Pictures and Stuff

How about them stock market!

As I drove around and listened to my radio, I was surprised how naive some of these US Congress folks sounded. There is this guy, who represents some district over in East Bay, who said that there needs to be no bail out. Something about Goldman Sachs is a hedge fund and that is how it got in trouble and it should just die. Something about Charles Schwab only exists to move money around and therefore, it will be fine.

Well, I am no economist, but I think Charles Schwab has an investment division and its purpose is to make money for Charles Schwab itself. Also, the credit mess is now becoming problematic as small businesses can't get loans, you know, that is about 75% of the US economy. But whatever.

I have things to do. Like making bread. In light of the economy, I have been restraining myself to not spend money. Therefore, making bread sounds like a good way to eat better, and save a few bucks. The cinnamon bread that we love is about $7 a loaf. SEVEN bucks. So I have made bread. In the last seven days, I have made cinnamon swirl bread, hot cross buns (I know, totally the wrong season...), cinnamon buns, and tonight, a challah is baking in the oven as I type.





With all this carbs, I think we are just getting fat...

Meanwhile, here are just some precious pictures of the A&Z.





Finally, I found out via facebook, that my med school friends, D and E, just had their THIRD baby. D is a surgeon, and E is an ER doc, and they have THREE boys under the age of 5. THREE BOYS under the age of FIVE. It has to be crazy busy there, but I can also picture the holidays, when the boys are grown, with their own families. SO FUN! Congrats! D and E!

New Phase

I had been feeling out of synch and couldn’t quit put my finger on it. Was it because life had been the same, more or less? Did I want change? Did the children change?

Alas, after much introspection, my realization was this: We had entered a new phase of life. It happened so subtly, that I couldn’t really say when it happened. But somewhere along the way, we picked up a toddler. When one parent takes both children to the park, it became more difficult. Gone was the sweet baby who happily sat in the backpack or Ergo, here to stay was this maniacal child who wanted to be lifted high up to get to the slide and came down with a crash while the preschooler demanded attention in a soccer game. It became impossible for one parent to make both kids happy. So, two of us would go. But we might as well be strangers at the park, other than getting there and leaving together, the guys would be on the field, while the gals would be at the play structure. Everywhere we go, we divide into two teams.

It all became really annoying. I want to hang out with my Hubby!

I am told that this won’t last forever. I am counting on that.

Meanwhile, Aidan had been pushing my buttons. Somehow, he just innately knew which questions would be particularly provocative to his mother.

Last night, he asked, “Mommy, what would you do if I got out of my bed and changed my clothes in the middle of the night?”

Me: (Thinking, what is this? He knows the sleep rules! Why?!) “What do you think Mommy should do?”

After a while of this, I finally asked, “Aidan, why would you need to change your clothes?” And then, “Honey, you have your pajamas on, you don’t need to change your clothes until the morning time, so if you get out of bed to play, you will be punished.”

Again, perhaps this provocative behavior won’t last forever either, at least, not in this form…

My Dark Secret

I have a dark secret to reveal. I secretly enjoy the challenges a borderline personality disordered (BPD) patient can bring.

The trick is to find something within that BPD person that I like. Sometimes, this can be hard, but usually, even BPD folks have something that I admire. Then, be super consistent in your interactions. When you are always the same, they know what to expect, and having such firm boundaries give them a new experience and therefore, potentially gaining insight into their own interactions in the 'real world.' Also, chant to yourself, "Nothing personal, it is just business."

As a resident, I actually had this therapy patient with a diagnosis of BPD, whom I saw twice a week for a good part of her treatment. I really liked her, and actually, really wanted her to like me. (The power of projective identification.) I always wished I had her eye for fashion, for beauty, for style.

Interestingly, I have bumped into her twice as a resident. Once, I saw her as I was leaving a brunch spot with Hubby and Aidan, I whispered to Hubby, "Patient alert, quick, cross the street." Don't worry, no HIPPA laws were broken, since it was totally crowded with about a hundred people out there. The other time, I was with Aidan (on his first birthday!) and we were strolling around the same neighborhood, when Aidan needed a diaper change. We ducked into the Apple Store, and there she was, waiting at the Genius Bar. We made eye contact, she smiled, I smiled.

The following session, nothing was spoken about this.

I managed to maneuver her thought onto transference issues, and explored what she thought about how therapy was going. Anyway, after a long time, we eventually talked about this incident. Get this: She had no recollection.

Psychodynamically, I thought she suppressed it. (Or am I narcissist for thinking that I was SO important that she had to suppress it?!)

Anyway, after becoming an attending, she came back to my service. And so far, I haven't run into her anywhere, although I know all the places she goes to. Secretly, I am looking forward to running into her.

Life wouldn't be as interesting if there weren't so many personality disordered people. I love my job.

Follow Up

A couple folks got in touch with me about my previous "Run-In" post.

I have run into patients who do come up to me and say hi and all that, and it is usually quite interesting to me too.

A year or so ago, I was walking around Target, not the one I usually go to. Anyway, a patient of mine was working there, and he stopped me, said hi, and insisted on showing me their on-sale bulletin board.

A few weeks ago, I was at Trader Joe's, the one I frequent mostly. While I was studying a box of figs, I saw another patient. Who then said, "Hi! We have an appointment on Friday, I will see you then!" I said, "Actually, the appointment was for last Friday. But I am free this Friday at 4, I will see you this Friday?"

The kind of patients that I have difficulty running into, are typically patients with personality disorders. My philosophy about personality disorder is this: the diagnosis fits when a person's temperament (ongoing thoughts and actions- a pattern in all spheres) becomes unproductive in that person's pursuit of life, freedom, and happiness. Because such people have a lot of interpersonal difficulties, I would expect for them to have the same kind of relational problems with me. Therefore, running into a psychiatrist is tricky for them, and thus, for me.

Overall though, I secretly like running into patients- I get to see them in situ! Not just the words they tell me, but in their own environment! If only I can be polished, calm, and clean, ALL THE TIME.

