March 28, 2023

by Dr. Plastic Picker

Our family continues to be very fortunate in our lives, and all the interesting projects we are able to participate in. We are still bathing in the glow of our son’s joy over his college admissions, and still awaiting more decisions. But as the children and I hugged last night, we were reminded – it’s important to stay humble. We realize we are a very normal family. And I reminded each of the children, to continue to go forth into the world and emanate love and joy, and do good.

I was a little bit stressed last night. I have a big presentation this morning, and I hadn’t really finalized my talk last night. It didn’t seem the right thing to finish, but I did start it. I used slides from a previous talk and began updating them. And then, I needed to take some time for myself after spending pretty much the entire vacation day off yesterday on climate legislative advocacy and also catching up with charting. So I stretched, took a walk after dinner, and I did some yoga. My daughter has a new passion and she wants me to participate, so I’m working on my strength. I still have a perpetual smile on my face from trying to manifest a different destiny, but I’ll leave that off the blog. It’s just a warm glow and this sense of rightness that in the next decade that event that I’m dreaming of , will happen.

But back to my actual climate advocacy. I’m speaking at 10am to the League of Women Voters San Diego . I entitled the talk “A Pediatrician’s Second Act: Climate and Health Advocacy.” I got to include this meaningful slide

This morning when I finished the presentation, it went very easily. It’s because I just tell my simple story and then usually talk about three climate projects that I’m working on. Since pretty much all I do is climate work, I always have a lot of images and narratives to choose from.

So what seemed daunting last night when the day was ending, was actually really easy this morning. So I’ll get the kids off to school. These few remaining months of having two high school students in the house are very special, so I’m relishing it all. I’ll take a walk and pick up a bag of plastic around the neighborhood. I’ll give my talk to the League of Women Voters San Diego at 10am-11am. I’ll go to a local Vegan Thai Restaurant to pick up food I ordered for an office party at 1130am. I’ll then drive to the office and deliver the food to the beautiful party room that has already been decorated by the phenomenal nurse Lea that I work with. We will have a party and celebrate someone who is retiring, who I care about as a person quite a bit. And then I’ll work this afternoon and see my patients. My charts were all caught up as of yesterday afternoon! We find out from NYU today. And then I’ll come home and use the pizza dough that I already prepped for dinner and split a dark chocolate bar my daughter and I bought at Trader Joe’s yesterday. Sounds pretty much like the perfect day in the life of your local litter picking pediatrician!

March 27, 2023

by Dr. Plastic Picker

The senior is on social media now, so I think it’s fair I share his picture. Plus, this blog’s readership has been so wonderful to follow along as our family has been navigating raising our kids and trying to save the earth at the same time.

I think our college hunt is nearing the end. We are still awaiting 8 more colleges (U Penn, Harvard, Columbia, Cornell, Georgetown, NYU, U Michigran, UC Berkeley) and on the waitlist for 2 schools. But he got into USC and I had no idea that he really wanted USC. If I know you in real life, please stop by and I’ll show you his reaction video. It is truly epic. We are having different discussions and imagining different scenarios, but our son knows his mind and he said frankly unless it’s Harvard, Columbia or Cornell – he’s rather go to USC. His father would rather him choose U Penn or Georgetown, and his sister as well would rather him choose Georgetown. And these are schools he has not even been accepted to. But our oldest is pretty chill, and already thinking about the Valorant tournament he wants to attend in LA and does not want to waste his time going to admit days of schools he is not that excited about. Each admission decision was so precious truly for us as parents. We had back-up plan after back-up plan. I had made vague plans to take the year off and travel the world with him, if he didn’t get into anything but his one safety school.

But I know the college hunt is near the end, because I started looking at costs and my jaw dropped again at how absolutely ridiculous the actual cost of attendance is at USC versus UCSD. It’s 60K difference!!! It makes absolutely no sense to choose USC over UCSD if you were looking at cost. But we will pay for it, since we’ve been saving from the time I was pregnant with him and Mr. Plastic Picker and I are relatively young and working almost full time and otherwise live very frugal lives. I think of private school tuition as Mr. Plastic Picker’s entertainment budget. The father in this family will work whatever overtime he needs and forgo all the usual fancy doctor vacations to send the only son of the only son of the only son to USC.

