ah, our little girl is growing up.
she turned 2 in september, and had a joint birthday with abby across the street, squeezed in between international travel. we left for buenos aires on her birthday. we kept it small this year. in fact, susan did not even want a non-family party. so it was low key and nice to do it jointly with friends. they joined us for our friday night costco outing (1-2x/month) to do the shopping. at one point during the party milagra disappeared! but it turns out she had gone into abby's place and was ok.
she also has moved from her crib into the big bed. we have a full guest bed on the floor. we were shopping for a new bed frame - found one at plummer's! but decided to just leave it on the floor to avoid the whole bed rail stage. she seems to be very good about staying in place. oddly, although she climbed out of the crib a few times at 18 months, she never did it again. it was just that she became increasingly resistant during her bedtime routine to being put down in the crib. normally we eat, play, bathe, and read books on the bed, then put her in the crib. so the new challenge is that when she wakes up, in the middle of the night or AM, she no longer stays put and plays quietly like she did in the crib. she comes running to our room. we tried different ways to recreate some boundaries, and settled on putting a gate outside her door. so she can open it, but cannot leave. it's worked quickly - even when the gate is not up, she will stop at the door and recognize she has to stay in her room.
11.09.2009
10.12.2009
don't cry for me ba
Saturday 9/19
Yay! milagra’s second birthday, we wake and gather our things for a long flight to argentina. with a stop in Atlanta, we spend ~15 hours in flight. we prepare with puzzles, coloring books, stickers, plastic food and other new toys.
at one point she was running through the airport in a hoodie with a plastic knife in her hand. uh oh.
she intermittently napped, ate, and played – and overall did very well.
since we went mainly south, the time difference was only 4 hours earlier.
we had rented a 2 bedroom apartment in recoleta. bidet in each bathroom took some tooling to determine the etiquette. any tips?
the place had been remodeled last year, and the owner just bought it this year. she’s a porteno (native) but has been living in DC with her Turkish husband for many years. they had requested that we pay upfront – in cash – i think the only time we’ve carried 4 figures in our wallet – so we were a bit apprehensive about the arrangements. but we met the property manager, young guy alex, and the owner and her friend and we seemed to hit it off well. she doesn’t have children but seemed to really love milagra. good thing – because we had to rearrange all the fragiles to keep them out of curious hands.
Sunday 9/20
we’re still quite tired, and travelling with child we have come to accept the need to honor the rest time that each of us requires. we went to the grocery store, walked around the neighborhood, had some gelato. some of the best ever: marsacapone con frutas y tiramisu. neither of us has been to italy, but i imagine it to be very similar – the food consists beef, pizza, pasta, empanadas, cake and wine. recoleta is a safe neighborhood, the doorman keeps an eye out for us, and there is a nice park across the street with a merry go round that runs at various hours.
susan gets to practice her spanish – too bad she didn’t prepare better right before the trip. the “ll” and “y” are prounced like “sh” which took some getting used to. but she enjoys immersion in a different culture, so we did our best to practice and ger around town.
argentine driving is notoriously frightening (i.e. mario) so we thought we might prefer the subway. but taxis were so cheap and convenient we only used it once. we must say though, it was very nerve-racking. no carseats, often no seat belts, and lanes are a guideline for the drivers, who usually speak no english at all.
Monday 9/21
susan and milagra head out to the corner cafe for a jarrito (3/4 espresso + ¼ milk) and tres medialunas, a common breakfast. hue meets up after quiet morning routine for himself. it was fun again to experience the culture – businessmen are making calls, but for the most part it seems that people don’t start work until quite late in the day. since susan loves coffee, we made it point to try a new cafe every morning. of course this meant making some eggs for the little one, then the cafe. lunch around 2pm and a late dinner. we didn’t go hungry.
so today we did the “BA free tour” which we highly recommend. Maca (macarena), sol and gaston run two walking tours 6d/wk to share their love of the city. they are ~30ish and speak good English, surviving mainly on tips. we meet at plaza congreso and milagra encounters the birds. city pajaritos, for which feeding dry corn provides endless hours of joy for children. now, both parents acknowledge that birds are yucky and dirty and carry disease, but watching her run around with the local kids trying to catch these pigeons was pretty fun.
we spend 3 hours walking around the city, learning about the history (good and bad), some of the politics, the architecture and other interesting tidbits. we see the pink house and witness our first of many protests in the street. this is the best way to learn a city – an overview of everything by someone with local knowledge, plus the chance to meet other tourists – from south africa, CA, kansas, lithuania, britain, etc.
but the best part is that we were walking and it was free – which meant we were able to swap in and out of the group, depending on what entertained milagra at the moment. so there were parts that hue learned and parts that susan picked up as well.
afterward we have amazing crispy pizza and more empanadas, then went downtown for some shopping, calle florida and the pacifico mall. the mall has a children’s area where milagra can play with blocks, legos or color – depending on her age – but she hits all areas regardless. and we have fun with the local kids by riding those automatic cars and carousels (2 pesos each)
we share some torta y bebidas and then head back home with our loot – but we have bad cab driver. it had started to rain, so we entered with all of our stuff (umbrella, stroller, ergo, baby, bags) before he answered susan’s question re: cost – and then he refused to turn the meter on. kept saying it was “not much” even though this was twice the real cost – and then when we ran into another protest that took some time to detour around – and probably realized that the price he quoted would now lose him money – he left us one block from our destination.
after that, we always got the quote before stepping inside (we should know better) but we had great drivers anyway.
at one mall, these 2 young guys were ushering people into cabs at a taxi stand, but it wasn’t clear what their role was. they didn’t look like official employees. so when we were ushered up and the driver balked at the quote, we just moved on without looking back. of course we find out later that those guys do take a cut off the ride for bringing in customers (at a taxi stand?)
Tuesday 9/22
it rains all day, so we head to abasto for our indoor activity. another mall, this is the jewish area of town, apparently a large community in BA. they have the only kosher McDonalds outside of israel, so of course susan wants hue to try it – and it is about the same. only no cheese, they are certain to remind him.
McD’s does not serve breakfast by the way, because you can’t get an egg or a bowl of oatmeal anywhere in the city. only coffee, pastries, and a submarino (bitter chocolate in a steaming cup of milk – hue’s daily fix). but McD’s does have an extensive McCafe where they also serve every type of coffee and sweets like all the others in the city. although susan loved this relaxed coffee culture best about the local cuisine, hue doesn’t drink coffee and we were both eager for an omelet by the time we left.
so the abasto mall has the museo de los ninos – kids museum – and it was great. there were school groups coming through, they had a place for nonambulatory babes to roll around, a grocery store, a farm, a soccer field, cars to drive, trucks to load. all the things you might expect, but it was really a nice museum. susan had a short-lived (thankfully) bug this day (no more food courts!), so it was good to be near to some clean restrooms and milagra could run at will.
afterward, we meet up with job and lalli (whose wedding we’re down here to attend) and job’s friend chuck who had flown in from dc. we ate near recoleta at cumana (excellent!) a place with bowls of meats and veggies. hue had some pumpkin stew that was delicious, and we all sampled some sweet empanadas for dessert. the wine was from mendoza, the napa valley of BA – very good, and the beer is called quilmes and actually tastes like wine – also very good.
milagra was getting restless at the establishment, but lalli was able to capture her attention wiht some table games, and she was won over (for life we think).
