Friday, September 30, 2016

Alexis the Unconquerable

I haven't mentioned something because even thinking about it and preparing for it has been stressful enough that sharing the details with anyone in writing or in any form has been more than I cared to do.  Now that the deed is history, however, I can probably gather the courage to recount the details of a recent and rather daunting task.  It involved serving as a guest lecturer for primarily first- and second-year students in "Practice of Medicine" and neuroscience courses.  The topic of my presentation was  my own experience with Post-Traumatic Stress Disorder and the events that, for me, precipitated the condition. Clerkship students currently in the psychiatry rotation were required to attend, and numerous psychiatry residents and some fellows were present, as well as faculty members and people whose identities were unknown to me. I spoke to a packed house in a large-ish auditorium-style lecture hall.  As someone who doesn't aspire to be the center of attention in most situations (if I'm the featured artist in a musical performance, I do expect that attention will be paid to me and would be affronted if were not given, but that's basically the lone exception), having everyone stare at me as I recount highly personal experiences is not exactly the stuff of which nightmares are made (the events about which i spoke are the ultimate fodder for nightmares), but it was still stress-inducing. To express it mildly,  I'm relieved to have the experience behind me.  In terms of class presentations of which I've been required to be a part, my expectations for the attention of the audience were based primarily on the premise that if I didn't have it, it would have meant either that I was doing a lousy job in my presentation or that the audience was disrespecting me, neither of which would have been acceptable. Still, for the most part, I'm far more comfortable with a background role or, even more so,  with being an attentive audience member than with being a presenter.

In one particular class presentation I was required to make in my pre-clerkship years, I dressed a bit [for me, anyway; I'm usually buttoned to my collarbone and otherwise well-covered] provocatively with the hope that I would at least have the attention of the males in the group. It worked. In this situation, I didn't feel that dressing in even a mildly sexualized manner would have been appropriate. I thought it would be more fitting for them to see a version of me that was closer to the person I was at fifteen, which was my age when both trauma-inducing events happened to me.  I didn't put my hair into French-braided pigtails tied with pink ribbons, but I wore a pale polo shirt with slacks, and I probably did not look eighteen, much less the nearly twenty-two years that I currently am.  I wanted my audience to get that what happened to this person who is youthful in appearance even today occurred a full six years ago; there was nothing sexualized about my appearance at that time that would have provoked the attack, if a sexualized appearance ever provokes an attack, which it most definitely does not. It was truly a crime of violence, in this case against a child. Not every female is a little girl at fifteen, but I was very much so.

One's medical history is detailed in one's application to medical school. The members of the selection panel who view the medical history are, for all intents and purposes,  bound by the same HIPAA regulations as would any medical personnel be. It is, nevertheless, considered significant by an applicant's interview panel and is likely discussed both among the panel members and with the applicant. Medical school is a rigorous process. Few individuals are likely to be allowed into a medical school program without major accommodations if they lack the strength and vitality to maintain the required workload. It isn't leaps and bounds less physically demanding than training to be an astronaut. 

My physical and sexual assault, as well as my experience of being trapped alone in a smoky home in a third-floor attic in a severely mobility-impaired state, and the subsequent PTSD that developed, as well as the treatment that followed, were addressed by the panel. No member of the panel was insensitive in asking questions.  I believe their collective intent was to ensure that no lingering issues related to the events would negatively impact me in performing my duties. Would I be uncomfortable in examining or treating a rape victim in an emergency room was a question I recall. I was able to honestly reassure the panel that, if anything, my experience would make me more qualified and effective than would be the average practitioner in such a situation and I would probably be the physician-in-training or intern  of choice to assign to that patient if the E.R. had the luxury of making such choices on a given day.  

The panel was also curious as to the nature of my treatment, and I was able to discuss it with them comfortably. I mentioned the name of my primary care provider during my inpatient stay and during the outpatient follow-up treatment. My psychiatrist was a graduate and resident of their institution. Most of them knew him personally. I was asked if it was acceptable to me for them to discuss my case and treatment with him. I replied that I had no reservations with their doing such, and offered to type and sign a waiver to that effect at the conclusion of the interview. This was all before the interview got really weird -- before they brought out musical instruments for me to play in order to ensure that I was not padding my application with skills I did not actually possess.

At one point during the interview, one of the panelists asked if I would be willing to serve as a guest lecturer concerning my own experiences as a sexual assault victim, a mental health patient,  and recovering PTSD patient. I told him that at that particular moment in time, such a task was more than I was capable of taking on, but that, given a few additional years to distance myself from the events that took place, I would consider it.  It's been a few additional years. I was asked, and I chose to oblige the person who asked.

I don't claim to be 100% recovered six years later; it's an ongoing process, though I'm well on my way to recovery, and I do intend to recover fully.  I don't have a precise timeline for the recovery process, but I can say that twenty years from now, I don't wish to still consider myself a sufferer of PTSD. Somewhere between now and then, I expect to have come to terms with what happened, although I may always be sensitive to the smell of smoke, and I may be cautious in terms of entering public restrooms for the rest of my life.  That's probably just who I am and will always be, though it won't necessarily mean I'm still suffering from PTSD.  If a young child with even a hint of intelligence touches a hot stove, he or she is not likely to repeat the mistake. If a person has ever been hit by a car, chances are that in the future,  the person will always look both ways more than once before crossing a street. If a person has been attacked by a Rottweiler, he or she will exercise caution around large dogs. It's a natural consequence or a sign of intelligence if the definition of intelligence is one's ability to adapt to his or her environment, but, at some point, not necessarily still PTSD.

If public speaking is difficult for me when the topic is one that is in no way sensitive to me to the extent that I'm willing to dress in borrowed zebra-print shorts and a clingy top to ensure the attention of at least part of the audience, a person can probably imagine the level of stress related to speaking to an even larger group about something that is intensely personal to me. What if, in virtually baring my soul to my peers, slight inferiors, and vast superiors, I were to see them yawning, looking at the clock, and fiddling with their cell phones? I'm not sure how well I could have dealt with the situation if such had been the case. I don't know if I would have burst into tears or if I would have walked out of the lecture hall with no explanation and without excusing myself. 

Fortunately, my worst-case scenario never came to fruition. I don't know if the underclassmen had been warned that their cell phones were not to be in sight and that they must be an attentive audience, or if I was simply seeing the humanity of everyone present, but it was as though almost everyone there -- especially the youngest audience members -- was on the edge of their seats from the moment I began to speak. My dad had learned from some unknown source -- I didn't tell him, nor did I even tell Matthew -- that I was to serve as a guest lecturer. He asked if he could attend, which was very kind of him, as he could have simply shown up unannounced. I assume he wanted to be there as a source of support to me rather than because he wanted to hear what I would say. I respectfully asked him not to come. His presence would have made the task even more daunting to me. I was then surprised to see my psychiatrist, otherwise known in previous blog postings as Chairman Mao, slip in the door and into one of the few remaining seats just after I had begun to speak. He held up a pre-made sign on a 12" by 18" paper. It read simply, "I'm here if you need me." He knows my story as well as I know it, and could have taken over for me at any time had I needed him to do so. If he had asked for permission to attend, I would have, as I did with my dad, respectfully declined his invitation. Seeing him, though, and knowing that he was available if I needed assistance bolstered my confidence.

I was told that my presentation, with a brief interval for questions at the conclusion, should  take an hour. From the first word I spoke until the final question had been answered (there were students whose questions I did not get to; four stayed to ask me privately afterward) I took exactly sixty minutes. I only began to lose composure when discussing the most painful and graphic aspects of the restroom attack, and the indignity of needing to be connected to a bladder catheter for eight days following the attack. Chairman Mao appeared prepared to rise from his seat, but I smiled at him through my tears and told him I was OK. I dabbed at my eyes with a tissue from a box someone had thoughtfully placed on the lectern, took a sip of water from the bottle left there for me, and continued.  It wasn't fun to talk about it, just as it isn't pleasant even to think about it, but it's possible that each time I tell the story, it has less power over me -- less of something to for me to hide, and less of something to fear in my mind when I hear myself speak the words aloud. 

