The Adventures of Aidan and Zoe

Tuesday, April 29, 2008

Why? How?

Some friends frequently ask me, why do I blog? How do I find time to blog?

Well, these evenings, Hubby and I sit together at our computer table, and while he works on various photo projects, I check my e mail, I blog, I woot. As we sit together, it almost is like how we used to study together as undergrads- I got lots of studying done, but Hubby said he almost always never got anything done. Supposedly, he was too distracted by me. I can't wait to go back to campus, to go back to the places where we sat and talked more than 10 years ago. It will be even more fun, when A&Z are adolescents and looking at colleges, to go back and tell them our stories, and possibly send our life savings to The Claremont Colleges. Hubby says that he doesn't want Aidan to go to Harvey Mudd College, that it would be mean to wish that upon his own flesh and blood. I, on the other hand, would be thrilled if Zoe chooses to go to Scripps, or Mudd. (Aidan can't go to Scripps, since it is an all-women institution.)

Anyway, as I blog, I also read other people's blogs. There is something about reading other people's stories, especially people I don't know. For some reason, I have been drawn to people with dramatic, traumatic, experiences. For instance, this blog is about a family who adopted a little girl from China, and found that this little girl had a little friend, who also needed to be adopted, and so they are trying to adopt the little boy too. (Except I can't find the link at the moment.) Or this blog, where the mom nearly died giving birth to triplets. Or their friend, whose daughter was born with a chromosome deletion and thus, severe disabilities. Or their cousin's story. Or the latest find, a family who lost their newborn, also due to congenital malformations.

It is hard to read these. It is also hard to read the stories of my patients' lives- essentially, each time I see a new patient, I prepare myself to hear about molestations, neglect, physical abuse. One can't help but to develop some thick skin, just to preserve one's own identity without being completely projected onto. I suppose, that is what I learned as a resident.

As for the patient I saw in the parking lot, at least he was calm. I will see him in the parking lot indefinitely, until he gains some insight. Meanwhile, this patient also comes with his own dramatic/traumatic story...

Even though these stories are hard to hear, these patients hard to treat, I can't stop myself- they are so interesting, and so I will keep being their doctor, and I will keep stalking random people.

Then sometimes, when I am trying to not post anything, I end up being a model for Hubby's post.

Tuesday, April 29, 2008

Just Thoughts

I am leaving clinic for about 10 days, return for a normal week, then away again for three weeks- and as I am trying to tie up the loose ends, my schedule is FULL. Theoretically. As if my patients know I need a break, or acting out that they are upset with my absence, or something, (I have been telling all my patients that I will be out a lot in May, and not to expect the usual policy of messages being returned within 24 hours) my patients are canceling on me. It is not good, since my next available appointment for them will be in June. But alas, they will be fine.

What is not fine, however, is this particular patient. This person has not been returning to see me, since he found my professional opinions utterly unhelpful. Unfortunately for him, he has not found any of his doctors to be helpful. That is an awful place to be in- not finding ANY doctor who understands your plight. Anyway, since he has not been in 'compliance' with treatment, I no longer refill his medications. He knows the 'rule': No face-to-face meeting, no meds. This guy has been visiting the ER, his other doctors, anyone will do now, for these meds. Unfortunately for him, since I work in an institution, nearly all these options have been turned off. He has been escalating, but the clinic and I are firm with our boundaries. Theoretically, he will return today, and because he has already been hostile and uncooperative with his previous encounters, I will now see him in the PARKING LOT. To be seen in my office is apparently a privilege, that he will have to earn back.

Thankfully, my private practice patients are all very nice, and they are all earned their privilege of being seen in the office.

Meanwhile, my home life is buzzing- we are going to my college reunion this weekend. 10 years. Wow. It feels like I just graduated last week. But alas, my life is definitely no longer of an undergrad.

We are flying this time, instead of driving, and so we must pack judiciously. Hubby must be somewhat concerned about this, since he is opting to not take his SLR, instead, to take my 'point and shoot' and truly practice his basic skills at Disneyland. I graciously offered to him, that he can follow us everywhere and just take pictures, in the sun, in the shade, while we run, while we cry, whatever, for practice. My plan, he doesn't quite know it yet, is for him to be a wedding photographer! HA! My plan is that when A&Z are older, he will quit his day job, and do more photography, and one can't really make a living unless one contracts with an agency and/or do wedding photography. So he needs practice. Also, my sister knows someone who makes a living as a wedding photographer, and I think Hubby's work is on par. So when we move to NYC, Hubby is moving there as a photographer. I will remain a psychiatrist. So I must be have my board certification, so I should go and review something, anything...

