Strep, Love and Vomit

I am experiencing the phase in life that many parents of young children know all too well.  My children are ALWAYS sick.   Two weeks ago the entire family enjoyed a good old fashioned case of strep throat courtesy my four year old.  This week it was pink eye.  In between was perhaps the worst of all.

I went downstairs to check on my babies and could smell the foul aroma wafting out of their room, through the hallway and into the playroom (it seriously filled like 2000 square feet of space).  Any physician worth their salt can instantly identify that smell.  It was rotavirus.

I carefully investigated to determine who the culprit might be.  It was Baby Bird, the two-year old.  After lifting her unconscious body, it became immediately apparent that she had soiled her entire backside and the bed.  I plucked her out of bed and placed her on a towel in the bathroom.  In an emergency, the best thing to do is to call for help, so I leaned out into the hallway to yell for my husband.

Big Mistake.  Huge.

By the time I lean back in, Baby Bird has woken up and is spewing forth like a tiny Linda Blair.  It just keeps coming. Did you know that a twenty-four pound baby can hold up to a gallon of vomit?   Me neither.   It was on the floor, walls, my clothes, her clothes, in our hair, everywhere.   We put her in the bath and I set about cleaning up the puke when suddenly my husband, who is a sympathetic puker by the way, starts yelling for me as she starts puking in the tub and there is just so much puke.  Did I mention puke?

After a bazillion towels, a gallon of bleach, some plastic bags, and several days of reflection, I have come to one very important conclusion: Thank the Good Lord for Puke.

I have so many reasons to thank God in this situation.

  1. I have a wonderful husband who was willing to help me with my sick child.  Many women are in this parenting thing all alone.
  2. I had an almost endless supply of towels to clean up after my child and a totally endless supply of clean, fresh water.   I just think about some poor woman living with her toddler in a grass hut somewhere.  I am sure they have rotavirus in grasshutistan.  This poor lady doesn’t have an endless supply of clean fresh linens and clean fresh water to take care of their child.  Heck, they do not have enough clean fresh water for their child to drink probably.  Look at me with all my clean fresh water and towels.
  3. Being a doctor,  I had a readily available supply of nausea medication to medicate my child with.   I didn’t have to make the choice to blow this month’s budget in order to take care of my sick child.
  4. I have wonderful people willing to help me with my sick child while I work that I can implicitly trust with her care.  Did you see where I said people?  As in several.  As in several people that I can trust with my sick child.   Some people have NO support like this in their life.

So, yeah, I think I am pretty lucky with this stomach virus thing.  It could be a lot worse and is for many.  Thank you Lord again for your goodness in showing me how great I have it. wp-1486785740138.jpg

 

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Why Long John Silvers Will Kill You

It should be noted that this is shared with permission*

 

I saw an elderly gentleman for a recheck the other day.   He had a blood pressure of 190/110.  He denied any chest pain or shortness of breath and insisted that he felt fine.   I insisted that he get an EKG with his blood work.

About five minutes after he left I received his EKG in my inbox and gasped deeply when it became apparent that he was “tombstoning”.  As one might imagine, tombstoning is not a good sign.  It is a finding on an EKG that looks like a tiny little tombstone in multiple leads and leads to the patient acquiring a real tombstone of their very own.

I proceeded to call the patient in a panic, informing him that he needed to go immediately to the emergency room.

After a moment of hostile silence, he replied, “I am in the drive thru at Long John Silvers, and I am going to get my *&^%#@ fish!”

I calmly explained to him that if he stays to eat the fish, it will likely be his last meal.

He reluctantly agreed to go to the emergency room.

When I saw him back after his hospitalization and heart catheterization I joked with him about it, “Are you going to Long John Silvers today?”

He replied with a twinkle, “I went before I came this time.”

So MUCH Shaking My Head

A terribly frail elderly couple came into my office today.  The gentleman is ninety two years old.  He has horn- rimmed glasses perched atop the fragile bridge of his nose.  He is hobbling in on his rolater.   (In case you don’t have the pleasure of knowing what a rolater is, it is one of those super snazzy walkers that have a seat and brakes that all the cool seniors are sporting these days.)  His was candy apple red, like a race car.

He uses every ounce of strength to sit down in the examination room, grimacing with pain.  After the pleasantries of greeting him, he says, “Doc, I got to have a cortisone shot for my joints.  I am just achy all over.”

“The cold weather must be really getting to your bones,” I nod sympathetically.

He grinned sheepishly at me, “Nah Doc, that’s not it.  I know what I done.”

I wait with baited breath.  Could it be the dreaded “fall in the bathroom” or “slipping on ice” that I frequently hear tell of.   I was totally unprepared for the next words out of his mouth.

“Well, I want to have a big garden this year, so I was out in the front yard with the chainsaw cutting down some trees to clear out a piece for it…” he starts

“Wait a second,” I interrupted, “Do you think at ninety-two you should be out there on your rolater using a chainsaw?  I have to question the safety of such a decision.”

