How a Doctor Turns Life into Story

My essay on how I turn life into story was published on KevinMD on September 19, 2017: http://www.kevinmd.com/blog/2017/09/doctor-turns-life-story.html

After almost fifteen years as a research physician, I grew tired of the relentless cycle of applying for grants, failing to obtain funding, and reapplying with variable success. Conducting clinical trials was rewarding, but the responsibility seemed endless. I began to feel burnt out, scorched. It was time for a change. I needed a hobby.

Around this time, I read Frank McCourt’s memoir, Angela’s Ashes.  The author described it as a story about a miserable Irish Catholic childhood. Ah-hah, I thought, I had a miserable Irish-American Catholic childhood; I’ll write a memoir. The old medical student adage fueled my thinking: see one, do one, teach one. I had read several memoirs. I believed I could sit down and pen one of my own. It would become an immediate bestseller, a movie would be made, and I would be rich enough to fund my own research.

I was quickly disavowed of this dream. My first feeble attempt fell flat, as in flat on the office floor of my previous book’s agent.  “Writing that must have been cathartic,” she said. I realized I needed help. Next, I enrolled in a year-long class in memoir writing. The teacher critiqued my work. The other students critiqued my work. They loved this section, didn’t understand that one. They ripped apart my favorite character description, the one about my bald, five foot two-inch tall granduncle, leaning on his shillelagh stick at his brother’s funeral. Painfully and slowly, I began to learn the art of writing memoir. During this process, I realized that there are several similarities between becoming a healer and learning to be a communicator.

Just as it takes years of concentrated medical training to make a doctor, the path to authorship is long and arduous. Both require patience, persistence, and practice.

In medicine, without the wisdom, teaching, and support of mentors, fellow doctors, and other health experts, you will fail, and your patients will suffer. The same is true of writing. The teaching, mentoring, and feedback from other writers is critical to producing work that will resonate with readers.  In my case, help came from teachers, editors, writing group members, other students, my agent, and my publisher.

“The patient comes first,” we learn early in medical school. First before meals, first before sleep, and, all too often, first before family. Similarly, when writing, it is critical to think about what the reader will gain from your work. It is not just your story; it is what your story will mean to your readers. You need to entertain, enlighten, encourage, and energize the person who has made the financial and time commitment to read your work.

As a student-writer, I learned that memoir demands a narrative arc. One common model is the heroine’s journey as described by Joseph Campbell and Valerie Frankel. The protagonist has a problem. She needs to search for an answer, but is reluctant to enter the world where she can find the solution. Finally, she is convinced to embark, and several people help her along her journey. Similarly, physicians communicate story as they think about and share information about their patients. This might take the form of student presentations on morning hospital rounds, a consult request to a colleague, or, less commonly now, a chart note.  In the patient narrative, the physician follows the trajectory of a patient’s illness experience. The story begins with the patient’s primary problem. It includes backstory. There is a narrative arc with progressive escalation of the condition, a climax occurs, and, finally, resolution.

Over the centuries, many physicians have contributed to popular literature. Modern examples include novelists (Tess Gerritsen, Robin Cook), essayists (Danielle Ofri, the late Oliver Sacks), nonfiction authors (Atul Gawande, Siddhartha Mukherjee), and several who write across genres (Perri Klass, Louise Aronson).  These doctors bring the art and science of medicine to a general audience, giving readers insight into the otherwise mysterious world of patients, illness, medical personnel, and treatments. Drs. Gerritsen and Cook frighten us with stories of the dark sides of human nature. Drs. Ofri, Aronson, and Sacks help us recognize the complexities of doctor-patient relationships and the intricate effects of biology on our patients’ lives. Drs. Mukherjee and Gawande enlighten us about modern medicine.

As electronic records replace written medical charts, the improvements in diagnostic documentation will be counterbalanced by the loss of patients’ stories. Hopefully, more physicians will fill the void by writing medical stories, so that this aspect of the art of medicine is not lost.

Anne McTiernan is a cancer prevention researcher and the author of Starved: A Nutrition Doctor’s Journey from Empty to Full.

 

 

What this physician learned from being a doughnut waitress

I wrote this essay for KevinMD

In high school and college, I waitressed in a Dunkin’ Donuts shop that sat between Boston Common and the Combat Zone’s porn shops, strip clubs, and bars. The wages paid for school, clothes, rent, and food. At the time, I didn’t realize this job would provide useful skills for my later medical career, an early pre-med training of sorts.

Look the part. I donned the bubblegum pink polyester uniform that clearly identified me as the girl who’d bring coffee and doughnuts. Customers called me “Hey you” or “Honey.” In medicine, I wore a white coat, stethoscope, and nametag that branded me as a knowledgeable healer. When some patients called me Hey You or Honey, I internally rolled my eyes and got on with the job, as I had done as a waitress.