But now I’m looking at the little one and she says she wants to be a lawyer! Geez Louise, I just double checked the cost of attendance to her target law school. I know she is only 14, but one needs to plan.

That’s crazy! I guess I should keep on working. I don’t mind. I really love being a pediatrician. So if you see me in real life, I’ll show you the reaction video. It truly is epic!

March 22, 2023

by Dr. Plastic Picker

I’m just living my life. I just finished another really cool interaction/interview with Dr. April Moreno from the Public Health Podcast Network https://www.publichealthpodcasters.com/. I talked about my advocacy and leaded aviation fuel pollution and leaded drinking water, and also the upcoming San Diego Heat and Human Health Summit that a group of us are organizing. I’ve started and deleted several blogposts in the last week. I’ve had to email many wonderful people and sometimes those emails are like mini-blogpost. So by the time I return to the blogpost that I’ve started, the words are gone. They are used up.

But even starting to type a new blogpost that never gets published, does help. It helps just to start, to start typing something. I realize there are people listening. 86 clicked on the ab 249 testimony. I just cut and pasted what I said at the committee hearing. It was my perspective as a front-line pediatrician who is decently knowledgeable about lead and has co-authored one article on lead pollution advocacy. I don’t pretend to be the world’s expert, but I also live my truth and know that I care and that this particular issue pertains to me and the children in my practice.

Being honest is really important. Honestly is underrated. I was talking to a young pediatrician who was seeking life-advice, and he asked me about my path. And I told him that I veered from the standard leadership path in our HMO because of my need to be true to my values and to be honest with myself. I also demand honestly in others that I work with. I know I come from a place of privilege in that I haven’t had to make myself work or associate with too many people who I find dishonest. As a child, my parents gave me the cover to avoid those folks. And you know what, it’s okay. It’s okay in your family life and your volunteer life to choose surround yourself with those that embody love and caring and positivity.

I was hugging our freshman last night and I realize that I’ve set a good example for her. She told me “I’m glad you have sheltered me. I’m glad I’m in a bubble.” And within that bubble my children and my students and those that I love, can be given the freedom to imagine the world that they deserve. I know the stark reality about the ugliness in the world. Certainly I do. I’m a pediatrician. But I also know there is absolute beauty and goodness out in the universe. And if you are one of my friends that I’ve sent long-winded emails to, thank you for being part of that beauty and goodness.

March 14, 2023

by Dr. Plastic Picker

On behalf of my committee and pediatricians, I urge your committee to vote Yes on AB 249. My main job is in clinic and I am a front line pediatrician for 2000 families.  Indeed, most of our membership within the AAP are that, your community pediatricians who treat our state’s children.

I am here to remind you that lead is a Pediatric Neurotoxin, and it’s an accumulative neurotoxin and it is stored in bones and teeth and never leaves the body. Children are uniquely susceptible to even low lead levels which can lower IQ and cause learning and behavioral problems which, in turn, elevate costs in health care, education, and criminal justice.

The reason I am here is very personal. I see the effects of lead pollution in real-life in my clinic, as I do increasing number of evaluations for children with ADHD and autism, prescribe more and more stimulants and have more children on antipsychotics to address behavioral issues  – and try to help families navigate the difficult world of special education and medical services like speech therapy, occupational therapy, ABA services. As my work day is filled with the increasing demands of these children who need our help, I can’t help but remember that much of that chaos that has been caused could have been averted if we had addressed leaded drinking water earlier.

Exposure of pregnant women to high levels of lead can cause miscarriage, stillbirth, premature birth and low birth weight, as well as birth malformations. There are astronomical economic costs from the negative impacts from exposure to lead by everyone. For every dollar spent on controlling lead hazards, it is estimated that $100 would be returned in health benefits, increased IQ, higher lifetime earnings, tax revenue, reduced spending on special education, and reduced criminal activity.

Children at highest risk are the very young (including the developing fetus) and the economically disadvantaged. This is because undernourished children are more susceptible to lead because their bodies absorb more lead if other nutrients, such as calcium or iron, are lacking.

