Poop and Primary Care

How to Destroy a Mother-Daughter Play Group

2015-10-12T16:14:00.000-04:00

There were so serene, so peaceful. Three mothers and six daughters all sat chatting on their trampoline at our local trampoline park. It definitely looked like a planned outing. Maybe they did it every week. They seemed to have that particular spot staked out.

As I had one eye on him, I had another eye on what would be the end of their tranquil morning outing. My son was struggling to get his shoes off, eyes transfixed on the rows of trampolines in front of him. I'm sure that playgroup looked at those trampolines each week and saw a lovely, relaxing morning. Unfortunately for them, my son saw his chance at toddler ninja warrior glory.

I probably should have warned them but I figured my son had already given them a decent warning shot across their bow. Immediately after getting our shoes off, my son ran up to one of the little girls to see hello. The timing could not have been better as the speaker system came to life, and music began booming through the whole place. Little buddy immediately began breaking it down, complete with yelling for the little girl to join in. Needless to say, she didn't join in but merely stared at him with mouth open.

Undeterred, little man moved on to the trampoline stretch occupied by the aforementioned playgroup and began to unleash the hounds on them. As he bounced and shrieked, I had an incredibly hard time holding in my laughter. The dainty girls tried to continue to sit quietly, but that's really difficult to do when a screaming banshee is right next to you.

Ultimately, I had a parenting choice to make. I could quiet my son and ask him to restrain himself at this trampoline park that we had paid good money to enter, or I could have some fun. I chose fun.

I hopped onto the adjoining trampoline and began jumping as high as I could go (not that high really, but toddlers can't tell that just yet). Another little boy came over and joined in. My son screamed his approval.

As the whole place began to shake, the exodus occurred. The mothers and daughters began running for their lives in much the same way that ants run from flowing water. While giving me the dirtiest looks possible, they beat a hasty retreat for the other side of the trampoline park, away from the raucous and unrefined males.

My little man and I had a marvelous time. We jumped and performed semi-dangerous tricks for about an hour. Those little girls didn't get with one hundred yards of us, and that's OK. We had a decision to make and we made it. When entering a trampoline park, you can either jump or you can sit. We chose to jump, and we took no prisoners.

I Work for VA

2015-07-25T15:44:00.001-04:00

I've received a lot of weird looks when I've uttered that sentence the past month or so. Colleagues look at me as if I've lost my mind. I've had a few ask me,"Is that a good thing?" Several people outright asked me if I was nuts when I informed them that I was transitioning to VA a few months ago.

I was inundated with horror stories about being treated poorly and delivering substandard care. I was told that no doctor works for VA unless you can't get a job anywhere else. In short, I was told that I was committing career suicide.

Let's be clear. There surely have been some unfortunate things that have happened at VA. No one is trying to hide from the hard work that must be done to give Veterans the care they deserve. That wasn't a mystery when I decided to work for VA, and it isn't a mystery now.

Now, allow me to be equally clear when I say that I have never been more proud to walk into work every day than I am now. Every day, my team and I get the opportunity to care for heroes. We hear stories from the beaches of Normandy to the mountains of Afghanistan. We give back to those that have given so much.

I say my team and I for a reason. Delivering health care at VA is unlike anywhere else. While many health systems are still exploring the concept of team based care, the VA has already embraced it. As the physician, I am the leader of the team, not the entire team.

Instead of asking for my patient to get a colonoscopy and praying that it actually happens, my nurse follows that consult all the through to the end, making sure the procedure gets done. When my patient's blood pressure is out of control, a telehealth nurse will call that patient regularly and track their blood pressure from home. Abnormalities are communicated back to me, and we can make adjustments, while the patient never has to set foot in the clinic.

So, I want to set the record straight. There is good work being done at VA. There is constant improvement happening. Our leader, Secretary McDonald, has brought with him a culture of service, and as one of the many new faces around VA during the past year, we are daily going about the task of bring world class health care to our Veterans. If you are a veteran, I invite you to stop by your local VA clinic to learn about how we can help you. If you are a health care provider, then join us. We don't just care for patients, we care for heroes

Reach Out and Touch Someone

2015-07-21T10:12:00.001-04:00

My wife and I differ in our communication styles. Pretty common for a married couple, but I’ve been struck by a thought recently that perhaps my personal communication flaws may be more a generational problem. At the risk of further admitting that my wife is right about a lot of things (love you honey!), I’m willing to put one of my flaws out there. My communication style is lazy.

What do I mean by this? Well, I grew up with instant messaging, text messaging, and email. It’s a really easy way to communicate and can be very convenient. It’s also very easy for someone to hide behind it. Want to break some bad news or say something that might make people uncomfortable? Send them a text. Don’t have to watch or hear their reaction and the message has been delivered. Want to say you “followed up” on something without really caring whether it happens or not? Send a busy person a two line email that will get buried in their inbox. Mission accomplished! I’ve checked a box off my to-do list without really accomplishing anything.

The more years that go by and the longer I work a real job, I’m much more inclined to “reach out and touch somebody” if there’s something I need to communicate. No, I don’t mean physically lay hands on people, but I do mean either talk in person or call. I’ve found that I can not only confirm that my message has been delivered much better, but whatever task needs to be done actually happens at a much higher frequency when there is a real voice on the other end of the line.

