"You've been waking with nightmares for months? Why didn't you tell me?" I bet almost every clinician has had the experience of asking a patient about a key symptom that they endorse as having been present for months. It can be so frustrating because if you had known they'd had neuropathy or hiccups or whatever, you would have been able to identify their problem sooner. It's really hard not to say "Why didn't you tell me sooner?"
The thing is, however, all of us have a whole list of odd symptoms that are happening at any one period in our lives and if we mentioned all of them, even to a sympathetic and interested doctor that you know will not look bored, you will feel like a hypochondriac. It can be hard to separate the important stuff from the not important stuff if you are not a doctor. And, if you are a doctor, imagine trying to construct a question that will get the patient to tell you that for the past eight or ten years, every few months, they get a few days where they intermittently have the sensation of a piece of yarn wrapped around their big toe and the rest of the time, their feet feel normal that will not also yield half an hour's worth of information you are not interested in.
Alternatively, it can be hard even if you know that your doctor would be interested in some symptom, if they don't ask about it, to offer it. No, I don't have diarrhea, coughing, shortness of breath, fatigue or weight loss, but I do have this weird feeling...
It's not clear to me what, if anything, one could do about this situation. Clearly, you can't ask questions about every potential variety of sensations that a patient might interpret the symptom of interest as. A doctor calls it shortness of breath; the patient feels it as "there is something lacking from my breath, but only when I take a deep breath" and will deny shortness of breath (true story). You can not ask every patient whom you want to know if they have shortness of breath, "do you feel something lacking in your breath?" and then you would also have to ask them "do you sometimes feel some pain above your collarbones?" (additional true story) because you never know how a particular symptom will manifest with a particular patient and you would have to ask them a nearly infinite set of questions on just that one symptom, then move on to orthopnea. I think the best you can do is to make it as comfortable as possible for them to bring you whatever they feel they can and to sort through it as best you can. It's those open ended questions again.
That's what I've been thinking about on this snowy day. That and "Sleepwalk with Me" which was pretty funny.
For me, for tomorrow, I will hope for a pleasant, inside storm day and safe travels for myself and also for you.
Friday, February 8, 2013
Thursday, February 7, 2013
Day 236 - everything you wanted to know about warm blankets
I realized this afternoon when I stepped out of the shower and grabbed my hot from the dryer towel that I have not yet written on the vital subject of warm blankets. It turns out that chemo, losing weight, anemia and infections are all things that make people feel cold. I almost always felt chilled even before I got leukemia so you can imagine how I felt during the worst of the treatment. Anyone reading this who lived through last summer in New England will for sure remember how it as a summer with a long stretch of over 100 degree days. During all of those days, Dr. Hill felt it was best for me to stay inside for infectious reasons so I did not partake. There was a night when the air conditioning broke and honestly, it was a little muggy, but I don't recall minding it.
At any rate, there were plenty of times when I was really cold and people would bring me a warm blanket. The first rule of warm blankets is do not ever decline if one is offered to you. They're so nice, you want one even if you think you don't. There was more than once that I would say "no thanks" and then get to thinking about how nice it would be and end up pressing my button to get someone to bring me one.
The second thing to know about warm blankets is how to maximize their potentials, i.e., how to distribute the blankets. We'll go back a step and I will mention that if you are going to spend any time in the hospital, bring a blanket from home. Hospital blankets are heavy and not warm. Also, they slip off the bed easily and get tangled up in most unattractive and revealing ways. They're best used to augment the real blankets. My sister in law bought me a down comforter style blanket that I took every second admission and a friend made me a fabulous quilt that I took on the other admissions. Some admissions I took both. When someone brings you a warm blanket, you want to move quickly because it won't be warm long. Push or pull your top blankets down by your feet and get the warm blanket spread out as close to your body as possible (I used a single sheet between me and the blanket.) Then speedily pull the real blankets up to trap the warmth in. A lot of nurses would hem and haw after they put the warm blanket on about which of the remaining blankets they would pull up and keep and which they would remove from the room. If you do not put more blankets over the warm blanket quickly, you will not have a warm blanket anymore. If you are strong enough, figure it out ahead of time and shove the rejected blankets to the side or throw them on a chair before they even unfold the warm blanket.
