In list form, because I’m just feeling that way today!
1- The new residents are orienting this week. Which means I have been busy! Today they will be doing things that do not require my presence (whew). They are so excited and shiny and impressively calm about starting residency mid-pandemic.
(We have really great residents overall. I feel very lucky about that!)
2- I survived my first nasal swab COVID-19 screening! It wasn’t thaaaaat bad. The nurse who swabbed me scared the #$&@ out of me by implying it was worse than childbirth. All I can say is — she must have had some easy deliveries! I’d rate it along the same lines of discomfort as a Pap smear. The sensation is uncomfortable (and weird!) but it doesn’t last terribly long. She did do a nice job of counting to 10 which helped. I am supposed to do this every 4 weeks so I am glad it wasn’t too terrible.
(also, I don’t have COVID-19. I mean, I didn’t think that I did – this was just a routine screening – but it’s always nice to know.)
3- We decided to focus our residency book club entirely on health disparities this year. Residents are (very) busy but we’ve managed to fit in 3 books/year, one every 4 months with a discussion session built into their didactic time. We are starting with The Immortal Life of Henrietta Lacks for some historical background. Other recs that specifically address racial disparities related to health care are welcome.
4- I went down a very dark road last night while on the phone with my sister. We started talking about a theoretical scenario where there is no lasting immunity for COVID-19 and no effective vaccine, so the pandemic would never end and we’d just have to adapt to living with the risk . . . until we die? Josh feels this is unlikely (given no historical precedent) but . . . no one really knows for sure, do they? Would we do things/see things differently today if we knew coronavirus was here to stay? I’m not exactly sure but it’s an interesting (yet slightly horrifying) thought experiment.
5- The kids held a full on dance contest for an hour last night. They seem happy and do not appear to be suffering though this — really at all. Honestly, they were more stressed when we had actual school and they were in multiple activities and often tired out.
I am glad we opted not to do camp because the one I would have sent them to opened for 2 weeks and then (yesterday) announced they were shutting down due to 2 separate outbreaks with both positive staff members and campers mentioned in email communications. I feel so bad for the many families depending on this camp as their childcare plan. #O*%#$&!! SO, yeah. Glad that we weren’t part of that roller coaster.
They still get their fill of screen time but I feel good about how we have implemented it. The big kids know there is no screen time until 1pm (when G takes her nap), and then enjoy 2-3 hours of Minecraft while she is asleep. They love the game and get to interact with their friends while playing, and while it’s probably not the world’s most educational it doesn’t seem too bad, either. It’s a fun world to explore while their real surroundings have become a bit repetitive! That’s it for iPad/computer time. After that window is over they are aware (and thankfully pretty accepting!) that they don’t get any more.
Then they are typically screen free until around 7:30 when I (sometimes) let them watch TV shows or a movie for 1-1.5 hours depending on behavior. If they are playing together I do not remind them about the TV.
I feel at peace with this amount for them. I would like them to spend more time outside (they spend about an hour each morning) but honestly it’s HOT AND HUMID and I don’t really want to be outside right now much either. In an ideal world, they could all swim in the afternoon but really we can only do that on weekends (our nanny is not comfortable with this and I 100% am fine with that!).
Someday when G can swim, that part will get easier. I *do* have lessons planned for her later this summer so that will be a nice added bonus.
Okay I wrote more than planned (the kids are still asleep!). Happy Thursday.
One day at a time. <– My new 2020 mantra
What do your kids do right when they wake up? My boys tend to want to play video games right away for an hour or so in that window of time when the house is still kind of quiet or it’s too early to be outside/ we are getting ready for the day, etc. We have been letting them have 1 hour then but no earlier than 7:30 a.m. (otherwise I have one who would bolt out of bed at 5 am to play if he could!). But sometimes I don’t like it because I feel like if they weren’t playing games then, they might go sit out on the deck and read and enjoy the beautiful morning or just do something else! But I also understand them wanting to sort of just veg out for a little bit when they get up (10 and almost 12 year old boys). I go back and forth on it all. They do spend a lot of time outside later in the day. We’ve been saying 2.5 hours total of screen time spread throughout the day however they want, but sometimes it’s hard to keep track of this way too…
My younger kids have screen time first thing in the morning on weekdays. They can do pretty much anything until 8:30. Then the screens are off, pretty much for the day. They can earn up to 40 minutes of Epic Books to use later in the day by reading real books for 30 minutes, practicing math for 15 minutes, playing outside for >1 hour and practicing their instruments. My 13 yo gets 3 hours to use any way he wants (he is usually trying to coordinate with friends). Lately they have been up with the sun, but they are self-reliant until about 7. We tried to get them to stay in bed later, but my 7 yo said “But Mommy! I have an alarm clock INSIDE me and I just CAN’T sleep any more!” What can you say to that.
they hang out, play with each other, get into fights (!), play with toys, draw, and then after our nanny gets here they typically do their outside time (otherwise it gets too hot!). they don’t even bother to ask for screens before 1pm b/c they are conditioned to know the answer will be a hard and fast no. it works for us. for now, anyway.
oh and mine are up any time between 6:45 and 8am and they just eat breakfast, loll around, entertain themselves. since i get up super early I am usually done with my workout etc by the time they wake up. If annabel is the first one up and I’m still working out she knows she has to let me finish 🙂
I really liked Henrietta Lacks (though I did the audio book). Kiese Laymon’s memoir Heavy might be of interest to you.
