Fireworks

When did it become popular and edgy to be an asshole about fireworks? I get that our beloved furry friends aren’t a huge fan of the week-long boom boom booming. No one loved Brandy, the Stockton Family golden retriever, more than we did. But Brandy was scared of the vacuum cleaner and lived a long, happy life amidst a more than weekly aural assault by the electric closet monster. It never occurred to us to find a less terrifying dust sucker or resort to sweeping. And fireworks are for all of us. They’re colorful and fun and celebratory and magical (except when they are blowing off the bits of amateurs). I say more fireworks. MORE.

Here at the Cape, we’re getting more. The neighborhood show is tonight and I’m as excited as a little kid who yells, “AGAIN!” after each blast. July 4th celebrations coincide with Bernie’s birthday (and mine a few days away), picture postcard weather, and Lees taking vacation days by the beach. We have resting smile faces. The biggest decision today will be where to nap.

Because we’re human, there are a few real stressors lurking. As we sit here draining the coffee pot, Bernie says aloud what we’re both thinking: ugh, there’s a lot of work to do. However, we have decided to actively NOT THINK about it today. So I’m not thinking about the large and expensive home improvement project that is delayed because my contractor’s truck and tools were stolen, or that he somehow crashed my car mere minutes after borrowing it. Nope. There’s a cookout and fireworks later.

I’ve never been a small stuff sweater, but Bernie is a champion at putting the bigger things (like crashed cars) into perspective, too. Summertime makes me more aware of the Big Picture. Maybe there is more time for reading, for prayer, for real relaxation. Maybe it’s also because summertime is a rather constant reminder of cancer for me. Bathing suits that have outstretched their ability to hide scars and summer friends who ask in hushed concern, “how’ve you been… are you OK?” are prompts to recall the whole scary time. To be clear, it’s sweet that they ask; after all, they watched me grow hair for three summers. And I am OK. So does it matter that the car we hardly use is in the shop? Nope. There’s a cookout and fireworks later.

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Missing Teddy

“It’s kinda lonely up there without Teddy.”

No kidding. Blessed with wanderlust, a growing proficiency with Japanese, and an indulgent, adventurous, and spry grandfather, Teddy has embarked on his second “buddy trip” with A Gong. They left over a week ago and I’ve received not one single text. NOT ONE SINGLE TEXT. The scores of pictures uploaded onto Facebook and the LINE group chat for the Lee Clan tell me he’s in some Japanese equivalent of hog heaven. But we miss him.

Here at the Cape, Brodie still shares a room with his slightly smaller, definitely stinkier, late-sleeping, Kanji work-booking little brother. And because Teddy is not here, but also living 13 hours into the future, we feel like he’s on another planet. His absence feels big. Last night the whole gang of Cape kids landed in my family room and we made fun of him and missed him together.

When Teddy was in 5th grade, he had a math assignment wherein he was given a mock budget of $5000 to plan a trip with a fictional friend. His travel plans included an 80-year-old travel pal named Jerry.

“Teddy, who is Jerry?

“He’s my travel friend.”

“Who is he?”

“I made him up.”

“Why is he 80?”

“For the senior discounts!”

Teddy sourced the seediest hotels and hostels and blew almost the whole budget on tickets to Hamilton. Money well spent.

According to my AmEx records, Teddy recently checked out of their hotel in Tokyo to spend a few more days in hot baths eating food that looks deliciously adorable. Next stop: Taipei. 22 more days without Teddy on this side of the world, 22 more days with his 80-year-old travel buddy over there.

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Parenting 2.0… the hyperventilating torture of the teen years

Little kids, little problems… big kids, big problems. The sage parents of teenagers told us this. While we wondered if our little ones would ever wipe their own butts or fall asleep without 10 stories, 3 drinks of water, and the theme song to Pepa Pig, they had bigger fish in the fry pan. Those parents had sympathy for us, sure. But there was a wistful nostalgia for these sorts of complaints. I wrote plenty about the sweet spot of parenting when I was in it. And though I love these budding bursting embarrassing distracted delusional occasionally noble and often lying humans, they’re exhausting.

We’re taking the radical honesty approach to parenting. My own parents put forth hard rules and likely knew we were lying to them. How often does the movie reel “break?” I wonder why they let us keep throwing good money at a theater that couldn’t get us home before curfew. But while our own teens dip toes in the deep end of teenage shenanigans, we prefer they tell us what is happening. But they won’t. Not entirely. Who does?

The smaller sins are merely annoying. Anyone who has let more than a handful of high schoolers into the basement knows the tell tale stench of vaping. Their burgeoning nicotine addiction means that any room they leave smells like grape bubble gum, stale cupcakes, or sickly sweet mint (that they swear is from chewing gum).

