ditching comfort zones

No sex talk please, Mom, I’m your middle aged daughter.

November 11, 2019 kales@umich.edu being a doctor, ditching comfort zones, family, geriatric psychiatry, my mom

The title of my sex talk was a play on the 1970’s movie “No Sex Please. We’re British”.

I was asked to give the talk 6 months ago, while I was still in Michigan. Like most “asks” so far ahead of time, it seemed like a fine idea. I was sure that by November, I would be comfortably ensconced in my new role at UC Davis. The talk would be a great way to become known among geriatric mental health providers in my new community of Sacramento.

The topic of the talk was definitely a departure from my usual repertoire which is the assessment and treatment of later-life depression or managing the behavioral symptoms of dementia. In fact, it scared me a little: sex and the aging adult.

But it was 6 months away, and so I avoided thinking about it for many months. I grew really busy with my new job as Chair. As the time grew nearer, the social worker coordinating details of the conference would ping me. “What is the title?” Several weeks later—”please give us a 3 sentence outline”. Then 2 weeks before the talk-“please send us your slides”.

Unlike many academics, I have had the amazing fortune to have two psychiatric experts close at hand my whole life; my father is Anthony Kales MD, one of the founders of sleep disorders medicine, and my mom is Joyce D. Kales MD, who devoted a significant part of her career to sex therapy. So, my “phone a friend” for my ‘sex talk’ was….my Mom.

My gorgeous mom in the 1970’s.

My mom was delighted about the talk! “I will send you an outline of my thoughts!”. Because of her trip to Boston to visit my brother and his family, my Mom’s outline didn’t arrive until I had already mostly prepared the talk, but it was uncanny how at the age of 85, my mom is still on top of this field. Her outline closely mirrored the content I had researched myself.

Funny how the topic and discussions with my mom prior to the day of the talk promoted an exploration of my own personal history with the topic. I recall going to my mom’s office as a prepubescent kid when I was sick (remember I had 2 working parents unless my YiaYia was with us at the time). In my mom’s office, there was a large bookshelf filled with books about sex. As you could imagine, I would sometimes help myself to her ‘lending library’ when she left the room. One of the books, the classic 1970’s Masters and Johnson, left me a little agape from the drawings of “hippies doing it” that I found in its pages.

The traumatizing text.

Later when I was a teenager, like many kids of working age, I worked in the ‘family business’. But unlike my friends working in local shops or restaurants or at Hersheypark, my first job was coding data on a study that looked at differentiating psychological from primary impotency. One of the big clues was the measurement of nocturnal penile tumescence or NPT (e.g. if a guy can get erect while asleep, the impotence with his partner is likely psychological). Yup. While my friends were flipping burgers or running rides, I was learning about NPT. Not your typical summer fare at 16.

My parents being so open likely made me a little more closed when talking about sex. When I eventually went into geriatric psychiatry, I would joke, “I went into this field so that I DON’T have to talk about sex”. But of course, that proved to be untrue. My patients would bring up sex regularly in my appointments with them, and so, I had to get comfortable with it.

During the weeks leading up to the talk, my mom called me with many various tips. One day she noted, “sometimes older women retain their androgen drive and find younger partners to satisfy themselves”. Um, thanks Mom. Another day, “AARP has a full-page ad this month for a video on sexual positions that older adults can try if they have physical limitations.” Gulp. Awesome.

My talk Friday was a big success. The Q and A period went on for more than half an hour after the talk. As I told stories about my lovely mother with affection and humor, she became an unseen but charming character in the narrative. So much so, that when I finished, the conference organizer joked, “Your mom just called and said you did an incredible job.” Thanks Mom. Like mother, like daughter.

Clash of the Turkeys

August 31, 2019 kales@umich.edu ditching comfort zones, leading

Since my last blogpost, we have made a lot of changes. In June, the whole family including Patrick and myself, the three “kids” (the girls are 22 and 19, but still) and our 2 dogs moved to California. I started a new job as Chair of Psychiatry at University of California Davis. We have a new house that came complete with a feral cat from the last owners. Our new cat, whom we have named Muffin, comes as regular as clockwork to the porch at 6 pm. He waits for his dinner, and then hangs out for another hour or so, luxuriating on the warm bricks.

