Monday, March 27, 2017

Supernanny, Walmart Tantrums, and Behavioral Observations



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     I have one more week here before I go to Canada to fulfill my psych rotation. I'm excited to go, but I don't wish to get ahead of myself. I still have one more important week here. For this week I will remain in pediatric neurology. Tomorrow I'll be in the office in addition to meeting with a behavior consultant. The behavior consultant will ensure that I understand the protocol for an extended behavioral observation. 

     The extended behavior observation will happen on Tuesday. It's not a job I will do as a physician -- I'll have underlings of my own to handle such tasks once I'm an actual physician -- but because it will be my responsibility to direct others in doing this task and because I will make decisions as a physician based on the data I will gather in this task, it's best if I actually perform the task myself at least once. I will have additional opportunities to perform this task and other related tasks if I choose to do my externship in the area of pediatric neurology.

     My superiors have warned me that in doing this observation and in the behavioral intervention of which I will be a part later in the week, I will encounter behaviors that I have likely never witnessed before. I was the "bad child" in my family (in part because my parents didn't know about some things my brother did in high school), buy my badness was limited to very minor back-talking, refusal to eat what I was told to eat in a timely manner, and rolling my eyes. Even branching out into the dysfunctional extended family, children very often essentially did as they were told.  The MD supervising me warned me that I would hear words I've possibly never spoken myself uttered by a five-year-old.
The MD is underestimating me, but that is a subject for another day's blog.

     This weekend I watched videos of bratty children shouting obscenities at their mothers and engaging in many other varieties of unacceptable behaviors. My source was YouTube, which made available a selection of videos ranging from Supernanny to random footage shot by spectators while preschoolers hurled epithets and merchandise at their parents, grandparents, and siblings in the aisles of Walmart. I was appalled at the behaviors tolerated by parents and other care-providers.

     When you have a child who routinely kicks, hits, bites, scratches, and spits at his parents and siblings, how did it reach that point? Didn't parents see it coming when the child was younger and perhaps was only hitting?  I acknowledge that civilizing a human being isn't an easy task, but the parent must have done essentially nothing to stop the behavior in some of the cases I viewed. I'm not necessarily advocating the violence of corporal punishment in response to the violence of a child attacking parents or siblings, but I will say that if it were applied consistently at all, even that would be better than doing nothing. In the 1950's or even early 1960's, a TV program such as Supernanny probably couldn't have been filmed in the U.S. because it would have been difficult to find enough families with truly outrageously-behaving children. The footage actually obtained would have bored viewers to sleep. While children of that generation were far from perfect in every way, the prevalence of parent-attacking toddlers simply wasn't to be found at the time. The single biggest reason for this lack of misbehaving children was probably the fear of corporal punishment. 

     Before going any further with a discussion of the merits and drawbacks of corporal punishment, I would like to first interject that corporal punishment is one thing and abuse is quite another. I will not discuss abusive forms of punishment in later paragraphs; if I mention corporal punishment, it would mean a slap or slaps with the open hand that did not leave marks. Anything beyond that is and always was abuse. Abuse was always pejorative in every sense even when it was tolerated by society. Abuse never helped any child in any way. While society permitted some abusive practices in disciplining children in previous generations, that does not make such practices retrospectively non-abusive regardless of when it happened. Beatings that left marks for longer than ten minutes or so were abusive even if the law did not forbid it at the time. Kicks and punches from parents to children always were and always will be abuse.

     I will suggest that the reasonable use of corporal punishment led, for the most part, to children who were generally compliant with adult authority. What corporal punishment failed to accomplish, however, was to teach children anything about self-governance or why it was that they should behave in certain ways. I'm not sure it's a bad thing for a child to know that in a real pinch, a parent has the right to whack him or her. I suspect that knowledge is what kept young children of early generations from physically assaulting their parents in the way that the kids in Supernanny or in the Walmart footage did. The worst bullies on a playground don't hit anyone who will hit them back just as hard, nor do they hit anyone whose big brother will nail them after school. It's a survival concept that nearly everyone grasps. It is preferable that the survival concept eventually be supplemented by higher-level reasoning skills and development of a sense of right and wrong, but for a time, that knowledge serves its purpose.

     So these parents have children who will repeatedly scratch, bite, kick, punch, spit at, pinch, and slap anyone who comes near them in the midst of their meltdowns, and the parents, who have allowed it to evolve to this point, are now clueless as to how to check the behavior. I acknowledge that anything we see on Supernanny has been edited to, in many cases, allow families' dysfunction to be maximized. Still, the produces of Supernanny didn't put words in the childrens' mouths, nor did they use computer simulations to create actions the children did not actually commit. Anything that a child is seen or heard doing or saying, the child actually did say or do. 

     Over the weekend I saw portions and entire episodes of Supernanny featuring close to 100 different families. Of these Supernanny cases, I recall three families with remotely normal dynamics. One of the "normal" families was the family of Wendy Wilson, who is the daughter of Brian Wilson of the Beach Boys and is herself a singer. Ms. Wilson and her husband were a family of four with two toddler sons until they were joined by twins. (I  don't know how old the episode I saw was.) The family was remarkably functional compared to the usual Supernanny clientele. The parents had a few questions about how to get the toddlers into bed more efficiently and about eliminating pacifiers for the toddlers. This episode would have been boring if someone in the family were not a celebrity. They simply had very little in common with the Supernanny regulars. They were all normal and civilized people.

     There were other two episodes I saw in which I perceived the families as being somewhat mainstream. One of these families had a child with Down Syndrome. The parents struggled a bit with the need for different expectations for their special-needs child, which is a very real problem for parents. How does a parent justify to a young child that his older special-needs sibling isn't held to as high a standard as he is? The supernanny convinced the parents that they weren't being unreasonable in their expectations for their neurotypical children and that they weren't being overly lenient in not requiring the same of their child with significant delays due to Down Syndrome. In the other episode in which the family seemed vaguely normal, I couldn't quite discern why this family with  two adorable preschoolers was even considered for Supernanny inclusion.

