Hey, you found us!

A sometimes irreverent, sometimes thoughtful blog
about daily ethical challenges, medicine, psychology, media, and most of all: Parenthood.

Wednesday, February 24, 2010

Kid Love

So Abby, my ten year old, and I were doing word-masters last night.  Word Masters.  Like tell me a synonym for scythe, and what’s the definition of hindrance.   There’s a long list of typed words with definitions, and at the bottom of the page, written in faint pencil, a tiny heart.  And the letters X & A in the heart. (Actually, it was a letter other than X)
Wait a minute. 
“Abby, what’s this?”  I point at the heart.
She ignores me.  “Do the next word.”  She says.
“Who’s X?”  I ask her.
“No one.  Do another word.” 
But the corners of her mouth crinkle upwards and she looks at the ceiling, suppressing something.  
Hello?  Abby is ten years old, a little gymnast with calloused hands who regularly points out that she can climb higher and faster up the ropes without using her legs than any of the boys in her class can even if they use their feet to hold on.  In fact, so far I haven’t heard boys mentioned in anything other than a competitive, sort of one down position.   Of course, I’m the product of an intensely co-educational Vassar education, so X could also be a girl. 
Wait, I must be wrong about this. Abby is only ten.  And not interested, right?
“Who’s X?”  I ask again.  And now she opens her bright blue eyes wide in what I’ve noticed is her “I’m cute, change the topic” look – which must work with me sometimes because she’s trying it now.  Only I don’t change expressions. 
“It’s okay to fall in love, Abby.  Who’s X?”
I expect her to tell me she was just doodling – it’s a joke – I was just making shapes -- but instead she chews a lip and says,
“He’s in another class.”
How do you know him? 
He was in her class last year.  He plays during recess with Zeke, a boy who sits near her. 
“What do you like about him?”  I ask. 
“He’s cute.  He plays football.  I dunno, I don’t get to spend much time with him,”  she says.  But the smile is effervescent.  She is literally aglow.
She’s in fourth grade.  Freud wrote about a latency period, when all psychosexual energy stops and gathers for the coming flood of puberty.  So much for that.  I’m tempted to blow this off completely – she’s just a little kid, but there’s something about that tiny heart on the page and the way she rocks in her chair that tells me – she really feels something.  And who am I to doubt its intensity?  This is real.  It may be raw and less informed – but is the fuel behind her passion any less intense than mine ever was?  I’m not so sure.  Shakespeare had kids just a few years older killing themselves over love in Romeo and Juliet – who’s to say when it starts?
So I rub her back and say, “Good for you kid.  Falling in love is good.”  And she smiles in relief.
There’s a lot more I want to say... 
But instead I say, “Okay, define hindrance...”

Wednesday, February 10, 2010

An open letter to my 13 year old daughter about alcohol

Ready for a science based discussion of alcohol?

So a few days ago you and I talked about a girl you know who has already started drinking, even though she’s only 13. Unfortunately, 13 is about when drinking starts for a lot of kids. (About 10% of 8th graders have started drinking, 21% of 10th graders, and about 30% of high school seniors – data from the National Institute on Alcohol Abuse and Alcoholism).

Let’s face it, it’s easy to get – you only need to know one set of parents among all of your friends who keeps alcohol around in an accessible place to start experimenting (my parents had an ancient bottle of peppermint schnapps next to a bottle of 151 rum in the basement).

I’m not expecting you to never drink when you get older. Alcohol can be an enjoyable part of social events and there’s research to suggest that alcohol in moderate quantities (like one drink a day) is related to reduced heart disease.
But adolescents don’t drink moderately because, well, for one, it’s illegal, and two, they tend towards binging. Binging is when you drink a lot at once, like more than three drinks (a drink is defined as a shot of “hard liquor” like whiskey, gin, tequila or vodka or one beer or glass of wine).

Why is binging bad? After all, everyone knows that three drinks is likely to give you a hangover, but won’t kill you. First, it will make it dangerous for you to operate machinery, drive, or, in some cases, even walk up or down stairs. The real problem is that most kids can’t regulate. Once they get tipsy, thinking disappears and they continue to drink until there isn’t alcohol available or they’ve done something stupid. If you have too many, ...well, the outcome can be dramatic.