He sighs, “Now Doc, I knew you were going to get on to me about that.  I was real safe.  I locked the rolater and sat on the seat.  I didn’t even climb up in the tree or nothing. “

“Well that IS a relief,” I replied, “I am glad that you didn’t climb into a tree with a chainsaw and your walker.”

So MUCH shaking my head.

*shared with permission

Hey Jerk, Don’t Bring Your Sick Kid to Church

The last two weeks my family has been afflicted with the stomach virus and we missed church two weeks in a row.  I want to share with you the strange thing that happened.   We did not get struck down by lightening.   I know, it is really strange, in my experience, most people believe that Jesus wants them to go to church no matter their state of health.

I could understand if our church was into faith healing. I don’t think a lot of that showboating actually goes on at our contemporary, coffee-bar style church. Besides, dropping your pestilence-ridden toddlers off at the nursery is NOT an attempt at faith healing. It is just a Jerk move.

I would propose that in addition to the contexts of your child actively spewing forth from both ends, coughing up hunks of green nastiness, or bleeding out their eyeballs that there are several other circumstances that merit staying at home.

  1. If your child has had a fever in the last forty-eight hours perhaps you should skip church or at least the nursery. (One day we were dropping off Z in the nursery and we overheard another couple talking about how their angel had been up sick all night and they were really looking forward to dropping him off for a break. Really? We just turned around and came home.) Also, if you are continually medicating your child to keep their fever down it doesn’t count as “not having a fever”.
  2. If your child has an actively snotty nose, or obvious respiratory infection. Don’t play. You know your baby is sick. Stop lying and saying things like, “oh her nose is really runny when she is teething.” That baby’s snot is green with blood in it. That is NOT teething.
  3. If your child has had stomach virus in the last week or so, you should pass up church. Rotovirus is highly contagious with just a few viral particles and can be transmitted for several days after the acute illness passes.   Plus, it is just gross and miserable and you are not a good person for doing this to others.   (On a related note, saw many people a couple of weeks ago on Facebook comment about how bad the stomach virus was at their house only to see them at church a couple of days I am sure all the volunteers are really going to be sending you a thank you card when they are missing valuable work time because for some reason you felt compelled to bring your sick child to church.)
  4. If your child has a positive flu and/or strep test, YOU. SHOULD. SKIP. CHURCH. (I shouldn’t even have to mention this, but sadly, I do.)

Just consider the above a public service announcement from both a physician and mommy.   Remember that there are other children, elderly and pregnant women at church who may have depressed immune systems. There are also numerous people that cannot be vaccinated for myriad reasons (transplants, allergies, etc.) They rely on us not to expose them to diseases.

I think the problem is that people feel “safe” at church and expect people there to act ethically and in the best interest of the whole community and they do not use the vigilance they would in other public settings to protect themselves against germs. Please realize that God is not going to strike you down for enjoying the sermon remotely while in your PJ’s if your family is sick. We will ALL thank you for this.   Also, remember to wash your hands and vaccinate those kiddos! We are all in this together!

Karma, or Dogs are Not Children

Traditionally, I have not gone home much for the holidays. During residency and early on in my medical practice I spent many holidays at the hospital.   Now that I have children, some of that has gone out the window, so we decided to make the trip home to my mother’s for Thanksgiving.   There are drawbacks. In the tradition of little old ladies everywhere, it is way too hot, also, NO HIGH SPEED INTERNET, or ANY internet for that matter. Bonuses include plentiful, delicious junk food, FREE Babysitting, and nostalgia.

On the Wednesday before Thanksgiving, my husband and I were taking advantage of the free babysitting by taking a nap. This is an absolute luxury available exclusively at the grandparent’s.   Imagine my surprise when I woke up to discover that my mother had cut my 2 year old’s hair without consulting me.   I mean she had casually mentioned beforehand that she thought she need a haircut, and I may have casually joked, “Good luck holding her down for that,” but I didn’t actually expect her to do it without me present.   But, we were taking advantage of the free babysitting so I decided to bite my tongue.

The next day, Dr. Pepper arrives and greets my toddler with, “Oh, who’s a pretty girl?   Did you get a new haircut Z?”   I mutter something under my breath about mom cutting her hair while I was asleep without my consent, and suddenly with wide-eyed, maniacal glee, my brother turns on me cackling, “So HOW does it feel? How does it FEEEEEEEEEEEEEEEEL?”

It took me a moment of thought to determine what he was referring to with such vigor. Suddenly I recalled an incident about three years ago, before my days of childbearing.   Dr. Pepper was at work and left his precious, angel, Lucky in my care. Please see picture below to include crazy-laser eyes (he gets those from his daddy).

 

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As you can see, Lucky looks like you took a Yorkie and supersized it.   He has “bangs” falling into his eyes chronically and on this particular day, he kept running into my table, walls, doors, etc. because HE COULD NOT see. So, I took it upon myself to do a grooming which Dr. Pepper claims he undertakes regularly.   It took a week, and a liter of industrial strength pipe cleaner to set my bathroom to rights after this grooming.   I gently trimmed his bangs so that he could see, and Dr. Pepper went absolutely ballistic. He started screaming about how grooming his dog’s hair was akin to assault and how he would one day cut my future children’s hair without permission.