     One thing that struck me about the cases with children being horribly abusive to their parents was just how much pain it caused the parents to hear their children scream and cry.  Maybe it's because I'm missing the "caring parent" gene, or maybe it's just because I have not yet had children of my own, but if I had children who behaved as horribly as most of the children shown on Supernanny behaved (in fairness, sometimes there was one child in the family with issues while the rest of the children were at least moderately well-behaved), I would not like those children even if they were my own. Does something happen when a person uses his or her own gonads to make a baby that causes the person to like that baby no matter how obnoxious a child he eventually becomes? There was nothing about the cries of those tantruming children that would elicit the slightest degree of sympathy in me. I would probably want to make them unhappy because they had done nothing to deserve even a shred of happiness. Perhaps I'm a bad person and shouldn't become a parent.

     In any event, the kid I observe on Tuesday will need to pull out all sorts of bells and whistles from his arsenal of behaviors if he hopes to impress me with his badness.

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Their parents will sue Walmart for compensation for the head injuries that occur when they fall.



Saturday, March 25, 2017

kids-with-bizarre-non-names-as-given-names-who mysteriously-grow-up-to-be-assholes syndrome

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Next week I get to go into a home of one of our patients, observe him,  devise a plan to help his parents deal with his most challenging behaviors, and spend part of two days helping them to implement it. Someone else from the office will follow up with the family the following week. I haven't met the child yet, but chance are that I'll like him more than I liked the twelve-year-old boy who grabbed my arm on Thursday because I wouldn't fix the broken video game in our waiting room.

I don't need to like the child, though. I need merely to be professional and to have a desire to help him. Teachers and other professionals sometimes beat themselves up over not liking some children in their charge. A person cannot necessarily control whether or not  he or she likes a particular child. A person can control how he or she acts toward the child, though.  It is the professional's duty to treat the child fairly and even to keep in mind that a person's view as to what is fair to the child may be skewed if the person does not like the child. A person has to try harder when working with a child of whom he or she is not particularly fond.

I've reached a conclusion in observing children in the pediatric neurology office and also while watching Supernanny. I decided to watch episodes of Supernanny on Youtube so that the behavior of the real-life child with whom I must work next week will seem less shocking to me by comparison.  The conclusion that I've reached, which is surely a bit of a broad generalization but at the same time, I suspect, something that is generally true, is that people who give their children highly unconventional names, as in made-up names that rarely make it onto lists of actual names (or even if the names do make it onto name lists, make it there only by virtue of a celebrity child having been given the name, which inspired commoners to use the name as well, granting the non-name a place on a list of actual names) more often than not have children who are not inclined to play by society's rules. The reasons for this are probably as varied as the bizarre non-names themselves, but I'm willing to name two of the most common factors in the kids-with-bizarre-non-names-as-given-names-who mysteriously-grow-up-to-be-assholes syndrome: A) Children with bizarre names are angry about having been given bizarre names that are not real names. This is particularly true if they're boys. I suspect that boys are for some reason a bit meaner to other boys who have strange names. Perhaps conformity is a bigger deal among makes as well. In general, girls are typically the gender that learns the art of psychological terrorism with amazing ease, but for some reason girls with highly unusual names fare better than boys with odd names. Years of research back this up. B) (and I believe this is the dominant factor) Parents who give their children, particularly their sons, names that are not actually names, often view their children as being highly original and therefore often exempt in terms of the expectation of adhering to norms. They want their children to be different, and they often consider their children to be just a bit more special and more entitled than is than the average child. The same force that motivated the parent to give the child a bizarre name that is not an actual name is at work in influencing the parent not to force too much of society's baggage onto his or her child, because the child is, for want of a better word, just too special for such baggage.

Regardless of whether my factors are at work in the non-conformity of a given child, teachers will tell you that the boys named Wild, River, Royalty, Warlord, Champion, Maverick, Innocent, and Touche' (THAT one looks and sounds a bit too much like douche to me) will be children who think they do not have to follow classroom or school rules. It would happen regardless of how the parents felt about the child having such an entitled attitude, but in most cases, the parents have given tacit approval to the child's attitude.

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Friday, March 24, 2017

We're Losing the War on Lousy Parenting

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The mother of the patient with whom I dealt today will soon be airing her grievances to law enforcement personnel and to judges.




I had an interesting afternoon. In our very last appointment, a rather large twelve-year-old boy became mildly distressed that the video game system in the waiting room of the pediatric neurological office to which I am currently assigned was non-operational. That in and of itself is not usual. The game system was already broken when it was brought to the office waiting room. Its sole purpose in the office is to gauge self-control and frustration tolerance issues in pediatric neurology patients. The twelve-year-old male patient apparently had very little self-control or frustration tolerance.

I walked through the waiting room and out the patients' exit to take a jacket to a patient who had left it in an examining room. As I walked back through the waiting room, the boy, who had been trying in vain to get the game system to work, sprang from his seat and grabbed my arm (not hard enough to leave a mark, for the record. "You need to let go of my arm right now!" I told him in a voice that was simultaneously both quiet and the most menacing voice I could manage. The boy's eyes seemed to get bigger as he let go of my arm and backed away from all ninety-five pounds of me. (I weigh ninety-five now if I keep my shoes on.)

Then Mama Bear attempted to come to the kid's rescue. "If you have a problem with anything my son does, you need to take it up with me!" she bellowed, poking herself in the chest for emphasis as though I otherwise would not have known to whom she was referring when she used the pronoun me -- "not with him!" Another parent in the waiting room grabbed her much younger child and moved away from the twelve-year-old. 

I turned to the kid, pointing right at him and deliberately ignoring his mother. "You need to learn to keep your hands to yourself." He tried to hide his roughly 160-pound body behind that of his mother. I then turned my attention to the mother. "You need to teach your kid some manners. You're running out of time."

The receptionist escorted the other mother and child in the waiting room to an exam room. The doctor came out of his office to ask what was going on. The receptionist filled him in. He stepped back into his office, printed something, then stepped into the waiting room. He gave the mother a list of the other pediatric neurologists in the area and told her she would need to find another practitioner for her son.

