Monthly Archives: November 2006

The second year in retrospect

I expected Jamie’s second year – the start of his official toddlerhood – to be tough, and it has been, but not really for the reasons I’d expected.

What I was expecting was tantrums.  I was braced for tantrums.  Lots of them.  The parenting books all assured me that toddlerhood and tantrumming are practically synonymous.  I’ve never seen the film ‘Kevin’, but apparently it starts out with a sweet co-operative child bidding his parents goodnight on the night before his thirteenth birthday, then coming downstairs the next day having mutated into a full-blown Teenager.  I sort of expected toddlerhood to be like that – my sweet baby would go to bed after a lovely day partying for his first birthday, and when he woke up in the morning his first act would be to throw himself down kicking and hitting the floor and screaming "Nooooo!  Noooooo!", and thus life would continue for the next year, with brief intermissions every so often while he picked up new words.  While I vaguely supposed it probably wouldn’t literally be like this, that’s still a fair summary of what I expected.

It has, in actual fact, been almost nothing like this (as far as either the tantrumming or, alas, the learning to talk is concerned).  Oh, we did have a brief spell after he met up with the granddaughter of a friend of my mother’s, who is about ten months older than him and who did have classic spells of screaming and arching her back when she was frustrated about anything, when he apparently thought "Aha!  That looks like fun.  Must try that".  Which, despite what I’d expected, turned out not to be a problem.  Although all the books go on about how infuriating tantrums are and what a pain they are to deal with, what none of them say is that they can actually be a highly welcome break.  Slumping to the floor screaming is one of the few activities a toddler can undertake that’s harmless to both himself and the world at large.  Whenever he started, I thought "Thank goodness for that!  I can get a couple of minutes of computer time in."  Unfortunately, he got bored within a few weeks and stopped, but, believe me, I made the most of those breaks while they lasted.

The hardest part of having a toddler is, you see – at least for me – the fact that their ability to get into everything is, at this point, running so far ahead of their ability to understand why it might be a good idea to show some caution and restraint in doing so.  Oh, we have the house safety-proofed, but safety-proofing isn’t annoyance-proofing.  Unless your decorating arrangements happen to include large numbers of high cupboards in every room into which you can simply shovel everything from the remote control to the salt-cellar to your entire pen collection, there are going to be plenty of things that are still within a toddler’s reach that they shouldn’t have, and that number is going to increase as time goes by.  (For example, Jamie has recently figured out how to climb onto the shredder next to my desk and thence onto my computer table, therefore gaining access not only to the stereo – which is what he’s really after – but also my expensive and pokable LCD monitor and the stuff such as pens and floppy disks that I put out of reach at the back of my desk or on the control tower.  And there just isn’t really anywhere else I can put the shredder.)

With a young toddler, the simplest of daily activities becomes an exercise in logistics.  A while back Shannon, from Peter’s Cross Station, wrote about how she spent a typical day caring for her then-eighteen-month-old toddler, and she was saying that after Nat’s breakfast Nat toddles round the kitchen while Shannon sorts out the stuff from the dishwasher and gets a load of laundry on… Believe me, that sort of simple description does not begin to cover it.  The reality is more like "Open dishwasher, put away one item, open dishwasher again because toddler has closed it as soon as you had your back turned, put away a couple more items, switch dishwasher off because toddler has closed it and pressed that interesting-looking button on the front, open dishwasher again and realise the knives on the top layer are within his reach, grab them and try to dry them while fending off a toddler with, um, the third hand, tell toddler how good he is for trying to help but could he give Mummy that plate, please, as it isn’t really a toy, and, yes, that fork as well, try to inspect items removed from toddler’s fingers for stickiness/do any needed rewiping/put them away before toddler has a chance to switch dishwasher off again, fail, remove toddler firmly from vicinity of dishwasher, switch off dishwasher, switch off washing machine that toddler has just switched on due to having been moved away from dishwasher, manage to put another glass away, agree with toddler that, yes, the bright lights on the front of the water filter are indeed most fascinating but DON’T PUT YOUR HAND IN THAT SALT, pull toddler’s questing hand out of salt container on water filter and put lid straight while trying not to drop glass or tea-towel that you haven’t had a chance to put down, remove toddler from vicinity of water filter and washing machine and dishwasher, maintain running commentary aimed at Enhancing Language Abilities on how Jamie’s opening the cupboard door, adding request that although that’s all well and good could he now please shut it again instead of playing with Mummy and Daddy’s wedding present crockery, remove toddler from vicinity of cupboard, realise he is now back in vicinity of dishwasher, switch off dishwasher that he’s just switched on, give up, take toddler out of kitchen, leave stuff in dishwasher until husband is awake to watch him."

Multiply that by every single darned activity, no matter how trivial, you do during the entire day (and then the day after that, and the day after that, and the day after…), and you can see how it gets pretty exhausting.  I’m glad I go out to work four days a week, because I desperately need the break.

And the not talking!  Watching Jamie learn to talk was the thing I’d been looking forward to most about the second year, so, believe me, it’s been pretty bloody annoying that he hasn’t.  While every other blogging parent of a toddler seems to be writing
about how quickly their child is picking up new words, combining them into sentences, and all that good stuff, Jamie has a vocabulary of four words total.  (To his original ‘Muh’ for ‘milk’ and ‘Dada’ for ‘daddy’ he eventually added ‘Hiya’, after Barry finally managed to convince him that this was a more appropriate form of telephonic conversation than blowing raspberries, and ‘Ooo-wow’n-wow’n’, which means ‘Round and round’, and is used as a catch-all term for the washing machine, the dryer, the home movies that Daddy’s been recording from Nana and Grandad’s old-fashioned projector onto computer, and anything else with a rotatory motion.)  I’m sure that in a few years I’ll be looking back on this time longingly – but, when I’m being driven mad by a child who won’t shut up, can someone please remind me just how darned frustrating I found the alternative?

