Tuesday, October 4, 2011

Fix You


Beth and I love this song.  I know, for those beating the testosterone drum, Chris Martin doesn't rock Standard Male Ideal #104, but there's something haunting about his voice and music.  But this song ...

I've read that Martin wrote the song for his wife, Gwyneth Paltrow, who was suffering in the wake of the death of her father.  The essence of another person grieving, and another being just being there, is woven into that song;  I can taste and smell it, and squeeze it through my fingers.

Today, I saw a family today whose infant has a concerning diagnosis.  Looming over him is a shadowy unknown that I am trying to pierce, but, ultimately, only the passage of time can tug that veil loose.  Until recently, the appointments with them, in my mind's eye ... the two of them are suspended by strings composed of this song, and there's that sense of angst within an embrace as they try to forge on despite not knowing what lies ahead for their child.

I earnestly believe they are ok because they have fixed each other, and I feel the strength of their young marriage shining softly.  Together, they will cope.  I am their child's doctor, but only inner circle, or inner heart, people can hold their hands, help them along, or carry them down the road to which I have guided them.

"Lights will guide you home."

Tuesday, September 13, 2011

What Matters

I named this blog Crumbs in the Carpet for many reasons; one of them was a wry nod at the idea that kids will eat things off the floor, even if they have no idea what crumb came from what snack from G-d knows how long ago.  The title is a bit of a nod to the idea of serendipity, a concept I enjoy.

Today, I stumbled upon such a crumb in a meeting of pediatricians puzzling out how to best engage families in treating asthma.  I observed that some kids will embrace their need for daily medications if we figure out what the "hook " is, noting that the buy-in for some teens came when they understood that 20 or so Olympic gold medalists won their golds despite their asthma.  Asthma is not a death sentence for athletics; not treating your asthma might be.

The discussion leader applauded this observation with others like it.  "That's great, Brian," she smiled.  "That was the key.  You figured out what matters to that child, and he accepted your advice."

Simple, right?  What matters?  Just figure out what's important.

Right then, a tsunami of epiphany washed over me, and it's possible I appeared to cease functioning for a time.  I felt like one of those matryoshka dolls, but in reverse; start with a small one and layer bigger and bigger dolls on top.  Or, even better, like a panning movie shot, starting with one person, expanding to the hero shot, the town, state, country, planet, solar system, and Mind of G-d views, in rapid succession, faster than thought.

What wouldn't be better, if we all merely addressed what matters?  I saw a mother today with one of her children.  He's a cute 2 year-old very similar in personality to my own sweet 2 year-old.  I suppose we talked about him a bit; after all, it was his check-up.  What she really wanted to address, however, was her other 2 children and how they fight all the time.  So we did.

When I came home tonight, my wife needed to unload the very stressful day she had.  I listened.

Tomorrow, my staff will need to know how better to manage our appointment scheduling, and they need for me to do it in a way that doesn't make them feel badly.  Done.

My 2 year-old will want oatmeal tomorrow.  She will run to me when I get home, saying "Daddy home," and "huggy, huggy, huggy," and I will drop my things and squeeze her, and probably tickle her to hear her musical giggles.  My big girls will want to tell me about their day, and will want a book read, a game played, an extra hug ... and another ... and possibly another, after they're really supposed to be in bed.  So I will.

Not that this is laissez-faire parenting, mind you.  I can't get behind THAT idea, but when what really matters matters, I will try.  It seems to be important in the Mind of G-d, or just the world, if that's not your thing.  It seems so simple, but, in the end, "what matters" is an acknowledgement that another person needs something.  If you're in the position to appreciate and satisfy that need, it's not only an expression of unselfishness and humanity, but also an ET finger to human finger moment of connection.  Those moments are like supernova points of light in an age where heads bend over iPhones and eye and ears un-focus on anything but one's own self.

I'm not dissing iPhones, but only saying that the clear view of S.F.W (So Fucking What) had it right.

One thing?

What matters.