Monday, March 20, 2017

A One-Night Stand




I'm not really in a relationship. I'm merely pretending to be. A guy in my cohort wants to dissuade his mother from trying to fix him up with the daughter of her new neighbor, so he's having me pose as his fiance during dinner with his mother tonight. He even borrowed an engagement ring from another member of the cohort whose ex-fiance was roughly as underfed as I am, so the ring somewhat fits me.

It's dishonest, but I feel for the guy. He gets one lousy week off this spring, and he doesn't want to spend it trying to ditch the daughter of his mother's new neighbor. As I understand it, his mother is seeing the neighbor, and they both think it would be charming if my cohort mate and the neighbor's daughter  got together. What they don't seem to acknowledge is that, statistically speaking, even if my cohort mate and his mother's neighbor's (or mother's boyfriend's, although that term doesn't seem fitting when both parties are over 55) daughter meet and hit it off well enough to go on a single date,  at least one of these relationships probably won't go the distance. So if one of the two relationships did actually work out and the parties chose to make a legal connection out of it, two other people for whom it didn't work out would occasionally be thrown together, probably uncomfortably. The same is true regardless of which relationship works out.

My cohort mate says his mother has tried to set him up for dates before, and always with disastrous results. The girls that his mother thinks are right for him, he says, are straight out of the Luther League. He's a Scandinavian who was raised Lutheran.  His parents split up when his father, who was the church choir director, had an affair with the pastor's wife. He escaped it all and wants no part in either parent's social scene.

I don't really care if I'm playing a part in someone's deception of someone else. I also am not worried about long-term ramifications of this scenario. It's up to my cohort mate to explain to his mother at graduation next year why the two of us who were engaged are no longer an item. It's really not my problem. I'm merely helping this one time. I don't expect it to become a recurring gig.

Sunday, March 19, 2017

The Rest of the Story for Two Especially Unpopular Judge Judy Litigants



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Derrick Moore's mugshot from 9/11/2015



  I am not proud of this, as my primary television-viewing loyalty will always be to Judge Alex even if his show Judge Alex is only available in reruns, but if I am to be truthful, I must admit that I occasionally watch episodes of Judge Judy. Judge Judy's regular viewers congregate at various websites to discuss the cases, the verdicts, and the litigants. Some degree of consensus has been reached as to whom are the two most contemptible litigants ever to grace the TV screen via Judge Judy's courtroom. Those two infamous litigants are (or were) Wendy Moore, who left the keys of her car in the car, allowing her son and the daughter of the defendant in the case to drive the car on Mrs. Moore's property, resulting in an automobile accident in which the defendant's daughter was killed, with Mrs. Moore wanting to be compensated by the deceased daughter's mother for damage to the car and for medical bills from injuries sustained in the accident by her son Derrick Moore; and Kelli Filkins, who perpetrated an ebay scam in which she artfully worded an ebay listing to state that bidders were bidding on pictures of two cell phone as opposed to the actual cell phones, on which the buyers thought they were bidding.

In Wendy Moore's case, the plaintiff Ms. Moore admitted to regularly letting her son, who was at the time reportedly a minor and not a licensed driver, drive the car on her property, and to keeping the keys in an unsecured location where her son could at any time have access to the car's keys without her permission. Since that time Ms. Moore hasn't been in the public eye, but her son, the passenger in the auto accident that left the defendant's daughter dead, has since been charged with attempted first-degree murder, first degree residential burglary, assault resulting in great bodily injury, and assault with a stun gun. The charges carried several enhancements including using a deadly weapon, causing great bodily injury, and committing a serious offense within five years of a prior prison term. (I don't know anything about the nature of his prior convictions.) As is typical of such incidents in California, the arrest and charges are met with much fanfare and media coverage, but the trial and end result is much more difficult to find. I cannot locate the end result of this case. If Mr. Moore was exonerated, I would like to be able to report his exoneration, though it's unlikely he was totally cleared, as his defense to the attempted murder charge, according to his attorney, anyway, was that he was merely robbing the woman when he stunned her with a stun gun, beat her, and grabbed her neck; he had no intention of killing her.  I would assume that the defendant in these charges pled guilty to lesser charges in exchange for a lighter sentence, though I presently have no way of confirming this.  I found Wendy Moore's Twitter account. https://twitter.com/mcwendy35  Both "Wendy" and "Moore" are common enough names that finding an isolated "Wendy Moore" is no guarantee of it being the same "Wendy Moore" as the one who appeared on Judge Judy, but if one reads far enough back on the Twitter account, Ms. Moore alludes to having flown to southern California to tape an episode of Judge Judy. In a post from less than two yeas ago, she disparages her son, refers to him as a hot mess, and alludes to referring him to the show Intervention.  Better late than never, I suppose.

Kelli Filkins' case had, if anything, a less happy ending. Judge Judy suggested that criminal proceedings against Ms. Filkins for fraud would be appropriate. It seems that she did face criminal proceedings and was jailed for fraud. In the Filkins case, the defendant, Ms. Kelli Filkins, advertised for sale in the cell phone section of ebay two photos of cell phones. The original ad wasn't displayed so I cannot share the precise wording. I'm not sure if she said in the ad itself or in fine print connected to the ad that the items being purchased were photos rather than actual cell phones, but she did not place the ad in the "photos" section of ebay. and she made the mistake of listing specifics regarding the cell phones including weight of 4.6 ounces, number of pixels, GSM/PCS compatability, text messaging capabilities (this was before ALL phones had such capacity). Obviously  pictures of cell phones would not align with the specifications detailed. Even had Filkins prevailed on her claim of "It's not mah fault they cain't read," she would have sunk herself in listing the specifications of the actual phones. Judge Judy wouldn't have been inclined to let her slide even without the specifications, as Ms. Filkins' clear intent was to defraud. 
Even without the product description discrepancy, Ms. Filkins might still have lost the case, as Scheindlin noted that a reasonable person would not pay in excess of four hundred dollars for two pictures of cellular phones and that the listings were clearly intended to scam potential purchasers. Scheindlin took particular delight, though, in using the defendant's own words pertaining to the specifications (primarily the weight) of the product she was selling to rule against her .