Lets not wait to address the clear danger of leaded drinking water in our schools that threaten our states’ future. It’s not fair to those children attending those schools now, and it’s simply not fair as it’s likely children in environmental justice communities.

March 10, 2023

by Dr. Plastic Picker

The little one approved this picture. I have more glamorous ones of her posing and being pretty and fourteen is her first real Vietnamese ao dai, a cute beacher romper and so forth and so forth, but this one is the one I want to remember. It was just the two of us visiting my parents when she found out about being accepted to this council. I just shared on the San Diego Women’s Facebook Group.

“Wanted to share because of what my daughter told me. I’m so proud of her. She was selected as 1 or 12 girls (there were 100 applicants) to serve on the Youth Advisory Council for the California Commission on the Status of Women and Girls. This is a well respected bipartisan and established council that advises our state on legislation and issues that are important to women. The YAC was formed to bring youth voices. She wrote in her essay about the importance of reproductive rights, prevention of family violence and legislation needed to ensure workplace equities for mothers namely pay equity. She deservedly is feeling proud of herself balancing all her activities and academics, but she said “I’m pretty awesome but that’s because you’re awesome.” She’s seen me struggle through work balance issues, and trying to figure out how to move the climate work forward in San Diego and all the joys and frustrations. And it’s because I’m a mommy doctor and I talk about issues, so many issues. She’s doing her Girl Scout Gold Award on raising awareness on the history of sexual violence during WWII and Korean “Comfort Women” through ceramic art. Sometimes I question the amount of time I spend volunteer mentoring and the climate work, but I realize I can do this because there are other loving adults around her doing the same for her. She told me while we were in Hawaii visiting my parents, “California is pretty awesome.” And I told her, yes California is pretty awesome. Thank you for letting me share. She’s the baby I had in fellowship and the one I had when I questioned so many of life’s choices. I’m most proud of being her momma.”

And this happened in Hawaii. We had five glorious days with my parents, where she was the center of attention. She has come back stronger, well rested, filled with stories and Vietnamese language and Vietnamese food. She made so many memories together with us. I can picture the after now. The after when it’s her advocacy, her activism, her career and her real-life kdrama. And it’s because she shared that with the three of us.

One of the best parts I wasn’t even around for. I haven’t seen the videos yet. I’ll look after she wakes up, as we are back in somewhat gloomy San Diego today.

But she got to ride is this all electric Akimoto up and down Waikiki as her grandfather was enjoying having a cute 14 year old in the backseat. They were getting donuts at Leonards, and the squeezed into a tiny parking spot. She said her grandfather wasn’t scared of anyone, and it was fun getting some attention. I guess these two apples don’t fall far from the tree. Oh yeah, we also own a solar farm now LOL.

March 1, 2023

by Dr. Plastic Picker

Am I 짜증나 (annoyed)? Yes I am. It took me a long time and all of my professional accomplishments to get into that board room. I forgot briefly how long it took me to get into that board room, about the 10 years in middle management, meeting the metrics, the burn out, and the rebirth. And then I ran for retirement committee on a clear divestment/ESG platform. I was honest and upfront about my goals for running for retirement committee. I won with a majority of support of over 700 physicians. And someone in a suit that is not a doctor looked at me, and equated wanting an index target fund that was ESG to a niche financial ask. He looked at me and he was annoyed, and I was polite and annoyed back. I followed the rules. Mr. Plastic Picker took the day off to drive me all the way to Pasadena for this meeting. I met everyone and shook hands. They know I am the Green Team/Sustainability Team co-lead here. They know I am a climate and health advocate. I shook hands and made myself physically known to someone else who has a big title in our organization. I’m sure I annoyed him too, and he annoyed me. We know we are on opposite sides right now in this discussion.

I realize I’m a fiduciary. But I will say it again, I AM ALSO AN EARTHLING. That is it. I’ll continue to show up at this committee meeting. Everything passes by unanimous vote anyway. Honestly I’ve been on so many committees and we are rubber stamping things that two people have already decided they want to do. That someone (namely a younger female pediatrician) dared show up and make the rubber stamping a bit harder probably annoyed them. But guess what, CLIMATE CHANGE ANNOYS ME!!! And sometimes men annoy me quite a bit. I am a SHE who prefers HEs, but sometimes those HEs can be so ANNOYING!!!