This would be a good time to mention that I also recommend bringing your own pillow. I had my pillow in a home pillow case with the hospital case over it because at times there was a lot of sweating too. Then you could switch it out easily, but always have a pillow case if it slipped out of the hospital one.
As long as we are on bed tips in the hospital, the hospital mattresses are covered in plastic so they are really not that comfy even after there are sheets on them. What the LNAs did for me was to put a bathblanket (a lighter blanket with a tighter weave than the usual blankets) over the mattress and under the bottom sheet. This was enough to insulate me from feeling like I was lying on a plastic sheet.
Here is a funny thing about sleeping in the hospital for me (trigger warning for discussion of mortality). For the first few weeks I was in the hospital, I could not bear to have my bed lie flat because it made me think of how during a code, they sometimes tip the head of your bed lower to help get blood to your brain. It scared me. (end trigger warning)
For me, for tomorrow, I will wish for courage to face what I need to. For all of us, I will wish for safe travels.
At any rate, there were plenty of times when I was really cold and people would bring me a warm blanket. The first rule of warm blankets is do not ever decline if one is offered to you. They're so nice, you want one even if you think you don't. There was more than once that I would say "no thanks" and then get to thinking about how nice it would be and end up pressing my button to get someone to bring me one.
The second thing to know about warm blankets is how to maximize their potentials, i.e., how to distribute the blankets. We'll go back a step and I will mention that if you are going to spend any time in the hospital, bring a blanket from home. Hospital blankets are heavy and not warm. Also, they slip off the bed easily and get tangled up in most unattractive and revealing ways. They're best used to augment the real blankets. My sister in law bought me a down comforter style blanket that I took every second admission and a friend made me a fabulous quilt that I took on the other admissions. Some admissions I took both. When someone brings you a warm blanket, you want to move quickly because it won't be warm long. Push or pull your top blankets down by your feet and get the warm blanket spread out as close to your body as possible (I used a single sheet between me and the blanket.) Then speedily pull the real blankets up to trap the warmth in. A lot of nurses would hem and haw after they put the warm blanket on about which of the remaining blankets they would pull up and keep and which they would remove from the room. If you do not put more blankets over the warm blanket quickly, you will not have a warm blanket anymore. If you are strong enough, figure it out ahead of time and shove the rejected blankets to the side or throw them on a chair before they even unfold the warm blanket.
This would be a good time to mention that I also recommend bringing your own pillow. I had my pillow in a home pillow case with the hospital case over it because at times there was a lot of sweating too. Then you could switch it out easily, but always have a pillow case if it slipped out of the hospital one.
As long as we are on bed tips in the hospital, the hospital mattresses are covered in plastic so they are really not that comfy even after there are sheets on them. What the LNAs did for me was to put a bathblanket (a lighter blanket with a tighter weave than the usual blankets) over the mattress and under the bottom sheet. This was enough to insulate me from feeling like I was lying on a plastic sheet.
Here is a funny thing about sleeping in the hospital for me (trigger warning for discussion of mortality). For the first few weeks I was in the hospital, I could not bear to have my bed lie flat because it made me think of how during a code, they sometimes tip the head of your bed lower to help get blood to your brain. It scared me. (end trigger warning)
For me, for tomorrow, I will wish for courage to face what I need to. For all of us, I will wish for safe travels.
Wednesday, February 6, 2013
Day 235 - some milestones
Today had another milestone in it. I had to call a pharmacy to coordinate a patient's meds and for the first time in seven months, I pressed "2 if you are a doctor." I've been calling pharmacies a lot in the past few months--a real lot--and have had to press the patient number. I always hear the doctor number, taunting me, reminding me that I am not doing my profession, but have behaved well and not pressed it when I was calling as a patient. It was very exciting to press the doctor number again.
Another milestone is that I watched a patient of mine get on a gurney and get loaded up in an ambulance today. I have seen patients on gurneys since being back, but the last person I saw get on a gurney was me. He did much better than I did both times as he was able to stand and pivot for transfer. I realized as I watched him get in the ambulance that I was a little sad that both times I'd been in an ambulance, I was too sick to enjoy it. I suppose that would be the definition of a wasteful ambulance ride: if you are well enough to enjoy the scenery and the cool technology in the rig, you are well enough to get in a regular car.