Interestingly, this is in contrast to what I was told by a local practitioner before I began treatment at the inpatient facility. She said that talking about it other than to her in therapy sessions would only cause me to relive the incident repeatedly. Perhaps what she said is true in some instances and for some people, but it hasn't been the case for me. It's not as though I want to go on the lecture circuit and tell my story every day, or even to relive it in casual conversations among acquaintances, but sharing it at times when it has felt right to do so has been therapeutic for me. I'm very grateful to have been under the care of the particular local therapist only for the brief time that I saw her. 

I called attention to the presence of Chairman Mao, my true savior in all of this. Many family members wanted to help and did so in their own ways, but Chairman Mao was tho one who possessed the knowledge and skills to enable me to begin putting the traumatic events past me. I asked him to stand, and we all applauded him. He bears more responsibility than anyone else for my progress in overcoming the lingering trauma from a set of unfortunate events that happened a little too closely together for me to bounce back from them easily and  on my own.  It was at this point that I shared stories of the fun times we were allowed to have in the in-patient facility, many instigated by us, the patients, and not by his rather lame "activity director," but how he went along with anything that seemed harmless. I expressed that it was a relief to know that many of the patients were not significantly "crazier" than I was; they were merely young people with issues; many of them suffered from lingering effects of PTSD just as I did. I told the story once again of deliberately dislocating my arm to avoid a confrontation with him, and how successful my ploy was. I then had to demonstrate my ability to dislocate both of my arms at the elbow, then put them back into place myself. My audience was impressed. if medicine doesn't work for me, the circus might.There are probably other joints i could dislocated if I put any real effort into it.

I felt that I did what was expected of me by the professor who asked me to speak. He wanted equal emphasis upon the events themselves and the subsequent treatment. While my audience was wonderfully and respectfully attentive throughout the presentation, their questions focused far more on the events than upon the treatment. They were understandably interested in the primary attacker, in his sentence, and in his current whereabouts.  I suspect the professor was disappointed that their questions were not more focused on the treatment, but they're human, and they wanted to know whatever it was they wanted to know.

The professor asked if I would consider presenting again in the future.  I told him that I didn't want to do it again very soon, but if he were to ask me again in a year or so, I would seriously consider speaking again. Meanwhile, I'm $500.00 wealthier for my effort.  Our cohort, or those of us who are off-duty,  will be having a beach party this weekend. I'll be generous with provisions and libations.  

As for me, I feel that I've metaphorically thrown a gorilla from my back.  I don't know who among my peers and superiors knew of my past -- it wasn't a total secret -- but now it's all out in the open. Anyone around here with whom I work who didn't know already either does now or will soon.  I no longer really need to worry about it. I hope no one will treat me differently as a result of their newly acquired knowledge of me, but if they do, the effect will be temporary. I'll return to being Cutthroat Bitch soon enough.

Thursday, September 29, 2016

One More Day in Outpatient Pediatrics

Tomorrow I will wrap up the outpatient portion of my pediatrics rotation. I have two more weeks of the pediatrics rotation. I'll be in pediatric E.R. next week, partly at the children's hospital and partly at a general university hospital, where pediatric cases still end up. I'm not especially apprehensive because, unless there's some sort of catastrophic event such as a major earthquake or collapse of a bridge or both, in which case sometimes even such employees  as custodians and receptionists function as medical personnel by necessity,  I won't be expected to manage anything especially grave by myself.  I may have the opportunity to stitch, staple, or glue boo boos, and now that I've done it before, I may be asked to remove foreign objects from noses or ears. If inserting IVs is necessary, that, too, is something I can do with ease. We're only rarely expected to draw blood -- usually in cases in which a child's veins are so tiny that a phlebotomist cannot find a vein -- but it's usually a registered nurse who takes over in such instances. Because I'm relatively skilled, I could be called into service should it be necessary. It's easier to draw blood than it is to insert an IV, anyway, and it's less painful to the patient.

I will then finish up my pediatric rotation with a week of pediatric oncology and hematology. I cannot say that it is something to which I'm looking forward. I won't complain if my dad decides to be here next week. I won't mind having him with me the first time I have to work on the pediatric oncology floor. (It's interesting that I don't mind having my dad around the hospital, but Matthew doesn't want him anywhere near when he's working and would prefer not to acknowledge that he's even related to my dad except that the physical resemblance is so strong that a denial would be an obvious lie.)We supposedly spend as more time interacting with and entertaining the pediatric oncology patients as we do performing  procedures on them. We do assess them, and we  observe a fair number of procedures. The idea is that these babies have been through so much already in their short lives without inflicting upon them the added burden of being turned into medical students' crash-test dummies. It's the only humane way of handling the situation.  Still, the prospect makes me very nervous.

The outpatient portion of pediatrics has been my favorite sub=rotation of my thus far short clerkship. That doesn't mean I'm seriously looking at pursuing pediatrics as a specialty. i'm not. It just means I've worked with people who are nice and fun. Because my Step 1 score on the USMLE was almost insanely high, I could probably choose almost anything as my subinternship yet not be adversely affected in terms of obtaining a desired match for my internship and residency. Applying for a pediatrics sub-internship is not out of the question. Then again, perhaps i'll like the next specialty even more.

Tuesday, September 27, 2016

A Very Silly Post Related to John F. Kennedy, Junior

What girl in her right mind wouldn't imagine herself married to this super-hunk?

I was born in the wrong time and place. A whole lot of people think that about themselves, but i think I have substance to back up my claims. Humor me for just a moment, please, and allow me to plead my case.

I'm not actually complaining so much about the era of my birth and life as I am complaining about the lack of synchronicity between my life and that of the late John F. Kennedy, Jr. The two of us would have been a fabulous couple, with the exception of the minor discrepancy of physical appearance. On a rating scale, JFK Jr. was clearly a perfect 10, while I'm closer to a 6.5 on a good day.

JFK Jr. had a perfectly decent wife in Carolyn Bessette Kennedy, and she had the stunning looks to go along with the Greek-God-like appearance of JFK Jr.  There were signs, however, that she was cracking under the strain of being married to the world's most gorgeous man. I don't think his looks were the problem.  The problem was more of the constant public scrutiny and the pursuit of paparazzi. It's something I believe i could have withstood, though we'll never know that for certain, because, barring my being an unwitting witness in a sensational media-frenzy-fueled crime, i will never be subjected to being hounded by the press. 

For the moment, let us forget about Carolyn Bessette Kennedy. I do not intend that to be disrespectful or disparaging in any way. It's just that she's not germane in any way to the points I'm intending to make. I'm not out to convince anyone that I am superior to the person she was in any way, because I'm not. She was a lovely, intelligent, charming person. My point is merely that had I come along before she and had I somehow convinced JFK Jr. and his family (while no one in the family other than the man himself had the final say, I'd venture a guess that they were not shy in voicing their opinions, and that he listened and considered their opinions at some level) that I wasn't a wholly unsuitable fit to be conjoined legally with America's royal family, the union might possibly have worked.

There would have been a few obvious factors working against us, with an obvious socioeconomic gap between our families being an especially salient distinction. While a few of the Robert F. Kennedy offspring married into the solid middle class, it wasn't something either John or Caroline was likely to do. It wasn't even wealth per se as much as lifestyle. I suspect a Tier One Kennedy would be or would have been perfectly compatible with someone who came from a family of old wealth whose family somehow managed not to hang onto their money. 

