Strawberries

We took our two and a half year old strawberry picking last weekend because it seemed like a good, wholesome activity to do with a toddler. So we looked on the internet for a farm near us that had a harvest your own program and drove down in the morning. We paid our twenty dollars for a one gallon bucket (harvesting your own strawberries is not a good deal financially; the same amount of fruit would have cost about $12 at our grocery store this week) and commenced picking. The fields were laid out in long double rows of strawberry plants heaped up on hillocks with grassy paths in between the rows. The sun was warm but not hot and the crickets were chirping and the air smelled, naturally, of ripe strawberries.

Happily, we were correct in our guess that this would be a fun family activity. Our daughter grasped the concept of picking the red berries immediately and had a wonderful time hunting through the plants finding nice red ones to pluck. The skill of grasping the berry and tugging on it was just right for her little hands. We spent some time discussing the idea that the flowers would turn into green berries which would then turn into red berries, which I hope helps her as she is beginning to wrestle with the concept of her own growth and development. She asks us “I getting bigger and bigger?” and we tell her “Yes! You are! It’s wonderful!” And of course, she had a ton of fun eating the strawberries and feeding some to her stuffed bunny, who was stained rather pink by the end of the morning. So the outing was a complete success, with one problem. Now we have a gallon of strawberries.

It may not sound like a lot, but that is a very significant amount of fruit. We typically buy strawberries one pint at a time, maybe a quart if they are on sale, and a quart will last for at least a week. I don’t think our gallon of strawberries has a 4 week shelf life. So we are trying to work out what to do with a gallon of strawberries. So far we are eating strawberries daily (I am chopping some up in my morning oatmeal, which definitely improves it) and we have made strawberry popsicles. My husband found a recipe with yogurt and sweetened condensed milk that turned out quite well and has served as our after dinner treat this week. I think strawberry shortcake, that old standby summer favorite, will feature in our dinner tomorrow. But we still have about a half gallon of strawberries left, so I am looking for ideas. A good (and very culinarily talented) friend of ours canned strawberry jam last year, but I don’t think we have the skill or equipment for that level of project. I looked online for strawberry recipes but the ones I found didn't appeal. They were either for smoothies or suggested using strawberries to garnish other dishes (salads or deserts) instead of focusing on the strawberries.

I really don't want to waste all this wonderful fruit. I suppose that, all else failing, we can clean and chop and freeze the strawberries and use them in more popsicles later in the summer. However, if anyone has any relatively easy suggestions for using a plenitude of strawberries, I’m all ears.

We Bought A House

We bought a house today. Well, to be exact, we bought 20% of a house and promised to pay off the rest over the next 30 years, but hey, let’s just say we bought a house. We’ve been looking at houses on and off since last fall, so this has been quite a process for us. We wanted something just right; close to my job, at least three bedrooms, a garage, some outdoor space for a garden but not too much yard, and not horribly expensive. That last criteria makes finding a home in northern Virginia really, really complicated. So we would look, then take a respite, and then look again. We had been looking back in January when I broke my ankle, which put a halt to the process for a solid 3 months. That was okay. We really weren’t seeing anything we truly wanted, and were trying to figure out where to make a compromise. Then the first day we got back to looking, the first house we saw, we really liked. It exactly matched the list of what we wanted. We thought about it for a few hours, looked at a few more houses, and then said – we want that house. We will be sad if we don’t get this house. So we made an offer and said a prayer, and our offer was accepted from among the competing offers. Over the past month we’ve been going through the process of inspection and appraisal and financing, and today we bought the house.

It feels slightly odd, being a homeowner again. I am glad to have our own space; we are already making plans on how to make the space feel like ours. I’m glad to have a little bit more space too, since we moved from a larger house to this smaller apartment when we came back to the East Coast a few years ago. We’ll have enough space to have more than 4-5 friends over at a time now, and that is something I’m happy about. I’m really, really looking forward to the shorter commute, since right now about 90-120 minutes a day is spent commuting to and from work. From the new house it should be about 50-60 minutes per day. And from our new house I will have some options in public transit (a bus that runs close to our home and would drop me off about a quarter mile from my job) and also possibly for biking. I couldn’t bike the most direct route (major highway, crazy drivers, not safe) but there appears to be a bike friendly path I could take that would be about 6 miles each way. My husband recently got out our bikes and fixed them up and we have started to ride a little again, and it’s great fun. I’ve missed doing more intense exercise since my ankle fracture (no running yet, although hopefully I’ll be cleared for it in another month or so) and biking is filling in that void. I will have to build up both my skill level and my stamina but biking to work seems like a feasible and attractive option, at least in good weather.

The odd part, of course, is the responsibility that comes with owning a home. One of the very nice things in an apartment is that if something breaks, all I have to do is call the maintenance department. They send someone to fix it and I’m good to go. No fuss, no extra cost and I don’t even have to wait around the house because they have a key. Now, owning a home, we will have to budget both money and time to attend to home maintenance, starting with all the big and little projects we want done before we move in. Which is okay, in the grand scheme of things, but it’s something to be considered. My mother, who works for HUD, has plenty of cautionary tales of individuals who didn’t account for maintenance costs when undertaking home ownership.

There’s also the commitment factor of owning a home. We were pretty solidly committed to my current job and this area anyway (which is why we bought a home) but purchasing property represents a commitment both to a geographical location and an income level. It makes things like the upcoming furloughs a little more anxiety provoking (although, obviously I think things will be okay, since we did move ahead with a purchase). And it precludes crazy dreams like taking a year off to travel. Which, ok, I probably wouldn’t have done anyway, especially with a toddler, but it is a favorite dream of mine. Overall, buying the house is a really good financial move for us right now and follows the other rule my mother taught me about home ownership (keep your costs under 30% of your total budget, less if possible). But it still represents a major commitment, and one of the rules of life is that when you take advantage of one opportunity you close the door on others.