Case in point, I needed my student loan servicer to fill out a form for me. They have a lovely chat function on their website where you can get “instant help.” I hopped on and chatted with customer service rep, who assured me this could be done without an issue. I faxed in my form and waited…and waited. Nothing happened. I got on again. They said they never received the form and to fax it again. I did…with no response.

This happened one more time before I finally called in. After explaining that I was not a happy camper, I was transferred to a “resolution specialist” who physically sat by the fax machine, received my form, signed it, and sent it back. The whole process took twenty minutes. I had been waiting for two weeks.

I know my wife is smiling at this point while reading this. She has been saying for years that this culture of sending email for everything and actually talking to no one slowed everyone down. Well honey, here are those words that you love to hear…you were right. As a culture, we tend to rely too much on technology assisted multi-tasking. We check boxes but don’t really accomplish anything. You want to get something substantive accomplished. Talk to someone. You might even enjoy it.

The Potty, Part 1

2015-07-19T21:14:00.001-04:00

We are starting to introduce the concept of the potty in our household. We're in no rush fortunately. By virtue of little man's birth date, he will be nearly 4 when he enters 3K, giving us a lot of extra time. We've decided to take it slow because he's just beginning to show interest.

I should clarify what I mean when I say "show interest." Currently, "showing interest" entails having all of your stuffed animal friends sit on the toddler potty, flushing, and all dancing together to the music. This experienced is capped off with an exclamation of "Yay! You went to the potty!"

We'll take what we can get. Little man notoriously starts slow with new activities and then quickly become a daredevil once he gets the hang of it. I did catch him trying to take his diaper off the other day, so maybe that's a good sign. Then again, he's also picked up watercolor painting recently and had his eye on a section of wall in the bathroom...

Communion Meditation 5/31/15

2015-05-31T12:00:00.000-04:00

In our church, people rotate giving a short meditation before communion each week. People typically do this for one month at a time and then rotate. It is my turn this month, and these are my thoughts I shared today in our communion meditation.

I've started gardening here recently. Nothing too complicated. Just four pots with one each labeled tomato, zucchini, cucumber, and squash. You can ask anyone that knows me; this was pretty shocking. I'm not the most handy individual. In fact, I often have no idea what I'm doing when it comes to any kind of home project or yard work. Tim Herlihy can vouch for me back there. He drove by and saw my yard after winter and just shook his head. I could hear him saying,"What is that boy doing?"

Believe it or not, I have managed to get the beginnings of some vegetable plants in my back yard. You see, despite my lack of green thumb or ability, growing vegetables isn't complicated. The ingredient list is short. Seeds, soil, pots, water, fertilizer, sunshine. That's it. Make sure you plant around the right time of year and keep the water and fertilizer coming. You'll have a fighting chance if you do that.

Watching these plants grow every day has been refreshing for me. Unlike us, these plants do not seek answers for their future or what God's will for them might be. The cucumber plant is a cucumber plant. That's what it aims to be. It doesn't try to become a tomato or zucchini. With all of it's needs supplies, the future of these plants is secure. They will become what they're supposed to be. Questioning that would be ludicrous.

The truth is that our questions about Gods will for our lives often sound just as ridiculous as if my cucumber plant were asking them. What job should I work? Should I live in this neighborhood or that one? Its just like my plants asking should I put my roots on this side or that side? Should I catch that raindrop or this one? These are really trivial questions in the grand scheme, and all of them come from an innate need for security and answers despite the fact that God has already provided for our every need no matter what neighborhood we live in.

So lets stop making it complicated. Lets stop being cucumbers trying to figure out if we should be tomatoes. Lets just be God's children and let that be enough.

Limits

2015-05-27T08:40:00.002-04:00

Those of you that have read my previous communion meditation have heard me talk about limits. The stark reality of critical illness causes these limits to be displayed most prominently. There is no denying your limits when the patient worsens in front of you and you have no answers. It is undeniable.

The idea that we don't have limits in all other aspects of medicine is pervasive, however, and ridiculous. People are like that, though. We will always deny what we can't do until it becomes immediately obvious that we can't do it. Happens in all other aspects of life. Politics, business, all the same. "Sure, I can get that order done by tomorrow." "Read my lips, no new taxes." We've all heard it. We've all fallen for it, and yet medicine still gets away with it.

There are very practical implications to refusing to acknowledge our shortcomings as a profession. Our stubborness translates into real dollars and cents, real resources wasted in the delusional pursuit of ends that we claim to be able to reach yet lack the tools to reach them.

End of life is the most obvious case study of this. What do you do if someone is dying but you view death as failure and merely a manifestation of some other lesser physician's previous mistakes? You burn through resources, that's what. You throw the kitchen sink at the "problem." And then? The patient dies. Every time. Without exception.

It's an oversimplification of course. Some folks are critically ill and will recover wonderfully. We can't perfectly predict who will recover and who won't, but we certainly have a good idea sometimes. More importantly, and more central to what I want to say today, we often know who wants to use those resources and who doesn't.

Informed consent was initiated in the noble pursuit of joint decision making and patient autonomy. Why don't we tell the patient all the possibilities and let them decide? Sounds nice. It's imperfect, though. How do I adequately explain the risks and benefits of a procedure that it took years of school and training to master and understand? Explain that in ten minutes? Forget about it. Its a farce.

No matter how many forms you get patients to sign saying they understand everything and have made the decision all by themselves, physicians will always play a central role in making patients' medical decisions. Sadly, this is where physicians' refusal to acknowledge our limits most hampers, and dare I say harms, our patients. What do you do if a patient is wavering on a procedure that could prolong their life if you believe that death is failure and only happens if you allow it to happen? You push. You cajole. You tell them how they really want the procedure, how it will help them.