But what I also hadn’t expected… was just how much things would improve over the course of the year.  I’d thought of the Toddler Years as a sort of vast desert of parenthood that stretched on until at least the age of three, and I somehow vaguely visualised them as all of a piece, so that the best I’d hoped for by the age of two was that there would be some sort of faint glimmer of light at the end of the, um, desert.  (I really must stop mixing those metaphors.)  I hadn’t realised what an amazing thing it would be to see the little two-year-old person who’s spent the year emerging from the one-year-old baby.

It’s been such a gradual change that I didn’t quite realise just how much things had improved until I started writing this – it’s one of the posts I’ve been meaning to write for months, and it was only when I finally sat down and did so that I realised that most of what I was writing came from the pre-written post that had been living in my head all this time.  It is not, any longer, an accurate description of current events.  These days – and I cannot tell you how dim and distant this halcyon state of affairs seemed just a few months ago – I can leave Jamie alone for a few minutes while I sort the dishwasher out or do something else that needs doing, and he will play contentedly by himself.  Of course, he’s quite likely to be playing contentedly with a biro or the remote controls or this computer or something else that he isn’t supposed to have, but, by checking in at frequent intervals, I can usually keep things under control.  And when we go out, he actually spends more time sitting in his pushchair than he does trying to climb out.  Amazingly enough, life is feeling almost restful.  Relatively speaking, anyway.

Another thing that’s improved drastically is his language comprehension.  He may not say many words, but, my goodness, he’s got them in his head all right.  For this particular change, I actually can pinpoint a turning point; the moment when, aged around eighteen months, he pointed emphatically at the picture of the ball in his Winnie-the-Pooh counting book and then at his own ball.  I agreed enthusiastically that it was indeed a ball – how clever of him to spot it.  The next day, he did the same thing, only this time pointing through to the next room where the ball was.  I know it doesn’t sound like much, as turning points go, but… it was like a light going on in his head.  Pictures aren’t just there for decoration – they represent concepts.  And words aren’t just sounds – they’re ways of expressing those concepts.  His understanding – not just of language, but of how the world works generally – has spiralled upwards in the second half of his second year.  I can see him putting it all together in his mind, making the connections. 

When I told him that we needed to put his clothes in the dryer, he responded "Ooowow’nwow’n", making the accompanying round-and-round gesture that I taught him by mistake when trying to illustrate the washing machine’s motion for him (understandably enough, he thought it was a new sign).  When I got the newly-dried clothes upstairs and started sorting them out, he grabbed an armful of trousers and stuffed them into the drawer before I’d even started to put things away.  Admittedly it wasn’t much help, since they hadn’t been folded yet and, besides, he was trying to put them in the T-shirt and sock drawer… but how impressive is it that he remembered, from the times he’d seen me putting away laundry before, that this was meant to be the next step?  When Barry told him we were going to the park, he signed "Ball".  He understands not just what words mean, but how the concept behind them fits together with other concepts and memories in his little universe. 

How much more of that understanding is he going to show by the end of his next year?  I don’t know – but I know I’m looking forward to finding out.

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Filed under Here Be Offspring, How quickly they grow up

Life as a two-year-old

Things Jamie enjoyed doing today:

Putting his feet into Duplo blocks.  This is in line with a general foot-related theme in recent times – if something has a concavity (parts of the mamushka doll, the plastic boats from his bath toy set, Mummy and Daddy’s shoes and slippers), he will try putting his feet in.  On this occasion, he spent some time stacking up three Duplo blocks in a mini-tower on first one foot, then the other.

Taking the lid off his box of blocks and getting me to put it back on again.  (He occasionally shook the box, for variety.)

Playing on the climbing frames and new bouncy seat in the park.  (This one admittedly lacks the endearing touch of eccentricity that the others have, but he enjoyed it too much for me to miss it out.)

Watching the washing machine.  Not only does it go roundandround, but it has lit-up numbers on it which change every minute.  What more could a boy ask for?  He was enthralled by this for an uninterrupted twelve minutes (by the washing machine’s timer) before wandering off elsewhere.  Then he came back later to watch the last few minutes, just before his dinner.

Lifting the sponge out of his bath water and watching all the water run off it, then putting it back in the water to lift it out again.

Things Jamie didn’t enjoy today:

Being told he couldn’t play with Mummy’s biro.  No, not even if he had managed to retrieve it from the desk via his own intrepid climbing skills and determination.

Being told he couldn’t play with the huge pack of paperclips on Mummy’s desk.  And, no, he couldn’t use Mummy’s drawer of Important Files as a step up to get that or anything else off the desk.

Things Mummy didn’t enjoy today:

Leaving him alone for a minute or two only to come back and find he had hold of aforementioned huge pack of paperclips and had spilt it all over the floor.

The inevitable results of a cold in a toddler too young to have the idea of nose-blowing.

Things Mummy enjoyed today:

Naptime.  Even if it wasn’t as long as usual, dammit.

Watching her son enjoy all the little things listed above, all the things that she’d never have thought to look twice at without a two-year-old to show her what fun they could be.

