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Archive for the ‘Tolkien’ Category

Healthcare Hot Potato

In Hazelnut, My thyroid, Peanut, Tolkien on September 24, 2013 at 3:23 pm

Oh you poor neglected blog you! I’m glad you’re not a baby human, and I’m sure Child Protective Services is too.

So how’ve you guys been? Things at Casa Much are trucking along. Update, you ask? Oh, you didn’t? Well, since I’ve already started …

On the thyroid front, when I went for my 1-year follow-up in February, my endocrinologist told me I would need to go through treatment again. For a variety of reasons (not even including the utter hassle it would be) this was concerning to us:

a) because of repeat radioactive iodine’s potential effects on fertility or implications for a future secondary malignancy

b) because of the fact that this recommendation did not follow published American Thyroid Association treatment guidelines, and

c) because of the inability to get a clear explanation from my endocrinologist about why he was recommending this. We seemed to have a tough time understanding each other in person (English was not his first language), and he totally ignored an e-mail I sent with my questions.

This latter issue was the straw that broke the camel’s back for me. I know just how chaotic a physician’s day in clinical practice can be, but I have never failed to respond in some way to a patient’s e-mail or phone call. I would have absolutely understood if he didn’t have the time to write out a four-page reply and if he had instead asked me to come in to discuss it — no problem at all there. But to pretend a patient has not communicated with you is unacceptable. So that was when I decided it was time to try to find another endocrinologist. But to pinpoint someone who takes our insurance, is located within 50 miles of us, has expertise in thyroid cancer, and has an opening within the next few months is a daunting task. Eventually, however, I did find someone, a doc who actually graduated in Tolkien’s and my medical school class, although he joined towards the end of our time at school so we didn’t know each other. As well, Dr. Med School Classmate (Dr. MSC) and I have a very close mutual friend who I’ll call Dallas Cowboy (these nicknames are cracking me, if nobody else, up) who also vouched for him. Dr. MSC turned out to be awesome. Really kind and helpful, even after I tortured him with endless questions, and he felt we could do some testing first rather than going right into a repeat round of treatment (which was what Tolkien and I also thought was the best plan.)

So there I was, friends, blissfully skipping along in the care of a new, sane endocrinologist, my long search over. It just so happened that Dallas Cowboy and his wife came to Easter services with Tolkien and I later that month. When we were leaving brunch together in the same car, Dallas Cowboy’s cell phone rang. “Look,” he said, “it’s Dr. MSC!”

“Oh!” I said. “Tell him I said hi!”

And why do you think Dr. MSC was calling Dallas Cowboy? Why, to tell his good friend some exciting news, of course: that he was moving. To join another practice. Out of state.

What are the odds I’d be present to actually hear that phone call sending me back to square one? You can’t make this stuff up! Of course I didn’t blame him at all and I was happy for his opportunity, but I needed a nap just thinking about starting my search anew.

So there I was back at the aforementioned square one: needing to find a new endocrinologist. (For those of you keeping track at home, this would be Endo #4 in the course of one year.) I was out of options as far as covered providers under my insurance, so I had no choice but to go back to [prominent academic hospital.] However, I wanted to see a different physician there since I’d had a less than satisfactory experience with the one prior to Dr. MSC. But roadblock! The endocrinology department at this hospital has an unusual policy — they do not allow you to switch providers without express consent from the first one. What? I’d have to ask my original, less-than-awesome doctor for permission to switch like a meek child, explain to his face why I was uncomfortable with his care, and then abide by his final judgment over whether I could stay or go? It’s not even like we have socialized healthcare in this country — I’m paying my own money for insurance and for these appointments, and it’s clear that the payor system treats patients as as consumers. And as one of those consumers, I still have no choice?

Luckily Dr. MSC trained at said hospital and very kindly offered to intercede on my behalf. (He also told me that he’d had multiple patients switch from Less-Than-Awesome Doctor to him over the course of his time there, which may be why the hospital has this policy in place to begin with, to ensure that Less-Than-Awesome Doctor doesn’t end up with no patients at all.) One endocrinologist did agree to see me, but his office still insisted that I had to write a letter to my original guy. Which I did, simply being grateful that I didn’t actually have to have an awkward conversation with him. (Never heard back from him.)

Several months later, I finally saw Endo #4, who seems very nice. He, too, felt that a second round of treatment was not warranted without some other testing first. In fact, he felt that another round of treatment was so far out of the bounds of standard practice that I must have misunderstood Less-Than-Awesome Doctor, since LTAD has an accent. I was not thrilled by this suggestion. Although I fully admit, as stated above, that he was not easy to understand, I am the child of immigrants — I’m not exactly scared away by accents. And I know what he recommended because I asked him a million incredulous questions about it. Anyway, it’s all water under the bridge now. More important is that Endo #4 then casually mentioned, after some varied comments about the weather, that he was moving … to Rome.

People, IS IT ME???? Should I start showering? Am I singlehandedly, one by one, driving all endocrinologists out of my state? Can they sense my unhealthy obsession with L. M. Montgomery? Should I instead start carrying around a copy of, I don’t know, The Art of War or some other universally “cool” tome as a talisman against loss of healthcare providers?

All is not lost, however, for two reasons. One is that Endo #4 is just taking a temporary professorship and should be back in the States next spring. The second is that all testing and treatment for me is on hold for now anyway, because of this:

Peanut #2

Yes, I currently have a uterine buddy. We are super-excited for this new addition (especially Peanut, who wants to know when her baby is finally going to exit my stomach into her smothering care) and are praying hard for a safe delivery and healthy baby. Baby Boy (I’m currently taking suggestions for his blog nickname … anyone?) is due in early December, and I’m trying to ignore all the people who have told us that going from 1 to 2 children actually increases your work by more than 100%. We’re concentrating on less important things at the moment, such as name selection. Boys’ names are hard! Forget blog nickname suggestions, anyone have real-life name suggestions? What did you guys name your sons? We are not above theft.

So no more news on the thyroid front for awhile (I hope), for a very welcome reason. I can’t believe that, after 4 years, we are re-entering the baby phase. It’s time to stop procrastinating, get out all that baby gear, and re-learn how to use it. You know, tomorrow.

Mishmash

In Books, Christianity, My thyroid, Peanut, Tolkien on February 21, 2013 at 2:54 pm

I am so impressed with these mommy bloggers who post every day and still have fed and clothed children. Where do they find the time? I’d be patting myself on the back if I could post once a week.

