The sound of one hand

So Sam's new trick is clapping and -- I know I'm his mother, and that makes my judgement suspect at best, but trust me here -- it's ridiculously cute. Off camera, he claps for anyone and anything, acheivements large and small. He's all about equal opportunity affirmation and he happily claps for me, Brian and himself. He claps on cue and he claps spontaneously. It's beyond delightful and we are lapping it up. Tonight we tried to catch the clapping on camera but he was having none of it. Still, the ensuing video was pretty adorable, so here it is.

(The usual caveat applies.)

Trial and error

It's been a crazy week on the general neurology service. During my mid-rotation feedback session with my attending yesterday (*mwah mwaaaah mwaah*), I cast about briefly for something -- anything -- positive to say about my experience so far. "We've seen a wide variety of patients since I came on service," is what I came up with.

"Well," he said, "it's not usually like this."

Have I mentioned that I just love in-patient neurology?

In any event, I really have seen a wide variety of patients since I came on service. There have been some good bread-and-butter cases: strokes and multiple sclerosis flares, a couple of people with seizure disorders, a case of neurocysticercosis. Two days ago, I admitted a man with glioblastoma multiforme, a devastating form of brain cancer. But there have also been some mysteries and even a few zebras: slurred speech caused by the same auto-antibodies that cause type 1 diabetes, progressive multifocal leukoencephalopahy in a patient with leukemia, weirdly chronic meningoencephalitis that didn't seem to be caused by an infection.

The upshot of all this variety has been surprisingly unvaried: brain MRIs and lumbar punctures for everybody; steroids for almost everybody. There were a couple days earlier this week when my team was a virtual lumbar puncture machine. There were so many LPs to go around that the residents let us medical students try our hands with the needle, which was simultaneously an opportunity (for me) and a torment (for both me and my patients -- and probably my resident too). I didn't succeed in finding the dural space a single time and at least once thrust my needle into a patient's spinal nerve root, sending a zing of electric pain down his leg. There's nothing quite like pulling a four inch needle out of someone's back, slightly adjusting the needle's angle and then shoving it back in. And then doing it again.

Good times, I tell ya.

Like every single medical student in the history of ever, I'm deeply ambivalent about practicing painful, invasive procdures on real live people. But I also understand that there's simply no way to learn medicine without practicing on patients. Other people have written more eloquently than I can hope to on this subject. For now, suffice it to say that I'm very grateful to my patients for trusting their medical student with something so precious.

Moviestar

I'm finally posting video! My dad has been asking for video of Sam crawling, so here it is. He's been working very hard on standing up lately, so I think the crawling is just about over. I'm in pre-mourning, I admit. The crawling has been so darn cute.

Warning: this video is only appropriate for serious sam-o-philes. It's pretty boring otherwise.

Zoology

Last weekend, Brian's parents came to visit us to celebrate my mother in law's birthday. We took Sam to the zoo for the first time. I expected him to relish the experience, but instead, he seemed almost disinterested. We could hardly get him to engage with the animals in the petting zoo at all.

The tigers were in a particularly fiesty mood; I've never seen tigers wrestle, race and pounce like they did last weekend. But Sam was much more interested in the large bolts that keep the tigers in their cage.

By the end of the day, Sam had found his groove: he loved the pigeons and squirrels best. I think we'll stick with the park for a few more months. The zoo can wait until he's a bit older.

Peace, love and neurology

So I'm one week into my neurology rotation and I have to say, I hate it exactly as much as I expected to. Neuroanatomy was by far my weakest subject during the preclinical years of medical school and even now, I get a little jumpy when I hear words like thalamus and medial lemniscus. Scanning through a brain -- or worse -- spine MRI is enough to make me feel queasy and I panic slightly when the conversation turns to cranial nerves. The upside I suppose is that this reaction confirms my decision to go into (internal) medicine. One of my patients, admitted following a small stroke, had the decency to muster up a little chest pain overnight and as a result I spent a few happy hours reading EKGs and checking troponins. Fotunately for her and unfortunately for me, her angina resolved after a single dose of sublingual nitroglycerin and hasn't been heard from since, so now I'm back to counting down the days until neurology is over.

One of the aspects of neurology that's particularly difficult is that it's damn depressing. One patient recently discharged from our service is a young woman with a history of leukemia for which she received chemotherapy injected directly into her spinal canal. The chemotherapy cured her cancer, but also caused a rare and catastrophic neurological toxicity. Apparently when she was admitted to the neurology service a few days before I began my rotation, she had completely ceased to speak or move. After a week or so of our able care (!), she was talking in one and two word sentences, following simple commands very slowly and copying her own name with a pencil. The left side of her body remains profoundly weak. Her husband has kept a vigil at her bedside, feeding her and encouraging her, taking her for slow walks around the hospital. She is expected to recover some additional function, but will almost certainly never regain her full self. I'm not even sure what to say about this couple. When I think about them, loneliness and disappointment wash over me. This can't be the way they expected life to go.

