What's A Poor Doctor To Do?

I was skimming through a recent issue of the Journal of the American Medical Society this morning and I came across an article analyzing trends in prescription drug use in adults from 1999 until 2012. It initially caught my attention because I misread the title and thought it was an analysis of prescription drug misuse, which is something I encounter frequently as a psychiatrist. On closer reading though, it was simply an analysis of prescription drug use, which has increased by 8 % over the two time periods in the analysis (from 51% of adults to 59% of adults). The prevalence of polypharmacy (use of five or more prescription medications) increased from 8.2% to 15.0% between the same two time periods.

The article itself was factual and neutral but I started to get hot under the collar as I read it. Polypharmacy is considered a negative thing in medicine. It exposes patients to more side effects and drug drug interactions, and it’s considered dangerous. And I’ve read many news articles about how doctors prescribe too many drugs for too many conditions, and how it’s terrible and expensive and dangerous. At the same time, there are multiple published standards for treating different conditions. There are specific, numeric goals for screening and treating hypertension, diabetes and high cholesterol, just to name a few. There are standards for screening for and treating depression and pain; to remain accredited with certain quality agencies you have to document that you are doing both.

The publication of specific standards for treating conditions and the publication of critiques of polypharmacy and overutilization of prescription medication creates a double-bind for physicians. A double bind is a situation in which no matter which option you take, you fail. You are given two conditions that you must meet, but they are mutually exclusive. There is no possible way to succeed.

For example, when I was a primary care doctor, I might have a patient come in who had hypertension, diabetes, high cholesterol and depression. Many of these illnesses run in packs, so that’s a pretty common scenario. I evaluate the patient and talk to her about treatment. My treatment is likely to be medication based, because even though I encourage her to exercise regularly (which would help all of her conditions) and to change her diet (ditto) and to reduce stress and get more sleep, my patient lets me know that these kinds of changes just aren’t realistic for her. So I start to work with prescriptions. Chances are, it will take two or three medications each to control her diabetes and hypertension and one or two each to get her high cholesterol and depression under control. Not to mention the “add-ons” like prescribing a baby aspirin a day for certain age and risk groups that are published as standards of care. I might succeed brilliantly in controlling her medical problems, but I’m a failure because my patient is taking 5 or more medications.

Double binds are incredibly bad for your psychological health. They create pain, depression and confusion because when you are in a double bind you are always wrong. The only way to “win” in a double bind is to stop playing the game; to refuse one or the other of the conditions that have been placed on you. However, double binds occur in situations in which you can’t just leave the problem; the classic example is between a parent and a child (the parent is the one inflicting the double bind on the child) and of course the child can’t just leave the parent. I would suggest that after the amount of money, time and energy most doctors spend acquiring their professional credentials they are equally unable to leave medicine. So what’s a poor doctor to do?

Most of us seem to muddle along focusing primarily on the patient in front of us at the moment, the one who needs multiple medications to get their chronic health problems under control. We keep our heads down and try to ignore all the criticism, implicit and explicit, that we get for trying our best to do our jobs. I notice though, that there seem to be more and more depressed doctors around. So that strategy doesn’t seem to be working. 

I don’t know if we, as doctors, can speak up for each other and ourselves. I don’t know if we can begin naming and refusing the double binds that are placed upon us. I’m starting to think that we need to try.

To See A Universe in the Changing Of The Clock

I was walking in to work this morning with a colleague, and she commented that the sunny weather had put her in a good mood.

“It’s nice.” I agreed. “It’s one of the things I enjoy about the end of daylight savings time. It’s going to be nice and bright and easier to get up in the morning for a few weeks.”

She looked at me in surprise. “A few weeks?” she asked.

So I explained that it is nice and light now when we are getting up and driving in to work but that as we get closer to the winter solstice it will be darker and darker in the morning. Then as we move towards spring it will slowly become lighter in the morning, but only for a little while until daylight savings time comes along. Then we move forward an hour and it’s dark again in the morning until we get closer to the summer solstice.

My colleague listened to this politely and with an appearance of interest until we reached the turnoff for our respective hallways. We wished each other a good day and moved on into the flow of work.

I walked off down the hall puzzling. This changing of the patterns of light at different hours of the day matters a lot to me. I’m not a morning person in any sense of the word and waking up in the dark is really challenging. If I had the choice I’d always sleep until past sunrise, but my job is not so flexible and so I often have to wake up before I’m ready. So I pay attention, roughly, to the seasonal patterns of light and how our cultural pattern of clock changes interacts with that. I can’t tell you when sunrise will be tomorrow, but usually by sometime in January I’m desperate enough for morning sunshine to have looked up a sunrise table in order to figure out when I’ll have the light back. (Yes, I’ve tried a sunrise alarm clock, and no, it didn’t work for me at all.)

Yet this pattern, which means so much to me, was apparently news to my colleague. At least it seemed that way to me. Maybe she knows all about it and was just being extra polite in listening to my pedantic chatter. I read an article recently that talked about how bad we humans are at interpreting what other people are thinking and feeling (We are very bad at it but we think we are good at it. This is bad news for me as a psychiatrist, although I think it’s true and it explains a lot). So I could be completely wrong. Still, she seemed surprised to me.

Conversations like this make me realize that we really do live in our own universes. The things that matter to me, the details I notice, the patterns of my thought and experience, the way I interpret events, is completely unique to me. Other people don’t care about how much light there is in the morning because it doesn’t affect them. It’s not even part of their world. They don’t even know about it unless I happen to mention it in passing.

No wonder we all have so much trouble understanding each other.

The Intriguing Mystery of A Child

One of the interesting things about parenting a kindergartener is that you get these strange little windows into what they are thinking, without much in the way of explanation or discussion.

For example, the other night I am sitting on the couch reading and my daughter is playing in her play area. She comes over to show me something she’s built, and helpfully tells me it’s a scooter for her doll. 

“Nice work!” I tell her.

She then explains that she is buying new safety equipment for her doll and that she buys her new safety equipment every year (because she outgrows it, like my daughter does her bathing suits).

“What kind of safety equipment?” I wonder. “Helmets?”

She tells me that it’s helmets and knee pads and elbow pads. This is strange, I think. As far as I know, my daughter has never worn knee or elbow pads. Where did this idea come from?

“Don’t you think that’s a bit much for scooter riding?” I ask.

“She’s my sweet girl and I don’t want her to get hurt.” she tells me.

