Poison!

I had the interesting experience as a physician and father a few weeks ago of having those two competing interests at odds with each other. It caused me a significant amount of psychiatric grief, something I’m not much prone to.

It begins with me taking a 4 month old child to Maui. I wouldn’t normally chose to travel to such a far destination with my child, for one reason that’s how you get kids sick. My little Ruthie did end up with her first cold a few days after coming back. For another thing: children don’t care about time zones. Their body tells them when they should go to bed and when they should get up, we try to adjust that by “sleep training them” but time zones through things for loop.

So we took Ruth to Hawaii, it’s a 1.5 hour drive to Boise, a 1.5 hour flight to LA, then a 5-5.5 hour flight to Maui. Keep in mind that as recent has a month ago my daughter cried for upwards of 4 hours straight the last time we tried to drive longer then 30 minutes (1.5 hour drive to Hailey and then several hours of crying after trying to put her to bed). It seemed daunting. The start of the trip went off without a hitch.

The thing about Ruth is that she is a social-a-holic. She loves being out and seeing people, even at the expense usually of taking a nap. I’ve joked about it many times before that no one even believes we have a fussy baby. When she’s a church she’s a smiling angel, but the drive home will be continuous tears and then nap refusal and fussy afternoon because of being over tired. So flying on the plane, and transfer, airports was constant social stimulation for her longest stretch ever. We got to Maui 4:30 Maui time which is 8:30 PM here. She is now 2+ hours over her bed time. We loaded in the car over an hour later. We clicked her into the car seat and she cried for 45 minutes straight to the resort.

Now we come to the crux of the conflicting internal emotions. We had a plan in place to give the baby a tiny dose of Benadryl to sleep when we got to the resort the first night and hopefully help her “sleep in” and adjust time zones. The doctor in me has given that advice at times and knew it to be reasonable. The father of a doted upon, precious, darling, 4 month old little girl was crying out “Poison!!!”

Let’s look at this analytically. Benadryl is an allergy medication. It’s an anti-histamine. It’s not a sleeping medication, per se. It helps people sleep because the molecule diphenhydramine blocks histamine receptors and histamine receptors are involved in both allergy but also sleep. By blocking the H1 receptors in the skin and nose it reduces allergy, by blocking it in the brain it makes you tired. It also cross reacts with another category of receptors called the cholinergic receptors and medications that do that often make one drowsy also. It’s pretty safe from a medical perspective at the correct dosing. The side effect is “drowsiness” not “life threatening coma and death in infants”.

I rarely advise it to parents as a physician because over-dosing a child on it can be dangerous and there are deaths linked to doses much higher than appropriate (for example I found an article about a day care provider using 6x the dose I used on my 4 month old on a 3 month old and it dying). I rarely advise it because I can’t be there to assure that the parents understand concentrations and dosing of medications. For me it’s intuitive what 12.5 mg/5ml means and how much 5 ml is. My typical patient doesn’t even know what that sort of formula is or how to use it. I spend a lot of my day during cold and flu season explaining how to dose Tylenol (fortunately most parents UNDER dose that and their kids come to my office with a fever of a 102 on a half dose of anti-fever medication- so maybe it’s unfortunatly).

So again, the MD in me was pretty comfortable with our plan to give our baby one does of Benadryl. The father in me was shouting internally “Kids have died!” Keep in mind that this was only like 2 weeks after I really fell in love with my daughter on the walk from my last blog post. We went ahead with it, giving her a ½ teaspoon, she spit/coughed/gagged most of it out and we put her to bed. She woke up at 4 AM and I couldn’t help but think “maybe we should have given her a little more”….

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Published in: on October 30, 2010 at 2:47 pm  Leave a Comment  

Sustainable Love

This is a two part entry based around this picture.

Part 1 Sustainable Exercise

I have been reading a book called Blue Zones by Dan Buettner about the places in the world with the longest life spans and the factors that lead to the “hot spots” of centenarians. I haven’t finished the book yet, but the thing that the book has really impressed upon me is the importance of what I’m calling “sustainable exercise”. The two places I’ve read about in Blue Zones the people are forced by lifestyle, geography, work, etc to exercise at a moderate level….indefinitely. This is very different then how I have lived most of my life. There was a time when I lived on Capital Hill that I walked a lot and the period during medical school that I commuted by bicycle. That has not been the norm and most of my exercise in my life has really been “training” for races. I’ve been in very good shape at different times, late high school I was in excellent shape. About 2-3 years ago I was in excellent shape, racing bicycles and/or running races. The bicycle racing was not sustainable for me however- see my other post about that.