As scheduled as Muffin’s dinnertime, we also have a group of 10-15 wild turkeys that saunter through the neighborhood in the morning, and then, again in the evening, in 12 hour cycle. Early yesterday morning, I went out to given Muffin some fresh filtered cool water (only the best for my feral cat) and saw something different going on with these birds.

Most of the turkeys were ambling around our neighbor’s lawn like usual, but two of them were off to the side fighting. Not a little skirmish, but a prolonged battle, pecking the hell out of each other’s faces and necks. Every few minutes, one turkey would wrap his neck around the other’s and try to take him down. Like Turkey Wrestlemania.

At first, I found it funny and Instagrammed a boomerang video making up a caption about the turkey version of West Side Story’s Jets and Sharks. But when it didn’t stop after 10 minutes, I started to find it disturbing and stood in the middle of the street telling them to cut it out. Finding that ineffectual (they didn’t even look up), I ran back to the porch and got the garden hose out to try to separate them. Sadly, my hose stream didn’t reach across the street to stop the pummeling poultry.

Next, I ran into the house to wake up the only other person there, 19 year old Sophia. She was fast asleep because her college class didn’t start until later. I yelled “Wake up! I need your help with 2 turkeys who are fighting!” She just blinked at me, seemingly not comprehending what I was saying. Concerned that she was missing the gravity of the situation, I just kept repeating my plea louder and more slowly, to which she replied “Isn’t there someone more responsible than me at home?” I told her no, that Patrick was dropping Theo off at school, and I needed her help asap before there was turkey blood on my hands.

Sophia stumbled outside, blinking in the sunlight like a hibernating bear who had been disturbed. I turned back to her and cried “Sophia! Google ‘how do you separate 2 turkeys who are fighting?’!” She took one look at the scene and said in her inimitable deadpan “Just let them work it out”, and went back into the house to climb back into bed.

A minute later, Patrick drove up. He had the gall to tell me with the absolutely fascinated voice of someone who grew up watching Mutual of Omaha’s Wild Kingdom, “Did you see those two turkeys fighting for dominance?”. I recounted all my efforts to stop the fracas, and he laughed so hard that I thought he would pee his pants. He gave me a comforting hug and said: “This is normal turkey behavior. They HAVE to do this to establish order in the group. Once they are done, they will just go on to their business as usual. No turkey is going to die.”[To give you a feel for Patrick’s incredible fund of wildlife knowledge, he informed me (kind of haughtily I must say) on reading this blogpost that a group of turkeys is called a “rafter”. Eye roll.]

It hit me pretty quickly that he was right. While it took about another hour, eventually the two turkeys did just move on. I thought about the turkey throw down the whole way to work, and how uncomfortable I was with their conflict. Ironically, a lot of my new job is about handling conflict. Like the wild turkeys, after 20 years in academia, conflict is just an everyday occurrence, and getting through it is part and parcel of my day.

Turkey détente established

With my faculty, I sometimes perceive that they feel avoidant of conflict. Because I am the new Chair, conflict avoidance might occur because they fear getting on “my bad side” too soon. Maybe they don’t get out a “hose” to make it stop (totally ridiculous, I admit it now), but they might try to dodge it at all costs. Rather, I want faculty to know that they can disagree with me and I don’t view it as a bad thing. An exchange of ideas will ultimately help me to make better decisions. Leaders should welcome opposing views rather than find them a threat.

In conflicts of other kinds such as with colleagues in other Departments, there may be a fear of being unlikeable, or being perceived as disagreeable (or a “bitch” if one is a woman). It could also be the worry about hurting or losing a collegial relationship. In truth, good people can disagree about an issue and still have a good relationship. I stopped worrying about being universally liked a long time ago. As an aside, I will say it was a pleasant surprise when another Chair told me in a meeting this week that I was “a breath of fresh air” (maybe because I am used to thinking of myself as “100% that bitch” to paraphrase Lizzo). Of course, the other Chair and I have not been in conflict yet, so the phrase he uses to describe me might change if a conflict arises.

Conflict drives compromise. On one occasion this week, a faculty member and I disagreed and later, we each independently emailed each other that in thinking about it more, we agreed with some of what the other had said. Conflict resolution is a process; Sometimes for the sake of expedience, we might try to resolve conflict prematurely, but if we have the luxury of a bit of time, giving each person the time to process the conversation and think about alternative views brings better results.

