just some pictures

My friend and neighbor, Ronja, has the good fortune to be raised in a bilingual home. (mostly good fortune anyway, being reprimanded in German is a little scary for anybody) Ronja frequently stops by to give us an update on the goings on around the farm. She is a skilled and enthusiastic conversationalist and if inquisitiveness was a sport, she would be sponsored by Nike. She has taught me an important but subtle point about grammar. (For the record, I don't put much stock in grammar, it's just another example of majority rule) She often uses "them" where I would use "they". For example, she might say "I saw the dogs in the yard, them are digging holes." Initially I found this endearingly wrong, but I've realized that I am the one in error. "Them" is a much more specific and intimate pronoun than "they". When she says "them" she means "them, you know, the dogs" whereas "they" is a much more aloof and distant sort of thing. Or as Tiffany says, "they" adds 50 feet to whoever you're talking about.
Stella is in some kind of rapid mutation phase of toddlerhood. Her potbelly has slowly whittled away, apparently used as a fuel for her volatile opposition to all parenting. We can be happily osmonding along as a family when one of us makes the fatal mistake of suggesting that Stella do something (even if she is already doing it with apparent enjoyment) and then we are locked into a deadly contest of wills. The other day I offered her a spoon and it was like I had accidentally stepped into a cagematch with a rabid badger. She has also decided that 530 is a damn fine time to get up in the morning. I told Tiffany last night that if they made home vasectomy kits, I would have used five of them this week.
I love toddlers but them are ridiculous little tyrants sometimes. Maybe Stella's middle name should have been Bonaparte instead of Firefly.

(Dr Short, Dr Sewalls, and Dr Pope making rounds)

late night tangential beer rant
My friend Troy has the habit of accidentally changing my life with random pieces of conversation. He was a year ahead of me in residency and while I was an intern working through the endless ankle sprains and noses full of Legos, I watched the second year residents with a mixture of awe and envy as they sorted through a constant stream of disease and recklessness gone awry. On an afternoon particularly ripe with chaos and it's aftermath of chart-work, I watched Troy idly eating french fries and looking around. when I asked him the secret of his fast fed zen state he answered, "There's always time to eat and there's always time to dictate." This may sound inconsequential but it has helped me in the ER over and over again. When the world is falling down you can only put the pieces back up one at a time and you sure can't do it well when you're hungry. (Troy is also the person that said "Why don't you go to Belize?", but that's a whole different story.)
It seems like when I talk to other doctors, we inevitably talk about what we would do if we weren't doctors. I always wonder if pastors do the same thing. A couple of years ago, though, Troy put the question to rest for me when he said "I'll never know as much about anything as I know about medicine, how would I not be a doctor in some way?" Maybe that's the whole point of the current soul-crushing approach to medical education; it melds your own identity with that of the profession so thoroughly that there's no separating it back out later on.
These last couple of months, watching my wife be a "cancer patient", has filled my brain-bucket to the brim with thoughts about what it is to be a doctor in this country. Western medicine is so proudly focused on a cause-and-effect model of healthcare. "Well sir, you have pneumonia because this bacteria grew in your lungs and this here chemical happens to make bacteria do the hokey-pokey til they waste away and die, so take it for a week and give me 500$." This narrow view and the solutions it creates can certainly be a miracle; Tiff wouldn't be alive without the wizardry of anesthesiology and modern surgery. That being said, I've also seen lives saved by compassion, hope, and placebos.
As doctors, we have actively participated in creating the abysmal state of health in this country. By allowing the profession to be turned into an industry, we have given up the right to use our intuition and compassion as we see fit in favor of guidelines and "standards of care". By allowing ourselves to only be paid for the treatment of disease we have crippled our ability to promote good health. By allowing insurance and pharmaceutical companies to insert themselves between ourselves and the patients we treat, we have severed the most important relationship in medicine.
In lieu of a real solution, I think it's time to listen to the advice of another of my ER mentors, the good doctor Sewalls, "Work's over, time to go home and give it to the wifey." (To be fair, this advice was accompanied by a dance that looks like riding a mechanical bull without using your hands)