A smile goes a long way. In waitressing, a smile can mean the difference between poverty-level wages and a decent working-class income. That friendly face means a full tip jar at the end of your shift. In clinical work, a smile shows your patients that you care about them and their problems.

Keep the counters clean. Spilled coffee or doughnut crumbs lingering more than five minutes would provoke a rebuke from the store manager. But doctors also are expected to keep a clean worksite. Near the end of my first emergency room night shift, a nurse told us to straighten out our patient charts. It had been a busy night full of screaming alcoholics, gunshot victims, and cardiac arrests. As the nurse disposed of syringes, tubing, and bandages, and wiped the doctors’ work surfaces with industrial-level solvent, she explained that dirt or disorder enraged the director. He arrived exactly on time, read chart notes, and barked questions as we stood to attention. Annoyed at the time, I later appreciated the efforts. By keeping our physical surroundings orderly, our thinking could proceed logically, and we would provide better care to the patients.

Wash your hands. No one wants germs served with their coffee and doughnuts, and employers put state-required signs in lavatories in the hopes that staff will comply with hand-washing rules. According to the United States Centers for Disease Control, contamination by hands of healthcare providers is a major cause of most healthcare-associated infections.

Listen to what the client wants, deliver the goods, and don’t mix up the orders. If my customer asked for the typical Bostonian order of coffee “regular” (i.e., with cream and sugar), but I delivered black coffee, he’d be rightfully annoyed. Similarly, I quickly learned that if a patient came to my clinic about the hip pain that kept her awake at night, I’d have to address her pain during the visit. If I focused only on that day’s blood pressure reading of 210/105, she might not listen to my advice and might not return at all.

Memorization skills are important. The more doughnut and coffee orders you could remember at one time, the faster you could feed the hungry masses, and the fuller the tip jar would become.  My personal best was memorizing orders for thirty customers at one time. To practice medicine efficiently, the ability to memorize facts and retain a depth and breadth of knowledge is essential.

It’s a money transaction. My doughnut waitress job was pretty simple: take orders, deliver coffee and doughnuts, and collect money. Clients knew the costs up front—the menu clearly listed the prices. In medicine, the focus is on the patient, the diagnosis, and the treatment, but cost is rarely mentioned. Think of how refreshing it would be if you were handed a menu with prices when you sign in for your next doctor’s visit: “Hmm, I’ll have the primary care check-up, a glucose test, and a vitamin D blood level. But the bone density scan doesn’t look that good to me, especially at that price.”

Take care of yourself. A sneezed-on doughnut loses much of its appeal; however, we waitresses didn’t have paid sick leave, so too many of us arrived for our shifts even when quite ill. Likewise, many physicians don’t have adequate backup for sick time and show up for work all too often. This puts patients at serious risk.

Treat the client with respect. The Dunkin’ Donuts shop attracted customers from all walks of life, and we provided the same service to the Boston Brahmins in furs and diamonds as to the unfortunates in rags and grime. The same applies in medicine for the physician-patient interaction: all patients look the same during an examination, and all deserve the same care.

Watch your coworkers’ backs. Don’t steal from the tip jar. Help others when they are overwhelmed on the job. Enough said.

Take the perks when you can get them. During an emotionally trying college semester, I made liberal use of the free doughnut policy and packed on several unwanted pounds. On call nights during my medical training, I was often too busy to eat until the cafeteria was closed. I adored the pharmaceutical reps who supplied us with free pizza.

Much has been written about what makes a good doctor, and how to prepare for a career in medicine. Schools advise potential applicants to take specific science courses, maximize grades and MCAT scores, volunteer in a clinic or hospital, and work in a lab. Many institutions now offer courses in communication for physicians, and some even require attendance. But there’s scant attention to real-world experiences that can prepare a person for a job that involves customer service on a daily basis.

Looking back, I can see that being a doughnut waitress didn’t promise a life of riches, but it did provide an enduring education. The length of training differed between becoming a waitress and becoming a physician — seven days versus seven years, in my case — and the pay scales didn’t overlap. But, both jobs involved hard work and long hours. They both required excellent listening skills and putting customers first. And they both provided comfort to persons in need.

Anne McTiernan is a cancer prevention researcher and the author of Starved: A Nutrition Doctor’s Journey from Empty to Full.