“Ugh, at least we looked COOL smoking actual cigarettes,” I tell them. I’ll call them out for spewing toxic vapor into our shared spaces, make them turn on the air filters, and remind them that they’re not fooling anybody. They’ll give me the usual deflections and excuses like I wasn’t at least 43% naughtier at their ages. I recall how my sister and I got away with murder, but our younger brother (likely smarter than the two of us together) was wildly incompetent at subterfuge and got caught all of the time. Odds are (hopes are?) my own teens are taking after Uncle Patrick.

“Did you ever sneak out of the house?” Brodie asked. You bet. Back in the ‘80s, few parents in the ‘burbs set up elaborate house alarms with doors and windows that beep beep beep. I met up with my girlfriends to share a furtive Marlboro Light, or made romantic plans to rendezvous with my boyfriend under a moonlit sky. Those were magical moments of borrowed time in the peak of youth. Looking back with the lens of a teenage parent, I see a too young girl risking lung and Lyme disease and sexual assault. How lucky that cigarettes are gross and took a substantial commitment to yield real addiction, and that my boyfriend was probably more scared than I was to make any sort of mileage on the old baseball metaphor.

Keeping me up at night are the larger mistakes with huge, life altering consequences. We’re excitedly reluctant to let our kids drive. Are we really giving large machine operating privileges to half formed people that still spill and leave doors unlocked and socks everywhere? Though we (okay, mostly I am) constantly harping about consent and the role of boys to protect all girls everywhere, in the moment does a teenage libido override all sense (and their mother’s voice)? Is the sharing of salacious gossip (or videos!) too tempting? Will they begin to, or ever, weigh risks and outcomes before actions? Am I expecting far, far too much from their mushy frontal lobes? SHOULD WE START HOMESCHOOLING. Raise your hand if you considered locking up your teens until they turn 21.

Recently, a pair of wise physicians of kids on the “other side” of parenting spoke with candor of the random drug tests and mandatory meetings with the Discipline Committee invoked by the actions of their then high schoolers. (God bless the parents who share these stories.) Another mom described her delightful, accomplished adult daughter like this: “She was unlikeable and awful from age 14 until last year.” I’m full of dread and anxiety about what comes next. Or maybe that’s just the pseudoephedrine coupled with the pot of coffee I swallowed while in full Mom Mode dropping wisdom on my teen that is likely landing on deaf ears and against a please-let-this-be-over closed door. If my boys are going to make mistakes (and they will), it will not be because I didn’t lay down the knowledge. Aside from locking them up and homeschooling, it’s all I’ve got.

Brodie has never been more excited to exit the house and go to tennis practice. I don’t blame him. Mom advice is invasive, embarrassing, obvious, unhelpful, trite, and irritating. Once a carefree Marlboro Light puffing teen swapping spit with boys on golf courses, I became the happy go lucky mom who enjoyed her sons’ adorable idiosyncrasies as they earned As and navigated nothing worse than the inevitable heartbreak of team sports and fickle friendships. Now all I can think about is Father Mike Dangelo’s motto for caring for these almost adults: “No life lost or created on my watch.”

In the end, I’ll need to trust my kids. They’re good kids, and if we paved the path and put up clear signage, certainly they’ll go in the right direction? (I can actually hear the snort laughs of seasoned parents just writing that.) As we navigate this next phase of parenting– the teen years– we’re also grappling with how tremendously stupid we were at that very age, how incredibly uncool our harpy warnings are to unsuccessfully thwart inevitable mistakes, how old this makes us feel in a way that crows feet and creaking joints cannot. As my kids stumble into adulthood, I admit that I thought this would be easier. Blaming an Internet-obsessed world for the shortcomings of our children feels like a cop out, and tolerating transgressions and exercising forgiveness are action verbs harder than any spin class. When once I wanted to fast forward to years when they wouldn’t need post poo help and could sleep until noon, now I’m wishing away the years until they can (legally) share a glass of Prosecco with me and confess all of the (minor) sins we never caught. Until then… no life lost or created on our watch… we pray.

 

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Social Mourning… by Steve Safran

This past month, one of my childhood idols died. He was my camp counselor during the late ‘70s at Camp Tel Noar (CTN) in Hampstead, NH. Steve Levy  was everyone’s favorite: smart, funny, and oh-so-cool. I learned a lot from Steve. He brought his music collection to camp and played Led Zep, The Who, The Stones and music otherwise inaccessible to nine year-olds. He taught drama and was one of my first directors, witnessing my transformation into the role of “theater kid” that lasted through college. He would also sneak us leftover Chinese contraband, waking us at midnight for a bull session and cold noodles.