But I had two great climate projects , a writing project and our H3 SD Summit to move forward. I got to send emails out to those two groups that not shockingly are mostly SHES!!! The entire time I was looking at those annoying two HEs yesterday, I was thinking that I’ve 100% worked more than they have. Between being a working pediatrician mother and picking up litter. I have more years of training and I’m certain I had higher SAT and MCAT scores. I’m pretty sure my networth is higher. And I realized yesterday that real estate is a climate-safe investment as well. The price of timber went up 400% which is why our Oregon farm has been a great buy!!!! I think that outperformed those investments that are tainted in oil and coal.

Thank you for listening. I’m less 짜증나 annoyed now. Yes I realize we can all get sued as fiduciaries although it’s never happened in the committee’s history. I realize the fear mongering. I have a large umbrella insurance policy, thank you very much as well. But what is more likely, is the seven fold increase in extreme heat events. I have a plan to move forward with this issue. It’s such an important issue. I think I’m just going to keep on showing up to these meetings and annoy these two men. Because as a pediatrician and as a mother, this is for my children and actually for theirs as well. Aaaarrgggghhh. It’s raining today which I remind you is due to atmospheric rivers and the wetter seasons are wetter and the dry seasons are more dry. I have 3 months until I have to annoy those two HEs again at the next quarterly meeting.

February 25, 2023

by Dr. Plastic Picker

I’m not sure what drives me? I find these really cool opportunities that will help the earth, and help a student or colleague – and I jump on in. Why not? I think. I don’t try to take over the project, but usually I find it’s helpful to mentor someone or to collaborate on these shared climate projects. And then when one project is brought across the finish line, I update my resume on Doximity. It’s a legitimate site that folks look toward. I even got a grant from doximity to travel to Peru years ago with our HMO Global Scholars Program. It was $1000 or so!

It’s all good for the earth and climate, which is the most important. I figure I might as well update my internet resume. Just checking now I have the “Most Press Mentions 2021 and 2022” and the “Most Published in 2021.” I’m not trying to get the most press mentions or most published. What I’m trying to do is get the most impact on green house gas emissions. But it’s fun to update things on the site.

What’s wrong with me? Nothing. I just wanted to type something today. And I wanted to thank everyone who reached out to me in person and virtually to encase me in that big cozy hug. Thank you. I feel better. I feel safe today. And it’s raining like crazy, and it’s a beautiful world.

February 22, 2023

by Dr. Plastic Picker

It’s 442am and I’m up more at my more natural awakening time. I’ve honestly watched most of the Kdrama netflix/Vikipass that I need to. So no more binge watching for me. I’ve caught up on most of them. And I stretched and did some light weight exercises to help me fall asleep last night. I asked my very tall and gentle son to hug me twice. I asked my husband to hug me last night, which he did before a little 12 pound poodle mix snuggled in between us and I had to scoot away. I could push her out of the way, since I am the alpha in the house (well maybe not the alpha, but the beta that pretends to be the alpha). I didn’t talk to our daughter too much about things, because I don’t need her at 14 to be exposed to the ugliness of the world too early. She will see it all soon enough, but while I have some semblance of control – I am raising her in a bubble of security and stability.

I was terrified yesterday. I had a parent patient interaction that I found absolutely terrifying. I find it helpful to process these emotions relatively quickly so things don’t fester. The details are not important here on this blog, and things need to be confidential – but it’s important to share my reaction. I think some of my reaction is because I’ve been mostly healed from many traumas, past emotional and professional abuses from blogging. It’s helped to write things and process, and for the most part I’m surrounding by positivity and joy. I also try to be positive and a force of good at the office and in the world, and certainly at home. But yesterday a person tried to emotionally pull me down into the darkness of chaos, and tried to provoke in me evil – and it terrified me. I was acutely aware of my racing heart beat, my hands began to shake, and I stood up even though that person was on the phone. I could feel my fight or flight response kick into gear. And I knew to politely set limits and hang up the phone. And then called the appropriate supervisor and threat management was alerted.

