I hate DVDs

Who would have thought that when we moved from 1970's technology to 1990's technology, we would be taking a gigantic step backwards? That is however what has happened, and as long as we remain capable of playing videotapes, that will be our preferred technology ("Honey, should I get it in video or DVD?" "It comes in video? Get the video!!!").

There are two main problems with DVDs -- they are fragile (more fragile than videos -- how could you do that?) and you have less control over how they are played. First the fragility -- DVDs are so easily scratched that 60% of the DVDs we get from the library won't play at least a segment and 10-15% of those from Netflicks won't finish. For reasons I don't entirely understand, it's always the climatic end of the movie that freezes. From video rental, the fraction is higher -- maybe 25%. Nice of Netflicks to ship you a working one, but in our busy lives we don't get a second chance a few days later to sit down again. Videos were never this bad -- it was a rare video that had problems -- as a teenager I rented tons of flicks, watched them from beginning to end. Then in college I worked at Pleasant Street Video renting videos and while we were prepared to refund rentals if the video didn't play, I don't remember having to fill out that paperwork a single time. They melted spectacularly in the car window -- but so do DVDs!

Add a technologically savey four year old to the mix and the stress goes through the roof. She knows how to pause and play the DVD player. She can turn off and on the TV, and she wants to load her own DVDs. At the moment, with her safe in bed, I don't think rationally that her little fingers make scratches between the case and the DVD player. But in the light of day, with half of the DVDs not playing, seeing her open a DVD case causes instant panic. I've heard of people who break the copyright protection to create copies, then file the originals and let their kids watch the copies -- that sounds smart. For our commute to work, we get lectures on CD from The Teaching Company, which has a lifetime warranty -- if any CD gets scratched, as long as they are still making it, they will replace it. DVDs are much cheaper to make and ship than the videotapes they replaced, but unlike The Teaching Company CDs we cannot make a backup copy, and the distributor feels no obligation to replace them when they fail.

The second problem with DVDs is the lack of control over how they play. We prefer our four year old to watch DVDs over TV precisely because we want to preselect what she watches and we don't want her watching advertisements. At first, if you wait patiently through the FBI and/or Interpol warning, followed by logo presentations with sound effects for two or three responsible entities, then pressing "MENU" would skip the previews -- important because we already steered her past Disney Princess movies, Lilo and Stitch in the library so we don't want the DVD we've selected drumming up demand for the things we've already tried to avoid. It's not just that we are against previews to kids movies -- some of the movies are veiled comericials -- Transformers, The Weebols Movie. Some are ads for merchandising related to Disney and some are ads for interactive computer and internet games. The last thing I need is my savey four year old on the internet at this age. Now "MENU" is as forbidden during previews as it is during FBI warnings, although skip will take you past one of the X number of previews. Then, last week, the final indignity. On the Wiggles DVD, "Menu" functioned properly, but the preview had been prepended to the episode!

I can understand being forced to sit through the FBI Interpol warning. However I think messing with the controls in any other way, preventing my skipping to the part I want to watch should be against the law. I have to say, I love videos -- I can get them used very cheaply, and we may just build our collection that way...and wait for technology to start serving consumers again.

Books that are too American

Recently I sent a care package to a German princess mewed in a tower in Spain. She's been keeping her sanity by reading English-language books, so I sent a wide variety of fiction and nonfiction to give her a mental escape route. However, as I came up with this list, I discarded a bunch of my favorite books as "too American" -- they were diverting, well written, but either too US-centric or required a sensitive finger on the American pulse to appreciate.

Only after I'd sent off the box did it strike me that as a set, the list of books that are "too American" was interesting. My patriotism has suffered in the last few years -- a week ago I passed the Statue of Liberty in a boat, and all I could think of was that recently we've really let Her down. But these books, inappropriate for my German Princess, have a uniquely American vitality. Some are nostalgic, some are unapologeticly critical, but they do embody a sense of life (sometimes struggle, sometime joy) that is truly unique. A small glimmer of hope for Liberty.