It was at this point that I pointed out that DOGS ARE NOT CHILDREN, much to the chagrin of my own personal Neurotic Beagle.   I understand.   I really do.   I have been that childless individual over-fixated on my four legger.   I still love the snot out of Neurotic Beagle, but the idea of someone grooming her not to my specifications does not fill me with the ire that the grooming of my toddler can inspire.   I know that this was a moment of Karmic justice in the eyes of Dr. Pepper, but I maintain that DOGS ARE NOT CHILDREN.

 

Patient Advocacy

I had an interesting patient encounter this week.   She is an older woman I have only seen once before. She is new to our clinic because of a change in insurance. She has already developed quite a reputation at our clinic for being a little “difficult”.   She made a complaint against Barbie Nurse.   Barbie Nurse is blonde and cute and sweet as pie.   Patients LOVE her. For this lady to make a complaint against Barbie Nurse, something must really be wrong with her.

So, as I sit down to speak with her, The Complainer says, “Sweetheart, could you speak up a little bit? You speak really softly.”

I almost laughed out loud at this statement. This is something that I have NEVER been accused of.   I am loud to a fault, but to humor her, I start speaking louder.   She asks me several times, “Huh?” and “What?”

I speak louder and louder to the point I am yelling at her. I suddenly recollect that the complaint against Barbie Nurse was that she was “yelling at her”.   A light bulb goes off in my rather dense brain.

“Ma’am, do you think you may need to see an Audiologist?” I inquire in my sweetest, most diplomatic tone.

“Sweetheart, there ain’t nothin’ wrong with my heart.   I don’t need to see no Cardiologist,” she replies.

Houston, we have a problem. I now understand why she complained that I “didn’t tell her anything” at our first patient encounter, and why the last two doctors she had “just couldn’t communicate.”     I wonder how many other interactions she is missing out on because she can’t hear.   I wonder how many other people have dubbed her as a “mean-old-lady” because of this.   I suddenly felt ashamed. Of course, I have scheduled an appointment for her with an Audiologist.

As I was reflecting on this, a student who is doing a research project with patients with lung disease at our clinic comes to speak with me.   She has seen one of my patients.   He is elderly and requires twenty-four hour care.   She informs me that he has no complaints about his lungs currently, but he is not on “the best medications for his condition.” She lets me know that the best choice would be two pricey inhalers

I pretty sarcastically look at her and say, “Oh really?   I had NEVER thought of that.   Why do you suppose I don’t have her on those?

She looks at me skeptically, clearly she doesn’t speak sarcasm, “Well I guess you are worried about his coordination and ability to use these, but I can help with teaching him.”

Great I think, glad she can do that for me since I am incapable of teaching a patient to use an inhaler.   I realize that I may be being a little hard on her.   I try to soften my approach. I patiently explain to her,

“The average retail price of the combined medications you suggested is $350 monthly. That is $4200 yearly. After $2850, Medicare patients are responsible for their own drug costs until they reach $4500.   The medications I have him on, although not the best for his condition are free under Medicare and won’t count toward this.   He is also on medications for his blood pressure, diabetes and blood clots. What do you expect he will do about these medications in August of each year when he runs out of money? And that is only if he only pays for the medications you are suggesting.”

I stop my speech confident that I have conveyed to her a new concept in patient care that was not introduced in her lecture classes. I am self-confident and assured that this will have opened her eyes to a new world of patient care and a different way of thinking.

She looks at me and said, “Well, will you at least put him on the $50 medication?”

Ok, she is a little more concrete-thinking and dense than I thought. Maybe we will take a different approach,

“Ok, I will put him on that medicine if YOU call him and tell him that you would like me to start a $50 medication for a condition he is not complaining about and that it will cost him $600 annually AND that it may very well put him in the Medicare Donut Hole so that he will have much greater out of pocket expenses.”

Oooooppps.   I forgot that she doesn’t speak sarcasm. She looked at me somewhat confused and wondered off.

These two incidents highlight to me what an awesome responsibility being an advocate for my patients first is. I am not to be an advocate for the pharmaceutical companies, or a government agenda or even my place of employment. I am to be an advocate of THE PATIENT.   I am really fortunate to work at a clinic where this is the priority and not the bottom line, but other places this is not the case.   I hope maybe this student will reflect on this conversation with some common sense and change her strategy. Maybe getting a hearing aid for my “difficult” patient will change her life. I hope so.

The Government Sucks

As a physician I have many friends who are nurses. I know, I know, this is somewhat unbelievable as that most physicians never even learn their nurses names and just shout things like, “Hey you!” or, “Nurse!”, or “Get over here!”. But it is true, nonetheless that I have several friends who are nurses. I can name twenty to thirty of them quite easily by name! Let me elaborate a little bit about these awesome people.

Most of the nurses I know are hard-working, and underpaid. They clean up the worst messes you can imagine that would turn most people’s stomachs. They clean patients who may not have bathed themselves for weeks. They serve as waitresses. They get yelled at for getting dinner orders incorrect that they weren’t responsible for taking in the first place.

