The decision to have a child was not a hard one for me. I love kids. I went into pediatrics because of the patients, not the medicine. But I have to admit, there was some serious trepidation on my part about having a second child. What would it do to my relationship with Grace? What would it mean for us as a family? Underlying it all, the nagging question: can I love two kids equally? Or would I then be splitting the love I have for Grace between two kids?
The answer to this is that I don't have to worry so much. There is a model readily established for dealing with dividing your love between two people... your first kid. Grace, too young to be stymied by logical arguments and mutual exclusivity, when professing her love for her parents will often say to me: "I love you better. I love Mommy the most." Yeah. I can't really say it much better than that, so thank you not-yet-four-year-old. I will always treasure Grace as my first child, the first one to evoke such deep rooted sensations of love and protection in me. I love Violet the same way, and yet differently. She didn't cause such a sea change in the makeup of our family as Grace did. But in her own way she has dramatically altered who we are as a family, and how I view myself as a dad. Now I am the father of kids, not just a kid. She looks (I think) more like me than Grace does. She sleeps differently, she babbles differently, and in many ways I have no idea yet what kind of little person she'll become. The excitement/uncertainty that was present with Grace is still very much there, I just have a bit more experience now.
So it's with this in mind that I have to approach the daunting task of preparing to adopt, which is how we've elected to expand our family to five. There is a whole new realm of murkiness and doubt in this. Will I be able to love my nonbiological child as much as my biological kids? Will I deal well with all the complexities and loss this child will face as he/she ages with me as a parent instead of the person who gave them life? Two worked out all right, but will I be able to split my love between three children?
But I know now that there is no splitting involved. The love you have for your kids is not a bag of candy, at constant risk of being emptied the more you dip into it. It's a living and growing thing, perhaps a fruit tree that's never out of season. And very large. And the fruit grows really fast. And you can't pick it all, because more will replace it. And... yeah, it's like that. I'm not so good at analogies. Maybe it's just a bettermost tree.
October 12, 2009
September 23, 2009
Just Say No, Kids
The other day I was sitting around having lunch with the other fellows in my allergy program. Talk turned to healthcare reform, and from there I had to ask the group: would you tell your kids to go in to medicine? The nearly universal answer was a quick "no". The lone exception was a pediatrician. Which I think is revealing.
In general pediatricians, or pediatric specialists (pediatric cardiology vs. adult cardiology, etc), make significantly less than their adult medicine counterparts. This is generally attributed to the fact that the complexity of medical problems is less in pediatric patients. Allergy is an odd bird in that it is the only specialty that can be entered from either pediatrics or medicine, and you see both pediatric and adult patients in your training. As people discuss reducing doctors' pay and other cost-cutting measures, you might expect that those on the lower end of the medical financial ladder would have the least incentive to want to perpetuate the career in their offspring. But I think the variable here is that despite lower compensation, pediatricians generally like what they do a whole lot more than medicine doctors. The money is secondary. This is not to say that people going in to internal medicine or medicine specialties are in it for the money. At least not initially. I think the system makes our lives so messy and focuses on so many things other than the practice of medicine that it makes it about the money. If you're going to have to put up with fighting through insurance prior authorizations, and lack of funds for the homeless guy you're trying to take care of, and 10,000 forms for every new patient... you're going to start to demand compensation for all the headache.
[As an aside, anyone who thinks that we don't already ration healthcare in the US has clearly never dealt with an insurance company. We have a multi-level rationing approach. Level 1) Do you have insurance or medicare/medicaid? If not, you will likely not be getting basic preventative medicines or procedures because you can't afford them (a month's supply of the basic inhaled steroid we use for most asthmatics would cost you $80-100 a month out of pocket). Level 2) If you do have insurance, will they go along with what your doctor wants to do? You have to ask for permission for a great number of procedures and medications, which often are initially rejected to see if you're serious about it, and when you fill out more paperwork will be reviewed by the insurance company to see if they agree with the treatment, having never seen the patient. In fairness, doctors when given free reign to do what they want may not give the most cost-effective medicine. Rationing is not inherently evil, society just has to decide on what basis we're going to ration the limited resources we have.]
Pediatricians perhaps have fewer hoops to jump through, and unlike medicine it's easier to get kids on some type of insurance program, but the big difference is that they feel compensated by the act of caring for their patients. Whether this is part of the culture of pediatrics, or just the nature of people who go into pediatrics I don't know. But from talking to my colleagues who come through the medicine side of things, and from my dealings with adult patients in fellowship, I have to say that the reward of the job doesn't feel like adequate compensation. So it comes down to financial compensation. And increasingly doctors feel like we can't help people anymore, except to guide them through this giant machine that is our patchwork healthcare system as best we can. It basically boiled down to "I'm not getting paid enough to put up with this".