Run-Ins

I am running into patients ALL over the place.

A while ago, I had to call in sick on a Friday because Zoe was ill. Then on Saturday, we all went out for a leisurely walk. As we were walking, I saw this couple get out of their very new Prius, and boy! Was I surprised to see that the guy was a patient of mine, who complained to me how he didn't have any money (and refused to get a job). We kept walking, and they passed us.

Last Friday, I went to my gym for a quick swim at lunch time. As I lugged my charming beach bucket full of my toiletries, held onto my swimsuit, walked as quickly as I could, I saw him. He was coming out of the men's locker room. He was my new patient last week. He was a young schizophrenic. We made eye contact, and I thought he might have recognized me, but by then, I had walked past him and ducked into the women's locker room.

Last night, I was back at the gym, watching Aidan swim while sweating it out on the elliptical machine. He was there again! I quickly looked down at my book, hoping that he won't notice me, won't recognized me, and if he did recognize me, he won't want to make conversation.

I really didn't need him to see me all sweaty, in a tank top, reading Chasing Harry Winston by Lauren Weisberger. I am going to explore with him what his schedule is like- so that I could avoid the gym when he goes.

Last Sunday, we made a quick trip to Joann's to pick up some ribbon for Hubby's Phat Baby Photography work. I was lugging Aidan into the store as he talked about how much he needed to pee, right away. Out came a patient from private practice. We made eye contact, and she continued with her way, and we made a mad dash for the restroom.

Today, I was headed to my women's Bible Study, as I walked across the lobby, I saw another patient. As I sat at my table, I prayed, "Dear God, please, please, don't let her be assigned to my table."

On average, I run into about one patient every week at the grocery store, church, gym, mall, Costco, random places.

I have a rule: When I run into patients, I don't say hi. Seriously, people probably don't want to introduce me to their friends, "Hey, this is my psychiatrist." No, people like their privacy. However, if people want to say hi to me, they can feel free to do so.

However, that rule doesn't account for times when I am disheveled, sweaty, cranky, vulnerable, lugging dirty, cranky, whining, crying children.

As my practice grows, this is only the beginning...

Ready to Go

This was taken a while ago, as I was figuring out what gear Z needed for school. I should have her pose with her new gear. Maybe this weekend.

Anyway, this girl is ready to go!

Absurd!!!

I think I am in a groove of figuring out our paperwork. The piles and piles of papers that we have around here are just maddening.

Anyway, I sat down with my AmEx statements, and realized that this Credit Monitoring people were still charging us $11.95 on the fourteenth of each month, despite the fact that Hubby had called them in January. We had not wanted to pay for this, and we never applied for this.

AmEx then started a dispute file and recommended that I call these people again. Imagine my shock, when the representative over at www.creditreport.com told me that someone, with initials RT, in Oregon, had used our credit card to obtain a credit report. The representative recommended that I call their fraud department.

Disturbed? Absolutely. Absurd? You bet.

How could a CREDIT REPORTING service allow the use of someone else’s credit card, without verifying the billing address, the name of the card holder and you know, BEING A RESPONSIBLE merchant?

I called AmEx and got ourselves new account numbers right away.

I called Equifax and placed alerts for Hubby and me also.

This morning, I called the fraud department. Apparently, it is COMMON for this to happen! That these THEIVES use credit reporting services as a test, to be sure that the credit card is valid. Also, this agency ALLOWS someone to use credit cards that belong to ‘a friend or relative’ without verifying any information.

Then, they had the audacity to say that nope, they will not provide any free services for ME to check on MY credit, despite THEIR negligence.

The weird thing is, (as if the above isn’t weird at all), there had been no suspicious activity in our AmEx account. So weird.

Anyway, I am going to get a real credit report for Hubby and me both. Argh.

Phew!

In March, I was given this task. I knew that the task would be way too much for me to handle on my own, and so Hubby agreed that we both need to take care of this. Together. However, getting our schedule synched proved difficult. Getting our schedules synched with the children's schedule proved even more difficult. And take the children we must, since, well, it was their blood work that needed to get done.

At age one, it is common and customary, to check for anemia and lead level. At 4 years, it is also usual and customary to check for lead level. We also wanted to see if Aidan's 'grade 3' peanut allergy had abated or what. (As uncommon as it is to grow out of a peanut allergy, I was quite certain that Aidan had consumed peanut products inadvertently, at one point or another.)

Six months after we were requested by the pediatrician to do so, we finally did it.
After Aidan's soccer game, we loaded the kids up, drove to the lab. Aidan went first, then Zoe. I held Aidan, and Hubby held Zoe. We were truly 'equal opportunity' in this.

Both children were troopers. No major tantrums or screaming.

Although, Aidan had a few questions. As I was tucking him into bed for the night, he looked at his bandaid, and asked, "Mommy, when are they taking my blood out of the test tubes?"

Me: "I think they did that this afternoon already, and they will spin down the blood and study the sample."

Aidan: "When do we go back so they can put it back in me? How will they put it back in me?"

Of course! If you take your toys out, you put it back. Thus, if you take some blood, you better put it back!

Aidan seemed both relieved and surprised when I explained that blood won't be put back in, because he has healthy bone marrows to make more!

Are You Kidding ME?!

While Hubby and Aidan played some indoor soccer last night, I thought I would put some papers away. With Wall Street being as volatile as can be, I was curious what was happening to some of our investment accounts- as it turned out, whole lot of nothing in the last few years. As I opened the cabinet where the folders were stored, I realized I hadn't been filing these papers all year. Hubby saw me working on this and asked, "Do you want to file all of them?" I thought, "Why of course!" He then whipped out "ALL OF THEM."

There were statements from 2004 that we didn't file away. I also found a stray statement from 2002.

It was like a very sick joke.

Bottom line: We need a better system to accommodate this monthly influx of statements. And it is a good thing we are no where near retirement.