I’ve been running semi-regularly over the summer and was getting back up to 5 or so miles with my weight having come down some and my fitness returning. The problem being that I would feel sore during the early part of the week, tired from work during the later part of the week and got to the point where I only ended up running on the weekend. Three days of weekend warrior running was not a sustainable program. So as I’ve been reading this book I came up with this idea of trying to just make moderate sustainable exercise a regular part of the daily activity. For me this probably isn’t going to be running. Biking maybe. Swimming (if that was available to me) would probably work, but there is no pool during the winter available in Jerome for lap swimming. Driving to Twin for exercise during the winter doesn’t seem to fit the idea of “sustainable” to me. So Dorothy and I started walking in the mornings before work. It’s about 1.5 miles round trip on the gravel road which we did every day this week so far- it takes about 30 minutes for us. The picture above was taken on Tuesday. It’s nice and cool in the mornings, we enjoy each other’s company, the sun rise and the exercise. It has been great for all of us (see part 2 below). This “sustainable” exercise will be supplemented on the weekend by much longer walks, running and eventually hiking and backpacking again. I’ll very likely get a mountain bike which I think will be sustainable exercise. I’m not sure how well this will work come winter as the temperatures get very low, but we’ll see, layers may just make this sustainable despite very cold temperatures. Maybe they make baby balaclavas?

Part 2 Scales in the Favor of Love

The picture also marks a turning point in my feelings about and my relationship with my daughter. We (Dorothy and I) have had a rough transition to parenthood. Few have seen our difficult times because Ruth seems to be pretty well behaved in public, but as recently as 13 days ago she cried for 3 straight hours while we tried to get her to bed. I have loved my daughter because she’s my daughter but honestly the joy I got out of having a child was far exceeded by the pain, inconvenience, crying, etc. The scales were tipped until Tuesday this week to “I kinda wish I hadn’t had a child” or maybe “there’s no freaking way I’m doing this again”.

Then something changes Tuesday morning. We had such an amazing walk that I had Dorothy take a picture of us on my camera phone (the one above). She was so cute, talking through 3/4 of the walk, which is mostly “ahhhhhgrahhhhhahhhhgrahhh”. The talking was punctuated by her looking up at me and smiling and then going back to looking to the side (much as she looks in the picture) and talking. For the last 1/4 she cuddled up to my chest and fell asleep. On Tuesday I could not stop thinking about her at work. I kept looking at that picture and showing to everyone. I was counting down the minutes until I could get home and see her. I worked late and got home just about as Dorothy got her to sleep and for the first time in Ruth’s life I was disappointed she was asleep.

Why the sudden turn around? Part of it is that our daughter has now been napping for about 12 days. The difference in a child from three 5 minute naps in a day to two-three hour long naps during the day, is pretty remarkable. She has been less fussy, more fun, more interactive and easier to get to bed at night. All things that have improved the mental health of our household. The difference started when Dorothy stopped drinking coffee two weeks ago today. Over-night change.

Before when people asked “How’s little Ruthie?” or “do you love being a daddy?, I’d respond one of two ways 1) those that I thought could take it I told them the truth “being a father kind of blows” or 2) those that I didn’t think could take the truth I told them “she’s really growing” which is a true statement but not quite the whole truth.

Now I can really say “I love my little girl”. A deeper love then the “I’ve decided to love and support my child (see my feelings about love in my previous blog post “You Complete Me”) that I had before. This is a “I adore my baby” kind of love. Several sagely fathers a little further down the road had told me “Just survive the first four months and it gets better”. Her 4 month birthday is tomorrow….I guess I’ll know what my advice to fathers will be.