The 1/31/13 NEJM has the article about myths, presumptions and facts about obesity that has been widely quoted. Sadly, it's not a free text article so I didn't link. I really think we know very little about obesity and weight loss, but we like to pretend we do.
Last night, I had a really nice conversation with my friend, Rob, about patients who are DNR having to reverse their DNR status before they have surgery or procedures. Several years ago, I had a patient who had reversed his DNR status for a procedure code during said procedure. I got to thinking about that day and how I had had 15 or so other patients to care for even though having a very nice, highly functional patient die, have attempted CPR and then have to talk with his elderly wife (who fortunately was not at all surprised) was a fairly heavy duty day, emotionally speaking, I had to keep going: admit, discharge, evaluate differential diagnoses, talk with patients and families, adjust meds, call consults, etc. for hours more. As I told Rob about it, I noticed my hands were shaking. There is so much stress to how we have to handle things sometimes--just shove them aside and keep going. I find it really a pleasant change that in hospice, as a more team oriented specialty, there are more people who understand the emotional situation I might be in with the patient in room E507 and who can then offer me some support. I think hospice providers are also trained more in providing emotional support and can offer it to fellow staff more effectively than non-hospice trained folks. I am very happy to be where I am. (Unrelated, but I do really find I miss hospitalist work.)
Today is day #3 of a so far 18 hour week. I am glad I will not be working tomorrow as I'm pretty excited about my bed tonight.
For me, for tomorrow, I hope only for restoration. For you, for tomorrow, restoration if you need it, otherwise, whatever you need instead.
Another milestone is that I watched a patient of mine get on a gurney and get loaded up in an ambulance today. I have seen patients on gurneys since being back, but the last person I saw get on a gurney was me. He did much better than I did both times as he was able to stand and pivot for transfer. I realized as I watched him get in the ambulance that I was a little sad that both times I'd been in an ambulance, I was too sick to enjoy it. I suppose that would be the definition of a wasteful ambulance ride: if you are well enough to enjoy the scenery and the cool technology in the rig, you are well enough to get in a regular car.
The 1/31/13 NEJM has the article about myths, presumptions and facts about obesity that has been widely quoted. Sadly, it's not a free text article so I didn't link. I really think we know very little about obesity and weight loss, but we like to pretend we do.
Last night, I had a really nice conversation with my friend, Rob, about patients who are DNR having to reverse their DNR status before they have surgery or procedures. Several years ago, I had a patient who had reversed his DNR status for a procedure code during said procedure. I got to thinking about that day and how I had had 15 or so other patients to care for even though having a very nice, highly functional patient die, have attempted CPR and then have to talk with his elderly wife (who fortunately was not at all surprised) was a fairly heavy duty day, emotionally speaking, I had to keep going: admit, discharge, evaluate differential diagnoses, talk with patients and families, adjust meds, call consults, etc. for hours more. As I told Rob about it, I noticed my hands were shaking. There is so much stress to how we have to handle things sometimes--just shove them aside and keep going. I find it really a pleasant change that in hospice, as a more team oriented specialty, there are more people who understand the emotional situation I might be in with the patient in room E507 and who can then offer me some support. I think hospice providers are also trained more in providing emotional support and can offer it to fellow staff more effectively than non-hospice trained folks. I am very happy to be where I am. (Unrelated, but I do really find I miss hospitalist work.)
Today is day #3 of a so far 18 hour week. I am glad I will not be working tomorrow as I'm pretty excited about my bed tonight.
For me, for tomorrow, I hope only for restoration. For you, for tomorrow, restoration if you need it, otherwise, whatever you need instead.
Tuesday, February 5, 2013
Day 234 - bring on the normal!
Today had lots of very nice little parts. Work was good; a couple of the patients had happy surprises for me. Then I got to have coffee with Jeanne-Marie who I hadn't seen in ages and who seems to be doing stellarly. To round out my afternoon, Ellie told me the entire plot of the most recent book she's read which involves a girl and her crush time traveling to pre-Civil War times in the U.S. It's funny how sometimes pre-teeners really don't want to talk at all and sometimes they can keep going with breaks only to inhale for twenty minutes.