That’s pretty much the end of the exchange, and I am left puzzling. “Sweet girl” is one of my pet names for my daughter, so I see where that came in. I do tell her that I don’t want her to get hurt, usually in the context of her doing something really foolish like standing on a kitchen chair and pushing on the back of it to tip it. (I caught her before she fell, but I wasn’t pleased.) In things like bike riding I actually encourage her to be brave.

In fact, this is not a kid who’s terrible sheltered when it comes to physical activity. She climbed a 20 foot climbing wall a month ago (in a harness, on a belay, but she was still 20 feet up in the air climbing the wall). She dives head first into the deep end of the pool. She gets bumps and bruises and scrapes and we talk about “the good kind of scrapes and bruises” meaning the kind you get because you were doing something really fun.

On the other hand, she really doesn’t like getting hurt. Not that anyone does, of course, but she is very intense in her reaction. I think it’s partly her age and partly the dramatic personality she inherited from my side of the family. Minor scrapes are often accompanied by loud wails, tears, and insistence that “It hurts me very much!” and “I want this scrape to go away right now!” Which makes it hard to keep a straight face sometimes while trying to comfort her.

So maybe she wishes we were protecting her a little more? That her mommy was doing a better job taking care of her sweet girl? Or maybe she saw a TV show or read a book featuring a kid wearing elbow and knee pads and wanted to try the idea out with her doll? Who knows? I can’t really ask her, because I don’t think she really knows either. Trust me, I've tried. Either her explanation doesn't really make sense to me or she gets bored with the conversation and veers off in another direction altogether. She’s just playing, and her game makes sense to her even when she can’t explain it to me. It hammers home that this kid I adore, this child who shares my home and my genes and my water bottles, this girl I think I know so well, I sometimes don't know at all.  Like any other human being, she’s forever an intriguing mystery to me.

Phonetics Blues

“I before E except after C and when it sounds like A as in neighbor and weigh. Weird, right?” says my husband this morning as we engage our daughter in yet another discussion of how to spell a particular word.

My daughter’s kindergarten teacher tells us not to spell words for her anymore. She wants my daughter to listen to the sounds and figure out the letters. The same principle applies when my daughter is trying to read. She is supposed to be sounding out the letters to figure out the words. The school uses a mixture of phonics and sight words (high frequency words that are simply memorized) to teach reading. In theory, it all sounds fine. It should help my daughter be more confident and independent in her reading.

In practice, English doesn’t seem to work well that way. Take the word “knight.” My daughter wants to be a knight for Halloween. My husband has made her a knight costume complete with shield and sequined “chain mail” armor. Public schools no longer celebrate Halloween, but they do have “Storybook Character” day on October 30^th in which the children are requested to bring a storybook to school and dress up as a character from the book. My daughter is quite excited about this idea, plans to wear her knight costume to school, and really, really wants to be able to read at least part of the book to her teacher if asked.

We have a cute little storybook about a Knight and a Dragon who are dismal failures at fighting each other and open up a restaurant together instead. (The Knight and The Dragon by Tomie dePaola).  We were practicing it this evening before bedtime. My daughter was trying to read it by sounding out the words. Unfortunately, if you sound out the word “knight” you get “k-nig-hit” which is adorably Monty Python but not particularly helpful to a five-year-old trying to make sense of a story. It took about five minutes for her to struggle through the first sentence (which also contained the words “fought” which comes out “f-o-uh-g-hit” and “castle” which comes out “s or k, mom? – k-a-s-t-lee”).  I’m not sure she had any sense of the meaning of the sentence because she was working so hard just sounding out the words. After she finished I told her that was enough practice for the evening (because frustration + five-year-old + bedtime = a more explosive combination than dynamite) and I read the rest of the book.

I confess, I’m still spelling words for my daughter, despite her teacher’s instructions. If the word makes sense phonetically I’ll get her to spell it, but I just can’t stand it otherwise. It just doesn’t make sense to me to teach her wrong ways of spelling and reading that she’ll have to unlearn later. I’m balancing between encouraging her to read and keeping reading fun by making sure she still gets the stories she loves. The phrase “yes, we know, sorry, English is strange” has become quite frequently heard around our house. I know I must have gone through the same thing as a child. I have dim, recently awakened memories of being taught about helper vowels and silent letters. So I know it all works out, because I started reading competently around the 2^nd or 3^rd grade. And I do believe that once it is learned English is a lovely, flexible, powerful language. I just feel sorry for the kindergarteners.

Being A "Nicey"

My daughter’s kindergarten class has read a book titled “The Meanies Came To School” (written by Joy Cawley). I presume with some guidance from the teacher, the children have all decided that they don’t want to be “meanies" and that instead they will all be “niceys.” This has become quite the topic for discussion around our house, as my daughter explores the question of being mean or being nice and what that implies for her behavior.

In the car one day, she announced that she thought that my husband and I were “niceys.” I was flattered and I thanked her. Then, of course, she follows the butter up with the tough questions. “Why are you a nicey?” she wants to know.

The question reminded me of a conversation I had with a colleague earlier that week. I had been very pleased about a particular patient who was doing well and who had mentioned during their visit that they had used something I told them to help someone else. I mentioned to my colleague how happy I was, and how I always hope that what I say will be helpful and will be passed along from person to person. My mental images is like the wave that happens at sport stadiums, but rather than arm waving, I’m hoping for a wave of good health. My colleague agreed and mentioned she’d like to see a wave of kindness as well, which sounded really good to me.

I answered my daughter’s question with one of my own, in approved Socratic fashion. “What would happen if I wasn’t a nicey? How would you feel?”

She responded immediately that she wouldn’t like that, that she’d feel bad. “How would Daddy feel, if I was a meanie to him?”

Again, she responded quickly that Daddy wouldn’t like that.v“Do you think that if I were a meanie then you and Daddy might end up being meanies too?”

That was more challenging (hypothetical contingencies are tough for grown-ups, let alone five-year-olds) but she came to the conclusion that yes, she and Daddy might be meanies if I was a meanie, and she was able to extend it and observe that her grandparents and aunts and uncles might all be meanies as well.

“Right. So, I don’t want to live in a world full of meanies. That’s no fun. I’d rather live in a world of niceys, so I try to be nice. Plus, when I’m nice to someone whose mean to me, then sometimes their meanness stops.”

Then, because I didn’t want to leave her with the idea that she couldn’t speak up for herself or do something to stop someone who was treating her badly, I elaborated. “When someone is mean to me I can use my words and say ‘Please Stop. I don’t like that.’ and then if they don’t stop I can walk away and get help. I can tell them to stop while still treating them kindly and speaking in a respectful voice. And my kindness and respect reminds them to be kind and respectful as well."