 

Unsaintly Language

My publisher and I are in the final stages of editing my coming-of-age memoir—Starved: A Nutrition Doctor’s Journey from Empty to Full—and we are on track for publication in November 2016. As I re-read the manuscript for the hundredth time, it struck me that the language of my family might not be the same as what other people experienced, and might need some explanation. My mother and aunt, who raised me together, learned their pattern of speech from their Irish mother. They drew heavily from God, his relatives, and his best friends, the Saints. Bringing God into their language helped give their statements extra emphasis. Placing God-words at the beginnings of sentences would cause the audience to listen carefully because, after all, good Catholics could not ignore God. The various words and phrases had different meanings in their lexicon. Here are some examples of what they said, and my guess of what they really meant:

Jesus, Mary, and Joseph = “This is a catastrophe.”

God help us = “We’re just helpless females and can’t do for ourselves in the world.”

With the help of God = “I’m hedging my bets here. If it doesn’t work I can blame God.”

What in the name of God do you think you’re doing? = “I don’t particularly like what’s going on, and I’m bringing in God to support me.”

Jesus H. Christ = “I’m very angry right now.”

Oh God bless you and may the saints preserve you = “You’re a very sweet person.”

Oh for the love of God or Oh for the sweet love of Jesus = “You exasperate me.”

Dear God Almighty = “I’m at my wit’s end with you.”

Glory be to God = “I’m showing off how holy I am.”

Dear Mother of God = “My life is so difficult, woe is me.”

May God forgive you = “I’m giving you a major guilt trip right now.”

I don’t know how much longer I’ll be on God’s green earth = “Whatever is bothering you, shut up about it, because I’m the important one here and only my feelings count, not yours.”

Glory be to Saint Patrick = “We are real Irish.” (Despite never having set foot in Ireland.)

Oh Dear God = “I have a miserable life having to take care of you.”

Christ = “Damn.”

Oh for Christ’s sake = “I’m pissed at you right now.”

God Almighty = “Really!”

Dear God and all His Saints = “I’m bone tired.”

Jesus = “I’m so angry I could spit.”

Heaven help us or God help us  = “I’m not sure we’ll get through this ordeal.”

Heaven help you = “I hope you feel guilty.”

Get down on your knees and beg God’s forgiveness for what you did = “I’m making you feel as guilty as possible.”

Oh good Lord God Almighty = “This is a terrible thing I’m hearing right now.”

Saints preserve us = “We’re in a miserable situation.”

Oh Lord = “Oh dear.”

Every blessed day = “Every single day.”

You’d try the patience of a saint = “I’m a saint, and you’re really trying my patience right now.”

My language has evolved over the years, and I don’t call on God or the saints very often. And a stubbed toe can elicit some pretty unsaintly words.

 

The Three Grandmas

I stepped out of the shower, shivering slightly on that cool Seattle August morning in 2015. As I reached up to grab my frayed towel, a knife pierced my lower back. I froze in mid-reach, and then slowly exhaled as I realized the pain had stopped. Please dear God don’t let it come back. My arm crept upward, removed the towel, and proceeded to cooperate with my other arm to dry me. I’m okay, I’m okay, I’m okay. It was just a fluke. Just a little spasm.

It’s incredible how well the brain can deny the fact that something physiologically significant must have happened. Excruciating spasms of pain aren’t normal, and for most of us they’re not a daily occurrence. But I convinced myself that I was fine, I hadn’t thrown my back out, I wouldn’t be down and out for three days like with my previous back injuries.

I had no more pain that day. Thank you, Lord. I didn’t have time for another down-on-the-couch-all-day-crab-walk-to-the-bathroom kind of back pain. I had grandchildren to babysit. I had scientific manuscripts to write, laundry to do. I had a work trip to Norway coming up. I had things to accomplish.

Plus, I didn’t get back pain anymore, not since I’d been through physical therapy several years before, and began working out with a trainer. Prior to that, my back “went out” on average every six months. Diligent with daily abdominal exercises, my most recent trainer told me that I had the strongest abdominal muscles of all her clients, including the women in their twenties who worked out to look good. So I knew it couldn’t be another back injury.

Another day passed without pain. I was okay.

Then it came back, just to the left of my spine at the top of my hip bone. Quick in and out like a shiv thrust so quickly no one could see the perpetrator. It struck when I reached for my face moisturizer, or when I cleaned my bifocals at the kitchen sink. It hit after I stooped to look for my grandson’s missing puzzle piece under the living room couch. One morning it happened several times in a row, taking my breath away, and forcing me to ask my husband to carry the cup of tea I’d just warmed in the microwave. As I reclined on the couch, Dr. Anne took over and deduced that this wasn’t a medical emergency since I had no neurological symptoms. Then Patient Anne said, But I’m in agony. I have to go to a real doctor.

So I saw my real doctor, a very knowledgeable internist whom I’d chosen because she’d trained in the same residency program I’d graduated from thirty years ago, and because she’d been a Chief Resident. Internists chosen to be Chief Resident at the end of the three-year program tend to be very smart. I wasn’t a Chief Resident.