There isn't a whole lot to report on today, just nice normal normalness so let me point out a couple of nice articles in the 1/24/13 NEJM. There is a nice viewpoint which they summarize as "Awaiting surgery for a malignant pleural effusion, the man is in pain and looks much older than his 50 years. The medical oncologist thinks he's dying. But the surgeon believes the procedure will help, and medical hierarchy discourages questioning of such decisions." I think I have played the part of everyone in this tableau (except the patient, hopefully). Go read it; it's worth the ten or fifteen minutes it takes. One of the things he doesn't talk about that I think is operative in this case is the "herd mentality" where the more people involved in a patient's care, the less likely any particular one is to speak up about things that seem to be going astray. I've had the experience myself where I feel like the patient has five specialists involved in their care and they all evidently think this is OK so why should I, the lowly generalist, make my differing opinion known. There are times I have wished that I had made my lowly opinion known and times it was just as good I hadn't. I try now not to be swayed and to make sure that things make sense to me in any case I'm involved in, but sometimes it's tough. Now that I think about it, I've had that experience most frequently as a hospitalist. I wonder if that is a typical hospitalist feeling or if I'm just special that way. When I've been in the office, I really feel like the internal medicine slogan of "internists: doctors who specialize in you" is true; that I may not be as expert in any medical field as the five specialists this patient is seeing, but chances are I know the patient better than any of their specialists and often I am the only person who understands what all the specialists have to say.
Yesterday, when I ran into some of my old pals, one of them is a specialist who has sent me a few patients all of whom I was very attached to. As we talked about them, I felt a real sense of sadness and real missing of my old primary care practice.
Back to the NEJM. There are a couple of nice articles on smoking, too. This one is on the hazards of smoking and benefits of cessation and has lots of cool statistics for the U.S. like this: "smokers lose at least one decade of life expectancy, as compared with those hwo have never smoked. Cessation before the age of 40 years reduces the risk of death associated with continued smoking by about 90%." Check out figure 2 which shows the survival curves of never smokers versus current smokers. At age 80, it's 70% versus 18%. Whoa, huh? There's also a nice "clinical practice" article about alcohol use. The CPC is a good one and, I am embarrassed to say, one that I should have figured out pretty early on and completely missed. A good reminder to me about that particular disease. (I don't want to say anything more in case you're going to read it; I don't want to spoil it for you.)
Tomorrow is planned to be another really lovely normal normal day. I'm all for it.
I'm going to hope for continued pleasant normalness for me and for you, I will hope that you are having pleasant normalness and that it continues. If not, I will hope that you are able to get to pleasant normalness.
There isn't a whole lot to report on today, just nice normal normalness so let me point out a couple of nice articles in the 1/24/13 NEJM. There is a nice viewpoint which they summarize as "Awaiting surgery for a malignant pleural effusion, the man is in pain and looks much older than his 50 years. The medical oncologist thinks he's dying. But the surgeon believes the procedure will help, and medical hierarchy discourages questioning of such decisions." I think I have played the part of everyone in this tableau (except the patient, hopefully). Go read it; it's worth the ten or fifteen minutes it takes. One of the things he doesn't talk about that I think is operative in this case is the "herd mentality" where the more people involved in a patient's care, the less likely any particular one is to speak up about things that seem to be going astray. I've had the experience myself where I feel like the patient has five specialists involved in their care and they all evidently think this is OK so why should I, the lowly generalist, make my differing opinion known. There are times I have wished that I had made my lowly opinion known and times it was just as good I hadn't. I try now not to be swayed and to make sure that things make sense to me in any case I'm involved in, but sometimes it's tough. Now that I think about it, I've had that experience most frequently as a hospitalist. I wonder if that is a typical hospitalist feeling or if I'm just special that way. When I've been in the office, I really feel like the internal medicine slogan of "internists: doctors who specialize in you" is true; that I may not be as expert in any medical field as the five specialists this patient is seeing, but chances are I know the patient better than any of their specialists and often I am the only person who understands what all the specialists have to say.