Sunday, April 27, 2008

What To Do?

Aidan is having trouble sleeping- he just stays in bed (I know I should count my lucky stars) and keeps his cute little eyes open, for a very LONG time. We think it is time to give up naps. And, he needs more physical activities.

So I check on-line and enroll him for our city's AYSO. However, it is with some caution that I sign him up for this- soccer players can have brain damage, from all the bumping with one's head. Seriously, this is a concern! They (some scientists) have found that pro soccer players have signs of dementia, with early onset. Hubby assures me that Aidan will not be taught to use his head at the age of 4. We will see.

Also, since his age group will have 20 minute "practice" followed by a 20 minute "game" on Saturday mornings, choosing to play soccer means that he will not be enrolling in Chinese school. I can't believe 4 year olds have to consider opportunity costs!

I don't feel too badly though, since a colleague of mine, a child psychiatrist reassured me earlier this week that age 5 would still be great to start Chinese school. And therefore, I have found myself sometime to figure this out. Meanwhile, in my discussions with Hubby, it is now clear that Hubby is way more invested in our children being able to speak Mandarin than I am.

Therefore, I search for Chinese school options, for instance, after Aidan finishes kindergarten, that he would be transported to Chinese school, everyday of the work week. That would be a lot of instructions.

But I would still need to find time for him to take piano lessons. And swim lessons. And tae kwon do lessons.

That will be a WHOLE LOT of lessons! He will also be practicing piano, hours a day, obviously. No wonder kids are so tired. My mother once had a piano student who would fall asleep DURING his lessons. So much so that his lessons got switched to the morning, at 7 am, before he went to school. No kidding.

Lucky for Aidan, I am too scared about not passing boards to start the madness. However, this summer, he WILL be swimming, wearing a black belt, composing, using an abacus, and I suppose, it is a good thing that he doesn't need so much sleep anymore, because he won't have time to sleep!

Saturday, April 26, 2008

• Debating

  I have this eternal debate within me. I want my toes to be ready for sandals, to be cutely shaped, polished, and shiny. I want my heels to be smooth, callous free. But I can't make myself go get a pedicure. In my long/short life, depending on how you look at it, I have only had 2 manicures (on my wedding day and when I got my first paycheck as an attending). And 1 pedicure- when I got paid like a real doctor, there was no time the day before my wedding to get a pedicure.
  
  What is stopping me today?
  
  Well, it is, or it feels really extravagant to have someone rub my feet, and in some ways, whatever amount I pay seems too little for what the lady has to do, yet the money also seems like a lot of greenback when I think how many gallons of organic whole milk I could purchase with it.
  
  Then, there is the infectious process. I don't need onychomycosis, because then I would need a 6 month treatment with Lamisil, and I would probably get liver failure. I don't need a staph infection, or flesh eating bacteria, because I really like my limbs. I was going to show an illustration of onychomycosis, but after my pilonidal cyst picture, and the outcry, I will stop myself now.
  
  I am still debating getting my toes done, and let's not even get started about eye brow shaping, or other kinds of hair removal services...
  

  
  

• Genetically Programmed?

  I don't know why, but when Aidan heard the theme from Star Wars, he picked up a rolled up piece of paper, and started to wave it... Must be on the Y chromosome or something... Also, notice his landing craft on the floor.
  
  

Friday, April 25, 2008

Friday Dinners

I have resigned to the fact that our Friday dinners will have to consist of take out for a while. After a full day of seeing patients, getting A&Z at 5:10, fighting traffic, I just want to open up some boxes. We have a trusty Chinese take out place, that Hubby can swing by, get dinner, and meet us at home by 5:45. The ladies at this place are so friendly, and chatty, that whenever I go in, they ask me about how A&Z are doing. BTW, these ladies were among the few that thought Z would be a girl. As much as I like them, sometimes, one just needs variety. My new Friday routine to procure dinner begins at noon, when I take my lunch break by taking a long walk, down the hill to a lovely Japanese (read...pricey) and pick up some sushi, gyoza, and a few other things. I lug all these back and stick them in the cooler already in my trunk. I buy some frozen edamame to keep it all cool. That way, I don't have to put these delicious things in the fridge at work- besides, one doesn't really want to refrigerate sushi- really cold sushi rice isn't very tasty.

