Friday, August 22, 2008

Zoe's toes

I have been meaning to write about Zoe's toes. After Aidan started on antibiotics for his wounded left big toe, Zoe injured her left big toe. Partly my fault. Oops. I let her carry something really heavy around the house, like a can of root beer. (Better than beer, right!?) She found it in the fridge when I opened the fridge to get dinner ingredients out. She was having a very fun time, toddling back and forth with her ginormous can. Then, I heard the can drop. A second of silence, than screaming. She dropped the lip of the can on her left big toe, made a laceration, and was bleeding all over the place. I tried to hold her while keeping my outfit clean (dry cleaning is $!) and after a minute, she calmed down, but only after showing me with her screaming mouth wide open, that she also bit her lip as she fell... and the bleeding from both sites stopped. Oops.
Fortunately for her, children heal so quickly. The toe already looks way better today.

Need Longer Arms...

This evening, as I was helping the children with bath time, Aidan and I were chatting. I started to get his shirt, off, then his pants, and underwear. What I found, was a big, brown, surprise. Apparently, Aidan had gone poopie at school, and 'wiped' himself, pulled up his pants, and used his underwear as the true wipe. Hubby was with Zoe, and as I showed him the underwear, we just had to laugh, because it was so ridiculous.
It was time for Aidan to take a wiping lesson. As I observed him, I realized, it wasn't his fault at all! His arms simply weren't long enough to reach properly. One of the reasons that babies are so cute is that they are totally out of proportion. Really big head, short arms, long torso, almost no legs. Aidan's arms are catching up, but clearly, reaching behind is still difficult. That child needs longer arms.
I am hoping that his longer arms will get here in time for kindergarten...

Wednesday, August 20, 2008

Providence

I have been thinking about God's providence. It is so easy for me to say, "Cool! It worked out!" without fully thinking through that God's work is in every facet of my life, and it is purely by His mercy when things happen. Left to my own devices, my life would be in pieces, following the law of entropy.

For example, we had to do some taping for our walls, and the final step of it was sanding. I didn't know when it would happen, and it was totally out of my control since it was up to the schedules of my contractor and his taper. I also usually get some extra help every other Tuesday to keep this house livable. When the taper came yesterday, Tuesday, he told me about sanding, and how he will use a vacuum sander, and he will still cover up our stuff with his plastic, but there still be some dust. Upon confirming with my extra help, it turned out that the taper will be done by the time she came! I came home to a dust free house! Is that providence or what?!

Even in finding Aidan's infected big toe last night, it was really God's mercy that I found it on a Tuesday evening, so that I can use my free day to take care of it. God could have led me to it on a Wednesday evening, and I would have to take extra time off for the pediatrician. By the way, no such luck for my plan that the treatment would be a punishment for picking at his toenails. The pediatrician thought there hadn't been enough studies done on intramuscular antibiotics for cellulitis, and he couldn't recommend a dosage that would be guaranteed to work. However, I did talk him into giving us something once a day instead of three times a day. The antibiotic, according to Aidan, tastes like strawberries. The lady next to us while I dosed Aidan right there at the pharmacy said, "Does it taste like candy?"

Anyway, in The Hiding Place, my all time favorite book, Corrie Ten Boom wrote about how her sister, Betsy, whispered to her while they were at Ravensbruck, "There is no if in God's world." I take so much comfort in that, knowing that while I apply the gifts God has given me, He will lead me to the decision that would serve His purpose.

Speaking of purpose. I have been struggling with whether or not to join an insurance panel. Up to now, my practice has been a fee-for-service practice. All the patients gave me my fee at the end of the session, and they billed insurance themselves to get whatever reimbursements they might get. For most of them, they probably only collected 50% from the insurance. It seems, according to David, the prime minister from my favorite movie, Love Actually, so elitist and wrong. The benefit from being on a panel, besides not carrying the guilt of being an elitist, is that I would get a lot of referrals from the insurance. Truth be told, I wouldn't even go see an optometrist out of my network, and I would only see him once a year! I would probably get a wider variety of patients, which is always a good thing. The cons are that I would have to take whatever insurance will pay me, and there is a delay in payment since I have to submit it, wait for insurance to act on it, and probably get the payment 30-60 days later.