Ms. Filkins marriage to the slimy Mr. Filkins (who was involved to some degree with the ebay scam but chose not to show his face on nationally syndicated TV and chose to allow his wife to suffer the consequences on her own) eventually ended. Ms. Filkins allegedly lost custody of her children for a time when she was incarcerated for fraud. According to her mother in later communications, Ms. Filkins paid for her misdeeds and later reformed. I'm not sure Ms. Filkins' mother's definition of having turned one's life around jibes with mine, but who am I to suggest that Ms. Filkins' life did not take a turn for the better?

If Ms. Filkins experienced good fortune, however, it was temporary. On January 26 of 2017, Ms. Filkins passed away. (In that sense, I suppose good fortune that any of us may have is temporary, as life will eventually end for all of us someday.) Some of the people who discuss Judge Judy and other TV shows on various internet forums are relentless. They learned of Ms. Filkins' death and discussed, among other things,  whether or not it was THE Kelli Filkins and whether the resulting GoFundMe account could be just the latest in Ms. Filkins' scams. At the risk of sounding cold-hearted and merciless, I shall state my opinion that it was a fair question. A person who would cheat people out of hard-earned cash by using trick wording to hand over photocopies of pictures of cell phones in place of actual cell phones would probably also create a GoFundMe account to collect money to be given in the event of her death while she was still alive.

Ms. Filkins' mother has apparently taken up the hobby of Googling her daughter's name, then blasting anyone who has anything remotely less than charitable to say about Ms. Filkins. Ms. Filkins' mother has every right in this land of free speech to do just that, but those who pose the questions and suppositions have the same right to post their queries. I don't yet have any children, but I'm told that the most devastating thing that can ever happen to a parent is to have his or her child precede him or her in death. Ms. Filkins' mother has my sympathy regarding her daughter's untimely death.

On the other hand, is it possible for a person to behave in such a despicable manner when he or she is alive that even once the person passes on, people still will have more unkind than kind things to say about the person? Apparently yes. Ms. Filkins' mother said that her daughter had paid for her mistakes, which may very well be true. The unfortunate aspect to it is that paying a fine or serving a sentence doesn't necessarily make everyone who was wronged whole again. Ms. Filkins left highly incriminating and false feedback on ebay concerning her victims, for which Judge Scheindlin could only offer the statutory maximum of $5,000. Even after losing her case on Judge Judy, Ms. Filkins trash-talked her courtroom opponents. And how many times might she have perpetrated similar scams when the victims couldn't find her to seek restitution?  

Ms. Filkins' mother would probably argue that  Ms. Filkins did nothing to most of the people who are writing negative things about her on message boards. It doesn't really matter. If a person does something that is against society's mores, some members of society will have negative things to say about the person. As long as what is being said or written is neither untrue nor otherwise slanderous, it can be said or written. For many people, a moral compass keeps them from committing truly reprehensible acts. For others it is only the fear of reproach that keeps them from acting as Ms. Filkins did. And when a person is caught in an improper act and forced to pay his or her debt to society, forgiveness of the person is optional. 

Ms. Filkins' mother described how very cute Ms. Filkins had been as a child. Ms. Filkins was allegedly taught when she was four years old to tell adults that she was going to be a proctologist when she grew up. She would reportedly keep a very straight face when she said this. Ms. Filkins mother thought this was a most adorable act. Posters on the message board questioned whether a four-year-old would be capable of telling others she planned to become a proctologist. Those posters must have had dull-witted or speech-impaired children if the children they were around  could not have been taught to pronounce a fairly straight-forward four-syllable word and couldn't have been taught in simple English what the term meant. (a proctologist is basically a "butt doctor." That's all the child would have to hear, and the child would understand if he or she were even approaching normal intelligence.) I don't have any trouble at all believing that four-year-old Kelli Filkins would hold back her laughter when telling adults that she planned to be a proctologist. It was much the same as watching her say to Judge Judy, "It's not mah fault that they cain't read" as she struggled to hide her smirk.

Ms. Filkins' mother may google her daughter's name again and end up here. If so, I'm sincerely sorry for your loss, ma'am, but sometimes a person reaps what he or she sows, and sometimes consequences to our actions are more far-reaching than any of us would ever imagine.


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Consult your local listings to learn where repeat episodes of Judge Alex can be found in your area.

Saturday, March 18, 2017

The Oxford Comma







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https://www.nytimes.com/2017/03/16/us/oxford-comma-lawsuit.html?src=recg&_r=0

The preceding address links to a news story involving a contract dispute regarding overtime wages. It appears that the dispute will be resolved in favor of the workers being paid collectively a hefty sum in overtime wages. at the root of the dispute is the absence of an Oxford comma. Had the comma been present, the meaning of the sentence would have been altered. I'm not a huge fan of grammar and English usage pet peeves, but if I were to become one, the place I would start would be in favor of the Oxford comma.

One reason I chose medicine over lae as a course of study is that I did not want to be involved in writing or reading lengthy missives in which the presence or absence of a comma would be the deciding factor. Attention to detail is necessary in the study of medicine as well, but it doesn't seem quite so nit-picky to have to spend so much time going over a CT scan to ensure nothing of importance is missed as it does to pore over every sentence to ensure that all commas are properly placed. 

I'm a fan of the Oxford comma. When it isn't used, at the very least a reader may have to read a sentence twice to ensure it was correctly interpreted. in other cases, the meaning is clearly altered by inclusion or omission of the final comma before a conjunction in a list.  My own preferences notwithstanding, and whether or not anyone else is or isn't a fan of using a comma before the conjunction in a series, if its omission leaves a sentence open to interpretation, is should be used. In the case of this particular corporation, not using it was sloppy writing at the very least, and it appears that the lack of clarification afforded by the non-use of the Oxford comma is going to bite an employer in the bank account. C'est la vie.