• Sarah Vowell -- The Partly Cloudy Patriot, Assassination Vacation, Take the Cannoli
• Connie Willis -- Lincoln's Dreams
• Eudora Welty -- in particular "Losing Battles"
• John McPhee -- just about anything
• James Loewen-- Lies My Teacher Told Me
• William Faukner -- As I Lay Dying
• Forrest Carter -- The Education of Little Tree
• Chaim Potok - My Name is Asher Lev
• Jean Craighead George -- My side of the Mountain
• Barbara Ehrenreich -- Nickel and Dimed
• To Kill a Mockingbird -- Harper Lee
• Stephen Dubner Morrow -- Freakonomics
• Susan Jane Gilman -- Hypocrite in a Pouffy White Dress

On Returning to Denver After 15 Years

So I went back to Denver to for the Science Fiction Recon Unit (SUFRU) reunion...I drove past the old house, the location of Toddy's, the Holly pool, went by (but not into) Kent Denver, ate ice cream (Grand Marnier chocolate in a chocolate dipped waffle cone -- yum, yum) at Bonnie Brae Ice Cream, went to the Tattered Cover (new location), went to the 16th Street Mall and found one of my two old climbing fountains in Skyline Park.

Two things really struck me about Denver. The first is that it's really big. Everyone warned me about how much development had happened, but it wasn't that which was surprising. Even when we lived there we saw the fields turned into developments -- Of the three large lots (tens of acres) near our house, the first (full of prairie dogs and dirt bike trails and mini canyons) was turned into the shopping center that housed Toddy's (site of my first job, bagging groceries), the second into upscale housing (where Dad got arrested with Stanley and Shane for setting off rockets in a dry field during a drought...and later subpoenaed the chief of police for his trial...) and the third, after I left home, into a public library. I wonder if it's easier in Colorado to let the fields go because they seem so featureless -- if you had to cut down trees or fill in wetlands you might find something to stage a protest over but in Colorado on the plains, one field looks much like another...each square foot doesn't seem individually valuable. Even the land that does get protected is called "Open Space", emphasis on emptiness.

So what did really shock me is how large the Denver Metro area is. I just didn't realize, as a teenager and beginning driver, how huge the metro area was. Washington DC plus suburbs is 30 miles across. Denver is easily 40 miles across. Really that hasn't changed much -- it was true fifteen years ago. We navigated this expanse as a matter of course -- Aurora to see Lawrence, Broomfield to see James, downtown to Megan's, Bonnie Brae Hobby Shop, and Vince, then field trips to Boulder and Red Rocks. The fabulous prom dinner I remember was in Thorton, 10 miles north of downtown Denver. Casa Bonita is six miles west of downtown. Brian Spanger and Matt Hazelton remember thinking that my family's house in a southern Denver suburb was out in the middle of nowhere (HA! then I dragged them to the "mountain house" beyond Red Rocks, and in a total fit of insanity to a Woodstock reenactment in Herford, Colorado, a scant 3 miles from the Wyoming boarder!).

Having lived in DC where often you can often choose between walking or take the metro, Raleigh (no more than 10 miles wide in any direction), Albuquerque (5 miles wide by 15 miles tall, including Rio Rancho), the scale of Denver just seems enormous -- and the idea that we drove all over it constantly, absurd. I didn't have specific rules about where I could take the car -- a '76 Jeep four wheel drive that got 12 miles to the gallon, but I got a $20 bill at the beginning of the week for gas, leftover change to go into my pocket, and that had to last. Let me tell you, that was a very short leash. I can't tell you the number of brilliant schemes discarded because we couldn't come up with enough gas money.