Me? While I am a pediatrician, I have to say that I wan't the pediatrician saying I'd encourage my kids to become physicians. I think that the reality of what it means to be a doctor nowadays is very difficult to convey to people thinking of going in to it. I heard similar complaints when I was entering medical school, but chalked them up to sour old doctors that weren't able to change with the times. In retrospect I had no intention of hearing the downsides of a career in doctoring, and perhaps was a bit naïve in dismissing the complaints I heard. If my girls want to be doctors, I would be all in favor of it, but I would do my darndest to make sure they knew what they were getting into.
By and large people felt that healthcare was still interesting and rewarding, but that having that shiny M.D. after your name wasn't likely to be the best way to be a part of the system going forward. The general consensus was: tell your kids to be nurses, or PAs, or researchers, or policy makers, but momma don't let your babies grow up to be doctors.
In general pediatricians, or pediatric specialists (pediatric cardiology vs. adult cardiology, etc), make significantly less than their adult medicine counterparts. This is generally attributed to the fact that the complexity of medical problems is less in pediatric patients. Allergy is an odd bird in that it is the only specialty that can be entered from either pediatrics or medicine, and you see both pediatric and adult patients in your training. As people discuss reducing doctors' pay and other cost-cutting measures, you might expect that those on the lower end of the medical financial ladder would have the least incentive to want to perpetuate the career in their offspring. But I think the variable here is that despite lower compensation, pediatricians generally like what they do a whole lot more than medicine doctors. The money is secondary. This is not to say that people going in to internal medicine or medicine specialties are in it for the money. At least not initially. I think the system makes our lives so messy and focuses on so many things other than the practice of medicine that it makes it about the money. If you're going to have to put up with fighting through insurance prior authorizations, and lack of funds for the homeless guy you're trying to take care of, and 10,000 forms for every new patient... you're going to start to demand compensation for all the headache.
[As an aside, anyone who thinks that we don't already ration healthcare in the US has clearly never dealt with an insurance company. We have a multi-level rationing approach. Level 1) Do you have insurance or medicare/medicaid? If not, you will likely not be getting basic preventative medicines or procedures because you can't afford them (a month's supply of the basic inhaled steroid we use for most asthmatics would cost you $80-100 a month out of pocket). Level 2) If you do have insurance, will they go along with what your doctor wants to do? You have to ask for permission for a great number of procedures and medications, which often are initially rejected to see if you're serious about it, and when you fill out more paperwork will be reviewed by the insurance company to see if they agree with the treatment, having never seen the patient. In fairness, doctors when given free reign to do what they want may not give the most cost-effective medicine. Rationing is not inherently evil, society just has to decide on what basis we're going to ration the limited resources we have.]
Pediatricians perhaps have fewer hoops to jump through, and unlike medicine it's easier to get kids on some type of insurance program, but the big difference is that they feel compensated by the act of caring for their patients. Whether this is part of the culture of pediatrics, or just the nature of people who go into pediatrics I don't know. But from talking to my colleagues who come through the medicine side of things, and from my dealings with adult patients in fellowship, I have to say that the reward of the job doesn't feel like adequate compensation. So it comes down to financial compensation. And increasingly doctors feel like we can't help people anymore, except to guide them through this giant machine that is our patchwork healthcare system as best we can. It basically boiled down to "I'm not getting paid enough to put up with this".
Me? While I am a pediatrician, I have to say that I wan't the pediatrician saying I'd encourage my kids to become physicians. I think that the reality of what it means to be a doctor nowadays is very difficult to convey to people thinking of going in to it. I heard similar complaints when I was entering medical school, but chalked them up to sour old doctors that weren't able to change with the times. In retrospect I had no intention of hearing the downsides of a career in doctoring, and perhaps was a bit naïve in dismissing the complaints I heard. If my girls want to be doctors, I would be all in favor of it, but I would do my darndest to make sure they knew what they were getting into.
By and large people felt that healthcare was still interesting and rewarding, but that having that shiny M.D. after your name wasn't likely to be the best way to be a part of the system going forward. The general consensus was: tell your kids to be nurses, or PAs, or researchers, or policy makers, but momma don't let your babies grow up to be doctors.
September 21, 2009
Why So Contrary?
So after a considerable hiatus I've dusted off the blog. I've imported most of the old posts here. It seemed a good idea at the time, but maybe I'm just furthering Google's takeover of all digital information in the world. Who can say?