Patients will relent usually. They trust their physicians. However, they won't be better for it. Unlike physicians and their God complex, most of the patients that I have cared for do not view death as failure. They view death for what it is. Inevitable. If we are really acting as a medical fiduciary for our patients, then how should this affect our decision making? Should we make decisions based on our personal views of death or our patients?

If we accept that our patients views of death and disease are more important than our own, then this begins to have every day implications. Do you use low value tests and procedures that often result in much lower quality of life with minute quantity of life gain? Probably not. Out the window goes "routine" blood tests every three months, a lot of heart caths and CT scans. Costs come down. Patients receive care more in line with what we know works the best.

From an individual physician standpoint, the trade off comes in time. It will take serious time to explain to patients why they don't need a test. Much more time than to simply order the tests. As in all situations, inaction must be explained more than action, even when inaction is the correct action. That means a lot more of our day sitting in exam rooms simply talking to patients, learning their views and preferences. We must know the whole person if we are to consider the whole person in our decision making.

That should be no problem, though. Most physicians indicate that they got into medicine for the purpose of knowing and helping people. So spending large amounts of time talking to patients and not ordering tests that can make you more money should be second nature, right? Let's hope so...

Ants

2015-05-22T13:13:00.001-04:00

Watching a two year old figure out the world can be pretty entertaining sometimes. There are hard times, of course, but some of the situations are downright hilarious. Take my little man's relationship with ants, for instance. The weather wasn't heating up for very long before those familiar ant hills appeared in our back yard. Little buddy was fascinated.

I could see the toddlers wheels turning. "How did this pile of dirt get here? I didn't put that there. This must be a trick." The first time he saw an ant crawl out of there, he immediately backed up. "What is this mystical, miniature being? There is no way that one of those could have moved all this dirt." The first time he saw me kick an ant pile and all the ants scatter? Pure chaos. "There's a million of them! We're being invaded!" He took off for safety immediately, otherwise known as Mama.

You more senior parents out there already know what huge mistake that was. Little man immediately took to using whatever objects were available to destory every ant hill he encountered. This was especially difficult becaus we were trying to impart to him how ants would hurt him. You could see the indecision gripping him. He would run up to the ant pile with ball in hand, ready to do battle. He would stop about two feet away and look back at me as if asking,"Are we going to war today or running for our lives?" I felt for him. No toddler warrior can work in this kind of environment.

We have managed to strike a balance in our relationship with ants now. We have adopted the same relationship with them that we use for strangers. That is, you are nice but wary. Thus, walking across our back yard with him is punctuated by stopping multiple times so he can wave at each ant hill and yell at the top of his lungs,"Hey, ants!" He will then stoop down to inspect each pile before moving on to the next one.

As icing on the cake, he has even figured out that each hill is the ants' home. Unfortunately, this has presented him with an entirely new set of problems. We are now at the stage where finding an ant outside of an ant hill is the equivalant of seeing a missing child when an amber alert is going on. He starts screaming,"Oh no! Ant, ant, ant!" I've even overheard him sternly telling a solitary ant marching across our driveway that it needed to go home immediately. Fortunately, I haven't witnessed any rescue attempts as of yet. We all know how well that would go. Toddler warrior would return and unleash Hiroshima on the ant population of greater Berkeley County. Our family just doesn't roll like that.

Communion Meditation 5/15/15

2015-05-17T21:10:00.003-04:00

I had written a meditation that I took to church with every intention of delivering. Holy Spirit changed that during Sunday School and the following is an approximation of what I said. The communion meditation that some of you may have seen posted earlier today will be reposted later this month when I use it.

This week's events in Berkeley County, notably the shooting of Lieutenant Rogers, have prompted me to change what I'm going to say today. I'll start today by reading 1 Peter 5:7:

Cast all your anxiety on him for he cares for you.

The ICU rooms at MUSC are all designed the same. Each room has a desk sitting outside the room with a computer. There is a window into the room that allows you a view of the patient. Having spent many hours in the ICU's of MUSC during residency, I am very familiar with those desks. Physicians typically sit there and enter orders while trying to oversee the, sometimes chaotic, scene unfolding in the room.

You find out a lot about yourself at those desks. I know I did. As an ICU physician, your job is to essentially wait for catastrophic things to happen and then you are expected to fix it. The truth is that you learn a lot about your limits while sitting at those desks. You are witness to great feats of teamwork and hard work sometimes, which are incredibly rewarding. You are also witness to situations that you are simply unable to change. Physicians don't like to talk about it much, but there are quite a few situations where we simply have no control or idea of what is going on.

On those nights sitting at those desks outside those rooms where Lieutenant Rogers is now being cared for, 1 Peter 5:7 got me through. I take great comfort today knowing that those walls have heard that verse repeated countless times. I have said it over and over again late at night when I was the lone physician sitting there trying to do my best to help patients, just like the ICU team is doing now for Lieutenant Rogers.

The reason that 1 Peter 5:7 can get you through situations like that is because of what Christ did on the Cross for us. Today, we commemorate what Christ did and how that gives us power now. We remember that 1 Peter 5:7 still applies, whether you are Lieutenant Rogers and his family or the physician trying your best to take care of him. We should remember that power every day in our daily lives.