On this walk, I have roses to smell, houses to look at, (mainly, how much water does it take to keep a lawn in California?) I also pass by a Jesuit all-boys high school. Hubby almost attended this high school, but when he took an algebra class there as an 8th-grader, he wasn't impressed, and ultimately chose to take bus to go to school in SF. Sometimes, the windows are open, and as I walk by, I can almost hear these young men getting instructed. I can't help but wonder, what will Aidan be like as a high schooler? I hope he will be considerate, sweet, empathetic, and most of all, happy and satisfied in Christ. Speaking of this boy, I should go and tuck him in bed.

Thursday, April 24, 2008

What We Are Up To?

Aidan was introduced to Star Wars, Indiana Jones, (all via youtube.com) and all that stuff when my bro was in town. Is 4 too young to get into Star Wars? Or a better question, do I want Aidan to get into these things?

Meanwhile, he thinks these are so funny. Check out this Star Wars clip. He has already built some kind of landing craft. Then, he asks for Star Wars music. We are now the proud owners of our own Star Wars theme via iTunes. He also finds this Harry Potter clip hilarious. And of course, can't leave Indiana Jones out!

BTW, he ate some kidney the other night. I didn't make this dish, and I actually wouldn't eat a filtration type organ, but he really liked it. I should introduce him to pig's ear, tripe, liver, pate...

Zoe is now signing more, getting cuter everyday, and super sweet. When I pick her up, she will pat me on my back, as if to say, "Thanks Ma! You the best!" She eats a lot some days, and barely anything the next. For instance, she ate TWO bananas this morning.

Hubby is trying to stay on top of his day job work, and his side job work.

I am trying to study, just about 1 month left!!!

Wednesday, April 23, 2008

To Live with Me...

Aidan and I went out to dinner with my parents, and my mom's siblings. Aidan was an excellent eater- we were at a Shanghainese restaurant, and he ate eel, drunk chicken, crab, XLB, whatever was on the table, he ate it. Dinner ended really late, and we had to go before it actually ended. So we said good-bye to my parents, and they flew home this morning.

I tossed and turned for a long time last night, wondering, what is it like to live with me?

Academically, I know how family dynamics work. Professionally, I work with difficult families. Along with this, I thought about how my siblings relate to one another, and that led to the BIG question. What is it like for my family to live with me, a psychiatrist?

It is true, I make interpretations of things people do. The implications. The unconscious thoughts. And similarly, I do the same for my poor parents and siblings. Unfortunately, to be me in the moment, doesn't allow time for 'helping' them to gain such insights. I would just come right out and say it. So my family 'gets' my professional opinion, but not delivered in the professional manner. Therefore, socks left on the floor no longer are just socks on the floor. They become symbolic of something, usually nothing good. To keep me waiting, again, means nothing good. Although, I also point out altruism, sublimation, and all those other mature defenses to Hubby, or whoever else would want to listen.

Thankfully, God is gracious. Hubby is excellent suited to be married to me. He has certainly absorbed my interpretations of common disagreements, and I think, we are in a good place.

When A&Z are adolescents, they are in for a treat! I will be pointing out resistance, splitting, and all those typical teenage tactics...

Tuesday, April 22, 2008

A Pause

We attended my grandmother's funeral today. It was a time for all of us to a pause, to remember her, and to be reminded that our days are numbered. Very somber, I know.

I learned quite a few interesting things about my family this past week. For instance, my parents are very, VERY, practical people. My sister is incredibly helpful, honest, and fun- seriously, Haas and Stanford are both excellent business schools. My brother is very generous, and an incredible playmate for Aidan- it is so fun to listen to them play, they sound like an old couple, bickering over which Lego piece would go where. Like I have written previously, they are both dating, and so happy too. We pray/hope that these are THE ones, and that they will marry, make babies, and more babies. Then, I will be justified in all my incessant opinion: "Being a parent is the HARDEST thing, EVER."

Of course, I also learned more about my grandmother and extended family. As families go, I think my mother's family is complicated, and seeing all of her six (SIX!) children together, certainly validates my affirmation to not have six kids. I remember the last time the six of them were all together- I was about 4 years old...

