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!