The last year has been interesting to say the least. New job, new city, new baby, and along with it all a new year, a new president, and some new outlooks on life. Living back in Dallas has reminded me of a lot of things I don't particularly like: consumerism, selfishness, insincerity of faith, disdain for honest thought or debate. That's not to say I'm above those things. In fact, what I think bugs me about them is that I see them in myself quite readily, either lurking at various depths beneath the surface, or bobbing merrily along on the waves and soaking up the sun. But being back here has also made me very aware of something else. I'm not sure I play well with others. In Connecticut I rolled my eyes at all the liberal elitism and self-righteous political leanings. Now that we're back in Dallas I can't stomach what seems like conservative greed, lack of concern for others, and self-righteous political leanings. No matter where we go I think I'll be going against the dominant culture.
It's not helped by the fact that we live in a society where the majority opinion has little incentive to pay any attention whatsoever to the minority opinion. Chances are that's just who I am; it could be that I just like to stir up trouble. I probably should have been a lawyer after all. (But I am rather fond of the fact that my dad speaks to me, and I can't guarantee that would be the case had professional arguer been my career choice.) So while it normally seems to apply to contrary financial investment strategies, The Contrarian seems an appropriate enough title for this thing. I'll try to periodically update with what's bouncing around in my head.
The last year has been interesting to say the least. New job, new city, new baby, and along with it all a new year, a new president, and some new outlooks on life. Living back in Dallas has reminded me of a lot of things I don't particularly like: consumerism, selfishness, insincerity of faith, disdain for honest thought or debate. That's not to say I'm above those things. In fact, what I think bugs me about them is that I see them in myself quite readily, either lurking at various depths beneath the surface, or bobbing merrily along on the waves and soaking up the sun. But being back here has also made me very aware of something else. I'm not sure I play well with others. In Connecticut I rolled my eyes at all the liberal elitism and self-righteous political leanings. Now that we're back in Dallas I can't stomach what seems like conservative greed, lack of concern for others, and self-righteous political leanings. No matter where we go I think I'll be going against the dominant culture.
It's not helped by the fact that we live in a society where the majority opinion has little incentive to pay any attention whatsoever to the minority opinion. Chances are that's just who I am; it could be that I just like to stir up trouble. I probably should have been a lawyer after all. (But I am rather fond of the fact that my dad speaks to me, and I can't guarantee that would be the case had professional arguer been my career choice.) So while it normally seems to apply to contrary financial investment strategies, The Contrarian seems an appropriate enough title for this thing. I'll try to periodically update with what's bouncing around in my head.
September 15, 2009
June 8, 2008
The Last Last
Things are winding down here in New Haven. Actually, that’s not quite true. Winding down implies a slow and steady decrease in pace. This was more like a frenetic dash through calendar days until suddenly... there’s nothing left to do.
We sold our house. We went to Texas and bought a new one. I gathered multiple documents and applied for my for-real-grown-up-doctor medical license. We packed up and moved our belongings. I went to the Pediatric Academic Society meeting in Hawaii to interview for the Pediatric Scientist Development Program. I studied for (and passed) the Texas Medical Jurisprudence exam. I worked long into the night making and editing our final residency class skit. I went to my graduation dinner (skit a huge success, thank you very much). I found out that I was awarded a PSDP grant.
Now I find myself vaguely blue, or at the least sentimental. It’s not that I’m not ready to move on with life. I most assuredly am, and will be glad to be done with residency. It’s just that our time here has been so filled with change and intensity. Despite how ready I am to be done there’s this angle of bitter-sweetness or melancholy that I can’t seem to shake.
I’ve been ticking lasts off of a mental list. Last call night. Last day on the wards. Last ED shift. Last night in the first house we owned. Last visit to restaurants we like. Last time I’ll see this friend or that attending. Last end of the year dinner. Last night with Julia and Grace in New Haven. Soon last continuity clinic and last night of pager call. After that, last day of residency. Then... what? I get in a car with the dog and drive out of town. And somewhere in there is the last last. At some point I have to stop counting lasts and start counting firsts.
March 1, 2008
One Man and a baby
OK, toddler. Due to the recent sad events in Julia’s family, she’s off to be with her family for the weekend. This means it is Grace and me (and the dog) left to our own devices for two days.So far things have been pretty good. When she woke up this morning to find that Mommy was gone there was a period of 10-15 minutes of pouting, not wanting to be in the same room as me, etc. We got over that pretty quickly though, and things have been pretty smooth since. We have come to terms with the fact that “Mommy on plane, see Nana and Granddaddy” although we’ll see how that goes tonight.
