May 2023 – Dr. Plastic Picker

Month: May 2023

Chalk drawings from the clinic recently.

May 27, 2023

by Dr. Plastic Picker

A mother I know well came in this week and it has been a while since I had seen her. She’s really sick right now and has around a year left to live from a cancer diagnosis, and I have been the children’s pediatrician for well over a decade. It’s one of those relationships where I know them well, and my nurse knows them well – just because we’ve seen them since birth. The children are in with therapy and the supports and resources have all been deployed.

What does one say as a pediatrician to a parent? How should a pediatrician react?

There is no answer because each relationships is different, each family is different, each parent and each pediatrician is different. For me, it is about responsibility. I have been lucky to be there for all those moments in clinic. The first visit when the parents come in so nervous and exhausted, meeting their pediatrician for the first time. We teach them how to swaddle the baby, or reassure them about the pooping frequency. We ask them, are you doing okay? Being in the clinic rooms, I often feel like being on a sitcom (I often laugh in clinic with my patient’s families) or sometimes it’s more of a series of commercials. But those moments are so powerful, the first weight check, the bilirubin visits, the anxiety about the high fevers, the first viral rash, and first broken bone. The main characters are of course the little adorable toddlers, and it’s true for me – my little patients even when they are big and grown, are perpetually toddlers in my mind. They are the adorable 15 month olds that are so mischievous that you forgive them their tantrums and their scowls when you try to examine them. It’s hard to be mad at little beings that have such huge eyes. Toddlers are really the manifestations of anime proportions, round face and big eyes and perfect skin.

After being there for a lifetime of those sitcom episodes or the short commercial visits for very focused moments, you get to the point in your career after practicing for 20 years when one of the parents have died. And that for me, is something I’ve been mulling over the last year and had been thinking about and reflecting on. It’s hard for those families of course, and as a pediatrician – the more connected one is the harder it is for us. I’m a connected pediatrician to my families and my community, and I hope it’s true for most – I know my families and I care for them. And because of this, when Stephanie was diagnosed with cancer, when Nicole died in a tragic car accident on Christmas break, when Jonathan was murdered when he went back home to Detroit likely because he was a young black man – it forever affected the lives of their children and the pediatrician who remains.

I needed to write out their names to make sure I remember them, and to my families I do. I remember the arguments I had with Johnathan about Malcolm X and race issues, and found it amusing that he trusted a small Vietnamese-American pediatrician about vaccines – despite his mistrust of the world in general. I remember Nicole all the times you drove down from East County to see me, trusted your boys with me and we talked about just random things – but always really liking each other for some reason. And I remember Stephanie each visit you had with your two little ones, how blond they were and the interplay within your family and felt sad when your family separated and now after we talked – I know a bit better why since your life was more complicated as a child then I ever realized the first years I knew you. I needed to write this down because I remember. I was there with you, and you were there for me as well.

It’s powerful mindfulness and being present. Yesterday I had what was probably just a ho-hum clinic day, where I worked the late staggered shift. But there were the two cephalohematomas that I’m still worried about, attached to two set of parents. There was the stress of finishing three triplet wic forms and doing the third version of them because I dared to spell Similac incorrectly , and me wondering if the WIC office really had so little to do to perseverate over my spelling, but attached was a loving uncle that always wears a certain kind of shirt and sweater , and so lovingly holds one of the triplets when his younger sister who is the mother comes in.

I’m still here. And what I said to the mother that came in this week who is dying of cancer was simple. I’m so sorry that you and the kids and your family are going through this. Can I let my old nurse who knows your family too know? So that he can pray for you, because he goes to church? He transferred to Bonita about a year ago. Do you need more supports? I am so glad the kids are in therapy, and we have more social workers now. Do you feel comfortable reaching out to me if you need help? And of course I’ll fill out that camp form that you need and this is when I review things for the kids through puberty. Maybe we should talk about sex sooner than later, especially so you don’t worry about them not having had the talk before you go. And, I will be here for them Stephanie. I’ll be their pediatrician until they turn 18, and please let me know if you need anything. And what I didn’t say was “I really want to give you a hug but our relationship is different. So I didn’t hug you, but I hugged the kids after you left the room, because it really sucks when your mother has cancer.”

Introverted me

May 18, 2023

by Dr. Plastic Picker

We are getting there. We are getting there. It’s been an absolute whirlwind of meetings and support, and emails and coming of like-minded hearts. For those of us deep in the climate work, we know that there is a very narrow window of time. It’s a literal planetary code. And that’s why that even though I know this the San Diego Heat and Human Health Summit won’t solve everything, it will move the climate work faster. We will get to averting rising global temperatures and ecosystem disruption a bit faster. Every act counts. Every bag of trash counts. Every major summit that changes the national conversation counts.

But it’s been a marathon of meetings and marathon of emails. Convincing and cajoling. Talking and persuading. Pleading and asking. And I’m doing this all for our collective children, but honestly for my own as well.