Wednesday 9/23
so we keep planning to hit that playground across the street, and still haven’t made it. the ground is still a little wet, but it’s a nice warm day. we have been shopping for children’s clothing – hard to try on adult wear with milagra running around the stores – and they have some very cute things. we thought it would be cheap to shop here, but actually it was comparable, if not more expensive, than the states. recent inflation apparently – the food was really cheap, but that was it. even at cumana, lalli said that prices had tripled in the few years that they had been eating there.
anyway, there was this coat that we saw and loved, but did not get because they had the wrong side. given how chilly these spring nights are, we felt it was necessary, so we went on a mission to find that place again to buy the coat (zuppachicos.com.ar). we couldn’t quite remember where the store was.. but eventually found it. back near calle florida, touristy but we didn’t mind.
since we were in the area, it was pacifico mall redux with more time on the 2 peso carousel with other kids. in the bathroom, susan noticed these teenage girls with a child, dressed like gypsies. multiple layers of clothing, barefoot. the woman ahead in line spoke disdainfully in spanish to susan about these kids, and refused to use the toilet stall next to them. susan kept her mouth shut as she didn’t understand every word – but was able to cut the line to her benefit. argentina is a socialist country, and in the city you don’t really see a lot of poverty. grafitti, protests, variations in the neigborhood retail, but not real poverty. we did see a few women on the street nursing young children, and then these teens – it was interesting that women were the ones who seemed impoverished (rather than santa monica, where it’s always a man with mental illness)..
we were out shopping again all day, when we suddenly realized that it was 4:30pm – and we had planned to do the other free tour at 5pm. the “aristocratic tour” of our own neighborhood, recoleta.
so we start running around, trying to figure out where to go, and hue smartly dodges into a hotel to get help from the concierge. it turns out that we were very close to where the tour begins, and we make it with just enough time to grab a submarino for the long walk ahead. maca was the tour guide this time (she attended but gaston was the lead on monday) and milagra was in a good mood. we walked through the art district, other historical places, and ended at the cemetary where eva peron is buried.
we ended at buller’s, a local brewery, where the beer was good, but the food – more of the same. pizza, nachos, etc. we ordered a fruit bowl for the girl.
italian food is susan’s least favorite cuisine to begin with, and we were starting to believe that the lifespan here must be exceptionally short with all these fried foods and sweets – but the walking tours helped to justify the diet.
Thursday 9/24
another warm day, and we head to palermo soho, a place with lakes and paddle boats, zoo, and, uh, more shopping. maca had recommended a restaurant called la cabrera. the highlight meal of the trip: traditional argentine beef with all the tapas on the side. good service, and lots of interesting tastes. susan didn’t touch the meat all week, so hue consumed about ¾ pound in that sitting alone. but there were fava beans, roasted garlic, and all sorts of tasty salads that were delicious. highly recommended to other visitors.
we spend the day shopping and run across a place called “california massage”. curious, we ring the bell and are buzzed upstairs.
a young woman greets us in a flat with two massage tables, dimly lit with spare modern furnishings. seems safe and clean – and a full body massage for 40$ US ? yes.
hue takes milagra out to freddo’s, the local and extremely popular ice cream chain, and susan enjoys her massage.
at the end, they run a wand around these crystal bowls to create a soothing vibration, and later let milagra play with them. they have a beautiful sound and hue wants to bring one home. the california in the name, is because the owner’s massage school is from california by the way.
Friday 9/25
so we were thinking that we might join sol for a trip to the matadores fair on sunday, an opportunity to see the gaucho culture, horse riding games, and get a glimpse outside the city. but we were realizing that since the saturday wedding would end at 6am sunday, we might not be up for a 9am pickup to an all – day event.
since susan still wanted to do the gaucho thing, we joined a tour to estancia susanna on friday instead.
we meet up in this really nicely equipped bus, all excited, end up driving around to other hotels for an hour before transferring buses (also nice) and we realize that there are 2 groups. some going to the ranch, and some going to temaikken, which is the suburban zoo near the ranch. once we figured out why we were taking so long getting to our destination, we were irritated but felt slightly better (reminds of our trip to the great wall, which included many random stops along the way: medical school, jewelry shop, lunch..).
but as soon we arrive at the ranch, we are greeted with warm empanadas: beef, olive, onion, seriously the best all week, and the wine is free flowing. we start with a carriage ride and it is fast. no waivers or helmets, just hold on tight milagra! the gauchos don’t speak english, but are very sweet in handling the girl.
susan chose to go off and ride a horse on her own, and milagra panicked that she would not return, but hue distracted her with a museum tour until lunch.
on the way out the tour guide had been providing information about the area, first in spanish, then in english. so it took twice as long to get the same information. we see the hippodrome, and this giant metal flower that opens and closes with the light. when were seated for lunch at the ranch, we were with all of the others on our own bus, and talked for the 1st time (most people got off at the zoo). we laughingly realized that everyone spoke english, and varying degrees of spanish.
lunch consisted of beef, blood sausage, chicken, other sausage, other meats. hue ate well, and susan had bread and salad. thank goodness for the wine.
milagra met a one-year old boy and they danced on the stage during the meal. afterward, we had a tango show and then returned outside to see the gauchos do some tricks. we had seen a woman take an infant on a horse ride – just propped him in her lap – and susan was telling her tablemates ( who live down the street in LA!) how crazy it was to have a child on a horse like that. when hue asked the gaucho to hold milagra in his lap for a photo op – then he rode off around the pasture! milagra was stunned into silence, which made her appear to be very well behaved. but it was shocking to susan..
it was a lot of fun – we let milagra run around again before boarding the bus, and she slept on the ride home.
