Reader Q, Probable Farewell

Q – I just discovered your blog and have had fun reading it, however, it seems that you have stopped blogging?

A – It’s true. I burned out a little. Well, that’s a simplification. Moving here (to Germany), emerging from survival mode from medical training and settling into a normal life opened up all kinds of new emotions in me that I didn’t anticipate. The most important of these was a distinct realization that I wanted to deepen and widen my relationship with my wife.

So instead of pounding out these blog posts, I’ve been cooking dinner once a week (“Daddy Dinners”) and spending the majority of my nights watching some show or other with my wife by my side as I run my fingers slowly through her hair.

I’m gradually putting together a new blog – “Lover, Daddy, Doctor” – that picks up where SW101 leaves off. But it reflects my new focus in life.  I’d anticipate some humor, occasionally more intensity, less medicine.  I’d even expect the occasional Bible verse to accompany an irrepressible proclivity to pepper my writing with a well-placed swear word (Hey, I’ve come a long way…plus I’ve long bet that God nods to honesty before Christian decorum).

To survive in medical training, you HAVE to make survival and success your number one priority. I would have sworn this wasn’t true for me, but it was. Failure anywhere along the training path is a conscription to a lifetime of insurmountable debt, even poverty. Now that I’ve survived, my genuine priorities have emerged. I love to write, so it’s natural that I would blog about this new direction in my life. But I’m not sure. This is personal. More personal than just the experiences of being a doctor trainee. Maybe the story of one guy’s quest to be a better man is better left to be pondered quietly in the heart.

So, I’m mulling my next “move”. Maybe I’ll just pick up where I left off and start up SW101 again (thanks, everyone of you who wrote in to ask where all the good times went). Maybe I’ll finally finish my book.

Ultimately, I just can’t tell you where I’m going because I myself don’t know.  I DO know that I’ve successfully grilled tuna fillets, invented a mango/pear/mint salad that everyone loved, and I can broil Portabello mushrooms all by myself.  I learned the difference between Goat Cheese and Feta Cheese.  I know where the measuring cups are in the kitchen.  I can tell you every character in Lost (and the top 4 theories about what the freaking show even means).

But what I REALLY know is that my wife looks at me with eyes I haven’t seen for 13 years.  And this stirs my soul in ways that make most of the rest of my life comfortably superfluous.  This blog got caught up in that eternal vortex…

When I know anything more than this, you will too.


“All that I am, all that I ever was, is there in your perfect eyes…they’re all I can see.”  -Chasing Cars, by Snow Patrol

The Family’s Doctor

Being a doctor to your family is tough. I didn’t think so, at first, but it gets harder to deal with as time goes on.

When I first became a resident – an actual doctor, in some people’s minds – I was flattered whenever someone from the family wanted to know what I thought. But further in to training, I began to see how much of medical diagnosis is based on the systematic physical and historical evaluation. Family and friends just dropping questions about real problems on me began to feel overwhelming because I knew I couldn’t give them good medical advice. Furthermore, other than saying things were fine…I couldn’t help anyway. “Go to the ER,” or “All good, dude, don’t worry about going to the hospital…just don’t use that hand anymore” were about the only 2 things I could say. Then, they take your word for it because you’re a doctor and you should know about these things and you worry that something will go wrong.

I’ve found that this conundrum is even harder to manage in my immediate family. With 4 kids, things happen all the time that could benefit from a primary care doctor’s evaluation. Additionally, with me working constantly – taking care of other people’s kids, as it were – you can imagine how hard it is for my wife to take one kid in to see their actual doctor rather than just having me check them out. But in the U.S., there’s all kinds of ethical issues with doctors taking care of family members. We’re strictly forbidden to take care of family members whenever they’re in the hospital – bastion of regulation and compulsive ethics that it is. In the clinic, things are a little more relaxed, but not by much. The general thinking is that doctors won’t be able to make objective medical decisions about family members. As if the decisions before us amounted to, “Foul insurrectionist of the imperial realm…OFF with your hea-! *Gulp* Wait a minute, aren’t you my kid? Well, OFF with your pigtails, then!”