Since I am not there yet, though, let me give you a quick update on what’s been going on over the last couple of months, category-style:

1. Tolkien – Seeing the light at the end of the tunnel. Only 4 months left of residency, and then only a year of fellowship before our decade of combined medical training is finally over. It’ll be tough for awhile yet — he’s currently cramming for the first of 3 board exams over the next 18 months, which means even less time he’s able to spend with us — but we can’t help but feel a bit encouraged.
2. Peanut – “Mama,” she told me after receiving excessive hugs and kisses while she wanted to be doing something else, “I have TOO MUCH LOVE.” What a problem. She is the poster child for gender differences being inborn and not environmentally determined, given her sudden and random development into a fashionista. She is currently obsessed with skirts and dresses and how her hair should be done. We’re puzzled about where this has come from. I’ll admit I really like fashion, but given that I now work from home, she doesn’t see me dress up that much, so I don’t think she’s getting it from me. Tolkien lives in scrubs and doesn’t wear ribbons in his hair (to my knowledge.) So, school? It’s a mystery. I don’t like too much of an emphasis on physical appearance, especially for girls (I want her to place her value on her brain and her soul), but I also don’t want to be a killjoy, so I’m trying to go with it in moderation for now. I also took her ice skating for the first time recently, something we did all the time growing up in Canada (and I am no athlete), and it was a moderate success, in that no one ended up in the hospital.

In her salwar kameez

In her salwar kameez

There’s nothing wrong with wall-hugging. Or hogging.

3. Me – Had my 10-month thyroid cancer follow-up yesterday, and my endocrinologist says we need to go through all of it again in a few months — the low-iodine diet, radioactive iodine, isolation — for some long and boring reasons. A big bummer. As always, your prayers would be appreciated!
4. To be filed under “Divine Timing” – Tolkien and I took our first vacation in 5 years two weeks ago, by going on a Carnival Caribbean cruise, just days before the ill-fated Carnival Triumph took its most famous voyage. We had a fantastic time, which is lucky, because I’m pretty sure that if I had seen feces dripping down walls that I would never, ever, ever go on vacation again. Like, ever.

St. Thomas, U.S. Virgin Islands

St. Thomas, U.S. Virgin Islands

5. Favourites – I love reading quizzes people fill out, so here’s a quick one on me. If you feel so inspired, send me your answers to these questions! Really, I find them fascinating.

Favourite colour: Red and purple
Favourite number: 17
Favourite book: Way too many to list. Here are some that come to mind immediately. My disclaimer is that this list is in no way inclusive, and that some titles are listed not because of their literary greatness but because of their exceptional creativity.
The Blue Castle, L.M. Montgomery
The Count of Monte Cristo, Alexandre Dumas
The Screwtape Letters, C.S. Lewis
The Likeness, Tana French
Encyclopedia of an Ordinary Life, Amy Krause Rosenthal
The Murder of Roger Ackroyd, Agatha Christie
Rebecca, Daphne du Maurier
Favourite food: Chocolate, French fries, raspberries
Favourite exercise: Oh dear
Favourite herb: Dill. I came to dill late in life, but now I adore it. I credit this recipe with lighting the fire of my love. It’s actually addictive.
Favourite current TV shows: The Office (though it’s not what it once was, my loyalty shackles me), Downton Abbey
Favourite meal out, ever: It’s funny, as there are so many wonderful meals we’ve had over the years. But for some reason, one that really stands out is a delicious meal Tolkien and I had 9 or 10 years ago at Nawab, an Indian restaurant in Roanoke, Virginia. It was nothing short of amazing that an ethnic restaurant in an area not known for its ethnic diversity could create such a perfect tikka masala, naan and lassi, from start to finish.
Favourite animal: Zebras? Because of the symbolic nature of their black and white skins and how harmoniously they create a whole? I’m stretching here. Seems I don’t care much for animals.
Favourite quote: “For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither height nor depth nor anything else in all creation, will be able to separate us from the love of God that is in Christ Jesus our Lord.” Romans 8:38-39
Favourite chore: Washing dishes. And cooking, if that can be considered a chore.

6. Speaking of cooking, some of our favourite recent recipes:

2012-10-27_18-37-52_221

Vegetables being prepped for Balsamic Roasted Vegetable Soup (I’m not a huge fan of soup, so I never think to make it. But Tolkien is, so one day I decided to search out a recipe. This disappeared fast.)

Pink Oreo-stuffed chocolate chip cookies for Peanut’s class Valentine’s Day party.

2013-02-17_19-21-04_453

Pistachio-encrusted broccoli pesto salmon and mushroom orzo.

… and much more, of which I have no photographic evidence. I would invest in a better camera, but then I’d need to remember to use it to take pictures of things. Dilemma!

7. Collective treat for the day – A must-watch clip of the Downton Abbey cast doing a spoken-word performance of One Direction’s “What Makes You Beautiful.” You’re welcome.

Adventures in Involuntary Off-Roading

In Peanut, Tolkien on October 18, 2012 at 2:46 pm

Ladies and gentlemen, it’s quiz time! Just one question, for the win:

How do you most like to spend your hard-earned money? Would you feel best about it going towards

a) Food
b) Shelter
c) Clothing
d) Costly repairs on a finicky, out-of-warranty, 7-year-old car

If you picked d), congratulations! You can move into Casa Much, because apparently that’s exactly how we like to allocate our household dollars too.

We have a Hyundai Sonata (I named it Fluffy, which Tolkien fought vociferously for years but has now accepted — nay, embraced.) For the first four years it was a pleasure. It was relatively affordable, drove like a dream (I have to admit that it still does), had plenty of interior space, earned multiple comments from strangers about how they too were now considering Hyundai purchases. It even kept that new-car smell for a good half-decade — seriously. But then, like a latent schizophrenia that rears its head in young adulthood, things started getting weird. The front passenger seat wouldn’t sense me when I sat in it no matter how I fastidiously I rearranged myself, so the passenger-side airbag would remain stubbornly off. It would, however, sense my purse if I left it alone in the seat, and really I found it rather insulting how quickly the passenger airbag light would switch to “ready”, as if I should be happy that though I might smash headfirst into the windshield in the case of an accident, my bag with its stale granola bars and spare burpcloth would be lovingly protected.

Then the ignition started becoming more and more difficult to turn, until one day it stopped turning completely and I could not start the car at all. It didn’t help that this was at lunchtime on a workday when I was trying to get from the hospital to the office to see a full schedule of patients for the afternoon. We found out, just by Googling, that this is a common malfunction in Hyundai Sonatas. But did that mean it would be covered by Hyundai’s much-vaunted 10-year, 100,000 mile Powertrain warranty? Oh the naivete! Even though it’s a known defect, caused through no action of our own, the company just could not see why they would need to cover it! During my migraine-inducing phone calls to Customer Service, I also could not get a clear answer on what WAS covered by this mythical warranty. So I ended up writing a sternly-worded letter, as I am wont to do, to the CEO of Hyundai. And here’s where I have to give credit where credit is due: I actually heard back, they covered the repair, and I got a personal e-mail from the CEO himself! I certainly believe in rewarding good if you complain about bad, so we remained relatively satisfied, if lukewarm, Hyundai owners.