The conversation went off on a tangent then, as conversations with five-year-olds have a tendency to do. It was probably too much at once, anyway. But it pops up again here and there. I know my daughter, so I know we’ll keep talking about it until she gets it settled in her mind. And I’ll keep trying to get my point across.

I’m a “nicey,” a kind person, because I truly do want to live in a world that is filled with kindness. I would love to see waves of kindness spreading around the world. I do believe that kindness can absorb and stop the spread of meanness and can set limits at the same time. How about you?

Healthy Relationships

I work with a lot of people who have experienced toxic, negative, hurtful relationships. Often they’ve been through an entire history of them. Whether these were romances or friendships, eventually a person who is getting healthier will ask the question “How can I have a healthy relationship in the future? or “How can I keep this from happening again?”

I’ve given my stock advice. Things like “learn to value and care about yourself. know what is important to you. don’t put up with people who treat you badly, even in small ways.  know your own limits and insist that others respect them. do things you enjoy for their own sake, and be friends with the people you meet there.” I do think all of that is pretty good advice, but I recognize that it hasn’t been completely satisfactory for many people. So I was pretty excited recently, while reading the book Simplify by Bill Hybels, to find a chapter (chapter 7, if you’re interested) on friendship. He outlined some common sense things to look for and some others to watch out for and some ways to go about making friends. I liked his list, but since he is a Christian writer and a pastor, his was very spiritually focused. I wanted something that was more general that I could share with people I’m working with. So, inspired by Mr. Hybels, here are some thoughts about forming healthy relationships.

First of all, for any of these characteristics, look for patterns. Anyone can have a good day or a bad day, but try to keep the overall pattern of a person’s behavior in mind. And look not just at how the person is treating you but at how they interact with everyone around them. Look at the small details that can be very telling. Many people can be charming when they are trying to win a new friend or romantic partner. How they treat the people they aren’t trying to impress can be much more revealing. How they behave when they don’t know anyone is watching is most likely to reflect the core of who they are.  

Characteristics to look for include having a positive attitude. Look for someone who appreciates the good in his own life and isn’t complaining all the time; someone who when faced with challenges says “ok, we can do this.” It’s also good to look for someone who is truthful and trustworthy. Honesty in small things, like admitting small faults or letting the cashier know he gave too much change is a great sign that a person will be honest in larger things. A person who is patient and kind, who doesn’t get upset or angry easily and who shows consideration for people around her, will likely be patient and kind with you as well. A self-disciplined person, who can say “no thanks, that’s not good for me” about an extra piece of cake, a late night, a drink, or an impulse purchase will encourage you to be healthy as well. A person who can respect his own limits is much more likely to respect yours. A person who keeps small promises, like showing up when she says she will, is more likely to come through on the big promises.

On the other hand, watch out for a person who is arrogant or entitled, someone who views themselves as better than other people. In particular, watch out for someone who is perfectly nice to you but is rude to people who she is categorizing as “not important” or “just there to serve me.” Sooner or later the person who berates the waitress, the bus driver, or the clerk is going to see you as an object as well. When you fail to meet her needs you’ll be in for the same treatment. Don’t get too close to someone who rants, trantrums, whines, sulks or pouts when things don’t go his way.  Being able to handle disappointment and even adversity with grace and class is the mark of a true grown-up, and relationships with people who are emotional children in adult bodies are often exhausting and painful. Someone who is habitually dishonest in small things is not likely to be honest in large things like faithfulness and commitment keeping. Someone who is constantly gossiping about others is probably going to gossip about you when you aren’t around. A person who complains about someone else’s behavior to you is probably not going to be able to work out problems with you in a healthy and relationship building way. A person who is mean and hurtful, who breaks the confidences of others, or causes trouble between other people is showing that they are toxic. Don’t put up with unkindness disguised as humor, no matter who the target is. That’s a form of bullying. And stay away from careless friends, people who are inconsiderate or thoughtless about other people’s time, energy, and feelings.

Finally, step into new relationships slowly. I hate to be a buzz-kill, but relationships that seem too good to be true probably are. I recommend being very wary of anyone who appears to completely understand, love and connect with you on the first meeting. Romantic ideas of soul mates or love at first sight aside, usually that kind of intense initial connection is much more about the holes and wounds inside each person and the fantasy of rescue than any kind of honest, adult connection. Relationships aren’t and can’t be a short cut to avoid doing hard emotional work. Instead of dumping your entire history and all of your emotional pain on someone at the first meeting, take it slow. Give it time. Developing a relationship is a dance of small, mutual steps, a process of growing give and take. Confide a little piece of information, something you don’t tell everyone, and see how she handles that. Try out trusting him with a little vulnerability and see if he is able to reciprocate. See how the two of you are able to navigate an area of disagreement or difference. Make sure you can talk about the tough, important topics (money, sex, politics, religion, families) bit by bit, and that you can do so with respect even when you don’t agree.

This can be a tough list to follow. Often the people who give you a thrill are the people who have more of the negative characteristics than the positive. They can seem sophisticated, funny, and exciting. The people who are honest, kind, patient, self-disciplined and positive can seem hopelessly dull. I get it. But I have to ask you this. If you’ve been chasing thrills for years and you’re now at the tail end of a string of painful relationships, how’s that working out for you? Is it time to try something else yet?

Friendship at Four is Hard

My daughter came home from preschool yesterday upset because two of her friends were playing on the playground and they wouldn't let her play. Today she came home distressed because she was at the playground with another friends and a third little girl was trying to intrude on their play. I wasn't there but my husband tells me that our daughter got so upset he had to take her home.

"I was afraid she'd take <friend's name> away from me." she told me as we cuddled on the couch.

I get it. My head knows that kids this age don't play well in groups of more than two, that someone will always be the odd girl out. My head knows that my daughter has been both one of the two girls playing and the third girl trying to get in on the fun. My head knows that the third little girl today probably felt a whole lot like my daughter did yesterday. My head knows that there is a good chance that the kids will work all this out themselves, eventually. But oh, how my heart aches for my precious girl. I wish, so deeply, that I could protect her from this. Failing that, since I my head knows that I can't, I wish I had more wisdom to guide her through this.

The truth is, I wasn't very socially competent as a child. I wasn't picked on or bullied but I was ignored and excluded a lot of the time. I was too smart, too quiet, too bookish, and too well behaved. So I spent a lot of time feeling left out. It wasn't until college that I really felt I had true friends, friends I could count on and who really liked me, not just my ability to help them with homework. And I'm not asking for pity or sympathy, but I still feel the effects of being excluded today, when I'm all grown up and successful and competent. I still tend to be quiet and retiring; I don't push myself forward. I try not to intrude on conversations and I look for signs that what I have to say isn't wanted. I feel rejected and hurt pretty easily and have to spend time talking myself back into good common sense. Somewhere inside, that lonely eight year old girl still lives inside me. So I really, really wish there was a way to spare my daughter all this.