jordie.jpgI can say that there’s some truth to this bias thing, although I wish there was some room for practicality. When my 3-year old daughter fell on a display rack at the grocery store and avulsed the tip of her left ring finger – her WEDDING finger, potentially – all I could think about was whether or not a new fingernail was going to grow back. As a doctor, I was worthless in the ER. Never mind distal tarsal functionality. Never mind osteomyletis or tendon rupture. WHAT ABOUT THE FINGERNAIL, YOU IDIOT KNOWNOTHING DOC!? SHE’S GOT 2 SISTER’S, YOU KNOW…FINGERNAILS ARE IMPORTANT AT MY HOUSE! Incidentally, it was around that time that I looked down at her pt. data armband and realized that based on the totally wrong birth date I’d given the front desk, my daughter was now in their system as a two year old male.

I also remember being quite an idiot for the birth of our 4th kid, which was via C-section. Just before the surgery started, I’m sitting in a chair at my wife’s head and a drape separates us from the surgical action about to start below. The doc says to me, “Hey, you recently finished med school, right?  We’re just about to get started here.  You can come down here an help or watch if you want” I about retched. Good GOD, man! Are you some kind of sadist? You’re about to eviscerate my wife! For the love of all that is holy, next time I want to watch someone commit seppuku, I’ll find it on You Tube! “Uhhh. No thanks.” I managed, severely nauseous and dizzy.

Many other countries see this issue differently. The idea that your son or daughter is a doctor means you have someone who you can implicitly trust in the medical field. You also have someone who you know will listen to you and give you the care you want (and won’t be bought off to kill you). Nobody’s going to sideline you or ignore you or mess something up if it’s your own kid who is taking care of you. In many countries, when children become professionals, there is cause for celebration because of how it will help the family, not the child.

I recently was wrestling around with my two oldest kids in our front yard. Just prior to ultimate triumph over both of them at the same time, my crafty 6 year old intertwined her entire body in mine and toppled me to the ground. In the process, I stepped on her wrist, which happened to not be in our yard anymore, but on the sidewalk. She cried, hard. In response, I performed “surgery” – a silly act where I make noises while pretending to be cutting and sewing.  This usually makes the injured tyke laugh while giving me a chance to actually examine the injury, and she seemed ok. No crying about it that night. But I a sliver of concern wedged itself into my comfortable analysis the next day when we noticed her trying to write and color with her non-dominant hand. “What’s wrong with your hand?” Mom asks, concerned. “It hurts where Dad stomped on it.  Better if I don’t move it.”

Great. I just broke my daughter’s wrist. In a perfect world, I could just call the radiologists (most of whom I know…except the contracted film-readers in Bhutan or wherever) and say, “Joohh! Hey, Geoff here. You remember my 6 year old from the BBQ last week? Yeah, need a quick zap of her left wrist. If you would, look for a distal ulnar fracture. Yeah, will send her right over. Thanks so much.” Kid gets zapped, rads reads, says minor fracture, I take kid into my clinic and wrap up her arm in a cast for a few weeks myself. Cost to me = some time and $0. Alternatively, Xray is negative so we skip the casting step and cost to me is less time and still $0.

