July 11, 2022

by Dr. Plastic Picker

I don’t talk about physician burn-out as much anymore. But as I get further from needing to talk about it, my own teen daughter brings it up here and there. I never realized how close we were to the other alternate reality of if I had not decided enough was enough – it was time to pick up trash and go to the beach. Then it was that decision a few months ago when everything was honestly fine with middle management and Assistant Boss, but I decided I wanted more time to work on climate work and spend time with family. I decided 5 years was enough of Assistant Boss, and as quietly as I could left without burning any bridges.

We are having a slow summer. It’s that beautiful time that I know will be gone in a moment, when both of our young people are here at home and still dependent on us. Our son is studying for his drivers permit and at 17, still has to ask for a ride. He’ll be driving soon enough and I’m happy to keep this one connection still strong between him and the adults in the house. Our daughter has friends that are traveling throughout the world, and she is here having a slow summer of mornings in the ceramics studio, afternoons practicing volleyball, reading and keeping herself busy. And I am still miraculously one of the people she still wants to be with.

So yesterday afternoon Mr. Plastic Picker had to again work extra shifts in the hospital, because that is what happens in his department. He’s still in the thick of middle management and surviving because I’ve decided I need to focus on him. I dropped our son off at a friend’s house for one of an endless stream of teenage summer get-togethers. They are seniors now and hanging out at the mall, beach, and doing innocent things like taking pictures with their shirts off and reenacting Lord of the Flies around a La Jolla backyard propane fire pit. I know because our son is close enough to us to text us some pictures, that his sister playfully threatens to keep as backup blackmail evidence. It’s a beautiful glimpse into a Southern California Suburban childhood that we wanted when we left Cambridge and our dreams of Harvard academic careers.

But after dropping off our son at his friend’s house, my now 14-year-old daughter was feeling restless with our relatively quiet weekend and wanted to DO SOMETHING. So I said, let’s keep the earth in mind and do something relatively close to where we are. We headed to Balboa Park and it was 430pm on a Sunday afternoon. We’ve been there before perhaps 6 months ago at 430pm on a Sunday afternoon, and I think it’s my favorite time to go there. There is parking as the days visitors are leaving. You can see the remaining stragglers who are still grasping the last moments of their well-planned weekend. There were couples sitting outside coffee shops that had already closed. There were families speaking Korean on skate boards around the plaza. New fancy restaurants were closed that were so fancy, that I cannot believe this is the same town I grew up in. I had forgotten my wallet and we only could find $5 in the car, and that is all we had. Only having $5 and knowing that we wanted only to drive as far as my electric hybrid car would take us but still remaining on the electric powered mileage part, had us wandering around the park on foot as San Diegans and tourists ended their day in Balboa Park.

As we walked hand in hand, and she was chatting her thoughts and I daydreamed about her future – she told me again what makes me sometimes sad but at the end grateful. I remember mommy when you were so busy, and angry sometimes. You would yell at us at times in the car, and I remember seeing a book on the table called “Stop Physician Burn Out.” And then you went to the beach and started picking up trash and you were happier. And in the context of her telling me this, she wanders into her volleyball tryouts and her new work-out strength regimen and how she realizes the running part she can stop at 30 minutes. She wants to concentrate on getting more touches into her volleyball regimen. I don’t comment on her body purposefully as I’ve seen too many mothers do this, and the downstream consequences of focusing on body image. And she talks about food in a beautiful way. We had just $5 and we bought a $4 ice cream. She wanted most of it, and she made sure we both had a good simple dinner at home which she cooked. And she mentioned off-hand that she realizes among the beauty tips on facial care that she is watching and the new hair cut she is planning and the new wardrobe that she is dreaming of, that at dinner it’s important to just add some tomatoes and fruit and it makes her body feel better and full.

That is the reality I live in. And I realize that the alternate reality was frightening closer than I imagined. Children especially teen girls need attention from their mothers. Tangential thoughts of your local litter picking pediatrician. It was a very nice weekend with only $5 to spend.