My parents aren't poor; how wealthy they are, I don't know, but I do know that they could choose never to work another day in their lives and would have the means to maintain a much more extravagant lifestyle than they've maintained thus far. Still, if my parents are wealthy, and it's probably a stretch to say that they are wealthy  -- they're probably more likely firmly entrenched in America's upper middle class -- they're nouveau riche. While my paternal grandparents possibly have the wealth to place them in the upper-class, speaking strictly of finances, as we know it takes more than money to propel a person to the bona fide upper class,  my grandfather's major windfall occurred after my father was on his own. Nothing my parents ever earned was as a result of a start-up fund from my grandparents. My dad didn't sell off stock to pay his college expenses; he had no stock to sell.  What undergraduate tuition and expenses were not covered by academic scholarship money - and most of them were - my father paid back to his parents.   My grandparents didn't contribute a cent to my father's medical school costs or living costs while in med school. 

Speaking of lifestyles of the jet set, I've left the American continent three times: twice to travel to Hawaii and once to visit Ireland. My parents are world travelers, but they've traveled the world without us. Their plan was to provide us with sufficiently substantial educations that we would have the ability to earn the money to travel to anywhere one can travel. We have  traveled, but on the North American continent. The majority of our trips were to visit relatives in the Utah-Idaho region, and in the neighboring states so that we could hit major tourist attractions while on those trips to visit relatives. We have hit both the northern and southern regions of the east coast as well. I don't wish to paint a picture of my parents plopping us in dismal central California and allowing us to rot. On the other hand, JFK Jr. probably spent as much time in airplanes as a child as I spent in automobiles. We grew up in different worlds.

On the other hand, I'm an adaptable person.  If someone wanted to place me in a situation where my vacations were limited only by time and not by means, I could live with that.  If I had to exist in a situation where paid help prepared most of the meals, cleared the dishes from the table, and handled the rest of the clean-up chores. that, too, would be within my scope of coping mechanisms. If I lived in a pristine home in which I didn't even know where the vacuum cleaner was kept, I wouldn't lose a great deal of sleep in worrying about the location of the vacuum cleaner or any other cleaning supplies.  I might not even bother to look for them unless a child tossed his or her cookies on a day when the hired help was off.  I could  go with the flow where those things were concerned.

I would have completed  medical school and the shortest possible residency.  I would have affiliated myself with some medical facility in the vicinity of the residence JFK Jr.chose. If I woke up and it seemed like a nice day to practice medicine, I would have shown up. If, on the other hand, I looked out the window, saw the snow softly coming down, and decided that it was more a doughnuts-and-hot-chocolate-while-reading-or-watching-garbage-TV-or-playing-the-piano sort of day, I would simply have placed a call to the medical facility to let them know I would be unavailable for the day barring a major subway crash or disaster of epic 9/11 proportions. It's a lifestyle to which I could have grown accustomed.

The downside of public scrutiny and paparazzi is something with which I could have dealt. The tabloid headlines of "JFK JR. is to ditch Plain Jane Wife for Italian Supermodel" might have been a bit cumbersome, but overlooking such things is an acquired skill. I could have smiled and waved at the paparazzi each time I left my apartment. I wouldn't have felt the need to make enemies of them. I'm secure enough in who I am not to be worried about a few unfavorable photographs hitting the tabloids. Furthermore, I've spent most of my life competing with a sibling for attention. A bit of free attention tossed in my direction is not something that would have caused me undue stress.

A bit of strategically applied cosmetic surgery (not of the Michael Jackson variety; I'd still look like myself, but just a bit prettier) might have downplayed some of the headlines lamenting the discrepancy between our appearances. Beyond that, I'm comfortable with my girl-next-door appearance, if JFK jR.could have grown accustomed to it. After years of dating Hollywood starlets and the like, it would have been a step down in the department of aesthetics. (It probably would have been a step up in the intellectual department, though.) I'm never going to be the prettiest girl in a room, but I'll not usually be the ugliest one, either.  And, when you get down to it, looks are highly superficial.

Height may have been a bit of an issue. I believe JFK Jr. was something like 6'3". I'm 5'3". Some people think tall men look "cute" with shorter women. Those people are a minority. I would have needed serious tutoring in walking in stilettos until I had perfected the art. The discrepancy in heights would then have been minimized, though never eliminated. I suppose I would have to tried to stand on a higher step for better photo opportunities.

Monogamy may possibly have been an issue, though I never read of rumors of dalliance once JFK Jr. was married. I know there were cases of marital infidelity among some of JFK Jr.'s cousins, but nothing that would compare with what was reported of their fathers. The genetic or learned behavioral tendency in that regard seems to have been diluted in the next generation. It's possible they don't even exceed the national average in that regard. Some of my professors and supervising physicians exhibit the same behaviors and none of them, to the best of my knowledge, are in any way related to the Kennedys.

It's a moot point. JFK, JR. was born in 1960, which is years before even my parents were born, while I came into this world in late 1994. It was never meant to be. Still, it's fun once in awhile to imagine how things might have been.

Monday, September 26, 2016

The Mysterious Case of Jonbenet Ramsey

The 20-year anniversary of  the death of Jonbenet Ramsey takes place this December.  Milestone anniversaries of newsworthy events tend to invite media outlets to re-visit the event.  This case in particular prompted new coverage because the initial case was never solved.  Conflict arose at the time between the district attorney's office and the local police department. Such conflict is basically never a good thing, and in this case seemed to set up all sorts of road blocks in terms of a resolution ever happening.

It's a gruesome story.  Any murder of a child is horrific. This one was ghastly  -- beginning with the fatal blow to the head, followed by what was alleged by some investigators to be a staged strangulation and fabricated molestation.  The case was made all the more sensational -- as though any added sensationalism was needed -- when photos and videos surfaced of the child victim in her living days as a participant in the child beauty pageant circuit.  The  photography and videography seemed to many to show very young girls in poses and choreographed moves that appeared entirely too sexualized for the ages of the children involved. In the end, the impropriety of the pageant participation as viewed by some turned out very likely to be entirely extraneous, but it did add to the media's frenzy in covering the case.

Public awareness of the case began when a 9-1-1 call was placed by Patsy Ramsey in the early morning hours of December 26.  Mrs Ramsey was understandably distraught when making the call.  She hung up the phone prior to the arrival of law enforcement personnel, which is, according to officials quoted in CBS' review of the case, somewhat unusual. When she hung up, the call wasn't properly disconnected, and the dispatcher could continue to hear, and the automatic 9-1-1 recordings continued to record sounds from the Ramseys' end of the line. The dispatcher, Ms. Archuletta, expressed that the distraught tone she had heard when speaking with Mrs. Ramsey was no longer evident in Mrs. Ramsey's voice. Additionally, voice analysts detected the voice of Burke Ramsey, Jonbenet's nine-year-old brother, on the recording. This is significant primarily because the Ramseys' official account held that Burke was in his bedroom through that time and was not awakened or did not leave his bedroom until hours later.

Investigators worked day and night on the case, only either to be released from their duties by superiors when disagreements occurred or to remove themselves from the case when either they felt justice was not being served or when they felt too burnt out to continue any longer. Accusations were slung back and forth between the local police force and the district attorney's office. The D.A.'s office accused the police investigators of tunnel vision in terms of the focus of their investigation, more specifically of focusing upon the Ramsey family at the expense of examining a large number of other potential suspects.  Police investigators denied this, citing a large number of suspects they had ruled out.

At the crux of the matter was the D.A.'s investigators' "intruder theory" versus the police investigators' "one or more of the three surviving  family members in the house orchestrated the chain of events."  The D.A.'s office cited as evidence contact DNA on Jonbenet's underwear and leggings. The police investigators felt that the DNA evidence was not necessarily substantial -- that the contact DNA n the underwear could easily of gotten there during the manufacturing of the underwear, and could just as easily have been transferred from the underwear to the leggings when the garments were pulled on or off.  The D.A.'s office demonstrated how easily an intruder could  have slid into the home  through a window leading to the basement. The police investigators pointed out spider webs and foliage that, they said, would surely have been displaced by anyone gaining access to the home through the window to the basement. They offered their own demonstration of such. The demonstration was reenacted on CBS' recently televised review of evidence of the case.