To be fair, in a departure from our battling turkeys, managing conflict should never be about mistreatment, aggression, raised voices, insults/making things personal or shows of dominance. Rather, it should be in the context of being present (ideally in person) and listening to others’ points. Conflict over email rarely goes well.

So, yes, I was a bit ridiculous yesterday in handling the neighborhood turkey clash, but in the end, as one of my med school lab partners always said, “at least it makes a good story”. And my kids will have another great “mom story” to pass on to their kids.

Running down a dream

November 18, 2018 kales@umich.edu being a doctor, ditching comfort zones, family, life events

It was a beautiful day, the sun beat down
I had the radio on, I was drivin’
Trees went by, me and Del were singin’ little Runaway
I was flyin’

Yeah runnin’ down a dream
That never would come to me
Workin’ on a mystery, goin’ wherever it leads
Runnin’ down a dream

–Runnin’ down a dream, Tom Petty and the Heartbreakers

I love Tom Petty’s music. He was an excellent musician who did his job really well without a lot of fanfare or bs. I had always intended to see Petty in concert and when he died last year, it became one of those life’s missed opportunities.

A few weeks after Petty’s death last year, I traveled to Palm Springs with Patrick to give a keynote talk at a psychiatry conference. Waiting for a connecting flight I ran into someone who had been a mentor to me when I was a resident. As we sat in the small dated airport waiting area, she urged me to think about using my time and talents for leadership, particularly given the dearth of women in those roles in Psychiatry. She noted that while I was achieving a lot in my research area and with my mentees, I was not using what she felt were my talents to create a shared vision, motivating and leading others forward on a large enough scale.

During that trip, Patrick and I traversed the gorgeous desert landscapes in our rented convertible. We blasted the stereo and sang at the top of our lungs with the sun and wind in our faces. One song we played was Petty’s “Running Down a Dream”. I found myself thinking more about my life and career and whether I would indeed ever “run down the dream” of leadership or whether I would stay in my lane within my current comfortable life and research career. No doubt I work very hard, but the idea of stagnation began to haunt me. Being in the desert, the vision of a wild horse running contrasted with a pony on a child’s carousel ride, going in a familiar circle over and over.

Returning back to Michigan, it was easy to settle back into my routine. I put the Palm Springs conversations aside and “rode in my familiar circle”.

Then in January, I got an intriguing email.

It was about the Chair of Psychiatry position at University of California Davis. As I read the description, I was intrigued. I thought of something my father and greatest mentor (Dr Anthony Kales) said to me a couple of years ago. My Dad was the founding Chair of Psychiatry at Pennsylvania State University at the unbelievably early age of 38. He was a wunderkind and someone whose accomplishments in sleep research as well as vision and mentorship as a Chair cannot be overstated. My father said “I can see you becoming a Chair someday, but you should only do it with the right Department”. I had received a lot of feelers about Chair positions over the years. This one stood out. This Department seemed special. I needed to know more.

My Dad as a young Chair.

I had my first interview (vis Skype) for the job in February which had the potential to start in ignominy. Shortly before the interview, I realized the desktop computer in my office did not have a camera. Panic set in and I ran down the hall to one of my staff’s offices to grab a laptop (and of course, I couldn’t tell her why I needed it). I had a bit of a flop sweat going by the time I connected to the interview.

How I felt at the beginning of the interview.

But I rose to the occasion, facing the entire search committee as I was peppered by a myriad of different questions.

I managed to pull myself together like Elastagirl after being worked over by Edna Mode in the Incredibles.

Overall, I thought it went well but a week later when I debriefed with someone from the search firm, I became concerned by what seemed like a fast timeline. With a family of five including a husband with his own career, one daughter in college, another graduating from high school and a son in middle school, there was no way I could contemplate moving within a few months.

Luckily, I connected with one of the leads on the search committee a few weeks later. I have since come to know her as an amazing person and researcher who also manages to be warm and down to earth. She called me from an airport back East where she had been visiting a family member (that immediately won points with me too). She reassured me that the process could take up to a year which would give me time to get my familial “ducks in a row”. She also urged me to come out to campus and see what they had to offer.