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Quick squint update

After a fair bit of further discussion and a consultation with some helpful anaesthetists over at Doctors.net.uk, I persuaded Barry that we ought to go ahead with the operation.  I’m glad now I did, because when I saw the orthoptist again (yes, she is an orthoptist!  I finally clarified that point!  I still have no idea what the difference is between this and an optometrist, but at least now I know whom I’ve been seeing), she told me that she recommended getting it done sooner rather than later.  Although, as the ophthalmologist said, the vision in that eye won’t be changed by the operation, it’s not quite correct to say that it’s purely a cosmetic thing – what the operation will give him is a chance of regaining binocular vision, if we do it soon enough.  So I’m glad we decided to proceed.  (Hell, if I’d known that I’d have put his name down even sooner.  Oh, well – hopefully he’ll never harbour any thwarted ambitions to be an RAF pilot or a professional tennis player, and it won’t matter.)

His eyesight in the squinting eye still appears to be doing fine.  Pat (I should just call her that – much easier) told me several months back that when he was around two we could test it more formally, by getting him to name a set of line drawings.  (Funny how far away that seemed then.)  Anyway, I knew his language wasn’t going to be good enough for him actually to name them by this stage, and she said that we couldn’t get him to point to them as we named them, because that would count as prompting.  Fortunately, there was another alternative – getting him to match identical drawings.  I knew he could learn to do this, so, at his last appointment, I got Pat to give me a copy of the sheet of pictures she used so that we could practice.  I copied it and then cut the copy into separate pictures so that I’d know he really was learning how to match the pictures themselves and not just their positions on the page, although this approach proved to have a drawback – he was so intrigued by what was effectively his first pack of cards that it was quite difficult to keep his mind on matching pictures.  Still, it didn’t take long for him to get the general idea. 

When Pat tested him she got me to hold him on my lap with the sheet of pictures while she stood at a distance holding up matching ones of different sizes, and Jamie took a careful look at each and then picked out the correct match for all except the smallest ones.  She pronounced herself happy with how his sight was going, but we still have to keep going with the patches, at least until he’s had the operation and maybe afterwards.  Which is a pain, because he’s much less willing to have them on than he used to be and it’s getting to be an increasing struggle.  (Oddly enough, he’s still quite happy with the idea of putting them on.  This morning, he managed to get hold of a box I’d left lying under the stairs, opened one of them up for himself, and toddled up to me with his glasses off and the patch in his hand all ready.  I put it on, and he ripped it off within a few minutes.)

Still, all in all, it seems things are going well.  So his name’s going to go down on the list now, and hopefully we can get the operation done in June or thereabouts (rules and regulations about waiting lists mean it shouldn’t take longer than that).  After that, we’ll have to wait & see how it goes.

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Filed under Adventures in Squint Correction, Here Be Offspring

Psychosomaticism and the cloud of unknowing

Some months back (in a post I didn’t see at the time), Dr Crippen wrote about a patient of his whose problems he believed to be psychological in origin.  In response to a follow-up post that he wrote on the issue, I queried this conclusion.   Dr Crippen responded by issuing a challenge:

Within the limits of the facts as given (and I appreciate that IS a bit
limiting) please come up with a better diagnosis than
family/social/psychological problems.

This is precisely the attitude that concerns me, and it’s precisely because so many doctors hold this attitude that I queried this particular case.

Now, the rest of this post is not aimed at Dr Crippen’s handling of this patient, because I do not have enough details on that to comment any further than raising the question.  Dr Crippen, quite rightly, changes the details in any patient account he puts on line to preserve anonymity, so even if he has specific reasons for thinking that "Joan’s" problems are psychological in origin, he’s not going to be able to tell me what they are.  From what he says in the follow-up comment that I linked to, it sounds as though he does have such reasons, despite not being able to discuss them.  And in that case, fair enough.

(A quick addendum: Since writing this post, I’ve also followed up a link of Dr Crippen’s and found that he makes much the same points as me in a further post.  So, I repeat that the rest of his post is not aimed at him.  But his challenge was a handy jumping-off point for a post I’ve been wanting to make for a good while now.)

But the point I wanted to make is that we should not be assuming that a patient’s problems are psychosomatic without having specific reasons.  And "I can’t come up with a better diagnosis" is not such a reason. 

There is far too much of a tendency among doctors to believe that ‘psychosomatic’ means ‘we can’t find a physical diagnosis’.  Spot the flaw in that logic?  If we can’t find a physical diagnosis, that definition is saying, then there can’t be one.  We couldn’t possibly have missed something.  There couldn’t possibly be anything about the human body that we just plain don’t know.  Why, we doctors know absolutely everything, and never miss a trick!

It’s a form of arrogance.  And it’s a way of putting the onus back on the patient.  We can’t admit that there might be things we don’t know, so, if we can’t make a diagnosis, then there must not be one to make.  Must be all in your mind… right?

We’ve been doing it for centuries.  Over a hundred years ago, Freud made his name by coming up with psychological diagnoses for a number of patients with complex, bizarre, otherwise inexplicable symptoms – in other words, symptoms that were clearly psychosomatic in origin.  Right?  Well, except that on reading the case descriptions in light of modern knowledge, it actually looks as though a lot of them had classic symptoms of temporal lobe epilepsy. 

These days, of course, we know all about temporal lobe epilepsy and the weird symptoms it causes.  So, these days, we wouldn’t make that mistake, would we?  Well, hopefully not – although it isn’t so many decades since Karen Armstrong spent years seeing a succession of psychiatrists about her distressing visual hallucinations without it ever apparently occuring to any of them that sending her to a neurologist for an EEG might be a smart idea.  (After all, she clearly did have all sorts of psychological problems – lots of difficulties adjusting to the world after seven years in a convent, culminating in anorexia nervosa – so of course any problems she had had to be secondary to those!  How could someone with psychological problems possibly have a physical illness as well?)  But how many similar mistakes might we be making without knowing it?  How many possible ways are there for the human body to malfunction that we simply don’t as yet have a clue about?