So what the development has done (beyond eating up all fields within the metro area) is added traffic beyond your wildest nightmares to this driving city. We knew in 1986 not to take the freeway during rush hour, but the freeway now has twice the number of lanes and is clogged during lunch as well. We drove the Mousetrap portion, just west of downtown, near 5 PM on a Saturday and a Sunday and found it clogged.

The second really notable thing about Denver is how prosperous and shiny it is. 16th Street Mall boasts every upscale venue you can think of -- you might as well be in Austin, San Francisco or Seattle: Hard Rock Cafe, Banana Republic, NikeTown, ESPN Zone, no less than three Starbucks, two Ann Taylors, Chipotle, The Cheesecake Factory, Rock Bottom Brewery, and Virgin Records Megastore, P. F. Chang's China Bistro, Ruth's Chris Steak House. (Of course this has it's plus side, Title Nine, my favorite catalog for bra's has a store here, note that the other stores are in Berkley, Seattle, and Portland -- I rest my case). Hidden among these names are a few pricier Colorado businesses...Rocky Mountain Chocolate Factory, Overland Sheepskin Co., and, OK, Jimmy John's Sandwiches.

When I was there there was a struggling symphony, a non-collecting but fun art museum, and a Zoo. Now Denver has a Children's Museum ($7 apiece for those over 12 months old ), a 90 million dollar new wing to the art museum, Opera, Ballet, a new Museum of Contemporary Art (in addition to the one with the new wing), and an aquarium, "Colorado Ocean Journey" (now in addition to finding the same retail everywhere you go, now you don't have to distinguish between cities with and without an ocean!).

The King Soopers which replaced Toddy's in Orchard Commons is way, way upscale. OK, so Toddy's had Parcel Pickup and carpet on the floor, but this King Soopers is very shiny. Michael was drooling -- Albuquerque has Wild Oats, which is fun to visit, but you can't shop there because they don't have things like dryer sheets and normal flavors of toothpaste. We have Rayley's, which pays their employees a living wage and gives them health insurance -- its fun to shop there because the employees are actually cheerful. But these have glaring florescent lighting, faint bleach smells and worn linoleum -- all the romantic ambiance you might expect from a grocery store. (I confess that the Westminster King Soopers and Downtown King Soopers were more normal versions...).

Our old neighborhood, Palos Verdes, is "pleasantville" tidy. There are a scant few weedy dirt yards, but they are vastly outnumbered by astroturf perfect greens marked with "Chemlawn" flags. Michael and I hung out in the little playground between Orchard Commons and Palos Verdes for about 40 minutes, overlapping with some sort of mom and toddler playgroup at 10AM on a Monday. We were within 15 feet of six moms with children of identical ages to Lynn and not one of them said hello to us -- there was this strong feeling we were crashing the party. Maybe it's just that I had brought Michael, who clearly should have been at work, earning the family bacon.

We walked by the old house -- still dark brick and vine covered. The lilac bush seems to have recovered from Mom's drastic pruning in 1984. They've taken out a tree in the back yard -- the light is very nice. Nobody home to let us in.

After a 7 hour trip in the car to Denver, Lynn was burning off unused energy, so I moved the car so she could walk from the park. We got out the stroller and circled the block, which brought back few memories. I think moving into a neighborhood at age 13 means you never really settle in -- the exploring, patrolling-your-territory-age is younger, maybe seven or eight? Even the house that backed up to ours returned our lost balls by silently launching them across the six foot privacy fence -- I have no idea who lived there. When we returned to the car, stowed the stroller, and coaxed Lynn back into the carseat, a women came out of the house we'd parked in front of to inquire pointedly, if politely, if we needed any help. Just what I'd wonder of two people with a kiddo and stroller who were obviously leaving.

After Orchard Commons, Palos Verdes, a drive through of Cherry Hills, and a drive-by of Kent Denver, Michael remarked "I could see how Eddy and SUFRU would be a breath of fresh air".

