Friday, September 21, 2007

Today is a La Jolla Day

I worked until 2 am this morning. My first shift in the Children’s Emergency Department. It went as well as could be expected I supposed. The first day of any rotation is all about figuring where everything is and it works and who to call and who to talk to. At least it is for me. I guess there are people who focus on the medicine through it all. I tend to ask questions more about how to get things done the first day. I find I can think more fully when I have an understanding of the workings of my surroundings. Tried a lumbar puncture on my own, but got a bloody tap and it clotted before it could clear enough to collect the CSF. A couple orthopedic patients; one with a ketamine closed reduction. Pop. Ouch. “I want my parents!” Silver lining is that thanks to the meds he won’t remember it.

I will be working weird hours and mostly night shifts for the next two weeks. Should be okay. I’ll have to figure out when to dose my prednisone in order to get the most out of my waking time.

So, I got home around 2:30 am to a dark apartment complex. S. had sent me a text message earlier, but no one was awake. I’d said goodbye to J. after I’d made us turkey burgers before I got ready for work; he’s off on another four day stint at work and school so his parking place was available in front.

He and I had had an eventful day together. We’d taken K. and L. to the Padres game. The first major league game for each of them. The were in awe of the whole experience. L. was enraptured with the Mac trucks on the way there. K. loved that he could throw peanut shells on the ground and it was okay. “Only at baseball games” I said. I learned that you have to be concrete with limit setting when they’re three years old. You can’t say “don’t be messy,” but instead have to give specific goals and limits, “don’t throw things on the ground.”

They both loved the snacks that J.’s sister (L.’s mom), T., and I had brought. K. liked the peanut butter in between L.’s crackers. He loved rummaging in his new friend’s backpack for novel treasures. I had him ask L. if he could rummage first, “You have to ask L. if you can share his snacks.” “L., can I have this food.” “Yes.” “Say ‘thank you.’” “Thank you.” “L., say you’re welcome.” “You’re welcome.” Modeling behavior. Teaching our cultural niceties. I can see it happening over just an afternoon.

I’ve been afraid to have children, as much as I’ve wanted them. When I took care of the newborns in the nursery, one of the new moms confessed that she was a little afraid to take her new love home. “I would be, too,” I shared her emotion. “Really?” she was surprised because I am a pediatrician and should know all the development and rules and knowledge it takes to raise a child perfectly. For one thing, no one is perfect. You just do your best and love them. I do know a lot about normal development and what to look for as problems. But there’s more to that when you take them home.

J. had to take L. to the bathroom a couple times. He came back looking a little frazzled, “That was a first,” he smiled rather tiredly, “Everything was too tall for him. I didn’t know what to do He was dancing around and waited until a stall opened up and then I just held him over it.” That works. Thank goodness they’re both potty trained.

I’d gone to journal club the night before. The speaker was Mark Katz, PhD and the topic was resiliency. Someone is following a group of people who underwent four major emotional hits and monitoring who recovers from these perceived tragedies. One third of them recover by the time they’re 18. Another third, surprisingly, recover by the time they’re 32. This is surprising because they did not do well through most of school. They did not fit into that context, but when the context was changed, they were able to adapt and overcome their past hurts. They’d found different successes to master themselves.

People respond differently to trials inherently. The first third were of easy temperament. They drew people in when they needed help and together they overcame the hurt. People develop a sense of self that is not necessarily set, but is powerful, by the age of 8-10 years. They base their sense of their abilities largely on outside interpretations of their successes or their failures. If a child does not do well in school, that is often culturally interpreted as being stupid and therefore communicated to the child that way, who then perceives himself as stupid and often stops trying to be anything else. The opposite is true also, for children who do well in school. For the first group, they find successes and are able to redefine themselves outside of school when they are successful in another area of life. They grow a belated sense of Mastery. “I CAN do this.” And they keep trying until they do.

That is the difference also between malleable learners and fixed learners. The malleable learners know that if they fail, they can try again and have another chance at success. The fixed learners fail and equate that to defining themselves as unable to succeed and give up. Malleable learners make it further. The beautiful part is that in eight sessions, the fixed learners can overcome their perceptions of themselves as fixed in their knowledge and abilities.

The truth is that no one is every always successful, or always failing. It is all in personal perceptions of what we can and cannot do and how that guides our behavior and choices.

It is fascinating to see in developing in young minds as they play at the baseball game. By the third time K. asked L. to share his food, we no longer had to remind them to ask or say please and thank you. They’d learned.

I think about a behavior and development rotation for the internal medicine half of my training. It is clear that we don’t become developmentally static when we become “grown up.” I’m not static. My parent’s aren’t static. My grandparents aren’t static. Piaget has his basic stages of developmental stages through the lifespan. I’m in isolation vs. intimacy stage.