The Truth

My private practice is going well, by going well, I really only mean that I am busy. (Not that everyone is improving- there are some people who are getting better, but some who are not...) There are lots of referrals coming my way, the hours are getting booked. It all makes me very happy.

It is so easy then to think, “Wow! I must have done something RIGHT! That is why God is paving the way for a busy practice. God is rewarding me because I decided to go to Bible Study, or maybe because He is pleased that we are good stewards of our money.”

However, these thoughts are totally false! The reason God is making my practice grow is because He is merciful, and He provides. It has NOTHING to do with what I did (or didn’t do), the commitments I made (or didn’t make).

Still, it is hard to get my mind wrapped on the fact that God is who God is, and He is good. I can’t earn His goodness.

Similarly, when the calendar is empty, it is tempting to think, “I must have been bad. God is punishing me.”

Well, the truth is, there really isn’t anything good about me. I am made good because God is GOOD! He sent His Son, to die for ME! Therefore, there is no such thing as punishment anymore.

I suspect I will be thinking and struggling about this for a long time.

Parallel Process

There is this very interesting phenomenon in psychotherapy called parallel process, where the therapist undergoes the same struggle, issue, clarity, in his/her own private life that the patient goes through. Really speaks to the power of the unconscious, or coincidence...

I saw this man for a consultation a few weeks ago. The main compliant was that he thought his depression was worsening and causing a lot of marital difficulties. He also started seeing a therapist around that same time. It was unclear to me if this therapy work was individual or couple at the time. Anyway, in the few weeks since our initial appointment, he had met with that therapist a few more times, and his spouse had also met with that therapist separately. The goal, was for them to see this therapist for couple's therapy. But I was really confused, mainly, that in couples' therapy, a therapist does not meet with one party more sessions than the other, that both parties get 'equal' time, so to speak. Just so that it is perfectly clear that there is no 'therapist's pet.'

So I went to check in with this therapist for a check in, and we talked about it for a while. I left and felt the issue was as clear as mud. And I felt like somehow, the case isn't managed properly. (For the record, this therapist is very experienced and I have complete respect and trust for his work.)

It plagued me all afternoon.

I was astounded to realize that what that therapist and I are encountering, is exactly how this patient is experiencing with his wife. Clear as mud. Don't know what is next. Totally. In. The. Dark. About therapy, about boundary issues, about 'goal.'

I love my job. I love all this thinking...

Nuance

We decided that we ought to paint the interior of our humble abode- the lovely new doors sure deserve a backdrop of new paint, of lovingly picked colors.

However, I am having a very hard time picking colors. The nuance between all those shades is beyond me.

Or not even that. I can't decide what color to use for the children's rooms. Aidan asked for blue, but wouldn't that be just so stereotypical? Do I then use pink for Zoe's room?

I did paint my own room pink once. It was atrocious, absolutely the worst pink, ever. Being of Chinese descent, I have this gene that only feels at peace with beige. (But have you seen how many shades of 'white' and 'beige' Benjamin Moore makes?)

I worry that I might go too light- so light that I won't be able to see the color. I worry that I might go too dark- so dark that we might die of claustrophobia.

I can't even decide on warm vs. cool tones. With such excitable family, we really need cool shades, but then I wonder, if they would grow up to be cold hearted people.

So I am thinking of stealing people's choices. Some people recently chose 'goldfinch.' Another friend chose 'flowering herbs.' But both seem so daring too me.

I am a whimp.

I think Aidan's room will be either polar sky, or breath of fresh air, or blue haze, or polar ice.

Zoe's room will possibly be hazelnut cream, or latte, or soft satin, or pristine, or old fashioned peach.

I know I can consult a colorist, but that would take time, money, and energy... for such nuance that I probably won't appreciate.

Too Much...

Lately, Aidan has been very interested about Star Wars. Although he hasn't seen any of the movies yet, (we are postponing that for as long as possible...) he reads books about them, he stages battles between the clones and the droids, he makes the Y-Wing fighter out of Lego. Of course, he engages Hubby in a lot of this play and leaves me out of it, mostly. Except to read him these long stories about the new Padawan.

Anyway, Hubby told me last night, that he had a dream a few days ago, about droids. He thought he probably had played too much of this game.

This evening, while I was taking care of Aidan's hygienic needs, he said, "Mommy, I am going to have 5 boys and 5 girls. The two oldest boys will be clones..." I didn't hear the rest, because I was trying so hard to stifle my laughter.

We need to move on beyond this Star Wars theme, for obvious reasons.

Crazy Times

These are some crazy times.

When we lived in NYC, we knew a lot of people in the financial industry, friends who worked at Lehman Brothers, Merrill Lynch, Bear Stearns, Goldman Sachs…etc. Hubby thought about becoming a banker, especially when he was a MBA student at Columbia University- it often bragged about its connections to these banks. I entertained the idea of being married to a banker, and aside from liking the possibility of swimming in lots of green, I couldn’t really see ourselves down this path. Hubby just wasn’t suited for that, he saw himself as a consultant, a management consultant. (I have/had no clear ideas what management consultants do, other than that they traveled a lot, but whatever Hubby really wanted was fine with me.)

Then September 11th happened. Overnight, our world changed. Aside from not seeing the Twin Towers from our front door steps in Brooklyn Heights, the issues of national security, the all these people who died, our hopes and dreams also shattered. Essentially, recruiting activities decreased tremendously in business schools. Recruiting was already pretty thin since the burst of tech bubble, and it was growing slimmer with each passing day. We had thought about staying around NYC for Hubby to pursue a career in consulting, but since no one was hiring (not completely true, I guess. Few people did end up as consultants, but mostly people who had done internships with them. Hubby was enrolled in the accelerated program and did not have time for an internship,) we left NYC.

Anyway, Hubby ended up graduating without a job. And he did not become a consultant.

But that is not the point for today’s entry. The point is, back then, we never thought investment banks could go out of business. Yet it has happened, I can’t imagine what our friends are going through, what is happening to these MBA students who had offers from Lehman that won’t be honored, what it means for the overall economy…

These are some crazy times we live in.

