Wednesday, December 26, 2007


Much has been made of the loss of tradition in the family and I think that loss is a bad thing. Ritual has a place and our children are none the better for its absence. Some ideas about ritual and tradition are:

Bedtime ritual: whether it's bath, book, and bed, or some other variation on this theme, it's a good idea to have a ritual that tells a child that bedtime is approaching. Then when the time changes or you're on vacation or some other unusual situation, that ritual adds a normal flavor to an abnormal circumstance, and kids and parents alike will benefit.
Mealtime traditions: my son's girlfriend's father has a rule against kids wearing hats at the dinner table. No matter where or when, it's not OK to have on a hat at a meal.
No phones, TV's, ipods, etc., at mealtime. That's a great tradition.
There is great support in family psychology literature for the importance of the family meal. I preach on this in my office regularly. Dinner is at a certain time, at a set place, or at least an agreed upon place, without distraction, every night or enough nights that when it is missed the kids will notice and miss it. The importance of this, starting when kids are very young, is hard to overstate.
Special traditions: ice cream after church or Friday night pizza. Good examples of "sins" that most of us would like to indulge in occasionally but need to keep to a minimum. If the family goes to church on Wed. night (i'm in Oklahoma!), then a trip to Braum's for ice cream is a reasonable tradition and one that gives the parents of an overweight child or a child that isn't always making the best food choices an "out" and a response to the request of that child for ice cream or other treat. It seems like a lot of successful weight loss/diet programs have a "free" day built in - we have to have ice cream sometimes! The point is that if there is a situation where a child is always wanting dessert or pizza or something that isn't good all the time, a tradition of Wed. night ice cream or Friday night pizza is a "safe" and "legal" opportunity to indulge that can be looked forward to by that child or the parent of that child when he/she asks. It's not just for that, though. The regularity of such tradition is reassuring to children and lends more credence to the family mentality so often missing in our soccer practice society (my pet peeve).
Be careful in establishing traditions or continuing traditions. Some traditions are best left in another generation. I won't mention any in particular, but the story of the women discussing why they cut the ends off the ham before cooking it is a nice illustration of tradition continuing without reason to continue. Just be sure the tradition is a good tradition, or at least is harmless.
respond with your traditions and idea for rituals and traditions.

birthday boxes

OK. I'm asking for help here. If anyone reads this and is interested, I've borrowed a concept/idea from somewhere, and if I find out where I will be glad to give credit, but here's the idea:
Birthday boxes: a box that a child opens each year. The box contains a list of privileges and responsibilities for that year or age. For instance, when can a child have a cell phone? a date? spend the night with a friend?
when should a child - empty the dishwasher? make their own bed? be responsible for their own laundry?

the idea is a good one and one that bears examination. i've ordered some books on development so i'll be an expert soon, but until then...i'd love the input of parents as to the answers to these and other things that might go in the boxes.

as far as sibling rivalry goes, this is a great concept. as far as the answer to that question your child asks at just the wrong time in just the wrong company, this will be helpful.
with siblings, the eldest is the one who "shovels the path" and then the others are coming up quickly behind and getting the benefit of the plowed road without the work, metaphorically. so when you decide that your 8 year old can spend the night with a friend but the friend has a 6 year old who is a friend of your 6 year old, it's pretty easy and tempting to let your 6 year old spend the night, too, right? but is that fair? ok, nothing is fair, but the birthday box idea puts down on paper these sticky questions and adds concrete to the ideas we have but so easily dismiss in the heat of the moment.
so...what can kids do at various ages? it's easy up to 5 years or so. but when do they get a cell phone, ipod, computer...? you might want to put "electronic/digital media device of current technological significance and popularity" to cover for the fact that my parents wouldn't have thought to put an ipod in my 48 year birthday box! you get my meaning. things are moving too fast to put the specifics down for certain things, but the basics will apply forever - spending the night, going to a movie, going on a date...
help! i'd love your comments.