I was driving around looking for a nail and waxing place that S. had found for me in November when I was on my VA rotation. I drove around about a 10 block radius for almost an hour. I should have parked and just walked, but I kept thinking it was right around the corner. Eventually I just drove to the cove and parked. I’d started out my search in a great mood and felt myself getting frustrated so decided to change tacks and watch the waves play with the people for a while.

I remembered that I’d called the place for directions in November and that my phone keeps track of every phone call I’ve ever made on it, so I looked back and found it and called for directions. It had been right around the corner the whole time.

Somewhere along the line, I have learned a sense of mastery, instead of helplessness. If I keep trying, I will succeed, eventually. Thank goodness, given everything that has happened in my life in the past couple years.

“What is to give light must endure burning.” –Victor Frankl

“There’s never anything so wrong with you that what’s right with you can’t fix.” Mark Katz

Adults continue to develop, I know it. You never “arrive.”

I am developing into someone who wants to be a parent. And, as I said, I feel ready now, at last. I’m not scared anymore. I will just do my best and it will be good enough. I think back to my day with K., J. and L. with a smile in my heart—and gliding out onto my lips. It will be challenging to do it full time, but it will be.

Things happen as they do—and that becomes as they should through our reactions and our perceptions of them.

Mom scoffed at me going to get my eyebrows waxed today, “That’s ridiculous,” She said. I’m getting better at making my mind accepting of external ideas only if they match what I want or have a positive impact. Her opinion doesn’t really affect how I think of myself unless I let it—unless I agree to her set of rules for herself. In the “Four Agreements” he talks about making your mind a fertile ground only for the thoughts that you have developed for yourself.

Katz talked about three perceptions of a negative even that can nearly guarantee an negative pathologic response:
1) the belief that the negative event is permenant, without any light at the end of the tunnel
2) the belief that it is pervasive, that is if this bad thing happened in one area of life, everything else must also be bad.
3) And taking the event personally

I’m sitting at La Jolla Cove writing this. The waves are splashing energetically over the smooth brown rocks on the shore. A dad and his son are standing teasing them to come closer, then running away with splashes of white foam spraying behind them. Tour buses have dropped off tourists to enjoy the place and the day. They’ve spread out along the beach.

I wore my fancy black sun hat today and had three or four people comment on it just on my trip into Vons, “How are you today young lady?!” a stocker asks exuberantly. I smile warmly, answer in the affirmative and return the sentiment. “I like that hat!” He responds and I move closer to the check out with my apples, carmel and hot chocolate.

J. has been teasing me for what feels like months but in reality is probably a couple weeks that I am a “redhead.” I’ve always though of myself as blond. “Strawberry blond, then,” he’ll correct and grin.

Today, after I parked my car in the parking structure next to the La Jolla gym, a black man polishing a fancy car in the handicapped spot looked up and inquired, “Are you the Volvo lady?” I’m quite enamored with my sporty Corolla so I said I wasn’t the Volvo lady. “Oh, well you have a twin then, except she is blond and you’re a strawberry blond.” I was stunned. Now a perfect stranger in a shady garage seeing me in my fancy black sunhat said I was a strawberry blond. That struck me as exceptionally entertaining and funny. “Really? You think I have strawberry blond hair,” and I took my hat off and pulled my pony tail down. “Yeah! Don’t you even know what color hair you have?” he teased too. The elevator arrived to take me to street level and I told him to have a nice day.

I can’t wait to tell J. My hair will be whatever color I perceive it to be apparently, just like my thoughts and my agreements with my world and myself.

Yesterday, on our way to drop K back off with T, I thought about how busy we’d both been with our charges chasing them all around the park as they ran to the grass and the playground and generally enjoyed life with us in emotional tow. Then we carried them blocks back to the car where he’d been frustrated to park so far away after dropping me and the two boys off. My back is sore from carrying K, but he gets tired sometimes because of his heart, plus for some of it the neighborhood wasn’t the greatest.

I thought about the amount of energy we’d put into the children that day. We’d poured really all of our joint energy into the children, short of a few moments of peace we got to talk. “I think this is what happened to my parents,” I told him in his car on our way to drop off L with his mom. “What?” he asked. “They poured everything in to me and my brothers for years and neglected each other. When we were gone they didn’t have anything left together.” “How many years are between you and your youngest brother?” “Seven.” “So that’s 25 years of raising children together.” “Yes.” “We’ll have to remember that, I guess,” I don’t mean necessarily with him, but with my someone. “I think date night is important. Something so you don’t lose touch with your partner.” “Yeah.” Then L pointed to another Red Mac.


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