Published in: on October 1, 2010 at 12:26 am  Comments (2)  

Fatigue

I really learned about fatigue in residency. Residency is rough, 80 hour work weeks for much of the year. Stress. Trying to live a normal life. They make for a lot of fatigue. I found that after working for 30 hours straight I was actually better off staying awake through that next day and going to bed at basically a normal time. The times I did come home at 1-2 PM in the afternoon and got to sleep after being awake since 7 AM the day before I would inevitably wake up at 11 PM feeling terrible, have a bite to eat, go back to bed and wake up the next day feeling even worse. Better to feel moderately bad and tired all afternoon then that terrible feeling the next day. Not everyone did that, but it was what worked for me.

I raced bicycles through much of residency and the affects of fatigue were incredibly evident with that. There was a 4 week criterium series in Nampa at the parking lot at the convention center. That was on Wed nights and was tough for me to make it to because of trying to get out of work, etc. I did however make all 4 races my 3rd year of residency and 2 of the weeks I was relatively well rested and 2 of the weeks I was post-call. The two weeks I was rested I got top 5. The two weeks I was post-call I couldn’t even finish, I had to “sit up” meaning I didn’t have the strength to even stay in the main pack and draft off the leaders. Amazing difference.

I was starting to feel extreme fatigue earlier this week. I was on call this last week, which wasn’t terrible but I did get called a handful of times in the middle of night. Mix that in with a few diaper changes at 4 AM and a baby alarm clock at 6 AM and you start to feel tired. I had Monday off but a meeting at 6 PM, work Tuesday and another meeting Tuesday night. I hate meetings. By Tuesday with a full day of work and another meeting staring me in the face I was starting to melt down. Friday’s (today) schedule was light on Tuesday so I had “the girls” reschedule those appointments and I’m taking the day off. So today was going to be my big day of rest and I actually went to bed pretty early last night-10:30! Then diaper change at 5 AM and I’m wide awake. Six and a half hours of uninterrupted sleep isn’t terrible for me, I do ok with that, but 5:30 is still too early to be up.

I was partially thinking about a blog post that I’ve been working on for some time about some of the differences between men and women and as I was starting to type out the title of it my wife hands me our daughter (now 6 AM) and says “She’s awake”. We played for the last hour and now she’s asleep again (she almost rolled over again today= 10 weeks, wow!). Needless to say I’m feeling fatigued and have no energy to write about something heavy and insightful. Maybe tomorrow morning….

Published in: on August 13, 2010 at 1:22 pm  Leave a Comment  

Delayed Gratification

Being a doctor is almost certainly equal to being an expert on delayed gratification. You can’t do a minimum of 11 years of college, medical school and residency training for essentially no reward without a healthy sense of delayed gratification. So I guess I should rephrase that. During training to get where I am, one must have a healthy sense of delayed gratification.

I’m not sure how long that lasts once doctors actually get to the point where they are making the much awaited for salary. You often see them quickly get new cars, new houses, etc. I’ve always been a bit of a tight wad and not really into cars, so that sort of possession accumulation hasn’t been that much of an issue for me. Most specialist make 2-5 x what I make so maybe that’s who I’m thinking of. But I definitely feel my delayed gratification skills fading. For the first time in my life I usually have the money for what I want or need, which is a first. It makes you soft from a delayed gratification stand-point. Why this is relevant now is being a father (and really probably any parent for that matter) requires a healthy bit of delayed gratification. I mean, let’s face it, being the parent of a 2 month old is not exactly that “fun”.

There are moments of fun, my daughter is very social and alert about 1-1.5 hours per day. During that window she smiles at you, goos and coos, and it’s wonderful. Then that window closes and she will cry for an hour because she’s dying of tiredness but refuses to go to sleep. I would not trade my work for Dorothy’s work at this point. She spends much of her day calming, soothing and cooing to the baby when little Ruth not in the mood to do anything. So 23 hours a day the baby sleeps, feeds, cries and poops. Not exactly the “good life”. Dorothy actually does get some “fun” with some of the feedings and just watching her precious baby sleeping, but I’m not sure fathers are programmed that way.