The last not great part about home ownership is the actual move itself. We’re planning to move mid-summer, which I am not looking forward to. To be completely honest, I’m dreading the move. I really detest the chaos and disorganization of being in transition. I know it is temporary but it makes me a little crazy. Although, once moved, I hope we will stay in this house throughout my daughter’s growing up years. So at least we won’t be facing the prospect of moving again in a few years, which I have faced my entire adult life, ever since I went off to college at age 17. So, with that thought to buoy me through the unpleasant prospect of packing and moving, I am pretty pleased this evening to think that we bought a house.

Exploring the Mission Area of San Francisco

Appearances can be deceiving sometimes. When we arrived at our rental apartment in the Mission area of San Francisco a week ago at 9pm I felt a little anxious, standing on a dark street with suitcases and a toddler, fumbling with a lock. It didn’t look like a great neighborhood. It didn’t help when the next day a good friend commented that he was surprised we were staying there. “It’s not a great area.” he said. Well, after staying there a week, I completely disagree. The Mission area of San Francisco, particularly Valencia street where we stayed, is a fabulous area.

The interior of the apartment we rented.

The first place I loved in the Mission area is the rental apartment we found on VRBO. This apartment was a two-story two bedroom place. The owners kindly lent us necessary toddler equipment (training potty, books, stroller, milk for the first night) and also gave directions for good restaurants, grocery stores and mass transit. The apartment was 3 blocks from the BART (one of San Francisco’s two subway systems) which made the entire city easily accessible. The apartment had free WiFi and cable, although we didn't spend too much time using these amenities. It had laundry on the premises as well, which is a huge help in packing. And we had all of this convenience and comfort for less than a single room would have cost us downtown. I would absolutely stay there again. 

About a two blocks from the apartment, on Mission street, we found two incredible places to satisfy our family sweet tooth. The first was Mission Pie (http://missionpie.com), a small shop serving both sweet

The pie counter at Mission Pie - Yum!

and savory pies. While we were visiting we tried the walnut, the banana cream, the apple rhubarb and the strawberry rhubarb. All of the pies featured properly light and flaky pie crust. The banana cream was the favorite of our daughter, but I liked the tart/sweet zing of the strawberry rhubarb the best, particularly with a dollop of whipped cream on top. Mission Pie sources their ingredients locally and rotates their menu seasonally. I found myself wishing that I lived in San Francisco, because I would probably go to Mission Pie two or three times a week to sit, eat pie and write in their café. On the other hand, perhaps it’s for the best that I don’t live anywhere close by.

The second fun (and funky) place near the apartment is an eclectic soda and candy shop named The Fizzary (http://www.thefizzary.com) which features walls lined with any and every type of soda you

The interior of The Fizzary.

can imagine. My particular favorites were the Chai soda (made by the store brand, Taylor’s Tonics) and the chocolate cream soda. My husband liked the expresso soda. Much to our surprise, our two year old loved the extremely zingy (non-alcoholic!) ginger beer. Other varieties we liked included apple, blueberry, pineapple coconut, and mint lime, but they had hundreds more. The store gives a free taffy with each purchased bottle of soda and the mango chili flavor of taffy was intriguingly spicy and sweet. One of the store owners mentioned that in the future they hope to move some of their soda making process to the back of the store and open that up for viewing. I hope they do!

Dandelion Chocolate (http://www.dandelionchocolate.com/) is already showing how well a company

can do making their production process visible. Dandelion chocolate is a small-batch chocolate company that has a small café in front of their production area. Their street sign caught my attention and lured me into the store with curiosity about what small-batch chocolate is. When I entered the store the enticing rich odor of chocolate washed over me. I couldn't resist and I immediately purchased a snack and a beverage and sat down to watch the chocolate magic happening right before my eyes. Their chocolate is excellent; they use cocoa beans sourced from different regions (two in Venezuela and one in Madagascar) with different drying and roasting procedures to develop unique flavors in their single origin 70% dark chocolate bars. While I was there I tried the lemon-ginger iced chocolate which was light and cooling accompanied by a buttermilk strawberry pie, which had a nice richness along with the tartness which worked well with the thinner, cooler chocolate drink. I liked the cafe so much I brought my husband and daughter back two days later and we shared the Mission hot chocolate which was rich, slightly spicy with a hint of almond flavor. I purchased a tasting pack of their three current chocolate bars and I suspect I will be ordering more over the internet, particularly around the holidays.

My final favorite find in the Mission area is ImagiKnit (http://www.imagiknit.com). I found this store based on the recommendation of a fellow knitter attending my conference. She saw me working on my

current project during a session (I almost always knit while in a classroom setting because it focuses my mind) and came over to chat. She showed me her project and mentioned she had to buy extra yarn while in San Francisco because she hadn’t brought enough. Then she proceeded to tell me about a great yarn shop in the mission area. I immediately looked it up and was delighted to find it within walking distance (about a mile) from where we were staying. I headed over after the conference was finished and spent a happy hour browsing through their stock. ImagiKnits covers two full, large rooms with floor to ceiling shelves, all packed with yarn of various textures, weights, colors and materials. The two employees were friendly and helpful without hovering. While I was there they found just the right yarn for a woman who came in with two of her children, based on the rather vague information she brought them. When I asked for something with a local feel to it they immediately pointed me towards several potential yarns and talked about what made each special to San Francisco. I ended up purchasing some superfine merino to make fingerless gloves for myself; the yarn is by Malabrigo which is a major brand but the particular weight and spin is an exclusive to their store. ImagiKnit was another store that made me wish I lived in San Francisco, but again for the sake of my budget perhaps it’s best that things are as they are.