I cuddled my daughter this evening. I empathized and let her know that I cared. "It sounds like you felt jealous. I know that's hard." I said. "It's scary to feel like someone might take your friend away."

She snuggled into me and said "Why?"

"Why does it feel hard and scary when you think someone might take your friend away?" I clarified.

"Yes." she agreed.

"I don't know, baby." I told her. "That's just how we are."

I do know, sort of, but I'm not going to tackle psychology, biology, and evolution this evening when we're all tired. And in another sense, I don't know why all my experience and knowledge, all the love I have from my family and friends, all my faith in my identity as G-D's child, doesn't overcome those things. I don't know why it's still so very scary as an adult to think someone might take my friend away. So I just hugged her and was grateful for preschool attention spans that quickly moved on to other topics.

Then after she went to bed I went online and bought some books about friendship for preschoolers. I talked to my husband, although his memories are different and I'm not sure little boys do this stuff, or at least not in the same way or at the same age. If I don't have wisdom in this area, and I don't think I do, I can at least have knowledge. I can at least equip her with the understanding of how to be a good friend. That way, even when her friends wander off, I can hope they'll always wander back.

No Complaints Allowed

Ash Wednesday marks the beginning of the Christian Season of Lent. The ashes on our foreheads symbolize both our own nature (created out of dust) and the grief we feel about our own failures and sins. During the 40 days (not counting Sundays) of Lent we prepare for the joy of Easter by engaging in self-reflection and honest sorrow for the things we do wrong. From this place of honesty and sorrow, we can make a new beginning. A pastor from a church I love wrote today "It's the chance to look at our lives with heightened honesty and see those stuck places where we might just be ready for change, for newfound freedom, and for growth." Yes. Repentance means turning around, turning back towards being the person G-D is calling you to be. It's not about guilt and shame, it's about growth and change.

Each year for Lent I choose something to give up. This is a traditional way to fast, by giving up something you enjoy. Not as a form of self-punishment or because G-D doesn't want us to enjoy things (because I believe he does want us to enjoy his good gifts) but because in turning away from something we like we open up to being more fully reliant on G-D. We signify that we are open to changing, open to putting G-D first in our hearts and asking him to fill our needs.

When I was a little girl my mother chose for me, and I gave up desert. As an adult I try to choose something that I enjoy but that I need to give up for a season in order to grow. I am looking for a sacrifice that will bring me that newfound freedom, that will go to work on a stuck place inside myself. Last year I gave up reading novels for Lent because in the months before Lent I found myself too often hiding in books instead of interacting with my family. I wanted to be more present for them and I wanted to relate to books and reading in a healthier way; as a pleasure but not as an escape from or substitute for life.

This year I am giving up complaining. I have come to realize that I complain quite often, that I do enjoy complaining, but my habit of complaining keeps me stuck. Complaining keeps my attention focused on what I don't like, don't have or don't want. It leaves me in the mindset of scarcity and deprivation. I don't want to live in that space. I don't want to feel constricted and shut down. I crave the spaciousness and freedom of living in gratitude for the abundance all around me.

So I'm giving up complaining for Lent. I expect it will be harder than giving up novels. With a novel, I'm either reading it or I'm not. I pick it up or I don't. It's very clear. Complaining is such a habit that I am not always sure I will even recognize it all the time. I have decided that if I make a statement followed by a polite request or a solution, that's not a complaint. For example, I came home from work this evening and said to my husband "My back hurts, please could you rub it for me this evening?" However, if I just stop at the negative statement, then that is a complaint. For every complaint this Lent that I catch myself in (or my husband, or anyone else, catches me in) I will put a quarter in a complaint jar. At the end of Lent I will donate that money to a charity.

During the Passover Seder (which will coincide with Good Friday this year, which I kind of like) there is a song we sing called "Dayenu." I don't know if my translation is quite right but the sense of the word I have learned is "it is enough." Whatever G-D has done for us, it is enough. If G-D had done only some things in the past, but not others, if he had only sent plagues, or only brought us out of Egypt, or only opened the Red Sea for us, or only given us the Torah, it would be enough. Any of those things would be enough, all of them together are riches overflowing. That's how I want to live my life, in Dayenu. That's where I hope my Lenten journey will take me.

Light In The Darkness

I went to church online tonight. I always go to church on Christmas Eve. I can't actually remember a time in my adult life when I didn't go to church, somewhere, somehow, for Christmas Eve services. If the church I was attending didn't have a service I would just drop in on another church. I even went to church on Christmas Eve in Iraq one year.

Tonight I'm away from home. I had intended to go to services with my mother anyway, at a church she found nearby, but it was a long day of travel after a poor night's sleep topped off with about thirty minutes of wandering around in the rainy dark dragging suitcases and a tired four year old trying to find the rental apartment we had arranged. My nerves and temper had frayed, I was snapping unfairly at my family, and I knew that going out to find another strange place in the cold wet dark would just not be wise. So I called my mother and let her know that we'd see her tomorrow but we needed to rest this evening.

I still wanted to go to church though, and it occurred to me that probably some church, somewhere, would have an online service. This is the twenty-first century, after all. So I looked, and sure enough there were quite a few. I ended up dropping in on Resurrection Church (http://www.rezonline.org), a United Methodist Church in Kansas City, as they were kind enough to stream their service. I was able to listen in on their service and watch their candlelighting, which is a very traditional (and much loved, at least by me) part of a Christmas Eve service. 

In a candlelight service the lights in the sanctuary are extinguished, to symbolize the darkness we all experience in life. Then a candle is brought in, which is called the Christ candle, the candle that represents G-D's living presence with us. The pastor lights his candle from the Christ candle, and then passes the light to a few others, who then move down the aisles of the sanctuary lighting the candles of the people at the ends of each row of seats who then spread the light to others. In the end, the sanctuary is lit once more with soft candlelight, and we are reminded that we are called to be the light ourselves. The gift we receive is given to be shared. 

Watching online, I could see in a different way the light spread across the room, person to person, flame by flame. I was reminded of something my pastor at home said at the beginning of this advent season. He said that it's important that Christians tell the story of Christmas, a story that isn't about buying things and travel and too many cookies at too many parties. Christmas is a story about light in the darkness, about G-D loving us too much to ever give up or turn his back on us. 