Also central to that matter was a rather lengthy and unusual ransom note left near the bottom of one of the home's staircases. The ransom note, self-identifying the abductors of Jonbenet as a "foreign faction,"  went on to state that it,  the "foreign faction," "respect[ed] Mr. Ramsey's business but not the country it served. " The note included lines from movies including  Dirty Harry. The  note, penned on a legal pad from the Ramsey home, took up the better part of three hand-written pages.  It was, as far as any experts connected with the case, a most unusual note written for the purpose of obtaining ransom. Handwriting analysts and linguists were able to exclude John Ramsey, the father of Jonbenet, as the author or the one who literally wrote out the note. Patsy Ramsey was not similarly excluded. Donald Foster, a linguist associated with Vassar University, who had recently determined  from a pool of journalists which of them had written Primary Colors, am anonymously written novel loosely based on the happenings of the 1992 Clinton campaign, compiled an 100+-page review of the evidence present in the ransom note in which he named Patsy ramsey as the author of the note. In a later grand jury proceeding, District Attorney Howard Hunter declined to use any of Foster's findings, basing his decision on  the premise that portions of the review contained references to writings found on a Ramsey home computer.  A warrant had been obtained to grant law enforcement access to content of the computer, but not, Hunter explained, for linguistic analysis.  Even taking Hunter's logic at face value, it would seem that there were alternatives to total exclusion of Foster's findings. A) Foster's document could have been rewritten to omit questionably admissible passages. B) Hunter could have sought a warrant for to use linguistic content found on the computer. C)  Hunter could have gone ahead with use of Foster's material, placing the burden to prove that all or any of it failed to meet standards of admissibility on the defense. Police investigators hinted that Hunter did not want to use Foster's document because he didn't want to make the case against the Ramseys stronger than it already was.

A particular investigator with the District Attorney's office, Lou Smit, allegedly grew close to the Ramseys, supposedly going so far as to pray with them concerning the case. He ultimately became a staunch defender of the Ramseys.

The Ramseys claimed to be in full cooperation with the police, but fought law enforcement attempts to interview them separately early following the case. Neither was Burke, the younger brother, interviewed immediately. Thirteen days following the death of Jonbenet, he was initially interviewed by personnel connected with law enforcement. I'm not a mental health professional, but his affect seemed off considering the occurrence of such a tragedy.  He seemed to me to be flippant in regard to his sister's death. He smiled off and on throughout the interview. He did indicate at one point that he could usually hear from his bed whenever anyone opened the refrigerator door. When asked if he had been at school recently, he answered negatively, alluding to the need to avoid the press. He quoted a friend as having bee accosted by media and asked if Burke Ramsey had been at school. The friend responded that he believed Burke had been absent. Burke's demeanor during this exchange was what I perceived is frivolous. Another interview took place in 1998. He squirmed around in his chair a great deal, as in sitting sideways in the chair with his feet under him. He still did not appear to grasp the gravity of the situation.  One comment he made that was in contrast to what had been said in the earlier interview was that he slept through almost anything and that almost no sounds woke him up or disturbed him. He had stated in the prior interview that the sound of the refrigerator door being opened was something that he could hear from his bedroom. In fairness, he did not say specifically that the sound of the refrigerator woke him up. Still, I found it curious.

The Ramsey family account was that Jonbenet had fallen asleep in the car on the way home from dinner at the home of friends, and that she had been carried upstairs and put to bed. Forensic evidence later indicated that undigested pineapple eaten recently before Jonbenet's death had been found in her upper intestine.  Pineapple was found in a bowl on the Ramseys' kitchen table when law enforcement arrived. 

One of CBS analysts' theories was that Burke was eating pineapple from the bowl when Jonbenet, who had come downstairs from her bedroom, grabbed a piece of pineapple from the bowl. Burke then, according to the proposed theory, likely grabbed a Maglite flashlight, which was found on the kitchen table, and impulsively hit Jonbenet in the head with it. According to CBS' experts, there wasn't necessarily any intent to cause serious injury or to kill Jonbenet. (A year or so previously, in a display of anger, Burke had hit Jonbenet in the face with a golf club.) CBS' analysts  recreated the scene to determine if it was possible for a child to inflict the force that fractured Jonbenet's skull and caused the catastrophic brain injury. Their conclusion was that such was indeed possible.

The garotte and strangulation were, according to the CBS analysts, likely attempts to make the earlier altercation appear to be a sexual assault or kidnapping-gone-wrong.

In 1999, a grand jury voted to indict both John and Patsy Ramsey  on child abuse resulting in death and of being accessories to the crime. District Attorney Howard Hunter chose not to go forward with the charges, citing insufficient evidence. The grand jury records were sealed until 2013. One grand jury member spoke after records were released, indicating that the consensus was that Jonbenet's brother had delivered the blow to her head. As a nine-year-old, under Colorado law, he was immune from prosecution.

In 2008, subsequently elected District Attorney Mary Lacy wrote a letter exonerating all members of the Ramsey family for Jonbenet's death, citing DNA evidence in addition to the strength of the intrude theory.

Burke Ramsey chose to be interviewed by television's Dr. Phil in relation to the case of his younger sister's death. Burke's affect, again, was seen by some viewers as being unusual. His tendency to smile when discussing his sister's fate was disconcerting to many viewers. Dr. Phil defended Burke, explaining that people sometimes smile when under stress. 

Lin Wood, attorney for the Ramsey family, has announced the Ramsey family's intent to sue  CBS over inaccuracies in the documentary. CBS responded with, "CBS stand by the broadcast and will do so in court."

Reach your own conclusions, as did I.

Sunday, September 25, 2016

The Case For or Against a Blog Pertaining to Jonbenet, Along with Various and Sundry Hospital and Musical Concerns

I told a friend that I would post no current blog about the Jonbenet situation. It would be wise for me to stick to what I told my friend I would not do, and not because of the importance of integrity, of keeping one's word, and of such general moral high ground. In ancient history as pertains to the Ramsey case, people every bit as  insignificant as I  am (it's tough to comprehend that such people exist, I concede) have been sued over such fodder as message board postings pertaining to the case. On the other hand, since when I have shown any tendency toward acting wisely?  I'll say a very few things about it, as i was more deeply impacted by the case than were most people who have no real connection whatsoever to anyone involved in the case. I won't say any of it in this post, however. The preceding sentences were essentially a tease, except it's probably a stretch to refer to something as a tease when the announced topic for an upcoming blog is more likely to turn potential readers away than to entice them to wait with bated breath for the promised future blog.  I would assume that with most of you who read this blog, if you have much if any interest in the Jonbenet case in the first place, your curiosity and/or interest has  already been more than satiated with the recent onslaught of media coverage. Still, I have a few opinions to share, which I will share very soon.Meanwhile, allow me to update you on the current details of life on Planet Alexis. 

The baby who was afflicted with meningitis is making a rapid recovery. In a worst-case scenario, he could be home now, and everything would probably be OK for him, but we are, and, more importantly, the baby is sufficiently providential not to be dealing with a worst-case scenario. His father's employer has chosen to pay for the two additional days of hospitalization that the attending physicians recommended but that the insurance carrier's review board denied. I will not say much, as privacy even beyond HIPAA regulations is of utmost importance, and I'm not sure how much I've already said that violated the spirit if not the letter of HIPAA laws. The patient's family really doesn't care, but my employers (who are technically more like supervisors per se than actual employers, as for them to be my employers, they would need to pay me something for the work I do;  in contrast, I am paying them for the privilege of providing free labor and of lightening the load of the paid hospital and health care staff, probably do care. Allow me to go on record,  however, as urging any and all who read this to use Google as his or her search engine.