Mother's Day Communion Meditation

2015-05-10T12:00:00.000-04:00

In our church, people rotate giving a short meditation before communion each week. People typically do this for one month at a time and then rotate. It is my turn this month, and these are my thoughts I shared today in our communion meditation.

As many of you know, today is Mother's Day. For those of you that have forgotten, its quite honestly too late for me to help you. Might as well enjoy the service now because you once walk out of those doors...it ain't gonna be pretty my friend.

Mother's Day is a special holiday for me. Sure, I always celebrated it with my mom growing up, and we would do nice things for her. But my perspective has changed over the past two and a half years as my wife has become a mother.

There's a whole new level appreciation for the fact that her work really never ends. You can hear it in my son's reply to almost any question around the house. Want to eat now, son? Momma? Want to take your bath now, son. Momma? Scared in the middle of the night and need someone to sleep on a half deflated air mattress next to your bed. Momma?

It's the only job that never ends, has no rules, and pays nothing, and God knew what he was doing when he put my wife and all of your wives and moms in that role. I know my job this morning is to get you ready for our time of communion, but the whole purpose of this day should already be doing that.

Today we celebrate the people in our lives that give all of themselves every day to make sure we are taken care of. They ignore their own personal wants and needs and think about their families before themselves. As we have been learning about in Sunday School the past few weeks, "Jesus spoke of that." Jesus gave His all so that we could be sons and daughters of God. Today, we think all mothers for being living, breathing examples of that kind of sacrifice every day in our lives.

Communion Meditation 5/3/15

2015-05-03T23:20:00.000-04:00

In our church, people rotate giving a short meditation before communion each week. People typically do this for one month at a time and then rotate. It is my turn this month, and these are my thoughts I shared today in our communion meditation.

There's several different degrees to the word different. That may not be quite so obvious at first, but let me give you an example. My wife says that I'm "different" sometimes. All the wives know what I'm talking about here. That meaning is usually somewhat funny and in jest. Husbands , quite honestly, tend to think the same thing about their wives. Youth, some of you might call people at your school "different." They don't blend in. Don't look like you. Maybe you don't quite understand them. Likely, everyone pressures them to not be different. This kind of different can have a little more of an edge to it, especially when you're a teenager and simply worried about fitting in.

Then, there's Jesus' brand of different. That's the whole "I'm going to allow myself to be hung a Cross to save you even though I'm blameless" different. That's a whole 'nother level of different. Yet, that is what we're called to. In an American culture and even church culture that is placing more and more emphasize on blending in and not being different, Jesus says no. Jesus asks us to be different, demands it from us even.

We see this in 1 John 2:15-17:

Do not love the world or the things in the world. If anyone loves the world, the love of the Father is not in him. For all that is in the world-the desires of the flesh and the desires of the eyes and pride in possessions-is not from the Father but is from the world. And the world is passing away along with its desires, but whoever does the will of God abides forever.

What Christ did on the cross, what we commemorate now around this table, was different. Whoever puts their hope in worldly things, in being just like everyone else, will perish, but for those of us that come around this table this morning, being different is the key to life. Let us remember that our lives should reflect that.

Toddler Nap Dibs

2015-05-02T08:00:00.000-04:00

Naps on the weekend are a sacred time in any household with kids. There is a very limited time during daylight hours where a child is sleeping, and the parents are free to do whatever they want. Our weekend nap time routine has a fairly predictable pattern. We usually spend about thirty minutes to an hour frantically getting tasks done that would be impossible if little man was awake. We then spend whatever time remains relaxing.

The interesting part of this routine is when the toddler awakens. As those familiar sounds begin to emerge from his room, an almost primal situation occurs. His mother and I look at each other like two opponents ready to do battle. As I said, there are only a precious few minutes of relaxation available. For the person who must go get the awakening toddler, this time is cut short and also usually punctuated by a wet diaper, cries for juice, and a generally very cranky toddler.

We have developed a system similar to the childhood tradition of calling dibs. The basics go something like this. The parent that is able to yell first that the other parent is coming gets to remain seated. For example, if my wife is able to get out,"Your father is coming" first, then I have to go. You might think that you could just say this before the toddler awakens, but we have ground rules to prevent this. If you yell prematurely and awaken the toddler, then you're up sweetheart.

It makes for some pretty interesting routines during nap time. You never want to be too far from the stairs because if you are, then you can't hear him stirring in time. We also have a baby monitor still in his room, so I've adopted the strategy of turning the volume way down so only I can hear it. That drew some complaints early on.

As you can imagine, I lose these battles a lot, so I've adopted a plan to salvage the situation and gain some parenting status points. Every time I go up the stairs I say,"Daddy's here. Momma left." You can imagine how that goes.

I'm Really Proud (If I Was Your Dad That Is)

2015-04-25T15:35:00.002-04:00

Little buddy had one of those moments at his cousin's softball game this past week. It's one of those moments as a parent where you want to burst with pride and crawl under a rock at the same time. Every parent has had one of these moments. Maybe your kid tied his shoes for the first time...and then tied his friends shoes together. You get the drift.

Little man was running around in front of the bleachers when he saw a little girl about his age. He walked up and gave her the patented wave and very loud,"Hi!" that has earned him many other girlfriends. They were soon playing together and having a good time. Then, the little girl's mother made a deadly mistake.

They were playing near a sign, and the little girl's mother asked her to point to the T. As the little girl struggled, I watched my son try to contain himself. To his credit, he waited a good five second before sticking his grubby little finger over the correct letter and loudly yelling,"T!"