Wednesday, March 15, 2017

I think I'm dying . . . not really, but it surely seems to be the case

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Medical school is, for once, going extremely well for me. I'm in a pediatric neurology portion of my neurology rotation, and I'm enjoying it to the extent that it is causing me to rethink my eventual area of focus in medicine. I cannot consider going into this precise specialty because it would require me to study straight neurology for three years of my residency, then to study the pediatric form of it. I'm scared shitless of regular neurology. Alzheimer's freaks me out. Lou Gehrig's Disease gives me the willies. Parkinson's scares the socks off of me. I  could probably to some degree deal with traumatic brain injury, seizure disorders, and multiple sclerosis, but I wouldn't actually like doing it.

This segment of my rotation is focusing essentially upon pediatric neuro-psychology, though the attending physician's board certification is in pediatric neurology. There's quite a bit of cross-over between the specialties. Though he has patients on his caseload whose chief complaints are related to seizure disorders, this physician's practice is fairly heavily into psychoeducational implications of his students' conditions The doctor deals to some degree with his patients' schools and educational programs. He is in contact with special education personnel. He does consultations and sometimes even attends IEP meetings. 

Because of  having a mother who has been a teacher, a school psychologist, and a director of two different  school districts' special education programs while I was growing up and because of my mother's tendency to figuratively and literally bring work home with her, I am well-versed in matters relating to special education. (My brother is less well-versed in the same subject matter than I am because he was always much better than I at tuning our parents out when they spoke of work-related matters.) My knowledge certainly has its gaps for the simple reason that I've never completed any course of study related to educating students with special needs, but I know far more of the qualifying conditions for special education, of Public Law 94-142 and of the other laws and regulations pertaining to special education, and of the procedures and methodologies utilized in educating students with special needs, including but not limited to students with learning disabilities and with speech disorders, than does the average medical school student. It never occurred to me that material stuck forever in my brain simply because I had no way of getting it out would ever be so useful to me in the study of medicine.

The attending physician is arranging for me to take the exam for the complete neurology rotation (which I'm less than halfway through) on Friday. If I can score well on it, he says, he can arrange for me to spend the rest of my neurology rotation right here in this psychoeducational-focus pediatric neurology practice. That means no Alzheimer's evaluations for me, no amyotrophic lateral sclerosis, no multiple sclerosis, no demyelinating disease, Bachmann-Strauss dystonia (or any other form of dystonia) , no Parkinson's, no Huntington's Chorea, no progressive supranuclear palsy (or any other form of palsy), no spinal-cerebellar ataxia, no hundreds of conditions I'd rather not even read about, much less encounter in the flesh. Instead I will be allowed to sit in on and occasionally offer opinions concerning ADD/ADHD, varying degrees of autism spectrum disorders, tic disorders, speech and language disorders, and other neurologically based conditions. 

I eventually told the attending physician here that even though I've tried hard to feign enthusiasm for the specialty of neurology, I have a degree of distaste for much of what it entails. I like what this attending physician does, but I probably could not do what he has done to be in the position he is in today. He suggested that there are different paths to essentially the same place. He mentioned that he would like to add a child and adolescent psychiatrist and pediatrician to his practice to more fully cover  the spectrum of patients he sees. He told me of five-year programs from which a resident physician emerges fully trained and, once board exams are passed, fully board-certified in pediatrics, adult psychiatry, and child and adolescent psychiatry. This may be something that is feasible for me. Though I don't want to work in any primary-care field, I enjoyed my pediatrics rotation. Psychiatry is my next clerkship rotation. If I find that it is an area of specialty that I enjoy, I can look seriously at what the attending physician suggested and can tailor my visits and interviews for residency programs at those institutions which offer the 5-year trifecta plan. 

This is the first week all year that I have been neither sick nor tired.  We finish working at a civilized hour every each evening, as in around six o'clock, and we are allowed to go home. The attending physician does not leave interns or medical students working after he has gone home. He doesn't want us in the office before his nursing staff arrives, either.  This doctor is on call at the hospital for general neurology only one weekend every two months. He said that if I return to his practice or a similar one at this facility, I, too, will be on call at the hospital for general psychiatry only one weekend out of every two months after I have completed my residency. 

While I genuinely like pediatrics, in the grand scheme of things, I do not wish for my ultimate job description to be that of a primary care physician for patients of any age. Pediatrics in particular involves too many hours for not enough pay, and the level of prestige associated with it is too low for me. Some people would say I'm a bad person for admitting that the level of prestige and rate of pay associated with a particular domain of medicine will impact my selection of a specialty, but I'm being honest.  I may eventually need to work substantially fewer than forty hours per week for several years if I have children and my spouse is not in a position to work part-time.  I need to be prepared to support myself and any children I may have while working essentially half-time, as I will not bring children into the world so that their de facto guardian can be a daycare provider or a nanny. I will likely need to rely upon on the services of a daycare provider or nanny, but I wish for my future children spend more time in the care of their parents than in the care of hired help. If my spouse is not in a position to spend substantial time each day caring for these potential children, I will need to do so. I can't do that easily on a pediatrician's salary. We will not have to live as the rich and famous do, but I will need to earn enough that I can support my family with or without the help of a spouse as necessary.

In terms of the prestige, I don't wish to say a great deal because it's almost impossible to say much about it without coming across as a snob. It may not seem as such to a person who has never worked in the health care system and operates under the assumption that all doctors are on the receiving end of esteem and respect, but such is not always the case. If it were my dream to work as a primary care pediatrician, I suppose I would do so anyway and would accept the baggage of being considered second class or lower among physicians, but since it's not my dream,  it's one thing with which I do not have to contend. After all these years, even being female causes a medical doctor to be given less than her due respect in the workplace. I choose not to place myself at further disadvantage. 

When everything is going well, something has to be just a little bit wrong. That's the way life is. My current problem -- really my only current problem -- is that I'm having difficulty swallowing. I can swallow food and drinks perfectly well. It's the physical act of swallowing saliva that is plaguing me. I'm fairly certain that it's an anxiety issue. I'm fine as long as I'm busy and have no time to think about the problem, but once I'm finished being busy and need to relax or to sleep, I cannot because of issues with swallowing. I'm not wishing the problem on anyone else, but if you want to know what I'm experiencing, try really thinking about the process of swallowing as you're doing it. If you over-think the act of swallowing, I suspect it becomes a difficult process for anyone. Then, even if you try not to think about it, once nothing else occupies your mind, thoughts about swallowing will invade your consciousness and will make the act of swallowing far more complicated than it needs to be. Try to fall asleep when your muscles are not cooperating in the act of swallowing. It's extremely difficult.