My Constant Struggle

My constant struggle is this: Eating at home. It isn't about the cooking, completely. I am a speedy cook- whipping up dinner in 30 minutes or less is my standard repertoire. It is also usually fairly tasty- nothing gourmet, but nothing disgusting. Hubby will say he LOVES, LOVES, LOVES my cooking. I am a fairly economical shopper, granted, our grocery bill has skyrocketed recently, but I will blame that on raising costs of food in general. It is unusual that I waste large amounts of ingredients.

What truly bugs me is the process of the whole thing. The preparation, the mess, the clean up. Argh. I can totally live without this.

Back in those leisurely college days, we sauntered into dining halls, whenever, whatever. Ate the stuff, complained about the stuff, shoved the stuff into big bins and walked out.

For the brief time that I lived on my own before getting married, all 18 months of it, I cooked for myself. I had to, there was no funds for eating out. I didn't mind that, I cooked my meals, scooped some onto my plate, ate it, and put my one plate and one fork away. (I also cooked about twice a week and constantly ate leftovers...)

These days, each meal is a big production, from the number of plates/utensils used, to the crumbs on the floor, to the number of times Hubby and I need to get up for this and that.

(And there are signs that Zoe doesn't like leftovers- I need to correct that, ASAP.)

It is just getting OLD.

I don't even do this three times a day. Except for weekends, at most, just twice a day. (And if Aidan agrees to eating in the car in the AM, then I only do this major production once a day.) I have NO IDEA how stay at home moms do this AGAIN AND AGAIN AND AGAIN.

I now know why my mom looked so resigned and frustrated so frequently at dinner, when we took our sweet old time getting to her diligently prepared meal, full of love.

ARGH!

Then I blame it on the government: like acork's comment on my blog a few days ago, if I only paid less in taxes, I would have more money to outsource this repetitive activity, to the PROS. And everyone would be happy, there would be more jobs, more revenue in terms of sales tax... But instead, I toil away at home.

I know that to serve my family is a privilege, and clearly, this is a lesson still in progress.

However, what keeps me going is this: if we tuck away $200 for not eating out (not that difficult to do, since that would mean saving $50 a week, probably just about 1 not-fancy meal with a family of four), and let it COMPOUND (go compounding interest rate!), in THIRTY YEARS, when I am in retirement, I would have an extra $170,000, assuming just a meager 5% interest rate.

The bummer thing is, by then, when it will be just Hubby and me, I won't mind the cooking, since there will only be two plates and two forks involved.

I know, I know, by then, I will also really miss the staggering mess those little ones make.

Meanwhile, I already snapped my pea pods (to get rid of the fibrous stuff), plated my fish so that is ready to be 'steamed' (I steam via microwave), the rice is already in the cooker, and we even have two different appetizers.

Make it Fit

Here are some pictures from Aidan's first ice-skating lesson: the beginning a promising career. And of a very patient sister who is willing to make that happen.

It is going to be a little tricky to keep Zoe OFF the ice since I won't have Hubby there as backup. We will see.

Meanwhile, I woke up early this morning at 4 am, wondering just how am I gonna make it all fit into my life.

First of all, how am I going to make our coats/shoes all fit in our hallway closet- with such pretty new doors, I don't want to use those over the door shoes racks... A&Z's shoes are also becoming bigger, and needing more space (and Zoe just has way too many pairs.) Just how am I gonna make it fit?

Hubby is also acquiring new photography equipment. The little storage space I made for him simply won't do anymore. Where is it all gonna go?

Lastly, I started paying for my private practice two days a week this month, and at first, I thought it would be pretty slow and it would take a while. However, before I realized what was happening, it is fully booked next week. Granted, my Wednesday mornings are devoted to Bible Study, and my earliest patient is at 11:30, and I wrap it up by 3:30 to go get A&Z for the aforementioned ice-skating. On Thursdays, I don't get to private practice until 12:30, since my salaried position ends at noon. I also have to wrap it up by 4:30, preferably, to get A&Z home for dinner. If my practice expands further, I am going to need another day, which will mean I will HAVE to cut down on my salaried position. Maybe by next spring? It is scary to be weaning myself off my salaried position, the security, the predictability. Besides, what else will I complain about if I gave up that job?

Besides, I gotta make time to go volunteer for the McCain/Palin campaign. (TOTALLY kidding.)

I gotta make it all fit. For now, I am going to tackle my incoming snail mail holder to make that fit.

As Promised

So I promised to talk about psychiatry today.

Sometimes, I really envy those physicians who write about their patients on blogs. I am often worried that if I wrote about a patient, that patient would stumble onto this blog, read about it, figure out that s/he is the person I am writing about it, and it would end badly. I don't know how one gets around the privacy issue, even if their names are changed.

Maybe it is because most of what I treat is so sensitive, unlike pilonidal cysts, erectile dysfunction, severe constipation.

Maybe it is because most of what I say about a patient isn't all that favorable, and hardly anyone gets 'cured.' Unlike constipation.

The other day, I got a phone call from a mediator who works in the family court system. A patient of mine and his/her former partner are in a custody disagreement. Both parties are asking for sole custody, of course. It really pains me, after discussing the case with this mediator for nearly 1/2 an hour, that my ultimate recommendation to the Judge, is that my patient should not be granted sole custody. Not that because s/he is mentally ill (there are plenty of mentally ill parents out there) but because s/he simply isn't able to provide a secure, stable environment for the child. Not that the other parent would be a totally awesome option either (granted I have never met him/her,) but s/he has seemed very controlling, according to my patient. So here it goes, he says, she says, blah, blah, blah.

I take comfort in the fact that this Judge has a formal way of thinking about all these custody cases, and that what I say is only a small part of the final decision.

Really depressing, actually.

Meanwhile, late this afternoon I get a visit from our nurse, who is fielding phone calls. "There is this patient who is getting 'lines' on her face."