Steve wore a signature necklace. This was no Jewish Star of David or Chai symbol. It was a wrench. When I asked him about it, his four-word reply was a more profound insight into the human condition than any after school special was offering:

“We are all tools.”

Other counselors caught on, and naturally, started wearing wrench necklaces, too. Now they were all tools.

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Steve Levy left CTN and began a professional career in standup comedy and acting. I followed his career with enthusiasm. It’s always a thrill to see someone you know on TV, and better still when it’s your childhood idol. When he had a cameo on “The West Wing,” I nearly lost it.

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From the West Wing: Steve and associate trying to convince Josh Lyman of something or other. 

He was on “Ray Donavan” and “JAG,” too. And then, Steve died of a particularly vicious form of cancer that first took his nose (a legendary nose at that), when he was just 58. You should read his amazingly touching, funny account of his life with nose cancer.

Now. We’ll wait.

I’d been in touch with him, the way you can in the era of emails and social media. But in the past 40 years, I never saw him. Steve lived in LA, and I never made the time. I regret that.

There are many of us who share camp memories of him or were genuine fans outside of the world of CTN, and it made me start to wonder about our collective mourning on line. People may share sad news tragically close to home on Facebook, but more often you’ll see a nostalgia thread after their favorite pop star passes. Something about social media makes us share the fact that we saw David Bowie on the Glass Spider tour… and also that one time at Whole Foods. That’s not necessarily deliberate; social media asks, “What are you thinking?” If you’re upset about something, that’s what you’re thinking. It’s a new kind of grief: Social Mourning.

Steve’s death reminds me of another loss that still stings– the murder of my friend Stu Meltzer on 9/11. If you follow me on social media, you’ve seen my yearly tributes. I want to share the karaoke-style tapes we made in 1990. I want keep his memory alive. I still miss him. But every year I also wonder if I am making this about me. Am I benefitting from unwarranted sympathy every September 11th? It’s Stu’s family that mourns most deeply. Does my public display of bereavement, however genuine, take a piece of that? Who am I to write about loss when they lost so much more? I’m simply one of the hundreds of people who mourn for Stu. Or… maybe our Social Mourning allows all of us to feel that closeness in our grief, even for just a moment as we blow on our morning coffees and scroll through our screens.

I’m going to surprise the heck out of Churchy Girl Britt now and turn to Judaism for a moment. I do this because I genuinely appreciate the Jewish rules on mourning. Among the most important is the concept of Yahrtzeit. Literally, it means “time of year” but really it means “time of one year.” Jews are instructed to recognize these sad anniversaries. There is even a candle involved, though I have yet to light one outside of the rare blackout.

(My Jewish friends may fault my Yahrtzeit candle usage, but I figure the Almighty’s cool with it, since His first act was to create light.)

In addition to the candlelit remembrances, it’s also standard protocol to go to Sabbath services the week of the Yahrzeit. I have never done this with any frequency, and I really loved my grandparents. But I will post about Stu every year, and write a blog remembering my favorite camp counselor. Is social media the new Yahrzeit

What are our intentions when we share our grief on line? What are we saying when we lament the loss of someone we only ever saw at Whole Foods? Or mourn someone we haven’t seen (in person) in more than 40 years? Are we pulling focus to ourselves to share our grief? Or are we compelled to tell the crowd “Look! I’m sad David Bowie’s dead, too!” for fear someone will take you to task for not posting “Heroes?”

I don’t know.

I’m a tool.

How do you clean a sex robot… and other dinner table discussions with teens

“Let me just stop you right there with your shaming of sex workers…” was how the Facebook rebuttal thread began. I normally avoid anything even approaching politics on social media. Honestly, the only time I’ve been “called out” on line was for admitting I still make the boys’ beds. (Mom-shaming on Facebook is a thing, people). Clapback for admitting dismay to discuss the latest news cycle with my kids was interpreted as a judgment of women engaged in “the world’s oldest profession.” But I have two teenage boys. As the only woman in the house, as a mom, as a feminist, as a human being, I cannot let it go. These boys are gonna know my FEELINGS around this. And none of them concern women who freely choose this profession.

A few years back when the kids were gifted with old gen iPhones and there were many rules associated with them, it hadn’t occurred to me to strictly disavow porn. But one morning accessing one of their devices to check the weather—these were the salad days of knowing their passwords—I found evidence that they had stumbled into it. When they got home, I made them come clean.

