The kool-aid? Oh we drank it.

Last week, four of the eight houses on our street had a Prius out front. Today that number is five.

I suspect it is the subliminally mind-alternating influence of the surrounding wireless networks named -and this is for reals now- "Peter Rabbit's Garden", "Peace", "Peace-Guest", "The Tomato Network", and "Avalon" that is responsible for our local Toyota dealership being the top Prius distributor in northern California. It only took six months before we decided to sell my cherished 1996 Honda Civic and join the legions of Davis yuppies in search of eco-chic.

It's GOOP - ugh.

I was rewarded to this special piece of drivel while checking my email this morning.

This week we showcase some beautifully made, very original lines of children's clothing that we have recently discovered and are adoring. Mostly started by mothers, these companies are producing very unique, very cool, and not yet ubiquitous things for the little ones in your life.

Love,
gp

Oh Gwenie, you and I are like two little peas in a vicuna-lined pod.  I was especially excited by Apple's favorite summer lounge wear, a cotton bloused shirt with matching candy cane knickers that retails for the bargain price of $82.  My own laborious quest for tyke haute couture led me into the fetid bowels of babygap's clearance rack and my local second-hand shop with little success, yet you, in producing this superlative newsletter, soared above the constraints of cost and reason and in doing so identified only the most revelant toddler trends. Brava! 


Air kisses, 
me

Never say never

You know what is fun? Being judgemental of how other people parent. It is especially fun if you have no children of your own. So, in partial recompense for any snide remarks I might have made about juice boxes and infant formula, I thought I would compose a list of a few things I thought I would never do.

1. Send my child to daycare with food on her shirt.
Turns out, there is an acceptable amount of oatmeal that one can have on one's shirt and still attend school. The amount is not stagnant, and is directly proportional to the tardiness of the mother.

2. Give my child a hippie-ish name.
Even though they don't mention it, aside from the loud "What?" when they were first introduced to their granddaughter, I think my parents are aghast that their straight-laced daughter named her child after a flower.

3. Hand her an iPad while on car trips and flights.
Yes, I know I might be forgoing meaningful interactions with my child, but it sure is nice to be able to catch up with my husband.

4. Feed her "cake pops" (which have the frosting actually blended into the cake batter) at a party so that I can hold adult conversations over her head.

"MAMA CAKE  CAKE MAMA CAKE CAKE MAMA CAKE!!!!"

(---silence---) 

5. Snuggle with her until she falls asleep.
When I was pregnant someone told me that I should never put my child to bed fully asleep. That I should put her down right after a feeding, still awake but somnolent. That way she would become accustomed to falling asleep on her own. And it sure did sound like a good idea at the time, that time being before she was born.  Now part of our bedtime ritual is for me to curl up next to her, often falling asleep myself. Sometimes it's the best part of my day.

6. Not breastfeeding for twelve months
I used to wonder if I could have been a Nobel laureate if only my mother had breastfeed me for more than four months. I would, of course, breastfeed my child for twelve months, in hopes of reducing the risk of infections, asthma, obesity, stupidity, and general delinquency. After six months of pumping in bathrooms and call rooms, including several instances of almost being walked in on by my colleagues, I decided to call it quits.

There are more, but that is all I can come up with for now. I would love to hear your "Never say never" surprises.

The Language Tyrant

Munch is at a stage where language mimicry can come before understanding, which lead me to teach her this trick, more for my amusement than anything else-

Munch: UP! UP! UP! (motioning to be picked up)
Me: What do you say?
Munch: MUNCH TYRANT! (which sounds more like TEE-RENT)
And I pick up her up.

She is, of course, also absorbing words unintentionally. Lincoln and I were reminded again of this blistering language acquisition when she repeated a four letter expletive that Lincoln had just muttered under his breath. And to make sure we hadn't missed it, she said it again, another three times. I sharply inhaled and held my breath, as if a mild hypoxia could stifle the wave of giggles about to overcome me. The only thing worse than hearing my daughter swear would be to reinforce this behavior by reacting to it. She has, for instance, taken to yelling "worm poop", guaranteed to elicit laughter, when she wants to divert attention away from negative subject matter such as spilled milk or bedtime.