Saturday, December 1, 2007

true love

I read an article in People magazine today. I know, my wife bought it, I wanted the National Enquirer that told whether this or that celebrity was gay or not. I'm not sure if the opinion is that it is a good or bad thing anymore, and as they say, any publicity is good publicity, but I hope I'm never on a cover with that title. Well, there was an article in the back, behind all the junk about stars and what they're wearing and who they're seeing and used to see and have procreated with and the progeny thereof, etc., that struck my fancy.
At first, from the title "Her Husband's New Love", I thought, "here we go again, a cheating husband, a scorned ex Supreme Court Justice. But the very short story, tucked between stupid crap like Wheel of Fortune's 25th anniversary and Wayne Newton's heart problem keeping him from "Dancing with the Stars" (funny, I thought it was his dancing that kept him out of that), was about Sandra Day O'Connor and her husband. He has Alzheimer's, she resigned from one of the most prestigious and unassailably secure jobs in the world to take care of him, her husband of 54 years. Wow. I'm a fan already. She deserves praise and recognition for that, more than on page 129. But since she didn't kill him or try to kill him, and since he didn't meet someone online and leave her, it's in the back. But it's a great story.
True love. Jesus said "Greater love hath no man than this, to lay down his life for his friends". At first you think He's talking about dying, and I suppose He was/is, but laying down a life while living is maybe harder. See my wife's blog at and read more of that on today's post. Well, Mrs. O'Connor's hubby, the one with Alzheimer's, has moved into a facility where he gets the care he needs around the clock. This is not a copout for her, to care for patients like this requires more than just a loving spouse, and I'm sure this place was well researched before she sent him there. And she visits him there a lot. Heck, she quit her job to help take care of him. So, when she visits, he doesn't remember her. Doesn't know they've been married for over half a century, or that she was one of the most powerful women in the world. She's just a lady who comes to visit. And he's got a girlfriend. Yes, that's probably why People picked up on it. He's got a girlfriend he met in this facility. When Justice O'Connor goes to dinner with him, he often brings the "other woman". Does the Judge go bonkers and demand separate facilities or a restraining order for this hussy? No, she approves of it. She understands that he doesn't know her and what he is doing, and she cares more about him than about herself. That is laying one's life down for a friend. That's true love. I'm sure there are many stories like this around, but unfortunately, they don't get publicity because we want "dirty laundry" as Glenn Frey or Don Henley sang, it was one of those Eagles.
True love. What a concept. What a visible example in this day of wanton selfishness of which I'm as guilty as the next guy to look at the car wrecks and divorces and arrests and addictions instead of the good stuff. Jack Johnson sings a song "Where did all the good people go". It's real good.
Way to go, Judge. If I published People, you'd be on the cover.


No wonder everybody's got ADD now. You can hardly go into a restaurant without a TV being visible from every seat. The distractions offered are often mundane reruns of football games now, but they are distracting nonetheless.
Unless you go to a pretty upscale restaurant you'll be assailed with the option of talking to your tablemates or watching the TV. Maybe it's ingrained in our brains now, but TV's are hard to ignore, harder than ignoring our spouses, it seems. Funny how it seemed the other night that if I asked to have the TV turned off I would be breaking some unwritten taboo of the restaurant, though the other tables nearby didn't seem any more interested in the rerun of the game than I was. Why was I so afraid to ask? Why don't I just tell them to turn off the TV by my table if everyone around agrees? Or if we're the only ones there?
Even when I make rounds in the hospital to see newborns, the TV is almost always on, regardless of the time of day or the program playing. It's just like background noise. It's a rare occurrence now that a mom or dad turns it off while I'm there. Some turn it down, rarely off. Maybe they don't have ADD like I do when I'm in a restaurant.
Now in a sports bar or a sport-oriented restaurant it's expected that a TV will be playing, and several games/sports may be offered at once depending on how one wants to be seated. I've even gone to specific restaurants to see specific sporting events. But when I'm going out to eat at a reasonably nice place, does there have to be a TV in every corner? Is it that the management is told from the owners that TV's were high on the opinion poll they did so they added them in response to the few people who fill out those surveys? Who knows? They are there and they are hard to ignore. If they weren't there, they'd be easier to ignore. Am I the only one who has noticed this or been annoyed by it? It seems to be a cultural trend to provide some sort of visual or auditory entertainment at all times and if one is left in the quiet with one's thoughts or one's spouse or friends it is an affront to societal norms. People might start talking about important stuff, make important decisions, have quality relationships, and who would that benefit? We might actually listen to each other, or read, if noise of an auditory and/or visual nature wasn't a constant presence. Is this subversive? Are they sending subliminal signals through ESPN? I doubt it. In fact, I'm pretty sure it's just because we swallow whatever they put in front of us most of the time without question and we watch because it's there, not necessarily in the same vein that people climb Mount Everest because it's there, but similar.
OK, off to watch TV.
Just kidding. In closing, I'll share my favorite 2 bumper stickers from a previous life in Boulder, Colorado, where things like this are debated on the editorial page as if they matter as much as who the next president is going to be (and maybe they're right, since TV will at least play a major role in that process): Subvert the dominant paradigm, and Question Authority. As long as it's not my authority you're questioning or my paradigm you're trying to subvert, these appeal to me. At least I'm honest.