It's been a tough year, I think. A tough year for everyone, all over the world. It's still tough. It is easy to fall prey to despair. Christmas is a story about hope. It's a story about small flames, spread person to person, in little actions and little stories. Nothing dramatic, nothing splashy, hardly ever anything that makes a home page or a headline or twitter feed. It's a story about people who are called to be light in the world, quietly, patiently. Following the humble example of our Emmanuel, G-D with us, who healed and taught through inclusion, mercy, and suffering. We fail so often, but the light is still there.

Enjoy The Moment: Mother Daughter Date

Going out to dinner with my daughter wasn't in my plans this evening. We are hosting a small party at our house tomorrow, and our schedule called for cooking, cleaning and last minute errands. However, around 2pm my daughter announced that she'd like to have a mother daughter date night. She wanted us to go out to dinner at IHOP, just the two of us, without her daddy.

I confess, my first impulse was to say no. I had other things I needed to be doing because we have company coming. I didn't want pancakes for dinner. I was tired and didn't want to drive anywhere. I was irritated because she had been hanging over my shoulder (literally) while I was working on a project for her which made it slower and more difficult. You try using your arms with over 30 pounds of preschooler leaning on one of them.

Fortunately, my brain engaged fully and jerked me up short before I opened my mouth. I realized that there is no need to stress about friends coming over tomorrow. All of my friends are awesome people who will be coming over to enjoy time together, not to judge our decorations, food, or cleanliness. Not to mention that the party is primarily oriented towards children, who will be making a mess in the kitchen decorating Christmas cookies when they aren't making a mess in the rest of the house playing with toys. So it's really pretty silly to get too wrapped up in making the house look perfect. And I'm not all that tired and none of my projects are urgent. Nothing has to be completed this weekend, or even by Christmas. It's all for fun anyway.

More importantly, I realized that there will be a time in my daughter's life when she won't want to go out to dinner with me on a Saturday night. All too soon, I won't be her date of choice. There will be a time that I have to insist on family time and cope with sulks and pouts when I decree a family outing. There will be a time when she has no time to lean on me while I am working on projects because she will have too many projects of her own that need to be done. And after these times there will be a time when she won't be here at all. She will be away at college and then living her own life, and it will be right and good for her to do that. When my daughter was born my mother told me that good parents are always preparing their children to leave them, and I know already that this is true. But when those times come I will miss her terribly.

I'm not a big believer in trying to live a life without regrets. I think it's a trap, because there's no way to know how things are going to turn out. Regrets are always possible, no matter how carefully you think out your choices. Sadness and pain are inevitable in life, and no amount of good decisions will get you out of them. I am a believer in trying to make the best choices I can, based on the best I know at the time the choice comes up and then trying my best to trust G-D with the outcome. Still, there are some things that I know I would eventually regret.

So I'm glad I took my daughter to IHOP tonight, just the two of us. The pancakes weren't bad, and we had fun doing the crossword puzzle on the kids menu together, me spelling the answers and her writing the letters. I'm glad we had a chance to talk about the things she is thinking about with holidays, and wanting another sleepover with her friend, and how she wants to earn some money for the Christmas project the children are doing at church, and a hundred other things we talked about this evening. I'm glad that I slowed down enough to enjoy this moment in her life, this time when she and I can take such delight in each other's company.

Cranberry Relish and Interdependence - Gratitude 4

We had Thanksgiving dinner this afternoon with my mother's family. My aunt has been hosting Thanksgiving at her house for over two decades at this point. She makes most of the dinner but my mother brings rolls and sweet potato muffins, another aunt brings desserts, and another aunt brings pumpkin bread. We are a carbohydrate loving family, as you can see. My husband and I bring vegetables when we come since everything else is pretty much claimed.

One of the items on our table was orange cranberry relish, which was purchased from a local grocery store.  That is completely acceptable and even encouraged in my family; we are big fans of keeping things easy. The relish was good, but certainly not the star of the dinner table. It's just a dish I happen to like and as I ate it I thought about how amazing it is to eat orange cranberry relish. I began to imagine how much effort and how many people are involved in what looks like a really simple event: a woman eating orange cranberry relish at Thanksgiving dinner.

Oranges were grown in one part of the world. I don't know much about how you grow oranges, but I'm pretty sure a warm climate, trees, a farmer, and some hard work were involved. Cranberries are usually a cooler climate crop and I know they are hard work because the grow in bogs that have to be flooded to harvest them. There had to be a farmer to plant the bushes, build the irrigation system, flood the bog, harvest the berries, and then pack and ship them. Someone else took the oranges and cranberries and cooked them together in a relish. Yet another person in a factory somewhere made the plastic dish to hold the relish. Someone else stocked the grocery store shelves. My aunt drove to the store, where someone sold her the relish, and she brought it back home for us to eat.

So there's a huge chain of people involved in me eating orange cranberry relish on Thanksgiving day this year. I didn't even get into the people involved in transporting the cranberries and oranges to the right places, or the people who worked to make sure there was electricity and fuel available for farms, stores, trucks, machinery, and cars. Not to mention the people who built the buildings involved and the machines and the vehicles, the people who designed all of those things, and the people who figured some of these things out in the first place, like the person who learned that cranberries and oranges are tasty together, the person who started to grow oranges or cranberries in the first place, the person who came up with the idea for plastic dishes and figured out how to make plastic. There's the people who designed and built and sold the car my husband drove to get us to my aunt's house.

I could go on and on, trying to list all the people involved in one small side dish on the Thanksgiving table. I don't think I could work out the huge web of people and events that had to happen. What's even more astonishing is that you can do this with pretty much any object you see around you. Even your own body; think about how many people were involved in getting you to the point that you are reading these words on your computer screen or mobile device. I won't list them because the list would be as long or longer than the cranberry relish list, and you get the point. Try the exercise for yourself; it's kind of fun to see how many different angles you can come up with, and it gives you a whole new perspective,

I find this astonishing, and wonderful, and awe-inspiring, and humbling, and even overwhelming. We are all, at every moment, relying on each other. We live in this web of trust and interdependence all the time, without even thinking about it. We are connected, one to another, to people we will never meet and might not even like, but we need them all the same, and they need us too. That seems like a reason to give thanks!

See other posts in my Thanksgiving Week series:
Thanksgiving Week - Gratitude 1
Teachers - Gratitude 2
Baking With My Daughter - Gratitude 3

Baking With My Daughter - Gratitude 3

For a long time I thought that I wasn't a particularly good cook. I muddled along in college and medical school, fixing rice and canned chili or grilled cheese and canned soup, but it wasn't something I really cared about or spent much time on. My husband, fortunately for me, is a fantastic cook. He is adventurous and creative and enjoys cooking so much that it has become a form of stress relief for him. So over the time we've been together I've essentially ceded the kitchen to him. We plan meals together most of the time but he does all the actual work.