Lunch was a fun experience. Grace has been on quite the non-eating kick of late. We had a showing of the house at 11:00 this morning, so after some frantic house cleaning, bathing, snow shoveling and dog walking we jumped in the car to go to a local burger/hot dog joint. Two weekends ago the three of us went there to be out of the house when people came to see it, and at that point Grace was very into french fries. I thought perhaps I could capitalize on this to get her to eat something. It worked! Well, sort of. She greatly loved dipping french fries in ketchup. She also loved sucking the ketchup off of the fries. Eating the fries? Not so much. There were some solid (albeit not the most healthy) calories consumed though. Afterwards we got a cup of chocolate ice cream. Gracie devoured it. By which I mean she devoured it the way a glacier devours a mountain range. I might have saved us both some time and just acquired a milkshake. But, by the time she was done converting herself into a messy chocolate monster it was time for us to go back home, so I can’t complain.
Some other things I’ve learned this afternoon:
- Grace lies. She will tell you she wants to go upstairs and go night-night at nap time. Do not believe her.
- Grace hates Guitar Hero and Rock Band. I’m not sure why, but something about that guitar controller sets her off. Needless to say, I won’t be making much progress this weekend on either game.
- Grace has a renewed love with keys. Every infant loves to jingle them around. Now that she’s figured out what they’re for, she goes around sticking my keys into everything: door knobs, cabinet pulls, DVD players. Some of these tolerate unlocking better than others.
- Grace is a harsh music critic. Guitar Hero aside, she also makes amazing snap judgements on whatever music we’re playing on the stereo. Within about two notes on some songs she will loudly declare “no like song” followed imploringly by “diffint song”.
So far so good though. I may be singing a different tune if I can’t get her to bed until 10:30 or something, but I choose to be optimistic. Now I have to run, before Grace tries to unlock the dog or something.
October 9, 2007
Daddysitting
Tonight Julia is off doing grown up things, leaving me (however unwisely) in charge of the child.
6:30- We eat dinner. Sort of. By eat dinner I mean that I set food in front of Grace, which she plays with for awhile, but refuses to eat. This is par for the course. So far I am not a failure as a parent. We are however very excited by peas ("peez") and eat a few of them.
6:40- We go out to walk the dog, Grace strapped to my back in the Ergo. Grace is very helpful in holding the plastic bag should any business be taken care of by Abbey. ("Poo poo" is a favorite word. As I discovered last night it's exceptionally hilarious if you can get her to whisper it to you.)
6:47- We talk on a toy cell phone left by our babysitter. I am not sure what message this is sending our daughter. Grace clamps her finger in the clamshell halves. I kiss it, unsure of whether or not I am a failure yet or not.
6:50- Grace chases the dog ("Aaa") around and tries to hold the phone up to her massive doggy head. Dog is amazingly tolerant of this, but uninterested in talking on the beeping Minnie Mouse cell phone. I cannot blame her. Earlier finger trauma seems forgotten. My prospects of being a successful father are restored.
6:52- Grace holds on to a blanket and waves it frantically around while throwing little toy children up in the air. Soon this gives way to putting the blanket in my lap, pointing at it, and grunting incomprehensible baby noises. I am unclear on what I am meant to do.
7:01- Grace flaps her arms up and down as if a bird. Unable to fly she resorts to gathering toys and piling them up on the stairs. I throw the blanket over her head a great many times. It does not get old.
7:09- Grace attempts to type on this laptop. She is disturbingly proficient at using the mouse. Typing becomes difficult. Thankfully our attention span is very short and we go back to playing with foam block thingies.
7:14- We spend some quality time with said foam block thingies. They have cutouts in the center of them with various shapes. We try to put the shapes back into their proper squares. Grace masters ball, all else is up to me. Grace seems awed by my seemingly mystical ability to get a shape back into its square with one good push.
7:17- We put the foam squares back into the toybox.
7:19- We get the foam squares out of the toybox.
7:29- After making me put all the pieces in the squares we put the foam squares back in the toybox.
7:30- We get the foam squares out of the toybox.
7:37- Grace runs the foam inserts in and out of the kitchen. They seem to enjoy the tour.
7:39- Minnie Mouse is calling Grace again. I am allowed to browse the internet.
7:44- Browsing is over. My job of putting foam cutouts in their squares is needed.
7:48- Foam squares are put back in the toybox. I smell something fairly noxious.
7:49- Grace checks out clean in the diaper department. I narrow my eyes at the dog.
8:00- I ask Grace if she wants to go night-night. She repeats "night-night". I am not sure if she knows what she's saying. However, she then points up at the stairs, so I feel reassured.
9:15- I return downstairs. The last hour and 15 minutes have consisted primarily of me practicing for a job with the CIA. After torturing my own child by refusing to pick her up when she is in “I don’t want to sleep in my crib” distress for about an hour, I feel well equipped to waterboard terrorism suspects. How much harder can it be? Eventually Grace caves and falls asleep, I count it a small victory that she still wanted to be held by me until the bitter end, despite the fact that I was clearly a horrible and uncaring parent.
9:45ish- Julia returns. All is set back to right in the world. Until next time.
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