Saturday 9/26
today is wedding day, so we had carefully considered how this is going to work for the girl. 9pm wedding – we will need an afternoon nap for us all. so we stay local at the recoleta fair, maca had called it a hippie fair because of all the mj smoke around – but the shopping was great. susan could have stayed for hours longer but we were nearing our nap time and milagra was breaking down.
so we returned to rest, and milagra and hue slept on the bed while susan cleaned the apartment and got ready for the wedding.
lalli’s brother (fede and nano) picked us up in the shuttle for their home town of platanos, and we gathered the other guests. there was a 3 yr old girl named victoria that became febrile during the evening – we spent some time admiring how quiet she was until we realized she was sick, and then we spent the night worried about her.
the ceremony was in spanish, performed by and italian priest in lalli’s home town outside the city. but milagra was restless, running up and down the pews, and we were really worried about her performance for the evening.
at the reception, she ate a fair meal, and then we brought her to the kid’s area with couches and other little one running about. we had food, dancing, food, dancing. eventually milagra took a nap, and woke around 4am and became a ham: dancing, running, playing with the glow toys. we sat with the other americans and it was a fabulous experience, but we were so exhausted that we didn’t partake in a lot of the dancing.
Sunday 9/27
we take the shuttle home from the wedding, and get in around 7am. we nap for a bit, and then head to san telmo for the antique fair. good thing we finished our gaucho day, because today was a 2nd day of rain. we had planned to meet up with these girls from south africa, but we were late to the fair and it was pouring rain. we took refuge in this restaurant in san telm where susan had her best meal: french onion soup and great submarino. we called it quits early and went back to the apt to pack.
Monday 9/28
flight home to lax, via atlanta. milagra is such a good sport - takes a lot of attention and energy from mom and dad, but a good flier nonetheless.
Yay! milagra’s second birthday, we wake and gather our things for a long flight to argentina. with a stop in Atlanta, we spend ~15 hours in flight. we prepare with puzzles, coloring books, stickers, plastic food and other new toys.
at one point she was running through the airport in a hoodie with a plastic knife in her hand. uh oh.
she intermittently napped, ate, and played – and overall did very well.
since we went mainly south, the time difference was only 4 hours earlier.
we had rented a 2 bedroom apartment in recoleta. bidet in each bathroom took some tooling to determine the etiquette. any tips?
the place had been remodeled last year, and the owner just bought it this year. she’s a porteno (native) but has been living in DC with her Turkish husband for many years. they had requested that we pay upfront – in cash – i think the only time we’ve carried 4 figures in our wallet – so we were a bit apprehensive about the arrangements. but we met the property manager, young guy alex, and the owner and her friend and we seemed to hit it off well. she doesn’t have children but seemed to really love milagra. good thing – because we had to rearrange all the fragiles to keep them out of curious hands.
Sunday 9/20
we’re still quite tired, and travelling with child we have come to accept the need to honor the rest time that each of us requires. we went to the grocery store, walked around the neighborhood, had some gelato. some of the best ever: marsacapone con frutas y tiramisu. neither of us has been to italy, but i imagine it to be very similar – the food consists beef, pizza, pasta, empanadas, cake and wine. recoleta is a safe neighborhood, the doorman keeps an eye out for us, and there is a nice park across the street with a merry go round that runs at various hours.
susan gets to practice her spanish – too bad she didn’t prepare better right before the trip. the “ll” and “y” are prounced like “sh” which took some getting used to. but she enjoys immersion in a different culture, so we did our best to practice and ger around town.
argentine driving is notoriously frightening (i.e. mario) so we thought we might prefer the subway. but taxis were so cheap and convenient we only used it once. we must say though, it was very nerve-racking. no carseats, often no seat belts, and lanes are a guideline for the drivers, who usually speak no english at all.
Monday 9/21
susan and milagra head out to the corner cafe for a jarrito (3/4 espresso + ¼ milk) and tres medialunas, a common breakfast. hue meets up after quiet morning routine for himself. it was fun again to experience the culture – businessmen are making calls, but for the most part it seems that people don’t start work until quite late in the day. since susan loves coffee, we made it point to try a new cafe every morning. of course this meant making some eggs for the little one, then the cafe. lunch around 2pm and a late dinner. we didn’t go hungry.
so today we did the “BA free tour” which we highly recommend. Maca (macarena), sol and gaston run two walking tours 6d/wk to share their love of the city. they are ~30ish and speak good English, surviving mainly on tips. we meet at plaza congreso and milagra encounters the birds. city pajaritos, for which feeding dry corn provides endless hours of joy for children. now, both parents acknowledge that birds are yucky and dirty and carry disease, but watching her run around with the local kids trying to catch these pigeons was pretty fun.
we spend 3 hours walking around the city, learning about the history (good and bad), some of the politics, the architecture and other interesting tidbits. we see the pink house and witness our first of many protests in the street. this is the best way to learn a city – an overview of everything by someone with local knowledge, plus the chance to meet other tourists – from south africa, CA, kansas, lithuania, britain, etc.
but the best part is that we were walking and it was free – which meant we were able to swap in and out of the group, depending on what entertained milagra at the moment. so there were parts that hue learned and parts that susan picked up as well.
afterward we have amazing crispy pizza and more empanadas, then went downtown for some shopping, calle florida and the pacifico mall. the mall has a children’s area where milagra can play with blocks, legos or color – depending on her age – but she hits all areas regardless. and we have fun with the local kids by riding those automatic cars and carousels (2 pesos each)
we share some torta y bebidas and then head back home with our loot – but we have bad cab driver. it had started to rain, so we entered with all of our stuff (umbrella, stroller, ergo, baby, bags) before he answered susan’s question re: cost – and then he refused to turn the meter on. kept saying it was “not much” even though this was twice the real cost – and then when we ran into another protest that took some time to detour around – and probably realized that the price he quoted would now lose him money – he left us one block from our destination.
after that, we always got the quote before stepping inside (we should know better) but we had great drivers anyway.
at one mall, these 2 young guys were ushering people into cabs at a taxi stand, but it wasn’t clear what their role was. they didn’t look like official employees. so when we were ushered up and the driver balked at the quote, we just moved on without looking back. of course we find out later that those guys do take a cut off the ride for bringing in customers (at a taxi stand?)
Tuesday 9/22
it rains all day, so we head to abasto for our indoor activity. another mall, this is the jewish area of town, apparently a large community in BA. they have the only kosher McDonalds outside of israel, so of course susan wants hue to try it – and it is about the same. only no cheese, they are certain to remind him.
McD’s does not serve breakfast by the way, because you can’t get an egg or a bowl of oatmeal anywhere in the city. only coffee, pastries, and a submarino (bitter chocolate in a steaming cup of milk – hue’s daily fix). but McD’s does have an extensive McCafe where they also serve every type of coffee and sweets like all the others in the city. although susan loved this relaxed coffee culture best about the local cuisine, hue doesn’t drink coffee and we were both eager for an omelet by the time we left.
so the abasto mall has the museo de los ninos – kids museum – and it was great. there were school groups coming through, they had a place for nonambulatory babes to roll around, a grocery store, a farm, a soccer field, cars to drive, trucks to load. all the things you might expect, but it was really a nice museum. susan had a short-lived (thankfully) bug this day (no more food courts!), so it was good to be near to some clean restrooms and milagra could run at will.
afterward, we meet up with job and lalli (whose wedding we’re down here to attend) and job’s friend chuck who had flown in from dc. we ate near recoleta at cumana (excellent!) a place with bowls of meats and veggies. hue had some pumpkin stew that was delicious, and we all sampled some sweet empanadas for dessert. the wine was from mendoza, the napa valley of BA – very good, and the beer is called quilmes and actually tastes like wine – also very good.
milagra was getting restless at the establishment, but lalli was able to capture her attention wiht some table games, and she was won over (for life we think).
