What's Good For Us Now

The salmon I'm eating

Once swam upstream, strong and barely stoppable

He died for my sins

Cleaning my arteries, basting my brain

The kale, flax seeds and walnuts faced a similar fate

Their higher purpose realized in my Runner's lunge,

my beating heart, my pliable and beautiful mind

The lush Mediterranean warms my pantry

Rogue cells that don't belong in this temple

Are obliterated with a gentle artillery

Of berries, greenery and roots

The clock doesn't stand a chance

With all this olive oil around

I'll die one way or another, whatever I do

But in the meantime, this midlife creature

Scales flight after flight unassisted

Stepping lithe as a dancer and spritely

If I get any lighter I'll grow wings

And flit about, ageless and barely visible

Soft as a whisper yet almost immortal

You won't have to bury me

I'll just evaporate

There are times when I miss the days

When kids drank their milk

And meat made strong muscles

We'd run in, hot and breathless from playing outside

Gulp our Kool- Aid in a gorgeous haze of laughter and cigarette smoke

Flawed, like tiny chips in fine bone china

Nothing that a little St. Joseph's Baby Aspirin couldn't fix

Incentives

There are things that I enjoy doing very much. Some of these things include reading, spending time with my family, watching TV, taking photographs, writing, making collages, hiking and socializing.

Then there are things that I don't really like and would rather not do. Some of these things, like swimming when it is below 95 degrees, zip-lining, watching the World Cup  and skiing, are things that can be easily avoided.   

Then there are things that I don't  like, but really should do them for my own good. One of these things is having a mammogram. Another one is having a Colonoscopy. 

We don't have much control over who gets cancer and who doesn't. I hope I  don't get cancer. However, the next best scenario to not getting cancer at all is to catch the cancer while it still very treatable. That is why I have these tests. 

The other reason I have the tests is because if I didn't, the doctor would talk to me about them too often. 

I have a great doctor. I don't want to use his real name, so I am going to refer to him as Dr. Isaac Moscowitz. He shares an office with his twin brother, who I will call Dr. Nathan Moscowitz. The twin brother is  a pulmonalogist. The part about the identical twin doctors is true. You really can't make this stuff up.

I could see the writing on the wall. I'd be going to Dr. Moskowitz with a sore throat and he'd be asking me about the colonoscopy. The man can be very persistent.  I don't want to talk with Dr. Moskowitz about my colon when I am there for a sore throat. So I just went ahead and made the appointment. I've already had the colonoscopy.

When it comes to mammograms, I'm more used to that. I've been going for the last 10 years. I used to get really worked up before going. I'm better about it now.

There are many reasons I am more relaxed about mammograms than I used to be. One of my coping mechanisms has to do with my deliberately working out a  system of incentives attached to going to the mammogram place.

There are incentives I have implemented for  before and during the mammogram, then additional incentives for after the mammogram. In addition to incentives that I've established on my own behalf, I've also discovered that there are certain rewards attached to the actual mammogram facility that I enjoy, but did not initiate.

Here is a typical mammogram experience.

I wake up in the morning, and I do my usual things except that I don't put on any deodorant, because the mammogram place doesn't want you to do that. I pack my deodorant for later.

Then I take the subway and then the bus to the mammogram place. That's where the first incentive kicks in. I am not allowed to do anything useful, like respond to email, make lists, work on Noah's IEP or research enrichments for the kids. I get to just read. I read whatever I want. 

I might read books or magazines, as long as they are not about ADHD, Autism , the NYC public school system, launching a career or attempting to renovate a small apartment. In other words, I get to luxuriate in totally useless, pleasurable reading. If I want to spend a long time on Facebook, I do it. 

I also love going into a special email folder called Blogs to Read which is exactly what it sounds like. The last time I had a mammogram, I read  what Gwyneth Paltrow wrote about Conscious Uncoupling. I read that I my iPad on the way there, then while I was in the mammogram room waiting for the radiologist, I read about Gwyneth Paltrow's uncoupling some more in a People Magazine they had in there.

Which brings me to the mammogram place itself. I always plan my mammograms for when my children are in school. One of the best things about the mammogram place is the lack of children. I've discovered that I can really get some solid peace and quiet in there. 

The lighting in the waiting room is dim and calming. They have some really good magazines there as long as I avoid any medical literature. The people are really nice.

By the time I'm actually having the mammogram, I'm reminding myself of the incentives I've planned for after the testing. That is because I am either contorting myself to get my breasts inside the machine, or waiting for the technician to talk with the radiologist and for the radiologist to ask her to do more views. The first couple of times this happened, I almost had a heart attack but now I'm used to it. The radiologist is just very thorough. More on that later.