A few months ago, an insurance panel contacted to offer me a higher fee schedule to join them. I thought about it, talked about it with Hubby, checked with a few colleagues, and got a wide variety of advice. Some said, "Are you crazy?" and some others said, "Of course you take insurance. You should take ALL kinds." I had to think about whether or not I really want to grow my practice, do I want to work more? Do I want to take these chances? What an unknown! It had been anxiety provoking- I couldn't sleep last night, and had been waking up at 5:30. However, a decision had been made. I will join the panel, if nothing else, I am early in my career and should know what it is like. I mean, I have done everything else, inpatient, outpatient, indigent, fee-for-service, HMO. Time to try this new thing. Besides, if I don't like it, I just give them 60 day notice.

So I am trying to get credentialed, which can take up to SIX MONTHS. The person I am working with actually said, "It will go by so fast, you might as well enjoy this downtime." Does she mean that it will be hectic? Do I really want that? Fortunately, God is at work in this. I am just an instrument.

Tuesday, August 19, 2008



This angelic child likes to smush unfamiliar foods before she eats them, or she likes to chew food and then spit out all that was in her mouth. Or, if I ever make the rookie mistake and offer her something else while she is already masticating on something, she will spit that out too. Regardless, it is all very messy. I found old, old, sticky, gooey mess under her booster seat after dinner today. Yuck! She also really needs a haircut...



This angelic child has an ingrown toenail- because he has been picking at his toenails. Why? He can't tell me, and I suspect because he is nervous about something. What is there to be nervous in this child's life? Transition to an older class, a sib who is becoming more 'involved' with his stuff, his mother...just to name a few possibilities. Instead of watching osteomyelitis set in, I am giving up a lunch with a colleague to take him to see a pediatrician. (What do you think are the slim chances that the physician would be on time for a noon appointment?!) I am thinking about requesting some sort of intramuscular placebo, just so that he is punished enough to not pick at his toes anymore. Or to not have the topical anesthetic when they trim his nail, or something. I am an evil, evil, mother.

Continuity of Care

My one year anniversary at my job is coming up. It is really hard to believe that I have been here for an entire year as an attending, adding on to the three years I was here as a resident, I have known some of these patients for four years. FOUR YEARS! I have known some of these people longer than I have known Aidan!

There are essentially two ways to categorize physicians: the ones that practice continuity of care, and the ones that don't. Typically, radiologists, emergency room physicians, costmetic dermatologists, and the like, don't follow patients over the long run. Psychiatrists, pediatricians, most internists, follow our patients for a very, very, very, long time. Some days, when I am so TIRED of the same compliant from the same patient, I think about how I would no longer have to treat this person, and the options are pretty limited. 1. I retire, 2. The patient fires me, or 3. The patient moves, or 4. I quit. Otherwise, most of these patients stick around.

I like knowing patients over the long run, to know them intimately is a privilege. Of course, it is also inevitably sad, since illness and diseases progress overtime. Just this week, a patient found a recurrence of breast cancer that she battled in 2000 (before I met her in 2003.) Another patient, with multiple medical problems, and schizophrenia, is also getting more and more sick. His primary care person and I already discussed his limited life expectancy (so I guess there is a fifth option, that the patient dies...) and I am prepared for the day when I get that phone call.

I think I am better at short term treatment, so in-patient work is definitely my calling- to discharge someone, wave good-bye, is a treat!

Monday, August 18, 2008

It Is Finished!

I triumphantly declare: The Task Is Finished.

I transferred all my xanga blog posts to here! It took a while and some of the videos didn't transfer correctly, but alas, I have better things to do. The change in blog hosting site is because so many of my friends are on blogspot, and it just looks better. Xanga's sketchy advertisements have gotten old...sure, I could pay to get the premium version, but then Hubby's blog is at blogspot! Gotta keep the family together.

So here I am!

Monday, August 18, 2008

Allusions...