The problem, I'm reasonably certain, is that difficulty in swallowing is a symptom of many neurological conditions that I read about every night when I study for my neurology exam. It's a classic case of hypochondria.  In the morning I'll run it by the attending physician under whom I'm working. Attending physicians supervising medical students are accustomed to the students imagining they are experiencing the symptoms they read about. I probably just need to take a benzo when it's time to relax, but I don't like to take benzodiazepenes unless I am directed to do so by a physician.

Tuesday, March 14, 2017

Pediatric Neurology and Gluten-Free Diets.



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    1.     I am now working and studying in the pediatric section of neurology. The good news is that it has basically nothing to do with Alzheimer's, which totally freaks me out. The bad news is that it has everything to do with parents who are trying to milk the system for everything it is worth and to have their offspring diagnosed with all sort of conditions for financial gain or for educational advantages. Usually it's educational advantages the parents seek. 

          One parent brought her eight-year-old child for a neurological evaluation. The exam didn't yield any tremendously informative results. Based both on in-office observations and on questionnaires completed by parents, the classroom teacher, and the after-school daycare provider, it's conceivable that the child might possibly have the most slight of attention deficits, but not enough of one that the attending physician who supervises me would be comfortable prescribing even the smallest dosage of any of the medications typically used to treat attention disorders. Furthermore, my conclusion based on a single day of observing the pediatric neurologist in question is that he's not particularly reluctant to prescribe medication for ADD or ADHD. 

           The pediatric neurologist told the mother that there are doctors who would prescribe attention medication for her child but that he wasn't comfortable doing so because in her child's case, the common side effects would likely outweigh any benefits. The side effects about which he was most worried were weight loss and interaction with the child's allergy medication. which, according to the mother, absolutely needed to be taken. The child was already bordering underweight, and stimulant types of medication used to treat attention deficit disorders frequently result in decreased appetite and subsequent weight loss.

           The mother wasn't as disappointed as I thought she might be at the doctor's refusal to prescribe Ritalin or another of the stimulant medications commonly prescribed for attention deficit disorders. (Non-stimulant medications are on the market but are less effective and present more harmful side effects.) I'm not certain precisely what the mother's actual objectives were in bringing her child to a pediatric neurologist. It surprised me that she didn't argue that point more. 

           As the appointment was winding down and the mother and child were practically out the door of the exam room, the mother mentioned to the doctor that the entire family was sensitive to gluten and that she needed a physician's directive so that the school would be forced to provide gluten-free breakfasts and lunches for her child. The neurologist told the mother that any directive from him ordering a special diet would be questioned and rightly so, as neurology and adverse reactions to gluten were for practical purposes mutually exclusive.

           The mother took exception to this and insisted that any medical doctor could prescribe a gluten-free diet for a child and that the school had no recourse but to adhere to the directive. The pediatric neurologist then told her that it shouldn't be any big deal to ask the doctor who diagnosed the gluten sensitivity to prescribe any special diet that was medically necessary. The mother then said that she herself had diagnosed the gluten sensitivity, to which she referred as Celiac Disease.  She had already done the hard work, she said. She merely needed a doctor to agree with her so that appropriate meals would be provided for her child. 

           In my opinion, the insistence upon  gluten-free products is a silly fad. Celiac Disease obviously exists in some people, as does other forms of gluten sensitivity in a relatively few people,  but not in the sheer numbers of people who claim it. What a person does or does not eat or provide to his or her children to eat is the person's own business as long as the person does not place a burden upon others to humor him or her in regard to adherence to whatever self-imposed diet the person has chosen. Asking a doctor to make a diagnosis out of his or her specialty in order to ask the school to go to extra trouble in accommodating the a child's diet when no evidence that it is medically necessary is placing an undue burden on both the physician and the school, in my opinion. 

           The doctor apparently shares my opinion. The mother pled her case for a full five minutes to no avail. my attending physician finally had to move onto his next patient in the middle of the mother's argument as to why the neurologist needed to prescribe the gluten-free diet. "How rude!" the mother exclaimed as she gathered her belongings and left with her child. As the mother pled her case to the receptionist, which was an exercise in futility as the receptionist had no power to authorize a gluten-free diet or anything else, the kid reached into the mother's oversized bag and pulled out a Hostess Ho Ho box. The child  removed a cellophane twin pack of the Ho Hos, ripped the cellophane with her incisors, and shoved a Ho Ho into her mouth. 

           I was too quick for her, though. I reached for the Ho Ho, pulled it out of the kid's mouth before she could take a bite of it, and exclaimed, "You can't have that! It has tons of gluten in it!"  If looks from either parents or their offspring could kill, i would be six feet under.



           

      Thursday, March 9, 2017

      Kellyanne the Stand-Up Comic

      Image result for kellyanne conway humor



           I gave up 11 1/2 minutes of my life that I'll never get back in order to watch a video of Kellyanne Conway doing a stand-up comedy routine for a charity. It was quite pathetic. She even sang at the end of her routine.  While I'm sympathetic to people who are not the world's greatest singers, I also think that everyone should have some idea of where they rank in terms of singing talents and should base their decisions regarding whether or not to inflict their singing voices on the general public on whether or not they possess sufficient talent to do so. Ms. Conway is probably one of the people who should not sing solos in public, but that's just my opinion. 


                                    This video does not belong to me.




      Sunday, March 5, 2017

      Time for Top Ten List of Favorite Songs Again

      Image result for nate ruess
      Nate Reuss is a genius even if he doesn't look like one.





           My brother and I are both off this weekend, which is vaguely a nice thing, as we had seen very little of each other in the past two weeks. I had almost forgotten what he looks like. One of our fellow students -- an older (early thirties) and mildly eccentric student I have nicknamed Raptor Jesus II after the original Raptor Jesus from the Recovery from Mormonism message board -- brought a few friends from our cohort to Matthew's and my condo to jam with us. We called a few other friends and ordered pizza, then got out instruments to make music. 