Then our check-engine light went on. Being rather afraid at this point of what this car was capable of, we took it to three different mechanics. The consensus? That it was something wrong with our check-engine light. You can’t make this stuff up! We drove around for a year and a half with that thing randomly coming on and going off, clinging to the diagnoses of our three manly mechanics.

Until a week or so ago, when I was driving Peanut to preschool and, after stopping at a red light, the entire vehicle suddenly became unresponsive. Picture, if you will, the gas pedal doing nothing, the brake locking up, and the steering wheel becoming impossible to turn. To this picture, add the growing realization that you are on a downhill slope and the car is therefore moving forward, with you utterly unable to stop it. As well, throw in a 3-year-old demanding from the backseat, “Mama, drive PROPERLY!” So, in the space of a few seconds, I made my decision. Self, I said to myself, we are going to have to crash this car. Which we did. I wrenched the steering wheel 180 degrees, which, since it was locked, succeeded in turning the car only about 10, and plowed into a median to avoid hitting anyone or anything else. And thank God, thank God, we didn’t. Poor Peanut was a bit emotionally traumatized, and Fluffy him/herself wasn’t going to win any auto beauty contests (after 7+ years, we still haven’t settled on whether he’s a he or a she) but at least we were all OK.

To make a long story short, turns out we had a stuck oil valve that was causing the engine to stall intermittently while in motion. Wow, that’s not dangerous or concerning at all. Really, don’t mechanics have the same responsibility as doctors to diagnose correctly? I mean, how do we even know if this is the correct culprit? Sheesh. Anyway, the final repair bill was big. Very, very big. As in, the current value of the car is not much bigger. But given that we own the car, and would like not to have to buy a new one until Tolkien is out of training, we went ahead and got it fixed. If it gets us another 2 years out of Fluffy, then it’ll be worth it. If it doesn’t, then we just got played by a hunk of metal. That hunk of metal now has Peanut asking every time we get in a car, “Mama, are you going to crash this car into the curb too?” If she’s telling any version of this story at school, I can only imagine what the teachers think.

Look at it, just sitting there conniving. Probably trying to figure out how it can access my 401k.

But whenever I fume at the chunk of change this entire incident cost us, I distract myself by thinking of a) the fact that no one was hurt, and b) this recent Peanut gem. I’ll share it with you for medicinal purposes. It might even be covered by your insurance.

Peanut: “I have to go get Anjali’s husband.”
Me: (in mock shock) “You let your baby get married?”
Peanut: (seriously) “Yes. As a special treat.”

The blushing bride

Drive safe out there!

You See Dead People? I See Trains. No, I Really Do.

In Baby Howie, Celebrity Obsessions, Peanut, Tolkien on September 25, 2012 at 12:14 pm

Is it September already? Where has the time gone? What have I been doing? What is this strange device in front of me with little buttons and a screen? And what is the meaning of life?

I’m not sure how three months have passed since my last post, but I’ll quickly recap what we’ve been up to: recovering, working, being in the weddings of close friends, Peanut starting preschool, Peanut’s 3rd birthday party (during the planning of which Tolkien said “After this, I don’t know if I’m going to have the energy to plan her wedding”), traveling, and the next thing you know the summer had gotten away from us. But we are all doing well and are secretly looking forward to a calmer autumn.

So the Peanut has turned 3. She started school this year, a wrenching transition for Tolkien and I but not for her. We ended up enrolling her in the infamous school with the horses, mainly because I ran out of time to see many other schools before my surgery and treatment, but she seems to be having a really good time and always wants to go back. It’s hard for me to see her be out of the house so much, but I try to remind myself that a) we wanted her to have the socialization of being with a large group of kids, and b) nothing is set in stone. I have a lot of conflicting feelings about what the best schooling situation is in this day and age, which is a topic for another post, and I’m sure we’ll go back and forth in the coming years on where she should be educated.

In the meantime, though, it’s been an eventful year. And when we look back on 2012, do you know what we’ll remember? That it was the Year of Thomas.

Don’t look so smug, Tommy.

This was the year that the Peanut became obsessed with Thomas the Train. I never watched it or read the books myself, so I didn’t know anything about it, but Baby Howie showed her an episode once on a rainy day and something about it immediately captured her feverish little imagination. Here are the proofs of her devotion:

  • She is allowed to watch 30 minutes of television a day, and for the past 4 months she has always insisted that the only thing she wants is Thomas. She has actually committed toddler blasphemy and said, “I don’t like Elmo. I only like Thomas.” (I think she said that for the shock value. I can’t imagine she means it.)
  • She has memorized all of the trains’ names. They all look the same to me, but she knows the minute differences between each one. Sample conversation: Me: “Is that Emily?” Peanut: (looking at me with real concern, as if maybe someone should drug-test her mother) “No Mama. That’s Edward. Emily’s eyebrows are rounder.”
  • Every single morning when she wakes up, the very first thing she says is “Today we’re going to have a PICNIC PARTY for [insert name of random train here]!”
  • The owner of our local consignment store thinks I’m the “train lady” and, whenever she sees me, immediately tells me if they have a new batch in.
  • Tolkien and I find ourselves singing “They’re 2, they’re 4, they’re 6, they’re 8 …” under our breath all day at work. Peanut scolds us if we don’t sing it in a British accent, as she does. (And now it can be stuck in your head too. You’re welcome.)

  • Our house is overrun with Thomas paraphernalia because family and friends heard Peanut’s breathless chatter and got her Thomas items for her birthday.
  • The sheer awe Peanut felt each time she found out family members had the same first or middle names as various trains was truly astounding — you could just see her admiring the luck one must have in life to be named after a celebrity.

But here’s the thing … for the last several days, she has started requesting Elmo again during TV time. And here we are, surrounded by Thomas toys and books that we bought used or received as gifts, and not willing to let their time be over so soon. I mean, how wasteful is that? Really, this character toy thing is such a scam! And the people who own the Thomas trademark totally milk this. Do you know that not only is there a never-ending supply of different trains, buses, planes and more, but they make each one with different expressions and in different seasons? I have come up with a very scientific equation to calculate their profit margin:

x number of characters x y number of expressions x 4 seasons = a year’s income and a spoiled generation

Happy Summer Percy

Sad Winter Percy

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

We just can’t do this every few months with whatever new book or toy Peanut pulls into her relentless embrace!

So I now find myself in the position of trying to get her back into Thomas and His Innumerable Friends. “Let’s play with Thomas! Isn’t Thomas so cool? I love Thomas!” (As my inner self apologizes to God for these blatant lies.) Next I think I’ll start reading them to her in her sleep. Since I can already recite them in mine.

Dear heaven, I hope something in here will be on my medical boards.