Tuesday, June 21, 2011

"A Toddler's Message"

I wanted to share this poem.  It's not mine.  It was written by a friend of mine, Lester Hartman, who's a fabulous pediatrician and great guy (who allowed me to post the poem).  Remembering that there are little people in our lives, at the knee, waist, shoulder, or chin, and crouching to their level (physically and otherwise) is more important than you might think.  Frankly, listening and interacting with anyone, with their circumstances in mind, and with empathy, would make our corner of the world a little less noisy.

A Toddler's Message

I live in a sea of giants
Who ofttimes view me as one of willful defiance.

How would you feel living in a forest of knees?
It's like living among towering trees.
Everything is so high up,
I can't even reach my own cup.

I have such little control over my day.
I'm told when to nap and when to play
So I tantrum over what seems like little stuff,
Sending you into quite a huff.

Please be lovingly consistent,
For to you my behavior may seem defiantly resistant.
I need you to be consistently persistent.

Make the environment safe and simple for me
So you won't always have to say no
And you can let me be.

Give me options when I play with others,
For fighting over the same toy is my druthers.
You see, I still don't have a good concept of how to share -
Age three is when I start to master that affair.

Be patient with me, I understand more than I can say,
Though I may respond in an indecisive way,
Shaking my head no then yes
To a question the answer seems so simple to guess.

Take time to listen to me.
Simple acknowledgement might be the key.

Get down on my level when talking to me,
And learn what it's like living at the level of the knee.

When your toddler has said, "Dada," 9 times to get your attention, maybe say, "What, Honey," even if you've acknowledged her 5 times already.  When he shakes his head no to your question, wait a second...the answer might change.  And crouching down to look in her eyes might erase that look of apprehension that she has when chattering at you from way...down...there...

Saturday, March 26, 2011

Rainbow-striped suitcase with blue pom-poms

Hello, everyone - it's been a while.  Kids, family, house, and a busy pediatric practice keep living life at the top of the pile and blogging at the bottom.  In any case...

A few weeks ago, I saw a boy and his father.  I've been seeing them since the boy was born about 3 years ago.  His parents are from different cultures, and some of the advice I have given them over the boy's 3 years has been concerned with helping them to a parenting middle-ground between their 2 cultures.

However, there has always been something nagging me about the father.  He's a very large man, with his wife being maybe 100 lbs if she were weighed in full winter gear with a pocket full of fishing lures.  I would often close the door after an appointment, wondering why I'd felt like his every point had been recorded on some ethereal tape recorder; why his every question strained with a hidden, threatened retort, should the answer not be what he'd expected.

A few times, the family arrived too late for me to be able to see them.  It's hard enough staying on time with families who have arrived on time, and those who arrive 30 minutes late make the whole schedule unmanageable.  After these times, I became aware of how my staff felt about him:  intimidated and annoyed.  Gradually, I would brace myself for their visits, knowing that the dynamic I have only touched upon would hold the door open for the family, and barge in to be part of the appointment.

Everything changed after a visit earlier this year.  My eyes fill a bit just thinking about it.

I remember the father telling me that he'd been married before his current marriage.  I knew he'd had other kids, but because of the extensive question-and-answer periods (which is the most important part of my job, mind you), I had been unable to fully interview him about this marriage.  Now that I have known them for 3 years or so, and the boy is well, I decided to gently pull aside that curtain.

I can't reveal the exact sadness-es, but I will say that the 4 significant details of that marriage and family, 2 supremely tragic, gave me a glimpse of the footprints across the dune behind this man.  The path he's taken, and how he keeps his family and kids together, is admirable; I could only hope to handle such circumstances so well, with the only side effect being that some people don't understand why I am how I am.

I'd like to say that I'll always be able to deal with the jerkwad who cuts me off and flips me the bird, or the kid down the street who blares his music, or the teacher who ignores the bullying in my patient's classroom, with the equanimity gained from understanding that people have baggage, but I'll have to settle with sometimes realizing, after my reaction, that I might have proceeded with a bit more circumspection.

Sunday, January 2, 2011

Just a little nosebleed

Our third child is a victim of benign neglect.  It shows, I think...