Recently though, I've become interested in baking. I'm not exactly sure why, but I think it has something to do with my daughter and being her mother. I have many, many memories of my mother baking. She still bakes at Christmas and we come home laden with cookies and treats that last us into January. I always loved hanging out with her in the kitchen, chatting and helping with the occasional stirring while she made cookies or cakes or brownies or some other wonderful treat. Somewhere deep inside, baking just feels like something a mother should be doing with her daughter.

So my daughter and I bake together. It is often one of our evening projects on the days my husband has a night out. We make scones, usually. I am crazy about scones and I found a really good recipe a few months back that lends itself to multiple variations. At least once a month I bring treats to work for our morning case conference meeting and so there is a ready and eager outlet for our baked goods. This evening we made sweet potato muffins so that I could bring a seasonal treat tomorrow. My daughter donned her apron and chef's cap and we went to town.

Sweet potato muffins are one of those favorite family recipes that my mother has been baking since I was a small girl myself. My mother makes them every Thanksgiving and they are generally devoured without leftovers. This evening I was so amazed watching my daughter help me measure the flour. She patiently scooped the flour into the measuring cup and then leveled it off, all on her own, before dumping it into the bowl. I asked her about that and she proudly told me "Daddy taught me that!" She cracked and beat eggs and mashed sweet potatoes and stirred and scooped batter into muffin tins. When we got to the actual baking she told me firmly "That's a mommy job" and stood well back from the oven. When the muffins were done and cooled we each tried one (quality control, you know - I can't bring bad muffins to work!) and decided we had done a good job.

Baking with my daughter is a lot more fun than baking by myself. I find that I am much more relaxed about the mess and much more engaged in the actual activity. As we bake we talk about ingredients, why muffins are quick breads, and who her friends are at school. I am thankful for the time we spend together, doing something we both enjoy. She told me this evening as we worked "I'm going to do this for my whole life!" and my thought was, me too.

See other posts in my Thanksgiving Week series here:
Thanksgiving Week - Gratitude 1
Teachers - Gratitude 2
Cranberry Relish and Interdependence - Gratitude 4

Teachers - Gratitude 2

I had the chance today to sign up for a teleconference with one of my favorite teachers, Rachel Naomi Remen. She is offering a free class in mid-December featuring stories on The Will to Live, and I am looking forward to hearing her read. Dr. Remen's books were introduced to me when I was a first year medical student by the volunteer who coordinated and led the complementary and alternative medicine group that I participated in. She gave each of us a copy of Kitchen Table Wisdom and I devoured it. I read it several times that busy first year becase it gave me courage and hope. It remains one of the most important, influential books that I have ever read in terms of how I approach patients and medicine. It reassured me that there is a place for me at medicine's table, that the spiritual and relational perspective that comes most naturally to me has its own voice, even now in the era of technology and randomized controlled trials and 10 minute visits. I have given the book in turn to many friends and students

In my life I have been so blessed by teachers. From grade school through high school through college through medical school through residency and even today, my life has been filled with people who have poured out their knowledge, wisdom and caring on me. I would not be the person I am today without my teachers. They taught me, and they taught me how to learn, and they taught me to love to learn, and that has made a tremendous difference to me and then in turn to others. One of my own deepest privileges is to take my own turn as a teacher, passing along the gifts that were given so freely to me as well as I am able. There is something sacred about taking part in this living, breathing lineage of human knowledge.

My daughter is just entering education at this point in her life, having officially started "real" preschool this year (as opposed to daycare preschool). I like her teacher very much; a veteran teacher of over twenty years with a fun but no nonsense approach. Her teacher is also from Texas which my husband and I appreciate a great deal, since our daughter was born in San Antonio and we still miss living there. I hope that my daughter will be so fortunate in her teachers all of her education, just as I have been.

I have friends who are full time teachers and I know how desperately hard they work and how deeply they care about their students. I know they don't get nearly the appreciation they deserve and that they often hear more complaints than compliments. So, today I am grateful for all teachers, everywhere. I am thankful to them for their dedication, concern, enthusiasm, knowledge, patience and persistence. None of us would be where we are, reading these words, without them.

See other posts in my Thanksgiving Week series here:
Thanksgiving Week - Gratitude 1
Baking With My Daughter - Gratitude 3
Cranberry Relish and Interdependence - Gratitude 4

Thanksgiving Week - Gratitude 1

In church this morning one of the pastors called this week "a week of gratitude, a week of really remembering how to say thank you." I liked that idea. A whole week of saying "Thank You!" instead of a day of stressful travel, eating way too much, and not talking much at all about what we are thankful for because, honestly, it's too much and kind of embarrassing to get real that way. A week of saying Thank You instead of a week of build-up to the insanity of consumerism that marks this time of year.

The follow-up in church to the pastor's prayer was an "open mike" sermon in which people went to the front and spoke for a few minutes about something they were grateful for, which I have to admit felt good and honest and weird and a little too intimate all at the same time. I find myself worried about any visitors today and wanting to reassure you all that my church is actually pretty normal, that we don't usually do things like that. Which is true but says a lot more about me and where I need to grow than it does about my church.

I couldn't think of anything to say in church (and I did pray and ask if G-D had anything for me, and I hope if something had popped into my head I would have had the courage to get up and say it, but nothing came, so I was off the hook anyway) but then I thought I could write about gratitude this week. My first thought was I could write a short piece every day about something I am grateful for and post it. Then I remembered that I often bite off more than I can chew and decided not to promise anything. Better just to start with something and then see how the rest of the week turns out.

A few years ago a friend was leading a Sunday school class I was in and she gave us an index card and a challenge. "Write down what you are grateful for" she told us. I filled up the card pretty quickly and I still have it. It's good to look back on, particularly when I am grumpy. The items on my card are my "big gratitude" items, the things that have a huge influence on me that I often take for granted. Here they are:

My husband, who is patient, funny, smart, and much calmer and more level headed than I am. 

Our daughter, who is healthy, smart, loving, creative and curious. She has a bright, energetic and adventurous spirit which teaches me every day.

The rest of our family; parents, grandparents, siblings, aunts, uncles, cousins - both my husband and I grew up knowing ourselves loved, encouraged to learn, and blessed to always have enough. We are still surrounded by a net of love.

Good health, throughout my family.

A job that allows me to do good and serve others every day, and also pays our bills so that we have enough.

Freedom to worship, speak, write, travel, work, live, have friends as seems best to me without restriction by our government.