I went out on the first visit to Davis in the late spring, in my mind 75/25 (staying/going). I spent 2 intense days on the medical campus. Meeting a jillion people. And yet as I went back to my hotel room, I felt exhilarated by the possibilities of this position. A much more diverse area and patient population. Really interesting clinical settings in public psychiatry. Huge opportunities for research growth and collaboration. I called my husband from the hotel. “I really like it here”.

UC Davis Medical Campus (located in Sacramento)

Still, I struggled. My husband. My kids. My parents. My comfortable life. I thought of something one of the nursing faculty (a transplant from the Midwest) said to me about her own decision to come to Davis “We woke up to the ice and snow one morning and my husband and I said to each other ‘Are we really going to live here the rest of our lives?’”. That statement kept ringing in my ears. I could keep doing what I was doing for the next 10-15 years. But what if I did something different?

I came back for a second visit in July with my family. My husband liked the area and was undaunted by the over 100 degree heat during the day saying “It’s just like in Idaho” where he lived as a kid and where much of his extended family lives now. He also loved that he would be closer to his family and felt ready for a change job-wise. The proximity to Lake Tahoe, San Francisco, Napa and Yosemite didn’t hurt. The family took a side trip to Lake Tahoe while I was interviewing and loved it. As for me, the 2nd visit only reinforced the idea that this was the “right department”, a Department I could see myself leading and loving. My son Theo announced that he was “fine” with moving “as long as we get a pool”.

Not Theo, but the spirit of exuberance would be the same.

The girls were initially more equivocal but came around to seeing a move as having potential merits.

As for me, I resolved the concern about leaving my sole focus on geriatric mental health and positive aging by concluding that I could make growing positive aging at Davis a part of my vision for the Department.

Fast forward 7 months and we are going for it. The family will be moving to California in June and I will be starting my new job in July. Running down the dream indeed. We will definitely be working on the mystery of our new futures and going where it leads like those wild horses. Please wish us luck!

The picture I sent to the Dean with my signed offer letter. I reasoned they might as well see the kind of gal they are getting.

Put away your tickbooks! Post cards from London, part III (final)

July 24, 2017 kales@umich.edu activity, being a doctor, dementia, ditching comfort zones, family, my kids

I have been thinking this week of Professor Peterec. He was one of the best professors I had at Bucknell University. He taught political geography with a larger than life presence. Almost live theater. His class was stellar and eye opening for 20 year old college kids. One of the things I remember most from that class was him talking derisively about “tick book travel”. Basically, this is traveling to another place with your list of things to see (your “tick book”), hurtling from one sight to another and checking them off as you go. In doing so, you are little changed as your interactions with true local culture are minimized. I have thought a lot about this over the years and tried to fight the impulse to merely check off sights in my tick book. Of course, to some extent, I still have one; on our first trip to London we made sure to see Big Ben, Buckingham Palace, etc. But I have tried to push myself to go beyond this “ticking”. This has been made easier by being raised by a father who tended to befriend everyone we met when we traveled as a family, whether in Athens or Warsaw or wherever. I am not quite at Tony Kales level yet, but my kids do laugh (as I did when I was their age at my dad) at my need “to talk to everyone!”.

As mentioned in Part I, we have stayed in a different part of London this trip. While the East End is definitely “hip” with lots of pockets of restaurants and trendy shops, it is also very diverse both culturally and in terms of class. Our building, Adelaide Wharf, is surrounded by what the British call council estates or public housing. It has been delightful to see the children marching off to school this week (their summer break is only 6 weeks) in their matching uniforms walking by the flat. Adelaide Wharf itself is a really interesting building and won awards for its design; it includes both privately sold and “socially rented” apartments and contains a large internal garden and play area.

I have loved walking the surrounding streets and seeing the murals on the buildings. Very different from West London.

And of course, the other thing that is quite non-tick book about this trip is the working nature of it.

The rest of the week at the conference has gone very well. My poster was presented on Wednesday. It was kind of hilarious to see what happens to posters if they are left behind. Poster graveyard.

That evening, Tasia and I traveled to Soho to meet the son of one of my best friends from residency. He is getting his PhD in the UK and his girlfriend is attending medical school in London. We had a delightful dinner at Cinnamon Bazaar and particularly enjoyed comparing notes on British vs. UK humor. And also, getting the important question answered of why there are two toilet buttons in the UK.