Usually what happens is once the radiologist has enough views, I sit and wait for a bit, then Dr. Greenburg comes in to say that everything looks great. He always looks very cheerfuI while he is sharing the news that I don't have cancer. I  think it's very nice that he cares one way or the other.

His enthusiasm is contagious and It is with a sense of celebration that  I get dressed, put on deodorant. and then go to Shake Shack for lunch. Shake Shack for lunch is my reward for having gone to the mammogram place, contorted myself, traveled about with no deodorant on, had multiple views and then waited for Dr. Greenburg without freaking out.

I order whatever I want at Shake Shack without regard to any dietary guidelines or health implications .

There are situations involving the mammogram place that call for additional incentives.

About a year ago, I went to the mammogram place and the technician did many views at the request of the radiologist. Then instead of the usual routine they asked me to go into a separate smaller room. Dr. Greenburg came in and explained that there was an area that he was concerned about. He wanted to get an ultrasound of the area. 

I asked him a couple of questions. Did it look like cancer? He said that he wasn't yet sure what to make of it. Was the area in question big or small? He said that the area in question was very tiny. Okay, good, I said. It isn't some out of control, enormous, wildly metastatic cancer. 

He felt that my assessment of the situation was accurate. He also facilitated an immediate ultrasound. 

The people working there are always nice. But once they think there might be something wrong with you, then they are extra nice. They kept on checking on me while I was waiting for the ultrasound room to free up. They also said complimentary things about me to one another in hushed voices. One of them used the words chatty and cheerful.

While I was waiting, I thought a little bit about the possibility of cancer. I felt surprisingly calm about it. My hunch was telling me that I didn't have cancer. I figured that even if I did, it was a very tiny cancer. I'm always a glass half full person. I was thinking that a tiny cancer was better than a larger, more challenging cancerous area.

I was aware of becoming bored waiting around. I then noted how much my medically triggered PTSD has improved, after some self congratulation, I took out my iPod and began reading some enjoyable blogs. 

I did not google tiny breast cancer lesions. 

What I did do was read about some hipster urban homesteaders. I read about someone's mom crush. I posted some photos that I took on the way to the mammogram place to Facebook. I did not post to Facebook about waiting for the ultrasound room to free up because I wasn't looking for that kind of attention.

The ultrasound technician was really nice. I decided  to watch everything she was doing on the  big screen. She took pictures of the tiny areas after blowing them up to enormous proportions on the monitor.  I checked in with her to make sure that this did not represent the actual size. We shared a laugh over that. There is nothing I like better than an ultrasound technician with a sense of humor.

I also shared my medical opinion with her. Those look like cysts I said. I was basing this on the fact that they were very round and regular looking. There were no jagged edges. 

The technician concurred with my medical opinion. After some more explaining and reassuring about cysts, I got dressed and waited for Dr. Greenburg. The ultrasound experience reminded me of the time that I watched Dr. Oz get a colonoscopy on TV. Dr. Oz decided to forgo the anesthesia so he could watch and narrate the entire thing. He never stopped talking during the procedure.

The next thing I know, I'm looking at scans of my cysts with Dr. Greenburg. These are very common at your age, he said. I'm not worried about this at all, but I still want to follow you very closely. Because of my OCD I'm always extra careful he said smiling.

I couldn't tell if he was revealing that he has OCD or was joking and exaggerating like people do. Whether he has OCD or not doesn't matter. Let's just say that he's detail oriented. Even on a good day, he takes multiple views. If you are going to have OCD or be detail oriented, radiology is a good field for you. I also hear that the hours are good.

He gave me some paperwork to take home and wrote the words not cancer and underlined them.

I made my appointment for four months later and went to Shake Shack, where I ordered a delectable combination of food and drinks in giddy disregard for sugar and fat content.

After Shake Shack, I decided that this mammogram experience while not horrible was deserving of a little extra in terms of rewards. And that little extra was a trip to Sephora. I gave myself some pleasant browsing time. Then I settled on a tinted lip balm from Fresh. The color is called Rosè and it's become a favorite of mine. I also used my VIP points to get some samples. 

So now, I have a multi-tiered incentive plan for when I go to the mammogram place. Any procedure other than a basic mammogram calls for a trip to Sephora for one makeup item plus samples. That is in addition to the basic incentive package of reading whatever I want, and lunch at Shake Shack.

So because I needed ultrasounds the next two times I went to monitor the cysts, I now have a lovely new blue eye shadow and some anti aging skin care samples.

If anything truly ambiguous happens at the mammogram place, then there's going to have to be more compensation. Like I've said before, I'll cross that bridge when I come to it.