July 9, 2022

by Dr. Plastic Picker

It happened. I had been asked to contribute a short article to Sketches, San Diego Audubon’s quarterly magazine https://www.sandiegoaudubon.org/news-events/sketches-magazine.html. It was a short piece, and I was writing another piece with one of our students for a popular science magazine in the Yucatan. But during that time, I wrote from my heart. I’m writing and publishing more now than I ever imagined possible. I’m mostly just documenting my evolving thoughts as a pediatrician awakened to the climate and health crisis – and how I’m trying to help stop this existential crisis. Meeting so many interesting people with different ideas and training backgrounds, and then it percolates in my brain with my experiences as a litter picker – and something happens. And this article happened. Thank you San Diego Audubon. This article is a spring board to further bend the arc of history toward a livable planet for birds and kids.

ReWild: What’s Good for Birds Is Good for Kids

Wetland conservationists and pediatricians have a lot in common. The conservationists work to preserve habitat for endangered birds. Pediatricians advocate for a built environment that promotes children’s health. We also have in common the northeast corner of Mission Bay, which is critical to the health and well-being of birds and children. The ReWild wetlands site is a literal nursery for juvenile fish and bird species and is the figurative nursery we seek to make available for children to improve their health. This is how the collaboration formed between San Diego Audubon and the American Academy of Pediatrics (AAP) San Diego.

I work through the AAP California Committee on Environmental Health, trying to help move legislation to protect the environment as it relates to children’s health—a pediatrician’s prime responsibility. Climate change is a pediatric public health crisis. The long-term health consequences of climate change have disproportionately affected children, with increasing cases of asthma and higher rates of premature
birth. Children are the most vulnerable victims to climate-related natural disasters. Air pollution, heat waves, and water-born pollution affect little bodies more because their organs are still developing.
A child’s greater body-to-surface area of epithelium to total body surface area exposes them to more environmental toxins. Children will suffer the most due to climate change, especially those who live in
environmental justice areas.

Our communities need to commit to ReWild Mission Bay. The local climate change math does not add up unless we maximize wetland restoration. But when I think of the ReWild work, I also think of the possibilities of how this area can function to improve the physical and mental health of children. AAP San Diego has officially joined the ReWild Mission Bay Coalition to bring healthcare voices to wetland
conservation. Pediatricians as a group have spent many hours with wetland conservationists at this site. Working together, pediatricians and wetland conservationists are imagining how we can collaborate
and make this wetland part of community healing.

It is well established that reflective time in nature improves mental health. There is now a national call to document adverse childhood events (ACES). Children who have suffered more ACES have higher levels of toxic stress. This has been associated with adverse health outcomes like asthma, heart disease, and poor mental health. Programs that combine nature bathing, mindfulness, and mentoring from caring adults like healthcare professionals and scientists would be a nature-based solution to ACES. Rather than building more concrete clinics, would it be possible to practice medicine on the wetlands? Meandering the wetlands with children, together listening to the sounds of the marsh, noting the anatomical details of our bird friends, and then checking our own vital signs? I think we will all find what studies have shown—our subjective well-being and stress levels are improved. I imagine affordable and accessible primitive camping opportunities for local San Diego children, as camping is shown to be one of the most effective ways to address the sleep problems facing our increasingly digitized young people. AAP San Diego invites
you to come and meet us on the wetlands and let your imagination wander. Join us in this important work. For me, the northeast corner of Mission Bay has been a literal nursery—where I’ve brought
pediatric patients and my own teenage children to wander and heal. And this is where I realized after meeting wetland conservationists, that what’s good for birds is good for kids. San Diego Audubon and
AAP are aligned and working together for the Wildest option for the northeast corner of Mission Bay.

Vi Thuy Nguyen, M.D., is Assistant Chief of Pediatrics at Kaiser San Diego. She is a Fellow of Environmental Health as part of the American Academy of Pediatrics and serves as Co-Chair of San Diego’s AAP Climate Change and Health Committee

July 4, 2020

by Dr. Plastic Picker

It happened!!! I finally switched my blog and all the login information over to my “new” computer which is not that new. But the “old” computer had almost a dead battery. I guess the old computer still has the DVD player which I need to use for one of our daughter’s language lesson programs. But this is a big “DONE” for me.