"Lines?"

"Yes, her PCP thinks it might be due to her psychiatric medications."

"Lines?"

"Yup, lines."

"You mean, wrinkles?!"

"I have no idea. She wants to stop by to have you look at it."

(I am about 99% certain that the meds she is on do not cause dermatologic changes. Her age, however, is appropriate for such formation of 'lines.')

I ended up calling the patient, explaining to her that as much as I can sense her distress, I am not a dermatologist, and I am of no help to her in the discussion/evaluation of these 'lines' that don't itch, or hurt, and that those 'lines' had been there for quite a while.

To think about the physiologic cause of the formation of lines was totally unfruitful. However, to think about the fact that this person's psychiatrist is on an extended vacation, that she recently terminated with a long term therapist, then it would totally make sense: Who is going to take care of me?

Meanwhile, Aidan is totally in the oedipal phase of his life. At bed time, while I was tucking him in.

"Mommy, you should always stay with me, forever."

"Really, even when you are married and I will still stay in your bed to tuck you in?"

"Yup. Stay with me forever."

"How about when you go to college?"

"Yeah, you stay with me. Daddy can sleep alone!" (Giggles...)

"Hey Aidan, what are you going to do in college?"

"Eat cereal with my friends, live in the same house with them. I will be in college for a day. You come stay with me though, ok?"

Zoe is obsessively re-reading the same books- books without actual sentences. I drone on like this, "Purple, Octapus, Stingray, Seashell. Orange, coral, sea star, crab. Turquoise, fish, whale, ocean." Again, and again, and again...

Group Dynamics

I don't particularly like discussing politics, but I LOVE to talk about group dynamics, and there are a few things that get people going, sex, money, politics. Therefore, I write about what I think and invite people to respond and to get the process going. Yes, I am an intensity junkie- thus I chose psychiatry, versus pathology...

Anyway, one of the tricks in group dynamics, is that once you say things like, "So I will probably get lynched," people are less likely to actually lynch you.

But I am loving getting to know my friends more- we try to stay so neutral most of the time that discussing politics is actually banned at my work (never mind that our resources are at the whim of politicians.) So, go read my Glutton for Punishment post and leave me a comment!

Meanwhile, I will talk about the other side of the coin. As a Christian, I actually also see the faults of 'less is more.' You see, I believe that people are innately imperfect and thus we need the One who is perfect, who had atoned for all sins and thus we are made right with God. If I believe people are not going to make the right choices, don't we need someone who can make the right choices for us, and thus, bigger government? So you see, I am not totally fixed on my political thoughts.

When I talk to Hubby about politics, I will say things like, "Can you believe how we voted for Bush? I mean...seriously. The guy looks like a monkey. Is his IQ really 142, according to the IQ prompts that always come up on my facebook page..." Hubby will say, "Well, he did appoint two Supreme Court Judges, and those people are going to be on the bench long after he is gone, and that was very important." Perhaps as a conservative, that would be one of the very few things I agree with. Sometimes, I wonder what it is like to be Bush. He seems oblivious to his negative image and could-care-less about negative criticism, will historians (Emilymr, this is going to be your job!) going to find his presidency totally inept in 50 years, or will we learn new information that would change our minds? What do his daughter say about him? "Yup, that is my dad, he is a great dad, but a bad president?" Or do they think all (or most) of his decisions are correct?

And just as a clarification, when I have talked about 'more taxes' I meant more than I am already paying now. For instance, it was ok with me that we didn't get our economic stimulus check last November because our income exceeded the upper limit, and Hubby would say, "Give Ceasar what is due Ceasar." It is NOT ok with me to possibly have to fork over 40-50% of my money.

Glutton for Punishment

If you came here to read about TJ, please scroll down. If you came here to read about my deepest, darkest secrets, read on.

After I wrote about the definition of 'wealth' by Obama and McCain, my liberal friends had left some comments for me.

And since I am glutton for punishment, I will write about my thoughts further here. (I really should write about psychiatry, no one ever disagrees with me about those thoughts. Maybe tomorrow.)

Here is one of the things I hate about living in the Bay Area: my conservative friends are ALL in hiding. Get out here. Leave some comments!!!

I will admit it: I am a conservative. I will probably vote for McCain in the fall, not because I like McCain/Palin (definitely not like the way my in-laws love them), but because Obama doesn't seem trustworthy- the man is on his THIRD economic/tax plan.

It is like going to an open house, according to Barbara Corcoran, who owns that very successful realtor business in NYC. People fall in love with a house within 8 seconds, after that, they are just honoring an appointment. Maybe it is like that with picking your president. We make up our minds in a snap, and the rest is just a facade to appear open minded. (Never mind that the likelihood of McCain not making it to 2014...and (gasp) Palin would become the president...) Hey, I voted for Bush, ok? I admit it. The other option just seemed worse. I do take comfort in the fact that living in California, my vote won't matter anyway. So, why am I writing about this? Because I am a glutton for punishment.

Here is my rule about voting: Always say no to propositions. By the way, why do Californians have to vote on our own laws? What do we pay our elected officials to do in Sacramento anyway? Certainly not to put together a budget (we still don't have one!), so we have to decide on our own law. And if we have gotten along (maybe just barely) without a law, we don't need it.

Case and point, a few years ago, Proposition 63 was on the ballot. It was a proposition that would tax people with million dollar + income an additional percent to pay for 'mental health services.' While I knew all my closet conservative friends voted NO on this, I took a chance. Hubby and I voted yes. (I convinced Hubby that maybe voting yes would mean a job for me in a few years.) Well, knowing how this money is being spent, I would say it is a WASTE. (Maybe no one will argue with me about this since I have the advantage of working in the system in this subject.) Anyway, the fine prints of the proposition said that the money could only be used in NEW programs (create a bigger government!) So the counties all scrambled and hired new admin people, new program managers, to start NEW programs. Never mind that existing programs were understaffed and overloaded. As part of this, they started Full Service Partnerships (FSP) for people with severe illnesses and need 'more care', however that is defined. So far, I have not succeeded in getting any patient of mine into FSP. The hoops to jump through are numerous and certainly doesn't seem like they are in it to help people!