OK. Another teaser title. I am definitely pro-life, make no mistake, but this is about other choices, not the life and death ones.
Parents want a say in their kid's medical care. I understand and respect, and even expect, that. They can go and get another opinion, they can challenge diagnoses and medication choices. In this day and age of insurance Nazi tactics, they are forced to do things they don't want to do to get to where they need to be. But that's another rant.
My wife likes to decorate and design, to put her "touch" on things to make them more beautiful or functional or both. She is very good at it. In buying or building a home, she has definite ideas. She knows what she wants and why she wants it. I've learned, at least most of the time, not to argue. The builder or tile-setter or painter or concrete guy or landscape designer or plumber can give her good reasons why her ideas can be done or cannot be done. And she's good at listening to them and usually agrees if they disagree. She doesn't, however, usually inspect the work of the guys who dig and lay the foundation and pour the slab, prepare the ground before these things occur, or have much input into the earliest stages, stages that make a house stand up to high winds and rain and tornadoes, etc. She trusts that they are doing that part right. They are experts, and she's chosen them because of that expertise, and her (and definitely my) lack of it in these areas.
To my point: Parents can participate in all decisions about their kids' healthcare if they like, but there are some areas in which the expertise of the physician should be trusted and left to faith since they (usually) chose this physician because of his or her expertise and reputation. Let them pick the wall colors and ceiling fan stuff. Stuff like which formula to feed, or whether to breast feed, but one must feed the baby. They can choose the crib and bedding, but let the doctor tell them how to let the baby sleep there. To school or not to school, fine. But you must teach. But it's interesting how people seem much more willing to argue with a doctor vs. a plumber over the best course to take to solve a certain problem. Granted, the parents live with the child. Well, at least one of them usually does, and when divorce happens, it's like two people whose interests couldn't be reconciled together trying to build a house apart and wondering why it looks like neither of them wanted. Once again, another rant. So, firsthand experience with the child and the behavior or illness is very important, and should be something the doc takes seriously. But then let the doctor tell you what to do some times. Not every time do you have to go with that, but the vast majority of times we know which ceiling fan will work in this room and why, and if you insist on the one you want because you heard about it on Oprah or the Today Show, don't come running to me when it falls out of the ceiling or gives you a buzz haircut because the ceiling isn't high enough for it. Parents are fearful, for instance, of steroids for asthma. Concerns about growth failure and immune suppression abound. Same with immunizations. But docs do have a little experience dealing with asthma and what works and why and why an inhaled steroid might work better for your kid than Singulair or vice versa regardless of what you read or saw or your neighbor told you or your good friend the urologist whose asthma expertise never materialized to begin with. Deep breath. It might do parents some good to listen to their docs more before putting in their two cents, and I agree the reverse is true as well, but if parents listened and did what the doc said, then if things don't work out as forecasted, it's the doc's fault. If I recommend a course of action and you take it and do it as I've prescribed, and it doesn't work, shame on me. I'll be doubly invested in finding another way that works for your child. If, however, you've already picked the road to take and I let you go down it, when it dead ends into failure, my first response is going to be outwardly, "gosh I'm sorry that didn't work out like you and Oprah thought it would", but inwardly know that I'm saying "if you had just listened to me this might have worked out differently". Those who know me recognize the "good luck" theory in practice, and I'm more than willing to be the "parent" in this scenario, but I hope that the "kids" learn from their mistakes.
I absolutely do not want total control of my patients. It scares me to think that some people go home and do things just like I told them to because I am so not used to that that most of my advice is 50% tougher than it needs to be to compensate for the 50% compliance rate expected of most parents. And I expect my parents to have, and use, brains. Theirs, or someone else's if need be. If they are seeing a problem that worries them, they are to call, or email. If it's a bad problem, like an allergic reaction to a medicine, they should stop it and call. But to follow my instructions blindly is not my intent. To tailor them to their liking is also not my intent. It's amazing how many constipated kids on miralax get better so guess what? Their parents stop the miralax, then they call and wonder what happened. Did you ever think the reason billy was better was the miralax? Or that the Singulair they've been taking is why they've not had any cough or wheezing? I'm all for keeping kids off medications if possible, but if not possible, and proven not possible, then just give it! It would be like me telling the builder that we haven't had any water problems yet so don't go ahead and put that roof on that we had planned, we don't seem to need it, and it really costs alot, even though there has been no rain! Or since we haven't had any burglaries we can just get rid of our security system - maybe that's why we haven't had any problems!
Enough on this. If the point isn't obvious, let me restate/summarize. The doctor is at least allegedly the expert in medicine, so let the doctor decide what's best, given your input, and go with what the doctor says, and see how things go. Your doctor might faint if you say "you're the doctor, just do what you think is best", but he/she will appreciate it. That may be why my dad, a pediatrician in another era, could see 80 patients in a day, and I'm busy with 40!