My special “daddy bonding time” as designated by mommy is bath time. Bath time usually sounds somewhere between a siren going off and a hysterical hyena as my daughter bawls through the entire thing. Not exactly “fun”. I think my baby stinks a little bit because I find excuses to not give her a bath because 15 minutes of solid bawling is so un-fun for me. Being a parent requires a significant amount of patience. That’s not something I’ve usually been accused of having in abundance. When I try to get the baby asleep I frequently pass the baby off to Dorothy 5 minutes before she goes to sleep but at times I just don’t have that last 5 minutes in me. I also really think that the baby falls asleep for Dorothy better than me, though Doro doesn’t agree with that.

I’m looking forward to tea parties and taking my daughter out on errands when she can talk and tell me stories and play games. I’m looking forward to cuddling, playing basketball, looking at grasshoppers in the yard, playing catch, reading books, all that “fun” stuff. This part….is about patience and delayed gratification. I’ve been dusting off my delayed gratification but it’s tough, I thought I had put that behind me. Dorothy wants to do this how many more times?!?

Published in: on August 7, 2010 at 10:57 pm  Leave a Comment  

Proud

Ruth Hazel Kern is born! June 1st at 7:26 AM Dorothy gave birth to our beautiful baby girl. The picture below is from today. She is amazing, wonderful, and mysterious. I love her. I’m not going to blog about her. I’m going to blog about my wife: whom is amazing, wonderful and mysterious. I’ve heard the phrase “proud papa” before, I had always assumed that the phrase applied to the new child. For me however the pride is in my wife.

Pride or more specifically “to be proud” is a difficult concept for me. Two very different definitions of proud that I will elaborate on here (from dictionary.com):
1.
feeling pleasure or satisfaction over something regarded as highly honorable or creditable to oneself (often fol. by of, an infinitive, or a clause).
2.
having, proceeding from, or showing a high opinion of one’s own dignity, importance, or superiority.

Biblically the word “proud” is never used as a positive. In fact it’s almost always used to describe those upon whom God’s vengeance is due. Pride is the root of most sin. It is the sin I suffered mightily from before conversion. The definition in view here is the second, “opinion in one’s own dignity, importance, or superiority.” When one thinks of oneself as higher then God, we face judgment.

Biblically the closest I’ve found to the first definition of the English word “proud” is the word “pleased” as used in Matthew, Mark, and Luke to describe how God feels about Jesus (from Luke3:22, King James): “And the Holy Ghost descended in a bodily shape like a dove upon him, and a voice came from heaven, which said, Thou art my beloved Son; in thee I am well pleased.” Strong’s defines the word used there for “pleased” (εὐδοκέω in Greek) as “to think well of”. Though I suspect, just from the context, that this English definition might not quite capture the strength of how God feels about Jesus. I think this type of “pleased” is probably a type of righteous pride. It’s proud that wouldn’t be deserving of judgment because it’s really a type of love.

In the 10-15 minutes before the birth of Ruth Hazel when Dorothy was really suffering and starting in her words to “freak out”, she kept saying “I don’t know” over and over. I knew that birth was imminent that one or two big pushes would result in the birth of our daughter. The pain was very intense for Dorothy and I could barely help her because I was starting to cry so much. As our daughter finally broke through and was finally born I wept to the point of almost sobbing. Dorothy looked in amazement the pain already gone (at least temporarily until her doctor began to clean up her birth injuries) and kept saying “Oh my gosh” and then the baby was on her chest she kept saying “Hi honey, oh honey”. I continued to cry so much I could barely see her. Later I realized that feeling that brought the tears was joy, to a degree, but the overriding feeling bringing those tears was pride, the first definition, the εὐδοκέω, for my wife. She had suffered at times mightily for almost 8 hours and already loved our daughter and had forgotten the suffering just moments after the birth.

I can’t recall ever feeling that way about anyone or anything. I certainly have never had εὐδοκέω for anything I have done in my life. Of any of the many “major” graduations I’ve had, getting a first job, buying a first house, I’ve felt thankful and I’ve felt relieved, but never really felt type 1 proud. The closest I’ve probably come (at least to my sleep deprived memory) was when my mother finished her 3 day 60 mile walk at age 50. The crowd, a packed stadium actually, was roaring for all these (mostly) women and I knew how my mom would be feeling down on the field as she entered the stadium and I felt a lesser degree of the εὐδοκέω at that moment for her.