I was reading my sweet readers' comments. Yes, I think Aidan is pretty mature for his tender age of 4.5 years, but sometimes, I think what I tell him might be considered inappropriate, or as they say in court, leading. For instance, to his question of "Why are people always buying houses?" I told him, "People always want to make more money, own bigger homes, bigger, newer cars, and so they spend a lot of time doing all those things." This afternoon on our way home, we were listening to the radio- 740 KCBS- and all of the sudden, he asked, "What are they talking about?" It was a commercial about infertility treatments. The ad went like this, "I was 38, I was 36, we thought we could do it, but we couldn't...etc." I told him, "Sometimes when people get older, it gets really difficult to make a baby. Daddy and I were really blessed, we made you and Zoe pretty easily." "How old were you when you had me?" "I was 26." He didn't actually move on to ask the next question: "How do you make a baby?" Oh but I am ready!

As for our good, happy moments, thankfully, we are having more of those. But let's not forget all the moments of, "WHAT ARE YOU DOING? Will you just come to x, or y, or z." Or this, "How many times do I need to ask? What did your mother just say?"

Or this morning. Aidan got timed out for speaking defiantly. "I don't want xyz! NO!!!" Hubby timed him out, he sobbed, while our contractor worked silently about 10 feet away. Geez.

I started formulating my tactical plans for passing my oral boards, I own this book called Passing the Psychiatry Oral Boards. From Amazon, I ordered a highly recommended book called Boarding Time. Upon my investigation, it seems like they fail about 50% of the test takers- I should have known, with my written board score, I am eligible to sit for the oral thrice within six years. Of course, each attempt would cost $1350. The exam itself contains 2 section, an hour for working with a real patient, and another hour of 4 written or video vignettes. I will be scored on a scale of 1-8, with some weird multiplication to 'balance' the scores, and out of a total of 64, I need 40 to pass.

Apparently, the oral is the more difficult part...

My Happy Campers
We had such a relaxing weekend, no set agenda, just whatever we wanted to do.

Aidan did almost everything he wanted to do, with the exception of visiting the Lego Store. We live close to one, and therefore, Aidan ALWAYS asks to go. He likes to paw through all the latest arrivals to figure out how long he would need to save for, and most times, we walk out empty handed but he is as happy as can be. What he DID get to do was a lot. He watched The Mighty Ducks, in snippets, he went to the library and found a Spot (by Eric Hill) book that he hadn't read before, he got to have some down time (actually, he is really good at staying in his room for at least an hour on his own), he got to go get ice-cream with me on Saturday, and we did grocery shopping on Sunday (he picked out a grass jelly drink, sounds weird, but really tasty.) He got to play hockey, and he got to see an ice-hockey game! He had fun.

Aidan is a great companion for errands, he knows to bring his good attitude and excellent behavior. This afternoon, while we were driving to the grocery store, he saw a bunch of open house signs, and he knew exactly what those were. And, he asked to GO to an open house. We found one, and he was great in there, asking all the right questions, "Why are there so many houses for sale?" "Why are people always wanting to buy houses?" "What is a sunken tub?" As I was telling him about how great he was at the open house, he said, "Do you like my good attitude? My good behavior? I brought my listening ears." SO. CUTE!

Zoe also did a lot of stuff, she went to the park with Hubby (just the two of them- Hubby didn't tell me, but this was a photography session to explain finer points of metering light, and she was his free model), she took long naps, she decided that she really has no taste for anything artificially sweet (she gags on ice-cream, she gags on the aforementioned grass jelly drink, she smashes her cake to teeny tiny pieces). She played a little hockey, played with an easel, ate an obscenely large amount of blueberries, she played in the car, and pooped every time we were out and about.

Zoe has really sprouted in the last few months. While I always think of her as a little girl, she really isn't so little. When we were at Toys R Us, (while the guys were watching the ice-hockey game- we left to stay warm) there was another little girl that was exactly Zoe's size, but she was speaking a lot. I asked those parents how old their girl was, and that little girl was 20 months old! I asked because I was curious when Zoe would be speaking more. (I honestly can't remember how old Aidan was when he started speaking.) Her gestural language is excellent, her sign language is passable, but spoken language? I am afraid Aidan speaks for her. I am sure she will catch up very soon though, and I will be in trouble...