Overall the Mission area of San Francisco felt energetic, bright and vibrant. The area is famous for

The Women's Building in San Francisco.
The entire building is covered with
these colorful, detailed depictions of women
in many different time periods and roles.

brightly colored murals painted on the buildings and we saw many of these visual treats. There were hundreds of small businesses and intriguing stores; I only scraped the surface in the time I spent exploring there. I wasn’t even able to stop at all the recommended restaurants, and there was a really fun looking toy store that I passed up in consideration of the fact that I would have to get home anything I purchased there. My husband, daughter and I had a wonderful, safe time exploring the Mission area (and were less bothered by San Francisco’s rather aggressive panhandlers than we were downtown) and can’t wait to get back again.

Protestors at the APA

Every year that I can, I attend the American Psychiatric Association annual meeting in order to obtain CME (continuing medical education) and connect with old friends. And pretty much every year that I’ve attended there have been people outside the meeting protesting. Some years there are more, some years there are less, but there always seems to be someone outside accusing psychiatrists of being dangerous, harmful, greedy individuals. This year, I finally got up my nerve to go speak to some of them. I wanted to know why they were there and what their concerns were in a more detailed way than I could work out from reading their signs. So I walked over to where one protestor was manning a large truck showing a looping video of how awful psychiatry is and introduced myself and asked “Why?” Why is this important to you? What are your concerns?

He was very nice and offered to walk me over to their main protest area, where they had literature and an exhibit set up. He let me know he belonged to a group called the Citizens Commission for Human Rights (CCHR). On the way over I asked him my questions about his specific concerns and why this is important to him. He noted that he is just “the most curious guy in the world” and claimed that once you start reading the abuses are obvious. I asked him if he had personal experiences with psychiatry for himself or his family members and he shrugged a little and commented that he knew a few people. He then kindly pointed me in the right direction and said goodbye.

I walked over to where the CCHR had their exhibit set up in Yerba Buena Gardens, across the street from the convention center where the meeting was being held. They had a long narrow white tent, the type you might see at an outdoor reception, and they had arranged a walk through exhibit that presented their argument that psychiatry is harmful. I walked through and read their displays and watched some of their videos, and I found several major problems with the statements that were being presented. The first problem is that many of the displays talked about events in the 1800’s, in Nazi Germany, and in the Soviet Union. I am not arguing that terrible things were done by psychiatrists (and many other people, including other medical doctors) in the past. But those events do not represent psychiatry as it is practiced today nor does it represent the psychiatrists who practice it. I’m not saying there aren’t bad or unethical psychiatrists, but as a group and a profession we repudiate past abusers and strive for high ethical and humanistic standards in caring for our patients.

The second problem was the persistent statement that psychiatry has no scientific basis. That statement is just wrong. There are hundreds of research papers documenting changes in the brain that occur with multiple psychiatric illnesses. There are hundreds more that document specific genetic abnormalities linked to different illnesses. There are even papers showing reversal of brain changes with treatment of depression. Is the science of psychiatry where it needs to be? No, absolutely not. It would be fantastic to have a blood or imaging test that could tell us in a simple, clear and specific fashion if someone had a mental illness, what illness they had and what treatment would be optimal. We don’t have any such testing yet, which is incredibly frustrating to psychiatrists as well as our patients. But it also isn’t surprising because the brain is the most complex organ in the human body. It has 100 billion neurons that connect to each other in over 100 trillion synapses. No offense to my cardiology or pulmonology colleagues, but the brain is just a lot more complicated than a heart or a lung. And we haven’t had the tools to study that complexity for very long. So the science of psychiatry is new, and growing, but it is absolutely there and psychiatrists are working hard to improve it. At my own hospital we are taking part in a study to see if EEG’s can give us guidance as to whether (and which) medication might be helpful for an individual. The DSM (Diagnostic and Statistical Manual, of which version 5 was just released) is not a perfect tool, and people are already talking about revisions for DSM-6. I would suggest, however, that our imperfect diagnostic and treatment systems are better than no care at all.

The third major problem I found was the repeated accusation that psychiatrists were greedy and power hungry. Quotes were taken out of context and plastered on billboards to convey the idea that psychiatrists want to infiltrate education and government and mind control the entire population. Other statements were made that psychiatrists make up illnesses and drug people to keep themselves in business. I am sure some psychiatrists have made extreme statements and that some psychiatrists are greedy. After all, we are a group of human beings and that means that we will have a range of intentions and goals. However no one goes into medicine to get rich (try business instead if wealth is your goal) and psychiatrists are on the low end of the physician pay scale. We do our work for other reasons than money. Do you know the best attended, most crowded sessions I found at the APA this year? Sessions on mindfulness and sessions on cognitive behavioral therapy were so tightly packed people were standing in the back. Neither of these sessions were about topics that are going to make anyone any money. They were about topics with profound potential to reach out and touch our patients and improve their lives.

The last major problem was the implication that psychiatrists go out looking for patients and harm them. I can’t speak for all psychiatrists, of course, but I’ve never gone out looking for patients in my life. People come to me, asking for help. It often feels like a flood of people beating down my door. People tell me they are suffering and I try to work with them to figure out what to do about that. I can’t speak for all psychiatrists, but I was taught and I continue to practice a collaborative model of psychiatric care. I attempt to think with my patients about what is going on in their brains and in their lives. I talk about a range of various interventions we could try and I speak honestly about the risks and potential benefits of medication, therapy, or even doing nothing. I’ve had many, many patients tell me I’ve helped them. I’ve even had a few where I think I saved their lives. I’ve had patients return months or years later to let me know they are doing well now and to thank me again for my help. Obviously that’s just my personal perspective and experience, but it just doesn’t match with the material the CCHR was presenting on the damage they feel my profession is causing.