Now over two days out from delivery I’m still somewhat choked up at times with type 1 pride for my wife. Being sleep deprived for 3 straight days helps make me more emotional, for sure. Today I have love for my wife like I haven’t felt ever, because of this amazing sense of pride in her. The picture below I think is tied for or perhaps even the most beautiful picture I have of her, the other being 1-2 amazing pictures of her from our wedding day. Now along with that love and beauty I have in my wife I have the same for my daughter. I now have a real “family”, which is such an amazing feeling. I am the proud papa.

Published in: on June 3, 2010 at 10:34 pm  Leave a Comment  

Adulthood

Being on the precipice of being a father has made me somewhat introspective. Dorothy was backing up some photos this week and ran across pictures from my bike accident. Looking at those pictures got me to thinking about the 3 years since my crash, the 1.5 years since I rode my bike and the 15 pounds I have gained since then.

March 2007: the start of what would be my last bike racing season. I was in an early season race in Seattle. Driving rain, cold, suffering, that was the order of the day. This was the season that I was going to graduate into Category 3 to a higher level of racing, but also a safer level of racing. I trained hard over the winter leading up to this, spending 4 hours on my bike every weekend day often watching movies in my basement in Boise because it was just too cold on the ground. I had spent a lot of time working the hills and I was my lightest weight since high school. I was ready. Forty miles into the race I’m, in fact, optimally positioned and going into the last .5 mile I was in the top 6-10 and as the final sprint is where I excel I was probably looking at a top 5+ easily.
We are now in the full sprint 100 yards from the finish, out of the saddle, 35+ MPH. Then… the guy in front of me lays his bike down.

Needless to say, in those wet conditions, in full sprint I hit the deck. I had been in very mild “skid-out” type crashes or “into the bushes” type crashes before, but nothing like this. I broke my helmet, tore up my bike, destroyed a racing jersey, separated my left AC joint, contused my ribs, and had a terrible amount of road rash. The pictures (for the strong of stomach) are below which show that since changing into my jeans (1-2 hours before) I bled through them from the one wound you can’t see in the pictures (on my left hip).

Dorothy was standing about 10 feet away when the crash occurred. She heard me cursing the pain and the other rider. There were about 5 others that hit the dirt. One of the other guys ended up with surgery to repair a tendon in his hand which was lacerated by the gears of another rider’s bike. A few other guys I knew came over and wanted me to sit down because I must have looked a mess and they were worried I was more hurt then I thought I was. Which later it turned out I was. On the way home I called the sports medicine fellow in my residency and she offered to call in some pain medication. I initially refused but about 15 minutes later when the pain started I called her back and requested some.

That was the worst pain I’ve had in my life. Showering when I got home was awful, trying to clean road rash like that on such a wide spread area of my body was excruciating. The worst pain though was my shoulder and ribs that first night when I awoke in the night and needed to use the restroom. I almost couldn’t get out of bed from the pain. It faded quickly over several days and I ended up only using about 10 of the pain pills. The damage was done though, I was racing bikes within 2 weeks but I was never the same. I was scared. You can’t be scared when you race bikes because to do well in the sprint you have to be willing to take risks. I finished out that season and had a few good results, but never had the fearlessness I had previously had. I remember one race in particular that we hit the last half mile, I was in the front, I was feeling strong and when the sprint started I just sat up because I got too afraid.

So I quit bike racing after that, but not because of the fear. Because I was about to graduate from residency, thinking about having a baby with my new wife, and knew that if I had been the guy with the lacerated tendon I wouldn’t be able to work to the full extent of my profession and I would lose money.

I think that had I trained biking over the next winter I would have been fine, from a fear stand-point, that next year. But this was the first time that I was forced to really face my mortality and I had to make the adult decision that a broken arm and loss of income probably wasn’t going to be worth the pleasure I got out of riding bikes. This is, however, part of what being an adult is. Besides maybe marrying Dorothy or going to medical school this was probably one of the first really adult decisions I ever made. I sacrificed what I wanted for what I needed to do to take care of my family. I foresee, of course, similar decisions to be made in the near term as we begin to raise our daughter.

Published in: on May 29, 2010 at 6:50 pm  Leave a Comment  

Curiosity and Fear

We live on two acres. Approximately 1 acre is watered green grass, a tree line, an orchard and house. The other acre makes me think of the Prologue to book five of one of my favorite fiction series “The Dark Tower Series”.