Dr. Plastic Picker loves getting things DONE. And what was DONE this month was 11 bags of trash and 9 salvaged items from the ocean’s edge. It’s less than my usual 20 bags a month, but June has been an epic climate month and I realize there is no race to get to 1000 bags. So here are the totals for this month. Lifetime total is now #704 bags and #1929 items salvaged. Click here to see them all! https://drplasticpicker.com/plastic-picking-round-up/

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July 1, 2022

by Dr. Plastic Picker

Yes dear readers. Dr. Plastic Picker strikes again. I spoke at a rally yesterday at the civic center, which I’m now very familiar with. I was one of the headline speakers and even had a fancy social media ad made about me. I spent at least 5 hours of my time yesterday committed as Chair, Public Health Advisory Council, Climate Actions Campaign. The updated San Diego Climate Action Plan that seeks to have net zero carbon by 2035 with accountability and transparency passed 4-0 in the Environmental Committee. It’s funny how I know the members of this committee by name as well as I used to know the members of the middle management HMO commitees I used to serve on.

We are all real people with real families, and San Diegans trying to get it right. But we are all playing our roles as well. My role was formal and I didn’t get to tell anyone I was Dr. Plastic Picker. I was a generic general pediatrician representing the generally shortest and less well paid but overly educated MDs who chose to take care of kids. I wore my white coat that I had upcycled from my Harvard residency MGH and just had my father-in-law iron on an SDPCA patch over it. I wore a bright light yellow and airy top with black trousers and flats. My hair was black and I wore glasses. Honestly, I was like every other pediatrician that you might meet out there. And even though in my real self, I’m off beat, I play that generic role honestly. I was there to speak for my profession and our children. I didn’t need to stand out. I think my comments went over well. I cried as I have real climate grief at times. I made my remarks toward our collective children. I’ll post them on the San Diego Pediatricians for Clean Air website. Here, on this blog, is my emotional environmental journey.

I let others take the attention. I introduced my wonderful former patient and now premed student to some law makers and climate leaders. We had a picture together and that was so meaningful, as our relationship is cemented in social media and in Fox News when they got her from the side of the climate rally. My student didn’t seek attention but I wanted her to get some. The Youth Vs. Oil speakers are young high school students who I now know play on the same volleyball club as my daughter and they demanded attention, and their youth and passion is the attention that the climate movement needs. And the politicians always demand attention and recognition, and that is well and good as they need to grand stand and take credit and the credit is well deserved. It’s amazing that Nicole Capretz the founder and executive director of Climate Actions Campaign never demands attention, but gets so much press coverage, and I hold her as an example of how to build an organization.

But in the end, Dr. Plastic Picker did get attention! During the public testimony of the San Diego CAP update, environmentalists from throughout San Diego came together and drowned out a few of the SDGE /fossil fuel voices. The Audubon Advocates showed up, and they were so awesome. You could tell it was their first time advocating because some of them did not know to change their zoom names to their actual names. But at the end of testimony where I was Chair, Public Health Advisory Council and American Academy of Pediatrics Environmental Health Council – I said “I just want to say AAP loves San Diego Audubon. What is good for the birds is good for kids!!!” And that is it. That is a sentence I’ve been emailing my friends at San Diego Audubon as we do shared projects and I said it as a pediatric shoutout to the bird people in the middle of city council chambers. There were chuckles from the chamber. I think I had the most fun yesterday. Dr. Plastic Picker with my new hashtag #whatisgoodforthebirdsisgoodforkids LOL LOL LOL.

June 30, 2022

by Dr. Plastic Picker

My back was bothering me a bit yesterday night, so I slept on a thicker mattress pad on the floor. It’s healtheir for your back to sleep on a firm surface. I’m not sure why my back was bothering me? I think it’s because I walked around yesterday in flip flops to pick up a bag of trash. I’ve gathered only 9 for the month and did get 3 recycleables as well.