Speaking of being a 4 year old- that was how old I was when I was left home alone for the first time. FOUR. We talked about it tonight, both my bro and I remember it so clearly. He was really ill with a high fever, and possibly febrile seizures, and needed IV fluids. One of the parents was with him at the pediatrics clinic in our neighborhood. The other parent had to go to church for something (like I said, VERY practical people,) so I was left home alone. FOUR years old. That would be leaving Aidan in his current state, at home. Apparently, according to my bro, he had been in charge of me plenty of times before that- and he was six years old.

When I was in college, I used to baby-sit for this family, and their boys were 10 and 12.

Parenting sure has changed, or at least, parenting in Taiwan is very different than parenting in the US.

My bro and I got into plenty of mischief when we were left home alone. He once decided to try to find out what would happen to some rubbing alcohol if he shot it through the flame of a candle. We lit the candle, filled a syringe (why did we even have a syringe?!) with rubbing alcohol, and took aim. The result? A hole in the screen door. We were BUSTED.

Another time, we decided to fill up those big soda bottles, poke holes in the caps, and shoot water at each other. We used water for a while, then that got DULL. We proceeded to fill it with a special concoction. A concoction that shouldn't be mentioned on a blog...

He used to be quite curious about these ants, until, these ants attacked him, and we had to take him to the doctor because well, the ants attacked an important part of his anatomy... All this happened before my sister was born, so we were younger than 9 and 7.

Good times, good times.

It was so good to see my family. As sad as it was to say good-bye to Wi-Pao, it was good to be with my family.

Saturday, April 12, 2008

No More for Me

Today marks the end of an era. I no longer have grandparents.

My grandmother died suddenly this morning at 6:12.

As I have written previously, my maternal grandfather died 13 years ago, my paternal grandfather died 9 years ago, my paternal grandmother died this past March, and with the loss of my maternal grandmother, I am all out of grandparents.

My Wi-Pao had been very special to me. When I was about 1 and a half, my mother entrusted me to her during the week. Partly because my mom couldn't find reliable care for me, and partly, because I loved my grandmother so much. I had parental visits on the weekends, and during the week, it was just me, and my grandparents. According to Wi-Pao, I spoke in complete sentences shortly after I turned one, and I used chopsticks. Clearly, someone was quite biased. After my parents purchased a home a block away from them when I was about 3 years old, my sibs and I continued to hang out with my grandparents everyday- we would go to their house after school, until my mother could pick us up, and she used to chat with them, FOR A VERY LONG TIME.

Wi-Pao taught me how to read Chinese prior to starting elementary school, and she was a huge part in my developement. I think, in retrospect, by being with them so much, I matured quickly, and thus, I was a precocious child, and continue to be 'an old lady trapped in my early thirties.'

Her decompensation came as a shock. I had been playing phone tag with my parents for the past few days, and yesterday, after tucking both kids in for the night, I dug my phone out to charge it, since the battery had died hours ago. My mom left a message, that Wi-Pao wasn't well. I had been hearing about how she wasn't feeling well, and she didn't look well last time I saw her, so I thought maybe, she caught another cold. When I called my mom, after playing more phone tag, mom simply asked me to head down to the hospital. It turned out that she had became unarousable, and the ambulance had taken her to the private hospital where I worked previously. I dug out my old badge, hoped that it wasn't deactivated, and drove down. With the badge, I got in the ER, found her nurse, and got a quick update. I also spoke with her attending physicians. She had a massive subdural hemorrhage, and due to mass effect, was in the process of herniating. I was thankful, that I had some alone time with her prior to her children returning from handling various things and all sorts of visitors. I stroked her hair, it was so incredibly soft, and said good-bye.

Out of respect, this blog will be silent until after the funeral.

At that time, I will discuss some proper hospital etiquette, because, you'll see, some people need a refresher.

Friday, April 11, 2008

CME

With my day job, I proudly earn 80 hours of 'educational leave.' Education leaves are supposed to be use for education activities, like conferences that earn Continuing Medical Education credits. This year, I am using all 80 hours for Boards preparation, and to actually take the Boards. However, in any given year, the rules clearly state that only 40 hours can go to Boards and related activities. I need to come up with something, to account for the other 40 hours.

I had worked on a bunch of CME activities on-line, and accrued 20 hours. I gladly found 'educational activities' that I had done in October of 07, (in my taxes folder) where I apparently had earned 20 hours doing something about risk management. (When physicians say risk management, they don't mean not running with scissors, they mean not getting sued.) I had done these CMEs to lower my malpractice insurance, but hey, I could use them for my ed leave.