Yesterday, when I ran into some of my old pals, one of them is a specialist who has sent me a few patients all of whom I was very attached to. As we talked about them, I felt a real sense of sadness and real missing of my old primary care practice.
Back to the NEJM. There are a couple of nice articles on smoking, too. This one is on the hazards of smoking and benefits of cessation and has lots of cool statistics for the U.S. like this: "smokers lose at least one decade of life expectancy, as compared with those hwo have never smoked. Cessation before the age of 40 years reduces the risk of death associated with continued smoking by about 90%." Check out figure 2 which shows the survival curves of never smokers versus current smokers. At age 80, it's 70% versus 18%. Whoa, huh? There's also a nice "clinical practice" article about alcohol use. The CPC is a good one and, I am embarrassed to say, one that I should have figured out pretty early on and completely missed. A good reminder to me about that particular disease. (I don't want to say anything more in case you're going to read it; I don't want to spoil it for you.)
Tomorrow is planned to be another really lovely normal normal day. I'm all for it.
I'm going to hope for continued pleasant normalness for me and for you, I will hope that you are having pleasant normalness and that it continues. If not, I will hope that you are able to get to pleasant normalness.
Monday, February 4, 2013
Day 233 - a pun a day keeps everyone away
Today at the hospital I ran into a couple of people who knew I'd been sick but didn't know with what. I had been as clear as I could be that it was OK to tell people what was going on, but not everyone got the message or maybe the folks I ran into were trying to be discrete. It's funny to think about what if I had cared very much that no one know my diagnosis. It is hard to think of seeing people and having them say "I noticed you were gone; you look so much healthier; thank God you're OK" and just saying "thanks." It seems a real part of the illness is the being re-integrated at the end part. It seems when people express an honest pleasure in one's being alive and healthy that it is a little cold to not give them a sketch of what happened. On the other hand, I remember how it did get tiresome to say the whole "I have leukemia. Chemo. Three more cycles." etc. routine. This feels very different. Perhaps my tolerance is higher because it's good news and it's kind of fun to say "I'm in remission and am expected to stay there" compared to the other business. Anyway, it's nice to see people and one day, everyone who knew me before I got sick is going to have greeted me and welcomed me back and then there will be a day after that (and another and another) when no one gives me a special "I'm so glad to see you!" I wonder what that day will be like.
Otherwise, today was spent working at the house, the hospital and then I went home and ran errands. Some college student is going to get a package soon and that same college student has a dog at her parent's house who has conjunctivitis. Also, we needed apples. I really like apples and Anica who is doing an integrative medicine fellowship tells me they are supposed to be good for people with leukemia. I am worried, however because if an apple a day keeps the doctor away, will I develop a split personality in an attempt to get away from myself?
This whole week, I have very little that is out of the ordinary on tap. However, there is always something popping up. The novelty of no novelty is something in itself.
For me for tomorrow, I will wish for the wisdom to enjoy plain, normalness. For you, I will wish the same.
Otherwise, today was spent working at the house, the hospital and then I went home and ran errands. Some college student is going to get a package soon and that same college student has a dog at her parent's house who has conjunctivitis. Also, we needed apples. I really like apples and Anica who is doing an integrative medicine fellowship tells me they are supposed to be good for people with leukemia. I am worried, however because if an apple a day keeps the doctor away, will I develop a split personality in an attempt to get away from myself?
This whole week, I have very little that is out of the ordinary on tap. However, there is always something popping up. The novelty of no novelty is something in itself.
For me for tomorrow, I will wish for the wisdom to enjoy plain, normalness. For you, I will wish the same.
Sunday, February 3, 2013
Day 232 - ducks are funny. Ducks and snow are even funnier.
