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

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.”

“Gross.”

“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.

Wednesday, January 13, 2010

the only way to self-esteem

Everyone’s worried about your self-esteem. Math teachers and talk show hosts and advisors sing out: Girls need to feel better about themselves!

Some writers have earned considerable bling by suggesting that girls should use positive self-statements to feel better about themselves and succeed in the world. Like, “I accept myself completely” and “I am a lovable person.” The recent smash-hit book “the secret” is chock full of this sort of hopeful advice (it goes even farther – “I am a money magnet”.)

This past July, researchers published one of the first careful, scientific studies of these happy thoughts, called self-affirmations. They discovered that people with low self-esteem actually feel worse after reciting these statements. No kidding. Worse. People who already have good self-esteem feel a little better, but for people who need them the most, the statements are a downer.

To me, this is not surprising. There is only one way to feel good about yourself.

Do things that make you proud of yourself.

See, you’ve got this little person in your head who scribbles down everything you do. She sees how you treat the people around you. She sees how hard you work, and if you’re there for your family and your friends, and what kind of grades you get and how you are in the world. Let’s face it, the one person who sees you in every situation you’re in – is you.

And you’re smart and observant.

I know that body image is a big deal, but it's not everything.

And I know that middle school and junior high and high school can be like the Lord of the Flies with crazy anti-social adolescents harming one another for sport and position. If these people are cruel or non-accepting, through no fault of your own, you can be treated horribly. But lets distinguish how you feel about yourself, and how you feel about your schoolmates. It’s when you agree with other people who view you badly that you really have a problem.

See, these schools are temporary. More temporary than they seem now. But your esteem, it’s like a big ship that turns slowly – and only with the preponderance of evidence. For better or worse, you’re going to take that with you. So when you’re in a situation with your friends, or your studies or your family or with boys, it’s worth remembering that little unbreakable recorder that sees everything.

A few hours and days and years from now, my dear offspring, what’cha gonna think?

Wood JV, Perunovic WQ, Lee JW. Positive self statements: Power for some, peril for others. Psychol Sci. 2009 Jul;20(7):860-6.

Sunday, January 10, 2010

A few words for my daughters about love and relationships.

You and I know two young women, sisters, who have different approaches to love. The first is deeply in love with a groovy guitar playing underachieving pot smoking intriguing counter culture kid. She loves him with every fiber of her being. She treats him how she hopes to be treated. She loves him completely and gives him everything she has.

This is a very romantic idea, but it also turns out to be misguided.

See, her key relationship strategy is hope.

He isn’t committed to her, he comes and goes and he wants, and half-loves her. She wishes and hopes -- someday he will realize he is truly in love with me -- and then he will treat me like I treat him. Meanwhile, she’s a little depressed, her grades have slipped and her academic future is uncertain.

Her little sister is in love too – but she demands to be treated well and on her terms. Her schedule dictates when they get together and she has a major say on what they do.

She doesn’t treat him how she hopes to be treated. She demands to be treated well and with respect at all times. Period. When they are together there is the easy ebb and flow of early love. She seems happy in her own skin and colleges are opening their arms to her.

When you love someone, it is brutally hard to say “No” to something they want, to make demands, or, in any way, prevent them from their immediate goals. And yet, the ironic thing is – the only way the older sister will get what she wants is to do this exact thing.

So, my girl. Fall in love. Fall with every fiber of your being. Fall until your bones ache. But never for a moment believe that you deserve anything less than to be treated brilliantly by men. And when they don’t – and sometimes they won’t –shape them up. Yell, indignantly. Wave your hands. Stomp your little feet.

But please. Don’t just hope.

Thursday, January 7, 2010

An open letter to my 13 year old daughter about sex.

Dear daughter.

You are way too young now, but I’ve noticed boys starting to visit and your friends have had some boyfriends. I guess you have too, but none of your relationships have lasted as long as your average cricket match, so I know it’s still early. But not for long.

First, before you roll your eyes and believe that you know all of this already: it is likely that sex will be different than you expect. You saying you understand it completely already is a little like saying I know what it will be like in Calcutta or Nigeria, even though I’ve never been there before.

The society is accustomed to bombarding you with sexual images and it may be difficult to figure out what the “real” rules are, so I’m going to tell you.

As I’ve shared with you before, the best way to understand how boys really feel about you is to watch what they do, and pay less attention to what they say. You will be able to tell when boys really love you because they will treat you well and care about what you say. They will have opinions about it, remember what you said, and seem passionate. That said, there are predators – some boys and men who are assholes and will pretend to care about you and won’t. They will rarely be able to keep it up for long though, so the longer you wait, the more likely you will discover which camp they belong in.

Okay, enough stalling. The rules:

1) Regarding sex: it’s important to go slowly and take your time. This is the best way to know how someone feels about you. You have nothing to prove. In the US, roughly 3 of 10 girls have had sex before their 17th birthday. In my humble opinion, this is too young.

2) You deserve respect at all times. Demand it.

3) Don’t put yourself in stupid situations. Ie, combining alcohol with being alone with people you don’t know. Actually, combining alcohol with a lot of situations turns out to be pretty dumb. Spending a lot of time with people you don’t know in unfamiliar places is kind of dumb.

4) It’s okay to say “No” after thinking you could handle a situation. People might be mad at you, but that’s not as bad as being mad at yourself for doing something you didn’t actually want to do.

5) The clearer you can be about what you want and don’t want, the better. Sometimes, this means thinking about it in advance.

6) There are consequences for everything. Having sex has consequences, You might have to be assertive to make sure things go down the way you want them to – this can be awkward.

7) Don’t believe the Hollywood versions of sex. Your life will not have a sound track. Your hair will not be perfect, you might get kneed and elbowed and sometimes there are even unpleasant noises and you stick to things, like car-seats. There are weird bodily fluids and...well, I've said enough.

8) No glove. No Love. That’s it. Condoms, dear one. If you have a child, I’m not raising it. Period. I’ve done my time with diapers and homework. And some communicable diseases are for life. Five minutes of sex and a future of pills, ointments, balms, lotions, creams and hassle.

9) Call me anytime, day or night, and I'll come get you.

10) Did I mention waiting a while? Yeah. Wait a while.

Tuesday, January 5, 2010

ministers and sobbing

Today I learned that on a recent national test for Presbyterian ministers, a number of them cheated, by using differences in time zones to find out the questions in advance. No kidding. Some of the New Jersey ministers phoned the Californians early in the morning and told them the answers in advance. Is nothing sacred?

It does seem remarkably prevalent, this cheating thing.

And what's on a minister exam, anyway? Scripture? Wedding organizational challenges?

Aunt Edna hates her ex but has requested an opportunity to speak at the rehearsal dinner. She's had a few drinks and is known for her vitriolic diatribes against her ex. Do you:

A) Allow her to speak.
B) Allow her to speak but feign an earthquake
C) take her aside and speak in tongues until she fears you
D) stuff her in the walk-in refrigerator

I'd ask the minister at our hospital, but I think she's from California...

Sunday, January 3, 2010

The Wet Willy

I posted this experience on facebook. I still feel badly...

This happened on a flight from Detroit to Indianapolis last thursday...

I sit next to our 10 year old on the plane, my wife sits in front of us with our 13 year old daughter. This is a perfect time for a "wet willy", so I stick my finger in the 13 year old's ear. Then I notice that my wife & the 13 yo are actually sitting behind us. And I've just stuck a finger in the ear of a middle aged Chinese woman.