I felt threatened and I don’t have to take that cr@p anymore. I’ve certainly been in more dangerous situations. We all have. I’ve had scalpels thrown at me by angry surgeons. I’ve had other surgeons berate me as a student for no good reason. I’ve had parents threaten my own safety and the safety of my team, when they were often child abusers as we’ve tried to protect children from the same abusers. I’ve seen fellow physicians haze younger colleagues, and it ate me up inside to sit there and witness the hazing that is done really indirectly through decisions that are obscured. But I am 100% me now, and daughter of my father, the wife of my husband, the mother of my children, and the pediatrician for over 2000 children. And I called someone who called threat management, because I don’t have to deal with that cr@p anymore and neither should you!

Yesterday was an epic climate date. I spent two hours writing our newsletter updates for SDPCA and AAP.-CA3 Climate Change and Health Committee. I mentored and recruited another premedical student who will help with the heat and human health summit. I reached out to patients and extended extra care to those that are subject to poorer health due to environmental toxins and racial discrimination. I attended the above clinic meeting where we all whacked at the COVID pinata (brilliant idea by a colleague) and ate half of a cookie without guilt. I also took a good whack at the COVID pinata because it’s been a rough few years for sure. And then I went home and attended an epic meeting between the Office of Health Equity and Climate Change and the League of Women Voters and got to talk more about the idea for the heat and human health summit. I was late for that meeting because I took what I thought would be a quick 30 minute nap but ended up being a 45 minute nap, but the League of Women Voters Environmental Justice Subcommittee were very understanding of my working momma/climate warrior exhaustion! I even got invited to their gala!!! My premedical intern was there which is like I was there on time, so we were able to meaningfully contribute to the conversation.

And all this was important for the earth. What scares me the most about the worsening heat waves is that it will drive up rates of interpersonal and domestic violence. That is the scariest part. We have to try to mitigate the climate crisis by continuing to reduce green house gas emissions. We have to better prepare for the heat waves, because no matter what they will be getting more frequent in the summers. And when they do, tempers will fly and the situation I was in yesterday – will happen more often.

But I’m so lucky. I’m so incredibly lucky to be able to see the link between it all. I am no longer scared. My heart rate is normal. My vitals are stable, as is my mental health. I thought about calling in sick for a mental health day, because it was terrifying yesterday. I thought about punishing the system for putting me through this. But I realize that I’m better and I can whether this one incident that was terrifying because I have you. I have climate work. And I have my loving family. And I’m thinking of someone who is very brave and I’m sending you out a virtual hug. Signing off now, to do a few climate emails! Your local litter picking pediatrician!

February 19. 2023

by Dr. Plastic Picker

I’m working the Sunday shift from 830-5pm and I’m at peace. I did a three way trade so that I could make an HMO Wellness and San Diego Audubon event in two weekends. That is for the earth and work, but I do that on my own time. Of course even though I am increasing our visibility in the community, and indirect advertising and membership growth and general goodwill – I am not paid for it. I created this opportunity for the earth, our HMO and myself through my own networking and creativity. It’s difficult because I don’t think the HMO upper leadership really gets me. Most people who work within the system – actually don’t. They are creatures of being told what to do, what do think, and have their times micromanaged down to the millisecond. After breaking away from true middle management, there is so much room for creativity. But I still work in the system I work in, and I do believe for now it’s the best system out there – so I will show up to work happy today. But I did a triple way shift trade in order for a friend to make a skiing trip, and myself to make the HMO Physician Wellness and San Diego Audubon event – and it all seemed to work out. This event is really the first of it’s kind. So I’m able to make that event and fulfill my obligations at work, which I used to find annoying because who likes to work on the weekend?

But I’m not annoyed this morning having to go to work even though my children have the day off. There is someone special there working also. This someone is someone who I haven’t seen in a long time. I want to give her a hug because we have a close friend in common that died. We all miss her acutely in different ways. I talked to another friend about her, and we used to talk and meet constantly during the years I was Assistant Boss. It’s hard. The sadness comes back once in a while when issues come up, where she would have had a fierce and just and insightful opinion. That passionate voice and that beautiful person is gone now. But those of us who knew her, were made better by her.