At the end of the exhibit I talked to another protestor. She was also very pleasant and courteous, even after I told her I was a psychiatrist. She shared her concerns that doctors use their authority to coerce people into treatment. She also mentioned that she hasn’t had a personal experience with psychiatry, but that her beliefs grew out of her religion of Scientology. She informed me that the Citizens Commission for Human Rights is Scientology group. She was open to hearing from me that one of the reasons I went into psychiatry is that a dear, much loved family member had ECT treatment after years of depression and suicide attempts and that it worked incredibly, amazingly well. We smiled and shook hands and I left, fairly certain I had not convinced her of anything but hoping I had given her something to think about.

Here’s what I wish CCHR understood. Being a psychiatrist is one of the hardest medical professions. Our science is new and underdeveloped. We struggle against the ongoing fear our culture has of mental illness and the mentally ill, and that stigma reaches out to brush us as professionals. Working as a psychiatrist can be painful and exhausting as we work with patients who have been deeply traumatized by either their biology or their environment or both. And we keep doing this work because we care. Most psychiatrists go into mental health because of a deep wish to connect with and heal others. Ours is the most philosophical branch of medicine, the branch that deals directly with the human experience in this world. Psychiatry touches on ethics, religion, science, art, sociology and medicine. As psychiatrists, we tap into the length and breadth of our lives to reach out a build a bridge to our patients, to help them walk back across the abyss into health. We do a difficult and necessary job, and we strive to do it well.

What A Trip!

I’m in San Francisco this week with my family, attending a pair of conferences. My husband and daughter are going to visit museums and zoos while I attend my meetings and get my continuing medical education credits. I love San Francisco. So I was really excited to come here, but wow it was a lot of work getting here. We had planned to take a 9:30 am flight directly from the airport near our home to the airport in San Francisco. It would have been a 6 hour flight and we would have arrived around 12:30 pm local time. The original idea was that we would arrive, grab a few groceries, and put our daughter down for a nap. Then I would attend my first conference event that evening. It was a great plan, but unfortunately the airlines had something to say about it.

In the words of my daughter “we got on the plane. Someone said no, no, no. we got off the plane. We waited. They didn’t fix it. We waited some more.” That’s a pretty accurate summation of events. We had just boarded the 9:30 am flight and gotten our daughter settled in her car seat when the captain announced that we had to deplane because there was a mechanical problem. They promised an update at 11:40 AM. So we got off and waited. The clever people went ahead and booked themselves on the next direct flight. The rest of us waited and were told at 11:40 that the flight was cancelled because they couldn’t fix it. Then of course there was a massive scramble for the customer service desk. My husband called the airline instead and managed to get us out on a 12:45 pm flight connecting through Chicago and eventually arriving at 8:00 pm local time in San Francisco. Which beat the option most of our fellow travelers found of getting out on a 5:45pm flight that connected through Chicago.

After that hiccup, though, the trip went very well. Our rebooked seats were three middle seats in separate rows but our fellow passengers were kind (or just self-interested) and were willing to swap so one of us could sit next to our daughter. We serendipitously found a great place to have a late lunch/early dinner in Chicago: Tortas Frontera by Rick Bayliss. The restaurant offers spicy, savory Mexican inspired sandwiches on grilled flatbread, guacamole that is smoothly dippable without being homogenized, crisp salty tortilla chips, and extraordinarily strong margaritas. My husband and I ended up pouring off the margarita we had bought to share into double the volume of mango-lime juice and it was still a little too strong for our taste. Although, obviously, we are light-weights when it comes to alcohol. The meal was something that I would have happily sought out for an evening out in our hometown if the restaurant only existed there. As it is, I will now look forward to connections through O’Hare a little bit more.

One advantage my husband and I have is that our daughter is an outstanding and experienced traveler for her age (she’s taken 38 separate flights on 12 different trips in her lifetime so far) and takes the vagaries of travel with a certain amount of joy and fun that I just can’t match as an adult. She told me on the flight from Chicago to San Francisco “I love people. They make me happy.” Which is a pretty accurate bit of self observation from a child who is 2 years and 8 months old. She happily strikes up conversations with passersby and generally seems to think a trip on a crowded airplane is a chance to make new friends. My husband and I are also pretty experienced as travelling parents at this point, so we’ve got the routine and the equipment down. The secrets to happy travel with a child, for us at least, are a foldable trolley for her car seat that converts it to a stroller, good snacks, and a kindle with plenty of Elmo and Sesame Street downloaded for viewing.

When we finally arrived in San Francisco we found our luggage had beaten us there by several hours. We grabbed our two suitcases, grabbed a taxi, and headed off to our lodgings. We are staying in a comfortable lower floor apartment of a converted firehouse in the Mission district of San Francisco. It’s not near the conferences but it is right on the BART (San Francisco’s subway system) and so getting to the conference site is a breeze. One of our travel lessons has been that trips away from home with a small child are more fun if we have a kitchen and separate sleeping spaces. We’ve also learned that we can often beat the price of a downtown hotel room if we do some searching on the internet and are willing to use public transit. My husband found this place on vacation rental by owner (http://www.vrbo.com) and the owner kindly met us when we arrived, showed us around, and brought us some milk since it was too late for the grocery shopping we had planed. 