On To Phase “The Next”

In Christianity, My thyroid, Peanut, Tolkien on May 29, 2012 at 4:10 pm

Friends, how have you been? I can hardly believe it’s been five weeks since surgery, it’s been such a whirlwind. Between starting back at work and getting ready for the next stage of treatment, I’ve hardly had a chance to breathe. Evidence of this is that I haven’t updated my other blog in ages. Sorry, you four people out there who read it!

So radioactive iodine treatment (RAI) begins next month. Being quite naive, (and not having studied endocrinology since med school), we didn’t realize it would literally take up the whole month. This is particularly irksome because June is both Tolkien’s and my birthday month, and while he like most adults would find it hard to care less about his birthday, I love birthdays. I don’t mean I’m one of those birthday-zillas Carolyn Hax is always writing about who demands that everyone throw me parties and buy me jewelry, I just mean I really like the idea of everyone on earth having one special day. I like planning what kind of chocolate cake I get to have on that day. I like going about my regular business thinking in my head “Hello world! It’s my birthday!” I like wearing my favourite shirt even though I just wore it the other day because I can, FOR IT IS MY BIRTHDAY. (Psychiatry friends, please keep your diagnoses to yourselves. Thanking you in advance.) I know, I know, who else really cares about your birthday after the age of 21? No one (although my poor family feels compelled to pretend otherwise), but that’s OK. I care, and I care about everyone else’s birthdays too — this totally goes both ways. On your birthday, I believe you should be the prince/princess (within reason; no expensive presents or genuflecting included) and eat/wear whatever you want. (Bathing of some sort is not optional though, I don’t care whose birthday it is.) So yes. Birthdays!

Where was I? Motherhood has made me so distractible. Oh yes, thyroid cancer treatment. So the full RAI dose is on June 21, but that event is only one in a series of appointments that will consume the last two weeks of June. And for the first two and a half weeks of June, I need to go on a low-iodine diet in preparation. (This is so that any remaining thyroid cells, which may or may not be cancerous, will be “hungry” enough for iodine to take up the radioactive stuff.) What is a low-iodine diet, you may ask? It is a quite restrictive instrument of torture wherein one is denied, or basically denied, many major food groups: no dairy, no store-bought baked goods or bread, no seafood, no meats where you didn’t personally raise the animal from birth and muck out its stall with your bare hands, no processed or canned foods, no chocolate, nothing with molasses, nothing with various specific food dyes, and on and on. But did you catch that? Because there is only one thing that matters: this diet is for the first half of June. I CANNOT HAVE CHOCOLATE ON MY BIRTHDAY.

I am still wrapping my mind around this impossibility. I mean, any day without chocolate is an impossibility, let’s be honest, but my One Special Day? I know, I know, I should be a grown-up, plus everyone’s saying once it’s all over, you can have as much chocolate as you want, we’ll just celebrate late, but you know what? I can’t substitute another day very easily. That just seems like a sham, to have a birthday dinner on, say, July 8, when I would know it wasn’t my birthday. (Yes I realize this birthday neurosis borders on crazy, why do you ask?) But then, my moral fibre isn’t going to be strong enough to actually prevent me from eating any chocolate that happens to be presented to me on July 8 or any other non-medical-diet day, so it’s really a moot point.

The diet is one part of what’s going to make June a challenge. The other part is that after RAI I need to go into isolation to protect those around me, particularly Peanut because she is under 5, from the radiation I will be emitting. The guidelines on how strict and how long isolation should be vary widely, even among medical literature, which is not that comforting when you’re on the patient side of things. The paperwork my own hospital sent me was blithely unconcerned (“Try to stay away from other people for 3 days. Also, try not to cheat on your taxes, but if you do, no biggie!”) But other reports have people renting apartments for weeks to stay away from their families. As you can imagine, the responsibility of not exposing your loved ones or anyone else weighs heavily. The radiation is contained in bodily fluids, so it is not passed on through touch or the air (unless you sneeze) but managing it until it’s all gone will still be complicated (using disposable dishes, using separate linens and a separate bathroom, covering electronics in plastic wrap in case you sweat, etc.). Trying to figure out exactly what to do and for how long has been somewhat stressful, because of the stakes. And during my research, I came upon a patient-information website that said “You will be admitted to the hospital the day before your RAI and your radiation levels will be checked every day. Once the doctors feel you are safe to go home, they will discharge you — usually about two weeks later.” Who in the what now? I soon realized it was a site from the United Kingdom. Oh right, I forgot we live in the U.S., the only developed country in the world without national healthcare! Anywhere else, I’d be admitted as an inpatient for this treatment, but here, because the FDA approved RAI for outpatient use in the 1970s, insurance companies promptly stopped paying for hospital admission (except in very narrow circumstances which don’t apply to me.) What this means is that protecting others from radiation depends solely on the dedication and/or ability of the patient. Some patients go to the hospital, get radioactive iodine, and take public transportation home (not maliciously — they may not have a car), thereby exposing us all.

Whatever — I don’t really want to segue into a discussion about socialized medicine, as it’s pretty obvious I think it’s a moral obligation. It’s not the point, and I am also aware that universal healthcare isn’t perfect either. Also, I don’t want to start complaining, because how incredibly fortunate are we to live in a place where this treatment is available at all? The actual point of this long-winded stream of consciousness is that Tolkien and I have to plan our own isolation using our limited resources. (For example, we don’t own a lead-shielded house.) The good news is that the radiation does degrade off surfaces and out of the patient; you just have to give it enough time. And as some of you know, I recently started a new job with a national company doing consulting for hospitals around the country, which I really enjoy, and I now work at home. Since I just started, I’ve already used up all my leave on the surgery, so I will still have to work while going through RAI, but it will be much easier when all that means is walking to the basement. And hopefully I’ll be one of the lucky ones who doesn’t get too sick.

The plan is that I’ll live in the basement for the last two weeks of June and Tolkien will stay upstairs. For the utmost protection, Peanut will go “on vacation” for two weeks to her grandparents’ houses — one week with each set. By the time she comes back, we should be all clear and back to normal. We’re so lucky to have them be able to do this for us, but I feel really bad at all the upheaval this has meant for poor little P. Don’t get me wrong — she remains the beneficiary of X-Treme Grandparent Spoiling, which will actually be an event at the 2012 London Olympics — but she’s still only two and a half years old. Your prayers that this will be a mere blip on the screen for her would be much appreciated!

The diet starts Monday, so I’ve been trying to cook low-iodine foods to freeze ahead of time (this cookbook that Tolkien found has been helpful) and steeling myself for the necessity of just stuffing this crap down my gullet no matter what it tastes like. (I haven’t taste-tested any of it because I’d like to delude myself a little longer that it might all be extremely delicious.) Last night I was up till 1 AM baking low-iodine bread in our bread machine. Now, I’ve used that machine before (back in, um, 2008) and I don’t remember the bread turning out like this (a dense, pentagon-shaped cube, if there could be such a thing) but maybe that’s how it’s supposed to look, you be the judge:

Yum.