Doctors don’t know everything.  Far from it.  And individual doctors are even further from knowing everything than doctors collectively, because the sum total of what we do know so far exceeds what any individual doctor could ever hold in memory.  So, maybe your problem happens to be one that is documented in some article or textbook somewhere – but if it’s one that your particular doctor hasn’t heard of, then you might just be out of luck.  (Ever heard of interstitial cystitis?  Krissy saw lots of doctors who hadn’t, before she finally got her diagnosis.  Guess what they all told her her symptoms were due to?)

Of course, hopefully your doctor will refer you for further investigations if things get really baffling.  Maybe the doctor you’re referred to will know what your problem happens to be… and maybe not.  Usually you’ll get a fair number of investigations before people throw their hands in the air and give up, but, at the end of the day, your problem may exclude diagnosis.

There isn’t really a way round that, because, no matter how much everybody expects us to be omniscient and omnipotent, we’re not.  Deal with it.  We’re not doing it to annoy you, believe me.  But that cuts both ways.  We should have the guts to come out and say "Sorry, but I’m afraid we really don’t have a clue what’s causing your symptoms."  And we shouldn’t stick a label of ‘psycholological’ or ‘psychosomatic’ on a patient just to give us something behind which we can hide our own ignorance.

None of this is meant to say that psychological causes of illness do not exist.  Of course they do.  But be honest with yourself about why you want to make that a diagnosis for any given patient.  If the only reason you have for diagnosing your patient with a psychosomatic disorder is that you can’t find a physical one, then forget it, because that isn’t a good enough reason.

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Filed under The doctor is OUT. To lunch.

Go answer, Alice!

That might just be the dumbest post title I’ve ever thought up.  I suspect I’ll live to regret my inability to resist it.

Anyway… Alice is a final-year medical student in the USA, who is currently facing ongoing/imminent interviews for her first training programme (which should probably be ‘program’, since it’s in the US).  About four months ago, she wrote about trying to prepare for the interviews.  Being my usual interfering self, I immediately thought of a whole bunch of advice I could give her, but, being my usual disorganised and procrastinating self, I didn’t get round to giving any of it until she recently mentioned that she’d been to her first interview, which made me realise that if I was ever going to pour forth my pearls of wisdom I should possibly get a move on and do so.  Then I realised that what I was writing was getting way too long for a comment on her blog, and she doesn’t give out her e-mail address.  So I’m posting it here, which is probably going to make for a bit of an odd post, but the hell with it – someone else somewhere might also find it of fleeting use.  Even if not, then at least it’ll get my post count up.

(By the way, I did ask her whether she actually wanted any of this advice, and she said she did.  I may be interfering, but I’m trying not to be too interfering.)

Trying to tell people how wonderful I am makes me so nervous. I
understand a popular interview question is, Why should we hire you
rather than the other applicants? Honestly, I don’t know why; I don’t
think I’m much use at all, and I’m sure there are tons of better
applicants.

From reading your blog regularly,
I can think of some excellent reasons why you’d be the sort of junior doctor
I’d want to take on to a training programme. You’re passionate about what
you do, totally dedicated, look for any opportunity to learn more, and focus on
keeping patients’ interests foremost. What you have to do is have enough confidence in these strengths to be
able to put them across at interview; and to recognise that having confidence
in your strengths is not the same thing as arrogance or boasting. It’s recognising that there are jobs that
need doing and that you are one of the people who can do those jobs and should
– for the ultimate benefit of others as well as yourself – be there doing them.

But something tells me that honesty/humility is not high on their list
of requirements during the interview, and that surely I can put an
optimistic perspective on it: I may not know much, but I’m ready to
learn. . . ?

Well, if you get into the habit of cutting out everything before the ‘but’, then you’ll be on the right lines there.  You are ready to learn.  You’re dedicated.  You want to accumulate as much experience as possible, and you’ve worked extremely hard at medical school to do this and continue to do so.  Now, practice looking people in the eye and saying those things as if you believe them – with no ‘buts’!

I’m looking at my application and thinking, I can see so many sticky questions coming out of this.

The questions you mention – do they come from examples of questions you know have been asked of other people, or from your own fears?  It’s important to distinguish between the two, because otherwise you’ll start hearing questions they aren’t asking you.

What I mean by that: When they ask you something, don’t immediately start working out how it could be a first step on a path with a trap set for you at the end.  If you do that, you’ll start getting defensive and over-explain.  So, for example: If they ask you whether you have a significant other, don’t immediately assume that the next question is going to be "You don’t?  What’s wrong with you?" and start trying to answer that one.  Just stick to the question you’ve been asked.  Instead of assuming that they’re trying to trip you up, assume that they’re trying to give you a chance to show your strengths – because, if they’re a half-decent programme, that’s exactly what they will do.  If you meet every question with that attitude, it’ll make a real difference to how positively you come across.  And it’ll enable you to give them what they want.  (I used to wonder what the hell interviewers were getting at when they said "Talk us through your CV" – wasn’t it all there in front of them?*  These days, I see it as a chance for me to bring out my strengths – to explain to them how all the jobs I’ve chosen to do have been aimed at the single goal of making me the best possible GP that I can be, and how the experience I’ve had has contributed to that.)