So now I am all set to take 80 hours of ed leave in May. Mind you, I only clock in 25 hours a week, which means, that I will only be working one week in the entire month of May. I am a little concerned when I return... I am thinking, that I need to call my voice mail and fill it up with my own messages, so that people can't leave me more messages, and that they will turn to the other clinicians at work.

As for my private practice, there is no such thing as going on vacation. So, I will still see patients, fill meds, try to get more referrals, and hopefully, God willing, not get sued.

Friday, April 11, 2008

Taxes...

Hubby began the very brave task of figuring out our taxes last night. I thought he was a little shocked about my 'organizational' system. Since I started my private practice, there existed a folder: "Psychiatry Practice" in our file cabinet- it included all sorts of receipts, my CME (continuing medical education) credits (totally unrelated to taxes...), random receipts I collected when I paid for various meals with colleagues (you know, 'networking', down to $1.75 for a rice crispie treat for my guest), rent receipts, and the best thing of all: there was this sheet of paper, where I wrote down how people paid me, which of them still owes me money, which date I sent a collection letter, and that I tallied up my earnings each month. When I was a hospitalist, I actually had a billing service, and they generated amazing looking reports, it was absolutely necessary back then, since I had to bill insurance companies. This had made our taxes very complicated. Also, none of my private practice earnings had taxes withheld...

Then there was Hubby's amazing system for his photography business: he had files, and files, and files. Everything was so organized. He generated actual BILLS for his clients. His business had been much more complicated, since he had to collect sales tax for the prints people ordered. Thankfully, health services had not been subject to taxes (although the city council of Beverly Hills had been trying to change that.)

I was utterly ashamed by my lack of organization.

But then again, I made more money in my practice than his photography business last year, so... not THAT ashamed. Never mind that my practice had been the bulk of my 'day job' while Hubby's business remained his 'other' job.

2008 though, will be a different story. So far, his earnings in March had outpaced me. I really need to get more serious about my work. I suppose I need proper equipment for a serious business, a new laptop, a printer at my office, maybe a new phone, and a pair of new shoes, definitely NEEDED for a successful practice. Actually, maybe I can deduct my footwear purchases, you know, proper arch support makes a happier/more insightful psychiatrist.

Thursday, April 10, 2008

• Staying Up Late

  My poor Hubby had been really busy with work. His day job, and his other, creative job. So much so, that our taxes remained incomplete. Actually, not incomplete. NOT STARTED. We had never cut it this close, ever. Also, I think our return will be somewhat complicated, since I was self-employed for a while last year, and frankly (do not tell him), I am not even sure I have all the stubs from various insurance companies. I mean, I am NOT about to add things up, and figure out who didn't send me one. Please don't ask who will have this awesome pleasure...
  
  He is still working on his presentation for 6:30 AM tomorrow, and to show solidarity, I am awake, still.
  
  We have also been busy, so busy, that it is difficult to think that more than a quarter of the year is already gone. We are both treasuring every moment we have with a preschooler and toddler. That's right. We already don't have a baby anymore. Zoe is truly a toddler- she walks, drinks out of a regular cup, and as my conference with her teacher revealed today, that she somehow has acquired a strong personality (hmmm... I wonder where those genes came from!) and that the other children know not to mess with her. While she isn't aggressive with the other children, they know, to not pull her hair, push her over...etc. Aidan has also just gotten HUGE, although he has been quite concerned about leaving us to go to college. He really doesn't ever want to leave this house, so he says.
  
  I hope he and Zoe leave the house sometime in their 20's and brings us grandbabies in their late 20's/early 30's. I already have plans of how I will help A&Z when they have children. I am going to show up, cook/clean/do laundry, hug them, kiss them, and go back to my own home/hotel to sleep. Can you tell I have been dreaming of the help I want to have?
  

• Carrots!

  Months ago, Aidan and I planted some seeds, carrot seeds. I wasn't sure if they would grow, since, I grew them in a pot, our little space came with very little sun, and we weren't great about watering the pot. With all these obstacles, the carrots managed to grow! I wasn't sure when they would be ready for harvest, since... you know, one can't see the carrot! I yanked one out of boredom, and I was so excited. That I dragged Aidan away from his Lego sets and made him harvest some. (And I was clearly, not oriented to date.)
  