“You don’t have neurological symptoms, and you haven’t blown a disc, so that’s good,”  she said. “There’s no good reason to take X-rays, because it rarely changes the recommended treatment. You could just take a lot of ibuprofen, and then you wouldn’t have pain. But if you want to fix the underlying problem, you’re probably looking at some physical therapy.”

I chose the physical therapy. Once you get into your sixties, you start to think twice about the same medications you popped like candy when you were young. Ibuprofen increases risk for stomach bleeding and heart attacks, and the risk increases with age. The risk of physical therapy would be lower.

Through the first couple months of physical therapy, I continued to have pain, usually about one sharp dig a day. While I couldn’t pinpoint the particular movements that caused it, I did discern a temporal trend. The evil monster in my back was a morning creature. She struck early, then napped for the rest of the day. With some concentration on my morning activities, I realized that by 11 a.m. I was just about home-free. At last, I had something I could work with. I would be extra careful with my movements and posture in the morning, and live my life in the afternoon and evening.

I became three people. Morning Anne was the old woman who had physical limitations and needed caretaking. Afternoon Anne was young, energetic, and able to pick up grandchildren. And Evening Anne was the caretaker—she got things ready for Morning Anne. She moved items to the edges of counters, got out clothes for the morning, filled the tea kettle. She did this so that Morning Anne could perform her basic activities of daily living with minimal pain until her morning icing and exercise routine kicked in to appease the evil force living in her lower back.

Thinking as Caretaker Anne, it occurred to me that it would be nice to send messages to my future self. Many of us say we’d like to talk to our younger selves, tell them they’re doing just fine, or maybe chastise them for the mistakes they are about to make. But we don’t talk to our future selves. I’ve thought of some things I’d like to tell the older Anne:

Don’t be scammed: if a gravelly-voiced stranger calls saying he’s from the firefighter’s defense league, hang up immediately, just like you do now.

Don’t be a shut-in: elderly people with active social lives live longer and happier than recluses.

Watch your step: your weak bones are going to break if you fall. Your doctor can treat your bones, but you need to control things that can trip you up like throw rugs, loose slippers, and the old cat who thinks his needs supersede his owners’.

Enjoy life: stay in the present instead of ruing the past or worrying about the future.

My physical therapist made me change my life—how I sit, sleep, move, exercise—and luckily it worked. The evil monster in my back is dormant. But part of me still watches out for the older, vulnerable, lady within.

 

 

 

 

The Lever

My daughter told a story recently about her two-and-a-half-year-old son. This is the grandchild who has the audacity to live 3000 miles away from me. They were playing soccer at a park, when he picked up a big stick and called it a lever. He then proceeded to place it under the soccer ball and demonstrate how one uses a lever to lift an object.

“Did you learn about levers in school?” his mom asked.

“No, from Maya the Bee.” Maya the Bee is his favorite TV cartoon. He’s watches it at night while his mom tames his half African/half Caucasian hair with creams and a comb. He can tolerate all sorts of head-rubbing and hair-tugging while absorbed in his shows.

My first reaction to this story was amazement and pride that this little toddler could remember what he saw on TV, figure a way to apply it in real life, and try it out. I’ve watched Maya the Bee many times with my grandson when I visit, and I sit there slack-mouthed, not absorbing a single bit of plot or character. The only things I learn from television are the chances of rain for a particular week, the antics of the U.S. Congress, and the people dying unnecessarily around the globe. My grandson has something to teach me here.

But then it made me think of how parents can use grandparents as a lever to raise a child. Just as our grandson could have lifted that soccer ball unassisted, our children would do a fantastic job with their children without our help. Like a lever, we grandparents can lighten the parenting load just a little.

A grandparent can provide invaluable information when parents are stymied. Things like:

“Did we have tantrums like this when we were little?”

“I don’t remember.”

0r

“How did you train us to sleep through the night?”

“We didn’t.”

A grandparent can offer advice even when not asked. One of my favorites is to paste a link from an online article about potential dangers to children like falling through screens and running with food in their mouths. The parents never respond to these, so I imagine them rolling their eyes if they even click on the danger-link. But I notice they occasionally do make some related household adjustments. What can I say? I try.

Probably the main thing that grandparents can provide is reassurance. Our pride in our grandchildren is a lever to lift up the parents’ confidence that they are doing just fine in raising these wonderful kids.

To Tell the Truth

“So what did you guys do this morning?” I asked my four-year-old granddaughter. I’d just arrived for my afternoon of babysitting, relieving my husband who’d done the morning shift. The kids had greeted me at the door. I love that they’re excited to see me. I’m enjoying the time until they’re old enough to realize I’m just a boring old lady who can’t hear very well.

“We went to the coffee shop!”