Tian was blessed (though few farmers would have used such a word) with three patches: River Field, where his family had grown rice since time out of mind; Roadside Field, where ka-Jaffords had grown sharproot, pumpkin, and corn for those same long years and generations; and Son of a Bitch, a thankless tract which mostly grew rocks, blisters, and busted hopes.

-Wolves of Calla, Steven King

He goes on to describe the tract of land called Son of a Bitch in more detail in the book and it’s a thankless stretch of land that is actually dangerous to work because of the dangerous terrain. I have felt like that at times about the other acre of our property here. In this part of the lawn there’s no established watering system and it’s mostly cheat grass, goatheads (nasty plants which dry out and make terrible thorns) and rugged terrain pockmarked by field mice dens. Out of part of this patch of land I have scratched a garden that’s about 45×25 feet.

An interesting observation I have made during my work on this garden: I get a crowd. Almost any time I’m down there working on it I gather a large crowd of cows. The pictures below show me in the garden with a typical crowd and the second after I went up to the house to take a picture after gathering my biggest crowd of cows ever.

You can get a sense in the first picture how intensely they cows are interested in me. They show an amazing degree of curiosity that perhaps I’m not giving them credit, becuase it my mind I think of them being such passive, grass chewing domesticated animals.

The more fascinating thing for me is how similar in behavior they are to my cats actually. Our cats are intensively curious about our activities. Any little move or noise however and they bolt. It’s like for these animals, the cows and cats, fear and curiosity are intertwined. Which does make sense to me. If you are so interested in what I’m doing why do you run if I step toward you? A common thing in the garden is that I’ll be down on the ground pulling weeds and if I stand up, about half the cows run. Or I’ll be working the hoe with my back to the cows and if I turn toward them, they run again. Within a few minutes they usually come back to continue to stare in abject fascination.

It dawned on me however that we are not too dissimilar in our relationship with God. Almost all mankind feels the need to search for God. Almost everyone at a point in their life searches for meaning and relationship with God. Often however as we draw close and discover some bit of truth the consequences of that discovery make us run away. The curiosity and the fear intertwined. When we are confronted by our sin, and our helplessness to combat it without giving in to God, we often reject that because of our pride. I know I lived like that for quite some time.

For a time in my life I thought I was actually more moral then my friends and some of them were Christian. As I got more curious about Christianity I began to be afraid of the implication that my morals were not a ticket to any kind of heaven. There was only one “Way, the Truth, and the Life”. It wasn’t me. Scary stuff! The horror…..run! I kept finding myself come back though. The curiosity is to innate. Eventually the Truth was more than my fear could ward off.

Published in: on May 18, 2010 at 5:46 am  Comments (1)  

Fruit

I remembered this post idea I had awhile back after going to Rudy’s twice in a week. Rudy’s is the local cooking/wine shop and first we went the wine tasting “First Friday” even last friday and then cooking class this week. The class was taught by a fairly well known chef name John Ash. He knew Julia Childs (if you haven’t seen Julie and Julia yet go to netflix and move it to the top, best movie I’ve seen in awhile), had a show on the early Food Network, has award winning cook books, and a top restaurant in California and somehow teaching a class in Twin Falls to 30 Idahoins. We had a wonderful time and Rudy’s is a great place, good wine selection especially given our local, see more here: http://cooksparadise.com/

So anyway, being immersed in foodie/wine culture twice in a week made me remember the hazards of being a discriminating palate. Anyone that knows my mother knows that I was raised in a food/wine culture. A comment I made at the age of six or so was “My mother doesn’t cook she makes recipes”. Which at the time was basically an insult to my mother’s complicated cooking, but now as an adult the fact that the list of foods I don’t like is limited to like 2 things (which I can’t think of right now) speaks to the diversity of exposure in my youth. My mother can tell you about the time I ordered the $30 Pheasant (again probably age eight) meal at a restaurant because it said “half off any entree under age 12”. The margin on fresh caught pheasant is presumably fairly tight and the restaurant could not honor the previously stated arrangement for the pheasant. And no they had not every run into that problem before.