I'm a Godmother once again. When the baby was at the most critical stage of his illness, a priest was called. The original plan had been for the baby to be baptized during the recent trip to Mexico for a family wedding, but an elderly relative died during the course of events, creating a wedding/funeral combination in the vacation. The wedding and the funeral were not a combined ceremony, thank goodness; I sometimes find the Mexican community's observance of Catholic tradition to lean in the direction of the macabre, and I'm glad this family drew the line at combining the bride's wedding with her grandmother's recitation of the rosary and funeral. In any event, Baby Boy was not baptized in Mexico as planned. The parents were not so unenlightened as to have consulted a priest before seeking medical help, which is one huge point in their favor, and I would like to think they grasp the concept that a just God would not hold it against their baby and allow it to play any role in determining the eternal fate of any baby who had the misfortune of succumbing to meningitis or to anything else prior to undergoing the sacrament of baptism. Perhaps they're even so forward thinking [in my mind it's forward thinking, anyway] that they view baptism as a mere formality and as a rite of passage -- a nice rite of passage, but essentially a tradition just the same.

Tradition, the stake of mortal souls, and all related points of view aside, the baby was baptized by a priest in the children's hospital's critical care unit. My father and I were there, and, as at least nominally practicing Catholics, we felt honored to have been asked not only to fill in as proxies for Godparents who would be named later, but to serve as the for-real Godparents to the baby boy. 
i have two other godchildren and take the role seriously, not so much as to be some sort of religious educator or moral force in the live of the children, but to be on the lives of the children. Providing gifts on birthdays and holidays to the extent that it is a financial feasibility is a part of it, of course, but not the most important part.  Making an effort to be physically and emotionally available  to the child when needed is really what it is about. This obligation is giving me a tie to the bay area that I wouldn't otherwise necessarily have, but I can live with the encumbrance.

My financial obligation to this endeavor is nominal, and the parents of this baby were quick to make it understood that there was no expectation on their part of anything at ll in that regard. They had no clue when they chose my father just how generous he is. (They knew only that he was "Miss Alexis' " father, that he spoke Spanish, and that he was generous with his time in terms of helping them to understand what was happening with their baby even though he had no formal connections or  obligations to their child's case and was volunteering his time in serving as an informal liaison between them and hospital personnel, too few of whom speak Spanish. I've this mentioned before, but the baby's father does speak enough English to get by at work and in the world in general, but speaking conversational English and understanding the essence of highly technical medical terminology, particularly when one's stress levels are nearly off-the-charts high due to one's child being gravely ill.) The financial aspects of the baby's and of his sister's education (I would say hope for the sake of my own eventual inheritance that these people are not a part of the "Quiverfull" movement and that they cease with reproduction after a reasonable number of children but that, fortunately is not anything about which I need to be concerned; the baby's mother has a precariously thin uterine wall, particularly considering that she has borne only two children, and both were in the moderate weight range; it was strongly recommended when Baby Boy was born via c-section that steps be taken to ensure that no additional children would join the family, at least biologically; following a few blasts with cauterization tools, such is now a reality) have been put into place. I hope the children turn out to be bright enough to take advantage of the readily financed university education awaiting them, but if they're not especially academically inclined, trade schools are also a viable option and will be covered under the plan my dad had put into place.

Little happens around any hospital that doesn't eventually become sustenance for the ubiquitous hospital rumor mill. I was summoned by the dean, who spoke to me of the importance of professional distance between patients and their care providers.  I expressed understanding of his concerns. I can see why he would uneasy because this happened on my very first significant involvement with a critically ill patient, but assured him that I could not afford in any way to make this sort of relationship a habit. I lack the emotional, financial, and chronological resources to become a Godmother or any equivalent to every patient whose chart is thrust in front of me. I will always care (despite the need for professional distance, I'm confident that all decent doctors care on some level; they're not robots or automatons), and perhaps a little more than does the average doctor, but I will not become a Godmother or its equivalent in any other religion or culture again at any time in the foreseeable future, if ever again. The bottom line is that I can say this to my dean or to anyone else until my lips turn purple from talking so much; it is now up to me to demonstrate that I am sincere in what I say and that I can maintain professional relationships with patients and their families. I know I can do it. I merely need to make it plain to others.

Inside my mind, I have an image of where the line between caring and objective needs to be drawn. I understand the importance of remaining on the correct side of it. All I need now is a few more patients - pediatric patients in particular, to demonstrate to my superiors my knowledge of where that line is and of my ability to avoid stepping across or even straddling with it. In this rotation, I have just two more weeks to convince those with power over me of my ability to exercise sound judgment with regard to the objectivity and professional distance a physician must maintain between patients and their families. My grade in this rotation of my clerkship depends upon it.

On a less serious note, I'm enjoying playing my cello less than i did initially. I do not regret the purchase and will continue to play the instrument, but the bowing action causes my hand to cramp.  I assumed the cramping would eventually subside, but it's been the better part of a year since I picked up the cello; if hand cramps due to the bowing action were ever going away, they should have done so by now, though I have not yet sought the help of Benny Hinn or any of God's other healers, nor have I consulted any chiropractors, reiki practitioners, or acupuncturists, or anyone from the headquarters of Scientology. (In some cases a cure can be worse than whatever precipitated the need for it.) It's a tough call to make when one considers the sound that emerges from an instrument to be among the most glorious -- if not the most glorious -- musical sounds on the face of the Earth, but literal pain is involved in the action that produces the sound. 

My cello is a limited edition model; I could likely sell it for at least what I paid for it. I'm not yet willing to part with it, though.  On occasion, I'll play through the pain to hear the sound I so dearly love. At other times, I'll play my piano, violin, or viola. The viola is beginning to grow on me in a way that I never thought it would. I was very conservative with regard to cost in the purchase of the viola. If my skill level continues to grow as rapidly as does my love of the viola, an upgrade may be in the future.

I'll soon share  just a bit of what is going through my mind concerning the current Jonbenet coverage. Meanwhile,  there are friends with whom to spend time, babies to hold, musical instruments to play, and sleep to savor. If your weekend is even half as divine as mine has been thus far, you should are a lucky person.

Tuesday, September 20, 2016

Summer at Children's Hospital: Life will not always be so sweet ; savor the moment when it is.

I'm spending another night at the hospital sort of as a metaphorical method of keeping my fingers crossed. Baby boy should pull through just fine. He'll need to stay here and under quarantine for his own protection; he should officially no longer be contagious within the next few hours or so. We did have a dispute as to whether or not to make calls during the wee hours of the morning pertaining to an electrolyte situation or to wait until daylight. I have the telephone numbers for a reason, and I'm not afraid to call physicians at home. That's why I'm here. Baby boy might have been fine anyway, but now he's recovering from that particular setback even faster.

I did hear a nurse complain to a house physician of her opinion that I think that being my father's daughter gives me the right to be full of myself. I'm far beyond letting things like that hurt my feelings. There may even be a bit of truth to it --  not so much that I'm full of myself (or at least I hope that part is not true) though I am confident in what I know,  but I am willing to push limits for the good of a patient possibly just a bit further than most in my situation because I'm maybe slightly less likely to get much flack for it. My only feeling about that is that yes, I am fortunate, and I wish everyone had a connection similar to mine that would allow him or her to feel supported in acting boldly in doing the right thing for his or her patients, but regardless, we all should be pushing our limits for the good of our patients and should be willing to take whatever flack comes our way as a result, regardless. As long as we are not practicing medicine unethically or incompetently, are not exceeding the scope of our training, and are not defying direct authority, and especially if no one dies on our watch, we are standing on solid ground.

