. Anxiety is annoying (especially to the people who feel stuck with it) and annoyingly common. I should never knowingly face Trichomoniasis before coffee. Same rule for toenail excisions. The nicest people seem to have the shittiest outcomes. And I forsee very little sleep in the next few years.

But my kids are still cute!

maybe we *should* get a puppy. . .

If you're looking for analysis, all you're going to find here is news, so feel free to come back when I have more available brain space.

I can't believe it's almost been a full year since the spawnlet! I have to go back to work. Gulp. I really hope that my new knowledge of prehistoric life (courtesy of the spawn) will sufficiently distract people from my utter cluelessness about medicine. Maintenance fluids? antibiotic dosages? crappy crap crap. 13 days left of my leave. I think I'm ready to leave the kiddies, and excited to get back to work that I like. I also know I'm going to miss them, and all the other folk I've managed to re/connect with over this year.

Fortunately, it looks like all I will be doing for the first month at least is dealing with influenza-like-illness and doling out vaccines against same, so my gaping knowledge gaps will be somewhat disguised.

Also: We bought a new house. Kind of on impulse. We got our water tested for lead in the place where we are currently living, and it came back very high. Also, the window sills are chipping paint. We haven't gotten the kids tested, and I'm not sure we're going to. I would hate to see a high Pb result that we can do nothing about except note in an IEP somewhere. And since the house we're in is too small anyway, we decided to just get out now. Before I go back to work. We're moving in three weeks.

The kitchen in the new place may make the hassle of moving worth it.



LittleE is unenthusiastic about change, and moving in particular. We told him our plan, and he requested that we not talk about moving again. I don't know whether that counts as denial or as suppression, but I figure it's a fair coping strategy for a 4 year old in any case. MamaM is in Winnipeg for 2 weeks, and I'm about to abandon him to kind friends (who he doesn't know very well) while I go away to a conference. He has enough to deal with at this point, so we're just going to deal with the whole relocation dilemma when we're all back in town.

And this came out. I wish I had enough available brain cells to do a decent review of the book. It was a pretty intense read. queer queer queer. I also found it sweet to find, if you plot the curve selectively, we can find our family in a kind of normal. I certainly suggest that if you're going to read it, read the whole book. I loved that there were so many pieces from queerspawn, from donors, and from unexpected perspectives. I wonder what the kids will think of it in 10 years. . .