My mom and dad have also cooked and frozen some meals for me, which is awesome. (No one seems tempted to sneak a bite though.) Unfortunately this all comes at a bad time since Tolkien has to go out of town as his fellowship interviews have started, not that there’s ever a good time in medical training. He has just 2 years left to go though (at which point we will have had 13 years of education and training post-college.) Friends, don’t be mean to your doctors — have pity on them!

So that’s the latest update. I wanted to write it all in one place since so many people have been asking for details. We’re incredibly grateful for your concern and prayers, and would love if you would pray that June will go quickly and smoothly. In the meantime, have a little iodized salt for me. Sprinkle that stuff on your coffee if you have to. Ahhh … it’s as if I’m sipping it myself.

Merci … Gracias … Danke Schon … Thank You

In Baby Howie, Christianity, My thyroid, Peanut, Tolkien on April 30, 2012 at 2:18 pm

Whew … and here I am on the other side!

It’s probably getting old to hear, but I just can’t thank everyone enough for all your support and love. The calls, messages, gifts and most of all your prayers have been such a blessing and comfort to us all. Although I am weeks behind on thanking everyone personally, know that I will catch up and we are so grateful! Most of all, we are so thankful to God for having carried us this far, and for letting me be able to honestly say that if having cancer surgery can ever be a positive experience, this was a positive experience.

Tolkien and Baby Howie accompanied me to the hospital Monday morning while my mom and dad cared for Peanut at home. Man, what a relief that we were able to do this at our hospital of choice, where Tolkien is a resident. Like most urban academic hospitals, this one is huge, and just the simple fact that Tolkien knows his way around (I don’t work there, so I would have been lost) made everything easier. And then of course knowing people on staff is always a stress-reliever as well. The anesthesiology team told me I’d be one of their family, which doesn’t actually make any difference in the medical care I’d receive, but still is nice to hear in the minutes before you go under the knife.

From my perspective, the best thing to happen that day was when my surgeon came by to check in with me beforehand, heard about my endocrinologist’s plan to make me hypothyroid, and said he’d get me in for a second opinion with [prominent academic hospital]’s endocrinology department the next day. When I had tried to schedule a second opinion myself, there was an eight-week waiting list. This endocrinology thing has been a big pain; although my old endocrinologist was perfectly nice, he wasn’t necessarily someone I’d have chosen. My PCP got me an appointment with him. In general, my bias is to select doctors who are young, recently out of training, because a) I feel like you can talk to them more like a peer, and b) they may be more familiar with whatever the latest treatments and procedures are in their field. Obviously this is a total generalization and is not really fair to the many excellent older practitioners out there (and doesn’t take into account the benefit of years of experience.)  But in this one case, my bias was correct, because this endocrinologist’s treatment plan was different from what all our endocrinologist friends, as well as the two surgeons I saw, were recommending. Tolkien and I were well aware of that, and yet didn’t have much choice if I couldn’t get an appointment with anyone else for months. Additionally, I was already questioning whether I should stay with him because it took him 10 days to return my phone call/e-mail with an important question, and he wasn’t on vacation. Now, I understand perfectly how crazily busy a day in private practice can be, but 10 days is a little ridiculous. So in all, it was really incredible that my surgeon was able to do this for me. We didn’t end up seeing the new endocrinologist while I was in the hospital (insurance issues) but we did go back to see him a few days later. And I now do not have to be hypothyroid for weeks, which is great. They started me on thyroid replacement medication right away. When I have radioactive iodine treatment in a few weeks, they’ll use a newer injectable medication to prepare my body instead of the weeks of uncomfortable hypothyroidism you used to have to go through. My endocrinologist friends will be glad to hear I am actually going to be able to do what you all have recommended! Suffice to say, I’ve transferred my care to the new endocrinologist. And am very grateful to my surgeon.

But back to the day of surgery. So I remember everything up through walking down the hall to the operating room with the nurse anesthetist, lying down on the operating table while they hooked EKG leads up to me and started running the medications into my IV, and the anesthesiologist asking what my daughter’s name was. I noticed that the objects in the room were starting to get wavy. The very last thing I remember is me asking her what her kids’ names were. I never heard her answer. The next thing I remember is seeing a very hazy Tolkien next to my bed (it was 6 hours later) and saying “I’m so confused.” That, of course, is what remember. What Tolkien says I actually said was, “I’m so confused. I’m really very confused. Where’s Words With Friends?” Which is weird, because although most new interests of mine quickly become obsessions, that game has not. (Don’t tell Alec Baldwin.)

But I gradually woke up, ended up in my room, and had a nice evening with Tolkien and Baby Howie. The surgery went really well and the lymph nodes appear to be negative. Praise God! The pain was not that bad (having a C-section was much worse) and I had no nausea at all, which is really a miracle and probably the main reason I felt this was a positive experience. Personally, I think nausea is a worse sensation than pain; and according to the research on post-op surveys, apparently most patients agree with me. And it’s lucky I’d rather have pain than nausea (within reason), since this was the third time (wisdom teeth extraction, C-section, and now thyroidectomy) that pain medication didn’t affect my pain at all. For that reason, I don’t think I’m in much danger of ever becoming a prescription-drug addict, but I also hope I don’t ever really need pain management for some reason, because I’ll be reduced to chewing on oak bark or whatever we used to do in the pre-opioid age.

The next day my dad relieved Baby Howie at the hospital, I was discharged, and Peanut and I went with my parents to their house out-of-state. Since then I have been resting while my parents wrangle a very energetic, very strong-willed two-and-a-half-year-old who believes that it is totally inappropriate for her mother not to be waiting on her hand and foot, and has the media been notified of this? I’m on lifting restrictions for two weeks (no lifting anything heavier than 10 lbs.) so I can’t pick her up or do much of her care, and of course she can see my surgical incision, which makes her very interested in the nature, and projected duration, of these proceedings. “Mama,” she asked me, “when we go home will your boo-boo be better, and can you drive me, and feed me, and carry me, and give me baths, and take me to the library, and take me to the park …” Basically, she wanted to know, do I have any intention of fulfilling my duties, or does she need to place an ad for a replacement? Ah, the brains of toddlers!

But Peanut can rest easy because overall, I’m doing pretty well. The pain is minimal at this point. My scar is obvious but not too bad, and will take a year to fully mature, so may be significantly less noticeable by then. I am tired, but that’s to be expected as it may take a little while to adjust my dosage of thyroid medication. So I’m so thankful to have my parents and in-laws nearby to take care of me and the Peanut and to give me this recovery time; I can’t imagine doing this without them. Tolkien and Baby Howie were here for the weekend and we had several friends and family come to visit, which was much appreciated although I was probably not very enchanting company (next time I will endeavour to be witty and fully awake, I promise.)