  
  

  
  They were delicious! Then I decided to sign up for a food delivery services: sustainably grown organic food, from a 'local' farm. (Local, as in about 2 hours away.) We got our shipment today: I am now the proud owner of these rather strange vegetables, I mean, non-Chinese vegetables: Rosemary, Chard and Fennel. We also have some more carrots, apples, pears, garlic (with the greens attached!) and asparagus (Hello! Aspartic acid, here we come- I think Zoe's teachers are in for a treat when they change her diapers!) I am really excited. This will be my chance to get out of my vegetable rut: broccoli, green beans, bok choy, and repeat. BTW, if you end up signing up, mention ME! So I can get a free box!

BOOKS!

After 'losing' my bid last week, Hubby and I decided to splurge and buy something with A&Z when we browsed at a local toy store. This toy store is amazing- because, it isn't a chain, and its existence dates back to Hubby's childhood! It amazes me when these stores can persist in today's economy, with Wal-Mart, Target, and Toys R Us in competition. Anyway, we like to support such a local store, and therefore, as much as possible, we get them stores from here, for instance, Aidan's new bike. We were feeling particularly generous, since whatever we were going to buy, it would be far less than $500.

However, we couldn't make ourselves buy books there, even though Aidan was SO excited to find Richard Scarry book that he hadn't seen before. You see, we were certain that at Amazon, the books would be at least 25% off. We did get Aidan a new helmet though. For bike stuff, Hubby prefers to buy them in brick and mortar bike shops, because, he had worked in several as an adolescent.

So Aidan had to wait a few days to get his book. The first read, however, was priceless. He found the "Three Fishermen" story to be absolutely hilarious. He had giggled so much, that I ran for the camcorder, while he still laughed hysterically, he was laughing even more before this clip.

Tuesday, April 08, 2008

Dinner!

We are pushing our dinner time back a little bit. By 15 minutes. I know, we are like robots. Or soldiers. Dinner is now served at 5:45- Aidan eats better a little later, and Zoe seems to do fine staying up a bit more. Seriously, 15 minutes is a BIG difference. I know I sound totally ridiculous.

Meanwhile, Aidan inevitably finishes earlier- something about having teeth and using utensils can speed up one's dinner time. One of us ends up sitting with Zoe. And here is a clip of tonight's dinner. Notice the laundry that needs to be put away, and all the Lego pieces around. BTW, Zoe despises these little pieces- when she accidentally walks on them, she yelps and starts to cry.

Monday, April 07, 2008

Need to LET IT GO!

So I am still perseverating over my lost bid of the bird house. Seriously, I need to let it go. The plan now is to alter the reality. I am going to go buy a wooden piece of something. Get Zoe to finger print around it, I will finish off the the project, write in her friends' names, and then write "Hummingbirds, 2007-2008." And take a picture of it next to Aidan's class project. I will then show her the pictures, "See, Mommy and Daddy got this for you." Then silently, "A week after the REAL auction, and finger prints, not related to the names next to them, all yours." I just don't want her to lose out on anything, because she isn't a first born...

Meanwhile, here is the AWESOME Owl Class lamp.



The Phat Photographer approves of this photo: "Very good lighting! Which mode did you use?" To that, I said, "I have no idea. I tried them all."

Sunday, April 06, 2008

Community

I have been thinking about community a lot, indirectly and directly. While our involvement with our church community is minimal, at best, simply because with work, 2 kids, illnesses, trying to launch my private practice and Hubby's photography business, there just isn't anything left in me/us, for this. Partly because we live far away from a lot of other families, and partly, because I am a resistant person.

Meanwhile, Hubby and I have communities of our own. He is now forming a photographer community, albeit very small, he has recently become friends with two very established professional photographers in our area. He also has his 'real' job community, and actually, his own creative business is about to merge with his day job- I will let him write about this when the project is near completion.

I have my work community- I belong to the 'lavender' team at work, and I think our team is fantastic. I also like my boss a lot, and the other physicians, so it is a really good community for me.