However, it’s possible that they will try to ask you sticky questions as a deliberate strategy – almost certainly not all the ones you thought of (can’t imagine anyone in this day and age getting away with asking a woman at interview what’s wrong with her for not having an SO), but some.  So, here, I have to tell you a quick story from my own medical school days.  We had some bigshot doctor come talk to
the medical students’ society about his life in medicine, and one of the things
he talked about was interviewing students for jobs. (Or maybe it was interviewing for places at
medical school, I forget which – but the point I want to make is the same.) He said that he used to ask women who were
interviewing “Suppose I said to you that I didn’t think there was any place for
women in medicine – what would you say?” The reason he said this, he explained to us, wasn’t because he actually
thought so, but because he wanted to see how women coped with the
question. He felt that if a woman went
into a flap when faced with a thorny question at interview, she’d do the same
when faced with an emergency on the wards. 

I have to say that I think this is a lousy method of
interviewing, and I don’t agree at all with him that a person’s response in one
situation would necessarily predict their response in the other (and I say this as someone
who’s effectively the other way round – I would make extremely short work of that question in an interview, but an emergency situation on the wards is much more likely to send me into a flap).  And, again, I can’t imagine that anyone would dare ask that particular question these days.  But that’s all by-the-by. The point I’m trying to make is that if they do ask you
thorny (non-medical) questions, it’s not because they care about the answers.  It’s because they care
about how you answer – how you handle being put on the spot. They probably don’t care exactly what your opinions are on homeschooling or single-payer systems – what they want to know is
whether you can look ‘em in the eye and come up with an answer that sounds
calm, confident and collected, regardless of what that answer is.

When I asked my husband (who’s not a medic, but, unlike me, has been on the other side of the interview desk) what his advice for this post would be, he said the single most important piece of advice he could give was: Be honest.  Don’t try to pretend to be someone you’re not, because if you can only get the job by doing this, it’ll be the wrong job for you.  I totally agree with this and have always based my job interviews on this principle, but I also want to say that it’s possible to be positive as well as being honest – even when it comes to your weak points.  They’re not expecting you to be perfect; what they want to know is that you’re aware of your weaknesses and prepared to put in the work to improve them. 

It’s possible to put a positive slant on just about any answer.  If you have a weak point, then it’s something you recognise and are working on.  If there’s something you don’t like, then there’s something else you like better.  When I was being interviewed for my current job, I was asked how I felt about the administrative side of the job.  I wasn’t about to pretend to them that I love administrative work – I knew they’d either see through that in a second and dismiss me as a phony, or, worse, employ me under the impression that I was going to want to do lots of something I actually hate.  However, I figured that although "I loathe it with every bone in my body" was a perfectly honest response, it might not be the best response I could make.  So I said "It’s part of the job,
isn’t it? I’m not going to pretend to
you that I love it, but it’s part of the job, and I’ll do what I need to
do.”  Also a perfectly honest response – just a better one.  And, yes, I got the job (and they stated in the letter confirming the job offer that they were impressed with my ‘honest
responses’ at interview!) 

Some specific examples of answers to the questions you mentioned (and, by the way, if you don’t feel these fit then tell me what your actual honest-to-goodness answers would be and I’ll translate them into Interviewese for you):

"Homeschooled? Have you recovered from your lack of socialization?"

"You know, it’s funny how many people think that homeschooling means living the life of a hermit.  We saw plenty of people at [whatever sorts of examples you can think of of places where you saw people].  I wouldn’t say I’ve had a lack of socialisation at all."  Or (smiling, jokey tone): "After four years of medical school, I’ve had plenty of opportunities to meet people!"

"You don’t like a
single-payer system?"

"Oh, I don’t think any system’s going to be perfect [hee-hee, pre-empted their counter-arguments].  But I do prefer [whatever the alternative to the single-payer system is], because [short summary of reasons]".  If they then ask you further tricky questions, start out your answer with: "Yes, I do agree that there are definite disadvantages to any system.  But I do feel that… [further short answer to whatever point they made].

(By the way, one of the best lines I’ve ever come up with for an interview was for the aforementioned interview, in which they asked me what I thought of the new GP contract – I don’t know whether you’ve read anything about that in Grand Rounds at any point, but let’s just say it’s a highly contentious issue in British primary care today!  I replied that the contract reminded me of the old joke about capitalism – the only thing worse than this system was all the other systems that had been tried.  They thought that was highly amusing.  If you want to borrow that line, I promise I won’t charge you royalties…)

"No research experience?"

"Not as yet.  Since your department is so strong in that area, I’m hoping that working for you will be the perfect chance for me to get more involved."

"You don’t subscribe to the NEJM?"

"No – I prefer [whatever it is you do prefer reading] because [give one or two reasons].

"How many hours do you sleep a night?"

"Normally seven, but on an on-call night when the adrenalin’s pumping I can get by on a lot less."  (Damn – you don’t call it adrenalin, do you?  Epinephrine?  This English-to-American translation is harder than it looks.)

"What other programs have you applied to?"

Just listing them would be a perfectly adequate answer to that one – after all, they know you’re going to be applying to more than one program, so it’s not as though they’re going to take it as a deliberate rejection.  A slightly more positive twist to put on it would be to start out by telling them the common theme behind your choices: "I’ve been looking for the ones that will offer me the most hands-on experience [or whatever], so, besides your program, I picked X, Y, and Z."

"What would you like to ask?"

The standard response to this is to use it as a subtle way to reiterate your main interest.  "I want to get as much hands-on experience as possible [or ‘get more experience in X subspecialty’, or ‘get involved with student teaching’, or whatever] and I understand, from the people that I’ve talked to, that your program will really give me a great chance to do this.  Would you say that’s so?"  (Alternatively, it’s perfectly legitimate to say "Thank you, but your department were marvellously helpful when I spoke to you during the application process, and I think really I’ve covered everything I wanted to know already.")