I will say major travel delays are a good chance to practice mindfulness. I definitely spent a lot of time taking deep breaths and practicing radical acceptance. After all, getting mad and upset wouldn't have changed the situation. It would only make me unhappy and less effective in coping. It would have made my husband and daughter unhappy too, since that kind of distress seems to be pretty contagious. And really, in the big scheme of things, an 8 hour delay is just not a big deal. We arrived in San Francisco safely (and with all our luggage) over 3000 miles from our home in less than 15 hours. I have done a lot of traveling in my life, but I still think that's pretty amazing.

Mindfulness, Attunement and Resonance: Chapters 2 and 3 in The Mindful Therapist

Back at the beginning of March I decided I would have a “mindfulness month” in which I would read five books about the topic of mindfulness and perhaps begin practicing. About a week later I realized that I was only about one chapter into the first book I wanted to read and that I should probably revise the project to a mindfulness year and give periodic updates. I’m pleased that I finished my first book today (two and a half months after starting, which puts me on track for finishing five books in a year, I think). I am starting on the second book and have begun experimenting with some simple mindfulness practices, mostly breath awareness and body scans. I am also working on teaching my toddler to use deep breathing when she is upset so that she can learn healthy ways to self soothe.

The book I just finished is “The Mindful Therapist” by Dr. Daniel Siegel. This was definitely a challenging book for me; I found myself taking extensive notes on each chapter as I went along because there was so much novel information. Over the next few weeks I plan to reflect on those notes and do some writing about what I learned in order to further consolidate my understanding. I have already talked about the first chapter in the book, which was about presence, a necessary quality for a therapist. The second chapter is devoted to attunement. Attunement is the process of focusing on another person and bringing their experience into our own inner world. Presence is required for attunement, but it is not the same thing. The idea of attunement in the second chapter then links to the idea of resonance in the third chapter. Resonance is the process of linking two people into a whole, so that a person recognizes that another person is attuned to him.

The most fascinating part of this chapter for me was Dr. Siegel’s description of the theory of how, biologically, attunement takes place. The reason the neurobiology is so fascinating for me is that it unites the two halves of psychiatry. When I was in training I found it very frustrating to have a lecture one hour on neurons and neurotransmitters and then the next hour on defense mechanisms and empathic listening. I couldn’t find a way to make those two worlds, the biological and the psychological, relate to each other. Yet they both seemed to have validity. Finally the work of Dr. Eric Kandel (a Nobel prize winning psychiatrist and neuroscientist) opened my eyes to how experiential learning can actually shape our physical brains. Since then I have been hooked whenever I find someone writing or talking about ways to base our psychology in our biology.

According to Dr. Siegel’s book, the biological process of attunement is likely to start in mirror neurons. These neurons have been shown to operate in preparing us to imitate the observed behavior of another person – for example, if I see you reach for an apple, the mirror neurons in my brain will fire as if I had reached for the apple myself. Mirror neurons also are likely to operate with emotional behavior as well, so that if I observe someone crying I myself will probably experience sadness. What I found even interesting is that mirror neurons relay to other neurons down into the body through the autonomic nervous system, so that I will literally “feel” what I observe in someone else, without my conscious awareness. Those internal bodily sensations are then carried back up through the spinal cord and finally relay back into the cortex of the brain in a particular area called the anterior insula, which is the point at which we develop conscious awareness of our internal feelings. This attunement can then be sensed by the other person, which creates resonance.

Interestingly, just the experience of attunement and resonance between two people can actually modify each person’s internal mental and emotional experience towards the direction of health. Hence the importance of the therapist maintaining his or her capacity to be present, to attune and to resonate when seeing a patient. One of the comments Dr. Siegel made in both of these chapter that I strongly agreed with is that attunement and resonance in the clinical encounter are hard, much harder than simply asking a patient questions designed to establish a diagnosis. You have to be humble and willing to let the patient lead, and you have to be willing to acknowledge that you don’t know. Being attuned and resonating also means keeping open your own “window of tolerance,” another metaphor Dr. Siegel introduced, for that emotional experience. You have to be able to tolerate feelings of fear, sadness, rage, etc… while remaining flexible and functional.

Dr. Siegel offers many exercises in these chapters designed to help therapists widen and stabilize their windows of tolerance. One exercise which I found very informative and also calming is a body scan exercise. In his book Dr. Siegel “talks” you through a slow scan of all of the different parts of the body. This exercise reminded me strongly of the Yoga Nidra exercise by Robin Carnes that a colleague recommended to me for sleep. It is very peaceful but it is also an exercise that builds your skill in attuning to yourself, so that you can have increased skill in attuning to others. Dr. Siegel also suggests ways to evaluate your own experiences with attunement and resonance (or the lack thereof) and how those experiences might be affecting your own capacities for presence, resonance and attunement today.

As I read these chapters I am struck by how well what he states matches my own experiences, not just as a therapist but as a spouse, parent and friend. When I am within my window of tolerance I am able to be present with others, open to my current experience and the information they are giving me so that I can attune and resonate. However when I am outside my own windows of tolerance: too uncomfortable, too stressed, too sad, etc… I can’t maintain that state. I shut down and try to shut the other person down too. I’m not listening, I’m not present, and I’m not mindful. I can see how the exercises Dr. Siegel suggests can be helpful in broadening the emotional and mental space in which I can be present and I can see how that is important for strong relationships in both professional and personal aspects of my life.

