my kids

It’s the Best Corniest Time of the Year: Our Love Affair with Christmas Romance TV Movies

The holiday season means gatherings, food and cheer. But it also means allowing ourselves to be “corny” (dictionary definition: predictable, clichéd, stereotyped). We see cars with antlers affixed to their hoods. People wearing santa or elf hats or bright and loud Christmas sweaters. Singing out loud to Ella or Bing, or even the undeniably grating “I Want a Hippopotamus for Christmas”. CORNY.

But starting last year, my family kicked it up a notch further during the holiday season. My daughter Sophia discovered the delirious corn-fest that is the Christmas Romance movie season (much of which can be found on the Hallmark channel ). It started innocently with The 12 Dates of Christmas: “Mom. You’ve GOT to watch this one”. We watched together (it is a fun holiday romance version of Groundhog Day) and had so much fun that one led to another and so on. And this year, the entire family has gotten into the act including husband Pat and 12 year old Theo. There is a lot of talking to the screen and eye rolling at the contrivances,and ultimately, a lot of  corny enjoyment.

If you have not yet had the pleasure of seeing one of these Christmas romances, I will try to summarize for you. The basic plot of most of the movies is that the protagonist (often a hard-charging young career woman) has “forgotten the true meaning of Christmas” and through some plot twists and turns,  has a “come to Jesus” moment (see what I did there? Christmas? Baby Jesus?) and turns his/her life around.

Some of the typical tried and true Christmas romance plot devices:

  • Having to spend Christmas in a small town filled with endearing characters. Typically these are delightful Midwestern villages that are contrasted with the heroine’s stark and empty life on one of the coasts. Kind of like Eva Gabor’s character in Green Acres, the heroine is initially a fish out of water, but the love and values of the small town grow on her as she spends the holidays there!
  • The hunky guy. In some of the variations, he lives in a small town, but don’t think he is some bumpkin! He is smart but laid back (sometimes having left a high power career behind), has some cool business (an inn perhaps) and helps the heroine to see the true meaning of Christmas. In some of these variations, the hunky guy contrasts with the guy the heroine is currently with–the WRONG guy, usually a fiancée who is inattentive, unsupportive and (GASP) not as cute or charming as the hunky guy. In other variations, the hunky guy IS the hard charger and the spunky heroine has to teach HIM the true meaning of Christmas (see Looks Like Christmas).
  • The elevator kiss. This is a classic, often used in the city versions of Christmas romances. The heroine and hunky guy (whom she may not have even met yet) are in an elevator together. The elevator jerks to a sudden stop which of COURSE throws them together, which of COURSE means they have to start making out. Elevator resumes functioning and the two of them find themselves smoothing out their clothes and hair, and then, thinking about THAT KISS for the rest of the movie. For the uninitiated, The Christmas Kiss is THE gateway elevator kiss movie.
  • If there is no elevator around to change someone’s life, a couple of other variations for “life changers” are: Santa or an angel granting a wish (like in Christmas at Cartwright’s), inheriting a time-consuming but ultimately wonderful family business (like in Christmas Land) or being knocked out (as a doctor, this is probably my least favorite plot twist because the reality of concussions is not usually so pretty).
  • The villainess. Often the boss of the heroine who is beautiful, smart and successful but brittle and superficial. A real Cruella (and unreformed hard charger), she even often steals or takes credit for the heroine’s hard work (e.g. plagiarizing her design sketches in A Christmas Kiss!). In some of the variations, the villainess is the girlfriend of the hunky guy. But after one elevator kiss with the heroine, the hunky guy starts to shift alliances!
  • The true meaning of Christmas. This is often the third main character in these movies. Likely for the broadest of appeal, “the reason for the season” (birth of Jesus) is rarely spoken of in these movies, so there tends to be a humanist message of love and family, e.g. people are more important than things, life is meaningless without loved ones to share it with and that taking time to celebrate with loved ones enriches our lives.

If all of this sounds very retro, it IS! These movies are often kind of mash ups—Scrooge meets Working Girl. As a life-long hard charger and feminist, what is funny is how much I enjoy them along with my feminist daughter.