Wednesday 9/23
so we keep planning to hit that playground across the street, and still haven’t made it. the ground is still a little wet, but it’s a nice warm day. we have been shopping for children’s clothing – hard to try on adult wear with milagra running around the stores – and they have some very cute things. we thought it would be cheap to shop here, but actually it was comparable, if not more expensive, than the states. recent inflation apparently – the food was really cheap, but that was it. even at cumana, lalli said that prices had tripled in the few years that they had been eating there.
anyway, there was this coat that we saw and loved, but did not get because they had the wrong side. given how chilly these spring nights are, we felt it was necessary, so we went on a mission to find that place again to buy the coat (zuppachicos.com.ar). we couldn’t quite remember where the store was.. but eventually found it. back near calle florida, touristy but we didn’t mind.
since we were in the area, it was pacifico mall redux with more time on the 2 peso carousel with other kids. in the bathroom, susan noticed these teenage girls with a child, dressed like gypsies. multiple layers of clothing, barefoot. the woman ahead in line spoke disdainfully in spanish to susan about these kids, and refused to use the toilet stall next to them. susan kept her mouth shut as she didn’t understand every word – but was able to cut the line to her benefit. argentina is a socialist country, and in the city you don’t really see a lot of poverty. grafitti, protests, variations in the neigborhood retail, but not real poverty. we did see a few women on the street nursing young children, and then these teens – it was interesting that women were the ones who seemed impoverished (rather than santa monica, where it’s always a man with mental illness)..
we were out shopping again all day, when we suddenly realized that it was 4:30pm – and we had planned to do the other free tour at 5pm. the “aristocratic tour” of our own neighborhood, recoleta.
so we start running around, trying to figure out where to go, and hue smartly dodges into a hotel to get help from the concierge. it turns out that we were very close to where the tour begins, and we make it with just enough time to grab a submarino for the long walk ahead. maca was the tour guide this time (she attended but gaston was the lead on monday) and milagra was in a good mood. we walked through the art district, other historical places, and ended at the cemetary where eva peron is buried.
we ended at buller’s, a local brewery, where the beer was good, but the food – more of the same. pizza, nachos, etc. we ordered a fruit bowl for the girl.
italian food is susan’s least favorite cuisine to begin with, and we were starting to believe that the lifespan here must be exceptionally short with all these fried foods and sweets – but the walking tours helped to justify the diet.
Thursday 9/24
another warm day, and we head to palermo soho, a place with lakes and paddle boats, zoo, and, uh, more shopping. maca had recommended a restaurant called la cabrera. the highlight meal of the trip: traditional argentine beef with all the tapas on the side. good service, and lots of interesting tastes. susan didn’t touch the meat all week, so hue consumed about ¾ pound in that sitting alone. but there were fava beans, roasted garlic, and all sorts of tasty salads that were delicious. highly recommended to other visitors.
we spend the day shopping and run across a place called “california massage”. curious, we ring the bell and are buzzed upstairs.
a young woman greets us in a flat with two massage tables, dimly lit with spare modern furnishings. seems safe and clean – and a full body massage for 40$ US ? yes.
hue takes milagra out to freddo’s, the local and extremely popular ice cream chain, and susan enjoys her massage.
at the end, they run a wand around these crystal bowls to create a soothing vibration, and later let milagra play with them. they have a beautiful sound and hue wants to bring one home. the california in the name, is because the owner’s massage school is from california by the way.
Friday 9/25
so we were thinking that we might join sol for a trip to the matadores fair on sunday, an opportunity to see the gaucho culture, horse riding games, and get a glimpse outside the city. but we were realizing that since the saturday wedding would end at 6am sunday, we might not be up for a 9am pickup to an all – day event.
since susan still wanted to do the gaucho thing, we joined a tour to estancia susanna on friday instead.
we meet up in this really nicely equipped bus, all excited, end up driving around to other hotels for an hour before transferring buses (also nice) and we realize that there are 2 groups. some going to the ranch, and some going to temaikken, which is the suburban zoo near the ranch. once we figured out why we were taking so long getting to our destination, we were irritated but felt slightly better (reminds of our trip to the great wall, which included many random stops along the way: medical school, jewelry shop, lunch..).
but as soon we arrive at the ranch, we are greeted with warm empanadas: beef, olive, onion, seriously the best all week, and the wine is free flowing. we start with a carriage ride and it is fast. no waivers or helmets, just hold on tight milagra! the gauchos don’t speak english, but are very sweet in handling the girl.
susan chose to go off and ride a horse on her own, and milagra panicked that she would not return, but hue distracted her with a museum tour until lunch.
on the way out the tour guide had been providing information about the area, first in spanish, then in english. so it took twice as long to get the same information. we see the hippodrome, and this giant metal flower that opens and closes with the light. when were seated for lunch at the ranch, we were with all of the others on our own bus, and talked for the 1st time (most people got off at the zoo). we laughingly realized that everyone spoke english, and varying degrees of spanish.
lunch consisted of beef, blood sausage, chicken, other sausage, other meats. hue ate well, and susan had bread and salad. thank goodness for the wine.
milagra met a one-year old boy and they danced on the stage during the meal. afterward, we had a tango show and then returned outside to see the gauchos do some tricks. we had seen a woman take an infant on a horse ride – just propped him in her lap – and susan was telling her tablemates ( who live down the street in LA!) how crazy it was to have a child on a horse like that. when hue asked the gaucho to hold milagra in his lap for a photo op – then he rode off around the pasture! milagra was stunned into silence, which made her appear to be very well behaved. but it was shocking to susan..
it was a lot of fun – we let milagra run around again before boarding the bus, and she slept on the ride home.