My kid also starts screens first thing am, which is helpful for me in terms of having some quiet time in which to read (mostly for work, though I’m here on your blog now!) If I had a napping child, I would definitely institute quiet time in the afternoons. Then Tiny Boy is off screens until dinner prep time and ‘earns’ it by doing his summer educational activities… (reading & math or writing).
The question about pandemic ongoing is a good one. It feels honestly likely to me, unless there’s a vaccine that works and soon.
We have a similar schedule – mellow wake up and stories, breakfast, playtime and then a long cycle ride, home for lunch, rest/nap, and then screentime for an hour, followed by playtime/working in the garden etc. If we do screentime early in the day, it’s a disaster, and he asks for it all day long. But if we’re really consistent with no screentime until 3pm, he’s fine with it.
Oh man, that nightmare scenario better be a nightmare and not something even close to reality! I have been dealing with all the changes fairly well because I tell myself by 2022 we will all hopefully be vaccinated (I know they think there will be a vaccine by end of year/2021 but it’s going to take quite awhile to have everyone vaccinated!)
How about “Black Man in a White Coat” for your book club? I’ve been meaning to write that. And, like you, the author went to Duke! I think he talks about the experience of being a black doctor, but also about the black population is more likely to suffer from things like hypertension, diabetes, strokes, etc. Could be an interesting read!
Also, that person who said the COVID test is worse than child birth? WTF. No way. I thought it was unpleasant and I did not know they had to count to 10 (and she didn’t count out loud) so I was wondering ‘why is she still poking around up there! I’d rate it worse than a pap, though! But child birth? No freaking way. Nothing is worse than child birth, although I’ve heard passing kidney stones is on par or worse but that makes sense. A nasal swab? nope.
Re: #4 I’ve gone down that dark road too. I’m older than you and worry about how life will be for my adult daughters in the future. I wonder if they will choose not to have children in this uncertain world. 😢 I’ve read several articles predicting a baby bust in the next few years.
hello Sarah! Love that you are focusing your resident reading on health care disparities. It has a surgical focus (trauma) but “Wrong Place, Wrong Time” by John Rich is excellent. Also another book (by a Duke grad!!) that is super is” Black Man in a White Coat” by Damon Tweedy.
I’m now the PD for my surgical residency and we are incorporating bi-monthly discussions on Social Determinants of Health into our Grand Rounds schedule.
I haven’t read other comments so don’t know if this was recommended, but I read “The Health Gap”by Michael Marmot. It was really interesting!!
“County” by David Ansell is a good one that explores how root causes (racism, segregation, poverty) impact public health and health care. It’s focused on Chicago’s Cook County hospital, but I’m sure applicable to other places.
I do think it’s fairly possible that immunity to COVID-19 is short-lived. It could be that we need annual boosters, which wouldn’t be so bad (and maybe would incentivize more people to also get the flu shot at the same time!)
I highly recommend ‘Health disparities in the United States: Social class, race, ethnicity, and the social determinants of health,’ by Donald A. Barr. The third edition came out in 2019. And, while ‘Stamped from the Beginning,’ by Ibram X. Kendi is not specifically about health disparities, Kendi does an excellent job of explaining racist ideas, including those that have affected patients in health care settings. I also recommend ‘Between the World and Me,’ by Ta-Nehisi Coates for a powerful discussion about coping with the physical experience of institutional and interpersonal racism.
I am curious if you knew whether the outbreaks (Meaning 3 cases?) were among the camp kids or staff? Also wondering if the cases came into the camp through a child or adult.
3 separate clusters of cases with positive staff and at least some positive kids. Our region is surging right now so this makes sense.
Omg!!! I have seen articles about the daycare centers that stayed open having very few cases like this. 3 separate clusters in 2 weeks is a lot even considering how much of a hot spot fl is
I went back and looked and it appears to be 2 separate clusters, one in preschool and one in upper camp. I thought it was 3 b/c they sent two separate announcement about cases in the preschool but I think they were all in same group. It’s STILL a lot.
I went back to the original emails and it was 2 clusters. Both positive staff & campers were mentioned. They did not comment on severity of illness, so could be anything (even asympomatic) – not sure.
There is some literature on how we still undertreat pain in black patients, including children. And a literature about trust in physicians. (Julia Rosenbloom, Katrina Armstrong). I am happy to forward you a research letter I wrote on rounding time in the ICU.
Ohhhh fascinatIng. Yes email it to me!!!
The Spirit Catches You and You Fall Down!
I read that book right as I started medical school & loved it!
Second vote for this! I read it probably 15 years ago and still think about it regularly with regard to patient care.