I met their I’ll-never-do-it-again, don’t-tell-dad, and am-I-grounded pleas with calm assurances that they weren’t actually in any trouble. The only thing they had to do was discuss it with me. Given the choice, they would have happily handed over their phones. But there was no choice. Instead, three truths and some questions:

  1. We pay for the phones: my phone, my rules, no porn.
  2. Pornography makes me… sad. Don’t make your mother sad.
  3. You will never know if the women in these videos were coerced, bribed, threatened, cajoled, terrified, or even compensated. You will never know if they are under age.

Q. If there is even the smallest chance of #3 being the case, is pornography less enjoyable to watch? If #3 is more the rule than the exception, is pornography… ethical?

Finally, I wanted them to consider that no little girl imagines this life for herself. No parent dreams of this vocational future for her child. Nearly 85% of the women in this world enter it from foster care or homelessness… and that statistic doesn’t include the women trafficked from foreign countries into a world of prostitution.

“Let me just stop you right there with your shaming of sex workers…” was one woman’s response to Truth #2. I hadn’t been shaming anyone, merely expressing regret over having to discuss prostitution with my boys. They know my feelings around pornography, but we hadn’t discussed massage parlor culture. Not yet. And I guess it needs to be said: I’m sure there are sex workers who are employed legally, safely, and with proper pay and, just as important, joy for the work. I just also think they are the extreme exception. Trotting out that example now does a disservice to thousands of marginalized women and is not useful when trying to frame this topic for teenage boys. I’d love to know how your dining table discussions are going.

Being total teenagers, this weekend my own kids advanced this devil’s advocate position: “Should a dude buying pot be punished for a drug trafficking ring?” And I let them bat that one around for a minute. That is, until I pointed out that they were comparing a FEMALE HUMAN BEING to a JOINT and I hated all men with a burning fury for about 15 seconds. This led to the discussion of decriminalizing sex work—another argument I loathe because what is happening at over 600 “massage parlors” just here in Massachusetts is not sex work, but some odious crime straddling slavery and rape. In fact, advancing the legalization of all sex work as a panacea in this climate would probably only safeguard the monsters holding power positions in this seedy realm.

Brodie pointed out that many of the men who have been outed are affluent enough to buy SEX ROBOTS. This led to the unsavory discussion about how sex robots are used, and Teddy wondered, cleaned. Questions of improved AI and the ethics of using sex robots with some sort of consciousness were also raised more quickly than the existence of this practice with ACTUAL HUMAN BEINGS and I hated all men with the fire of seven suns for another minute. And now you know what it’s like to have dinner at the Lees of late.

The sex-for-money world needs its #MeToo moment, and I’m hoping this recent scandal heralds it. Until we hear their stories, there will be comment threads on Facebook urging you to champion the happy hooker– this mythical, empowered woman safely using her body to make an honest buck. Until we hear their stories, soliciting prostitution is a faceless “misdemeanor” of a crime likened to buying a joint. Until we hear their stories, we will believe customers of Orchids of Asia had no reason to question the wellbeing of its employees. Until massage parlor culture of all ilk stops, our most vulnerable girls and women are not safe from it.

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The kids’ first phones… used to play Angry Birds, text poop emojis, and navigate the titillating world of hotgirlspeeingdotcom

 

Indelible Hate

It’s finals week. You have two papers due and that one lab report the professor said you could rewrite. There are three tests that will require three all nighters of memorizing and untold pots of coffee. Everyone is fighting a cold and a little bit drunk on exhaustion and holiday break anticipation. Somehow, there are still parties happening, and you don’t want to miss those, either. You’re hardly out of your teens, but real life is happening soon and this week counts. Big time. Grad school admissions officers, future employers, and likely your parents (who are paying big money for all of this) are expecting results. You get up early to caffeinate, or go running, or email that professor for another extension… and there it is.

The word. That word. And it’s everywhere. It’s everywhere and they’ll wash it off and paint over it and say sorry and condemn it and make feeble excuses for the feeble mind that wrote it, but it won’t matter. Black Lives… don’t.

And it’s finals week. You didn’t need this right now. You don’t have time to fight this one (but you will). You don’t have time to field the “I’m sorry/omg/don’t know what to do or how to help/I love you” texts from your friends who care, but cannot really get it… not unless those ugly words were aimed at them, too.

I don’t know what it’s like. What I do know is that students of color at Boston College have already been marching and organizing and engaging with leaders (some for a few years) to say, “Hey, this is happening… can you help?” Is there the smallest bit of consolation that this latest transgression is so egregious, so specifically racist and hateful? I mean, they cannot ignore this, can they? I mean, they’ll DO something this time, right? They’ll have to.