My back feels better this morning and I made sure to sleep at a good time. I’m drinking my matcha green tea soy latte home version. I am happy and content. I have about 15 charts to finish and then a half day of clinic to get through. I plan to eat a plant-based lunch at work, and maybe drink a decaf coffee. And this afternoon I will speak for 2 minutes at a rally in the Civic Center on behalf of a “complete climate action plan.”

It’s just 2 minutes of comments, but I’m one of the headline speakers. It’s my first official speaking slot as Chair, Public Health Advisory Council, Climate Actions Campaign. I’ve been on the Public Health Advsiory Council now three years? This has been in tandem with my advocacy work with the American Academy of Pediatrics. It’s all kind of amazing how quickly I’ve non-purposefully and unintentially moved up in the climate and health world. I kind of just showed up as an Instagram litter-picker @drplasticpicker and the rest in blog and instagram history.

I realized last night that even in my meandering environmentalism, I spent about 5 hours doing climate work yesterday. I spent 2 hours prepping a power point to present to the Oregon Pediatric Society regarding expanding our Youth Arts Exhibition to Oregon. Then I gave the presentation and met with the wonderful team at OPS at 2pm. That presentation and dialouge went very well. We have plans to go the next steps. And then I spent at least an hour or two writing my comments for today and practicing it at home.

When I was in high school, I was on the speech and debate team. I realize now that training was the most helpful in my climate work. I did Foreign Extemporaneous and National Extemporaneous and Impromptu Speech, and did go onto the California State competitions. I also was a track runner and famous for my negative splits. I used to always run my 2nd mile faster than my 1st mile, which is unusual. My PR for a mile was 5:20ish or so which is pretty good. I only made it at San Diego CIF because most of the really fast young runners got injured. This is kind of a metaphor on how I live my life. I’m in the 2nd stage of my career, and I’m running faster for the earth now. Negative splits. Rested to try to maximize my impact this afternoon for the 2 minutes I have at the Civic Center.

June 28, 2022

by Dr. Plastic Picker

It’s been a minute, hasn’t it? When I began blogging I found so much freedom in being able to write into the internet ether. I remember the first November, I was blogging up to sometimes twice a day. It was cathartic and it meant freedom for me. Freedom to vent. Freedom to create. Freedom to be silly. Blogging is also written in the first person narrative. I am a blogger. I am Dr. Plastic Picker. It’s mostly all about me, even this eco-avatar is still me.

And having that “me” time, oddly allowed me to be the third person narrative at work. I stopped talking about myself as much, because I was finally listening to myself when I was blogging and creating. And now during clinic, I listen more attentively. Being the third person narrative at work, has been life-changing.

I was with a mother yesterday in clinic, who I have cared for through three different partners. I have been the stable part of that mother’s life, the person who cares for all of the children’s medical needs in this complex blended family. Sometimes when families are torn apart and then blended and torn apart again, the medical problems get more complex. Referring to specialists, getting more labs, recommending new wellness classes, talking about recipes and vegetables and screen time – we together are only scratching the surface. But over almost a decade, I’ve been there for them. Even when I myself was going through burn-out and just making it as a young mother doctor, I was there for my patients. My patients never suffered. Adding them on when the schedule was already full. Pausing and taking that extra moment to suggest something new on their road to health. And now that I’m better and able to really listen and be the third person narrative, I realize that part of what families really needed was me. They need me to listen and to witness.

So that is what I did yesterday for this mother. I just listened and I finally understood better what was going on in her life and her narrative. The core of what was the cause of the different partners and the severed families. She was understanding herself. The patient in front of me, the toddler, is just beginning to learn her words. And what she says is filled with emotion and tangents and loose associations. It’s coming out garbled. She needs therapy. And it’s a metaphor for how the mother’s narrative came out garbled and in phrases and sentences and actions over the decade that confused me, and didn’t make sense. But the mother is learning the vocabulary and the words. And then she can teach her daughter along with the speech pathologists and the therapist, so that that child can also clearly express herself.