Perhaps this is because, family is so important to us and we DO live in the Midwest. But more likely it is because it allows us some time to be corny and just suspend disbelief (and believe me, you need to do so with some of these plots) and escape from the day’s stressors.

It also been funny to see the progression of my engineer husband, who typically is more into science fiction, as he has blossomed from irritation to enjoyment to addiction. Last night for example, as he came in 10 minutes into “A December Bride”, he plopped down on the couch next to me and said, “Fill me in, what do we have here?”. And I got him up to speed quickly (“Hard charger. Left at the altar by her fiancée for her cousin who are now getting married. Now pouring herself into her job. Has to fake a new relationship so she can hold her head up high at the wedding. Meets new hunky guy…..”).

What can I say? It’s the best corniest time of the year!! Happy Holidays!

 

 

 

 

kales@umich.eduIt’s the Best Corniest Time of the Year: Our Love Affair with Christmas Romance TV Movies
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Zen and the Art of Buying a Winter Coat

Recently, it occurred to me that my 12 year old son Theo needed a new winter coat when he came home from school with a giant rip in the arm of his old one. He had no idea how this happened (typical). Given that Theo is now in middle school, it triggered visions of bullies from 1980’s movies laughing and pointing at “ripped coat boy”.

Prototypical 1980’s movie bully (why do they always look 30 years old?)

Could not let that happen. So, off we went to a local outdoorsy outfitter place for a new coat. Along for the ride was 16 year old Sophia whose eyes are activated to roll by anything Theo does about every 15 minutes.

We walked into the store and we were immediately aided by a helpfully helpful employee who saw it as his life’s mission to get this boy a new coat. Theo made a beeline for what looked like the parka that might have been worn by explorer Sir Edmund Hillary in the men’s section. “I LOVE IT. This one.” Mr. Helpful laughed a little uncomfortably. “Ha Ha. Yes, everyone loves to try that one on.”

Which I immediately took to mean that the Sir Edmund Hillary coat was something aspirational, not something to really buy, but nonetheless, I asked, “Out of curiosity, how much is it?”. Again a nervous laugh. “Six hundred and forty nine dollars”. I barked “Theo take that coat off right now before you rip a hole into it!” “But I LOVE IT”. I peeled the pricey coat off his squirming body and physically moved him to the sale section in the back.

No way Theo. When you are ready to climb Everest, we can talk about a $649 coat.

The next coat Theo saw looked like a junior version of the Sir Edmund Hillary coat (at a fraction of the cost). Giant fur hood. Puffy beyond belief. He put it on and looked like a mini-Michelin Man. Mr. Helpful noted to Theo “check out the built in face mask!”. SOLD. Theo had a new love. “Mom. This is THE COAT. This is the one I want”.

Sophia was not pleased. “Mom, he looks so chubby in that coat”. She used all of her cool teen powers to try to dissuade her brother. She went and found several others that she deemed “so much better”. “Look– this one is kind of retro” (as if Theo could care). She called her University of Michigan sister Tasia and persuaded her to stop studying for her Organic Chemistry test, and come to the store to join the “stop the puffy grey coat effort”.

Time slowed and we found ourselves in an immense dressing room surrounded by eight other coats and THE ONE. Mr. Helpful apologized. He had to go off shift, and so, with a sad smile, he transferred us to a colleague (Mr. Somewhat Helpful). I found myself in the middle of CoatGate, between two sisters (correct that Theo looked more fashionable in some of the alternatives) and Theo (who kept joyfully going back to THE ONE).

Finally, my husband was called (in the middle of his commute home from work. I am sure he was thrilled to mediate CoatGate as he fought rush hour traffic). He weighed in with a solemn but firm voice: “Let the boy have the coat he wants”.

Theo did a quick jig and asked Mr. Somewhat Helpful if he could “wear his coat out of the store”. Theo’s eyes lit up at the “yes”, and he was further delighted that he could donate his old coat to the bin next to the checkout.

Theo wearing THE COAT

Theo wearing THE COAT

In all, we had been there for more than two hours.

In the aftermath of CoatGate 2016, I found myself remembering another CoatGate, long ago. This one occurred in the 1980’s with my Greek grandmother Yia Yia Mina. I was dispatched by my mom to take Yia Yia to a department store, to “get her a new winter coat”. Easy, I thought, she’d pick one out and I’d be back home to hang out with my friends in no time.