I’m not as annoyed to go into work because my children are doing well in life. That’s the honest fact. Physicians are stressed due to extra work duties, not because they want to go party. Come on! We were all studious premedical students. Most of us are annoyed to go into work on the weekends because we are worried about our families and want to spend time with our children. My own children are doing well for various reasons, but some of the reason is that after I decided to do climate work – I became happier. And a happier and more present parent, is a more effective parent.

And the beautiful toddler in the picture is now 14 going on 15, and I am so incredibly lucky. I am incredibly luck to be so loved by my daughter. She tells me often, and I tell her often the same. I still don’t know what I did to deserve such a living being in my life. She has so much love in her to give. Mr. Plastic Picker and I are not parents to overestimate our child’s abilities, but she is also incredibly intelligent. That is saying a lot when both parents are Crimson trained to the 8th power! Her spanish is progressing very well, and she is the honors track. She will get to the AP Spanish Literature level and will always have that skillset. Spanish is relatively easy to maintain since it’s so incredibly useful and an important international language. She also speaks Korean very well. She’s been in Korean language studies since she was four, at a Korean language school and now with a language professor who teaches her weekly. She does duolingo every day for both Spanish and Korean, and speaks with her grandparents every day. Most importantly, every day she takes linguistic risks and moves her language skills further and she enjoys languages. She’s been asking me to start Vietnamese language studies for the last few years. We’ve had fitful starts and she has learned some from me. Her intonation is perfect in Vietnamese and I’ve never been concerned since she’s heard the language her whole life. Now we have met with an excellent college Vietnamese language professor who is local, and speaks the more proper and easier to learn Northern dialect. So we start tomorrow with her official studies, and I’m confident that she will at least be conversational. Four languages isn’t bad! It’s the same four languages I speak, but other than the Vietnamese – I an honestly say her English, Spanish and Korean are better than mine!

That our children are better than us, and we try to leave the world better for them – is a central tenet in my life. But today I’m amazed that my daughter wants to learn my mother tongue, Vietnamese, mostly because she loves me and she hears me speak it often. After I had a prolonged conversation with our new Vietnamese language professor and she overhear, she turned to me and said “Mommy you are really awesome.” So that’s the happy mommy that doesn’t mind working the Sunday extra two shifts today.

February 17, 2023

by Dr. Plastic Picker

I’m really excited. I had this idea for a “Heat and Human Health” Summit at UCSD and it’s taking shape. I have some wise people guiding me. They believe in the earth but can taper my enthusiasm and guide it in the right direction. So it sounds like to make it doable, it should be a smallish gathering of 50 or so people for half the day. This advice helps me quite a bit, because it puts limits on my enthusiasm and grandiose plans. The most important thing is that it gets done, and we start it. The heat waves will be coming for the next 30 years or so. Having the first of it’s kind conference in San Diego will bring much needed attention to this issue. It also just gives us a goal to continue to address the real threat of heat waves and what we as health care organizations can start doing to plan as a region.

So I’m excited and reaching out to people. I thought I needed more students, but honestly I have enough right now. I have two premedical students who can help with this, and one high school student. That is all I really need. And then we have our Public Health Advisory Council, Climate Actions Campaign folks that are already bonded and can work together. Even the food won’t be that much. If it’s just a half day, then we just need coffee and drinks and snacks.

It’s really just a big meeting, but it’s an important meeting. It’s a kind of meeting with topics that are not being discussed right now. And we can do it for the first time in San Diego. It will create opportunity for three premedical students. And it’s really interesting to me. Probably initial address by Dr. Wilma Wooten or someone like that. I can make brief comments. Then breakout session at least 3. Heat waves and ED access. Heat waves and youth sports workflows. Heat waves and effect of NICU admissions and Ob-Gyn admissions. Heat waves and leveraging technology to help. Heat waves and psychiatric admissions. Increasing access to cooling centers to those that are most at risk.

Okay. That was a super productive blogpost. Do you like my trashart man? I call him “I am a fiduciary. I am an earthing.” That is a whole other project that I am working on. LOL. So grateful for green friends.