I think those are the main points I wanted to tell you. Hope that’s of some help – give me a shout if
I can answer anything else. By the way,
I expect you’ve been told this already – but, if you get turned down by anyone,
do get back in touch and tell them that, as you’re trying to improve your
interview technique, you would welcome any feedback they can give on the
reasons why you didn’t get the job and what you can improve in subsequent interviews.  While the answer usually just comes back as "Oh, you were perfectly OK and it’s just that the candidate we appointed was better", it’s always possible that they might tell you something useful.

*Sorry.  A CV is what you’d call a resumé.  Told you this English-to-American translation was tricky…

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Filed under The doctor is OUT. To lunch.

Birthday moments

Today – Jamie’s actual birthday – I’ve been at home with him.  When I worked out my annual leave a little while back I had a couple of stray days left over, so I booked one of them for today so that I could spend his birthday with him.  Barry’s family were still here as well, so he had lots of fun playmates.  We didn’t do anything much – hung around the house while Jamie played with his new toys – and I kept having to remind myself that it was his birthday, since, after yesterday, it felt quite ordinary.  But it was special in the way that the ordinary can be special if you know where to look.

The moments I want to remember from the day are the kind of thing I don’t normally blog about because I blog in anecdotes (well, except where I blog in opinion pieces, which is a different kind of article), and these aren’t anecdotes, they’re moments.  I never quite know how to write moments, because there doesn’t seem to be a way to make them readable rather than soppy and corny and clichéd.  But one of the reasons why I made my resolution to blog more is that just because something isn’t readable, that doesn’t mean I’m not going to want to remember it myself.  So these are the moments that don’t fit into anecdotes, the moments in my mind from Jamie’s second birthday:

Sitting on the couch, Jamie snuggled in my lap.  Normally there’s no chance of him sitting still for that long even when he’s being read to, but he’s tired out from his exciting day yesterday and getting to bed late.  So many children would be going into meltdowns at this point, but Jamie’s holding it together – I feel so proud of him.  It’s a rare moment of closeness to enjoy in his life of running round, climbing, exploring.

Was this little boy – legs spilling off my lap, so tall now – really a baby whom I could hold in the crook of one arm, just two years ago?  He must have been – I’ve got the photos to prove it.  But it’s so hard to remember exactly how that felt.  I concentrate on this moment, now.  The soft weight of him snuggled into the space between my arm and my side.  Brown hair falling across his forehead and a cheek that’s still so soft when I kiss it.  So big, and still my little boy.

Later on, at dinner time, he sits up at the table with the rest of us again, though we decide against giving him rice – he gets a plate of vegetable waffles with Dairylea spread and some pork sausage.  He looks so grown-up, sitting there and eating just like the rest of us.  Well, except for the wide outline of Dairylea around his mouth.  When he’s had enough he bangs on the table with his sippy cup, scrambles to his feet on the chair, and, grinning hugely, regales us with his after-dinner screech.

I scoop him up and take him upstairs for his bath, depositing him in the bathroom, starting the water running, then stripping off his clothes and nipping into his room, next door to the bathroom, as quickly as possible to deposit them in the laundry basket and return before he can create too much chaos while left unsupervised.  As I come back out, I hear Barry’s voice in the hall outside, that sheer note of laughter and delight that only an encounter with Jamie can produce – "Well, hello, you!  What do you think you’re doing?"  What he’s doing is making a run for it while Mummy’s got her back turned.  Except it’s actually more like a shuffle for it, since he’s stopped to put my slippers on.  Jamie is fascinated by his parents’ footwear – at every opportunity, he’ll try our shoes or slippers on.  In the case of my slippers, this actually works to some extent, because they’re the huge squashy kind of slipper (they’re shaped like furry flop-eared puppies) and thus they stay on his feet, as long as he steps slowly and carefully.  So there Jamie is, toddling carefully along the hall, wearing nothing but a nappy, a pair of slippers several sizes too big, a layer of Dairylea cheese spread, and an enormous grin at the sheer amusement of it all.

Later still.  I tuck a washed, pyjamaed, sleepy, contented little boy into his bed – stories all read, the last look taken out of the window to check for the moon, time for night-night now.  He switches on the musical star, the one that projects rotating pictures of moons and stars and winged teddy bears onto the ceiling for him to watch until he falls asleep.  As I look at him, marvel at him, I realise that my love for him has changed along the way just as he has.  When he was a newborn, mother love was a blind instinctive force, straight from the hormones, a bond so close that he felt like a part of me.  Somewhere along the way this has segued into loving him for his separateness, loving the wonderful little person that he is and that he’s becoming.  I love him for his very ability not to be a part of me.  I love watching the journey he takes through learning to be himself.  This is the biggest gift parenthood gives you – the privilege of watching that journey up close. 

And the privilege of those moments when your child still wants to be close to you even as he’s growing up and moving further away.  Jamie, small and determined, puts his arm around my neck and pulls me close for a tight hug, pointing happily up to the pictures the star projects onto the ceiling.  Sharing his images of the moon and stars with me.

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Figures

This is going to be a terribly dull post, but I’m recording this for myself:

Just weighed and measured Jamie.  His weight is 2 stone 5 for those of us in the UK, or 33 lb for any US readers I have, or 15 kg in new money.  This puts him on the 91st centile.  I’m impressed but not terribly surprised – he’s a solid little chunker!