Not so fast.

It turns out, while someone like Theo falls fast and hard for a coat, Yia Yia was one to play hard to get. It was already a bit of an uphill battle because she was so petite (under 4 feet 11). But she was also an extreme perfectionist. No coat was good enough.

“Eleni (my Greek name), this one has ugly buttons”. “Eleni, this one has a pocket that I don’t like”. “Eleni, I don’t like the way this one zips”. “Eleni, I would like this one if it had a different collar.” We were there for HOURS. Coats were ceremoniously brought out by hopeful saleswomen. And rejected. FINALLY, she found one she liked. But of course, it would have to be altered to fit her tiny frame AND she would change the buttons.

So, in a way, picking out a winter coat may be kind of a personality test.

Theo is a kid who is joyful and quirky. He dances to the beat of his own drummer whether people think it’s cool or not. He found the coat that met his needs, and would not be dissuaded come hell or high water.

My Yia Yia was definitely a perfectionist. She had high standards for others, but most of all for herself. As an immigrant, this is how she succeeded. But she was also a strong, powerful woman who felt good about herself. So, even in her old age (when many of her Greek female peers were wearing black from head to toe), she felt she was “worth it”, not settling for something that she didn’t feel comfortable in (no matter how many Xanax the saleswomen had to take).

My Yia Yia (aka the Greek General) at my wedding with my cousin Emily. I bet it took her about 12 hours to pick this lovely dress.

My Yia Yia (aka the Greek General) at my wedding with my cousin Emily. I bet it took her about 12 hours to pick this lovely dress.

Recently, I realized that after wearing the same winter coat for years, I was ready for a new one. And strangely enough, I found one quickly (like Theo) but it was also pretty perfect in terms of all of its features—best of all being very slimming on me!

Theo definitely likes it, and I’d like to think that Yia Yia would approve too.

 

kales@umich.eduZen and the Art of Buying a Winter Coat
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Bedazzling the Short Straw

Last spring, my 19 year old daughter Tasia called me about the house she and her group of 6 friends were renting for her next (sophomore) year. She had been really excited about the house (originally built in the 1880’s as a candy factory), because it was very close to campus as well as being beautiful–a cut above most of the rentals for students (which can be pretty run down) and yet, still in her budget.

Back to the call. “Hi mommy. Well, it turns out I drew the short straw. My room is in the basement.” We knew this was a possibility as each of the girls wanted their own room, and there were only 6 “upstairs” rooms, but my heart sunk. I got myself together and tried to sound positive. “OK. Well, you know us. We’ll make it great. Send me some pictures so I can see what we are dealing with.” When the pictures came, I felt even worse.

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BEFORE. Pictures I received from Tasia this past Spring that sunk my spirits.

 

Seriously, my darling daughter was going to be staying in this pit?

Over the summer, Tasia continued to be realistic about the space, expressing some wistfulness about not having drawn one of the nice rooms “upstairs”, but moving ahead methodically in thinking about how she could transform it. I decided to kick myself in the butt (metaphorically speaking) and align myself with her attitude. We arranged to get into the room early so that we could think about our transformation.

And there was a lot to transform.

  • While the room has beautiful windows, they came with window wells full of 3 foot high weeds.
  • An ugly pipe that ran through the room with a similarly ugly piece of old grey material attached to 1/3 of it that the landlord told her “not to move” (I have no idea).
  • A closet that while spacious, looked like a little cave.
  • An entrance from the laundry room that was so foreboding it gave me chills the first time I walked through it and I promptly named it “Jeffrey Dahmer’s basement” in my head.
  • Oh and did I mention that the day we first saw it over the summer, there was a little puddle of water in the closet?
BEFORE. Outside Tasia's room. Came complete with weeds and utility ladder.

BEFORE. Outside Tasia’s room. Came complete with weeds, old piece of gutter, and utility ladder.

We worked out butts off, looking for ideas on Pinterest and Etsy. We became regulars at our local amazing resale store Treasure Mart and hit up Matthei Gardens annual exotic plant sale for succulents. Tasia worked with the landlord on the closet water problem and a contractor found a little hole that chipmunks had made causing the leak and the problem was solved.