Hubby got to work on his stuff uninterrupted for a while, he slept, and relaxed.

I cooked an amazing meal, or so the guys said at dinner. Not much else for me, just reading, relaxing. Oh, and I canceled our weekend getaway for next weekend. We were planning on heading to Sonoma for a NASCAR race, but the adults got lazy, and realized we didn't even have tickets to NASCAR and figured that if we didn't have those by now, we wouldn't be able to get them. We will stay home instead, and do much of the same as this weekend.

I am, however, starting to plan our big vacation for 2009- a cruise trip around Greece! If Aidan goes to year round school, we will go in October, if he goes to traditional school, we will go in July!!! Hopefully, maybe...


Friday, August 15, 2008

Happy for Two Seconds

I have GREAT news! I passed my written boards. Like I had written previously, the whole thing seemed sketchy. I took the exam in early June, and I was told that I would get my results in about 8 weeks after the last day of test. Everyone's suspicion was that the Board needed that time to be sure to flunk a certain percentage of people, to ensure a certain amount in revenue (from people paying to take the same exam again.) Then I found on from their website that letters would be mailed on August 29. Well, yesterday certainly wasn't the 29th, and my letter was dated for the 29th. Strange.

Nonetheless, I was ecstatic that I had passed. Actually, the night before as I was drifting off to sleep, I was praying, "Dear God, the letter will be coming in about 2 weeks, please God, let it be good news. And if it is not good news, please help me to get through this. Please God, have mercy..."

So I was SO happy when I got the letter. But only for two seconds, because, enclosed in the letter is the registration for the oral boards. May, 2009. In Denver. And they want $1350 before November. Apparently, if I miss the November deadline, I forfeit this chance to take the oral boards and would have to START OVER. Seriously.

Like giddiemon said to me a few months ago, the best times of her life (as an actuary, who is constantly taking exams) is the time when the results are pending. She has neither new exams to study for, and no news is actually good news.

I am excited though, that after I pass the oral boards (Please God, be merciful and let me pass...) I won't have to get recert until 2018. Zoe will be ELEVEN. Aidan will be FOURTEEN. Wow.

And, good thing happiness is really not related to external circumstances, but a gift from God. Or else I really would have only been happy for 2 seconds...

Monday, August 11, 2008

This is what he is up to...

I ran a quick errand and made it home for lunch today. Leftovers, yum.
Anyway, I thought I sit down and read some blogs. And now, I know what Hubby is doing after I go to bed. Typically, I like to go to bed by 10. On the dot. Any later is just much too late. Hubby's circadian clock is totally different than mine. Last night, as I waved good night to my sweetheart, he was tinkering with his stuff. And now, I know what he did. It is always interesting to find out later what Hubby was doing while we were fast asleep. I don't think Hubby can put his thinking cap on until everyone else is silently enjoying REMs.

Sunday, August 10, 2008

How Many Cars Will Be Towed?!

After much anticipation, planning, and second thoughts, Hubby and I left our precious children with a sitter and spent a night in San Francisco. This trip had been my dream, for the past year, that we would find a sitter whom we trust completely and that these children would not scream their eyes out, and that Hubby and I would start down the path of 'getaway weekends without children.'

Jaclyn is a teacher from Aidan's school, whom Aidan adores, and we admire- simply because she never raises her voices, even at the most poorly behaved children. The month before the big Departure, I started writing down notes for her, including random things like how long to microwave her milk and such neurotic things.

On Saturday morning, we had planned that she would arrive about 11 am. I took Aidan on our little date to the mall, where he drank a bunch of juice and got a new set of Lego Star War- General Grevious' War Ship, in case you're interested. When we got home, Hubby informed me that Jaclyn was delayed because a car was blocking her car and she needed to wait for a tow truck. She finally made it by 12:15, and after running through everything on the list and putting Zoe down for a nap (we thought Zoe should see the person who would get her before she fell asleep) we finally took off.