The Urgent Care Center

It used to be if you had an urgent medical problem after hours or on weekends you would need to go to the Emergency Room. Even these days, you’ll still need to go to the ER sometimes, for some things.

Here in NYC, Urgent Care Centers are really taking off. This was excellent news for Jeremy on two occasions. Both occasions involved a kitchen type accident that required stitches.

The first time happened to take place on what we call a Jacob anniversary. People who’ve lost a child like we have will know what I’m talking about. When a child dies, you are left with all of these difficult dates to either acknowledge in some way or try to ignore. It’s a little different for everyone. For us, Jacob’s birthday, his diagnosis date and the day he died are all these kind of dates. There’s more, but that should give you an idea of what I’m talking about.

So we’re experiencing a Jacob Anniversary together and Jeremy cuts his hand in the kitchen while washing a Star Trek glass with Captain Kirk’s picture on it. Oh shit, I’m going to have to go to the ER, Jeremy said. I felt like the idea of Jeremy going to an ER on this particular Jacob date was bad idea.

I had just read an article about two former ER doctors who opened an Urgent Care Center not far from where we live. I made a quick phone call to make sure that they could handle a few stiches. They could. Jeremy wrapped his hand up and I helped him into a cab. The Urgent Care doctor was really nice and Jeremy was in and out quickly.

The next time Jeremy needed stitches, it was because he cut his hand on a tin can. We didn’t even consider the ER. We worked together like a well-oiled machine. While Jeremy was wrapping his hand, I called the car service and then the Urgent Care Center to let them know to expect him.

In the meantime, the Urgent Care Centers are popping up all over the place in many different neighborhoods. It’s such a great idea that it’s a wonder that someone didn’t think of it sooner.

When I navigate NYC, I usually use the subway to get where I am going.  But once I’m in the general vicinity of my destination, I do a lot of walking. I am fortunate to be able bodied. I don’t take that for granted. This asset allows me to do more walking around than many people.

As I walk around in all different neighborhoods, for different purposes, but never aimlessly, I began to notice a predictable thought pattern with myself.

As I pass different businesses, there is a dialogue going on in my own brain.  I walk by Trader Joe’s I wonder if we need anything that is a specialty of Trader Joe’s. I pass a library and ask myself if I need to book shop. Lately, I’ve noticed that the answer to that question is always yes, yet I have a big pile of books next to my bed that I still want to read. So I have started to distinguish between needing to book shop and wanting to book shop.

I’ll do similar things as I pass drug stores, independent gourmet food shops, Sephora, The Salvation Army and supermarkets.

This strikes me as pretty funny as I think about it. I’m not a particularly spontaneous person. I’m a planner and a maker of lists. Stopping at one of these places is something I would have already put on my schedule if we needed anything. But the questions do seem to serve some sort of purpose.

And so it is with the Urgent Care Center.

As Urgent Care Centers started to proliferate and I found myself walking by one or another of them on a semi regular basis, I developed this little habit. The habit was quite established before I started to really notice it.

I ask myself if I happen to have any urgent medical needs that can’t wait for an appointment with my regular doctor. Then I spend a minute or two mentally reviewing my health status.  I note that my head feels fine and I seem neurologically intact. My arms, legs and back are pain free. I’m not bleeding. I do not have a fever. I am not vomiting. I am not covered in unexplained bruises or petechiae.

I’ll acknowledge that there are some small things going on. A tiny patch of probable eczema near my knee.  A heavy feeling in my sinuses, indicating a possible cold coming on. Acne. Stuff like that. Barely noticeable issues that don’t even need the care of a doctor.

As far as I can tell, I am perfectly fine. Upon realizing this, I’ll feel myself smiling a little. There will be an extra spring in my step. Because I do not take my health for granted, it feels like I’m given a little gift every time I pass the Urgent Care Center.

I’ve gotten better in recent years at not worrying about things that could take me to the Urgent Care Center, or worse, the ER, in the future. I’m also not thinking about the idea that I might have something small and imperceptible now that will later develop into something large and life threatening and necessitate a visit to the Urgent Care Center. I seem to not be focusing on those things. I’m just grateful that I don’t need to be at the Urgent Care Center now.

It’s a similar feeling that I have when I’m sitting in the pediatrician’s waiting room for a well-child check up or minor health problem with Hannah or Noah. There will be a flurry of activity discernable from the waiting room. The doctor is running late. The over-scheduled moms are pacing and looking at their smartphones. Some nannies will be worried because they’re concerned about what’s scheduled after the appointment. It’s part of their job to get the kid to taekwondo or violin.

I’m calm and patient. We’re not the emergency today, as I look over at my child, reading a book or watching BuzzFeed. Then I go back to whatever I was doing before.