These lovely people got into this profession so that they could make a decent living while helping people and making a difference in a tangible way. They spend nights and weekends away from their precious babies because this is a calling. While most of us are kissing their children good night, these folks are missing theirs.

But I will tell you what they did not sign up for.   They did not sign up for an incompetent government who refuses to protect them from the threat of a deadly illness. They did not sign up to take care of patients that could kill them with inadequate protection. They certainly did not sign up to risk their lives of themselves and their families while being villainized by the same aforementioned incompetent government.

Make no mistakes folks, these nurses are HEROES. If I were faced with caring for a patient with a disease that is 50-70% fatal and the infectious dose of virus required to obtain the disease was 1-10, I would run screaming. They did not. They are HEROES.   If there was a breach of protocol it was on behalf of the CDC for inadequate preparation, not on the part of the nurses who have probably not been trained in that level of safety equipment in ten years if at all.

If this spreads, which hopefully it will not, a lot of health care workers will have difficult decisions to make. Currently, if they stay and take care of a patient with Ebola and get sick they are eviscerated in the media for their breach of protocol. If they refuse and leave, I am sure they will be demonized as well. They are in a darned if they do, darned if they don’t proposition. It is time we start treating these wonderful people like the everyday heroes they are.

My Toddler’s Eating Disorder

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In a responsible way I have made great efforts not to pass my body issues on to my daughters. I do not subscribe to ANY fashion magazines. Our television is not connected to cable, so this limits her viewing options to Dora or Wonder Pets. We do have a scale in the house, but I don’t weigh myself in front of her.

The scale is located in our bathroom and anyone who ever has had children will tell you that once you have a baby, you never get to go to the bathroom alone again. Sometimes if I have to go, I hold it until I can get to work and go by myself. By the way, this is the exact opposite of the practice I used to follow

I digress. In the course of my use of the facilities, Z has taken to standing on the scale and “checking her number”.   She doesn’t know what the number means, but she likes to make numbers appear on the digital scale.   Charming right?   We have even used this as a learning opportunity to teach her about numbers.

I spend a great deal of my day at work arguing with patients about their weight. Everyone insists that our scales are off and want to be weighed on a second or even third scale. Some patients have a favorite scale in the office and only want to be weighed on the favorite scale. Some want me to record the value they get on their home scale, and not the office scale. I have had patients remove everything from their shoes to jewelry in attempt to get that number a little lower.

Z has had a solid “number” of twenty-eight for the last couple of months. She proudly will stand on the scale and proclaim, “my number is twenty-eight”. Imagine my surprise last week when she announces, “I’m going to check my number,” and hopped up on the scale. The number said, “28.6”. I could see Z look at me with some degree of confusion and consternation.

I said, “Oh, look, your number has changed. It is twenty-eight point six. “ I mustered a great degree of excitement for this to ensure that she wouldn’t develop any life-long psychiatric scars because of mommy’s reaction to her weight at two years old.

She shrugged, “Its cuz I hab my shoes on.”

Great, I thought, Glad you are working on your eating disorder already. Its never too early to get started on that kiddo. I followed that up with a giant sigh and eye roll. I have a feeling I have years of sighs and eye rolls ahead of me.

Nutrition 101

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I went to my first ladies event at church today. I usually do not frequent such things. I am not really good in social situations. I know, I know, I am a doctor, and I see something like thirty patients a day, so how can I be bad in social situations? Well first off all, have you met most doctors? Most doctors don’t really have a great personality. That is why most people don’t like going to the doctor. Usually doctors are pretty self-absorbed and have horrible listening skills.

That being said, I am pretty great in a one on one setting. I even do well in small groups of people, but when thrown into a large group setting it is like I am back in middle school.

Suddenly, I am VERY awkward. My clothes aren’t right, I stand their nervously, and my mouth stops working. I mean to say witty and charming things and instead I start blurting out things like, “I saw a squirrel on the way here,” and, “my legs are itchy.” Also, I tend to be somewhat snarky, and when I do say something appropriate to the conversation it tends to come off sounding a little tactless and rude. Most other women just kind of look at me with a sad little head shake of pity and go back to their conversations about smocked outfits and Ferberizing their babies while I stand their clumsily trying to think of something to say.

I was doing okay during the brunch portion of the program. Apparently I am good at eating (it gives me something to do with my hands and gives the illusion that I know what I am talking about). I realized that for about the last two years I have had a baby with me to focus other women’s attention so I don’t have to carry on a real conversation. This was the first time I had been to a social event in a long time without a twenty-four inch buffer of cuteness in my arms to direct the conversation. I highly recommend that every socially awkward person carry a baby with them at all times to deflect social attention. It is magic in its effectiveness.

I navigated my way to a place to sit during the lecture portion of the program, and my panic settled into the calm of anonymity as I relaxed into my chair sipping my tea. That was until, the lecturer started discussing toddler nutrition and suddenly I am having an anxiety attack (See my post entitled “She Wont Eat That…”). They are all discussing organic smoothies and clever little bento boxes with healthy vegetarian options for toddlers. During this very discussion there was a bag of non-organic baby food and a bag of Cheetos in my bag that I was planning on feeding Z for lunch. Everyone around me was furiously taking notes and nodding in agreement while I am just freaking out about how my daughter is going to die from rickets and wet beri beri from her lack of vitamin D and protein rich nutrition sources.