Saturday 9/26
today is wedding day, so we had carefully considered how this is going to work for the girl. 9pm wedding – we will need an afternoon nap for us all. so we stay local at the recoleta fair, maca had called it a hippie fair because of all the mj smoke around – but the shopping was great. susan could have stayed for hours longer but we were nearing our nap time and milagra was breaking down.
so we returned to rest, and milagra and hue slept on the bed while susan cleaned the apartment and got ready for the wedding.
lalli’s brother (fede and nano) picked us up in the shuttle for their home town of platanos, and we gathered the other guests. there was a 3 yr old girl named victoria that became febrile during the evening – we spent some time admiring how quiet she was until we realized she was sick, and then we spent the night worried about her.
the ceremony was in spanish, performed by and italian priest in lalli’s home town outside the city. but milagra was restless, running up and down the pews, and we were really worried about her performance for the evening.
at the reception, she ate a fair meal, and then we brought her to the kid’s area with couches and other little one running about. we had food, dancing, food, dancing. eventually milagra took a nap, and woke around 4am and became a ham: dancing, running, playing with the glow toys. we sat with the other americans and it was a fabulous experience, but we were so exhausted that we didn’t partake in a lot of the dancing.
Sunday 9/27
we take the shuttle home from the wedding, and get in around 7am. we nap for a bit, and then head to san telmo for the antique fair. good thing we finished our gaucho day, because today was a 2nd day of rain. we had planned to meet up with these girls from south africa, but we were late to the fair and it was pouring rain. we took refuge in this restaurant in san telm where susan had her best meal: french onion soup and great submarino. we called it quits early and went back to the apt to pack.
Monday 9/28
flight home to lax, via atlanta. milagra is such a good sport - takes a lot of attention and energy from mom and dad, but a good flier nonetheless.
9.09.2009
hot in the city
bad news on the family front.
hue's stepdad was diagnosed with metastatic cancer of unknown primary. he was diagnosed with a met in his cervical spine, with 50% cord compression. which puts him at high risk of developing quadraplegia =/- respiratory depression. hue's mom has been in need of a lot of support, and has had trouble navigating the health system.
so we made a split decision to hop on a plane and go to taipei for labor day weekend. we had been planning our vacation to argentina with milagra, so she had her passport and her flu shot, and we were ready to go.
direct flight, thank goodness. we arrived late at night and got to catch up on the medical news. the weather was humid, 80' and 90's. ah, hard asian beds. milagra slept well in her peapod tent.
then an early morning, off to the hospital to see uncle liu. we visited, then held a meeting with his surgeon. he had been taken to the OR for internal stabilization of his spine, but the surgery was not successful. they did get a biopsy, and during this meeting the final pathology came back as: lung cancer. susan reviewed his films and conferenced with the family, including anchun, hue's stepbrother.
treatment options are limited: attempt anterior approach surgically. use external stabilization. chemotherapy with iressa. radiation to the spine. prognosis - 3-6 months.
we eat in that hospital food court often. we meet with radiation oncology. we meet with the oncology resident. on a trip to visit a family friend, susan talks to their son who is an oncologist, to discuss the taiwan health system and options. it's a national health system. basically you get choice A, which has good outcomes, but is harsh and not usually recommended for older patients. if you fail A, then you can take B, which is well tolerated but does not have significant benefit to the patient. If you skip A and start with B, you have to pay out of pocket, which ended up being the final decision here. the family also declined further surgery, radiation, or spinal stabilization. the doctor advised "don't fall" .
the government also pays for caregivers from Indonesia (?). it was a whirlwind busy trip, where hue was able to see susan's work in play. prognosis and treatment options in cancer. by the last day we were able to see some peace in hue's mother, but since then of course there is still a lot of grieving and struggle. uncle liu also was able to make some clearly stated wishes regarding end of life care. and on that last day milagra napped in the bed with uncle liu and played with him and it was very touching to see that interaction. she and her yeah yeah have a very special connection. she still asks for him.
we did have a bit of fun - we learned that milagra loves the piano, she played it at the house - and we spent an evening at the night market, where we ran out of NT (money) or we would have bought more super cute baby shirts.. milagra was able to ride this amusement park contraption where she went up and down in little airplanes. it was such a joy.
we saw the largest spider EVER crawling along the wall of the staircase. susan still has nightmares. we're talking wild tarantula.
and that oncology gentleman that susan spoke to on the phone from his parents house? turns out that she went to school with him - they worked on a project together while she was working on her Master's at UCLA. small world. so he stopped by the house for a visit. separate story- and another lesson in patient - physician communication for the husband.
we don't expect to be back to taiwan anytime soon, so we felt that this was a critical visit for the family. we've been skyping hue's mom every week to keep up on developments and uncle liu appears stable. we hope that he remains comfortable.
hue's stepdad was diagnosed with metastatic cancer of unknown primary. he was diagnosed with a met in his cervical spine, with 50% cord compression. which puts him at high risk of developing quadraplegia =/- respiratory depression. hue's mom has been in need of a lot of support, and has had trouble navigating the health system.
so we made a split decision to hop on a plane and go to taipei for labor day weekend. we had been planning our vacation to argentina with milagra, so she had her passport and her flu shot, and we were ready to go.
direct flight, thank goodness. we arrived late at night and got to catch up on the medical news. the weather was humid, 80' and 90's. ah, hard asian beds. milagra slept well in her peapod tent.
then an early morning, off to the hospital to see uncle liu. we visited, then held a meeting with his surgeon. he had been taken to the OR for internal stabilization of his spine, but the surgery was not successful. they did get a biopsy, and during this meeting the final pathology came back as: lung cancer. susan reviewed his films and conferenced with the family, including anchun, hue's stepbrother.
treatment options are limited: attempt anterior approach surgically. use external stabilization. chemotherapy with iressa. radiation to the spine. prognosis - 3-6 months.
we eat in that hospital food court often. we meet with radiation oncology. we meet with the oncology resident. on a trip to visit a family friend, susan talks to their son who is an oncologist, to discuss the taiwan health system and options. it's a national health system. basically you get choice A, which has good outcomes, but is harsh and not usually recommended for older patients. if you fail A, then you can take B, which is well tolerated but does not have significant benefit to the patient. If you skip A and start with B, you have to pay out of pocket, which ended up being the final decision here. the family also declined further surgery, radiation, or spinal stabilization. the doctor advised "don't fall" .
the government also pays for caregivers from Indonesia (?). it was a whirlwind busy trip, where hue was able to see susan's work in play. prognosis and treatment options in cancer. by the last day we were able to see some peace in hue's mother, but since then of course there is still a lot of grieving and struggle. uncle liu also was able to make some clearly stated wishes regarding end of life care. and on that last day milagra napped in the bed with uncle liu and played with him and it was very touching to see that interaction. she and her yeah yeah have a very special connection. she still asks for him.
we did have a bit of fun - we learned that milagra loves the piano, she played it at the house - and we spent an evening at the night market, where we ran out of NT (money) or we would have bought more super cute baby shirts.. milagra was able to ride this amusement park contraption where she went up and down in little airplanes. it was such a joy.
we saw the largest spider EVER crawling along the wall of the staircase. susan still has nightmares. we're talking wild tarantula.
and that oncology gentleman that susan spoke to on the phone from his parents house? turns out that she went to school with him - they worked on a project together while she was working on her Master's at UCLA. small world. so he stopped by the house for a visit. separate story- and another lesson in patient - physician communication for the husband.
we don't expect to be back to taiwan anytime soon, so we felt that this was a critical visit for the family. we've been skyping hue's mom every week to keep up on developments and uncle liu appears stable. we hope that he remains comfortable.
