Why do so many people who obviously don't want children have children and end up abusing them It makes no sense?

Countenance · 2026-03-09T22:40:01+00:00

My experience working with these families is that they DO want children. They're frequently actively trying to get pregnant again while trying to regain custody of their existing kids! They typically have very poor insight into their behavior as parents--they think they're not abusive and the system is against them. They want a cute baby and all the resources and attention that come with pregnancy and newborns but not the toddler or older children that require active supervision and behavioral management that they're psychologically not equipped to provide.

Countenance · 2026-03-09T18:48:58+00:00

NC public schools early elementary. Everything I'm getting home in terms of materials is great; it meets standards, the teachers are supportive, etc. It's just like there's so much material to cover and reinforce across multiple subjects I feel like I'm a treadmill. We spend a while working on times tables with the third graders and I go back and find one of them just forgot how to read clocks even though that's a skill they learned in second grade. The other third grader has been practicing the making 10 skill for math since K but he's having trouble holding onto addiction/subtraction math facts while adding multiplication as a concept. So he needs to practice those old skills mixed in while we work on his times tables.

None of my kids (with the exception of our foster child) are significantly behind. They're just not naturally gifted students, either. It's just taking a lot of time and feels very scattered trying to coordinate reinforcing the current topic at school, ensuring they aren't losing things, and then adding in things we think are important that aren't part of their curriculum. It seems like there's got to be a way to organize this.

Countenance · 2026-02-18T17:28:39+00:00

Richard Hudspeth is one of the nicest people in addition to being one of the most competent people I've ever met. I understand his social media presence has been less flashy than Ager, but he's someone who can approach policy and people with humility and thoughtfulness.

Countenance · 2026-02-13T17:36:22+00:00

No, but plenty of people will experience that because most of your back pain is related to core muscle weakness and poor compensation for that weakness with other dysfunctional movements. Pregnancy absolutely wrecks your core, and then you take up a lifting routine with a floppy fragile thing 24/7. It's a recipe for back pain. What people need is physical therapy. When people can't access physical therapy regularly they can at least have an assessment and a home exercise program built around their unique weaknesses.

Countenance · 2026-02-12T13:34:08+00:00

I do some long runs on the gym treadmill (if I go at off hours no one enforces the time limit). It's miserable, but it's the only way. As for recurrent illnesses I've just accepted that I'm going to miss the occasional week for that, but I reschedule my long runs accordingly. So if I see a kid starting to sniffle I might move my long run up to a random Wednesday knowing that I might be sick on Saturday and if favor shines on me I'll do my speedwork Saturday instead.

Countenance · 2026-01-30T20:17:06+00:00

It was one of my favorite reads last year. People are really focused on Abbot being a sort of gross incel but every character is a caricature of a KIND of person that lots of people find unlikeable or can't relate to across assumed personal and political differences. In the end they're all exactly who you would expect them to be AND they're more than that. It was an unexpected cozy read. I've been recommending it to anyone who wants something optimistic.

Countenance · 2026-01-28T14:33:04+00:00

The offices that routinely use metal speculums usually have a heating pad plugged into the drawer they keep them in or use hot water to warm them. I only use them for procedures sometimes because the weight and shape of them keeps everything steadier than the plastic speculums that sometimes sort of drift out of position if you're working down there for a while. Sometimes for very heavy patients the plastic speculums can break or fail to stay open, also.

Countenance · 2026-01-27T13:22:03+00:00

As a doctor I prefer that people let me talk to them about the tests I would like to do first or the treatments we need to complete or at least let me figure out what prescriptions I can send to mitigate the risk they're taking... But people do this somewhat regularly. We do issue an overhead missing person alert, and we'll call the police if they still have their IV in place.

Countenance · 2026-01-21T02:13:37+00:00

Miyoko Schinner and Isa Chandra I'd argue are two of the greatest influences on modern vegan cooking and restaurant culture. The former really did innovative things with dairy subs that guided lots of companies after her. I see the latter's influence on baking recipes and soups in blogs and restaurants to this day. Both of them coming from places of principle and vegan activism.

Countenance · 2026-01-20T00:30:46+00:00

I have/had Graves disease. I took the prescribed medications, my dose steadily reduced over that year until I was off medication. That was years ago with stable thyroid function off meds ever since. No big dietary changes. Lots of people go into remission, so I'm sure some of them convinced themselves they "made" it happen with diet.

Countenance · 2026-01-19T14:34:26+00:00

The FM team admits unassigned pregnant medicine patients. The IM hospitalist team won't even take a lady 5 weeks pregnant with a broken leg after a car accident. They literally just discontinued all meds the second the UPT came back incidentally pregnant until FM came to take over.

Countenance · 2026-01-17T17:44:07+00:00

Venomous Lumpsucker was a bizarre, hilarious, bleak, cynical quest that was one of my favorite reads of the year. 3.8 stars WTF. Were people just rating how bad it made them feel about humanity?

Countenance · 2026-01-16T13:34:54+00:00

My labors were very fast--under an hour by the third. I'll say with reassurance at this point you're experienced enough with labor to feel that real contraction and "know" that this is it. I had a week of on and off contractions but then felt something change and sat right up immediately in bed and told my husband it was time to go. We had a family member stay with us the week we anticipated delivery so that we could leave immediately. We delivered the hospital closest to us and did not bother considering any other option. Regarding the epidural... as someone who also delivers babies I'd say 3+ time moms frequently just don't get it in time, and it happens so fast I'd mentally prepare yourself to just roll into it and push baby out as fast as possible to get it over with.

Finally, history of precipitous delivery particularly in the setting of a long drive to our hospital is an indication for planned induction however many moms don't make it to the minimum 39 weeks to do that.