In case any of you were wondering if two year old girls have already developed the laser like stare when they're angry, the answer is yes. That little girl gave Garrison a look that could kill. Unfortunately, her mother didn't help her much. She promptly yells out," Thats OK! Find the S!" There was no hesitation this time. Little man immediately found and loudly proclaimed his discovery of the letter S. As if unleashing a torrent of pent up knowledge, he then began going down the letters in rapid fire yelling out each one.

The poor little girl, at this point, had no choice but to change tactics and run interference. She threw herself between little man and the sign and wouldn't let him see any of the letters. This didn't bother him in the slightest. Several inches taller than her, he simply got up on his toes, reached over her, and kept going.

Fortunately, the little girl's mother separated them at this point, otherwise little buddy probably would have been on the receiving end of his first slap from a girl. I will say that I don't think he really understood what was going on. After the little girl was dragged to the other side of the bleachers, he kept going up to her trying to get her to come back for more spelling. After a few holes burned through his forehead by her gaze, he finally dropped it.

You might ask where I was during all of this? Well, I was standing off to the side about 10 feet away rolling with laughter with other members of our family. Our general strategy was to enjoy the moment and then simply pretend to not know whose child he was if things went south quickly. Nothing will build your parent street cred like grabbing the unruly, show off toddler and loudly proclaiming that you're going to go find their mother. Dad of the year? You betcha.

Award Shows

2015-04-19T22:31:00.002-04:00

Glitter and glam surround

Carpet, the color of redemption,

Mistakenly placed,

Ushering those without need.

Normality escapes.

We are transported while

Art is parsed.

Snippets performed, though sometimes

Shell games are played.

And then a moment of clarity

Cuts through the veil of pretentiousness

And false importance.

A truth spoken or

Transcendent talent shines.

There are moments of intense clarity

In this constant cry for ego.

They are redemptive.

Perhaps the opening flooring

Should be like that of Dorothy.

The fake reality of riches

Versus the glory of humility.

Few are deserving.

How You Exit Is How You Live

2015-02-23T08:00:00.000-05:00

I have a pretty unique gift for pegging someone's parenting style based on random things I see. Now that little man is two, I've been to my fair share of Disney shows, circuses, and other similar events. I've noticed a really cool phenomenon throughout the past two years. During the show, you'll have typical toddler/baby problems going on. Screaming, tantrums, crying and the sudden realization that that Mickey doesn't look like the one we saw last week are all commonplace. The end of the show, however, is where the money's at.

As soon as there is any hint of the show coming to a close, the real show starts. People immediately begin to group themselves into three categories. As I sit back in my seat and observe, I can tell a lot about your life by which category you're in. I call it how you exit is how you live.

The Early Birds

Forget being off at the sound of the gun. These folks are gone when they even see the gun. As soon as a mention of the show ending comes, they are out of their seat dragging their kids towards the exit. These folks are known for their brutal family efficiency. The schedule is the schedule. You didn't eat your chicken tenders? Tough luck, junior. Next scheduled time to eat is the ten minute slot at 6:15, and those chicken tenders will be waiting. These folks have backed into their parking space out front and have brought along the grandparents so they can use the handicap spot. Ultimately this is their downfall as they try to run out of the theater with grandma in tow. Tough to make good time when someone is using a walker.

The Orderly Crowd

These are the regular folks that get up and leave when the show is over in a normal fashion. They are more relaxed than the first crowd but ready to move on with their day. They tend to let people out in front of them as they go so everyone can get out in short order. They have parked exactly where they were instructed to and have dutifully left their parking ticket right in the left lower corner of their dashboard as instructed. They are communal and like to make sure everyone is taken care of. Their deference creates problems though. They tend to get injured in the parking lot as the first crowd is already gunning it towards the exit by the time they get outside the building. "Is there a fire I didn't hear about" and "how rude" are common phrases to be heard from this group.

The Stragglers

My wife swears I am in this crowd. These folks ain't putting up with the rush. Why run? The car will be there no matter when we get out of here. These folks let everyone clear out first. While everyone else is trampling each other, they sit back and enjoy the scene. This can be a problem when you have toddlers. They have been sitting for quite some time at this point, and keeping them under control while everyone slides by you can be an issue. In general, these folks are more relaxed at home. You want to use the air mattress as a ladder to climb up on top of the dresser? Cool. Just make sure you slide back down instead of jumping. We ran out of super glue, and we'll have to go to Wal-Mart to get some if you cut yourself.

There it is folks. How you leave says everything about you. I tried to grab some representative photos to give good examples but there was no flash photography during the show, and the early leavers were already gone by the time the show actually ended. I'll try to be more prepared next time, as much as a straggler can be that is.

Is It Time to Laugh or Cry?

2015-02-16T13:24:00.001-05:00

If you really tried to use social media to follow along with your friends’ lives, then you would be disappointed. Getting honest insight into people’s lives can be pretty difficult. If you log in and scroll through people’s pictures, then it usually looks like everyone around you is living in utopia. Like most folks, I tend to scroll through on my phone more than on my computer. I usually do this while standing in the mall or some other public place with little buddy.