6.30.2009
5 years
we celebrate our 5th anniversary with a trip to hawaii. hue had been to kauai, but susan had never been to the state before. after much deliberation about the timing - every anniversary susan is either on-call or busy with some other work related event (last year milagra had a febrile seizure on our anniversary, and we were also submitting the PIF for program accreditation..)
so we decide to take a week away together - alone - before the start of the new palliative fellowship. it was our first extended time away from milagra. susan had a business trip to colorado, and she pumped milk, and a trip to texas where she also pumped milk. this would be a good opportunity to wean the tot, but in the end we decide to bring the pump on this trip as well.
so hue's dad and vicki move into the ranch to watch milagra and take her to school. we skype her every day but it seems that seeing us on tv only makes her more confused and agitated.
meanwhile, we take the trip. alas - a flight without a wiggling, curious child. one who needs to walk up and down the aisle and sleep across 4 seats and snack on goldfish and push playdoh into the chairs and requires a new activity every 20 minutes.. we remember why we used to enjoy flying. except - we planned to fly into kauai, and then on to oahu. a chance to do see all the major attractions. but the flight is late, really late. after we get into kauai we decide to just skip this leg and transfer on to oahu.
we stay at this nice hotel, ocean view, waikiki beach, where susan has the best nap ever. after a few days of spending very little time in the hotel, we decide to take keao up on his family connections and move over to another hotel at an unreasonably good rate. partial ocean view, courteous staff. every morning, we were awakened but sunlight streaming into the room. hue surprised susan - no sleeping in on vacation! so much to do.. but he did humor her with morning time for coffee and paper at a new place every day. this seems to be a recurring theme on vacation (see argentina. without the spanish-language news).
we hike diamond head. gorgeous views. yummy picnic at the dh market beforehand.
we horseback ride at kailoa ranch. this is where the show lost is filmed - we ride past other film sites, like jurassic park, 51st dates, etc. we ride through a herd of cows, which was pretty thrilling. truly one of the craziest rides ever. wild chickens run through the forest, who knew ?
we eat dinner late. we drink.
we watch hula dancer Kanoe Miller at House Without A Key. with drinks. and fireworks.
we use yelp every meal to determine where to go - gigantic pancakes at 24-7, macadamia nut / pineapple. we're talking huge - see the pics. we snacked on them all week.
susan developed a liking for shaved ice. we drove all over to sample. the best, by far, is at shimazu store.
we have a terrible but memorable brunch at smorgy's.
we go to costco and wal-mart, per keao's recs. we like to hit costco in every state or country we visit.
we walk along the beach, but amazingly, never go in until our last day. this is when we snorkel at haunama bay. ah, we couldn't do this with our daughter here.
we spend a day at the polynesian cultural center - highly recommended. we start planning our next trip to samoa or tonga or tahiti.. so sorry samoa was hit by a tsunami !! many memories from this day.. including susan losing her driver's license - pulled it out to buy some mochi. did we eat a lot here or what? never saw it again (it's november and i'm still driving with my passport. darn CA budget crisis, dmv never open..)
so boat parade, dancing, history of hula, luau with whole roasted pig, fire dance...
pearl harbor. uss arizona. susan spent an hour reading headlines from D-day newspapers. sigh. violence is cruel. we saw a sea turtle near the ship !
dole pineapple plantation. it takes 2 years to grow one pineapple. we do the garden tour, the maze, the history, the train ride.
we have taro pie at McD's.
malasadas at leanord's - hue's pick - chocolate, mango. decadent. susan's thighs grow just thinking about it.
hike to the lighthouse, watch a storm roll in.
ride up to north shore, watch the sun set. at sunset beach. try the garlic shrimp at the Giovanni's shrimp truck along the way.
flea market at the aloha stadium.
china town. of course - again, every city we have to see their chinatown. in fact 2 restaurants for one meal - dim sum and across the street for tofu dumplings.
and the very very best part of the trip -
for hue: doing so much every day and the polynesian cultural center.
for susan: daily foot massages on the waikiki strip at 11pm. these ladies work for "donation" probably because they're not licensed to be there. this guy jerry visits the beach often for work, and he seems to know all the characters. every night we same the same crew, with different tourists.. she befriends one of the ladies, who has a grown son and husband in the suburbs. they don't like that she comes down to the beach to work nights, but she does it to keep her independence, and make her own money. ends up being $20 for 40 minutes or so. wonderful after a full day of walking. this experience ruins her for life, and susan starts doing periodic maintenance massages once she gets home.
we love cities, and there was so much to do. we expect to return and experience the different islands. but a great way to celebrate our special event.
we did miss our daughter though!
so we decide to take a week away together - alone - before the start of the new palliative fellowship. it was our first extended time away from milagra. susan had a business trip to colorado, and she pumped milk, and a trip to texas where she also pumped milk. this would be a good opportunity to wean the tot, but in the end we decide to bring the pump on this trip as well.
so hue's dad and vicki move into the ranch to watch milagra and take her to school. we skype her every day but it seems that seeing us on tv only makes her more confused and agitated.
meanwhile, we take the trip. alas - a flight without a wiggling, curious child. one who needs to walk up and down the aisle and sleep across 4 seats and snack on goldfish and push playdoh into the chairs and requires a new activity every 20 minutes.. we remember why we used to enjoy flying. except - we planned to fly into kauai, and then on to oahu. a chance to do see all the major attractions. but the flight is late, really late. after we get into kauai we decide to just skip this leg and transfer on to oahu.
we stay at this nice hotel, ocean view, waikiki beach, where susan has the best nap ever. after a few days of spending very little time in the hotel, we decide to take keao up on his family connections and move over to another hotel at an unreasonably good rate. partial ocean view, courteous staff. every morning, we were awakened but sunlight streaming into the room. hue surprised susan - no sleeping in on vacation! so much to do.. but he did humor her with morning time for coffee and paper at a new place every day. this seems to be a recurring theme on vacation (see argentina. without the spanish-language news).
we hike diamond head. gorgeous views. yummy picnic at the dh market beforehand.
we horseback ride at kailoa ranch. this is where the show lost is filmed - we ride past other film sites, like jurassic park, 51st dates, etc. we ride through a herd of cows, which was pretty thrilling. truly one of the craziest rides ever. wild chickens run through the forest, who knew ?
we eat dinner late. we drink.
we watch hula dancer Kanoe Miller at House Without A Key. with drinks. and fireworks.