           Raptor Jesus II has eclectic tastes.  He came with a list of songs he wanted to play which included works from Elvis, the Beatles, the Monkees [probably because he knows I like them], Billy Joel, CCR, the Eagles, Queen, Tom Petty and the Heartbreakers, Bruno Mars, Survivor, Elton John, either Jefferson Starship or Starship [I don't know which songs are from which], Kansas, Fun, and a few others. We stopped at 10:00 because we were probably a bit noisy. We didn't get any complaints, but it seemed wise to quit before we got any.

           Musical nights like tonight always cause me to reevaluate my top ten list of songs. My list of favorite songs is constantly evolving and quite arbitrary. My playlists are similarly transient.  I don't base my "favorite" list on anything except what I feel like hearing at the precise time. I shall make my list, which consists of only song that have charted since the 1960's or so. Not a whole lot of good popular music happened before then in my opinion.  People allowed truly odd music to be popular before 1950. Some classical music is wonderful, but I don't try to compare it to or to contrast it with popular music. The two are entirely different, and each has its place. Ditto with Broadway songs, which I typically am less drawn to than the classics, but there's still some excellent music from those sources. If the songs haven't charted, though, they won't appear on my list.

                                     Alexis' List of Favorite Songs

      1. We Are Young / Fun (I'm quite convinced that this is the greatest song ever written. Nate Reuss is a genius.)
      2. House at Pooh Corner / Kenny Loggins or Loggins & Messina (This is a relic from my childhood but it never grows old to me.)
      3Hey Jude / the Beatles (The world as we know it would have continued to exist had there not been the Beatles.)
      4. Allentown/ Billy Joel (My list will probably always have a Billy Joel song on it, but not necessarily the same song each time.)
      5. Bohemian Rhapsody /Queen (The song speaks for itself.)
      6. Rocket Man / Elton John  (Elton John composed many great songs; Bernie Taupin was the lyricist for most including "Rocket Man." This one's a bit out there, but it's good nonetheless.)
      7. Sister Christian / Night Rider (While I'm far from the most devout adherent to Christianity on the planet, I relate to this song.)
      8. I Can't Get No Satisfaction / the Rolling Stones (I like any song House ever quoted or played on his show. He quoted this one in the pilot. The song is truer than true, and some people need to hear it.)
      9. Good Riddance / Green Day (My friend Claire liked this one, and if Claire liked it, it gets "favorite" status with me.)
      10. The Desiderata / Les Crane (The Desiderata itself is a work of prose, but it did chart, and a section in the middle is set to music, so it's eligible. I memorized this work to get out of giving a speech when I was in the eighth grade, and it's still a calming influence in my life ten years later. I was wise to have memorized this rather than to have given a speech.)
        

           On an unrelated note, Matthew was supposed to have called the guys in security at the gate of our condo complex to tell them we had ordered pizza. He forgot to do so. The guards let the pizza guy in without calling to check with us. (A few times Mormon missionaries have been let in as well. The manager of our complex would probably go into cardiac arrest if he knew about the Mormons invading the place.)That bothered me. Would they let any psycho or pervert or psychotic pervert into the complex as long as he had pizza (or Book of Mormon) with him or her? Usually pizza delivery people are in logoed cars, but not always, and besides, any axe murderer could put a logo on a car. I didn't want to tell on the security guys because I would feel terrible if someone were fired over doing something he thought was a favor to us, and one never knows how someone's employer will deal with him or her over an error in judgment. Instead, I drove my car to the gate [it was after dark] to discuss it with them. They saw my point and say they will check on all food delivery people in the future but that traffic was starting to back up in that lane, so they buzzed the gate and let him through because he looked legit. I personally think it would be better if all food delivery people had to be met at the gate by whomever ordered the food, but I understand how that's not very practical.  

           The security force is relatively competent here. Two people are on duty at night. If someone is sick or otherwise off, either the manager or assistant works it or one of the daytime people gets overtime. I've only called them about something problematic only once, but a security officer was at my door less than two minutes after I called. The jobs supposedly pay better than most security jobs around here, which they should with the homeowner fees my parents pay every month. Most of us are also generous at Christmas. Good security people are worth it. (The same is true of the Mr. Fixit guy.) There's only been one turnover since Matthew and I moved in, and the manager sent both emails and snail mail to us with the new guy's picture so we would know he wasn't an imposter. I think the people who work here are actually more paranoid than I am, which is fine with me.

           We're not a great place for prowlers anyway because the complex is surrounded by a ten-foot wall, and it's known locally that the place has so many security cameras and alarms on the premises that prowlers would presumably have better luck elsewhere. Supposedly an alarm will sound in the security office and their computers tell them where the wall was breached if anything weighing more than 25 pounds lands on the top of any part of the brick wall. It's set at 25 pounds so that a cat fat enough to weigh that much couldn't make it up there to set off the alarm. Most of the condos including ours have sophisticated security systems, too.  It probably sounds excessive, but I sleep better with the precautions. The world is crazy everywhere, but we're near a crazier-than-average loony tunes population. This is Zodiac Killer country -- probably safer than central Florida, where some of the stranger crimes that have ever happened took place, but not a whole lot safer.

      Friday, March 3, 2017

      I've Hit Rock Bottom; I actually watched Dr. Phil today.

      Image result for Dr. phil MADISON LIZ
      This is Maddy.



         I was off today because I ended up working a thirty-hour shift yesterday/early this morning. I've also essentially maxed out my hours for the week, so I'm only allowed to work four hours tomorrow, and I'm off this weekend. I can use the break. This is a tough rotation in many ways for me. Less than a week into it, I'm already counting the days until it is history.

            When I finally made it home this morning, I needed to unwind a bit before I could actually sleep, so I did a rather uncharacteristic thing, which was to watch an episode of Dr. Phil. I normally eschew Dr. Phil,  as he's a bit self-aggrandizing and bombastic for my tastes, but as I was surfing channels for something to watch, I came across the show introduction, and it was the proverbial train wreck from which I could not turn away. This particular episode of Dr. Phil featured an amazingly dysfunctional white middle class family presumably from somewhere in middle America. The show was every bit as torrential as the opening promised it would be. 