This isn’t how it would work, though. I have to work, first off, so my wife (all alone) would need to do the following: Take all 3 kids to clinic. Scream at two littlest ones as they expand their imagination in the waiting room.  The youngest is dragging his tongue along every surface he can reach…for some reason Freud described having to do with sex that nobody understands. I pass my family 2 or 3 times, unable to help in any way because I’m busy. Eventually, another doc who knows about as much as me – but “scrubbed” of bias – sees daughter. Youngest has now partially swallowed a reflex hammer. Doc learnedly proclaims, “Daughter needs an XRAY!” Film ordered. Wife stops at hospital financial aid office to explain that said hospital pays dirt and we need assistance. 45 minutes later (youngest now gnawing on some old guy’s cane), cheap(er) Xray is granted. 2 hours later, Xray is positive. Child needs cast. Clinic closed. Not sure what kind of break. Best evaluated by orthopedic doc. Ortho doc (avg income $700,000 per year) does not give financial assistance (“Doesn’t your husband work with me in the OR sometimes? Coool. Here’s your bill, mam.). Normal break, needs cast. Kid heals. All done. Total bill = $3500 because of Dad’s stupid, clumsy feet. Dad now eyed suspiciously by CPS drones who wonder what kind of father figure would initiate non-sexual contact with their child.

In Israel, where I trained, there is a term roughly pronounced “protexia”. It means that if you work at the hospital, you get a break. It’s understood that you’re helping out as many people as you can, and when you need help, the organization pulls together to get you taken care of. Not here. You do it by the book. The book written by Americans with American medical ethics.

So we didn’t take our daughter to the doctor, despite the irony that she lives with one. We decided instead to just sit around biting our nails about the issue, hoping she’s alright. Just like most Americans with crummy or non-existent health insurance who work full-time. But at least the bone doc’s doing alright.

Bajillion SPF or clothing?

Was recently asked if it was better to use SPF 50 lotion all day or to just have kids wear clothes when they’re in the sun.  By “better”, I mean which is better protection against skin cancer?themonk.jpg

The answer is clothing.  Clothes are always better than sunscreen no matter what the SPF rating.  Here’s some other surprising facts:

– sunscreen has never really been proven – by scientific means – to prevent skin cancer.  We know it stops certain kinds of UV light, but no one can say for sure that it prevents skin cancer. 

– not all clothing is sun-proof.  Especially many types of swimsuits.  If they don’t specifically say they’re sunproof on the label – and you aren’t paying an arm and a leg for the fact- they probably aren’t.  Of course, hats and thick clothing do block sun rays of all types.  But don’t just automatically assume that since your kid is wearing a bathing suit or thin shirt that s/he is protected from the sun.

– there’s two major types of UV light: UV-A and UV-B.  If you sit around all day in UV-A light, you’ll get super-tan and never really end up burnt.  It’s UV-B that causes the burns.  So, traditionally, suntan lotions stopped UV-B to keep people from burning and yet still allow them to tan to the point of looking like they’re from a different race.  Lately, it’s been figured out that UV-A light actually does change a person’s genetics…deep in the skin where the melanocytes reside.  This is not DNA you want to be messing with.  Of the skin cancers, melanoma is the really bad one and the one to be most feared.  Given that UV-A is the kind of light that causes the best tans, can you guess what kind of light is used almost exclusively in suntanning parlors?  That’s right.  UV-A.  Ask any dermatologist and they’ll freak out about tanning beds.  They’re a HUGE risk for skin cancer.  The best option if you want to be brown?  Use the lotions.  They’re getting less orange every day.

How Do We Stop Child Molesters?

I spent 3 years in Israel. There is very little pedophilia in the Middle East. Very little reported anyway. I remember returning one year from Israel and passing through the Salt Lake City airport. Plastered on every wall and window were pictures of a young girl named Elizabeth Smart – abducted right out of her own home in the middle of the night. I remember those fliers conjuring a number of feelings in me…including resentment at the fact that so many of my fellow Americans told me aloud how unwise I was for taking my wife and kids to such a dangerous place like Israel. In fact, I only got tense about the safety of my family once I’d crossed back into the States.

Pedophilia isn’t a strictly American problem. The curse spans the globe and may very well be more rampant in countries other than this one but simply less well-reported. Still, the practice is alive and well in the States and – fair or not – I have this sneaking suspicion we lead the way in terms of numbers and severity of the problem.