A couple of fun intellectual thing are happening in my life. I recently got to review an Article for Annals and that was fun. I'd never done a review before so I really had no idea of what I was doing. Obviously, I know how to read journal articles and how to evaluate them and to decide if the info in them should change practice or not, but it's very different to think about it for oneself and even to write about it in an informal venue like this compared to writing semi-formally about it for an editor, to try to convince them an article is worth printing or deserves an editorial or not, as the case may be. You also write a summary that goes directly to the authors of the article. That was actually the very hardest part for me to try to figure out what to say that would be constructive, not nit-picky and hardest to imagine--useful. These are people who are so together they can produce a nice little clinical trial, run it for a couple of years, analyze the results and then write them up. I come up with ideas for little research projects all the time and then when I imagine trying to do them, forgedaboudit! it's way too much work! Also, the authors are from a country where I don't know many people from and I have a hard time imagining to whom I might be writing. Anyway, that was my big intellectual activity for the weekend and I really enjoyed it.
My other non-work interesting thing that I am thinking about is PCORI (patient centered outcomes research institute). The idea of patient centered outcomes research is that a lot of research is focused on topics that are of importance to doctors and health care administrators, not to patients. For example, the diligent blog reader will recall that Marian asked what I knew about probiotics in neutropenic patients and I told her that there was zero research on it and that some neutropenic diets even disallowed yogurt so by extension, probiotics would probably also be on the no-list. Some neutropenic diets, however, allow yogurt with active cultures. There is very little actual research on neutropenic diets and you better believe that what you can and cannot eat when you are feeling crappy to begin with is a huge issue for patients. Anyway, the Institute tasked by congress for studying this sort of stuff is looking for people to sit on panels to help them define their priorities. That seems like fun so I'm going to write a 500 word blurb about why they should choose *me* and have been thinking about that, brushing up my CV, etc. So, that kind of sounds interesting, huh?
In the family realm, no real news. Ellie's hair is still red. Emily is still happy at U Mass. Maggie and I went for a three mile walk in PEA where it seemed 2 of every 3 dogs was a big black dog. She still is totally entranced when you wave a tennis ball in front of her. You know one thing that is funny about small towns is that even when you are in the woods with your dog, you run into people you know! For dinner tonight, our friends Rob and Louise invited Terry and I over for home cooked Ethiopian food. Wow! Delicious! Actually, the invitation included Ellie, but she rarely budges out of the house on weekends and especially not for adults she has not met.
I think these photos are funny.
For tomorrow, I will hope for all of us to see something that delights us.
My other non-work interesting thing that I am thinking about is PCORI (patient centered outcomes research institute). The idea of patient centered outcomes research is that a lot of research is focused on topics that are of importance to doctors and health care administrators, not to patients. For example, the diligent blog reader will recall that Marian asked what I knew about probiotics in neutropenic patients and I told her that there was zero research on it and that some neutropenic diets even disallowed yogurt so by extension, probiotics would probably also be on the no-list. Some neutropenic diets, however, allow yogurt with active cultures. There is very little actual research on neutropenic diets and you better believe that what you can and cannot eat when you are feeling crappy to begin with is a huge issue for patients. Anyway, the Institute tasked by congress for studying this sort of stuff is looking for people to sit on panels to help them define their priorities. That seems like fun so I'm going to write a 500 word blurb about why they should choose *me* and have been thinking about that, brushing up my CV, etc. So, that kind of sounds interesting, huh?
In the family realm, no real news. Ellie's hair is still red. Emily is still happy at U Mass. Maggie and I went for a three mile walk in PEA where it seemed 2 of every 3 dogs was a big black dog. She still is totally entranced when you wave a tennis ball in front of her. You know one thing that is funny about small towns is that even when you are in the woods with your dog, you run into people you know! For dinner tonight, our friends Rob and Louise invited Terry and I over for home cooked Ethiopian food. Wow! Delicious! Actually, the invitation included Ellie, but she rarely budges out of the house on weekends and especially not for adults she has not met.
 |
| These are duck footprints in the snow on the frozen river. The skids are where the ducks landed! |
 |
| The little teeny black dots in the distance on the river is a flock of ducks waddling along, clearly with a mission in their collective mind. |
For tomorrow, I will hope for all of us to see something that delights us.
Saturday, February 2, 2013
Day 230 and 231 - kid's stuff
Guess who went to the beach today?