Consider the case of Julia Gonzalez. She was 16 years old, and went out drinking with a few of her friends during Christmas Break. Her body was found ten hours later with an impressively high alcohol level. Dead. Or Sarah Btill, who drank a huge amount of vodka with a few of her friends and died two months ago in Santa Clara. Sarah was 15. I can keep going,... The internet provides a steady stream of these sad tales.

(By the way, if you happen to be with someone suffering from alcohol poisoning – have the guts to call for help my darling. Don’t use a shower, coffee, or anything else. Symptoms of alcohol poisoning are a stupor – the victim can’t be roused – they may also have vomiting, seizures, few than eight breaths per minute, hypothermia --bluish skin color -- or a combination of these things.) Laying in a pool of spittle is a bad sign  that teenagers usually fail to recognize.

The other problem – and very common -- with even modest binging is what it does to your squash. Adolescence is a critical developmental period for your brain. Put in too many toxic chemicals and surprise! the cake doesn’t bake right.

Check this out. Researcher Susan Tabert at the University of California in San Diego did an incredibly cool study. She scanned the brains of 12 – 14 year old kids before they started drinking and then followed them for years. Over time, some of these teenagers started classic binge drinking – they had 4 – 5 drinks 3 or more times a month. Then she compared them.

She found that the kids who drank heavily had about a 10% decrease in important brain functions like attention and tests of spatial functioning (in an NPR interview she said, “think of it as the difference between getting an “A” and getting a “B”.)

Dr. Tabert also found the alcohol decreased the quality of the white matter in their brains – a likely permanent assault on the brain’s cellular messengers – in addition, there were differences in the hippocampus, a key structure for memory.

So binge drinking in a developing brain likely leads to – that’s right -- brain damage.

(By the way, she’s not alone, other research has shown that adolescents who binge screw up serotonin and dopamine too – essential neurotransmitters for just about everything important to you that begins with “m” – like, you know, movement, memory, mood)

This shouldn’t be surprising. There’s a reason people throw up after drinking large quantities of alcohol – the body recognizes that it’s been poisoned.

The last issue I’ll raise now involves driving. Type the words “teenager dies crash alcohol” into google and you’ll get over 588,000 google entries from all over the world. Most cities in the world with cars and teenagers have suffered. I won’t say more, you’ve already seen this in your own life.

Like I said, I don’t expect you to never drink. I do expect you to be smart about it. Start your drinking after your brain has finished most of its development – like in your 20’s. Drink moderately when you do drink – that’s fewer than three drinks in one evening. And stay away from machinery and vehicles.

You realize, of course, that if you get a DUI or come home with alcohol on your breath when you’ve been driving and I will make GITMO seem like an exotic spa.

And please –darling – I beg you, don’t ever get in a car with someone who’s drinking – I don’t care where you are or whom they are. Parents, boyfriends, or Super Rabbi. If they’ve had more than one drink I’ll come get you – or pay for the cab – any hour of the day – no questions asked...

And since you’re asking – A friend and I did eventually try that ancient bottle of peppermint schnapps when I was a senior. It tasted like a combination of soap, mouthwash and electricity. I’ll suspend my rules if you want some. Here. Drink up.

Wednesday, January 27, 2010

The new family dinner

A few words about family time with children.

When I was growing up, we had dinner together as a family every night. The four of us sat round our Formica coated kitchen table and I tried to avoid leaning my head back into the baskets my mother had nailed into the wall behind my spot.

Dinner was an active event, it’s where stories were told, expectations set, and we learned about one another’s lives. It was there that I learned that my mother was struggling with her coworkers at the hospital or that the other teachers at my father’s schools were going to strike. I learned about David’s piano recitals and who was going to attend. And they asked me questions about my school work, my friends, and girlfriends. I didn’t always enjoy the conversations, especially during adolescence, but I never doubted that this was a part of my life.