The hardest thing for me about pedophilia is that I don’t really understand it. One half-glance at Angelina Jolie, or – insert scantily-clad, photoshopped, verneer-toothed, 1000 bucks/month hairstyle babe or hunk here – and I can understand the allure of adultery. That’s easy, actually.  Example:  I’m out walking my dog…well, actually I’m out pooping my dog.  When I take out my dog (Fetch) often all I want is for him to just not BM in my yard.  I take him all over the rural trail behind my house in the hopes that he’ll go there instead.  He snifs and prifs around forever, but it’s worth it.  It saves me from having to pick up – gagging – endless piles of dog poop and dumping them into a bag that gets disgustingly heavier as I find ever more gifts from my “best friend”.  Let’s pretend, then, that there I am, pooping my dog.  I’ve been working all day.  Dinner’s burnt (actually, my wife never burns anything, but we’re in make-believe).  I have lots of sick patients in hopeless situations in the hospital.  I haven’t worked out since bench-pressing was invented and the idea of being adventurous is as foreign to me as the click consonants of Zulu.  Unexpectedly, a woman jogs – no, gllliiides – up looking painfully lonely which is inexplicable because her face is airbrushed to perfection and she’s moving around all silky-like in her tight jogging stuff and looks just like a magazine cover. In fact, I think I see the word “Elle Magazine” hovering mistily just above her head.

“Oh, what a wonderful dog! Look at him pooop!” She exclaims, clearly impressed beyond belief at my dog-training skills.  She looks at me with unabashed admiration, flutters her eyelashes and demurrs, “Maybe we could take him to meet my dog and they could poop together.”

My answer in each of these type of bizarre fantasies is a gallant, loyal and banal, “No. I’m in love.” But why would I have the fantasy? Actually, this particular dog-pooping fantasy is just made up for you, dear readers.  Never dreamed up anything much like that except now, to make a point. And that point is that I can at least relate to the people who do have unhappy marriages and do run into some scantily-clad potential mate, and do fall into the very bad choices one can make in those circumstances. I get it. Haven’t done it. Don’t want to. But I get it.

Not so with pedophilia. I can’t make up a scenario that makes me say, “Well, it isn’t for me, but I guess I can understand it.” It just doesn’t make sense – even theoretically – to me.  Because of this, I fear it more than other things like leukemia or car wrecks.

Aside from fearing what I don’t understand, it makes sense to fear pedophilia because it is much more common than many other calamities that can befall kids. Bike helmets? Statistically useless.  Severe head trauma is almost non-existent compared to the risk of being sexually molested. Guess how many (I’d insert some funky little poll here that you could click on if I knew how to work the tech stuff, but I don’t.)? The depressing answer is at least one in every 4 kids will be sexually molested by the time they are 13! That’s 25% of the American child population. Additionally, a random survey waaay back in 1988 (so things are probably worse now) found that close to 1 in 10 men admitted sexually molesting a child at some point. This is a mind-boggling number. Please, if you have kids, let that number boggle your mind.

So, if you forget the bike helmet once in awhile (little more than peer pressure in head-shaped foam, I say), no big deal. But don’t forget, or neglect altogether, to teach your kids about sexual predators.

Here are some things to know:

– If done well, you won’t scare your kids by talking to them about sexual predators.
– Give your kids – even as young as 5 or 6 – the right words to describe their sexual organs. It doesn’t have to be “penis” and “vagina” exactly, but it does need to be specific to the areas.  They need to be comfortable talking about this area of their bodies.
– Educate on what is acceptable touching in those areas. It’s pretty limited (doctors, parents), so this should be a short conversation.
– Roll play. Kids like this because it’s imaginative. Be as creative as you can in your stories. Tell them you’re going to try to trick them, and then do it (“Hiii little girl, I have an extra Polly Pocket in my car that my own little girl doesn’t want, would you like it?). Most kids will think it’s fun, but be as persuasive as you can. Believe it or not, this is a great dinner-time conversation. The message to them is simple: NEVER BE ALONE WITH ANYONE UNLESS YOUR PARENTS KNOW ABOUT IT.