At the end of the trip we left with the sense that we were certainly priced out of Denver. We'd have to make a great deal more money to live there now. Albuquerque seems a bit impoverished by comparison. Well, let's says it has a shabby charm, which seems to go with crumbling adobe and the closed cowboy-themed motel on route 66. And no traffic, so to speak.

PS, Interestingly enough the incomes aren't very different for the two: Denver, median $39,500, per capita $24,101, average home $213,068. Albuquerque median $38,272, per capita $20,884 per capita, average home price $204,502. What this doesn't taken into account is that Denver has this huge outlying area (1.8 million), while Albuquerque has maybe Rio Rancho (67 thousand) and Bosque Farms (4000)...numbers from Wikipedia.

I love my doctor

A year ago, my three year old woke us up screaming in the middle of the night. Not tantrum-screaming, bloody-murder screaming. We turned on the lights, picked her up, found the favorite blanket, and tried to hold her writhing body. After about 20 minutes, without so much as a pause for air on her part, we called our pediatrician's after-hours number. This connected us to a switchboard who asked us several questions (date of birth, weight, etc) who then transferred us to a pediatric-nurse hotline, who then asked the same questions. She unhelpfully suggested we undress her to see if we saw anything on her body (hard to do with a screaming-writhing kid), then confessed she had no idea what to do and we should probably take her to the emergency room "just in case". Thinking that my pediatrician had admitting privileges at only certain hospitals or the practice might prefer the children's hospital, I asked which hospital to take her to. "The nearest one" she replied -- at which point I discovered that this nurse was in Wisconsin (we, and our pediatrician live in New Mexico). We bundled the now-naked screaming kid into the car and took off.

This isn't the first time a doctor (or their practice) has let us down in a time of need. I've waited for three hours for an appointment. I have had the temporary "doctor of the day" in a group practice override written instructions left by my midwife (who I can't see because she has to be scheduled five weeks in advance -- in fact my monthly appointments have to be "fit in"). A number of baby books have chapters on "How to select your child's pediatrician". You might as well save your breath. No matter how carefully you research your pediatrician you will see him or her only for scheduled shots. The majority of visits (head bonks, ear infections, weird rashes -- the most important visits from the patient's/parents's point of view) can't wait three weeks, so you will be seen by a rotation of nurse practitioners, none of whom will be working for the office next time you call. I've waited six weeks to see a doctor I'd hand picked to discuss surgery options, only to discover someone had changed my appointment so I'll be seeing the newly minted MD resident instead.

But it doesn't have to be like this. And right now, it isn't. Friends of ours recommended a doctor they "really liked" -- little did they tell me this was going to be a life-changing experience for our family. The first indication was her receptionist telling us that the first appointment would be for an hour, and suggesting that it would be better if we were completely well at the time of that appointment. With an hour, our new doctor had enough time to listen and take a health-history, write out ongoing prescriptions, and discuss toddler ear-infection philosophies. She takes her own call, except when someone covers for her on vacation. Standard appointments after the first are for 30 minutes and can usually be scheduled in a few days. What I call "fit in" appointments are 10-15 minutes and are usually same day or next morning. These include single issue urgent items: can you look at the baby's ear? Does she have pink eye? This family doctor understands the dynamics of infection in a family using daycare, she can check all of our throats for strep, and is gently, gradually getting us to take better care of our heath -- stress reduction here, cholesterol there. The difference continuity of care makes is enormous. Here is someone I actually trust -- she's been there for me, she knows how I think about my health and she sets me challenges -- I'm actually doing yoga and walking, rather than just thinking about it. As a single healthy 20-something, medical care played a tiny part in my life, but now as a 36 year-old with a child, this makes such a big difference in our quality of life I can't imagine moving, unless she comes with us. Oddly enough this "quality of life" effect persists outside her office. Read something scary on the web? Don't worry, we'll print it out and take it to the next visit for her opinion. Baby has a fever on a Friday afternoon? No panic. We'll treat it with ibuprofen, and if she breaks out in Dengue fever on Saturday, our doctor will be there. Someone we trust, who knows us, will answer the phone.