Little man has some of the best comedic timing of any toddler I’ve ever seen. As I’m scrolling through reams of videos of smiling two year olds doing trick shots behind their back or speaking multiple languages (Little Tommy started learning Portuguese today!!! #kidgenius #goingforlanguagenumber4), my little man is trying desperately to master the fine art of escaping from a five point harness stroller and two parents with graduate degrees. As I watch him succeed and my wife chases him down the hall, I usually try to cheer myself up with the fact that at least he has much better speed than his old man.

I will say that I had a major discovery this weekend though. We were at a mall, and I had commandeered little buddy after an epic meltdown in the Cheesecake Factory to go line. As we were standing there waiting for my wife to come meet us, a two year old girl came in the door with her parents. She proceeded to fling herself on the floor and go for broke. In between flails and screams, her dad managed to pin her down into her stroller and strap her in after about 15 seconds (pretty good time my man, respect). She continued screaming while her parents tried to get their bearings and pretend like nothing unusual was happening.

As I watched the drama unfold and smiled to communicate that I felt their pain, I realized that something magical had happened. Little man was absolutely silent. I looked down and he was staring at this little girl as if she had three heads. During the entire scene, he never moved a muscle or made a peep. Eureka! So that’s the secret. All I have to do is produce another screaming child, and he’ll never misbehave again!

To you non-parents out there, this may seem like a complete scratch. Why trade one screaming child for another? The parents out there, though, will know the difference. While the sound of your own child screaming is a second by second affirmation of your inability to control your own offspring, the sound of other kids screaming is pure relief that you aren’t the only one. Other people indeed have these less than perfect moments where they try to wrangle toddlers determined to display just how strong willed they really are. Take that little Tommy and your Portuguese. I know your mama photo shopped that.

My Valentine is Better Than Yours

2015-02-14T08:00:00.000-05:00

Valentine’s Day celebrates relationships and gives everyone an opportunity to show love to those that mean the most to them. My message today is short and sweet. My wife is awesome. She shoulders a load daily that most people can’t imagine and does it all with a smile on her face. The many hats my wife wears daily include:

Full time physician

Wife

Cook

Accountant

Interior Decorator

Hostess

General organizer of pure chaos

She does all these things 24/7 (literally now that little buddy likes to wake up a 3AM), rain or shine and on holidays. As I get out of the house quickly and efficiently in the morning to head off to work, she puts our family’s entire day on track and gets ready for work, all while trying to keep a two year old from jumping out of a window. There’s no one like her, and I’m blessed to have her. I love you!

Poop Drop

2014-03-24T13:39:00.001-04:00

One of the fun parts of starting your own family is establishing what your own traditions will be. Spouses tend to bring to the table whatever you have done with your family at first, but gradually, you start to establish how your own household will handle things. In my view, firming up your household schedule and priorities is a sign of a maturing family.

In terms of our daily routine, we don't vary too far from the norm. Both parents work in our house, so both of us have responsibilities at home after we get off work. I will openly admit that my wife outworks me in this arena and is generally better at it than I am. I give as much effort as I can to keep up with her and help out.

One of my daily duties is bath time. Early on, I just happened to be the one that gave him his bath, and it has evolved into one of the set times after dinner in our house. While my wife does other chores around the house, I get little man washed up and teach him new ways to goof off in the tub.

There is usually a dirty diaper involved somewhere around bath time. We use the indispensable diaper bags that will mask the smell to dispose of little man's stink bombs. It just so happened that I was busy chasing after him one day with one of these in my hand. I decided to just toss it down the stairs to save time. After I did it, an idea struck me, and a tradition was born. Check it out:

How awesome is that? Little buddy insists on disposing of his poop in this way anytime I change his diaper upstairs. In case you were wondering what happens next, we just about have him trained to pick it up and take it to the garbage can. Video to follow of course.

I know there are some "parenting experts" out there shuddering at this. Yes, I have taught my son to toss his feces over a second floor landing onto a hardwood floor. But, you have to have a little fun in life. At least he now knows that the stuff that comes out of his rear end has to make its way to the garbage can somehow, even if it does involve getting airborne. Most little boys his age just try to figure out a way to smear it in their hair. Think how far we've come!

March Madness Uncertainty

2014-03-23T08:31:00.002-04:00

My kid is a ham.

Yeah, we have mastered saying hi to ourselves. If only we can extend this greeting to other people. Rome wasn't built overnight...

So You Wanna Be A Doctor?

2014-03-19T13:14:00.001-04:00

Interviews, particularly med school interviews, become more and more silly the further I go. I firmly believe that the vast majority of admissions decisions have already been made before an applicant shows up on campus. The interview is really just a way to see if you can walk, talk, and not do anything resembling a sociopath for at least a few hours in a row.

Despite the grandiose stories you may hear, my own interviews were relatively benign. No one made me go through virtual patient scenarios or grill me on difficult ethical situations. I was fortunate to interview fairly widely, and there were some real characters on the interview trail.

One particular school paired me up with the most introverted interviewer I had ever seen. His opening bid was telling me his name, specialty, and asking how I envisioned myself connecting with patients. I was enthusiastic because that was by far one of the most interesting questions I had been asked to that point. After my answer, though, he just stared at me. We looked at each other for about twenty seconds before he said,"OK, are going to tell me anything else about yourself?" He actually expected me to fill up the entire interview by myself while he simply listened! Needless to say, I didn't get into that school. But I did get a wonderful idea of what kind of person I wouldn't admit to medical school if the tables were turned.