My Favorite Yarn

Cozy up on your couch under a hand-knit afghan and let’s talk about one of my favorite topics: yarn. My personal favorite yarn these days is Knit Picks’ Comfy Worsted yarn. This is the yarn I used to create my daughter’s baby blanket and which I continue to use for gifts for my friends. Baby knits need to be super soft, washable and durable. Comfy Worsted answers all of the requirements. This is not the scratchy acrylic yarn your great grandmother used to crochet granny square bedspreads. Comfy Worsted is a super soft blend of 75% pima cotton and 25% acrylic. The cotton base offers softness and lightness to the feel of the yarn, while the small amount of acrylic adds elasticity and durability. The 4-ply yarn is a pleasure to work with, sliding smoothly across your fingers without snagging or splitting as you knit. The worsted weight yarn looks great knit on size 9 or 10 needles, if you are interested in making a looser, large project in a hurry, or on size 5 or 6 needles, if you want a tighter fabric. Knit Picks does offer a sport weight yarn in the same blend if you are looking for something lighter, but the I have found the worsted weight to be the perfect texture for a soft, light yet warm blanket.

Comfy Worsted is a yarn that can be machine-washed and dried and creates a blanket capable of handling a toddler’s love. This is important, as you want the time invested in a handmade baby blanket to pay off in years of fun, not ruined with the first spit-up. My daughter’s blanket has stood up to almost three years of hard use, including her potty training period, and has only become softer. The colors remain bright and attractive and the shape of the blanket has held despite frequent use as a superhero’s cape. The blankets I’ve made for friends’ children seem to have held up similarly well when I’ve seen their children playing with them.

Besides the critical qualities of soft, washable and durable, this yarn is beautiful. Knit Picks offers Comfy Worsted in 30 different colors, including multiple variations on blues and pinks. There are also  shades of green, purple and neutrals such as brown and grey. Sadly, the warmer tones are somewhat lacking. There is no true shade of red in the collection and orange and yellow are limited to a single, rather pastel shade each. This is a disappointment, limiting blanket creation to the cooler and quieter tones instead of the vivid popping reds and oranges I’d like to use at times. However with 30 colors available there is plenty of creative scope to match blanket color choice to the particular friend or family for whom it is intended.

Knit Picks products are available only online at www.knitpicks.com. Comfy Worsted is sold for the bargain price of $2.99 for a 50-gram wound, center pull skein, which represents 109 yards of yarn. Baby blankets typically will use about 800 yards of yarn, so depending on your choices in size, design and knitting needles anywhere between seven and nine skeins will be enough for a blanket. The more intricate the design and the more color changes you make the more yarn you will require, but the prices at Knit Picks keep it easy on your pocketbook to pick up that extra skein for insurance (because one of the worst feelings as a knitter is realizing that you have run out of yarn about 2 rows before you were done with your project). The delivery has been reliable and fairly quick, which makes obtaining the yarn I want hassle free. I suspect Comfy is going to continue to be my favorite yarn for a long time to come.

Three Mothers

I remember asking my mother once when you began to feel like a grown-up. I was in my late 20’s at the time, so this was about a decade ago. I was already a doctor although still in residency training, and I was a homeowner, and by anyone’s measure a responsible adult. But I didn’t feel very adult, so I asked my mom about it. She said that having kids helped her feel more like a grown-up. Which I have also found to be true. I feel like more of an adult now than I did three years ago. Although I still feel like a big kid myself sometimes, more capable and knowledgable of course, but overall just a bigger child trying to help this smaller child get things done and figure things out. So I’m not really sure when you settle into steadily feeling like an adult. Maybe you don’t, really.

As a child, I am fortunate to have three mothers in my life, each of them different and each of them teaching me something different. My first mother is my mom, the woman who gave birth to me and raised me. She taught me to be caring and nurturing. We were talking this weekend and she is still the office “mom” at her job; she is the person who brings chocolates and keeps a sewing kit in her desk. She taught me to work hard and keep my promises. My mom is the type of person who will get the job done, no matter what. She goes above and beyond but doesn’t see it as anything special. My mom taught me to love G-D, and to trust his love for me and other people. When I get confused about theology I remember what my mom taught me. G-D made us, he loves us, each of us, the way we are. My mom loves G-D and she shows it by treating other people with compassion and kindness.

My second mother is my step-mother. She came into my life when I was about 14 or 15. Our relationship wasn’t easy in the beginning. Not that I ever fought with her or disliked her, or that she disliked me. It was more that I didn’t understand her or know how to connect. My sister connected with her right away but it took more time for me to find common ground. My step-mother is a very honest person, to the point of being blunt, which was shocking for me at first but I find refreshing now. She is athletic and creative; she goes on yoga retreats and walks three miles a day and makes her own pottery. She grows her own orchids and has about 50 of them, all in good health and blooming. She is confident and knows her own style and she never seems to be afraid of anything. She is a business owner and, like my own mother, was a single parent. My step-mother has helped me to loosen up, to take more chances. She also taught me the value of patience and persistence. She never gave up on me even when I was distant and quiet. She kept reaching out to me and finding ways to connect.

My third mother is my mother-in-law. I met her when I was 19 and first started dating her son. She welcomed me so lovingly, which is a big deal as my husband is Jewish and I am Christian. She could have been rejecting or even just cool towards me, but instead she has always made her home my own. My mother-in-law is a fabulous, stylish, sophisticated woman. She travels all over the world, including to places like Myanmar and Turkey and Morocco that many people don’t ever reach. Her home is a beautiful space filled with incredible art. She also knits and has a ball shopping at Costco and Big Lots. My mother-in-law has taught me to knit, which has become my favorite craft. She models a life engaged with the world around her, travelling and attending cultural events and working for charitable organizations. She taught me about value; that some things are worth spending money on but that it is also okay to find good deals.

Perhaps it is easy, then, to still feel like a child, when you have three incredible mothers. Three very different women who love you, encourage you, and accept you for who you are. Not that they make me a child or don’t accept me as an adult, but rather that I see so much that I still want to live up to. I know I am blessed by the presence of each of them in my life. I know my daughter is blessed by her three grandmothers. I hope I live in such a way that she will be blessed by me. 