Then, we broke into our small group sessions, and yikes, I am assigned to be in the one with our head Pastor’s wife. This is super scary for an agoraphobe. While we were doing introductions, one of the childcare workers interrupts in a flutter letting the Pastor’s wife know that there is something going on with her child. She steps outside the room to handle the crisis and when she returns she informs us, “My daughter is crying because they tried to give her marshmallows, and she told them she wasn’t allowed to have marshmallows”

By this point I am ready to just check out on this experience. I clearly cannot measure up to the Whole Foods, gluten-free, non-GMO crowd I have found myself in. I am done with this. Then, she says, “I don’t know why she said that. We eat marshmallows all the time at our house.”

Maybe I have misjudged these awesome, marshmallow-eating people. I went to pick Z up from the nursery and she has a plate with four pretzels, four giant marshmallows, and a small packet of raisins. She threw the pretzels out on the way out the door declaring them to be, “gross”, informed me that the raisins were “vitamins” and told me she was going to eat the marshmallows for lunch. I realized that maybe I should give this a fair shot.

Invasion of the Body Snatchers…. or “How I Got Fat”

I know it is hard to believe if you saw me now, but I used to be a size six on a good day and a size eight on a bad day.  I held on to this proudly pretty much all the way through college.  I mean, sure, I put on the dreaded Freshmen Fifteen, and by the time I graduated, I was much closer to an eight on a good day and a ten on a bad day, but still, hotness.

Then there was medical school.  I spent endless hours during my first two years pouring over books.  I made neat little packets of note cards, and would walk around my apartment complex for hours and hours while studying so that I could stay trim.  I was feeling pretty good about myself until third and fourth year of medical school when I worked thirty-six hour shifts at hospital after hospital every third or fourth night.  Guess what?  There was no built in time to exercise, unless you were running to a code, or leveraging all your muscle to pop someone’s arm back into socket.

Also, hospital food is not all it is made out to be.  You would think at a place where you go to make people healthy, that they would have healthy food, but you would be very, very wrong.  For instance, at The Med in Memphis, they actually had Hog Jaw Thursday.  I. am. dead. Serious.  Also, at Ehrlanger in Chattanooga they have perhaps the best apple dumplings you have ever put in your mouth.   I challenge you to resist them when you have been up for thirty-six hours straight.  I challenge you to make healthy food decisions when your body is so tired that you can barely stand up.  Fighting against fate, I was up to a size twelve.

So then came residency.  It is like the extended dance remix of the last two years of medical school.  On-call at the hospital once or twice a week, at least twenty-four hour shifts.  Pizza is an easier choice at this time than a salad.  Time for exercise is pretty much non-existent.

I guess I should insert a diatribe here about how little the medical machine promotes physical and emotional health in the very people that are responsible for public health policies, but I digress.

So then, I started my practice rocking the size fourteen scrubs.  I was doing really well with all this new-found time as a big, grown-up doctor.  I had time to exercise.  I even hired a personal trainer, and started eating healthy and was on the right track, down to size twelve again!  Hurray!

This was until I was helping a friend move, and I got stung multiple times by a wasp.  The wasp got trapped between my face and my glasses and it stung me multiple times.  I became intensely sick at my stomach and swollen all over.  I had never had a reaction like this to a wasp sting before.  It was awful.  Two weeks into it, I was like, “This is ridiculous!” and then I did some basic math, and took a pregnancy test and realized my problem was not a wasp sting.

The first thing that happened in pregnancy was a welcome change.  I realized that my usual B-cup bras were getting a little snug, so I stomped right into the nearest Vic Secret to get some new measurements.

When the girl looked at me and said, “well, that’s a double D,” I was like, “Score!  Most people have to pay for these babies.”

Then, the rest of pregnancy kicked in and I started gaining weight other places, less pleasant places, such as my face, and ankles.  My once graceful, svelte calves melted into an amalgamation of cankle glory.  But, it was okay, because one of the rules is, that when you are pregnant, no matter how big you get, everyone says you look “cute”.

(I must list one noticeable exception to this policy.  My father, during my thirty-fifth week of pregnancy with my second daughter suggested that I get ahead of the baby weight by starting Jenny Craig.  He’s a sweetheart folks.  I get my tact from my father, it is a gift.)

Then there is the great lie of breastfeeding that says you will lose weight by making milk for baby, but what they don’t tell you is that you are going to be as hungry as a line-backer.  I was nearly back down to a trim size fourteen after nursing my first daughter when SHABAAM… pregnant again.

Now, I have weaned Baby Bird, and find myself face to face with the reality that these kids have really screwed with my body.  I don’t even recognize my body anymore.  The double D’s have shrunk back down to baby B’s and my stomach sticks out, and I am a horrifying size sixteen after all this trauma.

I was in discussion with my friend, The Jillionare about when your body goes back to “normal”.  Her comforting advice was, “It never goes back to normal.  It is going to be weird dressing yourself for the rest of your life.”