This story is one of the extreme examples of ineffective interviewing, but I see it in all forms. Many people doing the interviewing for medical school are faculty that are simply volunteering their time. They are squeezing applicants into their schedule and are often unprepared to really learn anything about the person sitting in front of them.

This amateurish approach to interviewing seems particularly egregious to me. Fortune 500 companies spend large amounts of dollars and resources on making sure that they select good people to work for them. Why would selecting future physicians be less important? I realize that big corporations often have more resources to commit to this task, but that's not an excuse for cutting corners in my book.

The result of our poor interviewing is that the admissions process comes down to who can perform the best academically and then suitably pad their resume. I have no problem with making sure that future doctors can perform intellectually. I have a big problem, though, with our tacit suggestion that how you interact with people isn't just as important. Patients don't visit an encyclopedia. They visit a real, human being who can understand their problems and help them. We should make our selection process reflect that.

The Loud Reader

2014-03-17T14:50:00.000-04:00

I don't remember the first book I read. My memory is good but unfortunately not that good. I am sure, though, that my first reading experience was probably different from my son's. Like his mother and I, little buddy enjoys good literature. It's fun to watch him rifle through his collection until he finds the perfect one that he is looking for. Usually a squeal of delight follows, and he sits down to enjoy himself.

Some of you probably can harken back to the good old elementary school days and remember "that kid that read aloud." You know the one I'm talking about. The teacher gave out an in-class reading assignment. You'd settle down in your desk to get started and realize that some kid is just yammering away next to you. You turn to tell him to be quiet and realize that he's not talking, he's reading. I had several of these in my classes throughout the years. Invariably, the teacher would bring it up to the kid's parents, and they would proudly say that they taught him that! I understand that you want your kid to enjoy to read, but we have some social constraints that should at least be considered along the way.

Given my experience with these kids at an early age, you can imagine my feeling when I see my kid doing this:

Yep, my kid is a loud reader. This feels like God laughing at me right now. He is, isn't He? Needless to say, we have a few things to work on here in the HumorMD household. I must say that I suddenly feel much more sympathetic to those parents that were pulled aside by the teacher back in my day. Hey, at least the kid is reading, right?

Innovate and Palliate

2014-03-10T11:00:00.000-04:00

If I was a pure businessman, cancer drugs would be an interesting market niche to occupy. Research and development would be a potential problem. How many people in the world have the knowledge required to develop new cancer drugs? Not many. To top it off, most of them have no understanding or passion for business. Many of these scientists work in universities so as to not be bothered by corporate executives and the like.

On the other hand, you don't really have to accomplish much to hit it big. What happens if you come up with a drug that extends life by three months in metastatic lung cancer? Currently, that would probably make you a billionaire. That's right. Billion with a capital B. We simply don't have any great treatments for this, so anything that gives people longer survival by any length of time is pure gold.

The funny part is that we actually have a product that can increase survival by a few months without any of the nasty side effects of chemo. In fact, patients that use this product have drastically improved quality of life. What is this wonder drug, you might ask? Where can I buy stock in this? Actually, you can't buy stock in it at all. It's palliative care.

You can bet that us medical folk were a wee bit surprised when we found out that palliative care extends life in advanced lung cancer. The article was published in the New England Journal of medicine in 2010 (link here). Most physicians and patients think of palliative care as a fancy way of saying "we surrender." Nothing could be further from the truth. Early involvement of palliative care generally results in symptoms that are better managed and patients with better quality of life, regardless of whether curative treatment is being offered.

In general, the medical community doesn't get palliative care involved early enough. The aforementioned "we surrender" attitude means that physicians won't consult palliative care until the very end, which doesn't allow the time necessary for palliative care's full benefits to come to fruition. If we withheld a similarly performing medication, then it would be on the front page of CNN that physicians across America were being negligent. Would they be wrong? I don't like to think about the answer to that question...

This Just Feels Like a Circus

2014-03-09T15:16:00.003-04:00

I know. I went back to my old blog address. I'm sorry. The confusion will stop here fairly soon. Most of you click through from Facebook to get here anyway, so it shouldn't be too big of a deal. I was thinking that I would start fresh with a brand new blog address, but I soon realized that was dumb. I already have so much chronicled on this blog. Why put similar content in a completely separate place? There's no reason for foolishness like that.

On a more fun note, we took little man to the circus this weekend. We have quickly discovered that he LOVES shows of any kind. We've seen several live performances of his favorite TV shows, and he always enjoys it. The circus was no exception. He was riveted the entire time, in between squeals of delight that is. This should give you an idea of just how fixated he was:

You will also note that the circus is entertaining for all ages, which I can attest to. His grandparents found it just as thrilling as he did. You may wonder what they're looking at that would be so astonishing...

Now, this is impressive in its own right, but you have to think about this from a toddler's perspective. He has never seen an elephant before about twenty seconds ago, and now they are dancing to techno music in front of him. Mind=blown. I think he stared at that exact same spot for about ten minutes even after the elephant act was over.

We're really in a bind for figuring out how to top this next weekend. How do you get any better than pachyderms doing the polka? I'm thinking maybe order something from Amazon, have their fancy new drone system deliver it, and then tell him that the drone is part of Santa's new gift delivery system. Then, we can tell him drones will stop coming if he misbehaves. Move over Elf on the Shelf. That's next generation parenting for you.

Stocks 101

2014-03-09T14:42:00.001-04:00

I've been actively watching the stock market for about a year and a half now. I like this phrase, actively watching. It means I pay close attention, but I'm not out there trading. The money that I have in the stock market is in my retirement account, and it's currently in index funds.