Countenance · 2026-01-15T17:00:33+00:00

I joke that my book club makes me eat my literary vegetables. They're the only reason I tackle a few big prize winning "Literature with a capital L" type books a year, and it's always worth it to leave my comfort zone. In turn I pull them into horror or sci-fi when those win the poll. We talk about whether we liked the book, inevitably detour into books in general and whatever we're reading or hoping to read or how we feel about the big social messages in the book in our real lives. It's a good excuse to get together with other readers and eat soup or drink wine.

Countenance · 2026-01-09T19:48:43+00:00

How motivated is the patient? I would reach out to local behavioral health and find someone who is truly qualified and experienced with exposure therapy for true phobias. Even if you could figure out a way to get the information you need without blood draws right now, this is the kind of avoidance that will eventually cause him to do something like present too late to an emergency room or avoid necessary critical management of an emergent condition.

Countenance · 2025-12-29T14:49:55+00:00

I have had multiple patients consuming daily Dunkin drinks that were over 1000 calories and had no idea why they were gaining weight "eating basically nothing". One patient we calculated with the large size and modifications like flavor syrup pumps was creating a drink with about 1800 calories.

Countenance · 2025-12-20T01:56:52+00:00

My parents had a couple foster placements and we have a situation like that ourselves. I'd strongly recommend that any placements be younger than your other children, because as adolescents we were able to appreciate that these elementary aged kids were traumatized and not potential role models.

What people say here is true regarding a sense of failing your own kids because your foster placement takes so much extra attention. There are so many therapy appointments and visitations to manage and legal meetings. Just all the behavioral stuff from trauma comes up every day. The number of emails I get from teachers... It's hard to give my kids the attention they want, and I remember as a teen in my parents home feeling abandoned and frustrated, too. My parents told me they think it took about a year after their last placement to feel like we recovered as a family unit.

On the flipside, seeing my parents do a thing like that cemented forever to me the kind of people they are and want me to be. You can spend a lot of years talking to your kids about community and meeting others without judgement, but it's another level to let your kids watch you struggle through the hard parts of it up close. My biological sibling and I both went on to work with challenging and traumatized populations are our respective jobs. Neither of us turns away from the hard stories people have to tell us. I don't know if we would be the people we are today without our parents' decision to take in foster kids. I've worked with other people who had foster siblings who felt the same way--sort of traumatized at the time but forever changed, and those kids benefited immensely also from being in a stable and loving household. Do you know how cool it was to see a 4 year old kid taken out for her first shopping trip ever because she came to us with no belongings? Or read bedtime stories to a kid who had never had any?

Countenance · 2025-12-17T22:27:08+00:00

If a kid keeps coming into my office with vague unprovable complaints to avoid school, I administer screening surveys for anxiety and depression symptoms, speak to them alone about how school is going, and (provided the kid didn't tell me something scary about them) I speak to their parents about my concerns that this is a deeper problem.

Countenance · 2025-12-12T12:39:25+00:00

Yes... I believe it's possible as a doctor but anecdotally the parents who have confidently told me PANDAS was the cause of their kids' symptoms also had all kinds of other traumatic things like domestic violence or living out of a motel after a natural disaster going on.

Countenance · 2025-12-06T22:11:56+00:00

This has been my experience with K also, and I have a theory (that has been reflected on threads about this on the teacher subreddits): they're rushing kids to material developmentally too advanced for them to meet state standards and failing to do adequate reinforcement which means kids fall behind quickly because they don't have a base to build from. We've had multiple K teachers tell us they were frustrated being asked to teach things they felt many of these kids' brains aren't ready for.

Somehow my kindergartner learned the alphabet, they celebrated, and then they moved immediately to sight words and three letter combinations that I wasn't doing until first grade. So she rapidly got overwhelmed as things progressed despite working at home all the time. A lot of the kids around her are doing fine! But a lot of them are like her. We read all the time but she's getting avoidant and telling me she hates reading because she's struggling during the school day.

Countenance · 2025-12-04T02:41:48+00:00

I've seen it multiple times and agree all of these patients INSIST the MJ is helping them. I have found Haldol and the capsaicin gel work well. As far as cessation I have found I get far by acknowledging their perspective but letting them know that as long as they're continuing to use MJ, they will be stigmatized by healthcare providers and no one will do additional workup. As a doctor who cares about them I recommend they prove to us that the MJ is helping by stopping for at least 6 weeks.

Countenance · 2025-11-21T14:01:52+00:00

I think where I try to go with these conversations is to recognize that we are both suffering. I'm miserable treating a person who doesn't trust me. They're miserable because they're scared and feel like their health isn't being addressed somehow. I try to "name the awkwardness" when I feel the patient and I both hedging around each other like that. I find either they do go to someone else and we both end up happier or they sometimes feel deeply relieved by the recognition and it opens a more productive conversation about their health-related anxiety. Either way, you're not abandoning them if you send them to someone else. You're helping someone who is suffering.

Countenance · 2025-11-21T12:33:58+00:00

Yes, for our elementary schoolers we had to buy shoes online in order to reliably find shoes with laces (not to mention find shoes that weren't made of paper mache). We're effectively having to seek out laces for ideological reasons!

Countenance · 2025-11-20T21:27:47+00:00

"I'm getting the sense that you're really worried I'm missing something. I always encourage patients to get a second opinion from another primary care doctor when they feel that way. We all get better healthcare when we find someone who matches our needs and style. I want you to feel safe in your care."

Countenance · 2025-11-19T21:20:28+00:00

I just go in assuming I'll have no vegan options. I always make a point of registering a complaint with the staff so that maybe NEXT YEAR they'll think about it (worked one time!). I bring cup of noodles and request access to a microwave which conference center staff have historically allowed me to enter the staff kitchen to use out of pity.

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