I haven't been getting enough exercise lately because I've had so many little extra things going on: palliative care dinner, Ellie's school, Ellie's field trip, Ellie's hair shop appointments, my haircut etc. Wait, Ellie's hair shop appointments? Yes, Ellie now is a redhead:
First she got a bright pink streak in the underside which she enjoyed, but it was too subtle so she went back a week later and now no one can accuse her of being subtle. She normally wears it off her face and looks very pretty. She had it done Thursday after school so yesterday was the first day her pals saw it. The reviews were positive from her peers too.
I went in Friday morning to help teach "literary circles" to Ellie's class. The kids are divided up into groups of six and had read about a third of a pre-determined book. Everyone has a job: newspaper reporter, artists eye, interviewer, etc. and they presented to me and each other. My job was to keep the conversation on track and to let them know if things weren't making sense to me. The newspaper reporter went first and gave an account of the plot as though it was a newspaper article. The interviewer went next and asked everyone questions like "On page 94, some one is sent to the principal's office for calling the math teacher a weirdo. What do you think would happen if you called Mrs. Loh a weirdo?" or "What would you have done in Harris' situation on page 104?" The kids had lots of interesting things to say. One group read a book that was about a city person going to live on a farm for the summer. As we discussed the book, it became clear that we had a child who lived on a farm and the rest of the group lived in town. The kid from the farming family had different ideas than the rest of us about some of the stuff in the book. We all thought the part where he made a diorama and dressed the figurines in mouse pelts was disgusting, but the girl whose family had a farm didn't really think it was. I tried to relate the themes in the book to how the real life situation of us in this group right now, but it didn't fly. The good news is that Ellie tells me her friends who had me thought that I was "nice" and did a good job. Phew! I'm glad to hear I didn't embarrass her.
Then I went home and napped to prepare for the evening. At 4:15, Ellie and I and 98 or so other people climbed on a bus and went to Boston to see "Sister Act" and have dinner at the Hard Rock Cafe. There were about 70 kids and about 30 adults in two buses. The ride was unbelievably loud and from time to time, the kids would break out into song. It turns out that Hard Rock Cafe is also unbelievably loud and from time to time, the kids would break out into song, but not as much. I was surprised that when Justin Beiber (who is reviled in my family) came on, a lot of kids sang along--maybe half boys. Hunh. They had a very limited menu that we could choose from (it was a whole packaged field trip deal), but perfectly adequate for a field trip meal and they served us so fast, it was amazing. We were out in time, back on the buses and driving through congested theater district Boston. I felt badly for the cars around us because when the light changed, for the whole cycle all that happened was that our bus and the other bus went through. Block after block. Then we got there, went in, got into seats which were in the second balcony and waited for the show. I had gotten separated from Ellie and her pals so ended up sitting isolated with some people I didn't know at all. There was a lot of complaining from people who felt like they were going to pitch forward and fall all the way down, but of course, nothing like was going to happen. The show was OK. There seems to be a fashion now in singing to hold long notes out just a speck flat and then slide into the actual pitch right at the end of the five seconds you are holding it out. The female and male leads as well as the "bad guy" all did this and it got tiresome. The kids liked it although none of them really seemed to love it which surprised me. None of the songs were reconstructed in the bus on the way home either.
I don't know where our buses parked during the show, but it must have been very far away because the theater closed and the literally had us leave. There we were, all 100 of us waiting on the sidewalk for the buses, some of the kids without coats because when you are 13 or 14, if you don't want to wear a coat, you don't even if it is 25 degrees out. After we'd been standing around for about twenty minutes, a homeless man came up and told us he had just been diagnosed with HIV and had a bed at a drug rehab in Springfield, but didn't have bus money to get there. Could we give him money for the bus? It felt horrible because by ignoring him, one is not teaching the kids anything about compassion or generosity, but by engaging him, one is not teaching the kids anything about keeping oneself safe. On the other hand, just giving him money is not a good solution either especially if you imagine having provided him with the twenty bucks that he bought his fatal dose of heroin with. So, the whole problem of homelessness writ small and bitesized for us relatively rich and sheltered suburban folks and my response was found wanting, as was all of ours.
Eventually the buses came and I was so tired I fell asleep on the way home even though they were unbelievably loud and the kids would break into song from time to time.
Today except for the beach was beautifully dull. For tomorrow, I will hope for myself similar beautiful dullness. For you, I will hope for the level of interest you would like.
