KIDS CHANGE EVERYTHING

There is no doubt that having children changes one's perspective on life. However, I was not aware of how much it can also change one's perspective on work.

Today, on rounds in the hospital, we walked into the room of a man my age with metastatic, incurable pancreatic cancer. He was admitted with severe pain despite prior cycles of chemotherapy and a PCA (patient-controlled administration) pain pump. The latter is a device that allows the patient to hit a button to dispense high doses of intravenous narcotics on demand. The Heme-Onc fellow and nurse practitioner on the team who had met him before said his body was a shell of its former self, and it was clear that he had lost a lot of weight. He had lost so much weight, in fact, that it hurt him to lie for prolonged periods on his back or on his side due to the lack of any subcutaneous fat.

This morning he was in visible pain and said that his hospital bed, which had been changed to a more comfortable air mattress the night before, was unbearable. He begged us to send him home after a planned procedure to essentially abolish the abdominal nerves that his cancer was compressing. We explained that we wanted to ensure that he was stable after that procedure and that we did not want to discharge him too soon only to have him get re-admitted several days later. He pleaded with us, at which point his mom, who was also in the room, tried to convince him to stay while also trying to advocate strongly for us to help make her son comfortable.

I could see the powerlessness in her eyes, but, in them, I could also see how she would have been willing to give her own life to save his in a heartbeat... if only that were an option.

This patient's situation. This family's situation made me think of my own son and my own daughter and how sick I would feel if were in that mother's position facing the prospect of having to bury my own son. I have never cried on rounds, but I struggled to hold back tears and quickly excused myself after we were done comforting them.

Kids change everything.

When I got home, I gave Nicholas and Cate big hugs. I was extra patient and extra fun tonight because I was reminded how precious they are and that life is (to quote my former Chairman of Medicine Dan Foster) "until further notice."

THE FIRST GOODBYE

Tomorrow is Nicholas' last day at Alder Street Learning Center, the pre-school which he has attended for the past three and one-half years. It has been an amazing school, and we feel fortunate that Cate will remain there for at least the next three years.

Tonight we decided to write out thank you cards to three of his teachers- the center director Linda, who is an amazing teacher, his current teacher Nicole, and his former teacher Norma, who has reached him in a way that I can only dream of approaching one day.

The card to Norma is shown below.



Its contents included the following words (along with a Starbuck's gift card and the picture below):



"Dear Norma,

I love you so much. I love you because you stay with me until the end of the day, and you always love doing stuff to me that is so silly.

There's a lot of other stuff that I do not have room for, but I love you because you are my friend and my teacher.

I hope I have another teacher like you because you're my best teacher I have ever had at school!

Love,

Nicholas"

The choice of the sloth for the cover was mine, but the words were all his. Cue the kleenexes please. Sniff. Sniff.

THESE PICTURES ARE WORTH A THOUSAND...

My dad visited us in Portland for the first time this weekend. I will not wax poetic about how it was to see him after not having been in touch for the past few years. Suffice it to say that I had forgotten how amazing dad is with kids, and I had not witnessed recently what an all around great/fun guy dad is. These pictures speak for themselves.







Call it what you will, but I call this past weekend a great re-start. I am reminded (once again) that life is just too short...

ANOTHER FIRST

Today, we went to (of all places) the Oregon Zoo. Nicholas was fresh off zoo camp, but he wanted to go back and "see the whole zoo." While at "penguin camp" last week, he learned a "penguin salute" and the "penguin happy dance." Both involve a form of holding one's hands by one's side sticking out and promenading in a circle.

At the zoo today, we saw children dressed up in their red penguin zoo camp shirts, and I suggested we give them the proper salute. Nicholas was horrified. He said, " No dad, we cannot do that. Please stop."

I was taken aback but immediately desisted. Tonight, I asked him about it thinking that I had embarrassed him for the first time. He said that the dance was only for the current campers and that he did not want to distract the kids and the counselor. I think he was trying to let his old man off easy. Chalk one up to embarrassment... and to diplomacy!

ZOO CAMP CONT'D

Nicholas has been having a great time at zoo camp (surprise, surprise). He seems especially taken with his male camp counselor named Ben. Today, I asked Nicholas about all the counselors and whether they were college students (which they appear to be). Nicholas replied, "No daddy, they are grown ups."

I am going to remember that the first time he pulls the line "I am an adult, dad" anytime before it is time for him to collect social security. Remind me, okay?

ZOO CAMP

Today, Mr. Nicholas was to start zoo camp for the first time at the Oregon Zoo. He was visibly excited this morning after he woke up, but he maintained his composure and even exhibited a new trait I have never seen before- tact.

In the kitchen, while our nanny Grace, who was assigned to drop him off at said camp, cut up a peach for his breakfast, Nicholas took me aside. He said, "Dad, please come over here!" Then, he whispered in my ear, "Dad, do you think you can remind Grace what time zoo camp starts, so I will not be late?" I, in turn, whispered, "What are the hours of zoo camp?" He whispered back, "9 o'clock to 4 o'clock." I told him I would take care if it and then casually said, "So Nicholas what time does that camp of yours start?" He replied, "9 o'clock, daddy." I re-iterated the start and stop times and said that that was over 2 hours away and that I was certain that Grace would have him there on time. With that, he ate up his oatmeal and peaches with a big smile on his face... while flapping his arms...

In case you were wondering whether day one of camp was a success, Nicholas could not stop talking about his day on the way home. Apparently, he is quite certain that he will be a zoologist one day and that he will "focus on ostriches." I would not bet against it!