I also have a very good sense of smell. This delicate nose of mine can be quite a problem in my profession as we are frequently dealing with the smell of rotten butt abscesses or various other discharges of the nether regions which are unpleasant to the olfactory system of any person. With wine however it makes me quite astute as picking up subtleties that others perhaps don’t appreciate. I admit that my wife is somewhat better at brainstorming what she smells and we make a very good pair to taste wine. It’s the thing I miss the most about pre-pregnancy is drinking wine with my wife. The result of this wine enjoyment has been that I have built up a fairly impressive collection of expensive wine and I’ve tasted or drank some amazing wine as a result of this passion.

So I have a refined palate, broad food enjoyment potential and oenophelia. This however comes with it’s draw backs. The main drawback and the one that I’ll finish this small discussion is a degree of snootiness that borders on the wasteful or absurd. I originally thought of posting something about this when I found myself getting ready to throw away a piece of fruit at work. I don’t now remember the type of fruit, but the details were essentially this: the fruit was not spoiled, it did not taste bad, it was not bruised, it had no mold, is just simply was not very good. So I was going to throw it away.

I’m a little horrified at myself even now. I caught myself and finished eating the fruit as I should have in the first place. But the simple fact was that for a brief second I knew I had had better fruit before and I was not interested in finishing that piece of fruit despite being hungry and globally needing more fruit in the diet. This is my concern. It’s easy to do this with wine also. Have a few sips of less than delicious wine at a party and think “I’m not drinking freaking Merlot” (Sideways reference…if you haven’t seen that go and put that at #2 on Netflix), despite the fact that you are having fun at the party and the wine does not have poison in it.

It’s the rich stockbroker forgetting that they came from poverty and not associating with “common folk” anymore. Similar idea. In fact it was after that fruit incident that I decided I would use my wife’s pregnancy as an opportunity to revisit cheap wine (I went through a stretch where the average price of wine I was drinking was around $30!) and do what I did when I first really got into wine.

My wine turning point for me was an expensive bottle of wine ($60) I bought at the Co-op in Boise, which my mother still talks about to this day. I decided to splurge for my own birthday and on 5/26/2006 we drank a bottle of 2001 Elderton Shiraz, which had received like 96-98 points from one of the wine magazines. This wine was amazing, the quote of the night was “this is the best shiraz I have every had” –Susan Kern. I liked wine before that, but not like this. It totally changed my view on what was possible with taste. We had an amazing meal and it was after that that I really, really started getting into wine. I started buying about one good bottle per month to save away (which I’m still basically doing) and drinking a lot of cheaper wines to learn about the various tastes, sites, smells, etc. Overtime as I had more money available I stopped drinking as much of the cheap stuff. After the fruit incident and after my wife became pregnant however I have been going back to the $7.50-10 price range to re-hone my palate and prepare myself for enjoying wine again.

So it’s important to remember what not so good wine and not so good fruit tastes like so when the really amazing stuff comes along we appreciate it even more. I think this has broader applications in life, but I’ll leave it to you to decide on that since this post has already gotten pretty long…

Published in: on May 14, 2010 at 1:22 am  Leave a Comment  

A Tale of Two Disabilities

If it wasn’t clear to me that disability is a state of mind, it has become so over the last month. I have two patients with bad disease, but the wide difference between them has been weighing on me. Both are about the same age and both have what some might argue are self-inflicted disease.

One is applying for disability essentially because he is so obese that he cannot work. It is hard for him to get out of the house. We- the state tax payers- already pay for his medical bills because of his poverty. We sent him for evaluation for gastric bypass, but he was too heavy, needing to lose ~15 pounds to show that he was mentally ready for such a drastic change in his life. He has since gained weight and I have since filled out some paperwork related to his new disability claim. A lawyer out of Utah that specializes in “Bariatric Law” is helping him.