But when you’re white. Like, super white like me, maybe your first thought is that the bigger issue is our failure to treat mental illness, or to blame the current administration for emboldening crazies, or to put this incident in a box of outlier-type events. That’s where my mind wants to go. But that’s… unhelpful. I’m not an insider to an entire community that could laundry list similar gut punches to their humanity. It doesn’t matter why this happened; it matters how. And when a leader in that community—a community that is angry and hurting and still needs to take finals— asks you to discuss it in yours, that’s one small thing you can do. And I can try to do that without “white guilt,” which is unnecessary and vain, or guidance from black friends, who are not obliged to provide a primer for appropriate status updating to prove I’m one of the “good guys.” Especially now, when the wound is fresh… and there are still finals.

When I listen to, honor, believe, and even attempt to imagine that lived experience, I’m saying Black Lives Matter. Was this the crime of a traitor in the midst of a majority of students who believe all of The Right Things… or is it more insidious? How could you not assume the latter when you see the word. That word. Everywhere.

I cannot apologize on behalf of all white people for insane, hateful, unimaginative racists who do horrible things. But I can listen more and pray harder. Catching one bogeyman with a Sharpie might not feel like any sort of justice on campus, but rather proof of so many more hiding in dark corners.

Thinking of you, Savannah. Your strong voice, leadership, and unflagging faith are powerful. Our ears, hearts, minds, and arms are open. We’ll try harder and more often to shine light into dark corners. We’ll try harder to take up the slack.

You have studying to do.

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Christmas in 1982… by Al Norton

Al is the author of Al Norton’s Two Tivos to Paradise, my real estate agent, and most importantly, my friend and one of my favorite personalities on social media. This morning he posted a memory snapshot that was so lovely, I made him turn it into 5 paragraphs and let me publish it. Merry Christmas, friends!

In 1982, I was 11 years old… and I had my own TV. Kids of today watching a relatively new blockbuster movie on a handheld supercomputer that also makes phone calls may not find this impressive, but this was an enviable, shocking possession for a little kid in the ‘80s. Dad acquiesced to my obsession with television early on and created chores so I could earn the $100 I needed to buy it from my stepmother’s friend. It was a “portable” (like, with a handle on the top to carry it), the red model with a black and white screen hardly bigger than a lunchbox. It was all mine and I loved it. I lugged it back and forth between houses on the T every two weeks, following custody agreements of the day. I wish there was a picture of that 11 year old carrying a TV on the D Line.

Having my own TV wasn’t enough; I really wanted my own VCR. But they weren’t a thing yet. So I did what I did when making mix-tapes from my collection of 45s: I put my tape recorder up against the speaker of the TV and recorded my favorite episodes, and then I’d listen to them as I fell asleep at night. The one I remember best is the first ‘Dear Dad’ episode of M*A*S*H, which took place at Christmas time. At one point in the story, Hawkeye’s plans go awry and he sings “…if only in my dreams.”

I was driving my kids home from dinner last night when a lovely version of that song (Josh Groban) came on, and when he got to that line, I was 11 again in my childhood bedroom. I could hear that tape and the familiar but forgotten hum of a black-and-white TV, and I felt warm and secure and far away from all the stresses that come with adulthood. I could swear Mom and my stepfather were stringing popcorn and cranberries together in the living room. The smells and sounds of the season are powerful. Though I frequently entertain a fantasy of seeing Mom again, it’s always with the knowledge that she’s going to die before I turn 24. But in this more seasonal, nostalgic sort of time travel, I’m merely 11 again, with no awareness of the world to come, only the joy of family, the anticipation of Christmas, and… my very own TV.

And then I blinked, the light changed, and I was back on the highway, using the rest of the trip home to explain to the twins why ‘John Denver and The Muppets: A Christmas Together’ is the one true holiday album/special. Maybe someday they’ll be in the car with their own kids, hear John Denver and Rowlf singing “Have Yourself a Merry Little Christmas,” and remember this drive home. Maybe, someday.

I hope that you all are feeling similar spirits of the season, reliving old memories, and making new ones. I love my family. I love Christmas. I love television.

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Television, ’80s style

 

Question 1 Confusion: an argument for “No”

If Question 1 merely restricts the number of patients a nurse is expected to care for, why are so many nurses urging you to Vote No on 1? Some thoughts from a former surgical resident reminiscing about early implementation of the 80-hour work week… and why an inflexible law regarding patient care has no business at the bedside.

In 2001, I began a General Surgery residency at a well-known hospital on the Upper East Side. At that time, many programs were attempting to enact an 80-hour workweek for surgical trainees, ahead of the ACGME*-mandated law that would be enforced after July of 2003. During orientation, we were warned sternly (and with more than a modicum of sneering derision from our Chief Residents) to keep track of our work hours. After all, they had put in 110-hour workweeks for years without complaining. As they passed out the little cards, we knew they already thought we were “soft.”