So many medical students have been here before me. I wonder if they felt what I feel under similar circumstances. I think about how they dealt with the feelings. At some point we have mandatory joint support group counseling sessions to discuss this very thing. I scoffed at the idea initially, but am now beginning to believe that there might be justification for the practice.

I'll be tired tomorrow (technically today), because choosing to stay at the hospital with a patient tonight doesn't automatically give me the next day off. On the other hand, I am being supervised by incredibly kind pediatricians this week. One or another of them will probably notice the inevitable dark circles that will appear under my eyes (and no, I won't sketch them on with a blue eye shadow pencil if they don't show up on their own; I want sympathy in the form of time off for a few hours of make-up sleep, but I'm not that desperate for it) and will probably send me home early. Life is good.

If you've been following my saga in the last six weeks or so, you may very well believe that I am bi-polar. I'm not. Really. It's just the nature of the beast. Young adulthood changes from unbelievably dismal to equally sublime with less than a moment's notice.  Circumstances of this phase of medical school are similarly capricious. It would be perfectly lovely if every medical situation with which I'm ever connected were to have such a blissful ending as this one seemingly will. The sun shines a bit brighter and the world is a sweeter place when a baby whose life was in jeopardy makes a recovery.  I will not always be so fortunate, nor will my patients, so I shall pause, smell the flowers,  and savor the moment.

I don't own this video. To whomever owns the rights to it: please allow me to borrow it if only for a short time.

Sunday, September 18, 2016

Make it through the night, little guy.

May he wake up looking less like this  . . .

and more like this, except that I don't care about the color of his hair or skin.

Tonight is my second and final on-call night of this session. I may not have another on-call weekend for quite some time.  I want to receive calls because I want to demonstrate my ability to handle them to my superiors, but I don't want life-or-death situations, not because I cannot handle them: I don't handle them -- I pass them off to my superiors immediately -- but because I don't wish life-or-death situations on anyone, and in particular, on babies and children.

I'm spending tonight at the children's hospital associated with my medical school. I'm not required to do this, but I have one little guy who is only four months old who is at a very critical stage of meningitis. Even omitting his name, I cannot go into too many details regarding his condition without committing at least one HIPAA violation. Chances are that no one who had the power to do anything about it would ever be any the wiser if I did, but those laws exist for good reasons and are not mere technicalities. I can say that the form of meningitis he is fighting is bacterial, which is more serious than viral forms of the condition. It is a type for which a vaccine has not yet been approved. Even if it were one of the vaccinatable types, he might not have received enough of the boosters yet to have developed sufficient immunity and might have contracted the illness anyway. In any event, it's a fluke and happened through no fault of his parents, who are competent care providers who maintain a clean home environment for their two precious children.

I'm here tonight for a couple of reasons. This is probably the baby's make-it-or-break-it night. I probably wouldn't get any sleep at home, and would drive the nurse's station bonkers with my frequent calls. Secondly, I'm not sure such is really the case and not that it only seems to be true, but a disproportionate number of health crises seem to happen in the late night and early morning hours. Perhaps it only seems that way to doctors who hate being awakened in the middle of REM sleep cycles, but it surely does seem to be the case. If such is to happen with this baby, there's probably not much I can do to help him directly, but I can probably get the for-real on-call pediatrician and pediatric neurologist here faster than the nurse's station can or will. There are other pediatricians on duty tonight here at the hospital, but if there is a true crisis, we want both the primary care physician and the assigned pediatric neurologist here ASAP. I have no fear whatsoever of calling them no matter what time it is. Depending upon the doctor, nurses sometimes hesitate because they may have had their heads bitten off on more than one occasion by the doctor or doctors in question over arguably unnecessary calls. The nurses will have to continue to work with these doctors. In another three-and-one-half weeks, I'll move on to my OBGYN rotation and will say adios, arrivederci, and adieu to all the doctors I'm dealing with presently. These doctors will have a say in my final grade, but unless I'm being especially obnoxious, as in phoning them approximately every fifteen minutes for light and transient causes, my grade for this rotation will not suffer.

If you're thinking that I will never survive a medical career if I feel that I must spend the night in a hospital every time I have a sick patient, you're right. I cannot behave this way throughout my career. This little baby, however, is my very first critically ill patient, and I reserve the right to treat him differently than the others. When I reach my one-hundredth critically ill patient, which may or may not happen depending upon the specialty I choose, the circumstances of my life may be such that I will not have the luxury of spending the night in a hospital even if I feel the inclination. Real life may get in the way. At this juncture, however, real life has not yet interfered to the point that I have to stay home every  night. All I have at home is a cat, who could fend for herself if she needed to, but she doesn't even need to because she has my brother there with her, and she likes him more than she likes me, anyway. Matthew can babysit the cat. I'll stay with the baby and his family.

I'm situated just outside the baby's section of the quarantined intensive care unit, in a quiet end of the hall. We have a a crib against a wall for the three-year-old sister, who fell asleep in her father's arms about fifteen minutes ago and was placed in the crib. She's sleeping blissfully, unaware of the severity of her baby brother's condition. Sleeping with her is a stuffed panda (she's old enough that it's safe) that I bought for her. Once a doctor bought a stuffed panda for me when I was in the hospital. Even though I was almost too old for such a gift, it made me feel better. When I saw the stuffed panda in the gift shop, it reminded me of the one I had been given, and it occurred to me that even though the tiny girl doesn't understand the gravity of the situation, she clearly knows that something is wrong, and she is totally out of her element, and that I should get the stuffed panda for her.

The baby's mother is praying the rosary. I have a rosary in my pocket. I don't ordinarily carry one at work, but it seemed like something I might want to use tonight. I shall take it out of my pocket and join her in praying for her tiny boy. While deep in my heart I'm not sure how much it really helps, I'm pretty sure it can't hurt, and at least it's something she (and I) can do while awaiting the outcome. My dad is here, which is good. He can say the rosary along with me in Spanish until I get it right. The mother is whispering too quietly for me to hear her.

Please join me in wishing, hoping, praying, or any combination of the three, for a stronger and healthier little boy by the time the sun returns to our part of the Earth. This once,  I shall not be sincere in reciting the "Thy will be done" line of the "Our Father." Can my will and the will of the baby's parents be done  this time? I want with all my heart for this baby to return to full health, and to be safe at home with Mami and Papi and Hermana as soon as is possible.

My son just stuck a toothpick up his rectum: the joys of pediatric on-call weekends.

Is this something you should be eating? Think before putting it in your mouth.

I'm on call and getting quite a few calls tonight. Most are straightforward and I can answer. I sent a baby to the ER for a fever. It's probably routine -- I hope it IS routine -- but the fever was high enough that I didn't feel that meningitis could be ruled out.  I can't give out a lot of info even in this semi-anonymous blog because if someone were onto me, I could be up to my neck in HIPAA violations. Suffice it to say that I've received calls that I myself would have made as a parent if I were not a doctor, but some of the calls that have come to me either were stupid calls or calls that could have waited for the light of day or even for regular office hours on Monday.

I had an allergy call where I could hear wheezing so profound that I told the father to hang up and call 911 immediately. I also called 911 myself just in case the parent couldn't get through and to let the switchboard operator  know that it wasn't a hysterical parent calling needlessly, and that paramedics needed to get there STAT. Additionally, I told the father to administer the Epi-pen, which he fortunately had on hand. This was a several hours ago. It was a nut allergy. Sometimes it's trial and error in terms of what nuts a kid who has a peanut (which is not actually a nut, but that's a story for another day) allergy can tolerate. He had eaten an almond apparently at school (which his parents knew nothing about) and had done fine with it (thank goodness!), but that gave him the confidence to try a hazelnut when no one was looking, which was apparently NOT  OK.  By the time both the actual physician backing me up and I got to the hospital, epinephrine had been administered and he was much better. He's still spending the night in the hospital for observation, but he should be fine. He's ten and should have known better, but even adults do stupid things at times. I hope he learned something from this.