She has suffered injuries the others somehow avoided.  On a tour de force around the dining room table a few months ago, she pulled an apparently tippy chair on top of herself, sustaining an obvious cheek bruise.  A few hours later (my wife had been out, of course, as all bad things happen while Dad's in charge), Beth noticed that Corinne's eyelid was bruised (and thoroughly grilled me to make sure that the lass's vision would not be affected).  A few days later, Beth also discovered that one of Corinne's top teeth also had an obvious chip in it.

The most recent injury - TODAY! - was a bloody nose.  Seeking a redux of her other facial trauma incident, Corinne played stunt double baby while cruising around the dining room table, slipping and hitting her nose and upper lip on the stretcher (the piece of wood between two chair legs) of one of those blasted dining room chairs.  This time, Beth was the parent-in-charge, but I heard the thunk.

"What happened," I called over, seeing the splatted baby on the ground and seeing the crying face but hearing no sound.  Not good.  "She fell," observed Beth.  However, the tone of Beth's voice ramped up to concerned with "Uh, hon - she's bleeding," but I was already hopping over, having seen the dark red blood dripping from her little nose.

I immediately tipped her head forward and pressed her nostrils together, holding them that way for about 5 minutes.  Not an easy job - as it turns out, toddlers really hate that sort of thing.  After 5 minutes, her nose had stopped bleeding, her fat lip had become obvious, and she was finally settling into my lap for a good 10 minutes of  "why did that happen to me," or maybe "why did you squish my nose, Daddy?"

I am filing this incident in the "easier said than done" folder.  I didn't like seeing my child bleed, but applying first aid knowledge to her was even more jarring.  Looking back, I can see myself squashing her nose, with her frantically shaking her head and trying to pull my hand off of her face with her tiny fingers.  I can see myself being very calm, which I've come to see is how I behave when I am confronted with serious illness in the office, but apparently happens when my kids are hurt, too.  It's also grounding to be on the non-advice-giving side of illness and injury.

Poor baby.  Good thing her coordination should improve quickly enough that our inept parenting won't lead to all of her toenails falling out...

But, for the record, stopping nosebleeds is best done by pinching nostrils together.  Many people call after-hours, unable to stop a nosebleed, but tell me they are pinching the nasal bridge/bony part of the nose.  Pinching the nostrils, and even applying simultaneous pressure to the area between the upper lip and the nasal septum, is far more effective.  Remember to do it for at least 5, if not 10 or even 20 minutes!

Wednesday, September 29, 2010

Head Bonks - don't laugh

If you hang out with enough former football players, you've probably heard them talk about having gotten their "bells rung" at least once.  Fortunately, at this point, most people take head injuries more seriously, leading to the current policy on head injuries in the NFL.  Unfortunately, too few people really understand concussions.

The following short list encompasses the answers I get when I ask adults and kids "What do you think a concussion is?"

  • "It's when the brain smacks into the inside of the skull and gets bounced around and bruised."
  • "When you get knocked out."
  • "It's when you get hit in the head."
The first explanation is really what happens in a coup-contrecoup injury, and represents a more serious head injury; most head injuries don't feature this problem, fortunately.  The second and 3rd quotes are partial truths, and are part of the reason people, including doctors, miss concussions.

For definition purposes, a concussion occurs when a person sustains a significant impact, and then, essentially, feels funny.  Bonk/crunch ---> feel funny.  The impact can involve the head, or it can merely be a strong enough jolt to cause a snapping motion of the neck - back, forward, to the side, whatever.  The "feeling funny" refers to what doctors would call a change in mental status, and the following is a partial list of those symptoms:

  • loss of consciousness
  • blurry vision
  • feeling foggy
  • memory loss
  • dizziness
  • being off-balance
  • speech issues
  • discoordination
I have seen a lot of concussions, and here's (yet another) list of how they happened:
  • Kid boarded during a hockey game
  • Gymnast fell off uneven bars and landed on her backside but had her neck "bounce" hard
  • Any number of football collisions
  • Lacrosse cross-checking injury
  • Child shoved hard by another child
  • Kickball to the face
  • Teen in a rush, hit side of head against door frame of car
  • Home plate collision
  • Fastball to the (helmeted) head
  • Car accident with whiplash only.
Why are concussions so bad?  Instead of calling them concussions, let's call them "traumatic brain injuries," since that what these are - brain injuries.  I think most of us would agree that injuring your brain is bad, but how bad is it?  People with concussions and the dreaded post-concussion syndrome can suffer long-term or even permanent damage to vital brain functions like attention, judgement, balance, memory, and emotional control. 