She did not, thankfully, file that particular obscenity into her rapidly expanding lexicon or we would have much to answer for at daycare.

In celebration of Worm Poop silliness (and our narrow escape) we made a Play-Doh worm family - pink for Valentine's Day.

Vacation by the numbers

TEN: percentage time Munch spent wearing more than a diaper
NINE:  average bedtime hour
EIGHT:  hours a day spent swimming, snorkeling, surfing, hot-tubbing, hiking, and reading on the beach
SEVEN:  days in paradise
SIX:  trips to farmers market and grocery store for local pineapple, papaya, cherimoya, maui onions, yams, macadamia nuts, Kona coffee, guacamole, and local fish. And OMG passion fruit butter...
FIVE:  feet- preferred sand castle height
FOUR: containers of SPF 100 consumed
THREE: sunrises on the beach
TWO: total restaurant visits
ONE: Egyptian uprising
ZERO: Sunburns!

Maybe I could work for Fox News?

In some ways, I am very much like Fox new correspondent, minus the blond hair and big boobs. When it comes to parenting, I like to come up with a theory, preferably something that makes my life more convenient, then go find the evidence that supports my way of thinking. This is far less cumbersome than having to evaluate all available evidence. When I come across evidence that does not support my theory, I am free to disregard it as leftist propaganda.

Fox Convenient Theory: Unemployed? Well, it might be because Obama hates white people.
Supporting Evidence: Ah yes, of course.

My Convenient Theory: Dirt is good for Munch.
Supporting Evidence: Didn't I hear something about childhood exposure to germs preventing the development of Hodgkin's Lymphoma?

Thanks right, I did! And now I don't feel as bad about the fact Munch has been running around naked in the sand and eating unwashed fruit from the vendors lining the beach.

The evidence for my theory goes a little something like this- The link between higher socio-economic status (SES) and increased risk for early Hodgkin's Lymphoma (which occurs in bimodal distribution that affects the young [people in their 20s] and old [people in their 60s]) has been known for years, but the exact mechanism remains unknown.

One theory is early exposure to germs, as occurs when children have more siblings, share rooms, or attend daycare, primes one arm of the immune system over another arm. We have two types of helper T-cells (the cells responsible for altering our immune system to invading pathogens), conveniently known as "type 1" and "type 2". At birth we have more type 2 helper T-cells and with repeated exposure to germs we develop more type 1 helper T-cells.  It is speculated that a primed type 1 helper T-cell system, as occurs with repeated childhood infections, is protective against later development of Hodgkin's Lymphoma.

The link between germs, specifically viruses, and development of Hodgkin's Lymphoma was first suggested by the finding that Epstein-Barr Virus (EBV) could be isolated from 25-50% of the Reed-Sternberg cells that are characteristic, and diagnostic, of Hodgkin's Lymphoma.

At this point you might ask "well, if the virus is found in the cancerous cells, doesn't that suggest EBV causes Hodgkin's Lymphoma?"

Yes and no. It is estimated that 90% of the population has been infected by the ubiquitous EBV at some point during their lives, and that early childhood EBV infection is short and clinically mild whereas late EBV infection is more serious (think the "mono" of adolescence which lingers for months). EBV exposure in childhood primes the type 1 pathway and protects against the more protracted and serious EBV infections of adolescence. It is the late EBV infections that is associated with higher risk of Hodgkin's Lymphoma.

Viola! Now I can go back to pretending not to know that naked child who is drinking ocean water.