I have strong opinions related to nut and peanut allergies and how they should be handled.  The onus should be on the parent and/or care provider early in a child's life.  At the same time, the child should be taught that a nut or peanut can kill him from very early in his life, as in staring at about two. By the time a developmentally normal child is three, the concept should be firm in his or her mind what a nut or peanut is, that it is highly hazardous to his or her health, that it is unseen in many different foods, and that to be safe, he or she probably shouldn't eat ANYTHING without consulting a parent or care provider.  You still do not trust a three-year-old to self-monitor for his or her peanut or nut allergy, just as you wouldn't trust an unsupervised toddler around a swimming pool whether he or she had been given swimming lessons or not, but the seed must be planted. 

By the time a child is old enough for kindergarten, the concept should be so firm in his or her mind that you could leave him or her alone in a room full of peanuts and peanut butter, chocolate covered or otherwise, and he or she would run in the opposite direction rather than expose himself to the stuff. You should teach him that all sorts of candy and cookies contain peanuts, and that he must not eat any of such things without parent approval.  Also, unless the child has a very specific medical reason he or she absolutely cannot have products containing sugar, a kid with a nut allergy should not be denied sweets. If a child is totally denied access to sweets, he or he will sneak or steal them. The sweet the kid purloins won't be one the parent has checked or approved, and the child's life may be at risk. Perhaps even before you conceived your first child, you had lofty ideals of perfect nutrition for the children you would one day have. If your kid has a nut or peanut allergy, forget it.  A child's desire for something sweet is essentially innate. It's better to control the sweets your allergic child consumes than risk having him or her grab whatever he or she can reach on the sly. And if your child has a double-whammy of being diabetic as well as allergic, you'll need to invest in decent-tasting sugar-free treats. A diabetic child CAN have some sugary sweets, but it shouldn't be a habit. You don't want to build up insulin resistance.

By now, your nut- or peanut-allergic child is ready for kindergarten, or first grade if your school has half-day kindergarten. Some schools have nut-free policies for their cafeterias even for those students who bring their own lunches. If you think your child is therefore safe, think again. No one at school inspects the contents of every child's home-prepared lunches. Some parents are simply non-compliant. In other cases, someone other than the usual caregiver prepares a lunch for a child and is unaware of the peanut- and nut-free policy. In other cases, a child grabs a treat from his parents' stash and puts it in his or her pocket. YOUR CHILD MUST BE FULLY INDOCTRINATED TO NEVER ACCEPT FOOD FROM ANOTHER CHILD IN THE CAFETERIA.  The burden here is on you and on your child, assuming your child has no developmental delays. If developmental delays are present, additional supervision is in order.

Some schools do not ban peanuts or nuts. In such cases, parents have been fairly warned. Most school lunches no longer serve peanut products, and perhaps an allergic child can be seated among those eating school-provided lunches. This may minimize risks of allergic reactions related to peanuts and nuts, but it cannot eliminate them entirely.  Parents of allergic children must be vigilant in educating their children as to the dangers of peanut or nut ingestion. 
A child of normal intelligence who is old enough for school is old enough to be taught to steer clear of the things that are seriously harmful to him or her, whether it's rat poison or nuts. If your child is disobedient, use discipline, scare tactics, or whatever you must use.  Your child must know by the time he or she is of school age that he is not to eat nuts or peanuts, and furthermore, he or she is never to eat ANYTHING not approved by his parent, primary caregiver,   or teacher. 

Whether or not your child's school has a peanut- or nut-free policy,  your allergic child will have to behave smartly if he or she wishes to survive. Several years ago in Virginia, a peanut-allergic child seven years of age accepted a few peanut M&Ms from another child on a school playground. It resulted in the death of the allergic child. While the parent sought and probably received a whopping settlement, the fault, in my opinion,  belonged to the child and the child's caregiver. Seven is old enough to know better. Two supervising adults on a playground with one hundred or so children, vigilant as they may be, cannot possibly prevent every possible exchange of less than a handful of candy that might occur on a playground. Even if you doubled the level of supervision, transfer of small food items would still be possible. Most schools don't allow food on playgrounds, period, but children break rules, and they're not always caught.

The child I sent to the hospital tonight didn't do something terrible. He really thought the hazelnut was safe because the almond had been safe. The parents weren't terribly at fault either, as they had told him until they were purple in the face not to eat nuts. (His known allergy was peanuts, but it's wise to void all nuts with a peanut allergy until a board-certified allergist tells a parent otherwise.) Still, the incident underscores the need for caution on the part of those with peanut and nut allergies. 

The Reverend Alexis, Grand Vicar of the Church of Nut Allergies, has concluded her weekly sermon. Go now to love and serve the Lord, and to avoid any food to which you are allergic, and, perhaps more importantly, to teach your affected children to do the same. I must now consult with a parent whose child ate half a gummy bear, then stuck the remaining half up his nose. Why I'm not hearing about this until 5:00 a.m. is one of life's great mysteries.

P.S. I checked on the feverish baby while at the hospital. It's meningitis, though it is not yet known what type. Please pray for him or send positive thoughts. He's only four months old.
It may be cute and it may look harmless, but some people should not eat t.

Little pitchers have big ears.

I never really understood the old maxim "Little pitchers have big ears."  I know it means that a person should watch what he or she says around small children. I just don't get what any of it has to do with pitchers. Most maxims or proverbs can be analyzed and made sense of relatively easily. "You can't make a silk purse out of a sow's ear." You need the proper raw material for a particular end product. "Birds of a feather flock together." People spend time with people who are like themselves. "Beggars can't be choosers."  If you're asking for something from someone else, you get whatever they feel like giving you. Duh. Most are quite self-explanatory. **

Stupidity of a particular maxim aside, a person truly should watch what he or she says around young children.  My Godchildren, Andrew and Camille, ages 23 months and 14 months respectively, have learned a new word (or two new words, depending upon the form you use in writing it): damn it, or the more colloquial dammit. They certainly didn't learn it from me, their Godmother. I can swear right along with the most profane of sailors or truck drivers, but I don't do it in the presence of or within earshot of babies who are learning to talk. No, Andrew and Camille learned this one from their dear mother, whose favorite word up to this week was dammit (or damn it, if you prefer).

Jillian is not the most profane person on the planet. It takes something like a broken bone to elicit in f-bomb from her. I've never heard her call anyone the "b" word, either, nor have I even heard her say shit. Scott, her husband, actually curses far more than she does, but he mixes up his swear words a bit, and he probably doesn't say them right in front of the babies quite so much, either. Jillian just happens to be fond of saying damn it

I told Jillian she should turn on her video camera and try to catch both of them saying the word just to preserve it for posterity. She said she had already done so. It took about five minutes, she said, to get both of them saying it on camera.

Now comes the tough part, which is eradicating the word from the children's vocabulary.  Washing babies' mouths out with soap is no longer kosher if ever it was. Swearing in front of babies aside, Jillian is not an idiot. She knew that overreacting would be the very worst thing to do.  She employs a very proper nanny  who is very sensible as well. They've both been very good at ignoring any use of the word (from the babies; Jillian has stopped saying it).  Jillian is keeping her kids away from anyone except the few adult relatives who can be persuaded to pretend they don't hear anything when either child says damn it.
Jillian says Baby Camille articulates the term with a level of clarity that would make any speech pathologist proud. If the babies are saying it to each other, Jillian or the nanny might try to distract them. If they say it to her , Scott, or the nanny, they are totally ignored no matter what it is they're asking for unless they are choking or in similar distress. 