AFTER. Windows transformed with mums planted outside and sheer curtains.

AFTER. Windows transformed with mums planted outside and sheer curtains.

AFTER. Pipe covered with neutral burlap remnant and surplus Xmas lights.

AFTER. Pipe covered with neutral burlap remnant and surplus Xmas lights.

AFTER. Ugly pipe covered with neutral fabric and pretty lights.

AFTER. Desk area.

AFTER. Closet leak fixed. Carpet tiles added. Sheer hung.

AFTER. Closet leak fixed. Carpet tiles added. Sheer hung.

AFTER. Desk scored at Treasure Mart for $50. Brass hardware shined up and drawers painted grey.

AFTER. Desk scored at Treasure Mart for $50. Brass hardware shined up and drawers painted grey.

AFTER. French bulletin board recycled from Tasia's HS grad party with fabric and ribbon remnants.

AFTER. French bulletin board recycled from Tasia’s HS grad party with fabric and ribbon remnants.

AFTER. New reading area created with repainted $17 table from Treasure Mart, decals from Etsy and the one splurge, a new loveseat from Pottery Barn Teen. Also pictured 16 year old sister Sophia.

AFTER. New reading area created with repainted $17 table from Treasure Mart, decals from Etsy and the one splurge, a new loveseat from Pottery Barn Teen. Lamp and carpet from last year’s dorm room. Also pictured 16 year old sister Sophia and YiaYia Joyce in the mirror.

AFTER. Much less creepy post with covered pipes, carpet tiles, hung "curtains" (created with canvas drop cloths, metal pipes and flanges--thank you Pinterest and engineer husband!)

AFTER. Entrance to Tasia’s room. (Note: no “before” available as it was too terrifying). Much less creepy now with fabric-covered pipes, carpet tiles, screw in cheap drop light from Home Depot, hung “curtains” (created with canvas drop cloths, metal pipes and flanges–thank you Pinterest and engineer husband!)

The process ended up being transformative for the room, but it was also transformative for us. We talked about how life deals you surprises. You can sulk or you make the best the situation and go on. And sometimes with the right combination of effort and luck, it turns out even better than you had planned. This was one of those times.

Postscript: Tasia called yesterday. They are going to keep the house for next year. And rather than redrawing straws, she wants to keep her room. She loves it.

20160924_110218

Wall hanging from Tasia’s room (recycled from Sophia who no longer wanted it). Pretty apt, right?

kales@umich.eduBedazzling the Short Straw
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Kales/Gibson Family RV Vacation

 

We decided to go “Up North” this summer. For non-Michiganders, “Up North” is often used by downstaters to refer to anything north of where you live, and usually connotes going to a cottage by a beautiful lake (after fighting traffic on US 23 for several hours). But the more proper meaning of “Up North” is the Upper Peninsula of Michigan, affectionately known as the UP (pronounced “YOU PEE”, not “up”). Somehow in 20+ years of living in Michigan, Patrick and I had never been to the UP and we decided this was the summer. And an RV would be the mode of travel.

We rented from a national outfit as they had a 24 hour 1-800 number and I reasoned that this would protect us in the event of my greatest fear: a toilet breakdown. When we picked up our “unit”, we noted that the dusty and kind of deserted rental place had definitely seen better days. The dusty theme was continued in our RV which despite being a fairly nice unit, had been cleaned to the standards of an 11 year old boy (aka Theo who thought it was “awesome!!”). Needless to say, I stayed up till 1 AM the night before our trip vacuuming and Chlorox wiping the entire thing down.