Hubby and I had SO much fun. The whole 27 hours away had a theme: to be as spontaneous as possible. We shopped, I got a new pair of shoes (big surprise! But in fuschia pink! And for MUCH less!) and to our delight, got a reservation to The Slanted Door. To be honest, I had wanted to make a reservation at The Slanted Door, but by the time I got around to it, none was to be found. While we were checking in at the hotel, the young man helping us asked if we needed suggestions as to what to do, and we laughed and said that we actually live here. Then I was just talking to Hubby about maybe we would try to get a table for afternoon tea at The Slanted Door, before the dinner rush. This young man then said, "Actually, would you like to go at 7:30? We have a reservation for that time, but Mr. Michael Martin changed his mind in the end." We gleefully took the reservation and pretended to be the Martins. The atmosphere at The Slanted Door was way more hip than we could ever be, but the food was amazing. It was all very tasty. SO YUMMY!

We were determined to sleep in, our one opportunity in a life time, but at 8:30, my phone buzzed. As I looked at the number, it was from our home! That could not have been good. Upon calling Jaclyn, it seemed that her car got towed! (In our complex, to leave a car outside requires a special tag, and among all the things I wanted to tell her, I forgot about this one!) She was afraid it got stolen... After waking up a neighbor to inquire what she did to get her car back last time, I phoned Jaclyn, and she had arranged for another teacher, Melissa, also from Aidan's school, to help her get her car back. All that, cost $350. My forgetfulness= $350. Dude...

Hubby and I were mostly sad about the fact that due to this unexpected turn, we missed an opportunity to have Jaclyn go to church (I know, a little strange, but we had requested that she would take the kids to church.) Nonetheless, determined to not let this ruin the rest of our time away, we had breakfast in North Beach, picked up treats in Chinatown, and drove over to Noe Valley where found little gifts for A&Z. We got home promptly at 3, to a garage door that won't open, and random things around the house.

So I had a little re-entry problem. The kids were adorably sweet when we got home, but as Hubby tried to figure out the garage door and I tried to figure out what happened to the laundry- clean? dirty? This wasn't how I left it?! Or was it?! I discovered a few things. I like my floor REALLY clean. I load my dishwasher in a very particular way. And when one hires a sitter, it is guaranteed that one's children will convince the sitter to let them watch a lot of DVDs.




But so did we. To have a hotel room with a real TV was our one chance to catch any of the Olympics!

28 hours after we left them, everyone seemed to have had fun, and the floor is crumb free again. We did miss the children a LOT this morning, but also really enjoyed not having to feed people at appointed times, and to not have to pack for every conceivable situation. We will definitely do this again.


Friday, August 08, 2008

Too Many Options

Hubby and I attended a special meeting with the administrators and other parents from Aidan’s pre-school class yesterday. It is quite a privilege that Aidan is still in school with these friends, most of whom he has known since infancy! He has ‘played’ next to Ms. ML since they were about 4 weeks old- we were in the same Mommy-And-Me group. Anyway, some stuff had been happening in Aidan’s classroom, that as the new academic year gets going, all the parents wanted to have a heart-to-heart discussion with the folks in charge. It was a really productive meeting, and it sparked the quest for more information in me again.

With just one year left before kindergarten, we have decided to not pursue private school education for now. Our city’s public school system is excellent, has good reputation, and except for the fact that there is no high school in our little city, most parents are very happy educationally. The biggest dilemma now is whether to send Aidan to the school across the street, for traditional year, or another school that requires a five minute drive, for year-round schooling. While the School Across the Street (SAS) is perfectly acceptable, I have heard that Year-Round (YR) is the best funded elementary school EVER, and everyone raves about it. If my goal in life is to be green, we would choose SAS. However, life isn’t just about being green, and I know kids learn better in YR, less time to forget stuff in the summer, I guess. Also, YR school gives me more flexibility in traveling.