Monk Seal on the Ka'anapali shore

The Molokini snorkel trip that wasn't

Lincoln and I had a brief spat while standing in line to check in for our Molokini snorkel tour. He spotted 2 mm wet suit tops for sale and suddenly insisted that I get one. Absolutely not. I already had a long sleeved rash guard, and for crying out loud, it was going to be 80 degrees today. I did not need an overpriced wet suit top. It might also be mentioned that Lincoln is a bit of a gear head and I was not looking to expand our collection of snorkeling, scuba, boogie boarding, skiing, snowboarding, camping, rock climbing, and biking gear that clog all available storage space in our home.

However, in the interest of honestly, I have to admit that I will complain bitterly when I find myself cold. A related failing is that I am unable to predict when it is I will be cold. To me, it is as if I am sitting on a Caribbean beach, only to have the sky open into a hail storm and the water freeze in front of me. I can't be expected to anticipate such a drastic change in my ambient temperature, and am frequently left cruelly to face the elements unprepared. Lincoln disagrees with my general absolution in these cases, and rather accuses me of a chronic under-preparedness that he likens to "dealing with a small child".  And in his defense, I own both short and long sleeved rash guards, and a shortie wet suit, as well as gloves, hats, long johns, and scarfs, most of which were purchased under duress from well-situated and overpriced surf and ski shops.

I lost the argument and we boarded the ship with two (he wanted one for himself as well) 2 mm wet suit tops, now financially unable to send our daughter to college.

And with great humility, I realized he was right as soon as the boat picked up speed in open water. My only defense is that everyone else on the boat also lacked Lincoln's foresight and were soon huddled low in their seats, hotel towel wrapped around their skimpy bathing suits.

The trip was wonderful, except that we didn't get to snorkel along Molokini due to strong winds that made swimming along the volcanic reef treacherous.  The boat was diverted to out to Lanai, the island to the immediate southwest of Maui.  The fish, sea turtles, and coral were beautiful, but I was bummed at missing out on the famed Molokini crater. The ninety minute ride back to the harbor attenuated this disappointment as we were treated to such frequent humpback whale activity that we canceled plans for a whale watching trip later this week. 

My lovely parents babysat Munch while we were gone. It's interesting how being married myself has changed my perception of the relationship I have observed my whole life.

My parents haves been together for thirty-six years and by all accounts their marriage is a successful and happy one. So it is with humor, not concern, that I have found myself cataloging the sometimes shockingly poor manner of their communication.

Take, for instance, this gem I overheard while we were snorkeling in the water just off the hotel beach.

Mom- TELL ME IF YOU SEE ANYTHING !!!!

Dad- (wildly gesticulating to the water just under him) GAIL! OVER HERE! THEY ARE OVER HERE!!!!

Mom- WHO'S THEY??!!!

I laughed, and in doing so inhaled the water that had pooled in the bottom of my snorkel tube. This precipitated a fit of coughing that required me to get out of the water so that I could sputter on solid ground.

I think it was karmic retribution. And at least they hadn’t made a dozen strangers uncomfortable by squabbling about cold intolerance and spend thrift ways at seven in the morning.

Dad paddling out on the stand-up board

Sunset over Ka'anapali

Sunrise in the Ioa Valley

Ka'anapali

Our flight from Sacramento to the Kahului airport left yesterday morning. Because we are too cheap attached to Munch to buy an additional fare, I developed a sympathy for the poor soul who would be blocking our access to the airplane lavatory for five long hours. 

So it was with great relief that our aisle mate identified herself as a grandmother who desperately missed her two-year old granddaughter. Not one to pass up an opportunity, Munch unleashed a flood of smiles and charming babbles, and gradually helped herself to the grapes, apple slices, cheese, and crackers that the woman had brought aboard the flight. I would be remiss to imply that Munch stole her food the entire time, as our neighbor did have a forty-five minute window during which she was allowed to eat in peace. 

Munch is unaware of time zones, and woke all four of us (parents included) at 4:30 this morning with a declarative "Wake up! Wake up!". 

 Aloha from Ka'anapali, shortly after sunrise

.

We left the hotel room respectfully dressed for a day of swimming and snorkeling. 