Superpowers and Wishful Thinking

What superpower would you most like to have? I’ve always been fascinated by the idea of superpowers and psychic powers. Some of my favorite books, even as a child, featured characters that had psychic abilities. Not that it’s a real possibility, but sometimes I wonder what I would pick if I were suddenly given a choice.

Tonight I would like to be able to levitate. I am at my mother’s house and she has this one cat who is really, really insane. He hisses and snarls and swipes at people for no reason at all. He bit my mom about 20 minutes ago, just out of nowhere. He’s pretty scary, to be honest, and so I was wishing I could levitate so I could get around the house without having to walk past him. I could just levitate over, you see. Although my mom pointed out that he’d probably be even crazier and jump up and try to bite me. So perhaps that's not a great idea.

When I’m stuck in traffic on the way to work, I wish I could teleport. I especially wish this on days I am running a little late. Just concentrate hard and pop! I dematerialize and rematerialize somewhere else. If I could just teleport myself into my office the daily commute would be so much easier. If it worked over long distances or I could carry other people with me that would be even better. Just think, no more waiting around in airports in order to be crammed into an airplane for multiple hours desperately trying to amuse a toddler.

I sometimes wish I could be telepathic with specific people. You know, send my husband a telepathic message when I don’t want someone else to hear something. Around our daughter we spell but that gets tedious after a while and also I’m not sure it will work well for more than a few more years. As a general rule though I’m not sure I really want to know what most people are thinking. I am a firm believer in the idea that what counts is the words you actually say and the actions you actually perform. I’d rather not have anyone else know what I wrestle with beforehand and I’d rather not know about other people either. I think in general being telepathic would be a pretty awful experience. It’s just better not to know some things.

When my ankle was first broken I wished pretty strongly to be able to move things with my mind (telekinesis). It was very frustrating to have to constantly ask my husband to get me this or bring me that. He was very sweet about it but I think it was a little wearing for him too. I also wanted to be able to help pick up my daughter’s toys, which I couldn’t do well on crutches or from the scooter. So the idea of zipping things around the room with my mind was really appealing.

I suppose what I would want most of all would be the ability to heal. When I’m sitting with a patient I sometimes wish for this very strongly. Particularly when I am working with very sick people in the hospital, or some of the cancer patients I see. And also sometimes with patients who have really challenging psychiatric illnesses, people who are suffering terribly whom I just can’t help well enough. I do pray for them, quietly and unobtrusively, but it would be awesome to be able to take their sickness and pain away and give them back health. It can be really frustrating to be a doctor sometimes. Medicine is wonderful; don’t get me wrong. We’ve certainly come a long way in a short period of time, and more is learned every day. But medicine is also so limited. There is still so much more we don’t know and can’t do. A healing superpower would be really nice to have.

Magic Wands and Crafts with Toddlers

I absolutely love doing craft projects. My favorite craft is knitting and that’s where I invest most of my craft time and where I have developed the most skill. But I have dabbled in scrapbooking, small quilting projects, beaded jewelry and other crafts over the years. I’m the kind of person who happily walks the aisles of A.C. Moore or Michael’s or JoAnn’s looking at all the potential projects and dreaming of having infinite time and money to spend on crafts. There is just such a rush when I am able to create something beautiful, particularly if it is also useful. For me, one of the exciting aspects of having a child was the prospect of doing kid crafts again. I have been waiting, more or less patiently, since my daughter was born for her to be capable of doing craft projects with me. Tonight I took the plunge and we had our first mother daughter craft night.

There were several things that inspired me to move ahead with doing craft projects. Lately my daughter has been into painting with watercolors, which she does during the day with my husband. She’s having a blast with that, according to him, and I’ve been fairly jealous. Although some of the jealousy was soothed by being the recipient of a new masterpiece for my wall at work. Several friends have told me about projects with their kids that went well which was encouraging. Finally, my daughter lost her magic wand. As I have mentioned before, her favorite Sesame Street character is Abby, a young fairy godmother in training who uses a wand to “twinkle think.” My daughter had a pumpkin flashlight that she had designated as a wand and which she would put to her temple and announce “I need to twinkle think.” Sadly, pumpkin wand has gone missing sometime over the past week, apparently lost somewhere in the no mans land between the house the playground and daycare. It has been missed by my daughter several times, and although we’ve been able to distract her I wanted to obtain a replacement wand before we have the total meltdown.

My initial thought was that I would cut out a wand shape (stick with a star) from cardboard and cover it with aluminum foil for her. However, I realized I didn’t have any boxes around that I was willing to cut up. I also thought it would be more fun to make a wand with my daughter. So off to Michael’s we went. I found a package of popsicle sticks and another package of cut out wood shapes – stars and hearts and diamonds. I found glitter glue and gem stickers and foam stickers and we were in business. Tonight after dinner I put down the large plastic tablecloth we use for messy activities, brought out the art supplies, and we went at it for 45 minutes before bedtime. I think between us we decorated about 10 wands and most importantly we had fun.

As an adult, I’ve learned I need to hold myself in check when doing activities with my two and a half year old daughter. It’s hard sometimes because I have distinct ideas about how things should be done. I have to sit on and squelch the part of me that wants things done “right.” Yes, my toddler squeezes the glitter glue in big clumps all over the wands so that it won’t dry. Yes, she peels the stickers off and sticks them on until they lose their stickiness. Yes, we have to negotiate sharing the glitter glue and gem stickers. Yes, she has more fun sticking the stickers on her own hands (and mine) than on the wands. Yes, she makes a huge mess. And that’s all okay.