“Yeah, coffee shop,” her two-year-old brother chimed in as he busily opened and closed his sister’s animal-print umbrella. First I could see him, then I couldn’t, then I could, then I couldn’t.

“Did you have a snack?” I asked.

“Yes. I had a magic chocolate bar,” said my granddaughter. She spun around as she talked, some wisps of her dark brown hair falling over her equally dark eyes.

“I had a magic chocolate bar, too,” my grandson announced, proudly showing off his new ability to form complete sentences.

“Why is your umbrella out?” I asked my granddaughter.

“We took it in the stroller, coz it was pouring rain,” she replied.

“Oh, really?” I pictured an umbrella shakily held over the stroller, most likely not covering either child.

“Yes, and we also brought the water-table umbrella,” she added.

This seemed odd. While that shade umbrella was a favorite plaything, and served several purposes like a handy sword, a tent, or a battering ram, to my knowledge it had never left our grandchildren’s backyard.

“Is your brother allowed to play with your umbrella?” I asked. At one time, their parents had not allowed indoor play with umbrellas because they preferred their children to keep their facial structures intact. I wasn’t sure if that rule had been relaxed yet.

“Oh, sure, it’s fine,” she said.

“Yeah, it’s fine,” echoed her brother, his eyes big and blue and innocent.

I hung up my coat and purse and followed the kids into the house. My husband was just finishing lunch.

“You realize that not a single word of that entire conversation is true,” he said. “We didn’t go to the coffee shop, We did go out, but the kids were on their bikes, not the stroller. We just went up the sidewalk.”

“So there was no magic chocolate bar?”

“Nope.”

“Did you bring umbrellas with the bikes?”

“No umbrellas, certainly not the water table one. And, no, they’re still not allowed to open the umbrella indoors.”

“Did it rain over here?” It had been dry all morning at our house, eight miles to the east.

“Not a drop.”

As I think back on this interchange, I’m fascinated by the different perspectives on reality. Our grandchildren aren’t purposefully dishonest. They didn’t huddle together to plan a fake story to tell Grandma. I think our granddaughter just wanted to tell me about the events she wished had happened. While she enjoys going out on her bike, she loves the coffee shop more. It has enough toys to fill a small toy store, and a cozy corner where she can play to her heart’s content. The sweet snack her grandfather buys just adds to the special bliss.

Kids aren’t the only people who have varying perspectives on truth. I’ve been in numerous work meetings where everyone comes out with a different take on what occurred, usually reflecting what they wanted going in to the meeting. I’ve learned to send emails after meetings to document my understanding of what was decided. On occasion, I’ll decline a face-to-face in favor of an email exchange so I can have documentation of decisions.

Writing personal narrative such as memoirs or essays brings a whole new dimension to the idea of truth. While we’re taught to tell the truth in our writing, that truth is always going to be interpreted through additional experiences of time. We forget. We interpret. We embellish. We make things better or worse or more interesting than they really were. Indeed, the little vignette I presented at the beginning of this blog just occurred yesterday, and yet I’ve probably distorted it considerably. If I ask my granddaughter what she remembers about it, she’ll probably tell me that we talked about one of her most recent passions, like Greek mythological creatures, or Elsa from the Frozen movie, or dinosaurs. And her story will be much more interesting than mine.

In Training

It doesn’t come with a training manual. An online search won’t yield instructions specific to your make and model. The “it” of course is the grandparent role. There’s no Dr. Spock for Grandmas. If there were adequate training materials, there would be plenty of time to get ready. Nowadays, young couples know they’re expecting almost immediately after conception. And they share the news early. So for each of our three grandchildren, we had almost nine months to prepare. We thought hard, and decided to get ready for the big events the same way we prepared for the arrival of our own children: we would just wing it and hope for the best.

Not knowing either of my grandmothers, I had no role models. My mother’s mother died in her forties of stomach cancer, when my mother was eighteen years old. I knew her only from the stories my mother and aunt told of their wild Irish mother. Her death sucked some of the life out of her daughters; they never recovered from their early loss. My father’s mother, a rare female Irish alcoholic, died when I was an infant. Other than one black-and-white photo of her holding me, I have no proof we’d ever connected. Growing up, I made a habit of adopting people to replace my missing relatives, but I never told them of their honorary status. It was like secret love, but not the romantic kind. A kindly landlady, with fluffy white hair that surrounded her head like a halo, was my “grandma” for several years. She’d bring me ginger ale when I was home sick, seeming to know that a seven-year-old girl shouldn’t be on her own with a raging fever and a bottle full of orange-flavored aspirin gum.

I’ve had to learn to grandmother as I go. Luckily, my role as Grandma is not as critical as was my role of Mom. While “winging it” for parenting could be seen as irresponsible, for grandparenting it’s tolerable, maybe even cute.