teacher.jpgHere’s a couple of known strategies of pedophiles:

– They’re usually known – personally or visually (janitor, or teacher across the hall, etc) to the child.
– They usually start small. Always be wary of a present given to a child from an adult.
– Their push is always going to trend – eventually – toward being alone with the child.
– Molesters tend to know what your kid likes and dislikes. They’re often very current on child trends.
– They often speak harshly about molesters.
– They are often charming, good-looking, in leadership roles and work with children.

I recently saw a child who had been molested by another older child. The molester was 12, and already had a strong addiction to porn and a fetish for oral sex. Naturally, this kid was almost certainly abused at an earlier age, and now has a very grim life to look forward to. The prognosis for the younger kid is actually good, if he continues to get good treatment. Bravo to the parents for listening to their child and believing him when he made a few off-hand comments that were out of character.

Lately I’ve wondered if my response to pedophilia is similar to the medical establishment’s response to homosexuality 60 years ago.  They said it was aberrant.  It was a psychological disorder.  They were opposed by a committed group of people (mostly gay themselves) who insisted the practice was normal.  Today, the docs of that generation are considered to have been in error and homosexuality is accepted as a normal variant of human sexual relations.  Perhaps this is my generation’s bias.  Maybe we’ll look back in 60 years and think of people like me as close-minded fascist prudes.  There are actually a number of groups that promote pedophilia (replacing my ominous language with terms like ‘love’) and see it as completely normal.

maddie.jpgWhile I’m open and often intrigued by the myriad ways that people think and behave, I don’t think I’ll ever see pedophilia as anything other than strength preying on weakness, leading ultimately to complete destruction.  I see it as an evil and a horror and a practice that must be opposed in every way.  

I suppose I’m just a bigot like that. 

When Can I Swat the Tot?


That’s the answer from the AAP (American Academy of Pediatrics). ‘Course, these are the same hardliners who can’t just come out and say what they really think about circumcision. If you really managed to nail them down, I think they’d say circumcision is a medically useless. Most would say it’s somewhat barbaric and the practice is rooted in outdated cultural norms long abdicated by the rest of the developed world. Instead, they say they have “no recommendation for or against” the procedure, but that it isn’t terribly “medically necessary.” So I kinda think of them as softies who take the most expedient position on any hot topic. The Hilary Clinton of the medical world, if you will.

Thus, I’m a little dubious that their recommendations about spanking are just as expedient. Or maybe they just can’t appreciate the magnitude of what they’re actually recommending. When they say you shouldn’t spank a spoiled brat as he throws paint and smashes china, I immediately imagine just who comprises that “academy”. I see lots of gray hair. Kind faces. Serene smiles.

I see grandparents.

car.jpgIt’s hard to imagine that anyone who strongly says you shouldn’t spank your kid – they like to call it Corporeal Punishment, which sounds so much more severe and dire – has many kids. It’s easier to imagine that they had a single kid who was born with reading glasses, a 6th grade vocabulary and a keen interest in impressionist art. Then I imagine that their single kid grew up and miraculously managed to generate enough coital passion with someone of the opposite sex to birth, say, 5 kids.

Now suddenly grandparents, these ACPA’s (anti-Corporeal-Punishment-Advocates, I’ll call them) find themselves surrounded by the love and adulation of all the best that children have to offer: Grandkids are all smiles and no poop. Beautiful, creative…they like imagination and building blocks. They’re the future. Even if they disobey a little bit…hey, they’re just kids, right? Oh, look honey, time for the 4pm buffet at Shari’s, better move along just before dinner-time at the 15-ring circus (since each kid has 3 issues to deal with at all times). Oh, and don’t spank them, dear precocious daughter. That’s called Corporeal Punishment, and we never used it on you.

