Saturday, November 28, 2009

Thank you Bob Herbert and David Brooks

As I begin to see light in my refrigerator again and continue to clean and put away dishes, I am thankful for the chaos and mess that my children have wrought. And for my dishwasher that keeps on purring.

I am also grateful for articulate people in positions of power who speak out for our children. In today's New York Times, Bob Herbert waxes poetic about the innocent joys of children watching Macy's Thanksgiving Day parade. And he admonishes the adult world for continuing to tolerate a society that is unfair to the disadvantaged, that engages in "stupid" wars, and that perpetuates a "hideously dysfunctional" education system.

On the PBS Newshour on Wednesday night, David Brooks struck a more hopeful but less specific note when he closed the hour by mentioning how grateful we can be for young people under thirty in our country. He noted how many wonderful, creative and laudable activities they are all engaged in. And he reminded us that in these times of reflection about where our country is going and what our values ought to be that these kids are out in front.

In my family and professional circle, I know of countless young people who are looking to the Peace Corps, Teach for America and the military;engaging in internships in all manner of health care and education institutions; providing low or no cost legal and medical services to the poor; and seeking work across the globe. A few years ago Brooks coined the term "the odyssey generation" for these college grads who may wander, switch, experiment, question, turn around, and seek their paths. They are surfing the globe in search of the best mix of work, play, contribution and meaning.

I feel blessed by their optimism, agility, and ability to look at this complex world in a relatively directed way and work to see their way through.

Tuesday, November 24, 2009

Orchid or Dandelion?

As you look around the Thanksgiving table on Thursday and size up friends and family, try this new framework for thinking about loved ones. Would Uncle Larry be best described as a dandelion--a hardy, rugged, weed-like character who can push up through the asphalt and survive with little attention? Or would he best be described as an orchid, an unusual and finicky guy who has required hot-house conditions but has made good--and then some--in his circuitous life?

In an article in December's The Atlantic entitled The Science of Success, David Dobbs elaborates on this metaphor in a thought-provoking way that might have bearing on how we view and raise our children. He cites a number of research studies that show what might seem intuitively obvious--that environment and parenting (read nurture)impact personalities and have huge effect on the expression of certain emotional/psychological genetic tendencies (read nature). We know that if a person has an inherited tendency to depression, an unfortunate confluence of life events (divorce, death, debt or disease to name the big D's of life) or any one of them alone can be enough to trigger severe psychological disorder.

What Dobbs says we have not taken into account is the idea that these genetic tendencies must have survived in the gene pool for some "reason." In fact, he says, a genetic predisposition for some emotional "disorders"--and he especially looks at ADD (attention deficit disorder)--may actually impart a selective genetic advantage under the right (hot house?) conditions. The energy, ability to multi-task, and the creativity and flexibility inherent in some of these folks will make them productive contributors to society at levels beyond those of the dandelions in our midst. But only if their disorganization, inattention, proclivity to accidents and poor judgment doesn't get the better of them first.

So what is a parent to do? My answer would be that we need to be realistic about our genetic tendencies (look at Uncle Larry with an objective eye), recognize potential emotional and psychological problems early in our children, and learn to be "professional parents" to the more complicated plants under our care. And now, in addition, we can be thankful for their presence in our midst and optimistic that with careful nurturing they will bloom and flourish alongside the hardy dandelions.

Wednesday, November 18, 2009

Unfriending Hits Home

Many of us have heard by now that yesterday the Oxford English Dictionary (OED) announced its word of the year-- “unfriend.” At first I thought “how modern!” of the OED to choose a word associated with social networking.

Then I heard on NPR that “unfriend” actually dates back to the 17th century and meant about the same thing it does now, although it is currently exercised in previously unthinkable and creative ways on Facebook and elsewhere. No longer is an actual gauntlet or epee required to “unfriend.”