This journey isn’t over yet, but everything up until now could hardly have gone better. And we know that is due to the grace of God and to the power of the multitude of prayers you have made for us, from e-mailed Bible verses to fasting for us to the prayer conference call on the day of surgery. Thank you so much, dear friends, and let us return the gift for you by giving us your prayer requests. And of course we’re remembering Psalm 107:1 at this time: “Give thanks to the Lord, for He is good; His love endures forever.” It’s naptime for me … but soon hopefully I’ll be back to my multitasking self!

Oh, and that post-surgical milkshake? Oreo cookies and cream — and delicious 🙂

On the Morrow

In Baby Howie, Christianity, Medicine, My thyroid, Tolkien on April 22, 2012 at 11:33 pm

So this is it. The last night for the two of us, me and my thyroid.

I never gave my thyroid the slightest thought before ten weeks ago, but I must admit that now I feel a little twinge at the realization that tomorrow, this organ that has been with me since the day I was born, from the beginning to the end of every day I have ever had, that has traveled with me wherever in the world I have been, will be labeled “Human Waste” and discarded. Seems so ignominious, doesn’t it? Oh well. Obviously, I am really excited to be moving forward. After surgery, Peanut and I will be going to my parents’ house for two weeks with Tolkien visiting on any days off. After that, my in-laws will be coming for a week to stay with us. So we’re really grateful to have such supportive family and friends. And thanks to all of you for your love and prayers — I don’t mean to sound like a broken record, but I can’t say it enough.

Tolkien saw my name pop up on the hospital surgical schedule last week, which is kind of a weird feeling. You’re so used to patients’ names being the names of relative strangers, not loved ones. But he was allowed to select my anesthesiology team, which is one of the reasons we wanted to be at this particular hospital. When he talked to the anesthesiologist assigned to me, she promised to be generous with my anti-nausea meds, since I have every risk factor for post-op nausea. (Having had really terrible nausea during my pregnancy with Peanut, I’m not surprised.) So that’s one thing I’m not looking forward to. Things, however, that I AM looking forward to:

1) There’s a famous milkshake place that delivers to this hospital but is too far to deliver to our house. I never thought I’d get to partake of one of these much-lauded concoctions that Tolkien gets to enjoy on call. But post-op, since I’m going to be starving after having been NPO for a day, but will be on a liquid diet, Tolkien and Baby Howie have promised me we will order some.

2) A sort-of vacation! Is it sad that I’m looking at recovering from major surgery as a vacation? Well, Tolkien and I haven’t had a real vacation in 4 years, and won’t have one for at least another year, so I will take what I can get! I’m stocking up on reading materials and pajamas as we speak. My endocrinologist is now planning on starting radioactive iodine treatment right after surgery, so the two weeks of recovery will also be used to make me hypothyroid in preparation. This will make for a more uncomfortable two weeks, but will kill two birds with one stone (rather than having to have a separate two weeks of letting my thyroid hormone levels drop later.) I’m hoping I won’t be too miserable to concentrate on my Nook books and Seasons 1 and 2 of Downton Abbey (thanks to my dear friend Sandy!) And of course I have work I’m hoping to catch up on too.

3) Seeing how the Lord will use this to His glory. As Mark 11:24 says, “Therefore I say to you, whatever things you ask when you pray, believe that you receive them and you will have them.” And 1 Peter 2:24b: “… by His wounds you have been healed” — past tense!

Thank you again, all of you, for praying that God will be with us and the medical team, and hope to be blogging again soon!

Gratitude and Praise … and an Interesting Dilemma

In Christianity, My thyroid, Tolkien on March 21, 2012 at 6:57 pm

I am really humbled by two things this week: the outpouring of love and support from the people around us, both near and far (that includes each of you who is reading this!) and the amazing response of God to prayer.

I had a surveillance lymph node ultrasound yesterday to evaluate for spread of the cancer. The tumour is in the left lobe of my thyroid, and the lymph nodes on the left are all negative, which is fantastic. There are a few positive lymph nodes on the right, but because this is contralateral to the malignancy, the surgeons feel they are likely incidental, so they’ll check them out intraoperatively (while they’re actually in there with their scalpels) and dissect them then if they look suspicious. But basically, they feel the risk of distant metastasis is low. Praise God! As I mentioned before, we knew that papillary thyroid carcinoma is a very good cancer to have, in the grand scheme of things, as it’s not aggressive and responds well to treatment. There are plenty of people who have gone through this and been fine. But because mine was large and has apparently been sitting there getting comfy in my annoyingly-welcoming thyroid (“Make yourself at home! Can I get you a hot cocoa? A warm bath?”) for several years, the concern for spread was higher. The relief we all feel is rivaled only by our awe and thanks at how quickly and generously this particular prayer was answered. Psalm 28:7 says it perfectly.

I’ll never be able to say thank you enough, but thank you for praying and for your continued prayers! My personal faith has always been sort of average, and I’ve always envied the strong faith and spiritual life of many of my brilliant, impressive friends. But in looking for Bible verses to meditate upon daily over the past weeks, I’ve been really amazed at what a difference that particular exercise has made, even as someone who grew up reading the Bible. God’s listening. It’s pretty incredible.

So now, we’ve reached an interesting decision point. Yesterday I met a surgeon at [prominent academic hospital] where Tolkien is a resident. This hospital is tops and the surgeon was really impressive. So nice and took the time to answer all our questions without making us feel rushed, which are not always qualities surgeons are known for. (To all my surgical friends, naturally YOU are the exceptions to this rule!) My top choice would be to go with him. However, he has a 3-4 month waiting list. He said that’s because the only way he can control quality is by limiting the number of operations he does a day (which I totally believe) and that that’s why he’s in academia, since in private practice the pressure to see more and more patients and book more and more surgeries does not allow for the practice of that kind of careful medicine. My thoughts on this sad aspect of healthcare could fill another blog entry, but let’s not digress. Today I saw another surgeon at a medium-sized private hospital. He too was very nice, and he gave me an OR date 4 weeks from now. So … go with the surgeon I really liked at the better hospital (where Tolkien is on staff, which could come in handy) but wait till I’m old and grey, or go with the surgeon at the slightly less-prominent hospital who is probably nearly as good and just move the heck on with our lives? Tough decision. The other thing is that pregnancy is verboten until 1 year (some say 6 months, but my endocrinologist is old-school) after the radioactive iodine, which is a couple of months after surgery, so putting off surgery also increases the time till we can try to have Peanut #2, and obviously delaying childbearing in these times of fragile fertility is not a super-awesome idea. Neither surgeon is worried about spread if we wait the 3-4 months, but I kind of want to just get this over with. First Surgeon said he would try to get me in earlier than 3-4 months, so we will see. Now we’re praying that the right decision will be made clear.