Measuring him was more difficult as I made the mistake of letting him see the pencil I’d put ready to mark his height on the wall, and he was most annoyed that I wouldn’t let him play with it.  However, we were able to establish that he is now 89 cm, or 2′ 11".  If we go by the old rule of doubling his height now to get his height as an adult, this means we can expect him to be 5’10".  However, there are some big-time height genes in Barry’s side of the family (Barry is 6′ 4", and all the men in his mum’s side are over six feet), and my mother-in-law tells me that Barry’s brother was less than three feet at the age of two (he’s now six feet two), so we shall see.  I don’t think he’ll be as tall as his father, but that’s just as well – it would be nice for him to be spared the lifetime of never fitting in aeroplane seats or being able to buy trousers that Barry’s faced.

His height is 75th percentile for his age.  Now, I didn’t measure him when he turned one, which is a shame – I’d have loved to have a direct comparison.  (And we’d already moved into this house then, so I could have had a succession of heights up the wall for each birthday.)  But the measurements that I have for his length at six months and his height at sixteen and eighteen months all have him on or near the 25th centile, so it seems a reasonable bet that that’s where he was when he was one.  If so, that would mean he’s grown six inches in the past year.

Six inches?!  No wonder I feel like it’s got a lot harder to put stuff out of his reach!

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Last day as a one-year-old

It seems strange to think of Jamie as a one-year-old, although as I type this it will technically be true for another fifty minutes.  There’s so much difference between a child who’s just turned one and a child who’s just about to turn two.  On his first birthday, Jamie was officially a toddler not just according to the baby book chapter headings, but also in the literal sense – he would, when he felt like it, lurch a few unsupported steps.  But he was still very much a baby toddler, if you see what I mean.  Now, he’s a little boy toddler.  He’s grown up so much in a year, and all day I’ve been thinking about the differences.

His last day as a one-year-old started with him waking up twice in the early hours of the morning, which only underlined how unusual an event this is now – he has the occasional morning waking, but I can’t remember the last time he woke twice.  The first time was at around 5.20 with an excessively wet nappy that had soaked through – I thought it might take a while to settle him, but as soon as I’d finished changing him he crawled back into bed and went straight back to sleep.  Then he came in again around – I can’t remember exactly, but some time between 6 and 7, and I just took him back and lay down with him in his bed for half an hour.

After that, he slept until an unheard of 9.00.  In fact, he was still sound asleep then, but I woke him at that point.  I hated to do it (for my sake, not his – seemed a shame to throw away perfectly good blogging time), but we’d planned to take him swimming that morning and, if we were to get back in time to let the guests in, we needed to get going.  So I got him up and ready and we set off.

This was Jamie’s third swimming session.  His attitude’s certainly changed since the first, thanks to Barry putting in the effort to nudge him that little bit past his fears – this time, as last time, he was raring to go.  The only problem was that he seemed to have forgotten about kicking when he got in the water, which meant that he couldn’t warm up, which meant that he clung to me as closely as he could to try to stay warm, which was something of a vicious circle as it made him even less willing to kick.  After a short while, Barry hit on the idea of moving him towards me through the water as I moved backwards gradually so that we stayed the same distance apart, until he started kicking, whereupon I stood still so that he closed the distance between us.  The idea was that this way, he’d make the association between kicking and moving closer to his goal.  This seemed to work well.  By the end of the quarter-hour we spent in the pool, he was a lot more willing to kick when we moved him through the water, and, after seeing me swim a few strokes, he even started making the arm movements as well.

We stopped off on our way home to buy a couple of helium balloons (I got one with Bob the Builder on, as he loves his Bob the Builder CD and musical doll, and one which lets you apply your own number stickers to say which birthday it is, because he’s fascinated by numbers) and a card for him, and then managed to get home before the others arrived.  Jamie was delighted with his Bob the Builder balloon, promptly heading into my study to switch on the stereo with the CD in and grab the Bob the Builder figure to show me that it was the same as the one in the picture.  Barry’s parents and brother turned up shortly, then my mother, and finally my sister with her boyfriend, and there was a short chaotic time of people running round trying to get lunch put out for the nine of us and find someplace for the piles of presents (and my mother trying to wrap the last of the presents). 

Before going through to eat, we gave Jamie his first couple of presents – I wanted to spread them out a bit during the day, as we did last year.  One thing that has definitely changed is that he now gets the whole idea of trying to get the paper off presents to get to what’s inside, a concept that definitely baffled him last time around.  (In fact, when we left him unsupervised for two minutes in the general pre-lunch kerfuffle, we found him up on a chair on the dining room table half-way through unwrapping the present my mother had just wrapped.)  This is interesting, because the last time he had any wrapped presents was at Christmas – nearly a year ago, and he wasn’t too sure what to do with them then, either, as far as I can remember.  So this isn’t something he’s learned directly.  It’s one of the many, many little signs of how much more he’s learned about how the world works, how you go about doing things.

The first present he opened was his Aunty Ruth’s present, which was a tractor and trailer which did lots of interesting things when the appropriate buttons were pressed (lights went on, horn blared, animals made species-appropriate noises, tractor chugged forwards, and it played a cheery little song).  He was very pleased with this, and had so much fun trying out all the buttons that it took a few minutes to distract him long enough to open my mother’s present, a shape-sorting sphere.  He liked that a lot, as well, but he couldn’t get the hang of finding the hole that matched each shape, so we helped him find all the right holes to post all the shapes before we went through and all crowded in round the dining table for lunch.

Jamie joined us at the main table for lunch last year as well, but then he was in his high chair, still eating with his fingers.  This time, he was sitting up properly on a chair (though he did find it easier when we gave him a cushion) and even having a fair bit of success in using a fork.  In fact, he was almost trying too hard with this – he hadn’t realised some foods were meant to be eaten with the fingers and was trying to eat everything with a fork.  This worked quite well with the grapes, but he was rather stymied by the slice of bread and butter.