On Thursday, we had the big unveiling of a report issued by an international dementia care commission that I was privileged to serve on. Two colleagues from the UK and I gave commentary about the impact of the panel to a crowd of about 150 people. You can read the gist of my comments here. The report has been widely picked up internationally including in the US which is very gratifying. To see a group of international experts come together and get something truly relevant done has been a great process. So very “chuffed” about this as they say in the UK.

That night we celebrated with a dinner in the Covent Garden area at Café Murano and also toasted to a new grant that my team will be participating in. We made plans to meet at the conference that is being held in Chicago next year as well as for two of the colleagues to visit Ann Arbor.

Tasia finished up her week at the National Health Service on Friday afternoon. She has had an amazing experience going to many different types of sites. One of her favorite parts of the week has been the home visits; seeing people in their own homes adds an important part of the picture that we clinic doctors often do not see.

We headed off for a last day adventure, starting off to Palm Vaults, a café and coffee place recommended to us by our waitress at El Ganso several nights earlier (whom we had befriended when we told her we were going to ‘steal’ the 1/2 consumed bottle of sparkling water and she termed us “naughty Americans”).

Next stop was the Hackney City Farm where, missing our 2 dogs like crazy, we got in our fix of adorable animals. We never saw the “inquisitive goose” mentioned in the picture below but the description gave us a laugh.

That evening we decided to go to the West End to see a play and chose “An American in Paris“. It was lovely with exhilarating choreography, striking sets and Gershwin music. A perfect ending to a great trip with its themes of living as an American in another city. Goodbye to London for now!

Postcards from London 2017- Part II

July 19, 2017 kales@umich.edu activity, being a doctor, ditching comfort zones, family, my kids

Monday was a working from “home” day for me. I worked all day from the flat while Tasia went off to her National Health Service clinical observations. Two things about that:

It surprises me how quickly a place becomes “home” if I am comfortable. I love this flat. I love the street noise that lulls me to sleep with my open window. I love making myself a cup of strong French press coffee in the morning. I love looking at the flowers we bought at the Columbia Market. Lots of work got done including my prepared remarks for a Thursday press conference at the meeting.

Work from home Monday messy casual.

Tasia had loads of interesting experiences at NHS on day one, but the one that cracked me up the most was one of the doctors asking her “Are you in a sorority?” (No.) And then “Are American sororities like what you see in the movies?” She said the room fell silent as she gave her answer and everyone turned to her with rapt attention.

Once back, Tasia and I walked to Shoreditch and went to The Grocery, a sort of smallish Whole Foods-type store where we bought the makings for sandwiches and some pre-made soups. Some blush wine on the deck was a perfect ending to the evening.

On Tuesday, I met a colleague and collaborator in Canary Wharf. This is a really new, modern part of London. You really don’t feel like you are in London there. It is all skyscrapers and business-types bustling off to their jobs. He and I played a round of what felt like hide and go seek to find each other as it turned out his saying “meet me at the Canada Square exit of the Jubilee line” was too vague. Turns out there are about 4 exits and we were at different ones. We eventually found each other after 1/2 an hour via a combination of phone calls (though it was really hard to hear each other with all the street noise), texts and pictures of where we were standing.

Waiting on a friend in Canary Wharf.

We walked a short ways over to West India Quay where we had a lovely lunch meeting at Browns in a converted warehouse area, and discussed our collaborations including a paper we are working on and a possible grant.

After our meeting, he suggested that I head over to the Docklands Museum in a way that is adorably British: “there is a brilliant exhibit on things they have found while excavating for the new Crossrail like people’s skulls and bones”. This turned out to be a great suggestion as this free museum was awesome. The exhibit on the excavations for the new trainline was truly “brilliant” with vivid displays of finds from the Roman (coins, bones), Medieval (Black Death burial grounds) and Victorian periods (lotsa china and goblets). Other features of the museum include a sobering exhibit on the British role in the slave trade as well as a lively exhibit on the evolution of the Docklands including a simulation of walking thru the Docks in the 1800’s and the role the Docklands played in WWII. I had a funny conversation with one of the staff who asked me where I was from and hearing Michigan, responded “Is that what they called ‘flyover country’? I heard that in a Jason Aldean song”. LOL.