Certainly an 80-hour workweek is not worthy of you’re-so-lazy eye rolling. And here is exactly how much we were “allowed” to work in the words of the ACGME:

“The new requirements include an 80-hour weekly limit, averaged over 4 weeks; at least 10 hours of rest between duty periods; a 24-hour limit to continuous duty plus up to 6 more hours for continuity of care and education; 1 day in 7 free from patient care; and in-house call no more than once every 3 nights averaged over 4 weeks.”

So, you know, easy peasy (eye roll). If you do the math, you’ll notice a 30-hour day was well within the rules, and for us, didn’t include the extra hour of travel time to an outside hospital rotation. In any case, these work hour restrictions did not make residency easier… because no one was working that little.

After I turned in my first little stack of time cards, with faithful tracking of all hours I was in the hospital or home answering the beeper (and often going back into the hospital), the assistant to the Chief of Surgery called me at my apartment.

“Britt, we need you to come in to talk to the boss about your time cards.”

“Did I do it wrong?”

“Well, you wrote that you are working 100 to 110 hour weeks. We need to discuss with you why you are unable to finish your work in a timely fashion.”

“Oh! I definitely did it wrong. I’ll hand in new ones tomorrow.”

I thought they were going to fire me. Eventually, and probably before the actual law rolled out, my program figured out how to have residents actually working less instead of just lying about it. One way programs tried to solve the work hour issue was to assign a resident the “night float” beeper. After each service finished evening rounds, they would arrange to meet with the Night Float who would hold its beeper and list of patients until rounds the next morning. It’s a great system, unless you are Night Float to a program with six services.

On a slow night, there were still probably 30-40 patients scattered over a handful of pages with instructions to check on a few who had gotten out of surgery late, or who needed labs ordered or drawn. Busier nights, which were far more frequent, meant running from floor to floor to answer questions about patients I might have only learned about six minutes before and whose chart I’d never seen. It was such a night when a patient’s daughter insisted she speak with The Doctor about her father who had just endured a rather messy gallbladder removal. There was a bile leak requiring a drain, and maybe this hadn’t been explained well by the surgeon, or maybe this was an entirely different daughter than the one in the PACU, or maybe Dad oozing green was just plain alarming. Either way, this woman wanted answers. Now. From The Doctor.

Enter Night Float Britt, The Doctor. The intern assigned to the service had “signed out” to me before this patient landed on the “floor.” This Dad wasn’t even on my list. I introduced myself to the anxious family members and confessed that I was the Night Float and would need a minute before I could answer questions.

“So you’re telling me that you are the physician in charge of my father tonight and you have no idea what is going on?”

“Yes. But I promise—“

“SHAME ON YOU.”

I’ll never forget it. Shame, indeed. She wasn’t wrong. The system was wrong. In order to adhere to work hour restrictions, the very people who were in the operating room with her dad were required to leave. Ultimately, I was able to flag down a Chief Resident to explain the green oozing and by the end of the night was on good terms with the daughter. But there were many times I watched residents fudge the work hour rules not only because it was in the best interest of the patient, but also because we cared about the patient and we were there to learn. And that night, strictly following restrictions designed to protect us, an intern was unable to follow through communicating with the family and trust between patients and providers was compromised. That night, following the rules wasn’t necessarily the right thing to do.

Patients with their unpredictable diseases cannot be expected to adhere to even the most well-intentioned timetable, nor should their doctors be forced (by law!) to abandon them. It is called the Art of Medicine for this reason, and the quality of its delivery is diminished by inflexible rules regarding the hours it can be practiced. Ask any doctor about a pivotal moment in her training and I’ll bet 80% of the time it happened during hours that would be considered “overtime” in any other profession.

In Massachusetts on November 6th, citizens will be asked to vote for a similar sort of restrictions for nurses. Though limiting the number of patients any one nurse should be allowed to cover sounds reasonable, all of the best nurses I know want you to vote against it. (And I know many, many nurses.) Voting NO on 1 means we trust that nurses and their administrators know the limits of their services. No on 1 means we have our best patient advocates, our nurses, deciding how to allocate care with informed adjustments. No on 1 might mean fewer family members saying, “Shame on you.” Patient load restrictions intended to protect our front-line care providers may undermine their judgment and hamstring their talent, instead. And you can go ahead and make comparisons to pilots or daycare workers whose profession is certainly safer for law-mandated restrictions, but when it comes to caring for a vulnerable human at the bedside, well, it’s just different.