The second patient is a lifetime smoker. Until recently he has smoked upwards of 3 packs per day. He now has terrible lung disease at a premature age as a result. He has been in my office with an O2 saturation of 75%….having just come from work. This is a guy that continues to work despite the fact that he cannot wear his oxygen while at work. His lung disease is so bad that it is giving him heart failure. His 5 year survival rate is around 30%. All this guy wants to do is work. It would not take him a lawyer to get on disability; it would take quitting his job. That’s all, he already qualifies for disability, but he does not want to quit his job. We- the state tax payers- now pay his medical bills, but he previously was paying for office visits out of his own pockets and continuing to work. Last time I had him in the hospital he wanted to leave before I thought he was ready because he didn’t want to take any more time off work. This is not a bikini model sun tan lotion applier kind of a job. This is a factory job, on a line.

Self inflicted disease? Perhaps. Totally different world views? Clearly. The problem for me is the emotional reaction each of these patient’s evokes in me. I probably don’t really even need to spell it out, because I suspect most people would feel the same way. Many would be quick to point out that it is very hard to weigh over 400 pounds, the strain on his body and joints is immense and he probably really can’t work. Which is probably true, but the other patient is literally killing himself to work (wearing his oxygen all the time would basically help halt the heart damage and help him live longer and healthier).

Regardless of what anyone might feel about these patients, the obviously underlying message is that disability is a state of mind. Two patients with disease which results directly from a combination of addiction and bad genetics (not everyone that smokes gets lung disease and not everyone that over-eats gets to be 400 pounds), but one has whatever feature of personality that lets him continue to work and the other is perfectly content to let us pay for his 3500 calories per day just to maintain that weight lying in bed all day. Oops that sounded like judgementalism. I need a cigarette

Published in: on April 13, 2010 at 7:02 pm  Comments (5)  

The Drawbacks

I went out for beers last night with a buddy of mine who’s a physician in Twin Falls, the neighboring larger town with the referral hospital.  Doing that and the conversation that we had led me to think this morning about the two worst things about my job (for me in particular).  Number 1 is I often feel like I can’t drink alcohol.  Number 2 is managing chronic pain.  I’ll elaborate briefly though, these don’t require much more than that.

Not drinking alcohol. This isn’t that huge of a problem I guess.  I gave up my brief stint of drinking regularly to excess quite some time ago.  In the meantime however I do very much enjoy a hoppy beer or a glass of wine. I often feel like I’m limited in my ability to do that however because of the nature of my job.  Even last night I met my friend for a beer about 6 hours after finishing a C-section.  The patient’s doing fine, she didn’t need my attention, but the possibility of something going wrong still exists and after two beers I would then have to dump this problem on the doctor on-call.  More commonly I feel the weight of my next OB patient’s looming due day on my consciousness.  I think “She could go into labor anytime, I’d hate to miss her delivery just for a glass of beer.”  Which is both for the financial impact of missing a delivery, but that’s also my favorite part of the job.  So what I’ve been doing is if I have a patient coming due, I generally will only have a glass of wine on Friday nights which is the night that I turn my work phone off and sign out.  But “women coming due” can be a fairly long time period and if you have 2 within a month’s time, it at times doesn’t leave me much window.  At the end of the day, it’s not really about actually having the drink because I might not drink much more then I do anyway, but it’s about the lack of control over my time and my lifestyle.   If I weren’t a physician I’d probably have a small glass of wine every night for the health benefits.  I still collect wine and will continue to do so, I just have to pick my times to actually imbibe them. 

Number 2 is a huge problem in this country.  Upwards of 20% of people in this country have used prescription pain medications for “non-medical” reasons.  Upwards of 9.5% of 12th graders in this country reported using Vicodin without a prescription in the last year.  It has gotten to the point that it’s often hard to tell the real chronic pain patient that is responsible from those selling/abusing them.  The street value of narcotics (last I did research into this)  is around $1 per milligram of drug and it’s not uncommon for a pain patient to get in the neighborhood of 1800 mg per month!  That’s not even on the high end, that’s pretty typical.  So if your doctor ever seems reluctant to give you prescription pain medications, that’s why.  I have a policy of not writing narcotic pain prescriptions for new patients.  That cuts down on the drugs seekers quickly because word gets out.  Some doctors pass them out like candy, why come to me if there is someone else that the “pill popper” community knows will probably give you some, but I do still get a patient that comes in and first visit needs a refill of their $2000 street value of prescription pain pills.  That conversation often goes poorly.  It’s sucky.

Published in: on March 23, 2010 at 1:38 pm  Comments (1)