Loads of skulls and bones as promised.

This cracked me up for some reason.

Back to the flat, where I met Tasia and we headed off to the Old Spitalfields Market area for some shopping where we found a shop called Gandys that we loved.

Then to fabulous bar called Dirty Bones for some cocktails. My Lavender Martini was sublime (topped with a flaming spring of Lavender. C’mon!) and Tasia enjoyed something called “the littlest Hobo” (cute, right?).

I will dream of this drink for years to come.

We headed back towards the flat for dinner at a local wonderful tapas place called El Ganso where we were so close to the other diners that we could have eaten off their plates. At one point, the diners from the restaurant to the left asked us what we were eating so that they might try it another day!

Three random observations from the past two days:

On this trip we have been Uber-ing all over as the area we are staying is not so proximal to the Tube. I have been amazed at the diversity of the drivers; in three days, have been driven by people from Somalia, Romania, Poland, and Pakistan to name a few. The driver from Pakistan and I had a long conversation and he told me how ideal Uber is for him to make a living wage (he now owns his own home and is very “house proud” as they say here) and have the flexibility for his family of three small boys and a wife who is training to be a social worker. He noted that there is no discrimination on Uber (as there might be for more traditional British jobs) as the rides are determined by computer algorithm. So, while I know people feel mixed at times about Uber, I thought this was really interesting.

I love love love British slang and have my ears pricked up at all times for new words. “Brilliant” for anything good is ubiquitous and known from past trips and my collaborators. New faves include: “lazy bint” (slothful be-yotch), “silly slag” (dumb coarse woman) and “drunk punter” (drunk/bad customer).

As stated, I am in love with the flat, but I am in hate with the lip on the shower. I cannot stop tripping on it and stubbed my toe so hard, it felt like it was broken. I might be a silly slag with regard to this part of the apartment.

It’s me vs. this lip. Every. Damn. Day.

Cheers for now!

Me and Tasia with her ‘littlest hobo’.

Postcards from London 2017-Part I

July 17, 2017 kales@umich.edu activity, being a doctor, dementia, ditching comfort zones, family, geriatric psychiatry, my kids

We left for London on Friday night. This trip, it is my older daughter Tasia and I. For me, a week in London at the Alzheimer’s Association International Conference, as well as meeting with London collaborators on dementia research. For Tasia, a pre-med student, the opportunity to shadow doctors at the National Health Service. On our fourth trip to London, we decided to stay in hip East London to experience a different part of the City. The specific area (Shoreditch/Hackney) has been compared to Brooklyn and the Meatpacking district of NYC. So, pretty different than the places we have stayed before in the West End. Also, having “done” the usual sites (Big Ben, Parliament, Buckingham Palace, etc) on prior trips, we wanted experience something a little more local.

The trip started pretty auspiciously. We had time for a quick snack at PF Changs in the airport and got these promising fortunes.

On the flight, we settled in Delta Economy Comfort with that little bit extra of legroom. However, despite sleep masks and good intentions, neither of us seemed able to doze off for more than 15 minutes at a stretch. Arriving in London at 6:25 AM, we guessed that both of us had had a total of 3 hours of intermittent sleep.

We stumbled thru customs and got in touch with Tasia’s friend and University of Michigan housemate Abby. Abby has been traveling all over Europe this summer and arranged to meet us in London for 2 days. We found a “Hotel Hoppa” bus (the name of which in our sleep-deprived state gave us the giggles as we repeated it to ourselves) to take us to Abby’s hotel. The bus must have stopped at five hotels before we got to Abby’s and we amused ourselves by crabbing to each other about everything and everybody on the bus. Once there, calls were made to the management of the flat where we would be staying. We were dismayed to find we couldn’t get in until 2:30 PM. Now the task was to stay awake, upright, and sane until then.

We dragged our suitcases to the East End where the company offices were and ditched them there. We then headed off to the BOXPARK shopping area of Shoreditch (a popup mall made out of shipping containers) and wandered around. While ordinarily I would have been thrilled by such a jaunt, I found myself tired and completely irritable. Tasia recalls saying at one point, “Look at that dog!” To which I nonsensically but crabbily replied, “Oh great. Here we go.”