Day 1.  The first thing we notice is how LOUD the RV is as we travel–like travelling in a large squeaky box. The second thing we notice (after Theo announces he has to pee 20 minutes down the road) is how nice it is to have a traveling toilet. Patrick: “Well, use the bathroom!”. Theo’s eyes light up like it is Christmas, and he runs to the potty. We drive all the way to the Mackinac Bridge and cross over into the UP (making the crossing even more meaningful by scaring the kids with the tale handed down through generations of Michigan families of “the Yugo that was blown off the bridge in the 80’s”). We drive into the RV park about 7 PM and note: 1) everyone is already “set up” (and by set up, I mean that they literally have front porches, chairs, hummingbird feeders, and name placards out proclaiming “George and Yvette’s Slice of Heaven”) and 2) everyone is staring at us. Then we remember that we are literally driving a 30 foot billboard for RV travel, and just own it, waving “yes, we are first timers, hi there”. We get to our spot only to find that there is a somewhat sketchy guy already in it. One of our “neighbors” ambles over to tell us that in his opinion, the sketchy guy is “squatting” in our space and that he will be happy to “back us up in getting him out of there”. We are not sure what our neighbor means by “back up”, but don’t want to find out, and tell him thanks, but we will handle it. After showing the sketchy guy our reservation, he leaves without too much fuss. We wish him well and he drives off. We sink into our first RV sleep.

Day 1. To the UP or bust.

Day 1. To the UP or bust.

 

Day 2. We get up early to go see the Sault Ste Marie Locks. Amazingly, our two teenage girls are completely uninterested. We discover another wonderful thing about RV travel. You can simply put any naysayer sleepyheads in the back of the RV and start driving. While at the Locks, Theo, Patrick and I meet an older man who had made a pilgrimage there because his father had died in the building of the locks in the 1940’s. He is tearful as he shows us pictures of his father, but says he felt like he had closed a loop for himself. Leaving the locks, we realize that we left all of Theo’s clothes back in Ann Arbor. Theo takes this news completely in stride and revels in his new wardrobe from the local Walmart. Next stop: Tahquemenon Falls. During the 45 minute traffic jam to get into the park, I make sandwiches for everyone while we wait (another plus of RV travel). The falls are lovely and the dog loves the chance to get out and walk and sniff at the multiple other dogs in the park. As we begin the long drive to our next campsite, Theo announces “the toilet is not flushing”. Let me say that again for emphasis. THE TOILET IS NOT FLUSHING. We pull over and Patrick discovers that the piece of the toilet that opens some valve is not working (Look. I am a psychiatrist, not an engineer, and that is how I understand it). In about ½ an hour, the RV is “starting to smell like an outhouse!” in Tasia’s words. Me: “No problem. I will call the 1-800 number!” Remember, this is why we rented from the national chain. After a half hour on hold, I connect with a nice but completely unhelpful lady who takes our info and says she’ll get back to us. An hour later, no call. I call back the 1-800 number, this time a little more shrill. I get a snarky guy who has been expertly schooled in the deadly art of passive aggressiveness; he tells me we’ll have to wait 2 days to “possibly” get a fix because “tomorrow is July 4th and nothing is open”. I go ballistic and ask for his manager, to which he coolly replies “I don’t have one”. To which I un-coolly reply, “you must work for someone!”. To which he snappily anwers, “Yes. I work for (large national company)”. Patrick and the kids talk me down after I hang up with steam coming out of my ears and bad words coming out of my mouth. In particular, Sophia makes a poignant speech about “not letting this setback ruin the trip”. I feel slightly moved by her speech and decide to try to go with the sentiment. We stop at a beautiful local beach. While the kids swim, Patrick figures out a stopgap fix for the toilet that at least stops the sewer smell (more later). I call nearby campgrounds, and find us a spot at a lovely place about an hour down the road. We pull in, fix dinner and call it a night.

Day 2. Us vs. the toilet

Day 2. Us vs. the toilet

Day 3. We wake up and Patrick schools us on the “new toilet deal”. For the squeamish, just skip the next few lines. For the rest of you, it involves gloving up your hand, reaching INTO the toilet bowl, pulling open the broken valve (through whatever you have “deposited”) and closing it manually. Good times. Tasia announces that she will not be going to the bathroom in the RV for the rest of the trip. We pack up and drive to the Keewenaw Peninsula (stopping for ginormous sweet rolls in L’Anse). Most everything is closed because it is the 4th of July. We have lunch by a beautiful beach near Baraga with a little lighthouse. We set off for the next campsite, whose name (Summer Breeze) has Patrick and I repeatedly and annoyingly singing the Seals and Crofts song for most of the rest of the day. By the time we make dinner (10 PM), most of the other RV’ers at Summer Breeze are sawing logs. Tasia decides she has “had it” with her parents’ poor organization skills and announces that she is planning Day #4. We say “go for it”. Patrick and the kids take the RV into Iron Mountain to see fireworks since it is July 4th. I am “there”, but sleeping in the back of the RV, completely wiped out. Patrick tells me later that while I was asleep and they were watching fireworks, Theo puts his arms around everyone and says dreamily “I love you guys”.