I listened and took the time yesterday. I didn’t think about the green dots that are annoying sometimes, and remind me other patients are waiting. It turned out no one was waiting and I was on time at that part of the day. I can read body language well being a pediatrician for almost 20 years now. She didn’t need a hug. I put my hand lightly on her right shoulder in comfort. I kneeled in front of my little patient and at eye level, thanked her for coming it and waved good-bye with two hands. And during the visit as we went back to forth in a somewhat garbled patient visit, we figured out the next steps. I said sandwiched in between us trying to figure things out together, “I’m proud of you. My general impression is that you are starting to reach out. You are reaching out and forming your support network. You came today and I’m lucky to be part of that network. I’m proud of you for breaking this cycle of abuse. You will end it in this generation.” What a remarkable narrative I witnessed yesterday.

June 16, 2022

by Dr. Plastic Picker

Hey Rachel. We miss you a lot. All of us miss you. A bunch of emails are going around the department listserv and people are saying memories and their goodbyes. Not much grand-standing or politiking, I think because most of us know you could not stand that crap. I haven’t replied to the email chain because it seemed so inadequate. I posted a cryptic message on Instagram that was heartfelt and Saadia saw it, and replied. Gosh, you’ve left such a big hole in our department. For those that don’t know me in real life, one of our colleages a well respected pediatrician died after a year and a half battle with cancer. She was young.

Thanks for letting me interview you for my blog a long time ago. https://drplasticpicker.com/dr-rachel-guest-pediatrician-and-nature-defender-5/ You were nature defender, pediatrician #5. I hadn’t interviewed many people after you. I think because you were a hard act to follow.

I was in the nurses triage room at Otay, and there is just a bit of quietness. They all worried about you, asked how you were doing. I never really knew all the details of your illness, and I know that you know – it’s because I didn’t want to overstep the work/friend boundaries. I don’t make friends easily. You knew I was there when you needed me. Jong and I emailed a final message to all the nuclear medicine doctors that helped you get those PET scans scheduled asap. I knew you knew I was there when you needed me. I thanked them for you, and included a short few senteces about how much you meant to all of us and the kids you took care of.

It really sucks. #cancersucks I can think of many other people I’d rather died of cancer than you. I’m being morbid and dark now, but you understand I know. We vented a lot together. You called it how it was. But I have to say that at those migraine-inducing early morninng leadership meetings with all the clinic leads, you always seemed a glass half-empty kind of person. Don’t get me wrong. I’ve always been your biggest fan, but you were kind of intimidating. Remember when I sent you a sketch of how I thought we could fix afterhours with mock schedules for the 3 urgentologist. OMG, your response was fierce. You essentially ripped me to pieces. I almost peed in my pants! That is true. I mean you trained at Wash U one of the best pediatric training programs in the country and one of the few people at our HMO who knew who Will Keenan was. That man was scary and you survivied a training program that had that brilliant pediatrician questioning your every GI decision. I bow down to you Rachel. You are a better pediatrician than me, which given how fundamentally arrogant I am – is saying a lot.

But your battle with cancer showed me that you aren’t a glass half-empty kind of person. You were tenanciously holding onto life and hope and fighting this cancer injustice every step of the way. It was really passion you had. I was telling Melissa in the lunchroom yesterday, she’s not doing too well by the way. But I was telling her that you were fierce.

What I will remember mostly about you is how fiercely you fought for the young doctors. You advocated for them. You cared so much about them, that you made the rest of us with any sort of decision making responsibility – care as well. I think that is why there is a quietness when we are all thinking of you right now. We are reflecting on how you fundamentally made us all better. This is not a platitude when written about you. It is absolutely true.