we use yelp every meal to determine where to go - gigantic pancakes at 24-7, macadamia nut / pineapple. we're talking huge - see the pics. we snacked on them all week.
susan developed a liking for shaved ice. we drove all over to sample. the best, by far, is at shimazu store.
we have a terrible but memorable brunch at smorgy's.
we go to costco and wal-mart, per keao's recs. we like to hit costco in every state or country we visit.
we walk along the beach, but amazingly, never go in until our last day. this is when we snorkel at haunama bay. ah, we couldn't do this with our daughter here.
we spend a day at the polynesian cultural center - highly recommended. we start planning our next trip to samoa or tonga or tahiti.. so sorry samoa was hit by a tsunami !! many memories from this day.. including susan losing her driver's license - pulled it out to buy some mochi. did we eat a lot here or what? never saw it again (it's november and i'm still driving with my passport. darn CA budget crisis, dmv never open..)
so boat parade, dancing, history of hula, luau with whole roasted pig, fire dance...
pearl harbor. uss arizona. susan spent an hour reading headlines from D-day newspapers. sigh. violence is cruel. we saw a sea turtle near the ship !
dole pineapple plantation. it takes 2 years to grow one pineapple. we do the garden tour, the maze, the history, the train ride.
we have taro pie at McD's.
malasadas at leanord's - hue's pick - chocolate, mango. decadent. susan's thighs grow just thinking about it.
hike to the lighthouse, watch a storm roll in.
ride up to north shore, watch the sun set. at sunset beach. try the garlic shrimp at the Giovanni's shrimp truck along the way.
flea market at the aloha stadium.
china town. of course - again, every city we have to see their chinatown. in fact 2 restaurants for one meal - dim sum and across the street for tofu dumplings.
and the very very best part of the trip -
for hue: doing so much every day and the polynesian cultural center.
for susan: daily foot massages on the waikiki strip at 11pm. these ladies work for "donation" probably because they're not licensed to be there. this guy jerry visits the beach often for work, and he seems to know all the characters. every night we same the same crew, with different tourists.. she befriends one of the ladies, who has a grown son and husband in the suburbs. they don't like that she comes down to the beach to work nights, but she does it to keep her independence, and make her own money. ends up being $20 for 40 minutes or so. wonderful after a full day of walking. this experience ruins her for life, and susan starts doing periodic maintenance massages once she gets home.
we love cities, and there was so much to do. we expect to return and experience the different islands. but a great way to celebrate our special event.
we did miss our daughter though!
6.05.2009
houdini
thursday night we found milagra standing on the floor in her room. that's a few minutes after we put her in her crib. we haven't witnessed it first hand, but our daughter is able to climb out of her bed. milagra's repertoire of tricks is growing everyday. the next morning she's out of her crib again...without either parent witnessing the feat. she won't do it in front of us (a magician never reveals her tricks). we're keeping our eyes glued to the video monitor from now on.
for her next accomplishment, she's also able to put on her own pants, which makes us think she may be ready for potty training. that's not to say that her parent are ready to take on this endeavor. baby steps as they say.
for her next accomplishment, she's also able to put on her own pants, which makes us think she may be ready for potty training. that's not to say that her parent are ready to take on this endeavor. baby steps as they say.
5.31.2009
new school year
we made the big move! hired movers to go one block. across the street. they were quick, but we made the mistake of letting them leave a few things behind, thinking that it would be easy to clean up and haul it over. that decision ended up being 20 grocery cart trips for hue, hauling item by item.
same phone numbers.
we've been extraordinarily blessed to have the privilege to stay at UCLA housing for 5 years. but it's finally time to go. we wanted to stay in the area, 1 mile from milagra's school. and also to keep our work commute light, which has been a priority.
shortly after the move, milagra was accepted into UCLA's preschool program. after 2.5 years on the wait list. we're thrilled with the program, the structure, and that we don't have to do the tours and waitlists all over again for preschool. our 2nd choice was the growing place in santa monica. hopefully we won't need that option.
same phone numbers.
we've been extraordinarily blessed to have the privilege to stay at UCLA housing for 5 years. but it's finally time to go. we wanted to stay in the area, 1 mile from milagra's school. and also to keep our work commute light, which has been a priority.
shortly after the move, milagra was accepted into UCLA's preschool program. after 2.5 years on the wait list. we're thrilled with the program, the structure, and that we don't have to do the tours and waitlists all over again for preschool. our 2nd choice was the growing place in santa monica. hopefully we won't need that option.
3.14.2009
dallas
Susan just finished attendance at the accreditation council on graduate medical education. She has been dreaming in core competencies. These kind of meetings always serve to encourage and inspire, a good setting for her own learning. Yet there is always the limiting factor of finding time to translate these ideas into the curriculum.
The first day was for new program directors and served to orient her to the residency review committee and the site visit process. The meeting focus was on residency duty hours, but with two fellows in hospice and palliative medicine, unless they are heavily moonlighting, exceeding hour limits is not likely. it remains a sensitive issue for many faculty though, and even she would tell you that some of her most meaningful learning experiences happened at the end of 40 hour days. As the restrictions are only going to become tighter, it’s not meaningful to keep lamenting the change.
One conference that hit home will be relayed here per her lecture notes:
K. Anders Ericcson from U of Florida
Constraint of supervision and feedback. Trainees get feedback re: their diagnosis but patients do not, have no idea what is happening to them.
Novice (cognitive) -> Master (intuitive)
Chess
Improving performance:
1. Requires feedback – over many cases but won’t improve you higher than the current trainers/faculty. How to be excellent?
2. Copy masters – art iterative, record chess games and note your moves vs the master. Chess rating is proportional to # of books owned on chess (or read)
3. Requires volume
4. Review errors – 1/50 -> 1/1000 iterative. 1904 considered outlawing double somersault dive b/c impossible and dangerous. Early Olympic winners would now not qualify for high school teams.
5. Specify necessary conditions – acquire fundamentals first diving. Piano techniques (one hand, then the other, alternate). What about Mozart? ~150 on a skill scale starting at 100. better than avg, but now avg children can become more advanced than Mozart at an earlier age. They looked at piano players daily activity. Leisure (most enjoyable), Sleep (least effort), Solitary (most relevant to practice). Best players practiced 9a-1p and napped more. Would train, sleep and eat. Avg players had not clustered peak practice time and less sleep. Also increased solitary practice by age. Peak as teenagers/20, 4 hours daily x 2 yrs.
Physical therapy. Pt management.
6. Learn to practice – increases duration.
7. Deliberate practice – specify coaching via repetition and refinement.
8. Experience is necessary – no prodigy without training. Career peak at age 30’s. young vs old pianists: Speed and Accuracy were the same if practice was maintained. But decreased intensity. Experts can be identified that way w/o demonstration of talent. Knowledge does not = performance. Socially defined expertise does not = superior performance.