Okay…. Great.

So something has to be done about this.  I gotta get serious folks.  If you see me around town with a Twinkie in my hand, be a friend and walk up to me and smack that sucker out of there.  I am going to try and get healthier, and I can say it is for an example for my daughters and patients and for good health, but that would be lying.  Really it is so I don’t have to buy new clothes.

No one told me that having babies would change my body forever.  This wasn’t part of the deal.  No one also told me that they would change my heart forever.  No one told me they would change my soul forever.  No one told me that they would change the way I interact with God and with the world around me forever.  I may never see my early twenties body again, but if that is the price I have to pay for this much joy, then so be it and a million times over.  But for now, I guess I am going shopping.  See you at Lane Bryant.

The Patients NO Doctor Likes

I love most of my patients. Most. Some of my patients are such a pleasure that I see them on my schedule and look forward to the visit regarding not just their health, but their lives and their families and their stories. (Stalker Nurse, you are my favorite, and you know who you are.) There are those other patients that annoy me to my bones.  When I see these people on my schedule, the anxiety starts to build in advance of what I know is going to be a highly unpleasant interaction. I start to hyperventilate and plan for the multiple contingencies of ways that I can minimize conflict (maybe I can fake a page, or have my nurse claim there is an emergency, or yell fire and run out of the room). In fact, after lengthy discussion with my colleagues, there are several archetypes of patients that almost all doctors cringe with repugnance and loathing to find on their schedules. So with no further adieu, I present to you the patients that ALL doctors despise.

The Hypochondriac– At best, this person is on your schedule every week for a “sinus infection”. This sinus infection is never really a sinus infection. It is usually an allergy or a virus which you can really do nothing about, because viruses don’t respond to antibiotics, even though they never believe you on this one, and the allergy is to the thirty-seven cats they insist on living with even though they are highly allergic. At worst, this patient is convinced there is something really wrong with them because they have done extensive research through the internet and Doctor Oz on the subject. Their fatigue cannot possibly be a result of their morbid obesity and two pack a day smoking habit. It must be some sort of mysterious “syndrome”, probably one that is going to make them eligible for disability.

The Rock Star- This patient knows they deserve special treatment. Let me be clear. I always try to do the best job I can with each and every patient. That will never be good enough for this patient. They will always find something wrong with something you or your staff does. It brings to mind one special patient of mine that was seen at the end of a clinic session and because I had no other patients scheduled for the morning, I spent forty-five minutes with her. She later spoke with my nurse on the phone and asked if I was leaving for the day, because it sure didn’t seem like I had any time for her. No matter how much you give, this patient will never be satisfied. They will tie your nurse up for hours on the phone with myriad special requests. They will write letters of complaint against you and your staff for the most minor of infractions.

**Even worse is that frequently there is the perfect storm of evil found in The Rock Star who is also The Hypochondriac. Because when that happens, you are going to be seeing this person a LOT.**

-The Abe Simpson– For those of you who are unversed in The Simpsons, grandfather Abe is a character who tells pointless stories, and these patients do the same thing. You will get sucked into a ten minute diatribe about something that you assume is relevant only to find out that they have lured you down a rabbit hole into a vortex of nothingness. THEY don’t even remember the point to their story. I once listened to a fifteen minute account of a women’s relationship with her Welsch Corgi. I incorrectly assumed this was going somewhere with her medical condition, maybe flea infestation, or worms or something, but NO, it went nowhere.   Later I found out that the Corgi had been dead for six years, and we still hadn’t discussed anything about her medical condition.

The Crier – The crier starts crying the moment you walk in the room. At. Every. Visit. I understand that people disclose many things to their physicians that are deeply personal, and frequently people shed a few tears at the doctor’s office when recounting some particularly traumatic, frustrating event, and that is normal. But, breaking down into snot-driveling, ugly crying to the point that I cannot even understand the words you are saying and it takes you ten minutes to collect yourself at every office visit is not normal.

I think there is the capacity in each of us to be a hypochondriac, a rock star, an Abe Simpson, or a crier from time to time (I don’t know when this turned into the essay from TheBreakfast Club). I think furthermore it is probably normal that people assume these different personas throughout different periods in your life, but if you find yourself consistently being one of these people with your healthcare provider, you are probably not realizing a satisfying therapeutic relationship. Your doctor and their staff will be much better able to care for your medical needs if their energies are not spent on how to avoid your phone calls and office visits.  Thankfully, these are not frequent encounters.  Please help your physician to exercise their practice in the greatest compassion possible by realizing we and our staff are also human beings with feelings and respecting the time and needs of other patients as well in a time of dwindling healthcare resources.

Stagnation

IMG_20140218_185602_659                I have a confession to make.   I co-sleep. I know, I know, there was no stronger opponent to this abhorrent practice than myself. As a physician, I have had the unpleasant, heart-breaking task of pronouncing four babies dead from Sudden Infant Death Syndrome, and all but one of these was due to co-sleeping. Now granted, alcohol or drugs were involved in each of these cases, but that did not alter the tragic look on the parent’s faces, or my hardline stance on the practice. It was during this depressing time in my life that I determined that I no longer wanted to work in an Emergency Department setting. It was also when I became a strong adversary to the co-sleeping movement. I preached loudly to patients and friends alike about the dangers of co-sleeping and how they would most certainly roll over and smother their baby beneath their ponderous, non-organic food eating American fat rolls.  