As part of this proposition, they also created community worker positions, meaning that people who had utilized the system before are eligible to come work in the system. It sounds REALLY nice, but seeing how it is going, I think those who had utilized the system and succeed in this position would have succeeded regardless. Most of the hires had failed miserably- that working in this stressful mental health services just became too overwhelming. I keep getting patients back in my case load after they went on to this position because they would get fired... That being said, I really like the community worker on my team, although he is totally underemployed (the man has a master's degree in math, for crying out loud! Meanwhile, he is serving snacks, fetching me charts...)

Therefore, general rule of thumb: vote for someone who does not want to make our government bigger. And since I already pay a lot in taxes, more than people who make 40K a year, I do not need to pay more in alternative minimum tax or regular tax, so I prefer the candidate who isn't screaming about taxing me even more. Thirdly, I happen to like a guy who doesn't use technology: I want my president to think about the BIG issues, not to be holding on to his crackberry and micromanaging everything. That is what aids are for.

Now you know where I stand. I will probably get lynched in the morning... But then again, my vote won't matter in California anyway!

TJ's and Other Thoughts

Here is a picture of Aidan and Zoe at his most recent soccer match. I gotta get one of those little chairs for Z. A whole hour is just too long for a little girl to be standing. It is too long for this much older woman to be standing...

We have no interior doors today. As the last thing of THIS renovation, the new doors are now drying in the garage after getting a sparkling coat of 'right white' from Restoration Hardware.

As for the rest of the house... I think we will probably need to paint soon or else those white doors will look really odd, but I just can't make myself commit to more mess.

One more note about our contractor: Our project came in UNDER budget by $1000! I have never experienced such joy. UNDER budget. Right on time. Wow.

Meanwhile, so many friends had commented on my facebook page that they are shocked that I hadn't been eating TJ's frozen foods since I wrote a status that I was 'discovering' them.

Truth be told, we have been eating a lot of their vegetarian corn dogs over the years- Aidan eats two in one sitting. I also like their already-cooked-just-microwave Thai potstickers- I leave them in the freezer at work. However, I have this guilt whenever I feed my family dinner from the frozen food aisle, like it isn't real food. I guess growing up, my mom always made dinner from scratch, nothing fancy, but everything came from a recognizable living being that was recently very much alive, either a cabbage or a whole fish. Therefore to me, to microwave up something seems like cheating. I try really hard to not just heat and serve for dinner, but am giving myself a break for lunch.

The most recent discoveries though, has been their frozen desserts. I get chocolate croissants regularly (although they puff up WAY more in summer than winter), tiny cheesecakes, raspberry filled donut holes, and tonight, chocolate lava cakes. Yummers.

Kind of a Victory...

Today was my 'off' day, so I spent it running around.

First of all, I have started going to a Women's Bible Study. As I sat there and listened, I realized that it had been 4.5 years since I was in a real Bible Study, and 9 years since I was in a women's study. I am super happy to have found this group though. As for Hubby, he will be going to a Men's group, they meet at 6 am. We will see if he goes tomorrow.

The remodeling is nearly finished, and I am nearly finished. I am SO sick and tired of dusting and mopping after getting home every evening. ARGH! But I think today would be the last day of major dusting, and everything went back in the closets. Phew.

I am thinking that we won't get the house repainted until we replace the carpet. We will replace the carpet when Zoe is potty trained. Aidan was potty trained a few months before he turned 3. So I guess we will have the house painted in 2010. Whatever. I don't want to take my stuff out of closets again.

I also tried to go exercise today, but I was so exhausted, I took a nap in the parking lot at the gym instead.

Gotta save up my energy for Aidan's ice skating class!

As for the class... Big revelation as soon as we walked in: Ice skating is mainly a girls thing. Everywhere I looked, little girls, big girls, medium girls, all girls. Aidan was the only boy in his class, along with two other girls. He was a trooper. When he first got on the ice, he looked so scared as he lost his balance. Turned out, I didn't lace him up properly... With ten minutes left to go of the lesson, he came up to me and said, "I am so scared and tired, can we leave now?" But I convinced him to go back and finish, which he did!

I have one more sport to add as a possible option for Aidan: water polo. This way, he could play a sport involving a goal on ice, on a field, and in water!

As for Zoe, she REALLY wanted to get on the ice.

Victory!

We went to swim lesson today and it was a victory.

Aidan was awesome, totally at ease with his new teacher and new swim buddies. I worked out for half an hour, burned 200 calories (according to the machine, although it never asked me for my weight...) and got to watch Aidan swim at the same time.

Victory was mine.

I am really excited about this, excited for Aidan's potential Olympic swimming career, but also for my own physical buffness.

I also convinced my malpractice career to give me a discount for my premium for next year. Victory!

Tomorrow, we tackle ice skating lessons for his eventual career as an Olympic figure skater, speed skater, or ice hockey player. I think I offer this child too many choices.

Here is Something Else to Think About...

Last night we had dinner with our lovely friends, Anna and Steve. We LOVE Anna, ok, and Steve too. We actually know Steve from WAY back, and are so happy that he got Anna to say to his proposal. He is one LUCKY guy. =) (I know they read this, and our teasing of Steve is endless.)

Anyway, they were telling us about some interviews they had seen of our presidential candidates. Both candidates were asked the question of how much money does one have to make to be "wealthy." McCain said something in the magnitude of millions (in annual income), whereas Obama said $100,000.

A HUNDRED THOUSAND DOLLARS in annual income does not 'wealthy' make!

I was a little shocked how clueless Obama is of the plight of the middle class people in California, (ok, ok, I am really just talking about ME!)