The nanny says Jillian needs to replace damn it with a harmless term, then act as though she shouldn't have said it, and the babies will pick up on the new term and forget damn it. I suggested Donald Trump. She's considering it. Hillary would work equally well.

I asked Jillian how she survived three years of teaching in Utah County with the tendency to say damn it approximately once every twenty seconds. She says she turned her back to the students and said it under her breath.

My father is a frequent user of profanity, but he didn't exercise his full vocabulary in front of us until we knew what we could and could not say. I doubt he would have said much had we repeated any of his salty terms, but if my mother had learned of it, God only knows what our fate might have been. Matthew and I got our rebellion out of our systems by using poor grammar when our parents could not hear us. Ain't in our household probably would have merited a far more severe reprimand than the f-bomb, anyway. Double negatives, once we were old enough to understand how the English language was supposed to be constructed, would have been considered just about as bad.
My brother for some reason liked to use the term iffen. He must have heard it on a TV show, or maybe Donnie Baker said it on Bob & Tom, because I don't think we ever knew a single person in real life who used that word.

Baby Andrew has his two-year exam and Baby Camille has her fifteen-month exam next month. If Jillian doesn't give me the scoop on whether or not they got through the appointment damn it-free, my uncle, who is their pediatrician, will probably tell me. I'm sure it's a HIPAA violation, but he'll tell me anyway. 

** Idioms, on the other hand, are totally different.  "Pull a rabbit out of a hat," "by the skin of your teeth," "shake a leg," "break a leg," or "shoot from the hip," are far less literal and more perplexing to those learning the English language.

Friday, September 16, 2016

If his name is Tyler, cross him off your list.

or, in my case, literally running as opposed to running errands

Today was a doozy of a day, or it at least started out that way. I won't give you every single gory detail, but I'll share just enough that you understand from whence I come.

I've been in a relationship for a couple of weeks. The guy is an elementary school teacher currently working toward a doctorate in physics. His aim is to work in upper-level academia as opposed to research.  Let us hope that his gifts for teaching at the college level far exceed those of his teaching skills at the mid-elementary level. I sat in on a math class on a day that I had off. He might as well have spoken Turkish to those poor English-speaking students. I ordinarily don't step on toes to such a degree, but I eventually asked if I could have a try at explaining the concept at which he was so miserably failing in getting across to his students. In five minutes, I had every kid in the class clear on the concept that he had spent the previous thirty-five minutes attempting in vain to teach, and I'm not even a properly credentialed teacher. (I do hold emergency credentials in multiple subjects and mathematics.) Teaching university students (if he's ever lucky enough to be granted an actual professorship) is far different than teaching sixth graders, but a teacher still needs the ability to convey mathematical concepts verbally even at the university level.  I'm surprised he ever passed the teacher education component of his credentialing program.

At any rate, I shall not be teaching mathematical concepts to sixth graders at any point in the near future. The "teacher" and I are finished. Kaput. The relationship is every bit as dead as is Abraham Lincoln.(I might have used JFK as my example of deadness, but there are still a few wingnut conspiracy theorists out there who  believe that JFK is still alive and is being kept in a highly secluded wing of a rehabilitation facility somewhere in west Texas.)  I'm not a huge fan (though I'm not a huge detractor, either) of Taylor Swift, but she perfectly summed my current relationship with this guy, whom we shall call "Tyler" (which may or may not be his actual name) with the title of her song "We Are Never Ever Getting Back Together."

The immediate impetus for the breakup, which is an example of perfectly good riddance, happened when he realized in the midst of an early morning breakfast on the enclosed terrace of his apartment (FYI, I drove to his apartment this morning; it wasn't a sleepover) that he was late for an early morning curriculum meeting. He departed in haste and in not the most polite manner, though  I excuse him for that on the grounds that I can imagine what it's like to realize one is not where one is supposed to be. The issues for which I cannot quite forgive him were that A) he locked me inside his terrace, which is enclosed by ten-foot cinderblock walls; B) my purse, keys, ID, and cell phone were in his locked apartment. C) most importantly , he both tried to blow me off and failed to apologize for his transgressions. To err is human; to fail to forgive is even more human. I'm every bit as human as humans come.

I had to scale the wall (by law there is supposed to be a ladder in the terraces with ten-foot cinderblock walls, but dumbo thought it was a good idea to let a friend borrow his ladder; he would run the risk of burning to a crisp if there were a fire and the only way out was through the back, except that I extended him the kindness of ratting on him to the local fire department), then was forced to jump down and run the risk of injuring an ankle on the ten-foot drop; fortunately I'm a retired gymnast and can usually land a drop without injury, then was forced to run the roughly four miles (in scrubs, though I was at least wearing tennies) to make it to work on time, since I had no way of telephoning anyone. The doctors and nurses handed me extra scrubs and a towel, and I was allowed to go into the private doctors' bathroom to scrub up. The scrubs were miles too big for me. The drawstring on the waist of the pants wasn't capable of being tied tightly enough to actually cinch the garment to my waist. The pants fell twice during the day.  A male RN who bats for the other team made a disparaging remark that I should feel free to go braless for the day if it would make me feel fresher, as absolutely no one would ever know the difference. I could have screamed, "SEXUAL HARASSMENT"  at the top of my lungs, but the very last thing I need is to be on the accusatory end of another sexual harassment charge. I instead accused him of being jealous of my flat and tightly muscled chest and my legs as well. His man boobs are bigger than I'd want my female boobs to be.

Though some subterfuge by one of the pediatricians, my purse and keys were delivered to my office by the noon hour even though the moron initial insisted he couldn't possibly meet me or get them to me until at least 6:30 tonight. The half-wit lacked the cojones to deliver them to me himself. He had a co-worker bring them.

I was tired all day. I sprint and hurdle, but do not run long distances unless forced to do so. I probably couldn't even complete a 10K without walking part of it.  Necessity, however, sometimes forces one to do even what he or she ordinarily cannot accomplish.  I'm capable of running close to an eight-minute mile in a pinch, and I did. Then, however, I was tired all day. Some people exercise early in the day because it gives them an added boost of energy. For me, though, it depletes whatever energy supply I was lucky enough to have had in the first place. When I exercise, I do so after everything else that has to be done has been done. 

The one nice thing about the fiasco is that one of the senior pediatricians gave me tomorrow off. She said that I probably would have had Friday off because I'm going to be on call this weekend, but that my body needs the rest more tomorrow than it will on Friday.  Third-year students don't usually take on-call duties, but the pediatricians feel that I can manage it, primarily because I possess the common sense (medically, anyway) to know when I'm in over my head and to consult an actual M.D. I've been told to forward to the doctor who is actually on call any questions that are in the gray area. If in doubt send them to the E.R. or to urgent care. If semi-in doubt, forward it on to real the pediatrician on call. The pediatrician will see a log of all calls and the action taken or recommended, anyway. If a parent complains and insists upon talking to a real MD, I've been told to refer them to urgent care or the E.R., and to tell them that everything is being forwarded to the MD on call anyway, and she will call them only if she sees that there's something I've overlooked. (Anything involving a baby two months old or younger will automatically be referred to the physician on call.)

I'm nervous about the on-call duty, but honored just the same to be trusted with the responsibility so early in my career. It won't take very many interrupted weekend before this starts to get very old very fast, but I'm not there yet, and there probably won't be too many on-call situations for me this year. Furthermore, if I'm hit too hard with weekend calls, I'll get Monday morning off.
This is something with which I can live.

Girls and women of the world: avoid men named "Tyler," and think twice before dating physics majors. It's not merely the inherent intelligence of a physics major, as I'm every bit as intelligent as "Tyler" is; it's just an odd intrinsic factor which I cannot exactly pinpoint precisely, but which is, nonetheless, present more often than not.

  my philosophy and primary m.o. as an on-call practitioner