G-D's love and care, and his abiding presence with me in each day and circumstance. 

Those are my big items, the ones on my card, the ones I can think of off the top of my head when I focus my mind on gratitude.

See other posts in my Thanksgiving Week series here:
Teachers - Gratitude 2
Baking With My Daughter - Gratitude 3
Cranberry Relish and Interdependence - Gratitude 4

Family Masterpiece

When we were setting up the nursery for our daughter, my husband and I repurposed a small chest of drawers to be a changing table and dresser. My mother organized it for us the week after our daughter was born and it worked wonderfully for the first year. Unfortunately, once she learned to pull herself up and open drawers our daughter quickly discovered that it was delightful to take every bit of clothing out of the drawers and scatter it over the floor of her room. This was much less delightful for me, and after a few repetitions of this I wised up and we started putting all her clothes in the closet. We put blankets in the chest since those were easier to put away again. As a bonus, they were apparently less fun to take out in the first place and our daughter turned to other sources of entertainment. The chest of drawers got broken in one of the following moves and so it has been closets for us ever since.

Our daughter is four now and recently we decided it was time for a dresser once again. She has been able to open her closet door and pull down her own clothing in the morning for at least the past six months and we haven't had any repetitions of the clothing covered floor phenomenon. Frankly, we have become a little tired of hanging up all her shirts and pants and putting things in drawers seems like it would just be easier. So my husband ventured to IKEA and bought the drawer sets that promised to work in the large white cabinet that stores her sheets and blankets. 

The starting point.

Plain white furniture isn't terribly cheerful for a four year old and my husband bought some colorful drawer fronts from a different product line to liven things up a bit. Unfortunately, the colorful drawer fronts didn't actually work with the cabinet and drawers. I guess there is a reason you are supposed to buy everything from the same grouping. My husband was mourning this fact and the upcoming trip to return the colorful drawers to get boring white ones when I commented "Well, we could paint them any color we want." 

We looked at each other with realization dawning in both of our eyes. "Why yes. Yes we could. We could paint them not just in colors but in pictures." And so a weekend project was born. We schlepped back to IKEA to exchange the colorful fronts for white ones. Then we hit the craft store for acrylic paint and paintbrushes. We covered the kitchen table with a plastic cloth and got to work.

Work In Progress

We each painted one drawer. My husband gamely took on the fourth since my daughter fell asleep and I was worn out with my artistic endeavors.

Work In Progress

After they were dry we took them outside and sprayed them with a glossy sealant, reasoning that we were likely to need to wipe them down from time to time. Also, we felt just a little protective after all our hard work, and from experience we know that acrylic paint will peel.

This afternoon we assembled the drawers, removed a cabinet door, and installed the runners. My husband lifted each drawer into place and my daughter and I filled them with her clothes.

As our daughter would say "It's our masterpiece!"

Our Masterpiece!

Mother Daughter Night

My daughter and I went out together this evening for a special mother-daughter night. Disney On Ice's show Frozen is in town and I purchased tickets months ago with a group of colleagues who have daughters around the same age.

I treasure these times with my daughter because it's usually not me who gets to take her to special events. At least, not on my own. My husband, as the stay at home parent, takes her to museums and sporting events and parks all the time. When I'm not at work we usually go out as a family. We set this evening up as a mother-daughter event though, which means I got to do something special with my little girl. We went out to dinner together, an actual sit down restaurant (although not a fancy one) and then to a 7:30 pm show. I kept the event a secret until we arrived and had the fun of hearing her exclaim in delight "It's a Frozen show!" when we walked into the venue.

The problem with a 7:30 pm show is that bedtime at our house is at 8:00 pm. At four years old my daughter's outgrown naps, except for the occasional dozing off while in the car. We sat down for the show and sure initially she was fascinated, all wide eyed intensity watching the performance. Sure enough though, by 8:00 pm  she was curled up in my lap. By about 8:30 she was covering her ears and hiding her eyes from the more dramatic special effects and by intermission she was very clearly no longer having fun. The noise and the heat were overwhelming, and then she remembered a scary scene coming up and then she asked to go home. So we left at the end of intermission. My goal was for us to have fun together, after all. Better to leave early, while it's still a good evening for both of us.

To be honest, I wasn't all that disappointed to leave. I'm not big on crowds and noise myself. As my dad says, the apple doesn't fall far from the tree.  And I am not in such a hurry for her to grow up. I like having a child I can take out to dinner, but I also like having a child who wants to cuddle up when she is tired. I know that all too soon she will not be so snuggly; she will have more stamina and will also be too grown-up to lean on mom that way. I want to enjoy it while I can.

Skyline Drive

I had all kinds of plans for today. I was going to spend the afternoon after church catching up on homework, writing one blog post and roughing out some other ideas, tidying up the house and yard and generally getting things done. It was a difficult past 2 weeks being on call and I'm feeling rather behind on my life. Yesterday was my day to play, with a lovely picnic with good friends in a beautiful winery and then some time with my husband and daughter out shopping for Halloween costumes together while we waited for my cell phone screen to be repaired. Today was going to be my day to catch up and get ahead.

But. 

It really was a beautiful day. Sunny, cool, just the right amount of breeziness. Who knows how many more beautiful days we will have this year anyway? Winter is coming soon. The leaves are beginning to turn and fall color doesn't last forever either. It just didn't seem right to waste a day like this indoors. It would have been ungrateful, I think.

So, instead of a well written, thoughtful blog post I have pictures and memories. My husband, daughter and I drove out to Skyline drive for the afternoon. There is a nice visitor's center near Front Royal, about 90 minutes from D.C., that has a number of short hikes and some outstanding views. My husband and I picked the shortest trail with some help from a ranger and we all set off with our water bottles and cameras. Our daughter examined leaves, recognized trail markers, picked up acorns and rocks (that she left behind: take only pictures, leave only footprints!), and banged sticks together to make music. She managed the entire hike, including some long uphill sections, under her own steam, which is a first for all of us. We enjoyed the day and each other. I'm still feeling behind on life, but at least I'm cheerful about it.

Already Home

We celebrated Break Fast with my husband's cousins this evening in their beautiful home in Maryland. It was a low key and lovely gathering over bagels, fish, and sweets to celebrate the end of Yom Kippur as a family. The kids were big enough to play more or less on their own this year, under the direction of the oldest girl cousin and her friend. The adults chatted and ate too much, wandering from room to room as little groups coalesced, conversed and dispersed over and over again.