I've been thinking about disappointment in general lately, in part because I submitted my rank order list for the match a couple of weeks ago. In the end, I ranked Stanford first; staying here in Palo Alto is what's best for my little family and I'm deeply grateful to be in a position where I have the luxury to simply choose what's best for my husband and son. Plenty of medical students every year feel lucky to match anywhere, let alone to a program as excellent as Stanford's. But I'm also disappointed, maybe more than I'm willing to admit, that I'm giving up BWH. The truth is, that's where I want to be next year and I suppose I'll always wonder how my career might have been different had I trained there. Of course, this is a very small disappointment, and already I feel more wistful than resentful. But I've vicariously encounted a few other disappointments lately, much larger than the little scratch I'm currently nursing. So I'm thinking about disappointment.

And, of course, we're in Lent, the season of loneliness and disappointment. Last week, my priest caught up to me at coffee hour and handed me a printed packet of poetry, left over from a Lenten concert. The poems, she said, were for the part of me that's "neither a doctor nor a mother."

"That part is very small," I told her.

"Of course it is," she said. "But don't worry. It's there, just waiting for when you're 60."

Inside the packet were poems by Shakespeare, Auden and two poems by Wendell Berry, new to me. Here are a few lines from 'A Timbered Choir':

The clearning rests in song and shade.
It is a creature made
By old light held in soil and leaf,
By human joy and grief,
By human work,
Fidelity of sight and stroke,
By rain, by water on
The parent stone.

We join our work to Heaven's gift,
Our hope to what is left,
That field and woods at last agree
In an economy
Of widest worth.
High Heaven's Kingdom come on earth.
Imagine Paradise.
O dust, arise!

And suddenly, I think I can see that the cure for disappointment is anticipation. So as my Lenten observance this year, I'm looking forward. Looking forward to Easter, to being an intern at Stanford, to being 60.

Economizing

Today I was sidelined at home because our daycare center closed for Presidents' Day. It rained most of the day, so Sam and I camped out in the living room, building block towers and listening to NPR. As I always do when I listen to the radio all day long, I learned a few things. For one, it turns out the unemployment rate in California is almost 10%. I knew it was bad out there ... but geez. Unemployment in my fair state has nearly doubled in the last year. If our legislators can't arrive at a budget compromise -- now eight or nine months late -- our governor is threatening to lay off another 20,000 people. But our state's economic crisis feels surreal to me because I have been virtually unaffected. I'm already unemployed, and my job for next year is secure. So far as we can tell, Brian's job is secure too. If anything, we stand to benefit from the mess: real estate is on clearance and gas is oddly cheap. I feel a touch of survivor's guilt.

In other news, last night Brian and I went to a Punch Brothers concert and earlier in the week, we attended an evening event at church. We left Sam with a sitter both nights: his first experience with being put to bed by a non-parent. Apparently, he rose to the occassion reasonably well, so I'm optimistic that it will be possible for me and Brian to go on somewhat earlier dates from here on out. I'm continually surprised that this parenting gig appears to be getting easier and easier. Now that my kid sleeps 11 hours straight at night, gobbles down table food and puts himself to bed when he's with a babysitter ... being a mother is a snap! Bring on the octuplets!

25 things

I recently stumbled across a list, published in the October 2008 issue of Popular Mechanics, of 25 skills a man should know. It's a pretty sexist list, I suppose, and lots of items on the list are things both men and women had better know how to do, like perform CPR and maneuver a car out of a skid. On the other hand, there are plenty of things on the list that a) I have no intention of ever doing because b) my husband can do them, and do them well. Like fillet a fish. And back up a trailer. And build a campfire. And navigate with a map and compass. Actually, he can do everything on that list, with the possible exception of framing a wall. But I bet if we ever needed a wall framed, he'd be up to the task. His general guy-competency isn't a surprise to me, of course. I like to joke that experimental physicists are the handiest kind of white-collar husband, but my guy is particularly handy, even among his experimental physicist peers. It's something I really appreciate about him.

But this list has got me thinking over the past several days. What are the essentials skills that women should have? I've come up with a preliminary list of 25 and I admit that my list suffers from the same sexism that the Popular Mechanics list exhibits.

1. Make a pie
2. Negotiate a raise
3. Be a gracious hostess
4. Walk in stiletto heels
5. Allocate the investments in her 401(k) with confidence
6. Cook Thanksgiving dinner
7. Flirt
8. Do her taxes
9. Rebuff an unwanted advance graciously but firmly
10. Care for a sick person
11. Comfort a grieving person
12. Entertain a child
13. Travel alone
14. Speak before a group
15. Organize a child’s birthday party, a charitable fundraiser and a funeral
16. Bring order and beauty to a home
17. Run a meeting
18. Speak her mind without apology
19. Chose clothing and makeup that suit her
20. Make her guy feel like a hero
21. Write a thank you note
22. Make small talk that’s interesting and effortless
23. Be the boss without being a bitch
24. Purchase a thoughtful gift and wrap it beautifully
25. Make other people feel at ease at socially awkward moments

I'm very interested to know how other women think about this question. What do the women you admire know how to do? What do you wish you could do?