To all my friends, let me have my innocent dreams of my daughter and innocent hopes for her future. I need it so badly because I know how truly dire the situation is. Rising temperatures, hurricanes, atmospheric rivers, asthma. I usually have hope. But this morning I have to put on my happy persona which is mostly true. I’m excited to go to DC. I really am. I’m excited to be invited to the World Economic Forum. I’m mostly excited to see all of my friends on August 12, 2023 at UCSD School of Medicine. But I’m so much of an introvert , that it’s hard for me. It’s hard for me to reach out again and again. Usually people say yes, but sometimes I get a no. And the no, they hurt so much. But I keep on re-engaging and re-connecting, because we have to do this together as a region and as a community and as a people.

I think the introverts, those like me. We are the beautiful ones that the world does not see, because we are afraid to get hurt. We hide. But after being hurt and being healed, it gives you this sort of super human strength and knowledge. Those that tried to hurt you. The naysayers, The negative people. They are gone now. And all is left is the stark reality of the climate crisis and the planetary code, and I’m there and you are there – and what does one do, but try to resuscitate the patient.

So it’s really happening, The summit is really happening and thank you to my real friends who have seen me run up and down the hallway. I’m exhausted because I was so happy. And being so happy, you crash. It’s not a natural state for me, this extremes of emotion. But I’ll take it, for the earth and realize that I am meant to be where I am and to be who I am. And that I’m allowed to look at a picture and smile, and dream for my daughter.

The epic selfie!

May 12, 2023

by Dr. Plastic Picker

That was honestly way too much fun! My good friend Dr. ABG and I stopped by UCSD AMSA Premedical Society and spoke. Dr. ABG is one of the doctors I admire the most, and also happens to be on the San Diego Air Pollution Control District Governing Board. I had a part in getting her elected and I did so because I believe so strongly in her heart, her clinical skills and her ability to enact change. But she’s also a good friend, and UCSD alumnus. So we headed over to UCSD AMSA and amused the premedical students with our anecdotes about climate and health, but mostly about our friendship, our families, our husbands and our kids.

We were REALLY FUNNY!!! Totally not planned but I kind of knew what the trajectory of our open flow dialogue would go. Our premedical students and high school students said we were hilarious and entertaining and inspiring. The room was filled with laughter, and filled with beautiful young faces looking for leadership and inspiration. I’m hoping that two middle-aged pediatricians in our 40s gave some of that to them.

We also invited them to the San Diego Heat and Human Health Summit! It’s at their college and university and 100% they should be involved. So we’ve invited the premedical students. I got ALOT of new really cute UCSD premedical instagram followers yesterday. And I think we picked up a few new premedical interns. We have two graduating so we actually do need a few more to fill out our ranks.

new student! So cute!

My heart.

May 6, 2023

by Dr. Plastic Picker

It’s been on epic climate almost 2 weeks now. I haven’t been present as much on the blog to update the readership. I’ll update you now but mostly wanted to let you know that one of the main characters in my life turns 15 this month.

Our final version of the climate divestment paper was accepted to the Yale Journal of Biology and Medicine. I helped substantially with those edits and am in the middle of the authorship group, and incredibly grateful to have contributed to the writing of the paper. I was able to secure an interview session with Contemporary Pediatrics for our lead author to amplify the message of our paper. I initially thought we would have to write a commentary, so I’m relieved this will be an interview and I actually don’t need to do anything further. This paper helped me further understanding divestment work, and it will help with the overall movement to have this paper with important names on it to distribute to our friends on the front-lines advocating for divestment as child advocacy as climate change affects children’s health.

I also received a big award which I’m not allowed to share on social media but I don’t think this blog counts? I’m really honored to receive it. There is going to be a fancy reception and I’m getting a trophy! A real engraved trophy! Thank you to the American Academy of Pediatrics CA3 – San Diego and Imperial Counties for nominating me.

But it seems really simple and a bit selfish. One of the biggest reason I am working so hard to fight climate change, is that I want the above teenager to have a livable planet. I want her and her brother not to have to deal with as catastrophic heat waves that are predicted right now. I want to have grandchildren that can remain in San Diego, or at least not have to migrate too far. I want to hold my grandchildren and watch them, and it not to be that hot. I want this for them and myself, and for all our children and grandchildren.

And most of my time these days is organizing the epic San Diego Heat and Human Health Summit. I’m making lots of noise with my climate friends, to draw attention to the health effects of deadly heat waves. We need all hands on deck. And I think it’s working. Can you believe it? Its working. And honestly it began with a burned out pediatrician who almost left medicine because I was stressed and sad, and I found happiness on the beach picking up trash.

If you know me in real life and want to help with this summit, let me know! It’s going to be epic and filled with beautiful people who are so good and joyful, that it just shines when they walk in the room. Trust me. I see it! I see it in all of you. So to the being who has brought me 15 years of joy. I love you so very much. And this weekend, we will spend it together just our family.