I haven't been getting enough exercise lately because I've had so many little extra things going on: palliative care dinner, Ellie's school, Ellie's field trip, Ellie's hair shop appointments, my haircut etc. Wait, Ellie's hair shop appointments? Yes, Ellie now is a redhead:
I went in Friday morning to help teach "literary circles" to Ellie's class. The kids are divided up into groups of six and had read about a third of a pre-determined book. Everyone has a job: newspaper reporter, artists eye, interviewer, etc. and they presented to me and each other. My job was to keep the conversation on track and to let them know if things weren't making sense to me. The newspaper reporter went first and gave an account of the plot as though it was a newspaper article. The interviewer went next and asked everyone questions like "On page 94, some one is sent to the principal's office for calling the math teacher a weirdo. What do you think would happen if you called Mrs. Loh a weirdo?" or "What would you have done in Harris' situation on page 104?" The kids had lots of interesting things to say. One group read a book that was about a city person going to live on a farm for the summer. As we discussed the book, it became clear that we had a child who lived on a farm and the rest of the group lived in town. The kid from the farming family had different ideas than the rest of us about some of the stuff in the book. We all thought the part where he made a diorama and dressed the figurines in mouse pelts was disgusting, but the girl whose family had a farm didn't really think it was. I tried to relate the themes in the book to how the real life situation of us in this group right now, but it didn't fly. The good news is that Ellie tells me her friends who had me thought that I was "nice" and did a good job. Phew! I'm glad to hear I didn't embarrass her.
Then I went home and napped to prepare for the evening. At 4:15, Ellie and I and 98 or so other people climbed on a bus and went to Boston to see "Sister Act" and have dinner at the Hard Rock Cafe. There were about 70 kids and about 30 adults in two buses. The ride was unbelievably loud and from time to time, the kids would break out into song. It turns out that Hard Rock Cafe is also unbelievably loud and from time to time, the kids would break out into song, but not as much. I was surprised that when Justin Beiber (who is reviled in my family) came on, a lot of kids sang along--maybe half boys. Hunh. They had a very limited menu that we could choose from (it was a whole packaged field trip deal), but perfectly adequate for a field trip meal and they served us so fast, it was amazing. We were out in time, back on the buses and driving through congested theater district Boston. I felt badly for the cars around us because when the light changed, for the whole cycle all that happened was that our bus and the other bus went through. Block after block. Then we got there, went in, got into seats which were in the second balcony and waited for the show. I had gotten separated from Ellie and her pals so ended up sitting isolated with some people I didn't know at all. There was a lot of complaining from people who felt like they were going to pitch forward and fall all the way down, but of course, nothing like was going to happen. The show was OK. There seems to be a fashion now in singing to hold long notes out just a speck flat and then slide into the actual pitch right at the end of the five seconds you are holding it out. The female and male leads as well as the "bad guy" all did this and it got tiresome. The kids liked it although none of them really seemed to love it which surprised me. None of the songs were reconstructed in the bus on the way home either.
I don't know where our buses parked during the show, but it must have been very far away because the theater closed and the literally had us leave. There we were, all 100 of us waiting on the sidewalk for the buses, some of the kids without coats because when you are 13 or 14, if you don't want to wear a coat, you don't even if it is 25 degrees out. After we'd been standing around for about twenty minutes, a homeless man came up and told us he had just been diagnosed with HIV and had a bed at a drug rehab in Springfield, but didn't have bus money to get there. Could we give him money for the bus? It felt horrible because by ignoring him, one is not teaching the kids anything about compassion or generosity, but by engaging him, one is not teaching the kids anything about keeping oneself safe. On the other hand, just giving him money is not a good solution either especially if you imagine having provided him with the twenty bucks that he bought his fatal dose of heroin with. So, the whole problem of homelessness writ small and bitesized for us relatively rich and sheltered suburban folks and my response was found wanting, as was all of ours.
Eventually the buses came and I was so tired I fell asleep on the way home even though they were unbelievably loud and the kids would break into song from time to time.
Today except for the beach was beautifully dull. For tomorrow, I will hope for myself similar beautiful dullness. For you, I will hope for the level of interest you would like.
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