            Tom and Karen are the parents of fifteen-year-old Madison, thirteen-year-old Liz, and at least one younger sibling, with a seemingly venomous grandmother who likes to play armchair quarterback in regard to the family's dysfunctionality as the supporting cast. While there was plenty to criticize, the grandmother blamed her daughter-in-law too much for the myriad of family issues. This family was so troubled that there was ample blame to be shared.

           The show featured two absolutely beautiful blonde girls, Maddy and her younger sister Liz. Maddy has, for the past three years or so, essentially terrorized the family, and to some extent, their schools and communities as well. Though she had previously shown a life-long disdain for her younger sister, the two had joined forces to become literal partners in crime.  The mother repeatedly referred to the two as "partners in crime." Usually people are joking when they use the expression, but it was deadly serious with the two girls in this family. The thirteen-year-old, Liz, had smoked marijuana, cyber-bullied others who attended her school, and physically assaulted another girl in one of her classes on the second day of school this year, just to highlight a few of her behavioral disturbances. Maddy stole and sold close to $20, 0000 dollars of her parents' possessions, physically attacked them, and, the night before the family appeared on Dr. Phil, was part of a group that robbed another person of his Xanax and drove the getaway car in a high-speed chase (without possession of a driver's license). She's had so many brushes with the law that it would be redundant to list them all, though she's never been formally charged with anything. My parents were relatively upstanding and prominent members of the communities in which I grew up, yet I doubt they would have had the influence to make all of Maddy's crimes go away had she been their child. I also don't think my parents would have aided me in any way in attempting to avoid prosecution once I committed my second crime and probably not even after my first. I really don't know, though, and I don't want to unfairly blame the parents for everything without really knowing exactly what went wrong.

           One reason this horrible episode caught my attention was that I had a comparatively rough period in my life from the age of thirteen until I was almost sixteen. I thought I had been a very difficult child. After viewing this, I can see clearly that I let my parents off entirely too easily, though I would not want to live the lives of either of the two girls on Dr. Phil today.  Some of what the girls accomplished by way of violence directed at their parents was beyond my physical capability.  The girls are very normal in size and could hold their own physically against either parent. I still weighed eighty pounds at the age of fifteen and couldn't have come out ahead in a physical confrontation with either of my parents without a weapon.   My father would have had the physical advantage of  being male and more than twice my size. My mother was, in her previous career as a public school educator, a trainer of appropriate restraint and physical intervention tactics for educators to use with violent students and would have used her training to easily overpower me even thought she's only 5'3" and maybe 110 or 115 pounds. 

           It would have been highly enlightening to have seen footage taken in previous years in order to spot the roots of the dysfunction. Behavioral disorders of this magnitude aren't created in a single day or even in a single year.  Most likely there were parenting practices even in the daughters' early years that would make a typical parent's skin crawl. Beyond that, the footage we saw was when the parents knew Dr. Phil's camera was rolling. I don't know if it was a hidden camera or if the crew physically showed up and started taping. Regardless, I'm sure we didn't see exactly how Tom and Karen normally handle their daughters' misbehavior when no one outside of the family is present.

           I would suspect, however,  that Tom and Karen got an especially strong-willed kid in Maddy just as the luck of the draw. Some children are more difficult to parent than others are. The younger daughter, Liz, seemed more pathologically demented and more dangerous. It may be that she has been the victim of violence at the hands of her older sister and has responded by joining her as a "partner in crime" as the easiest way to survive. I don't know, though I hate to give her any kind of a pass, as she seems truly vitriolic and sociopathic. 

           A relative of a relative of mine had a difficult child, though she was Mother Teresa compared to Maddy and Liz.  Her primary method of acting out was non-compliance, particularly when in the care of her mother (her parents were divorced) as opposed to Maddy's violence and destruction. The relative of a relative got into drugs as a young adult. It came out when she was going through treatment that she had been molested over a span of several years by a relative who held an important job and was a pillar of his community. He threatened her that she would not be believed if she and that she would suffer consequences. As a result, she didn't tell. Instead, she dealt with the situation by acting out and later by abusing drugs.  I can't help wondering if anything like that might have happened to Maddy.  

           Dr. Phil, with the consent of the parents,  placed Maddy in an in-patient therapy program. She was not pleased.  The parents got to take Liz home with them. If what I saw of her was not a misrepresentation or a distortion (I'm a bit skeptical of the authenticity of the footage), I would conclude that Dr. Phil erred in not placing her in a residential treatment facility as well. She's the one of whom the parents really need to be wary. Because Tom and Karen were afraid of Maddy, they had been securing their door with multiple safeguards at night so they wouldn't be killed in their sleep. I hope they don't discontinue that practice just because Maddy is no longer in the house. The only thing about that which bothered me was that even though she wasn't shown, there is supposedly at least one other child in the home. She is unprotected if the parents cope simply by locking their daughters out of their room. 

           I never knew what force was at work in causing me to be somewhat rebellious back in the day.  For some children, puberty with its wild hormone swings is a major causative factor. That would not have been the case for me. I didn't officially reach puberty until months after I had turned eighteen. I'm hormonal now, but I wasn't at thirteen. Perhaps I was unconsciously angry that everyone else at school was hormonal and I wasn't. I have no idea. I'm really grateful that I suffered no serious trauma in my childhood and that my parents were sensible people who, for the most part, knew when to make an issue of a behavior and when to ignore it.  Perhaps I would have been as evil as Maddy and Liz are had I been raised in their home.

            I don't know if Dr. Phil follows up on his cases.  Conceivably we will have an episode detailing the outcome of treatment. I'm not optimistic. I don't really see how the two girls can ever make it from their present state back to civilization, if they ever were there in the first place.

           UPDATE: I read on Dr. Phil's Facebook page that Liz is being sent to a residential treatment facility, though not the same one that is serving her sister.