Then there is the dilemma about what to do with Aidan when kindergarten finishes. I don’t know why kindergarten finishes at 12:30, I mean, isn’t that a really short day?! As much as I want to switch my work schedule around, I can’t cut it down to 20 hours a week. We have two options, a Chinese program or a program on campus. I plan on visiting the Chinese program (it will be Aidan’s one chance to learn some Mandarin, I think), and the two on-site programs at SAS and YR. I have a faint inkling, that our choice of either SAS or YR will be determined by how much we like the after school program on site. Also, I plan on begging my father-in-law, to take Aidan perhaps one afternoon a week. And I can be with him one afternoon a week, so hopefully, he will only need to be in extended care 3 times a week, you know, since he will be mixed in with older kids, older kids who might eat these young kindergarteners.

As Aidan’s schooling will be super local, we will also have to reconsider whether to continue Zoe at their current location, or not. The Day School they attend is about 7 miles away from home, and I think, I can do without getting on the dreaded freeway, and I will also gain some more precious time with A&Z outside of the car. Fortunately, their Day School has a campusy in our little city, so it might work out to just ‘transfer’.

That is all good, in theory, but, what if I change jobs? My best plans might not then, be best plans. But that is okay, God provides.


Wednesday, August 06, 2008

The Inevitable

I probably hold a not-too-popular opinion, one that I am about to express, but oh well, read on, it is your choice.

I am growing increasingly skeptical of Candidate Obama. It seems that he is willing to say whatever to get votes. Even some things that is starting to cast a doubt on his intelligence, abilities, and experience. For instance, he wants to tax the Big Bad Oil companies for their 'windfall' profits. Hello! Such a tax would be on the Saudis, the Iraqis, the Iranians, the people who sit and watch this oil just ooze out of the ground. The Big Bad Oil companies in the States invested billions in transporting liquid gold back here, refine it, and sell it. The problem with expensive gas is that we like to drive big cars, far distances, frequently. Of course, Big Oil companies have profits, you know, funding jobs, insurance, retirement, INVESTORS (like an average American who might hold a mutual fund.) (This is of course, an over simplification of the complicated supply and demand law of economics, but you know, so is Obama's grand plan.)

He also wants to give money to American car makers to develop electric cars- which I am sure, will be very favorable for his union voters. However, Japanese automakers are investigating this, and in a free market, may the one who plans a head, with a vision, good execution, wins.

I don't have any thoughts, yet, about Candidate McCain. Probably because everytime I think about him, I am a little worried that he might fall over and succumb to his old age.

I shudder at the state of the Union. BTW, I loved a particular sentence from the Wall Street Journal a few weeks ago, in jest, that Fannie Mae and Freddie Mac had made a Faustinian deal with Congress. That's right, I think the government, let it be the White House, or the Congress/Senate, have been doing way too much manipulating/protecting/saving a.s.s. of the credit crisis. That essentially, Fannie and Freddie should not have continued to sell risky mortgages, but the government was so busy propping up housing prices that Fannie and Freddie sold their souls. If it were up to me, I would let it crash and burn, probably also a very unpopular opinion.

Well, I should go and put away about 10 loads of laundry... There is no one to rescue me from this task, and I can't tax anyone about this task, and there is just no spinning this, as mundane as it is, it is important for the state of this union.


Monday, August 04, 2008

Urticaria

I had high hopes of exercising regularly this summer. I was going to be toned, strong, with amazing endurance. But alas, my body had other plans.

I went for a run about 10 days ago, and when I got home, I had some serious hives on my thighs. The more I scratched, the redder it got, and eventually, hives broke out. I had exercise induced urticaria (cholinergic urticaria), since then, it seemed like I woke up the beast, also known as mast cells. It is still in the actue phase (duration shorter than 6 weeks), but good grief, there is such a thing called chronic urticaria, up to 30% of all urticaria cases! I do NOT want chronic urticaria. Must. Get. To. Some. Antihistimines. Very. Soon.

Cholinergic_urticaria

(BTW, this isn't MY urticaria, someone else's, from a textbook.)

I don't think my body is meant to be exercised.