Realizing I had “had it”, I retired to a coffee shop to read email while the girls continued on. We stopped for lunch at Dishoom which we had discovered on the last trip. Dishoom is said to be modeled after the old Irani cafes of Bombay, and has delicious Indian food in a vintage comfortable atmosphere. We sunk into a booth and lunched on Samosas, Ruby chicken (think chicken makhani) and Dishoom’s version of calamari. Feeling slightly better, we realized it was time to go get our suitcases and Uber-ed over to our home for the week.

Sadly, the 2:30 time came and went, and we were still standing outside the building. At this point, I could barely stand up. I tried to sit on my suitcase, and somehow fell over, which cracked the girls up. The building manager saw us and after seeing our paperwork, let us into the lobby to wait. There, to Tasia’s chagrin, I laid down on the couch.

My rest was shortlived as I realized that my phone was dead and I couldn’t reach the flat manager. I found a plug behind a desk and briefly charged my phone to call her. A woman with a baby carriage waiting for the elevator suddenly confronted me “Are you charging your phone? You know, that is electricity we all pay for!”. Dumbfounded and beyond grouchy, I somehow calmly but sarcastically stated “Seriously? I am charging for a few minutes to make an urgent call. But thank you SO much for your concern.” She slunk away and the girls dissolved into laughter. In a Seinfeld George Costanza moment, I realized the only thing that would have made that retort more perfect would have been to bestow a pound on her for the electricity I was using for that minute.

Finally, a woman came down and led us into the flat. Totally worth it. I will let a few pictures tell that story.

Loving the chandeliers.

It only took me an hour to figure out how to turn on the stove.

View of Regent’s Canal from the living room window.

The girls went out for Italian while I headed to the local Tesco for the basics including coffee and single cream (there is no “half and half” in the UK, half cream is hard to find, so I get the same effect by using single cream and watering it down in my coffee). I also purchased a new battery for the smoke detector that was constantly chirping, and was thrilled that I was able to change it myself (usually such tasks are reserved for my engineer husband).

Look at me! Fixing something!

After a shower and some Cheerios, I began to feel a little more normal. I sat on the deck overlooking the bustling street and enjoyed the sunset.

After a wonderful sleep, we woke up on Sunday and headed for the Columbia Road Flower Market, a short walk from the flat. Every Sunday, this street is transformed into a garden of flowers and foliage. Walking toward the market you see people carrying everything from bouquets of roses to giant rubber plants. Of course, I had to buy flowers for the flat.

Beautiful bouquets. Crazy bangs due to the cool/humid British weather.

After the Flower Market, we headed to the Geffrye Museum whose stated purpose is to depict the home lives of the “middling classes” in London from 1600 onward. Tasia had found it online and said “Mom, you will totally love this”. While we walked to the Geffrye, we noted weekend “markets” selling everything from paella to hand made clothes everywhere we turned. Once at the Geffrye, it did not disappoint (Tasia knows me so well), with time capsule rooms including my favorite mid-century period.

Art Deco room.

Mid-century room.

Outside, the Geffrye’s gardens (also by time period) were also a delight. I had to laugh at the signs on the lily of the valley that noted not to eat them as they were poisonous. My parents have a ton of those outside their condo in Ann Arbor. Duly noted not to eat.

After the Geffrye, the girls and I went to a smart café called Beagle. I observed to the girls that I was the oldest person in the restaurant—by far. They laughed and then Tasia scanned the place and said “Oh no, there is a grandma over there with a young family”. Haha. Great.

I parted ways with the girls who went on to see some sights since Abby had never been to London. I headed for the meeting at the ExCeL conference center. Located East of the City, ExCeL is monstrous, and it felt like I had to walk a mile to get to the registration. Following that, I loaded up my slides in the speaker’s ready room and headed off to where I would give my talk.

A quick stop in the bathroom confirmed my worries that the cool but somehow humid British weather was funking up my bangs even worse, but there was little I could do about that. I found that the meeting room was much bigger than expected, holding several hundred people. I quickly adjusted my expectations, noting that I would be talking to a crowd rather than the handful I expected in the late afternoon on a Sunday.

Once the bangs start to curl up, there is nothing I can do but smile.