Today, the four of us – my wife and daughters -- eat together as a family twice a week. Abby has gymnastics three nights during the week, and Alex has dance, so we manage to pull it off only on two evenings.

There is only one place where I can reliably learn about my children's lives and only if I tightly control the distractions and other technology available there.

The car.

I am in the car with my children for three to four hours every week. Two or three hours with the little one back and forth to gymnastics, and an hour with the older one. Because the older one is a more efficient sharer of information, this is probably the right ratio.

And I’m usually exhausted from a long day and Abby and I even eat on our way home. I’m working to get better at it. It’s here that I’ve learned about Alex’s friendships and issues with teachers and schoolwork and even about her new boyfriend. And Abby’s friends and her teacher and what happened at gymnastics. And I occasionally tell stories from our past – the kids seem to enjoy hearing about themselves as little kids.

I think it’s harder than those dinner-time conversations from my youth, but it can work.

It has to.

Friday, January 22, 2010

A note to my daughter about weed

All the research says that 12-13 is the risk years. When it all starts, if it’s going to. So.

Pot. Herb. Ghanja. Dope. Mary Jane. Rope. Stink Weed. Ditch Weed. Sugar Weed. Wacky Weed. Sweet Lucy. Spliff. Cannabis. Marijiana. Weed.

Let’s talk about weed. A real talk, not one of those weed-is-evil-and-no-one you-know-has-ever-used and if you do it’s only a matter of time before you’re living under a bridge pushing a shopping cart (which, I will point out, would be incredibly difficult for you given the amount of clothing and other detritus you seem to have accumulated.)

I want to write you the truth because you already know the “no one has ever used” speech is crap and if I leave you to figure everything out on your own you’ll just ask your friends -- whose sum of information comes from only slightly less clueless older brothers and sisters or the internet – which is a three car garage stuffed by hoarders. There may be some truth buried in the internet about weed, but you’d have to clean off ferret droppings to find it. Why I, or any other parent, would leave on your own to think this through is beyond me because you lack the resources to get real information. So here goes. Just say no. Just kidding. Ha ha. Little parental humor for you there.

Anyway, a doctor/writer friend of some renown pointed out to me once that it’s completely natural to want to change your mental state. He asked, “why do you think little kids spin around or swing or jump around? They want to play with cognition, it’s completely normal.” He has a point. That he said this to me while he was, himself, at the moment, intoxicated is not relevant.

So it’s not crazy to want to experiment with your cognitive state.

And I know you’re curious – you told me you’ve already seen a few kids get booted from college and your old school for smoking weedand getting caught. So you’re probably thinking, “why would they risk getting kicked out of school unless that weed thing is fun?”

And you already know I wrote a book with “marijuana” in the title, so you’re aware that I’ve inhaled.

So here’s the bottom line.

There are three kinds of marijuana smokers.

Visitors. There are the ones that smoke occasionally and for whom it’s a visit to a strange place. They may spend time giggling, and likely eat too much food, and end up a bit paranoid. Maybe even “wicked” paranoid, as we used to say. They may have fun physical sensations and get disoriented about time – but nothing too far beyond their experience to be frightening, and then, the next day they probably feel wiped out, kind of down and have minor memory issues. They may even say to themselves, “that’s what all the excitement is about?”

Then there’s the Regulars. These tend to be folks for whom weed is an anti-anxiety medication. It soothes their worries, they see the world differently when they smoke, and they maintain function. They smoke all the time – they may even “wake an bake” which means smoking first thing in the morning instead of coffee. With the exception of the smoker’s hack – a cough -- and their crappy memory-- you can’t usually tell who these people are because they are entirely functional. I’ve known hikers and small plane pilots and teachers who smoke regularly and seem to pull it off (though I wish I’d never met the pilot because I wasn’t trustworthy even with a popcorn popper when stoned but that story is for some other time).

But some of them convert to a third type.