This is my blog goodbye, my friend. I’ve cried so much for you. I don’t know what it is. Maybe it’s all those beach walks. We never got to pick trash together as we talked about. Thanks for being there for all of us doing this climate work. Co-signing all those letters. Being there for moral support for us. I’ll be seeing your family still, and I’m so lucky to know that I’ll get to watch your nieces grow up. Your family are environmentalists, and intertwined with mine as we try to save the earth. Your niece is beautiful by the way. I always thought you were beautiful and thought it was a shame you didn’t have daughters yourself, as they would have been beautiful. But you did have children, your nieces, your patients, and all the young doctors that you helped mentor. I’ve written this last blog post but I will repeat it again. There is no way that souls aren’t recycled. Everything is reused in nature. I think you will be reborn as this graceful egret, it reminds me of you. Lets meet in the next life and work together again. #cancersucks and you are a work friend that changed me and made me better. I can’t imagine the pain your parents are going through now. You were their baby girl who has died before them. But I hope in the next life, you will be again their daughter and the brilliant beautiful fierce person you were in this life. Good-bye my friend.

by Dr. Plastic Picker

I’m almost at bag #700 to my #1000 goal! This month I gathered 13 bags for a grand total of 694. I gathered #11 items for a grand total of #1920 items. I’m going to dispense with the table format today. Next month I’ll be more motivated to do that.

Mostly this blog has been to keep myself accountable to the ether of the internet and blogsphere, as a fun way to keep myself motivated. I never dreamed that I would have sometimes up to 1000 unique visitors a day to this “Personal Environmental Action Blog.” But this morning was proof that this blog has meant something to me and meant something to the world, as frugal pediatrician me paid $110 a year to protect the blog against Brute Force attacks. I guess I’m a moderate sized website that deserves this protection. The blog pieces are my thoughts and my environmental journey, and a real facebook friend said that as a cherished hobby – I should spend the money. So I did.

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June 8, 2022

by Dr. Plastic Picker

Savings the earth and picking up plastic is my hobby. I don’t get paid to plog (picking up plastic and jogging), and I don’t get paid to be a climate and health advocate. I get paid to take care of patients in clinic, and that is it. This blog is non-monetized and purposefully so. I remember back when this all started and Mr. Money Mustache’s blog people approached me about monetizing things, and I stuck with my origianl purpose. I’m an environmental hobbyist and I’m totally into it.

But like most hobbies, it cost money but I want to make sure it doesn’t break the bank. I try to mostly donate money to other environmental organizations like Rainforest Trust, Eden Projects, EDF and want to make it cost effective. The blog cost $25 a year for the domain name. Blogging is fun for me. It’s my environmental journal. But now my silliness is under brute force attack. Not sure what they are looking for on the blog? But it is, and I hadn’t realized it’s sometimes 800K attacks a day. There is an option for $110 a year to install a plug-in to protect this site. I’m not sure how much protection it will provide. I’m going to ask around, but it just brought up the issue of finances.

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June 7, 2022

by Dr. Plastic Picker

I’m watching this current K-drama that I told my friend Dr. Sandra Gee about. She’s my green pediatric climate friend up in University of Rochester. It’s about an alien that arrived to Earth specifically Korean 400 years ago during the Joseon era. He stays for 400 years because he was stranded due to his fated love, who dies with arrows in her back as she sacrifices herself for him. Of course he is a very handsome alien of the Korean-persuasian. And now he is in our modern time, ready to leave earth 400 years later but waylaid by the reincarnation of his fated love who is now an A-list Korean actress.

The current K-drama is kind of silly, but I like it and I get to learn new korean words and rewatch scenes as I practice the conversations. This sillier K-drama works for me, because it’s not as addictive as the really excellent ones like “Descendents of the Sun” or “Reply 1988.” Those were really really good, just good story telling and better than anything I’ve seen in English. The non-addictive nature of the current K-drama is really good for me, because I went to bed on time and now I’m up blogging. The blog traffic is really going up. I’m not sure who is reading but it’s just me – Dr. Plastic Picker, former Assistant Boss and now just almost full time (technically 80% time) pediatrician doing volunteer climate work outside and showing up where I should.

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