So hearing this, it could not have been more timely to see a patient in my office yesterday afternoon who was describing the drama of her last year and a half as she emerged from a painful middle school experience and has begun to settle nicely into high school. In the process, however, she has had to “unfriend” a MeanGirlWannabee or two. Liberating herself from the toxic influences of these personalities was not a negative move at all. Instead, I supported her decision to be herself and to accept that not everyone is “friend” material. The dewy eyes that I saw as we talked were a clear indicator of the intensity and anguish involved in the decision and process of extricating herself from an old group. Not to mention the scary steps of judging, navigating and cultivating a new set of companions moving forward.

There may be pain in severing relationships whether that happens electronically or through face to face negotiation. Having language to describe what happens in the new world of e-communication—apparently “sexting” was a runner-up for Word of the Year—will go a long way to encouraging dialogue as we all grow and evolve with the many new inventions quite literally at our fingertips.

Sunday, November 15, 2009

Health Care Reform and Restoring Dignity to Medicine

With so much talk about health care reform it's easy to lose track of the individual stories of people across the country who live, get sick, need care and "consume" health care. There is probably no better way to appreciate these stories than to hear Anna Deveare Smith tell them. The actress, interviewer and playwright is currently in performance in New York with her "Let Me Down Easy" show which is a distillation of interviews conducted with over 300 patients and people across the country over the past eight years. From this vast trove, Smith has developed 20 roles that she plays on stage in her one woman show.

Her project started as an assignment from a Yale medical school professor who asked Smith to show doctors how to gain understanding and insight from really listening to patients' stories. But she goes way beyond her original assignment to show us how the likes of Lance Armstrong, Ann Richardson, a rodeo rider and a New Orleans Charity Hospital physician look at illness and suffering in the broadest sense. We learn from Smith about our health care system, about the ways folks struggle with life and death and the life cycle, and about how to rescue "grace and kindness" in a world of suffering, disappointment, and broken hearts.

One of the best segments is about the notion of charging one price for whatever ails you. It makes complete moral sense that the cost of whatever problem a patient has should not be based on its threat to his or her life. In an interview on public television with Bill Moyers
Smith says that when people are charged a "flat rate" for care, "that's when you'll get your good doctors," when money doesn't matter any more.

Now that Wall Street can no longer necessarily pull the best and the brightest, we can hope that the helping professions will attract some of those best and brightest for the right reasons--namely to engage with people. Prospective doctors will see that they can treat themselves to the joy of medicine through patients' marvelous stories, not merely because of a dearth of money-making jobs elsewhere.

Friday, November 6, 2009

Hands Free Parenting

In its online article, "Nagging Goes High Tech", ABC news reported that 63% of parents say that texting has improved communication with their kids. On the other hand, it can easily be seen by teens as a new way for parents to breathe down their necks. "One time my mom got my report card and texted me, telling me I was grounded for two weeks," recalled Jessica Purcell in the ABC report.

During a recent parents' meeting at my childrens' high school, the principal implored parents not to text kids during the day as it is not only disruptive, but bad parenting. For instance, he said, it is not a good idea to text right after the math test. Let your child process his thoughts, feelings, anxieties and concerns or even his elation over the test before you try to edit those sentiments by intruding with :"How did it go?" The principal went on to describe a parent who phoned the math teacher after such a test/text situation before the school day was even over! How will we teach our kids resilience and self-reliance if we don't allow them to tussle with and deal with emotion-laden moments on their own?

It is useful to remind ourselves that teens change their feelings and viewpoints very quickly and it is often healthier (and brings less drama) to wait a few hours and see how they have sorted things out for themselves without parental input.

Monday, November 2, 2009

Play the Pneumonia Game with your kids and students

Today is World Pneumonia Day. I had no idea until I received a clever email from Save the Children entreating me to play "Mission Pneumonia". Never one to turn down a challenge (I love the SAT question of the day, for instance), I clicked into the game. It is an apparently simple strategy to get you to donate money (of course) but just as important it teaches us about pneumonia:

  • pneumonia is preventable and treatable;
  • a child dies from pneumonia every 15 seconds somewhere in the world
  • community health workers are a powerful force against the #1 killer of children under 5

What are the most critical actions you can take? Log on and play the game at Mission Pneumonia.