My realization that I was going to be throwing a significant portion of each pay check into this "retirement account" thing was what spawned my interest to know exactly what was happening with that money. It's been an eye-opening experience to say the least. The stock market is a lesson in humanity in it's most primal state. Profit, loss, fear, greed, elation, disappointment, power. Just a few things you can readily identify when looking at a basic stock chart.

With all of my reading, I've come across a few initial take home points to share. First, most of the money being made in the stock market is not being made by people actively trading stocks. Most of the money being made is going to people that have actually built these companies. If you want to hit it big on Wall Street, then build a Fortune 500 company. Surefire way to make millions. Go...

Second, online stock trading seems to be a lesson in how technology has made things easier but not necessarily better. Buying shares in companies used to be a deliberate, thoughtful act that required much thought and effort to even get your order to the trading floor. Now, you can spend millions buying stocks in seconds. Is this really better? Has using technology to chase quick profits really been a good addition to our culture? I think not.

Even more ironic is how the appeal of online stock trading has stacked the deck even further against the individual, if you fall into the trap. Ever tried to day trade against a multi-billion dollar corporation with supercomputers and countless Ivy League trained mathematicians and businessmen? Swing for the fences Average Joe. Just make sure you don't get that uniform dirty because you are going to be out of the game quick.

I'm going to be writing more about stocks in the future. It's a subject that I really enjoy. Though it may sound like I dislike the entire system, I actually support the idea of buying and selling ownership in a company. Only in America can you find a company you like and hitch your financial wagon to them. You also might be able to buy a naked put option and lose your shirt when the stock crashes, but you never get the good without the bad. Welcome to life.

On Top of My Game

2014-03-09T14:41:00.000-04:00

My son has some unusual habits sometimes. Nothing out of the ordinary for any other toddler figuring life out. But it can be pretty entertaining. For instance, his latest dance move is simply spinning around over and over again in the middle of the living room floor. This is usually followed by him falling down and being unable to get back up. Baby dizziness can take quite the toll. I've gotten a few good videos so far, but all of them feature his parents in their pajamas. Not exactly world wide web material.

He also has a penchant for playing ON things rather than IN them. A while back, we bought a little blow up ball pit. He LOVES this. He would spend twenty-four hours a day there if we would let him. Despite it's design to draw toddlers inside the structure, he has devised an alternative way of playing with the ball pit, as illustrated here:

No, it is not deflated, in case you were wondering. He simply flung himself on top of it and collapsed it so that he could sit on it. I have no idea where he dreams up this stuff, but he's a pretty creative little booger.

The FDA Doesn't Regulate Health

2014-03-09T14:39:00.002-04:00

Little man and I went to Wal-Mart today. We were on a mission to pick up a new black ink cartridge for our printer. Since little buddy loves to ride in the cart, I decided to take a little stroll around Wally World. One area I enjoy visiting in particular is the pharmacy section. Some of you may be familiar with my fondness for the store pharmacy aisle. With the proper knowledge, this aisle can be a veritable treasure trove of disease killing power.

There is danger there, however. I can usually find a few chuckles about whatever the latest and greatest over the counter supplement may be. These new products are usually some of the same old things re-branded as something new. As soon as the TV infomercials go out, people dash for the store to pick it up or call their physician demanding to know why they weren't advised to take this amazing new medication.

Many of these supplements are advertised as substances that can improve some form of "health." I've seen advertisements for things that will improve brain health, liver health, immune system health, and even prostate health. Many people don't bat an eye at this phrasing. It's incredible important, though, that little word. When consumers think of the word health, they think of models in jogging clothes that smile and hold up a bottle of whatever product it may be. Do you know what I think of when I see a product designed to improve some type of "health?" Pure junk.

When a regular medication is approved by the FDA, this approval is backed up by clinical studies that prove efficacy in some way. There are also studies reviewed by the FDA that prove the medication is safe. Guess how many safety and efficacy studies the FDA reviews before a dietary supplement hits the market? Zero. Nada. Dietary supplements fall under a completely different set of rules. It is the manufacturer's responsibility to make sure a dietary supplement is safe, not the FDA. Therefore, the FDA reviews nothing and will only step in if some type of adverse event occurs.

When advertising, these supplements are not allowed to say that they do anything specific, such as actually help with your chronic fatigue, because there have been no studies verifying this. They are allowed to use general phrases, however, and "improving health" is a common go to.

Some of you probably think that I'm being a bit harsh. How do I know that these drugs don't actually work? No studies means you don't know either way, right? Unfortunately not. These manufacturers are in business to make money. Do you know what kind of money they are giving up by not being FDA approved? To put it in perspective, it costs about $1 billion on average to bring an FDA approved drug to the market, and companies like Pfizer and Merck are some of the richest in the world. Think about that. $1 billion up front cost, and they are still making tons of money. If you sell your drug as a dietary supplement, it probably doesn't mean you chose to. It means that you know the FDA won't approve it.

I want to be clear that I'm not disparaging drug companies. Many people don't see or don't take advantage of a lot of the good work that many of these companies do for folks that can't afford different medications. To be fair, very few of the major drug companies are in the dietary supplement business either. Would you jeopardize your reputation and excellent business model by being involved with this? I wouldn't. They already know what I know. What comes out of your GI tract after you take that "gastrointestinal health" pill is exactly equivalent to it's value. Crap.