So that’s where we are … and thank you again to all of you. I’ll keep updating here when there are things to report. In the meantime, though the thyroid is certainly a very fascinating topic, let’s talk about something else, shall we? Is anyone else bored by Andy and Erin on The Office? Anyone? 🙂

Opinion-Sharing With the Woman Behind Kelly Kapoor

In Baby Howie, Books, Celebrity Obsessions, Christianity, Tolkien on December 7, 2011 at 1:59 pm

My family has always had that stoic Indian thing going on wherein one generally remains responsible and thoughtful as much as possible and avoids unnecessary emotional outbursts. (Read: all emotional outbursts.) This translates into some very pragmatic Christmas traditions, such as not wrapping our gifts to each other because they’ll just be unwrapped anyway. We are Christians, so it’s not like the holiday isn’t important to us, it’s just that it’s always been a religious occasion first, a gift-giving occasion second. I believe in this philosophy 100% myself, so that’s totally cool. (Although I will admit that once Tolkien and I got married, my family and I did start trying to throw around some tissue paper every December so as not to totally horrify him, the child of a family that recreates a Norman Rockwell Christmas every year.) Anyway, my brother Baby Howie, who you will remember is not a baby and is not named Howie, went one step further and, when ordering my Christmas gift online on Black Friday, just had it delivered directly to my house. I opened it on Dec. 3. I am proud to be the latest, very late owner of an e-reader. We will see how and if this revamps my life. And the first e-book I purchased was Mindy Kaling’s Is Everyone Hanging Out Without Me? (And Other Concerns).

I was going to use a picture of me reading the book, but it's an e-book. It'd just be a picture of me and a 7-ounce electronic device sitting on the couch.

I know that to be cool I should pretend it makes no difference to me that we’re both Indian and around the same age, but dude, that’s totally why I like her. Plus she writes and acts on my favourite show. (As an aside, I just love that four of NBC’s current hit shows have major Indian characters whose Indianness is incidental, not pointed out at every opportunity for cheap laughs. Outsourced excepted.) Of course her book was great and made me laugh out loud, but the thing that really hit me was how much I agreed with one of her essays, entitled “Don’t Peak in High School.”

In the ongoing debate about why kids from some ethnic backgrounds tend to do much better in school than others, the basic American assumption that high school should be the best years of your life, filled with dating and sports and parties, has got to be given some blame. I always remember my great-uncle, the father of three Ivy League grads who are now well-adjusted professionals, telling a story about how his daughter’s high school guidance counselor balked at her challenging course schedule because it didn’t “leave room for her social life.” To my relatives, the very idea is preposterous. Academics need to be arranged around a social life? Are you in school to prepare for a lucrative career or to increase your chances of getting voted “Best Legs” in the yearbook? Teen books and TV shows programmed me to think I was deprived because high school was definitely not the best four years of my life (of course, moving to a new country in the twelfth grade didn’t help), but as Mindy points out, they were wrong and we were right. You know what the best four years of my academic life were? Not high school, not even college, but medical school. For the first time I was around hundreds of driven people who had the same goals I did and weren’t afraid of people seeing them working hard, but who also believed in playing hard too. It was brain-enhancing and socially stimulating at the same time. In all, it was so much fun, and it was made more so with the added knowledge that we were all headed for a life of public service and gainful employment. As Mindy says, where are the kids from that stupid “Jack and Diane” song now? Pumping gas? The day that: 1) crowds of spectators show up at Math League events instead of football games, 2) dating is seen as something you do in your twenties to find a good spouse, and 3) hanging out with your family is considered just as cool and important as hanging out with your friends, is the day this country’s educational standings will start rising. Mark my immigrant-child words.

I also really liked MK’s anecdotes about the kindness Amy Poehler showed to her. One of the things that having gone through a major move at a crucial time in my teenage life taught me was exactly what it feels like to be a new kid on the outside. It’s really nice to hear that some people remember that even after they’ve made it big. And I think I agree with MK that the single funniest moment on The Office was when Michael is driving along smugly talking about how much he cares for his employees and then promptly breaks Meredith’s pelvis with his car. That was hilarious. But I’d probably have to rewatch all 7 seasons to make my final determination. (I’ll use any excuse.)

For the record, though, I do not agree with MK that cap sleeves should be worn by no one. Are you telling me this is not cute?

Or this?

I didn’t think so.

Medicine vs. Motherhood vs. Martyrdom

In Medicine, Peanut, Tolkien on June 22, 2011 at 4:53 pm

It almost feels like a cliche for me to jump into the fray surrounding this recent New York Times op-ed by one Dr. Karen Sibert.  If you haven’t heard about it, Dr. Sibert is a physician who claims that the problem with American medicine today is female physicians who work part-time.  Practicing medicine is a privilege, she says, and to be worthy of that privilege, women need to put their medical careers first.  She is a full-time physician and a mother of four who “never took cupcakes to [her] children’s homerooms” because she had her priorities in order.

OK.  I am a doctor.  I am a mother.  And I work part-time.  As someone who is apparently part of the downfall of Western medicine, allow me my rebuttal.

I agree with Dr. Sibert that practicing medicine is a privilege.  Despite all my years of work, stress and self-denial, I still remember plenty of pre-meds who would have killed for a med school acceptance and never got any.  So in that sense, an MD is something to be thankful for and to live up to.  On a visceral level, too, it is a true honour to have someone consent to be your patient; to have people put their trust and their health in your hands.  I feel the weight of that honour and responsibility every day.  I went into medicine to help people (like almost every physician I’ve ever known) and it’s a gift to know that your job is doing some good in the world.

That being said, however, going into medicine requires a tremendous level of sacrifice of which the public is often not aware.  I would venture to say that most people going into it are also not aware — till they’re in it.  The years alone are a burden: becoming a doctor entails 4 years of college, 4 years of med school, 3-7 years of residency, and 1-5 semi-optional years of fellowship.  Then there is the financial cost: for those first 8 years, you are accruing a frightening amount of debt (for some, close to $300,000) even if you are fortunate enough to go to in-state schools and receive scholarships.  For residency and fellowship, you are making just enough to live on and usually not enough to start paying down your debt.  That means that by the time you are in your mid-30s, interest has been added to your principal at an alarming rate.

Then there is the level of personal sacrifice.  The hundreds of big and little family events that you will miss because you are studying or on call; the numerous “firsts” of your children that your spouse or nanny tells you about because you weren’t there; the times your loved ones needed you and you were forced to let them down.  A colleague in my own residency program was told that she could not accompany her husband to surgery because she was expected at work.  Tolkien himself was the best man at his brother’s wedding last month and could not get a single day off; the only way he could attend was to take call the night before (which, thanks to recent resident work-hour laws, now entitles you to go home the next day) which meant that he had to travel and participate in the wedding on no sleep, had to miss the rehearsal dinner, and of course had to miss the Caribbean cruise the entire wedding party except us took afterwards.  I know the toddlers of several friends who believe they live at home and their mommy or daddy lives at the hospital.  I distinctly remember going to pick up some groceries post-call one day as an exhausted intern, looking around at the smiling, well-rested customers in the store, and resenting them for leading what seemed to me to be a normal, unattainable life.