After that, I took a sleepy little boy upstairs and he settled down easily for his nap.  (Another big change from last year and the baby who could only fall asleep nursing or drinking from his bottle, with someone cuddled next to him.)  Then, when he woke up, Barry got the birthday jelly ready on the dining room table, illuminated by torchlight from underneath, along with the football cake we’d bought for the grown-ups of the party who didn’t like jelly.  Jamie was very pleased with the jelly.  He ate two bowlfuls of it, and even managed to use his spoon for some of it.

After I’d taken him upstairs for his clean-up and change of clothes, I brought him downstairs and the present-opening started again.  Let’s see if I can remember everything he got:

I gave him a CD of children’s songs, and some plastic zoo animals.  Barry’s brother Simon gave him Thomas the Tank Engine wellingtons that light up when he stamps his feet.  Barry’s parents gave him a little gadget from the Doctor Who exhibition that lights up with lots of flashing lights when he presses a button, and Archie Mouse from Bagpuss, who sings the mice’s song when Jamie presses his tummy.  And from Barry, he got Teletubbies.  First a mini-Dipsy, to go with the mini-Laa-Laa we’ve already given him; then, as the grand finale to his presents, a Po which plays the Teletubby song when you squeeze its hand, complete with moving pictures on the tummy screen.

Jamie really liked all his presents, and it was hard to get him to stop playing with each one long enough to open the next.  (We should really have stuck to the spreading-the-presents-out plan, but by then people were carried away with the sheer enjoyment of watching him open them.)  He’s almost figured out all the shapes on the shape-sorter already, and he’s had enormous fun pressing the buttons on the various other things and looking at the flashing lights.  And Po was every bit as much of a success as Barry hoped for.  Jamie’s eyes got huge when he pulled the wrapping paper off and saw what it was.  The evening’s activities have been conducted to a steady background of the Teletubbies theme tune as Jamie made her play over and over again, interspersed with bursts of "We will mend it, we will mend it…"

When Barry’s mother pumped up the inflatable mattress for Simon in my study, he thought this was great fun as well.  He wanted to try stepping on the pump as well, alternating this with throwing himself down on the mattress, giggling, rolling over, jumping up to run back to the pump and step on that again.  Dinner was a lot later than he was used to, but he dealt with this like a trouper.  He sat up at the table again and ate chicken and mashed potatoes and potato wedges and carrots and sprouts, and did such a nice job of using his fork.  Even though it was after his bedtime by now and he’d had a long and tiring day, he stayed in a really good mood, though I could see his eyelids drooping.  When he finished his dinner, I took him upstairs for his bath and stories and bed.  And, at the end of his last day as a one-year-old, he fell asleep playing his musical star and cuddled up to his little Dipsy toy.

When I tucked him into bed and talked softly to him about all the exciting things he’d been doing that day, the way I always do last thing before I kiss him goodnight, I tried to tell him how special it had been watching him that day, how special it was to have him for a son, how very much I loved him.  I know he can’t understand the words yet.  But he understands what I really want him to understand.  He understands that when he wakes up in the middle of the night and he’s soaking wet or just a bit confused and not sure how to get back to sleep, it’s OK.  He doesn’t need to cry, because he can just come and find Mummy, and Mummy will take care of him and make it all better again.

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I think this might actually be the cutest child in China

Sometimes, things are worth even the longest of waits.

I am so thrilled for Jo and Charlie.  Their new daughter sounds – and looks – wonderful.

Eagerly awaiting more pictures, more details, and anything else Jo can share!

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Filed under Glory, glory, hallelujiah

The Queen of Sweden and Jamie’s birthday party

My son was born on a Saturday.  This not only means that, according to the old rhyme, he’s destined to work hard for his living (I’m glad to know that folklore backs up my plan to instill a work ethic in him), but also that his first birthday fell conveniently on a Sunday.  So, the assorted family were able to assemble at our house to celebrate the day, on the day. This year, however, his birthday is on a Monday, which meant we had a choice between holding the family party the weekend before or the weekend after.  The weekend before would be closest, obviously, but it somehow seemed like cheating to have his party before he’d actually completed the whole reaching-the-age-of-two job.  (I mean, if he’s had all his presents the day before, what kind of incentive does he have to make it through that one last night?) 

Fortunately, I never did get a chance to run that particular bit of logic past my husband, since before we’d even got round to discussing it an old friend of the family won some kind of Extraspecial Extremely Excellent Photographer award for his work (I’m sure it’s got a more official-sounding name, but you get the idea), with a terribly grand award ceremony in Sweden to which my mother has been invited, which just happens to fall on the weekend after Jamie’s birthday.  The ceremony is hosted by no less a person than the Queen of Sweden, and the invitations were issued in her name, and it would seem a little unreasonable to expect my mother to turn down an invitation from the Queen of Sweden just so that my son can have his second birthday party after he’s officially two rather than before, so the weekend before his birthday it’s going to be.  I am not one to name-drop, but I do invite you to speculate on just how few children in the world can say that the precise date of their birthday party was decided by the Queen of Sweden.  Even indirectly.

So, this Sunday my mother and sister and in-laws will all assemble at the house for the second anniversary of the last day on which Jamie was enjoying intrauterine life.  Presents will be opened, my husband has been preparing an amazing illuminated multicoloured jelly for his birthday cake, and a good time should be had by all.  Meanwhile, prepare for another nostalgiafest over the next day or several, because, of course, the imminent arrival of another birthday is my cue to start musing on the past year, the further changes that have taken place therein, How My Little Boy Is Growing Up, and general thoughts on toddlerdom.  Stay tuned!

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