Yom Kippur is an intense, serious, Holy Day. It' a time to reflect on how you are treating others, how you are honoring G-D, and how you are using the gifts you have been given. It's a time to pray, to abstain from food and to focus on G-D; a time to confess your wrongs and to receive his forgiveness. It's a fraught and holy time, so it is particularly sweet at its end to come together with family and food and fun, in the softer beauty of regular life.

When it comes down to it, this is the reason my husband and I moved our little family back to the East Coast. We lived in Texas when our daughter was born and we liked it a great deal. We had wonderful friends and Texas itself has many advantages; less traffic, friendlier people, lower cost of living. But despite all this we came back to the East Coast, where it is noisy and stressed and congested. We came back in order to come home.

We came home so that our little family could be part of our bigger family. We came home to celebrate Break Fast each year with our family, and see the cousins playing and not miss the children growing up. We came home so that my daughter can see her grandparents once or twice a month instead of once or twice a year. We came home to raise our child amidst the solid network of family and friends centered here, so that she would always feel that love and support. We came home so that our lives would be patterned with bright ribbons of community and tradition, each season flowing with a rhythm of observation and celebration.

Every once in a while my husband and I talk about moving. Some job or another in an interesting location crosses our email and we say "what if?" And then we attend a birthday party, or spend Sunday afternoon with our parents, or attend Break Fast, and we remember that we are already home.

How Was Your Weekend?

The question of the day on Monday is "How was your weekend?" I can count on being asked at least two or three times on Monday morning by various people. The socially acceptable answers are, of course "Fine." and "Great!" with "Too short!" as a possible variation. It's an elevator question, not an essay question. Even if the weekend was difficult or something really cool happened, it's not the time or place or people with whom to get into it.

The truthful answer about the quality of my weekend depends on my perspective. For example, take this weekend.

I could tell you that this was a frustrating weekend. Our daughter was mildly ill and majorly cranky, so we've had about fifteen time-outs and about seven major temper tantrums. A normal weekend would be between zero and three time-outs and between zero and two temper tantrums, so she's way off kilter. Nothing we did seemed to be right and our normal routines and transitions were sources of angst and fury. Also, I couldn't find the items I wanted for our fall yard work, despite checking two stores and getting lost along the way. We spent two hours raking leaves and pulling weeds, two chores that in my mind should fall at different times of the year but somehow manage to coincide at our house. Half the weeds we pulled in the backyard were colonized from our neighbors wild meadow that they are growing instead of a yard. Which means we pulled vines off our fence and our house but we know it will all be back, since we couldn't get to the source. I had to take a proctored exam at the local community college for an online course I am taking and forgot to bring a pen. I ended up using a very old red pen that I dug up out of my glove box which had my fingers stained red by the end of the test. I goofed up the knitting project I am working on and had to rip out twenty rows of stitching so I could go back and correct my mistake. Frustrating, right?

Squirrel, mixed media. Rose Anne Karesh. 2014.

I could also tell you that this was a wonderful weekend. We spent several hours with a dear friend from out of town whom we don't see nearly often enough. When we got lost we ran across a bagel store that actually had my favorite bagels, pumpernickel, in stock. In our hunts through stores for what we couldn't find, we serendipitously found a hummingbird feeder that I've been wanting for a while and leaf scoops that I'd never heard of before. Leaf scoops are two large handheld plastic paddles with rake teeth along the bottom edges. They make me think of bear paws, and they are excellent for scooping up fallen leaves. Raking went much, much faster than it has in the past. We listened to music and worked as a family as we weeded the backyard. I found a great website where I could order some of the things I couldn't find and now I can look forward to even more flowers next year. We took two long family walks, exploring the neighborhood across the street and finding a shortcut path through to another road that will really help me if I ever make good on my plan to start biking to work. The shortcut not only cuts distance it allows me to stay off a larger road without a bike path that has been a safety barrier. During our walks our daughter found acorns. I'm not sure why, but she is enthralled by acorns this year and collected several pocketfuls to use in various art projects. We worked on one this evening, a mixed media collaboration portrait of a squirrel. She made a new friend at the playground in our neighborhood, a little girl who is about her age and lives across the street. I think my test went pretty well, which is a good feeling for someone who hasn't been in school for a while. I had time to knit and catch up on some TV shows on Saturday night, and even with my mistake the dinosaur project for my daughter is coming along pretty quickly.

So, really, it's all in my perspective and where I focus the lens of my memory. How was my weekend? Most of the time, it's really up to me.

Indecision

I finished the sweater I have been working on for the past four months. This is the one I wrote about back in June (Work In Progress). I finished it today, it looks the way I planned it to look, it actually fits me, and it's done in time to wear it when the weather turns cold. I knit it starting at the neck and it's knit in the round, seamlessly, all the way down, which makes me feel clever. Quite a success, all in all.

Now my dilemma is which project do I work on next. My daughter has a request in for a sweater herself, and she even helped choose the pattern one evening while looking over my shoulder as I was perusing a favorite knitting website (knitty.com). Unfortunately, the yarn used in the pattern is a large part of what she likes about the sweater, and it's not washable. Washable is a critical characteristic when the recipient of a hand knit item is a child, because things will inevitably get dirty. Especially with my child, who loves to paint on her arms, dig in the dirt, and climb everything she can get a foothold on. So her sweater may be on hold until I find a good substitute yarn that will look just as good but also stand up to her activity.

I wanted to make my daughter a doll for Christmas, and I even bought an entire book of doll patterns along with clothing. It has a basic doll pattern with variations for hair, facial features and wardrobe to create about ten different gorgeously outfitted characters. Which I absolutely love. I pored over the book when it arrived, and then I showed it to my daughter and she yawned. She wants a knitted dinosaur instead. I have a book of dinosaur patterns as well, but I really liked those dolls. Maybe I should make a dinosaur for her and a doll for me? I have a sneaky feeling that if I actually made a doll she would like it very much, so a doll for me would probably become a doll for her in the end.

I have other projects on my list as well. A few years ago I made knitted Christmas tree ornaments, and those were a lot of fun to create. I have some ideas for new variations this year that I'd like to play with. I have yarn and patterns for more sweaters for me, since I love wearing my own hand knit items to work. Even when no one notices, it just makes me happy. Socks are fun to knit and don't take as long as sweaters, so that would be another way to wear my knitting to work. And I've been working on and off on a lacy shawl that doesn't look like much so far, but I'm optimistic that when it's completely done it will be beautiful. I just have to put in the time to get it finished.

Too many ideas, not enough time to knit. It's a silly problem, I know. In the scheme of things in the world, really not a problem at all. Still, I wish there was someone out there who'd be willing to pay me to just stay home and knit all day.