Admittedly, the 80-hour workweek was ultimately good for surgical residents. Once they worked out the kinks, it was shown to improve quality of life and decrease “burnout” without affecting the quality of care delivered. However, there were many studies that revealed how restricting hours had a negative impact on metrics of “continuity of care” and contributed to a “shiftwork mentality” in a profession that had always prided itself to condemn. But with a bit of “give” in how work hours could be adjusted to be in compliance with ACGME guidelines, surgeons in training still have the option to see the aortic aneurysm repair to completion, check an x-ray, or even say goodnight to a patient and his family– because mandated work hours can be averaged over time.

However, a “Yes” on 1 has no such leniency and would (rather paternalistically) deny nurses any autonomy over their patient load. This is the most worrisome aspect of the ballot question because it reduces humans to mere numbers. Never included in examples around Question 1 is how a nurse with a patient that requires all of his time, faculties, patience, and skill might be asked to take on a few more because his quota is not filled. Or how the ER nurse who knows your “frequent flier” asthmatic son best might have to hand him off because the kid with a sports form that needs signing “counts” as a patient. Also, preliminary data regarding patient load-limiting for ICU nurses has shown that care was not improved after implementing restrictions. Meanwhile, both sides will agree that enforcing strict nurse staffing ratios will be difficult and very, very pricy.

Box checkers do not belong in medicine. I am wary whenever people who have never taken direct care of a patient have power over how it is practiced. I hope I have illustrated here how the argument is nuanced, and why there is so much confusion over Question 1. Some limits are good, even necessary. No one wants to, or even can sustainably, work 110-hour weeks. But anyone who has taken care of a patient in any medical capacity knows that blanket, one-size-fits-all restrictions go against the human aspect of doctoring, nursing, healing. The only people who should be calculating nurse to patient ratios are those delivering the care, and it’s a delicate balance that changes daily, hourly. At times a single patient is too much, other times 8 means you still have time to pee. I worry that strict mandated law will undermine the “art” in medicine. And here, in Massachusetts, and especially in Boston, we can trust our nurses to know how to get the work done responsibly and safely without a law telling them how to do that. Here in Massachusetts, our nurses anything but “soft.”

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Posted on FB by my favorite nurse… who is voting No on 1.

*Accreditation Council for Graduate Medical Education

 

 

 

Sexy Halloween

Nicole was my bosom-est buddy and roomie for a handful of graduate school years. We became close only at the tail end of college when, maybe, she decided to brave my off-putting seriousness or nerdiness-charading-as-snobbery and finally talk to me. (Apart from my true blue writer and musical theater friends, college was a lonely time.) Most stories worth reading describe a Nicole: exciting, interesting and interested, funny, whip smart, and crazy sexy. When I think about us in our 20s, I remember her as… bursting. Her easy confidence with boys was a tactile one, and I saw her literally nibble on a few who found that experience titillating. Even her nervous energy manifested as adorable hilarity. An utterly irresistible Italian girl, Nicole was all hair and curves and hugs and pinches. Ultimately, this untamable juggernaut of charisma and beauty settled down with the only boy smart and lucky enough to interest her for the next two decades.

But there were many years of dating that occurred between the moment she spotted him and the dramatic presentation of rings and promises, and what I remember fondly and vividly is Halloween. There were plenty of beer-ponging costume parties scattered around our Boston neighborhoods and hosted in our crappy apartments, and a few quite famous soirees with our very, very RISD artsy friends in Providence. The idea that we planned elaborate outfits and drove hours to attend a one-night-only party is unfathomable until I remember once upon a time we had zero children and an entire weekend to nurse a hangover. Carla and her then boyfriend once arrived from NYC as tin toys; and the next year after they had eloped, returned to the same party as mullet groom and pregnant bride. Everyone (but me) was extremely creative and delightful.

This was the ‘90s. Naturally, I dressed as Britney Spears because I could rock that look, and also because I already owned some version of a Catholic schoolgirl uniform that I wore every day until grunge took hold. I bet I could still find a plaid miniskirt in my closet. Another year I borrowed Nicole’s extreme cleavage dress with the silver fishtail silhouette, attached seashells to the busty velvet bodice with sticky tape, and was Sexy Mermaid. (The fact that I hadn’t asked Nicole if I could do that was testament to our friendship, or her inability to stay angry with me.) I don’t remember other clichéd costumes I cobbled together, though I’m sure they were all designed around wearing more makeup than usual and trying to look cuter than usual. It wasn’t until after I married Bernie that I was pulled out of my vanity rut and we went as Jay and Silent Bob. As I said, it was the nineties.