Sitting in on the featured talks right before ours. Cavernous room holding hundreds of people.

The talk went fine and people were very interested in our DICE Approach and WeCareAdvisor tool. As I left the room, people continued to ask me questions, which was very gratifying. Presentation #1 down and 2 more to go later this week!

I headed back to the flat, meeting Abby and Tasia. We walked over to Broadway Market, an East London street running from London Fields to the Regent’s Canal in Hackney that is full of shops and restaurants. We chose Bella Ditta, a lively Italian place and had delicious pasta and shared a scrumptious dessert (forget the name but some kind of chocolate cream-puffy thing).

Off to bed to start the rest of the week! More updates to come. Moral of the story so far: when you hit the wall, push through because what is on the other side is pretty great.

Bedazzling the Short Straw

September 24, 2016 kales@umich.edu ditching comfort zones, family, mindfulness, my kids

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. 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. 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. 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.

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

Kales/Gibson Family RV Vacation

August 6, 2016 kales@umich.edu ditching comfort zones, family, my kids

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 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 4^th 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 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 4^th 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 4^th. 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 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 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 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.

Garden Lessons

July 31, 2016 kales@umich.edu activity, ditching comfort zones, family, mindfulness

Garden Brigade at work

This spring we decided to plant a vegetable garden for the first time. We built (or should I say husband Pat built after I ordered it online) the container garden in April– which for non-Michiganders means we put our container garden together hunched over outside while being pelted by freezing rain.

Our container gardener, out of the box and set up. Freezing rain not included.

Our container gardener, out of the box and set up. If you look closely, you can actually see the freezing rain we were working in!

Once the danger of frost was past (which in Michigan means midish-May), we planted a combination of small plants and seeds and waited. It has been a joy to watch our little patch of earth grow. Theo, my 11 year old son, and I have formed a “garden brigade” that checks out the garden every morning, looking for changes and spotting potential candidates ready for picking.

A few lessons to share from our garden:

#1. It’s worthwhile to go out on a limb. We planted the usual suspects in the garden: peas, tomatoes, lettuce, etc. But, we also planted some less typical vegetables because Theo was excited about them: Brussel sprouts, broccoli and artichokes. While the broccoli still hasn’t born any heads (and I am not sure ever will) and we seem to be growing Brussel sprouts mainly for the deer’s pleasure, the artichokes were a delightful surprise. Beautiful to watch growing, and tender and delicious in the harvest.

Artichokes and beets

#2. Quality and the experience (and not quantity) matter. While I would love to say that we haven’t had to buy veggies at the store all summer, our garden is more like a beautiful vegetable “boutique”: a gorgeous tomato here, an artisanal zucchini there so far. But the joy that Theo gets in picking each jewel when it’s ready has been worth all the hard work. Here are some of the delights we have enjoyed:

Buttery lettuce in multiple salads
Lots and lots (and lots) of kale chips
Fried zucchini
Pasta with fresh tomatoes
Artichokes with lemon butter

#3. Sometimes no matter what you do, others will come in and reap your harvest. It really is inevitable. Despite deer spray (some spicy weird-smelling concoction), motion-triggered night lights, and 2 “garden owls” (that only seem to scare Theo who has dubbed them “really REALLY creepy”), critters literally ate all of our peas (chipmunks: I am talking about you) and have been nibbling our sprouts (Hi deer!).

Dinner guests, literally eating and running.

#4. When all else fails, you can start over. Today, Theo and I noticed that something was burrowing into our beets (after the deer had come in and eaten most of the leaves off). We decided to cut our losses, harvest the 7 medium beets we had and call it a day on beets (Polish chilled beet soup will be on the menu soon!). In their place, we planted green onions and spinach. We’ll see how those do.

It is this “garden lesson” that I cherish perhaps the most. So many times in life we struggle and struggle to make something work and sometimes the hardest, but best path we can take is to start over. Move on. And what the garden teaches us is that it will pay off. Maybe not in the “crop” you were thinking about and hoping for, but something different but still wonderful.

Starting over. Fingers crossed for green onions and spinach.

The Power of “I don’t know”

June 27, 2016 kales@umich.edu being a doctor, ditching comfort zones, life events, my kids

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).

Our 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.

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.

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.”