He plans to tax 'the wealthy.' I am very afraid of these taxes. The old time formula of 'how much house can you afford' is typically 3-4 times your annual income. If we use that rule (which is a good rule, mind you, if people actually stuck to rules, the housing bubble wouldn't have been so catastrophic) the 'wealthy' people would be buying $400,000 homes. The medium home price in the greater Bay Area is well into $600,000-$700,000. This kind of thinking just doesn't apply here!


So if I were to vote based on my taxes alone, Obama would not get my vote.

I wonder what my very liberal colleagues/friends would say about this?

Why Do I Have So Much Stuff?

Our contractor, Taylor, requested that we empty out our closets, so that he could get inside and install casings, baseboards...etc. So far, we have only vacated 3 closets- the hall way closet, the linen closet, and the pantry- those with doors, and already, we clearly own way too much stuff.

I found dinner napkins that I had registered eight years ago, with tags still attached. I found way too many sets of sheets, way too many blankets, and just way too much stuff.

Note to people getting married and compiling registries- don't bother asking for table clothes, unless you KNOW what size table you will end up having, and you know you won't shrink your table cloth. We had a square table when we got married, and so I have these square table clothes, but no square table. I also have an oblong table cloth, but I shrank it after the first wash, and it is just not the same anymore.

I also have gabillion baby blankets, ones that people made, ones that Chinese people made... Must get rid of them.

I shudder at the fact that sometime next week, I will be emptying out our wardrobe closets...

Argh

So, we owe IRS a lot of money. Hubby says it is better this way than being audited. To be audited means you have to prove everything, and they will still make you pay. Meanwhile, we also need to file an amendment for our state tax and will owe them money too. Argh.

Our new doors are in place, and I am very happy with them. The house looks 'finished.' Although we are not finished AT ALL! New baseboards will be in next week, and then I will really have to pick out paint colors and get that going.

There are a two things I despise about home renovations. Nope, the cost isn't one of them, although in light of our debt to IRS, maybe that will change.

I hate coming home to dirty floor and bugs. I totally understand that when you work on the house, the contractors have to wear shoes- for safety reasons, and therefore, the floors are going to get dirty. I also understand that the door will be left open as our contractor goes in and out while he diligently works on our abode. Our contractor is actually awesome. He cleans up after himself everyday, and is just great when we ask him to do this and that. He is also super responsive, always calls me back, and very reliable. His work is also excellent. Anyway, if you want his contact info, I am happy to pass them on. I also know that my standards for what a clean floor is can be a tad high... Still, argh. Everyday, I drag the kids home, mop the floor, chase the bugs out, all the while making dinner... This so needs to be over.

Well, I should get my sweet son, who has been very quiet for the last 90 minutes, in his west facing room, upstairs, probably because he is already baked through and through in this heat wave...

Reading

I just found another colleague who wants to make music together! She had been looking for a singer actually, and it will be awesome! We even made plans to get together to read through some music, of course, that appointment wouldn't be until the end of the month. What is up with making appointments with my fellow psychiatrists? Whenever I want to see Wes, whom I trained with, we make lunch plans about 10 weeks out. Anyway, she said she was really excited to accompany me, especially for pieces that would be challenging for her. I was excited to have my new version of Paul again.

Paul was the faithful accompanist I had all through out college- Mr. Paul was simply awesome. There was nothing that Paul couldn't do. I really miss him.

I also really miss MaryBeth- my sweet voice teacher.

I had no idea how GOOD I had it in college- to have an hour long singing lesson every week, with another hour for singing for my peers. All of which were properly accompanied. With no extra cost to my tuition! Good times, good times.

In terms of reading, I stayed up late last night and finished A Thousand Spendid Suns by Khaled Hosseini. An amazing story, totally on par with his first book, The Kite Runner. I thought I had problems... Mariam and Laila had problems. While the book is fictional, I am quite certain similar stories happened. High recommend it!

I am now going to read my tax return from 2006. We got a letter from IRS about that... S.U.C.K.S.

Humoring Myself

Everyday, on our way to school and back home, we pass by this ginormous TV screen off the freeway. Aidan loves looking at it to see what advertisement they are showing, in the recent months, he has really enjoyed looking for Wall-E on it everyday. Recently, the screen is showing Little Mermaid, I suppose Disney is re-releasing it or something. So Aidan wants to see the movie, and he wants me to tell him the story.

So I tell him this version: “There is this mermaid who wants to go on land and explore. She finds this octopus that sells tricks and gives the octopus her voice to buy legs. She would only get her voice back if she manages to get a kiss from the prince in 3 days. She goes on shore, falls in love with this prince, and is about to marry him but the octopus gets really angry. The octopus then changes into this other woman who than sabotages the wedding. The prince and the mermaid find out what is happening and they destroy the octopus. Then they get married.”

What question does a 4.5 year old boy ask?

“Mommy, what weapon do they use to destroy the octopus?”

What answer does a mother who thinks she is funny say?

“They use the lightsaber.”

Aidan is really happy with that answer.

Happy Anniversary to ME!

As of today, I have been on this job for 52 weeks. This is the longest I have had a 'real' job. Granted, this is only my second job- I don't count residency, because one continues one's education during residency and one cannot be sued as a resident (only the attending gets sued...usually, I think.) I am amazed I have held on to this job for this long... A colleague asked me today if I had thought about leaving, I honestly told her, with a grin, 'almost everyday.'

The thing is, with this job, my patients don't leave me, my case load just gets bigger, people don't really get better, and it just goes on, and on, and on.

As for the patient who was glad I went looking for my groove- it is actually interesting to think about this diagnostically. Essentially, all the patients who say these inappropriate, out of boundary things, are either personality disordered, or manic.

I have had patients who tell me their opinions about my clothes, weight, hair... and inevitably, only people with very loose boundaries (or any) will say that to their physician. So I bet you are wondering if you have those thoughts about your doctors... It is ok to have a personality disorder. 1 out of 10 people meet diagnostic criteria. And actually, I think, all politicians have some sort of personality disorder, I mean, you don't get to such powerful positions without pushing boundaries. The important thing is to use your personality traits (doesn't that sound so much better than 'disorder'?) to your advantage.

