#overthinking #outofmydepth

It's Christmastime, which means that la p'tite, who lives a ludicrously pampered first-world-plus existence at baseline, is bang in the middle of an eight day stretch of truly mindblowing indulgence, as the trifecta of her birthday, Christmas, and a contentious co-parenting relationship convene to (transiently, one hopes) stamp out any vestiges of moral fibre, restraint, and humility that may have developed over the preceding 12 months. 

For her birthday/Christmas this year, the present she has most consistently requested whenever the subject has come up is, I am not making this up, 'shackles.'  Rather than go deeper into what she would plan to do with shackles, should Father Christmas decide he's down with this (because I really, really don't want to know), I have been trying the Good Mummy diversion tactic of "what presents are you excited to make/give other people?" which turns out doesn't really work if you have the kind of kid who wants shackles to begin with. 

When I was little, I wanted a Barbie for Christmas; my mother, like any self-respecting hippie feminist child of the 60's, was horrified, but she squared it with her soul, and stayed up late the night before Christmas sewing Barbie outfits. Thus I awoke on Christmas morning not just to a new Barbie (with a plastic panel in its back which you pushed to get a kissing noise eeeeeuw) but also to a whole wardrobe of tiny Liberty-print floral hippie smocks, all ready for Barbie to start boiling her own soap, dipping her own beeswax candles, and putting on her wellies to go out to the pea-patch to harvest her curly kale to make a bulgur salad. I do remember a slight pang of disappointment at the time that my Barbie did not have more flashy outfits as-seen-on-TV, but I now think of my Barbie's flower child/Mennonite wardrobe as an act of tremendous beauty and sweetness by my mother. (By the time I was la p'tite's age, my mother had taught me to sew myself, and there was no looking back: all my teddy bears had reproduction Elizabethan ball gowns for regal functions, executive suits for work, and chintz floral prints for casual daywear while on tropical vacations: truly the gift that has kept on giving through the decades.) Neither my Barbie (unless you count her lurid pink plastic high heels) or my teddybear, however, went in for BDSM, so I don't have much in the way of parenting precedent to lean on, here.

La p'tite's interest in sewing is cursory, but her interest in dominatrix gear has been pretty consistent since the age of about six, long enough to not really be a phase, I think. (Favourite superheroines are without fail the baddies, the ones who dress in skintight black leather, carry whips, and have fangs). There are plenty of things I make her do that she's not into (piano lessons, chewing with her mouth shut, math) so I should honour her other interests when I can, right? So: shackles. I stopped by JoAnn Fabrics this afternoon and picked up a yard of chunky plastic silver chain and a strip of black leather with silver studs, and I made the girl her shackles. (All her other presents, scouts' honour, are entirely virtuous, innocent, and focused on self-improvement: art supplies, musical instruments, books, etc.... with the possible exception of a pair of socks which say "Fuck off, I'm reading" which I couldn't resist.) 

I am going to wrestle in private with the murky question of whether I should have indulged this particular whim at all BUT here's the question for the wide reading public: is it creepier to receive your gift shackles from an weird old semi-magical dude you've never met who sneaks into your room at night to leave stuff at the end of your bed (Santa)... or from your mother? 

Kafka in times of COVID

So yes, big long gap there for a minute, but I have not had anything more notable happening in my life than anyone else on the planet has (masks, long lines to buy food, child at home, obsessive checking of IHME stats), but there's a wee gap in patient care duties and a situation which is just so, so indicative of how completely stupid the medical system is that I can't resist; it is truly a self-sustaining industrial monster at this point, absolutely definitely not set up to serve any actual human beings other than possibly the corporate  overlords. To wit: 

1. I work several different jobs. 

2. Each job requires that I get fitted for the particular type of N95 mask that they stock.

3. I have been successfully fit-tested for multiple types of N95 mask without difficulty. 

4. The one exception was for my one un-busy job, which already has presented me over the last year with a number of bizarre and surreal situations, not the least of which is insisting that I physically come in to clinic at the height of the pandemic to see exactly zero patients. At the fit-testing for this job, (outsourced to an outside company), the technician seemed unsure of herself, saying it was her first time fit-testing someone. She had trouble decanting the saccharin into the test sprayer gizmo, and when she sprayed it, I couldn't smell anything. I suspected that she had just done it wrong, but I also have had a stuffy nose since March because of wearing an N95 all day every day, so who knows. I therefore failed that particular fit test; I wasn't terribly worried because there was another provider at that job who was willing and able to see any/all potential COVID patients and the total number of patients seen is very low, and I have other N95's from other jobs that I can wear to help keep myself safe. 

5. Fast forward six months, we got a fit-testing kit to actually have at the clinic so it seemed reasonable to have another go. I filled out the preliminary questionnaire, marking 'no' to every question about symptoms other than 'Have you ever had difficulty getting fit-tested because of inability to smell?" The medical assistant sprayed saccharin at me, confirmed I could smell/taste it, and successfully fit-tested me. 

6. I got an email from the clinic manager saying that before I could _wear_ the N95 mask I had just been fit-tested for to see actual patients with actual COVID symptoms I would need to get signed off by the medical director, because bureaucracy.

7. This is the waking-up-as-a-cockroach part: the medical director, who is a doctor, declined to sign off on my using the N95 mask I had been fit-tested for because I had marked 'yes' in answer to the question re: smell above, and told me I needed to get signoff to use the mask from... a doctor. (At my own expense, they made a point of telling me).  Full disclosure: I am a doctor. I have no idea how I would evaluate someone's fitness to wear an N95 mask other than asking them if they'd passed their N95 fit test. I asked the medical director (a doctor whose job it is to provide other doctors with medical advice) this, and he has thus far declined to answer. 

9. I now have a telephone appointment with my own lovely doctor, to ask her to write a letter either clearing me (or not) to wear the N95 mask I have been fit-tested for. She is way smarter than I am, so if there is some other way of determining fitness to wear an N95 mask other than doing an N95 fit test, she may know about it, but am I cynical to think this is more about keeping lawyers happy than about keeping me or patients safe? Hmm. 

10. What I will likely ask my own lovely doctor to write (and what she will likely write): "Clearance given to wear N95 mask." What I want to ask her to write: "ARRRGHGHGHGHHGHGHGHGH what the FUCK this is a ridiculous farce if your own N95 fit testing procedure is not enough to guarantee someone's ability to wear an N95 mask, you shouldn't bother doing it; what the hell additional objective criteria is someone supposed to apply - over the phone, mind you - to determine this? I hereby grant permission for the patient to hide under a rock until the pandemic is over, at time-and-a-half pay." 

Note that this is the same institution that, back in April (remember April? widespread asymptomatic transmission, no tests, completely overwhelmed Public Health... eerily similar to December except for the test part...), was instructing providers to "rule out COVID-19 over the phone" and to refer anyone for whom we could not magically, telephonically and definitively rule out COVID to, yup, Public Health, that same Public Health not answering the phones or website inquiries because they were at max capacity just trying to figure out how to test people with both symptoms AND recent travel history to Wuhan. 

Can someone just make Atul Gawande God already?