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Already a favorite among my oldest friends and wildly popular with my newer acquaintances in medical school, Nicole attended many of these monster mash-up parties with her future husband. One time, she was The Karate Kid with authentic competition garb. Sexy Daniel-san, this was not. Another time, as arguably the coolest girl at the party, and likely the spiciest gal in three towns, Nicole dressed up as Jimmy Buffet: hairy prosthetic belly protruding out of a horrible Hawaiian shirt, shaggy beard, bird perched on her shoulder… god, did she have a cheeseburger? This was no Sexy Parrothead costume. I’ll never forget giggling with her date over his half-lamentations regarding costumes that included more body hair than he had. Maybe next year, she wouldn’t dress up as a dude? I think we both kind of loved that she didn’t want to sex up her Halloween costume, preferring to be kind of gross or funny instead. Only a girl with that much confidence chooses not to be cute for Halloween.

(She was totally cute as Daniel-san.)

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I wonder if Nicole is still pulling these punches and adding realistic, rubbery warts to her Witch Crone getup. I wonder if her adorable daughter has inherited this trait and has made plans to be Groot or Morty or Post Malone instead of Wonder Woman or Cardi B. Truth be told, that year dressing as Jay to Bernie’s Silent Bob was the most physically comfortable I’ve ever been at a party. As Cher ruminated famously, “… party clothes are so binding.”

This past weekend was spent strolling down memory lane with my parents as they celebrated 50 years of marriage. Nicole’s name came up a few times, as you can imagine (see description, paragraph 1). And in that spirit of nostalgia, enjoy these ridiculous pictures of other, completely un-sexy Halloween outfits. Yes, that is I, an inexplicably pregnant 7 year old (wtf), an elementary school “scullery maid” (hand to heart, that is what mom called this), Frenchman (why), and a good Do Bee!

 

SHOW ME YOUR UNSEXY COSTUMES.

 

 

Cold and Hot

The biggest compliment I ever get is, “Hey, write something again, already.” Actually, it’s not the BIGGEST compliment. That one is awarded to a certain teenager who thinks his charm will be compensated with unlimited egg sandwiches and brownie sundaes. “Britt… have you lost weight?” Sit down, kiddo, I’ve got steaks for dinner. A similar kindness was delivered during Curriculum Night Cocktail Hour, which is a thing… a very good thing. Sweet, funny, cool, brilliant Michelle reminded me that I have this little virtual journal over here that’s been languishing in the back-to-school hubbub. Michelle encouraging me to write was a compliment, indeed… and she’s not even expecting egg sandwiches.

And now I find myself with some time. I’m currently shivering in a Chicago hotel room waiting for my thermostat to win the battle against refrigerated public spaces. I loathe air-conditioning nearly as much as spin class. Even air travel is a dreaded, trapped eternity where we are squeezed into small spaces and kept chilled like Diet Cokes in a Coleman. As I wait for the room temperature to approach room temperature, I’m fondly reminiscing about my last hot yoga class. Yes, exercise and “fondly” in the same sentence. That is how much I love being hot.

Vinyasa flow landing on Yom Kippur meant most of a local high school girls soccer team could trade Trig and turf to downward dog with a room full of moms who take this class for far more frequent, physical atonement. We couldn’t help ourselves from asking them who they were. It’s unusual to see physically perfect teenagers with high ponytails and borrowed mats at the 9:15 class, filling our quiet sanctuary with poorly stifled giggles and chitchat. But goodness, they were beautiful: bursting with youth and vigor and everything-ahead-of-them-ness. It was hard not to stare at them, harder still to not want to be them for just one humidified hour in clingy clothes. Finally, places were found, the room quieted, the yogi said his ridiculous yogi things (fodder for another post), and class began.

And the girls… those toned and tanned and lovely girls… they SUCKED. And it was delightful. They were inflexible and off balance, mock chagrined and truly embarrassed. Their make-fun-of-this stage whispering we could all hear was another bonus. Young pretty soccer girls were flailing and falling and flummoxed by exercises minivan moms and AARP cardholders do regularly, with ease. There was sweet beauty in that. I wondered if the other 9:15 regulars were having similarly ungenerous, stay-in-your-lane thoughts as we toweled off in shared spaces. Or, maybe other people who do yoga aren’t horrible people. But it was my favorite power hour ever… even with the far too many ohms at the end.

I hope all of us went back to closets and mirrors and scales with a little more kindness toward our (older) selves. How odd to look through the eyes of girls in their own physical prime and find ourselves elevated in the comparison, if for only one morning on a hot mat. It’s a big enough compliment to reward yourself with an egg sandwich. Bagel. Extra cheese.

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One of the reasons I do hot yoga…