So what have I learned over the past several years?

As with the proverbial riding a bicycle, some things come back to you instantly. Like how to hold an infant, make quiet sh-sh noises, and rock her just the right amount, to calm her to sleep. And how to distract a squirming toddler long enough to change her diaper. My fingers remember the way to make pigtails stay in place for almost a half hour.  I still read to kids with a voice that shows my excitement about story, and I sing Raffi songs, although I’m now more often off-key than on.

Some modern baby and kid things are beyond me. I just don’t get the diaper set-ups. I can’t handle the various buttons on the baby monitor. I’m so bad at assembling the spill-proof sippy cups that my daughters make sure to have those all put together before Grandma comes over. And as soon as I get the hang of a stroller, the parents decide to get a newer, better one with more bells and whistles to learn. I realize too late that I don’t know how to do some of the key functions like braking. If the toddler is allowed to watch cartoons while recovering from an illness, chances are Grandma will have to ask him which of the half dozen remotes to use, and which buttons to push.

Some things I had problems with as a Mom are just as difficult as a grandmother. I now know why I was thinner as a young mother. I can’t eat when kids are upset or demanding or whining or getting into trouble. Since all of those happened with my kids at just about every meal, I didn’t eat very much. I find myself reacting the same way when I’m taking care of the grandkids. My stomach tightens up with the slightest complaint, and I lose any semblance of appetite. I jump up to get more cheddar bunnies, more fruit leather, more dried cherries, and more water. I lunge to catch a glass of milk the preschooler balanced on her fork, then wipe up the mess resulting from my inability to react fast enough. I kiss the boo-boo the little one got as he took a tumble from his chair. I catch the toddler who tries to run around with his mouth stuffed with food. I do an end run on the tyke who thinks opening and closing the freezer door is a fun rainy-day activity. Since my grandparent shift usually involves at most one meal and one snack, I have lots of opportunity outside that period to stuff myself. I’m decidedly not thin now. Sigh.

I think if there was a training manual for Grandparents, the first chapters should focus on how to relax and enjoy getting to know these wonderful little creatures, how to be more of a help than hindrance to the kids’ parents, and how to get away with spoiling your grandchildren just a little.

Good Enough Grandma

My daughter recently shared an article on parenting called, “The Gift of the Good Enough Mother.” (http://seleni.org/advice-support/article/the-gift-of-the-good-enough-mother?nl=style&emc=edit_ml_20150730) The theory isn’t new—decades ago an English pediatrician and psychoanalyst developed the notion of the best mother as being a real one who helps the child grow to independence. While the mother tends to the newborn’s every needs as much as possible, over time she gradually reduces her level of responsiveness, and even makes mistakes now and then. The child learns to adapt to a world where her every whim isn’t answered, where she has to share, where she has to wait for mom or dad’s attention. This teaches her how to cope with an imperfect world.

I love this concept because it takes some pressure off parents. Of course, you can’t slack when it comes to safety. It’s not okay to say that getting the kid into the car, but without a child restraint, was just being a “good enough parent.” And if you never pay attention to your child, and never listen to what he wants, he may grow up distrusting people. But there’s a lot of wiggle room between striving for perfection and neglecting your child. Your house doesn’t have to be spotless, you don’t need to host elaborate dinners, and you don’t need to volunteer for every school committee. You just need to figure out what works for you, your family, and your child.

In fact I like this idea so much that I think it should be extended to “Good Enough Grandparent.” I’ve come up with some examples.

A “Good Enough Grandma:”

Does a lot of babysitting, in part because she wants to help her own children, but mostly because she wants to be close to her grandchildren.

Helps out financially when she can, but enjoys seeing her children being careful about money.

Doesn’t bake cookies, for the simple reason that she can’t eat them and doesn’t want the temptation. She knows she’ll lose points for this when the grandchildren realize that grandmothers are supposed to make them treats.

Begs the parents for a set of rules (naptime, bottle, feeding, schedules, anything), and then texts the parents repeatedly for clarification.

Agrees to a babysitting schedule that works for her, and rearranges her other activities only for babysitting emergencies.

Learns and re-learns lullabies and toddler songs, but doesn’t worry about her off-key renditions.

Wriggles around the “no food in the living room” regulation. Who says the kids can’t eat right at the border between the dining room and living room, on a towel spread out to mimic a picnic?

Neglects to have the kids use the potty as often as she should, then shrugs her shoulders as she tells Mom that the toddler had a little accident that day.

Sometimes forgets to implement the behavioral techniques Mom and Dad use. So instead of asking a shrieking kid if he’s upset, telling him to take a few breaths to calm down, and asking if he want a hug, Grandma says, “Don’t yell at me, you’re hurting my ears.”