I highly recommend “The Spirit Catches You and You Fall Down.” It’s a commonly read book in public health undergrad and graduate programs and highlights cultural competency, medical mistrust, and health communication all focused on a pediatric patient.
love this book & read it prior to starting med school. it was required and for good reason.
Long time reader, first time commenter and history professor. I know you asked for books, but would you consider documentaries as well? I highly recommend “No Más Bebés,” a documentary about the forced sterilization of Mexican-American women in LA in the 1970s. It provides great context about other groups around the country that experienced this as well. Also, “Bad Blood: The Tuskegee Syphilis Experiment”
Also a history prof here 🙂
A book companion to No Más Bebés is Alexandra Minna Stern’s Eugenic Nation: Faults and Frontiers of Better Breeding in Modern America.
*Harriet Washington, Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present
*Dorothy Roberts, Killing the Black Body
*Michelle Goodwin, Policing the Womb: Invisible Women and the Criminalization of Motherhood
*Osagie Obasogie, Blinded by Sight: Seeing Race Through the Eyes of the Blind
*Keith Wailoo, Dying in the City of the Blues: Sickle Cell Anemia and the Politics of Race and Health
*Alondra Nelson, Body and Soul: The Black Panther Party and the Fight against Medical Discrimination
*Alondra Nelson, The Social Life of DNA: Race, Reparations, and Reconciliation after the Genome
*Ruha Benjamin, People’s Science: Bodies and Rights on the Stem Cell Frontier
Omg thank you!!
Yikes, that dark road!! I can’t think about that! Also, I started the total body cardio fix from 21 Day Fix today and it was great! I’m not a huuuge weights person (I find it hard to stick to it for some reason…) so I’m hoping by telling you about it maybe I’ll last a bit longer this time? Haha.
You can do it!!!! 🙂 🙂 🙂
“The Spirit Catches You and You Fall Down” (I’m sure you’ve already read it) I work in deploying technology in rural communities, mostly in East Africa, and there are a lot of parallels with medicine.
I agree with Josh, I think that dark scenario is HIGHLY unlikely!
The fact that there is evidence of an immune response (development of antibodies following infection) is encouraging for vaccine development. Thankfully COVID isn’t mutating as quickly as say, HIV, which also leads to a high likelihood that a good vaccine will be available in the not so distant future. It’s also true that immunity from either a vaccine or exposure might not be lifelong, which means that vaccines will need to be boostered yearly. Just like H1N1 is now endemic, COVID will probably become endemic too. But eventually enough people will either be infected or vaccinated against it, reducing community transmission and allowing us to get on with our lives.
But if I’m wrong, and COVID behaves more like malaria or HIV, then at some point we will have effective treatments that reduce morbidity and mortality. HIV used to be a death sentence, and now the situation is so much different than it was in the mid-1980s. People will keep having babies, living their lives, and start traveling again– I promise!
For resident reading, I recommend Tracy Kidder’s Mountains Beyond Mountains (about Dr. Paul Farmer, founder of Partners in Health) and Randy Shilts’s And the Band Played On (about the early years of the AIDS epidemic).
They could even watch And the Band Played On (such a good movie!). Angels in America is good too.
I totally have been having that nightmare scenario fear all week as cases are going up. And also what if people get collectively brainwashed to refuse the vaccine. Maybe that is too far though…
Bad Blood-the Tuskegee syphilis experiment
Not a book, but I show Unnatural causes: In sickness and in wealth in one of my classes. It does a fantastic job in summarizing a lot of the important early research on health inequalities, outlining the different things we’ve been thinking about from several different social sciences, and interviews some of major people who did the early research. Plus it is available for free online from PBS. https://www.pbs.org/unnaturalcauses/hour_01.htm I cannot recommend it enough and it’s only about an hour long. It’s how we start the disparities section of the class right after Spring Break and it sets up the rest of the semester beautifully.
It is a little old, but it is not at all out of date. None of the research they talk about has been disproven to my knowledge, it’s all foundational to the newer work that has been done since.
There’s also a frontline documentary on teeth that isn’t just focused on racial disparities but really sticks with my students because it highlights how big companies and guilds collude to defraud the government and take advantage of Medicaid patients, among other things. They get their friends to watch it(!) (Also available online and very eye-opening.)
Great choice with Henrietta Lacks, and I agree with Tasha about the Tuskegee syphilis experiment. A couple of my friends recently did an amazing paper on how the legacy of Tuskegee still has negative health effects today.
I need to check out the other recommendations in this thread!
ARGH. Here’s the actual link to In Sickeness and In Wealth. I always start with the wrong page… https://www.kanopy.com/product/sickness-and-wealth
Also loved The spirit catches you and you fall down, as well as Mountains Beyond Mountains. What the eyes don’t see by Dr Mona Hanna-Attisha about the Flint water crisis is great too.
I learned so much from the Henrietta Lacks book… was also deeply moved by this book by Abraham Verghese https://www.amazon.com/My-Own-Country-Doctors-People-ebook/dp/B01N8QME9P