Furthermore, some people have sleep problems, chronic headaches, and fatigue, chronic or not.  Some people even appear to suffer from ADHD/ADD-like or depression.  Google enough, and you'll see that former athletes have committed suicide after suffering from these issues.  Kids especially seem to be vulnerable to something called "second impact syndrome," which can result in either severe neurological damage or death when a person who already had a concussion suffers a similar injury before the original injury resolves.

Deep breath.

What can you do?  Read up on it; here are some good websites:
Most importantly, if your children sustain big bonks and are acting funny, take them out of the game or situation and watch them carefully.  Call your doctor if you're concerned.  Have them checked out as soon as you can, in the ER right then if you're worried.  You don't need a CT scan or MRI, but you do need a good doctor who will listen to you and your concerns.

If you're really motivated, move for your town or school system to institute concussion education programs and make sure that your coaches, from youth sports all the way to high school sports, are aware of what traumatic brain injuries are.  Push for your school to have certified athletic trainers at every game.  Hopefully, with enough awareness, I won't hear the following after I advise parents to pull their kids from sports until they're feeling better...

"Yeah, doc, I hear you...you're trying to cover your butt, and I get that, but I had my bell rung a few times when I played football, and I'm just fine..."

Tuesday, September 21, 2010


I coach my daughter's U6 soccer team.  The kids named us Orange Juice, because we have orange shirts.  We almost called ourselves the Orange Hats, but the funnier Orange Juice voted down Orange Hats by a vote total of 7 to 4. 

To feel my role as coach, imagine herding a bunch of insane leprechauns trying either to get the same pot of gold or to throw pulled-up grass at each other.  That pretty much describes it.  True enough, there are a number of 5 year-olds that grasp the concept of "small touches" on the ball to keep the ball in front of them, and there are even some kids who understand that getting in front of someone slows that person down.  The rest of the kids just run around and behave like 5 year-olds. 

The other day, I saw a parent on the sideline.  I already knew 5 of the families from last season; this parent is not one of the veterans of Orange Juice.  I asked her how her son was enjoying the U6 experience.  She replied that he loved it, but that she was trying to get him to be on the ball more.  I told her that he was doing great, if only because he's having fun.  It also happens to be true that he might be the best soccer player on our team, but that's not really all that important.

There's a part of all of us that wants our kids to do well at everything they do.  We want our kids to try hard; we know that practice makes better, if not perfect.  For kids, though, there are no failed athletic stints or knowledge of past semi-serious efforts that might have borne athletic scholarship fruit "if only."  For many kids, especially younger kids, trying hard means doing well.  Further, the goal is to have fun - why else would one play a sport or do anything, really?  Boring sucks.

If we can remove ourselves from the equation, and just let our kids have fun, the whole experience becomes better.  There is no "parents versus child" dynamic, no struggle for control.  The kids participate at the level they're at, and as long as no one is hitting anyone else with a baseball bat, or flicking snot at anyone else, everything is fine.

Last season, a parent walked up to my wife and told her that her daughter was having a great time with soccer.  During the game, her daughter, a child with some special needs, had run very hard to where the other kids were clustered around the ball, and started jumping up and down.  We coaches yelled, "Great job, Melinda!  Nice run!"  Her mother, apparently, had been about to say, "Melinda, kick the ball!  Don't just stand there!"  However, she realized that her daughter's goal is to run hard and jump up and down.

Should high school athletes have a similar goal?  Clearly, the answer is no.  How about 10 year-olds?  8 year-olds?  I think how you address practice and game habits depends on your children's interests, but always cheer them on.  If they feel bad about what they do, it won't matter if they're PelĂ© or if they like peeling oranges.  They'll quit.