Says “no” to finger painting when Mom or Dad will be home soon, because she doesn’t feel like cleaning up a huge mess when she’s about to go off duty.

Says “yes” to blowing bubbles even though she knows she and the kids will be completely covered with slimy, liquid soap and there isn’t enough time for a bath before dinner.

Doesn’t learn to knit just to prove she’s a caring grandmother. This is similar to the cookie issue above. While there’s no health reason to prevent her from knitting, the talent and patience needed are beyond her abilities.

Doesn’t let sneezing, coughing kids share drinks and food with her. This probably has no effect on transmission of viruses, because she’s getting super-exposed from wiping their noses and breathing the air they just coughed into. But it makes her feel better.

When you think of it, being a “Good Enough Grandma” is beneficial for the grandchildren’s parents. While they know you made mistakes in parenting them (and only their therapists understand the magnitude of damage), they probably don’t realize how you screwed up in their toddler years. Now they can see it first-hand, and can rest assured that their parenting abilities are so much better.

Vitamin G

Vitamin G: this newly discovered miracle can improve your life. Other vitamins have risen and fallen in popularity. Vitamins A, B, C, D, and E all failed to match their once-touted benefits. While they are necessary for life, high doses haven’t been shown to improve health more than the minimum nutritional requirements.

So why push yet another one? Never heard of vitamin G you say? No, the “G” doesn’t stand for “Grandma.” Vitamin G is what I’m calling green space, nature, trees, bushes, plants. As it turns out, these are all really good for you, and we have the science to prove it.

When I was a busy mom, working full-time as a physician and researcher, my only time to exercise was at 5 a.m. Not feeling safe outdoors alone at that hour, I opted for the treadmill route. It got the job done, but wasn’t particularly pleasurable. After the kids were grown, I moved my exercise program outdoors. I began to drag my husband out of the house for walks, and later added walking with neighborhood friends. I’ve discovered the pleasure and peace of outdoor walking, especially in natural areas. In the Pacific Northwest, we are blessed with moderate climates that allow walks in parks and trails year-round. The favorable weather conditions also mean beautiful neighborhood gardens. My eyes are drawn to the greenest areas—a tree canopy on an old street, the bushes on a local bike path, a neighbor’s plantings, everything in an old-growth forest. I now feel deprived if I haven’t had my daily dose of green.

I’ll admit I’m not always thinking of the health benefits as I walk. If I’m with my husband or friend, I’m concentrating on the conversation. On a difficult path, I’m wondering if I’ll fall head first down that cliff. If I’m alone in a deserted area, I’m worried about safety. On what I call a “zen walk,” alone on a safe pedestrian path, I’m trying not to think of anything, trying to remain in the present. But through all of these experiences, I feel the restorative powers of green. My racing thoughts slow down, my heart rate feels more regular, the tension in my shoulders dissipates.

Recently, a rigorous clinical trial found that a 90 minute walk in nature significantly decreased the participants’ levels of brooding. The study assigned 19 individuals randomly to walk in nature, and 19 to walk near urban traffic. The participants also underwent brain scans, and the researchers were able to see less activity in the rumination centers of the brain after the nature walk, but no change after the urban-setting walk. Earlier, these and other researchers discovered that exposure to nature lowers anxiety, improves mood, enhances thinking skills, and has benefits on measurable health parameters like blood pressure, heart rate, and blood indicators of stress.

Of course, these benefits depend on taking precautions to lower adverse experiences. The restorative power of a walk in nature will be ruined if you fall and break an ankle. Similarly, a bee sting from sniffing a neighbor’s lavender bush could lessen your outdoor joy. So think about what you’re doing and where, and take steps to lower your risk. Protect yourself against climate, use sunscreen, take water with you, and have a phone for emergencies. Women and other vulnerable populations attend to risks of assault, and may feel more comfortable walking with companions, or in well-lit, populated, open areas. Dog walking can benefit both the animal and the owner’s sense of safety. And please vigilantly watch for motor vehicles as you travel to and from your areas of nature. I guarantee you those drivers aren’t sharing your zen thoughts as they speed through the crosswalk you thought gave you priority.

If you’re not able to walk outdoors, you can still enjoy the pleasures of nature in other ways, such as indoor or outdoor gardening, visiting an arboretum or plant store, or just sitting in a park, forest, or nature preserve. In her young wisdom, Anne Frank said it best: “The best remedy for those who are afraid, lonely or unhappy is to go outside, somewhere where they can be quiet, alone with the heavens, nature and God.”

Grandma’s House-work-out

A couple of years ago, I decided to stop using a housekeeping service. I’d used several over the years, beginning when I was a medical student. Prior to that, I always assumed that only rich ladies had housecleaners. Given the state of our checkbook, I knew that luxuries like someone to clean your house were out of our reach. But with two young children, my husband’s demanding research job, and the insanity of medical school, I clearly needed help.