The price you pay with your own mental and physical health is another given.  It depends on your specialty and your program, but in general residents live on far too little sleep for years.  A couple of nights a week they take overnight call, which means they work 30 hours straight, and several times a year they work the night shift for weeks at a time.  The stress level is through the roof when you are dealing with life-or-death issues, heavy caseloads, rude or violent patients and/or unreasonable residency supervisors.  Eating on the run, if at all, is the norm.

So after all these years of delayed gratification (a popular catchphrase in medicine) I think it is only reasonable for physicians to feel that they finally deserve a more tolerable lifestyle.  Medical training is only doable because there is a light at the end of the tunnel.  I can tell you that if I thought my whole working life was going to be like med school and residency, I would have left medicine completely — and I actually had really good experiences in med school and residency!  But the unfortunate truth is that practicing medicine as a fully-trained physician is still a very stressful, time-consuming endeavour; the hours might be slightly better than residency, and the pay usually is better, but you shoulder the added burden of high legal risk in a society where doctors can and will be sued for things over which they have absolutely no control.  In order to survive and continue to provide a service to at least some patients, I don’t blame physicians at all who feel they need to go part-time to preserve their sanity.

Then there’s the whole parenthood thing.  Women in medicine, because of our biological clocks, often have no choice but to start having children before their training is over, because most physicians are well into their 30s by the time they’re done.  Dr. Sibert claims that we owe it to our patients to take full-time care of them.  So what do we owe our children?  They don’t deserve as much as we give our patients?  I would argue that if what she says is correct, and part-time physicians don’t deserve to be physicians, then full-time physicians don’t deserve to be parents.  I’d love to hear if she thinks that’s fair.  (I’d also love to hear how happy her own four children were with her parenting.)

Dr. Sibert’s argument that physicians should ALWAYS be taking care of their patients can also be carried much farther than she takes it.  Has she ever taken a weekend off?  Does she plan to retire one day?  How dare she?  Additionally, I thought it was a total contradiction in terms that she said she never drove her kids’ carpools, but she attended their soccer games and plays.  What does that even mean?  How was she caring for her patients while she was doing those things?  She says, “If you want to be a doctor, be a doctor.”  Then why was she ever taking a break to be a parent?

I’m sure my fellow docs will agree with me on my next point, which is that, hello, this woman is an anesthesiologist.  It’s all well and good to claim you care more about your patients than someone who works part-time, but let’s be real here: YOUR PATIENTS ARE ASLEEP.  If you cared so much more than everyone else in medicine, why aren’t you an underpaid, overworked primary care physician (who are the real heroes of medicine, in my opinion)?  As many of you know, Tolkien is in anesthesiology, so I’m speaking with some inside knowledge here.  I have the utmost respect for anesthesiologists — they provide essential medical services.  They are absolutely highly skilled and indispensable.  It’s just that it’s totally disingenuous not to tell the public that the reason why a lot of people go into anesthesiology is so that they don’t have to deal with mean patients.  I’m glad anesthesiologists do what they do; just don’t pretend that other physicians don’t have very different challenges.

I’ve seen a lot of different comments on this op-ed around the Internet, and one thing someone said was that what this woman wants is for doctors to live inhuman lives to accommodate a broken system, rather than fixing the system itself.  The op-ed raises a good point about the government not being able to capitalize as well on its investment when doctors go part-time.  I don’t pretend to know the solutions, but I suspect there must be at least a slightly better way, given that many other developed countries have excellent medical systems without their physicians leading brutal lives.  I remember speaking to a surgeon who trained in India and had practiced in the U.S. for 25 years.  “I worked only 12-hour shifts as a resident,” he told me, “and the truth is that I am just as adept a surgeon as anyone else here.”  I’m sure there will be people who argue that he was fooling himself, but the fact remains that many, many people who were trained elsewhere have expressed the same sentiment.  They can’t all be crazy.  The argument in the U.S. is that long work hours allow for many more patients and cases to be seen over the course of a residency, but there’s a lot to be said for the effects of sleep and decreased stress on the retention of learning and knowledge.  And that philosophy of a work-life balance would probably improve things if carried over to the rest of a physician’s career.  People go into medicine because they want to help people.  They could have chosen much easier ways to make a living.  So why would we want to beat that caring out of them?

And if Dr. Sibert is so convinced that part-timers are sending medicine to hell in a handbasket, why is she targeting only women?  What about men who go part-time?  It’s amazing to me that in this day and age, the biggest opponents of women are often other women.  Wasn’t the women’s lib movement about the freedom to choose your own life?  I’m not sure how it’s progress to go from being forced to be a housewife to being forced to work full-time outside the home.  I understand that she feels it’s OK to work part-time in any other field but medicine, that medicine is different.  All I have to say to that is that if you want the best and brightest to go into medicine (and let me tell you, I DO; there’s nothing more dangerous than a dumb doctor) then you better make it somewhat appealing.  If you’re a good student who sees that medicine involves heavy debt, legal risk, poor health, never seeing your loved ones and slaving for long hours for the rest of your life, wouldn’t investment banking start seeming like the smarter option?

Really, though, this woman was looking for a fight.  There’s no way she could have written this in the New York-freaking-Times without knowing she was inciting the ire of thousands.  As my good friend Ollie noted, it makes you wonder what kind of practice she works in.  I’d guess it’s one with several female part-timers whom Dr. Sibert resents, with the leadership comprised fully of male full-timers on whose good side Dr. Sibert wants to get.  The national punishment must be worth her local reward.

Well, good luck to you, Dr. Sibert.  It’s no surprise that I would bristle at her article, but all she did was convince me that I am doing the right thing (for us; I fully support any other parent who believes that working full-time is the right thing for them.)  In a lot of ways I’m a single parent while Tolkien is in residency, and taking care of Peanut and the house and the rest of our lives would be utterly impossible if we were both working crazy hours.  I cherish the fact that I can spend the little moments with Peanut on a regular basis and that I’ll be able to look back on this short baby/toddler stage knowing that I didn’t have to miss it.  I am eternally grateful for the fact that I am able to work part-time and maintain my medical license and skills while still being there for my child at least some of the time.  I really believe that patients are better served by a happy, less-stressed physician.  (Peanut’s pediatrician is a part-timer and I can tell the difference in her entire demeanor.  And I myself spend a lot more time on careful documentation and looking up things for my patients simply because I have more time.  Of course, that’s working time for which I’m not paid, but that’s just a fact of life in the world of part-time work.)  And I really like the comment of one Susan K. Burden who commented on Dr. Sibert’s article: “The degree is a doctorate in medicine, not an application for martyrdom.”  Hallelujah, sister.  Working hard benefits everyone; working yourself to death benefits no one.