                That was BBB or Before Baby Bird. I understand that there are some co-sleeping, baby-wearing, attachment-parenting, modern hippies who actually enjoy co-sleeping and do this as a matter of personal preference. I assure you I am not in this crowd. I enjoy building a pillow fort around myself and having as much sleeping space to myself as possible. I would get twin beds like Lucy and Ricky if my husband would let me. My co-sleeping experience is a little less granola and a little more like being held hostage by a tiny tyrant.

                Baby Bird will absolutely not sleep without being able to both touch and see me, and if Baby Bird doesn’t sleep, then NO ONE sleeps. We have tried tricking her by putting a pack and play or a co-sleeper in the room, even shoved up next to the bed with my arm draped precariously off the edge of our bed to be in constant contact with her minute, heaving chest. Baby Bird is neither fooled nor appeased by that. She wants to be IN our bed, and as of late she has added an extra entertaining and particularly demanding element to her evening routine.

                The newest element of torture she has employed against us is obligatory hand holding. That’s right, hand holding. I must take her diminutive fist in mine and hold it between my hands until she falls asleep. Don’t tell my captor, but I secretly love this part of the bedtime ritual. She caresses my hand with her free hand over and over again until she falls asleep while wriggling her petite captive hand betwixt my palms. I fall asleep happy every night.

                Then, the creeping sensation settles in. I am in that dreamlike state somewhere between waking and sleeping. It is subtle at first, a gradual loss of proprioception. We have all experienced it. Your body is heavy and you no longer can feel where your leg is in space without twitching it slightly. I know logically that my hands still encase this petite treasure in their grasp, but I can no longer feel her movement against my palms. Occasionally she will quiver in her sleep and I will feel her precious presence. Sometimes, even though I know it may wake her, I stir slightly myself to feel her move.

                I reflect on my relationship with God. When I am standing still and refusing to move in my faith it is harder and harder to feel His presence. Sometimes I will feel a flicker of his movement over me in my stagnation, but in order to really feel Him, and I mean really feel Him, I find that I must move. Even if it is the slightest shadow of a movement toward Him, I am rewarded by the feeling of His enveloping presence.

                For now, I will enjoy the ephemeral, all too transient feel of my baby’s touch. I wonder if God in His omnipresence and eternal nature finds our touch so fleeting as well, as this time passes us by, or can He just revisit joyful times with us at his will?

 

Grumpy Old Man

                My father is politely described by people who know and like him as a “character”. People who do not like him tend to have a more colorful description of him.   If the filter that covers my mouth is like a mesh that allows far too much particulate matter to contaminate the conversation, then my father’s mouth is like a sieve allowing everything to pour forth with very few restrictions.

                He is in his mid-seventies. He likes whiskey, golf, gambling at cards, and his two Yorkie puppies, “Bo and Butch”. He is a contradiction in terms.   He is a former physical education teacher who doesn’t particularly enjoy children.   To understand the most recent conversation I had with my father, some background is required.

                A few years ago my father had bypass surgery and was given a cat that he named Gus to keep him company during his recovery. After his convalescence, he decided that his cat needed a cat because it was lonely. So Daddy went down to the local cat shelter and picked him out a fine cat.

Daddy: I want that one.

Cat lady: Thank you sir, we really appreciate you adopting one of our precious angels.

Daddy: I’ll take really good care of him. I am gonna get him fixed and declawed and everything.

Cat lady: Hold up a minute buddy. We can’t give you that cat, declawing a cat is cruel.

Daddy: Lady, I’ve got Italian leather.

Cat lady: You can’t adopt that cat, we don’t consider declawing humane

Daddy: What do you care? Fine, just say I won’t declaw the cat and then I will take it home, and once that cat is mine I will do what I want.

Cat lady: …which is why you can’t have the cat.

Daddy: Listen here you b#%$h, ya’ll are just gonna kill the f&^%ing cat anyways. Just give me the g#&@&amn cat.

Cat lady: I will see you in H*&L!

 

                And that is how my father got banned from the local cat shelter. Keep in mind that I was not actually present for the conversation, so the actual encounter probably was a lot worse in person. It resulted in my father calling me and my brother and asking us to go get the cat for him out of spite. I didn’t do it, but I suspect that my brother did because a black cat remarkably similar to the one in the story appeared at my father’s house in short order and was seen atop the Italian leather trying to sharpen its poor non-existent claws.

 

                So, fast forward about fifteen years and another conversation with my father. He has a doctor’s appointment.   Apparently, the receptionist had the audacity to ask him for his co-pay. This was not a good idea on her part.

 

Daddy: Look, I pay two –hundred dollars a month on this policy, and I have a five-hundred dollar deductible, and now I have to pay thirty dollars every time I walk in the door.

Receptionist: I’m sorry sir, this is the new guidelines under Medicare.