Stoners. These are folks whose lives have slowed, and then stopped. For them, smoking weed results in gravity turning up -- it takes enormous effort for them to do anything, so they don’t. Ambition – even once fierce ambition -- evaporates and a creeping sadness replaces it. They sleep too much, hygiene sucks, they can’t remember what they did yesterday even though it’s exactly the same as what their doing today -- and they begin to look like a BEFORE photograph in some twisted makeover reality show.

Oh yeah, Bus-Riders. Okay, right, there’s a fourth type too -- for a small number of people, weed is just a bus stop on the quick road to harder, more immediately dangerous stuff, but you and I aren’t talking about heroin or cocaine or PCP or their latest derivatives because it’s the same as jumping in front of a car, only slightly less efficient. Oh, by the way, if I catch you with that stuff – or prescriptions – I’ll take you to the police myself, and when you get out you will find that I’ve taken everything out of your room including your door and bed – and you’ll slowly earn them back over the next year with meetings and drug tests. Doubt. Me Not.

OOooops, sorry, I got lost there in my own horrid little parental fantasy. Where were we? Oh yeah. Weed.

Unfortunately, before you inhale from your first joint, it’s impossible to know which group you’ll be in. Everyone thinks they’ll be a visitor the first time, but you never know. You’ll notice I haven’t even mentioned getting kicked out of school, driving when stoned, or other legal outcomes – just pay attention in your own world and you’ll notice the consequences yourself.

But of course, no matter what you decide. I’ll be here. If you ever need me, you just call and I’ll come get you, no matter where you are or how high you are.

And I’ll try to remember not to tweak you out by taking advantage of your paranoia when I get there.

Thursday, January 21, 2010

Feeding the other wolf

I read a great article today by Margaret Plews-Ogan (and a flock of others) -- she was writing about graduate medical education and teaching, but the opening story reminded me of parenting.

This is how it goes.

There is a story of a Cherokee elder sitting with his grandchildren. he says to them, "In every life there is a terrible fight -- a fight between two wolves. One is evil: he is fear, anger, envy, greed, arrogance, self-pity, resentment, and deceit. The other is good: joy, serenity, humility, confidence, generosity, truth, gentleness, and compassion."

And one of the children asks, "Grandfather, which wolf will win?"

The elder looks him in the eye. "The one you feed."

I snapped at Abby, our ten year old, yesterday. She was screwing around, not getting dressed and we only had a few minutes before we had to be out the door to gymnastics.

I've heard we're the yelling generation, and certainly, I'm as guilty as the next parent. We've stopped beating our children, so now we just scream. I know from behaviorism that it's entirely ineffective as a parenting strategy, but man, she ticked me off.

Better stop on the way home and pick up a steak for the other wolf...

Plews-Ogan et al, (2007) Feeding the Good Wolf: Appreciative Inquiry and Graduate Medical Education. ACGME Bulletin, 5-8.

Monday, January 18, 2010

NO, you can't grow up. No more conversation.

IN THEORY, we parents want the same thing as the adolescent.

We want them to emerge from adolescence as a young adult, capable of living independently without, you know, being a heroin dealer or endorsing any political efforts we find objectionable.

But the reality is slightly different.

There are many of us who mourn and idealize those younger years. When the little ones spontaneously held our hands and couldn’t possibly fall asleep without an elaborate ritual involving parental reading, singing, and, if necessary, sacrificing a goat.

Strictly speaking, if we were being logical, we would give them incremental independence, and as they demonstrated they could handle it, we’d offer a little more. But we aren’t.

Let’s face it, a small part of us sings and dies with each new independent burst. I call them bursts, because that’s how this works – growth isn’t linear – one moment a kid can’t tie her shoes, the next she works in the city and has a tattoo.

Yesterday my wife dropped our eldest at her boyfriend’s house – my wife spent a few minutes with his mother – and drove home. Alex is only 13 and they’re hanging out with his family listening to music and facebooking. But my wife wept in the car on the way home.

She (and I) miss that little girl who was so full of wonder and songs and was mesmerized by all things bedazzled and sparkly.

We’d debated the trip over to the boyfriends house -- and grilled her. Who’s going to be there? What are you going to do? We were, in truth, a little over the top. She thought we were worried about her having sex -- but that wasn't it.