Day 3. Everything is closed, so go to the beach!

Day 3. Everything is closed, so go to the beach!

Day 4. AKA the day Tasia made. We head to a local waterfall (the small but cute Fumee Falls) and then to a local vintage store the “Wishing Well” in Iron Mountain. There, we meet the adorable owner Mr. Khouri (who continuously whistles, but somehow it doesn’t bother me as whistling usually does). He seems to specialize in turning found objects into art, and I buy one of his toolbox flowerboxes. Next on tap is some go-carting (Super fun. I enjoy trying to run Sophia off the road more than she enjoys me doing it) and mini golf (Sophia who doesn’t want to keep score, somehow starts keeping score once she begins to do well). Then, a cool dip in the Summer Breeze pool. We finish with a lovely dinner at a local Italian restaurant. Well played Tasia. Well played.

Day 4. The day Tasia took over.

Day 4. The day Tasia took over.

Day 5. We set off for Pictured Rocks. On the way, we stop at what we have now dubbed perhaps the greatest roadside attraction ever (and we have seen MANY on various road trips), the Iron Mine. A trip deep into the mine that is educational, kitschy (a MUST for roadside attractions in our family) and fun. Delicious pasties (a UP delicacy that typically contain meat, potatoes, and root vegetables) for lunch in Escanaba. We make it to Pictured Rocks. Sadly, Patrick has a dream that will not come true–to kayak in Pictured Rocks. As usual, we have arrived too late. [An aside: when you travel in an RV, there is a gap in the space-time continuum. Any distance that should take an hour will end up taking somewhere between 2 to 15 hours more. Not even kidding.] Back to Pat’s dream. We find out that to do that kayaking thing you would have to spend something like 8 hours doing it. Which (thank God) we don’t have. Patrick pouts while the rest of the family heaves a GIANT sigh of relief. We set out on one of the more touristy boat tours of Pictured Rocks as I pop 2 Dramamine to make the boat ride tolerable. The site is truly beautiful (and made even sweeter by the fact that I win a picture book of Pictured Rocks at the end of the boat ride! I LOVE winning!) The family decides to order pizza for dinner and take it back to the RV park.

Day 5. Pictured Rocks and more.

Day 5. Pictured Rocks and more.

Day 6. We begin the long ride back to Ann Arbor. Likely reflecting his mood at the time, Patrick puts on the Gordon Lightfoot classic “The Wreck of the Edmund Fitzgerald” as we drive and demands silence for the duration of the song. We spend some time contemplating the trip. I ask the group, “would we do this again?”:

Patrick: Maybe. But it will be awhile.

Sophia: Not likely.

Tasia: I doubt it. But I do love this family.

Theo: YEAH! As long as the toilet works!

Not able to ask Sasha, but my guess is for her part, yes. She pretty much owned this couch during the journey:

Sasha in her favorite trip spot.

As for me, I would do it again. Probably differently, and with more knowledge. And a fully operational toilet. But I would do it again.

kales@umich.eduKales/Gibson Family RV Vacation
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The Power of “I don’t know”

My team and I recently had the privilege of attending a course on “Lean” management in healthcare. In a nutshell, Lean is the idea of making work processes visible and understandable, digging deep to find the root causes of problems, making incremental changes to the processes, and then evaluating the effect on the results. Note that I didn’t say “jump to a solution”. We admit that WE DON’T KNOW WHY something is happening. Sounds simple, but it is deceptively hard.

Three examples:

Example One: During our Lean training, our course leaders craftily immersed us in a “Lego Emergency Room” simulation for the first two days. My team was “Team 4”. Team 4 had 8 people who were assigned a job (e.g. registration clerk, triage nurse orderly, ER doc, lab tech, etc). Our overall goal was to get 15 lego patients thru an ER process at different sites (tables).