I've been told you can get medical treatment of this quality in large cities such as Washington DC and Los Anglos, under the name of "concierge medicine"-- you pay an annual fee $1,000-$20,000 (completely unreimbursable under your health insurance). For this you get continuity of care, same day appointments that start within 30 minutes of their scheduled time, and the pager number of your doctor. The extra money allows the doctor to see fewer patients and run a smaller practice without losing income.

But what my doctor is doing is different. She's in a solo practice; she calls it "providing a medical home for her patients". She's part of a larger group that calls their goal Ideal Micropractice. They are participating in a study by The Physicians Foundation for Health System Excellence (the preliminary and rather technical report).

I asked her what this is like from her perspective. In the old office she used to see 20-25 patients a day, then chart for 2 hours, and answer calls. Now she sees 10-12 patients each day, giving her time to care for and enjoy her relationship with patients. Unlike a group practice she does her own chores. She cleans up after herself, answers most of her own calls, call pharmacies, orders medical supplies, calls to find lost labs, and fills in forms. However, daily, it takes no more time than charting, answering calls and taking call did at the group practice. (She protests "It is still too much time!"). Her solo practice works financially because the average overhead for a family practice office is 65-70%. She's cuts this to 25-30%. So despite seeing half the number of patients, she makes (only?) 20% less than she would in a local group practice. While her solo practice is doing well, she does worry that in the long run, her practice will get squeezed to death between rising costs and malpractice, rising demands by all insurance plans for more paperwork and lower or flat insurance payments. She says she feels like she walks a thin line each day between the number of patients she can care for well, and the financial costs. (Actually her worst complaint is that she has to administer shots herself to the babies -- a chore the nurses get to do in typical group practice.)

It's not just me that appreciates the quality of care. The first visit with a newborn/new mom always includes help with breast-feeding. Teenagers don't have to explain delicate health issues to first a receptionist, then a nurse, before they get to a doctor they know and trust. She says "A lot of them call me from college with crises and news". There are about 50-70 of these doctors in the US (in addition to the small town types who have known their patients well for years).

Want one for yourself? You can get a list of them at

• Cutting Edge MDs (Excel format)
  and a map of where they work at:
• Ideal Micropractices

Do these people have anything in common? Does working solo actually imply a philosophy? In fact it they do seem to hold some common truths. They don't like medicine as it's being practiced -- they don't enjoy doing it and they don't think it's good for the health of their patients. While quality-of-care sounds like a throwback to small town family doctor days, they are pro-technology -- electronic records, evidence based medicine and surveys (in particular "How's Your Health") and determined to beat costly and debilitating disease by being proactive with patient behavior (note my walking and yoga...more than I've ever done for any other doctor).

Other article on micropractice/solo practice/ideal practice/medical homes:

• The article that started it all
• A blog of a half-time newbie solo doc

And the screaming in the middle of the night, how did that end? My daughter fell fast asleep in the car on the way to the emergency room. She stayed that way through the first two hours of our wait (I wasn't upset with the wait -- I was relieved she'd quit screaming and we certainly no longer looked like any kind of emergency) and then started causing mischief in the waiting room at 4 AM. Four hours after we arrived we gave up and went home, mostly exhausted but slightly uncomfortable about the lack of medical feedback that our kiddo was going to be OK. The next day the assistant to the nurse who assists our doctor called us (evidently they keep track of who uses the rent-a-nurse line) to see if we were OK. She tentatively suggested it might have been gas(!) or a nightmare(!) but didn't know for sure, not being medically trained. She also didn't offer us an appointment or a phone call to discus it with the doctor. She had no idea that the after-hours line connected to somewhere out of state. We fired that pediatrician -- or rather her practice -- and having found a "medical home" we haven't looked back.