With A&Z's school, we belong to the MDS community. This has been a very important part of our lives in the last four years. I have learned so much, about life and parenting, from A&Z's teachers. We love, love, LOVE Teachers Kerri, Dena, Anna H, Sedi, Susan, Benetta, Judy, Sean, Dora, Anna A, Rita, Jaclyn, Barbara, and Melissa. Every spring, MDS hosts a tremendous fundraiser at the Ritz in San Francisco. It is quite an event- as there are quite a few campuses throughout the Bay Area, this is THE event where parents get together to raise additional funds for the schools. Sure, we feel like we give them our retirement pensions monthly, but we know, quality child care is just expensive. For us, it is money well spent. We have gone to this fund raiser twice, but have had to miss it last year, due to having a newborn, going to a reunion and all of that. This year, it is also special for us, since Hubby has given his services as part of the auction. The kids also all make something in each class for parents to buy. I have been hoping that we would be able to snag both items from A&Z's classes. Zoe's class has made this cute birdhouse, with their finger prints decorated into flowers and bugs. Aidan's class has made this awesome lamp. The starting bid for Z's item is $50. I have been thinking, SURE! It turns out, there is another family, who really wants this. They started their bid at $250! We put in ours at $260, but ten minutes prior to closing, Teacher Dena walks up, and tells me, (as I am lurking to make sure we GET IT!) that this family sends their specific directions that the upper limit is $500! And $510 is just a little, well, out of our price range.

Meanwhile, I just don't want Zoe to say, when she is 15, "You always get Aidan more stuff! See, there is nothing from MDS in the house from my classes!" (See, I am a middle child...)

At the same time, Aidan's awesome lamp is quite a bargain. We got it at $160.

I am going to have to get some wood craft thing to school, and beg the teachers to make something of it with the children, and buy them lunch, to complete this year's acquisition.

Finally, in terms of community, we have been talking with friends from the above communities, about their neighborhood communities. Specifically, for us to move to a neighborhood with lots of children. There are three areas that we know this exists in so far, in B.Game, where there are these few blocks that actually throw block parties, and kids run around by themselves, and all that. In P. Valley, where there is this community of 500 homes and they also have community parties. Finally, in M. Park, where these four blocks have over 100 children, and kids as young as 4 can walk to their friends' houses on their own! Meanwhile, we live in a complex where I know there are children A&Z' s ages, but there just isn't time for us to meet and play and have community. Would shelling out more money for a home get me some community? I doubt it. You see, I am a resistant kind of person.

Friday, April 04, 2008

Work...

Today is a very full day of working with patients. It is interesting what one considers to be a full day. For psychiatrists, a typical follow-up appointment is 20-25 minutes long. For primary care docs, the return is 10-15 minutes long. In one hour, I would see 2 returns, whereas A&Z’s pediatrician would have seen FOUR people. After a day, I would see 12 patients, since I have some meetings and paperwork time that I block out. For a pediatrician, they probably would see about 24-30 patients. That is a lot of people. Why do primary care docs have to see so many patients? Partly, there isn’t enough of them. Why? Because reimbursements are very low for these primary care specialties- meaning, they are not procedure driven specialties. How these people make a living is through tremendous volume of people.

Some interesting/ironic snippets of this morning so far…

Patient: “My eyes have been hurting.”

Me: “For how long?”

Patient: “Since I went to the hospital.”

Me thinking: “In the six months I have worked with you, I can’t remember that you went to the hospital…did you really go to the hospital and I forgot about it? Medical? Psychiatric? Which hospital? What?!”

Me: “When was that?”

Patient: “Two years ago. They really hurt.”

Me thinking: “TWO YEARS!? And you are telling me this for the first time?”

Me: “Have you talked about this with your primary care doctor?”

Patient: “He thinks I should get glasses.”

Me: “Do you have your glasses?”

Patient: “No. Do you think anything else could be wrong with them?”

Me thinking: “If I knew, I would be an OPHTHOMOLOGIST, not a PSYCHIATRIST…”

Me: “Well, perhaps trying new glasses is the first step.”

I have this other patient, who has had a lot of medical problems in the last few months. It feels like every I see her, I give her a non-psychiatric illness, rhabdomyloysis, drug interactions, and today, mononucleosis.

Patient: “So I keep you sharp, Doctor, so that you stay on top your medical knowledge.”

Me thinking: “That is what I have always wanted… to be a primary care person…”

Me: “It is good to remember all those things. I hope you get better soon, and I won’t have to give you yet another medical diagnosis.”

Wednesday, April 02, 2008

Where is the Baby?

When Zoe sleeps, she likes to snuggle up with her Asian doll, both of them like to sleep on their tummies, in a way, her doll is really a miniture of her.