It’s these times -- when the theory and reality get confabulated that we need to step back. When we confuse putting on the brakes because our child is ahead of herself – biting off more than she’s capable of handling – with putting on the brakes because we can’t bear to see them take one more step towards launching out of childhood.

Look, there’s no question that adolescents sometimes lie, cheat, steal, and routinely reveal their immaturity. But sometimes, it’s us – wishing the cosmic toothpaste back in the tube, trying to force them just a few developmental milestones in reverse.

The reality is that Alex, while only 13, has a good head on her shoulders. I’m sure she lies to us and withholds a good deal, but she’s assertive, perceptive and smart. She was ready for a boyfriend, and if you’re going to have one, you probably should be allowed to spend a little time with him.

So eventually, I picked her up from his house and when we got home, she hung around the kitchen with her mother, and then goofed off with the camera with me, and for a little while, she was that little girl -- and all was right with the world.

Friday, January 15, 2010

That's not a Hamster

Abby, at nine, was playing with her mother’s phone when she said, “hey, look mom, someone sent you a picture of a hamster.” Her mother, still distracted by her day at the hospital and making chili and an NPR’s story about the uninsured said, “that’s nice.”

Her older sister Alex, 13, flashed into the kitchen in hopes of a quick pre-dinner snack , glanced at the phone and said, “Uh. Abby. That’s not a hamster.”

Abby turned the phone upside down and said, “You’re right, it’s just the hamster’s mouth.”

“No.” Alex said. “It’s not.”

Perhaps it was my older daughter’s tone that tipped my wife off that this was not an ordinary photograph. Or maybe it was she said next.

“That’s definitely a vagina.”


“It’s not gross. You’ve got one.”

“Stop it Alex.” Growled Abby.

My wife, now holding her phone, looked for the number and dialed. A man answered, thirties or forties, a professional voice. When my wife explained that she had a young vagina on her phone the man apologized, and said his son had been caught before doing this. “I assure you,” The man said, “This will never, ever, happen again and I am so sorry.”

My wife took a moment to berate him about our daughter seeing the vagina and made a few other choice suggestions. She’s good at thinking quickly under pressure.

Regardless of whether he was telling the truth, it's clear that someone was forwarding a photo of someone else's vagina.

“It’s sexting.” My 13 year-old explained to me later. “I know five kids who do it at school.”

“Are they going out?” I asked.

“No. They’re just a group, and they send each other photos of themselves.”

“Do the boys send photos too?”

“I don’t think so.”

“Why sext if you aren’t going out?” I asked. I had thought "sext" had something to do with sex.

We considered this question. Some of the girls, she decided, are generally lost. Sexting is just another in a long line of activities probably designed to declare independence and early adulthood – like smoking, the nose stud and the tattoos, the died black hair and the lying. Or it can be competitive, like seeing which girl has the cojones to show more.

She clicked off the names. One of the girls is getting kicked out of school, another has been caught with alcohol. But one of the girls has friends, a stable family and is a good student. I suggested that this might feel like her best way to get attention, and it’s working if we’re talking about her. But like many things that get attention, the down side might be profound. One of the boys got caught by his mother, a rather conservative sort anyway, and now he's grounded. "like for life." my daughter said.

There’s nothing new about being able to take naked photos of yourself. Many a Polaroid camera has been used in this way. What’s different is how many kids have access to cameras, now that they are ubiquitous in even the lowliest cell phone. And of course, the eternal life a photo can have after it exists. We figured it out, after the photo exists, people in Nepal and Narobi can see it after only about six clicks and a few forwards.

“Can you imagine a college interviewer googling you and her finding your naked body parts?" I asked.

She nodded in that vague agreement that means either, “yeah” or “can we be done talking about this?”

And it made me realize – we the first generation of parents to deal -- on this scale -- with raising kids who can harm their own futures by simply pressing a few buttons on a machine they interact with multiple times every day. I envy parents who only dealt with weed and cigarettes, alcohol and automobiles. Now we have to teach them how to avoid posting dangerous things about themselves.

You know, like their hamsters.