DSC05382s2Our first run was a spectacular failure. Broken Lego patients, a long waiting room line and loss of money. We only got 1 patient through the process intact. The facilitator came to our group and in debriefing asked us what we thought we needed. “More doctors!!” we cried! “It’s obvious that doctors are the rate-limiting step!”.

However, over the next day as we dug deeper into understanding the process, mapping it and looking at root causes, we discovered that counter to our strongly held biases and assumptions, the rate limiting step (bottleneck) was actually…..CLEAN ROOMS! Meaning our ability to efficiently and effectively evaluate and treat patients in our ER was limited not by our single doctor and his/her speed, but in our ability to have a clean room ready to receive a patient.

Long story short, we eventually caught on and fixed it and we began to transform our ER. A real AHA moment and we couldn’t have had it until we put aside our assumptions and admitted we DIDN’T KNOW why our Lego ER was a mess.

 

Example Two: A big part of my job right now is teaching doctors, other healthcare providers and family caregivers to say I DON’T KNOW when it comes to behavioral symptoms of dementia (agitation, anxiety, wandering, inappropriate behaviors, etc). Many of these folks will see a behavior like agitation and prescribe (if they are a doctor) or ask a doctor (if they are not one) to prescribe a medication. That’s where unlearning this assumption (difficult behavior=need for medication) comes into play. Just like in our ER simulation where we thought the answer was more docs and it turned out to be clean rooms, often the “answer” to a behavior like agitation is found not in a medication, but in figuring out the root cause of the behavior: a urinary tract infection, boredom, an overstimulating environment, etc. But before we can figure out the root cause, we have to convince doctors and others that they need to admit that they DON’T KNOW why a behavior is occurring and start brainstorming the possible causes. In many cases, if we assume any behavior is a “medication deficit”, we miss understanding the actual cause and being able to correct it.

i-dont-know

Example Three: This one is personal. Eleven years ago, my son Theo was born. He was born two weeks early (a scheduled C-section, since I had 2 “failed” vaginal births with my girls). To our surprise and terror, Theo “went blue” shortly after delivery, just after we had arrived in our room. He was whisked out of my arms into the Neonatal ICU. There, he spent two weeks where they tried to figure out why he had apneas AND a club foot with zillions of tests including brain scanning. All negative. This one is harder, because despite a lot of effort, unlike in the Lego ER, the team couldn’t find a root cause. So, one doctor (who will forever live in infamy in our memories) told us that Theo probably had some type of neurological syndrome (he wanted to tie together the apneas and club foot) and would likely have developmental problems, but “not to worry” because “there are special schools for those children”. We were of course, devastated. About a week later, our wonderful regular pediatrician appeared at Theo’s bedside. She looked us in the eyes and said “We don’t know why Theo is having apneas. Another possibility is that he needed more time in utero. Instead of 34 weeks, maybe he needed 38 to fully develop. The club foot may be unrelated. But the bottom line is that Theo will tell us what he needs and we will follow his development and go from there”.

The breathing issues resolved within the next month and Theo thrived and developed. As with any child, there have been bumps along the road (he will never be a track star because of his corrected club foot), but the bottom line (eleven years later): Theo just “graduated” from fifth grade with A’s in most of his subjects. He is a little engineer who can take the most complex lego set and build it in an hour. During the past 11 years, at times, it’s been hard for me because the words the neonatologist uttered have been imprinted at the back of my mind. I have had to watch Theo’s lovely mind and personality unfold NOT knowing automatically that all would be ok.

My beautiful boy.

My beautiful boy.

But in the end, isn’t that true for all of our lives? We never really have any full reassurance it will “be ok”. We have to go about our daily existence not fully knowing and dealing with whatever we are dealt.

Despite these experiences, sometimes, it’s still can be really hard to say I DON’T KNOW. Especially for a doctor. I have to stop myself all the time. We are expected to have all the answers. But often it is the best first step. And often, like our amazing pediatrician,  the best gift you can give a patient or family is to say, “I am not sure. Let’s figure this out together.”

 

 

kales@umich.eduThe Power of “I don’t know”
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