There is an article in The Wall Street Journal yesterday about a research study, by Dr. Wilson, of Washington & Lee University of Law, finds that women with advanced degrees, such as law, medicine, and MBA, have higher divorce rates than their male peers who also hold these advanced degrees. She speculates that is is perhaps such women "can't summon up the TLC and support that high earning men need." Her advice is for these women to find particularly loving and supportive men.

I think, of course, this issue is multi-factorial. One can argue, that the kind of women who would go to professional schools, are the divorcing kind anyway, or the kind to opt out of having children. That regardless their education, divorce would happen anyway. Also, possibly that by having professional degrees, these women are at financial liberty to leave a marriage. That possibly, the wives of male lawyers and physicians and MBAs stick around, for the material comforts.

Anyway, I am sure the above paragraph is going to generate some strong feelings in people. Because it surely stirs up things in me.

By the way, looking at the numbers, the divorce rates is only higher by one percentage point. So, it isn't like the 'risk' is so much more elevated. Perhaps I should read the whole article, not just the diluted down version in the WSJ. But then again, my time is probably more fruitfully used to provide some TLC to my family. Anyway...

Since I began writing this entry about my sweet little girl, of course, I should return to my thoughts about her and her future. (And in a way, my own.) I would actually, encourage her to go to professional schools, preferably, medical school, because, it gives her more options. My parents always told me, "Your Hubby is wonderful and all, but you know, he could die. You need to be able to provide for yourself." And in a way, my career track, while it seemed so dark as an undergrad- training until I am nearly done with my 'youth.' It had proved itself to be worth the effort. for one, I love what I do.

So anyway, while she picked out the drum at her first birthday party, I still whisper into her cute little ears, "radiology...cosmetic dermatology...emergency medicine...psychiatry..."

Tuesday, April 01, 2008

Test Prep My exam is about 2 months away. It has been paid for- a whopping $2100! (It is totally a scam...but like all other physicians, I can't help but subject myself to this.) I am staying on track of my goals. However, it occurs to me today, that I don't know how many questions I will encounter that day. So I turn to the ABPN site- they have an entire syllabus of things I am responsible for, and the exam is apparently 2 blocks, each one is 3.5 hours long. However, after searching high and low, I still don't know how many questions will be asked. Since it is a computer based exam, maybe, the more questions you answer incorrectly, the shorter the exam becomes, because... there is just no point in asking more questions. When I took my Step I exam EIGHT years ago (USMLE Step 1 is the first exam a medical student takes after the completion of second year, to begin the licensing process), it was the first year that the exam was offered on the computer. The joke was that, it was based on how many questions you answer correctly- that if you know your stuff, the questions actually get harder, and vice versa. Therefore, doom on you, if the questions get easier and easier, that the last question of the exam is: Where is the heart? a. the thorax b. in the skull c. in the pelvis Kind of funny, how as much as I studied for that exam, I now can't remember if the above scenario is true- so, all my med student readers, let me know. Meanwhile, the joke about study time for the 3 steps of USMILE is this, "2 months for Step I, 2 weeks for Step II, and 2 number 2 pencils for Step 3." But of course, this is no longer applicable, since it is all computerized. I kind of like it being computerized- it takes the fear of bubbling in things incorrectly out of the picture. You know, missing a bubble at number 20, only to realize that when you get to the 80th question, and there is less than a minute left... Although, it was truly demoralizing, that I didn't realize the Step II exam had one more hour of testing than Step I: imagine my horror, that at 4 pm, there was ONE MORE HOUR to go! I ended up putting my head on the table, and just clicked whatever looked reasonable. I was out of there SO fast. For Step III, it was the first year they included this clinical section: you get a 'real' patient, you can order 'real' tests, and you get 'real' test results. If you manage the patiently poorly, the patient DIES. The horror. It was interesting, (and in a sick way, almost fun), that I got this patient, with some history and physical findings, then I did this, or that, and the computer came back with this or that result in '10 minutes' and I proceeded to do this or that. There was really only a handful of diagnoses to truly be good at, part of the effort to raise 'safe' doctors, so myocardial infarction, pulmonary embolus, urinary tract infection, meningitis, and of course, GONORRHEA, If a young person shows up with a very painful joint, and the patient swears that the erythematous joint is due to a 'spider bite', the correct answer is always, GONORRHEA! Anyway, so I still don't know how many questions will be on my test.