Munch regarded her rash guard and swim bottoms as superfluous affectation. She whined and pulled at them until I acquiesced and let her run around naked. Please take notice of the tum-tum, which doesn't quit fit into the hole.  

Between Medicine and Motherhood: Where the Rubber Hits the Road

Q: Why do they put nails in the coffin?
A: To keep the oncologist from giving more chemotherapy.

There is a vaguely defined notion in medicine that physicians who are "well-rounded" are also better practitioners.  Parenthood is a certain type of "roundedness" that allows us to provide superior patient-centered care, presumably because we empathize with the need prioritize our children before ourselves.

I think this assumption is, at best, a half truth, and fails to acknowledge how a being parent can skew our judgement from the practice of academic medicine.

One of my co-workers told us about a difficult conversation she'd had with one of her patients suffering from metastatic breast cancer.  This relatively young woman continued to demand what my colleague considered futile care because "My children are better off every day they have a mother".  I shuttered at those visceral words, not able to imagine how the knowledge I would shortly be stranding my daughter in a motherless world would exponentially increase the anxiety of my own impending death.  As a physician, I might offer this patient the aggressive care she seeks, and in doing so would violate the golden rule of oncology: that patients should die of their disease, not of our therapy. The irony is that as the body decompensates from cancer it becomes dangerous to administer our toxic therapies, and by attempting to prolong life we inadvertently shorten it.

I do not mean to imply that I prioritize or care more for my patients with young children.  My emotional reaction (or perhaps overreaction) to that patient's story is symptomatic of a greater fear of my own death that has developed since Munch was born.  Like all parents, I feel a fundamental obligation to be here, in this life, every day that I can.  I am professionally required to provide care only that evidence supports will prolong life or palliate symptoms, but yet I remain emotionally vulnerable to the desperate idea that perhaps the patient in front of me, or myself if in the same position, could beat the odds even if confronted with a last therapeutic option more likely to harm than to heal.

There is an overlooked aspect of the "God complex" that is used to stereotype physicians. I would guess that a lot of unnecessary or ineffective care (ie regimens or cycles of chemotherapy that are administered beyond that which is supportive by evidence) can be attributed to the treating physician not wanting to be the one to decide it is time for someone else to die.

Why? Because it feels like playing God. And despite the stereotype, most of us aren't comfortable with a power that is usually ascribed to a deity. I know for myself, I never feel so mortal as I do when I look at my daughter.

Date Night Wrap-Up

Last night we had our first dinner-and-a-movie since Munch was born. I wanted to celebrate by eating only food that used to have a mother.

I am kidding, although after months of meat abstinence I did find my appetite whetted for something other than the tired stalwarts "wild mushroom risotto" or "butternut squash ravioli", which are frequently the only vegetarian offerings.

We went to The Mustard Seed, a locally owned restaurant in Davis known for its rustic decor and emphasis on seasonal cuisine, a description specific to about 99.9% of non-franchised restaurants in northern California. As an added bonus the owners are known to yell at the waitstaff, some of whom are their children. Feel free to insert a joke about "eating your youth" as I don't have the heart to do it twice in one post.

The meal was wonderful, including the dessert of profiteroles stuffed with homemade ice cream. I feel the same way about "profiteroles" as I do about "steel cut oats" in that somehow both have become ubiquitous in the blogosphere and on menus, for reasons that elude me still.  Homemade ice cream requires no such hype.

I wanted to see The King's Speech, but Lincoln would sooner wax his legs than watch Collin Firth on the big screen. I think I inadvertently spawned his dislike by watching the 1996 BBC rendition of Pride and Prejudice more times than he found palatable.  Mmmm. Dreaming Mr. Darcy.

True Grit was hilarious, mostly due to Jeff Bridge's perfect deadpan. Although one wonders how much of an artistic contortion he had to undergo to play a washed up drunk.

In other news, we are soon headed to Maui in hopes of trading in a little of this-

 For a little of this-

However, the forecast looks like this-