I remind myself of several things. Everything washes; kid, clothes, floor, tablecloth and Mommy. I’ve learned to only buy washable craft supplies. Messes can be fun sometimes if you aren’t tense about them. Sharing with Mommy is good practice for sharing with other people. It’s arts and crafts, so there really isn’t any such thing as “right” anyhow. It’s not necessary or even important to have a beautifully decorated magic wand. (Although, I confess, I did make a few wands that I thought looked nice because I played with the art supplies a little on my own last night. My reasoning was that I would pre-glue some shapes and also get a feel for how the glitter pens worked. Uh-huh. Yep. That’s my story and I’m sticking to it.)

The most important thing this evening is that we had great time together, so that this will be the first of many mother daughter craft nights. The most important thing is that we will have great memories of doing something really fun together. So this evening I sat back, played with glitter glue (the best part of the supplies in both of our opinions) and made art with my two and a half year old daughter. That's the real magic in my book.

Fiber Weekend

It has been a very fiber oriented weekend. Months ago I signed up for a workshop at my local yarn store, Fibre Space (http://www.fibrespace.com/)  in Alexandria, Virginia with one of my favorite knitting designers, Susan B. Anderson (found on line at http://susanbanderson.blogspot.com/) who designs amazing reversible toys among many other things. I absolutely love knitting toys and reversible toys have become my favorite kind of toys to knit. There is just something that is so enchanting about a toy that turns inside out to become something else. It feels like a magic trick. In addition, reversible toys leave you feeling very clever and accomplished as a knitter. These workshop promised a brand new pattern, a reversible turtle and egg, which is not found in any of her books. It also offered me a chance to meet one of my knitting heroes.

It's an egg!

It's a turtle!

It's an inside out reversible toy! A turtle emerging from an egg!

I was a little nervous about signing up for a workshop after work, since I can’t always count on getting out on time. But with the support of my lovely colleagues I made it there. I was late, but due to delays in her flight and then terrible traffic, Ms. Anderson was even later so I was comparatively on time. The evening was just as much fun as I had hoped. I spent two and a half hours with a cheerful creative group of women, all there and determined to enjoy the event. Ms. Anderson was kind and gracious despite her dreadful day spent travelling and the prospect of another such day in front of her so she could be home in time for her daughter’s special event the next night. She showed us some great techniques not just on knitting the toys but on stuffing them and embroidering the faces which I really appreciated. Finishing toys is harder than knitting them sometimes, and really makes a difference to how the project looks in the end. She was even sweet enough to sign our books for us, since she had just published a new book all about reversible toys. I liked the project so much that I actually completed it in one weekend.

Then on Saturday I attended the Maryland Sheep and Wool Festival in West Friendship, MD. This is an annual festival that is held the first weekend in May at the Howard County Fairgrounds. This festival is a celebration of all things fiber. As you might expect from the name of the festival there are plenty of sheep that are shown in competition. There are also sheep shearing competitions, demonstrations of sheep herding with sheep dogs, and a sheep to shawl competition in which one shearer, three spinners and one weaver work to produce a shawl within hours. However, the actual sheep have become just a small part of the festival.

In the main exhbition hall and in most of the smaller barns there is a profusion of exhibitors selling anything you can think of that is remotely connected with fiber: handmade garments and blankets, angora rabbits, wool dusters, supplies for tending sheep, looms, spindles, garden plants, spinning wheels, books of techniques and patterns, knitting needles, special soaps for wool and fine garments, fleeces, needles and blocks for felting, portraits and landscapes made with tiny embroidered stitches, buttons, toys, alpacas, and, of course, yarn. Hundreds upon hundreds of skeins of yarn in every color and texture imaginable. Handspun, hand dyed yarn that is completely unique and not available anywhere else. Rows of commercially dyed and spun yarn that can work in any project. Chunky yarn and fine yarn and crazy yarn with elastic or tied threads or beads incorporated into the yarn itself. This year sparkly yarn seems to be in style, with most of the large exhibitors showing large swaths of yarn with strands of metallic color that glittered in the sunlight. The festival is absolutely a knitter’s dream landscape.

Every year that I am able I attend the festival with my mother-in-law, who taught me to knit. The sheep and wool festival is a crowded but friendly place. It’s the kind of place where people wear their own handmade garments and it’s perfectly acceptable to walk up to a stranger and let them know how much you like their sweater or shawl. In fact, twice when I did this the wearer gave me the name of the pattern and the name of the yarn she used to create her masterpiece. This year my two and a half year old daughter came with us to the festival for the first half of the day. We took her to see the demonstrations of dogs herding sheep, which I thought was impressive but which didn’t keep her interest. We fed her festival food, the kind of hot dogs, kettle corn, and boardwalk fries that you can find at any fair worth its name. We found a group of people spinning angora yarn directly off their rabbits and she was able to pet a real live bunny, which she later told me was her favorite part of the day. Then my husband took her back to my mother-in-law’s house and she and I continued on to see the rest of the exhibits.

Some of my favorites were the booth by “Going Gnome,” in which two sisters sold their handmade, needle felted wool sculptures of gnomes, birds and mushrooms and the booth by “Hunt Country Yarn” a Virginia store which features yarn made and sold by women owned businesses. Another booth featured alpaca yarn and had a large sign on its side offering two male alpacas for $800. They are beautiful animals but I wasn’t tempted; where would I put an alpaca? And what would I feed it? A third booth offered registration for a week long fiber arts retreat in New England, which is also impractical for me. It’s fun though, to imagine the different things I could do in another life. A life that involved less time spent at work and more time spent on interesting hand made crafts.