IQ does not = performance, only true if you have reasonably high level of proficiency.
Cognition. Decision psychology. Gender concerns related to women having children during critical years of expert development.
Teachers. Experts not defined by k-12 skill in improving student performance or by education. Tenure. Clinical psychologist expertise not related to experience or education.
Objective measures. Running: same start. Same lane. Same finish. Don’t look for peer experts or past achievements or prior knowledge. Seek current performance and tx of pts.
9. Requires internal representation – methods and monitoring and changing child
10. Reach beyond your ability – elite athletes fall more than amateurs.
Measure current level of performance -> identify optimal training tasks -> teacher and coach critical.
Simulator – has not been trusted historically. Evidence for? When used with deliberate practice. Allows exposure to dangerous/rare situations under conditions Optimal for learning: learner is focused and ready, has immediate feedback, and comparable cases are available.
Knowledge vs Wisdom. Osler looked at >1000 autopsies to confirm diagnoses.
Review final discharge summary
Yes, genetic endowment is fundamental. But expertise may be “training-induced”
How to capture expert performance?
Daily activities mundane. It’s under stress/difficulty that they show expertise. So give trainees that stress. Structural differences in approach b/w novice and expert.
100 hrs observation of chess play (volume) vs few hrs focused on best moves (deliberate)
Music – play simple piece and have student repeat it. Best task.
Use critically unexpected problems / nurse.
Fake out the opposing player / soccer.
Emergencies / police.
How to get deliberate practice?
Cognitive (understand and start it) – Associative (practice) – Autonomous (not paying attention, no additional improvement. Get faster, not better)
Problems with automation and intuitive action. With suboptimal conditions and then how to check oneself and improve ?
Use thinking aloud processing:
Initial orientation / Generate possibilities (intuitive both) /
Explore possibilities / Look for consequences
Allows amazing things. Blindfold chess players. Briefly present chess board and expert memory will be near perfect (chunked) then scramble pieces to be random on board and memory is no better than novice. Meaningful patterns.
Experts constantly challenge self vs arrested development vs everyday skills.
Need time to think
Can STM improve? Took college student and trained from 7 digit memory to 80 digits in 1.5 yrs. Avg strategy = rehearsal. Key = meaningful associations and retrieval. Applies to ALL. Not a native or genetic trait.
Learnable. Teachable.
The first day was for new program directors and served to orient her to the residency review committee and the site visit process. The meeting focus was on residency duty hours, but with two fellows in hospice and palliative medicine, unless they are heavily moonlighting, exceeding hour limits is not likely. it remains a sensitive issue for many faculty though, and even she would tell you that some of her most meaningful learning experiences happened at the end of 40 hour days. As the restrictions are only going to become tighter, it’s not meaningful to keep lamenting the change.
One conference that hit home will be relayed here per her lecture notes:
K. Anders Ericcson from U of Florida
Constraint of supervision and feedback. Trainees get feedback re: their diagnosis but patients do not, have no idea what is happening to them.
Novice (cognitive) -> Master (intuitive)
Chess
Improving performance:
1. Requires feedback – over many cases but won’t improve you higher than the current trainers/faculty. How to be excellent?
2. Copy masters – art iterative, record chess games and note your moves vs the master. Chess rating is proportional to # of books owned on chess (or read)
3. Requires volume
4. Review errors – 1/50 -> 1/1000 iterative. 1904 considered outlawing double somersault dive b/c impossible and dangerous. Early Olympic winners would now not qualify for high school teams.
5. Specify necessary conditions – acquire fundamentals first diving. Piano techniques (one hand, then the other, alternate). What about Mozart? ~150 on a skill scale starting at 100. better than avg, but now avg children can become more advanced than Mozart at an earlier age. They looked at piano players daily activity. Leisure (most enjoyable), Sleep (least effort), Solitary (most relevant to practice). Best players practiced 9a-1p and napped more. Would train, sleep and eat. Avg players had not clustered peak practice time and less sleep. Also increased solitary practice by age. Peak as teenagers/20, 4 hours daily x 2 yrs.
Physical therapy. Pt management.
6. Learn to practice – increases duration.
7. Deliberate practice – specify coaching via repetition and refinement.
8. Experience is necessary – no prodigy without training. Career peak at age 30’s. young vs old pianists: Speed and Accuracy were the same if practice was maintained. But decreased intensity. Experts can be identified that way w/o demonstration of talent. Knowledge does not = performance. Socially defined expertise does not = superior performance.
IQ does not = performance, only true if you have reasonably high level of proficiency.
Cognition. Decision psychology. Gender concerns related to women having children during critical years of expert development.
Teachers. Experts not defined by k-12 skill in improving student performance or by education. Tenure. Clinical psychologist expertise not related to experience or education.
Objective measures. Running: same start. Same lane. Same finish. Don’t look for peer experts or past achievements or prior knowledge. Seek current performance and tx of pts.
9. Requires internal representation – methods and monitoring and changing child
10. Reach beyond your ability – elite athletes fall more than amateurs.
Measure current level of performance -> identify optimal training tasks -> teacher and coach critical.
Simulator – has not been trusted historically. Evidence for? When used with deliberate practice. Allows exposure to dangerous/rare situations under conditions Optimal for learning: learner is focused and ready, has immediate feedback, and comparable cases are available.
Knowledge vs Wisdom. Osler looked at >1000 autopsies to confirm diagnoses.
Review final discharge summary
Yes, genetic endowment is fundamental. But expertise may be “training-induced”
How to capture expert performance?
Daily activities mundane. It’s under stress/difficulty that they show expertise. So give trainees that stress. Structural differences in approach b/w novice and expert.
100 hrs observation of chess play (volume) vs few hrs focused on best moves (deliberate)
Music – play simple piece and have student repeat it. Best task.
Use critically unexpected problems / nurse.
Fake out the opposing player / soccer.
Emergencies / police.
How to get deliberate practice?
Cognitive (understand and start it) – Associative (practice) – Autonomous (not paying attention, no additional improvement. Get faster, not better)
Problems with automation and intuitive action. With suboptimal conditions and then how to check oneself and improve ?
Use thinking aloud processing:
Initial orientation / Generate possibilities (intuitive both) /
Explore possibilities / Look for consequences
Allows amazing things. Blindfold chess players. Briefly present chess board and expert memory will be near perfect (chunked) then scramble pieces to be random on board and memory is no better than novice. Meaningful patterns.
Experts constantly challenge self vs arrested development vs everyday skills.
Need time to think
Can STM improve? Took college student and trained from 7 digit memory to 80 digits in 1.5 yrs. Avg strategy = rehearsal. Key = meaningful associations and retrieval. Applies to ALL. Not a native or genetic trait.
Learnable. Teachable.
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