Strangely, while the prevalence is about 10% in the community, my case load has about 70% personality disordered people... very exhausting...

On a lighter note, I would like to talk about my charting practices. (SO exciting, I am sure.)
Sometimes I use our electronic charting program- then print out a copy of it to put in the chart. Not paperless, at all. I find it rude to type while I am listening to a patient, so I have to wait to do my charting after the patient walks out, which doesn't save me time. So if I am in a big hurry, I write as I listen, which I don't find rude at all. (Okay, it is still really rude to do this...) but I have to keep up with the flow! I find that I write in greater detail when I am writing as the patient is going along, I write things like "wearing a totally different outfit today than ever, a shirt with flames on it." I know, really useful stuff. I can already picture this, "Your Honor, I did write that. He was wearing a different outfit. Usually he wears dirty pants, but on 9/2/2008, the pants were different."

The trouble with writing the note as I go, is that a patient might start off very cooperative (so my mental status exam says, "Cooperative, polite, well related." But then I say something about tapering their hypnotic, or some other habit-forming medication, or discuss their Mary Jane usage, which then makes them unhappy and less cooperative. However, I can't go back and say that patient was irritable, uncooperative, and rude. I have to write so many other words, to make a smooth transition. Smooth transition in charting is what is really on my mind...

The electronic charting option is very useful for returning phone messages. As I dial, I start typing what they said in their message to me, and then I type as I talk, and hope that they can't hear the clicking of my keyboard.

Okay, enough about charting. I gotta go clear the dinner table.

Wrapping It Up

I know the end of my mini vacation is over, when I try to call into my work voice mail. To access this voice mail, I first have to call a 'special' number- there is actually nothing special about this number, I have called it hundreds, if not thousands of times. But of course, I cannot remember it for the life of me. I try calling the operator at work, she says she has no idea. I try calling the Emergency Room, hoping to speak with a colleague who would clue me in. Of course, my esteemed colleague is no where to be seen by the nurse. Of course, nurses don't ever get voice mail so he doesn't know what number I am calling about. I really want to check my voice mail! Sometimes, it can take me a very long time to check voice mail after a long weekend- there are times that box contains 20+ messages, with each caller leaving a message of about 2 minutes, it would take me close to an hour to retrieve them, never mind returning them. I really want to get this done this evening, so my day can be about returning messages instead of scribbling down messages, all the while getting a new message while I am trying to get through them all.

I call a resident, whom I know well, so it isn't like the boss calling someone else at home. Or is it? Anyway, she knows the number! I call it. Gloriously, there are only three messages! Even more gloriously, none of them are really my issues- medications are my issues. Housing issues are not mine.

Meanwhile, I do get this message. Literally, it goes like this.

"Hi Doctor. I am so glad to know you are taking some days off (WHAT?! YOU MEAN YOU THINK I NEEDED TIME OFF?!) and I really want to talk to you (blah, blah, blah, he goes on for a while), so when you get back on Tuesday, when you get your groove back (NO KIDDING!) can you call me?"

This comes from a patient whom I have never met (he had called last Monday at 10:10 AM that he wouldn't make it to our 10 am intake appointment, but then his name wasn't actually listed as my new intake. On the other hand, my new intake never showed anyway, so maybe he was the intake, he just has two names?!) and already, he thinks I need to find my groove.

I have my groove, thank you very much.

I will have more groove when I start exercising seriously.

Aidan, on the other hand, is going to be so RIPPED. With weekly lessons in swimming, ice-skating, soccer, on top of the usual run-around exercise he gets at school... I have high hopes for all three- since all three are excellent all-body workouts. Imagine, endless laps, either on the field, in water, on ice... It is going to be beautiful...

Relajar

Hubby has been teasing me these past six days with the word, "Relajar." Whenever I am focused on something, he would walk up, and say, "Honey, Relajar!"

These are few words I picked up in Spanish as a medical student.
Relajar
Respire profunde

Yup. That's all. Relajar is a useful word, for vaginal exams, rectal exams, abdominal exams... And apparently, also sums up these past six days.

It has been super fun to have Aidan and Zoe home with us all these days, to not have anywhere to rush to, to eat out whenever, whatever, sleep in, take naps everyday. I am so well rested that I actually can't nap anymore. While we accomplished an outing to the Monterey Aquarium, it has been super low key here. Aidan requested to go see a 'not so scary' movie- so Hubby and Aidan went to see Space Chimps after lunch today. Zoe went down for a nap, and is still, thankfully, sleeping. I decided to make THREE batches of my scones. (Mention those scones to Hubby, and he is all smiles, how could I not make them?) I now have 24 scones in the fridge/freezer, waiting to be baked/stored. Yum.

We are also breaking rules. Well, just one. Remember our rule, that A&Z will not be involved with more than two extracurricular activities at a time? Well...I am eating those words. Aidan is loving soccer (although he has only had 1 game.) He is so excited about ice-skating/hockey lessons. And, since he has been 'swimming' this summer, we feel we should take advantage of his excitement about being in the water, and try swim lessons again. Rules are meant to be broken anyway, right?

My plan, though, if I may say so myself, is brilliant. I rejoined our local YMCA, and signed Aidan up for a Tuesday evening lesson. The way the Y was built, I could go work out myself while watching him in his swim lesson! As much as I resisted going back to a gym and paying monthly fees and driving to go exercise, working out on my own just isn't happening. (And I am still break out in hives, from time to time, which really makes me not want to exercise outdoors with those pollens/cold temperatures.) I figured that I would work out on Tuesday evenings (still make it home by his bedtime of 8), swim on Wednesdays (my day off) and go in either Saturday or Sunday during nap time. I need to take care of this body... Gotta live LONG to see A&Z with kids of their own and say, "I am so glad you have a child who is JUST like you!"