I grew up in fear of The Paddle. Spanking was routine in my world. Knowing I’d messed up big time, I once put on every pair of underwear I owned – and a couple pairs of my brother’s too – in anticipation of the big Swat…and it still hurt like mad when my backside met that inevitable swooshing wood. Did it keep me in line? I don’t know. All I know is that spankings were part of my life. They hurt. They ruined my day. But by the time I was in high school, I didn’t even have a curfew because I just sorta did what I was supposed to do all the time. My parents didn’t even worry about me.

The AAP held something called a “consensus conference” specifically on this issue (read their policy statement here). They concluded that the word discipline comes from the a root word that means to teach or instruct. Specifically, it refers to preparing children to achieve competence, self-control, self-direction and empathy. Sounds good, right? I think I got all that from The Paddle.

These AAP grandparents go on to say that every discipline “system” must contain 3 elements:

1.) learning environment that is positive and supportive between parents and kid,
2.) a strategy for teaching wanted behaviors – this is considered the “proactive” part, and
3.) another strategy for stopping crappy behaviors – that’s the “reactive” part.

When I think of those 3 things – again – El Paddle Grande comes to mind…hovering in my peripheral vision like a specter of Mother Mary Joseph, Stalin and Javert combined into one terrifying henchman.

Let’s be honest. Most parents have 1 and 2 figured out, or at least they usually aren’t asking their docs about those. They’re asking about #3. And here’s my personal – and I guess professional – opinion on the matter: The best way to address #3 – spank or no spank – is with consistency. While allowing for times when you actually are in error, in general, you have to follow through on what you say. Discipline should be loving, without anger, in control and cause no harm. And most of all, it should be consistent. Don’t say you’ll do something you have no intention of really doing, “Jimmie! If you swallow that slug, I’ll cram 50 more in your mouth and hold it shut ’till they’re crawling out of your eyes!”. Keep your threats small, realistic and fair. If the child merits the punishment, be extremely committed to following through on your threat.

I think AAP can’t advocate for corporeal punishment, because there are a tragic few parents out there that take the practice way beyond the bounds of normal. I also harbor the opinion that just about every parent gets some catharsis out of spanking their kid, which is why most parents regret how hard or how much they have spanked their child at some time in the past. I think the AAP theorizes that if spanking is not one of the options for parents, the potential for abuse or simple over-use is diminished or eliminated completely. Equally effective, they say, are strategies like being consistent, calm and firm and using punishments such as time-outs and removal of privileges. These approaches work just as well as the violent, corporeal approach employed, no doubt, by the likes of Osama Bin Laden and Charles Manson, had either of them ever managed to have kids and stick around to raise them.

Research says that more than 90% of parents spank their kids. And I think that easily 90% of that group have no intention or inclination to abuse their kids. But keep in mind that if a mark – other than just red skin – is left on a child after spanking, it is reportable to child protective services (read: a crime). A bruise of any kind is considered abuse. One report won’t get your kids taken away, but a few of them will.

scream1.jpgMany people in my church a few years back were influenced by a small book called “To Train Up A Child” by Michael and Debi Perle, which describes a religious-oriented approach to discipline that advocates very light spanking for any infraction. When used exactly as he prescribes, I can see how it might work. But most parents can’t stay in control of themselves all the time, and often end up spanking too hard, or too often. Better, then, say the grandparents at the AAP, to simply never spank.

Whether or not you agree with the “no-spanking” approach – which puts you in a 5% minority of parents – one thing most do agree on is that spoiled kids that don’t obey their parents are one of life’s singular annoyances. Furthermore, our nation in general is regarded by most other nations as one that won’t share, never wants to be “it” in tag, has to be first in line, wants the most toys and never wants to wait its turn. Could it be that part of our low standing in the world is a direct result of bad parenting?

Everyone can agree that a major component of good parenting is good discipline. The question is how it’s done. I think using controlled consistency – spank or no spank – is the secret.