                Here is where another grumpy old curmudgeon enters the picture and starts commiserating with my father about the good old days when Cokes were a nickel and everyone had free socialized health care. As they are discussing this, one of them mentions that it is highway robbery and extortion to hold them hostage for a copay to see the doctor. This is where the receptionist did make a small error in judgment.

Smart A*& Receptionist: Well, you don’t HAVE to see the doctor. (smirk)

Daddy: Listen here young lady, I wasn’t talking to you and I am seventy-four g*&^%amn years old and I don’t need you telling me when I need to see the doctor or not.

                Here is where a female bystander tries to check my father’s behavior and tell him he is being rude to the receptionist. This did not go well for her

Daddy: Sit your fat a&^ down and shut the f&^% up and stay out of it. No one asked you, you dumb b&^%h

                The situation degraded from there, and my father called to ask my opinion on how the situation unfolded. I was shocked to find that the doctor actually saw my father after this. My father completely thinks he is in the right and that the receptionist’s comments totally justify his behavior. I think the receptionist should have probably should have kept her mouth shut, but I have a no tolerance policy for people being rude to my receptionists and nurses.

                                I do think my father’s ability to make a public scene at least once a month and still come out smelling like a rose is a special life skill. Sometimes I wish I could get away with saying exactly what I think like him without consequences.

Specialists Are Jerks

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                It is a well-established fact in medicine that specialists are jerks. (To my friends and partners who are specialists, I am not talking about you. I am talking about those other specialists. To my fellow Family Practice colleagues who would like to split hairs and say that Family Medicine is a specialty, I with a resounding eye-roll say, whatever.)

                I had a patient encounter the other day with a woman who has had cancer. Twice. She just moved to a new area. She has not been to the doctor for three years because of financial concerns. When we discussed what her oncologist and her surgeon had recommended for ongoing surveillance for her cancer, she informed me that she had previously been getting MRI’s every other years but her last one was three years ago due to her finances.

                This protocol is not a frequent protocol, but is also not unusual given specific circumstances. I have about four other patients undergoing the same post-cancer protocol. It is one that should be decided by a team of oncologists and surgeons based on the genetics of the tumor and the patient’s prior treatments. None of this is information I have access to, and requesting records and compiling them can take months. This lady in front of me is already a year late for her screening. Did I mention she has had cancer twice?

                So, I order the test. Then I get a call back saying that a certain radiologist needs to speak to me before he can allow the test to go forward. I think this is a little odd, but try calling him back, and stay on hold for thirty minutes only to be informed that he has left for lunch. I leave him my direct phone number so he can reach me easily without any problems.

                The specialist calls me back. And here is the conversation

Specialist Jerk: I don’t understand this protocol. I have never heard of this before.

Me: Oh, really, well I have a few patients who are on this protocol. It isn’t usual, but it isn’t all that uncommon.

SJ: Well I have never heard of it.

Me: Well it is the protocol she has been following from her oncologist and her surgeon.

SJ: What kind of procedure did she have? What are her tumor markers? What was the pathology on the tumor?

Me: I don’t have her records yet, and that may take months to get, and she is late for her screening. We have cleared it with insurance and they are ready to pay for the test.

SJ: I think you should get her established with a surgeon here and an oncologist before we order the test.

Me: Well, considering she is broke, I’m not sure she is going to want to pay for two office visits before paying for an expensive test.

SJ: Well I am not going to let you order the test.

Me: Ok, well, that’s fine, I will just document in her record that you will not allow the test to be ordered, although I recommended we continue with her protocol.

(This may seem like a perfectly reasonable, benign comment to the layperson, but I assure you, that this is basically the medical equivalent of saying, “I will be happy to testify against you on this subject.” It is a like the equivalent of medical napalm, but he left me little option)

SJ: (getting irate) OH REALLY, IS THAT THE WAY YOU WANT TO DO THINGS? LISTEN SWEETIE, I KNOW YOU’RE FRUSTRATED.

Me: Well, yes I am a little frustrated. I am just trying to do the best thing for my patient, and you asked me to call you regarding this, and you didn’t give me your direct line, so I was on hold for thirty minutes and then was informed that you left for lunch.

SJ: LOOK, I HAVE BEEN AWAKE SINCE SEVEN, AND I AM ALLOWED TO TAKE A LUNCH.

Me: (thinking about how my baby got up at 2 am and then again at 5 am, and then I went to work at 7am, and spent my lunch trying to get ahold of him) Yes, I agree you are allowed to take a lunch, but it is a basic courtesy to give another physician your number when you are requesting a call back. That is why I left my direct number for you.

SJ: I DON’T HAVE YOUR DIRECT NUMBER. I DON’T EVEN KNOW WHAT YOU ARE TALKING ABOUT.

Me: I left it with Christy. That is how you just got a hold of me.

SJ:   WHO’S CHRISTY?

Me: Your nurse.

 

                And that proves my point that specialists are jerks (again to my specialist friends… not you silly). If that wasn’t enough, he then contacted people at my office to complain about me. I am wondering if he is going to have his mother call to complain about me next, that is if he can remember her name.

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