Over the ensuing three decades, I used several types of services—single, self-employed cleaning ladies, companies where a half dozen people converge on your house and sanitize it in an hour, and services that send out rotating cleaners so you never know who will be in your house. Sometimes I’d have them come every two weeks. When our family life expanded to include dirt-producing activities like cat ownership, gardening, and horseback riding, I had cleaners in every week, and even that didn’t seem often enough. They all did a good job, more or less. None got into corners with a vacuum, but most did a much better job with my stovetop than I.

But with an empty nest, and the prospect of salaries decreasing (what my daughter calls being “pre-tired”), I decided to dust off my own vacuum, pull out those old rags hanging in a plastic bag in the utility closet, and get to work. Besides, part of my research focuses on the health effects of increased physical activity. I needed to practice what I preach. I knew that cleaning house can burn calories, without having to buy a gym membership or become an athlete.

It was a good idea in theory.

I’d forgotten that housecleaning is actually hard work. Or maybe my older body just reacted badly to new muscles being used. I was already active—every day I walk, bike, or do elliptical, and each morning I do strength training exercises. But vacuuming and sweeping found new muscles to annoy, and the inch I’ve shrunk over the years made stretching to clean mirrors even more of a challenge.

I was no stranger to housecleaning. Growing up in a household with two working class Irish-American women, housework was a family weekend activity. I was not exempt. (My mother once locked me out of the house for several hours when I went out to play with friends instead of staying home to clean. I didn’t repeat that again.) I recall scrubbing sinks at age four under my Aunt Margie’s tutelage. I had to stand on a step-stool, and was only allowed to use Ajax when she was nearby. (Somehow the picture of a four-year-old wielding Ajax is not comforting.) As I grew older, so did my responsibilities. Beginning in first grade, my afterschool chores included sweeping the kitchen floor, setting the table, and scrubbing the potatoes (being Irish, we ate these every night).

In high school and college, my advanced cleaning skills won me jobs as a hotel maid and live-in housekeeper. Even in medical school, I couldn’t stop myself from emptying a patient’s bedpan. A resident scolded me for doing this, said it wasn’t my job. Little did he know.

In my years of hiring cleaning companies, I’d also forgotten how much time this work takes. Somehow I had an image of getting the house completely clean in the same amount of time as the half-dozen-worker companies. As if I could morph myself into several Annes, scrub for an hour, and meet up at the end for a nice cup of tea and a chat.

But, I was determined. I wanted to save those few extra thousand dollars a year by not hiring someone else to perform work I should be able to do. And I wanted to burn more calories, because my mouth doesn’t listen to my brain when it says to curb my caloric intake to match my needs.

Here are how many calories a person can burn per hour for several household activities. These assume you weigh 150 pounds. If you weigh more, you’ll burn a few more calories. If you weigh less, you won’t burn quite as many. These numbers assume that you actually do the activity. The time you stop to watch the soaps when you are supposed to be dusting doesn’t count.

Vacuuming                                        235

Scrubbing floors                140 to 465 (depending on how vigorously you scrub)

Dusting                                              165

Sweeping                                           270

Cleaning windows                           230

There are many online sites that can provide calorie expending counts for other activities. In general, things that seem more difficult burn more calories, kind of a no-brainer. The ones I listed are those most commonly done for cleaning house. If you spend four hours a week doing a combination of these activities, you’ll probably burn off about 1000 calories or more each week. If you don’t increase your calorie intake, you could lose a pound every month or so, although in reality, exercise doesn’t produce the amount of weight loss you’d expect. Most likely, the increased exercise will just help you stop gaining weight, which is an achievement in itself. In comparison, a 150-pound person would burn less than 100 calories while sitting and watching TV for an hour.

If you’ve always done your own housework, whether because you had no choice financially or because you opted to do it yourself, then hopefully you’ll feel better about the health benefits it provides. Perhaps you use a cleaning service, and don’t want to cause someone to lose a job. In that case, you could just do some housework in between their visits, taking on the things they miss like getting into corners. Then your house will really sparkle!

You may be too busy taking care of family, or working two jobs, to even think about housework. You might be able to find small bits of time to fit in some activity. Even the time you spend in the kitchen preparing meals and washing up burns calories, to the tune of about 235 calories per hour. So if you can just resist the temptation to flop down in a chair as soon as you arrive home from work, your household can make you healthier. You don’t have to do this alone, either. You can convince your spouse, partner, or kids of the benefits of helping with housework!

Two years after my momentous decision, I’m still cleaning. I’m not sure the house looks any the better for my personal attention, but I’m sitting less and saving a few bucks in the process.