A Letter to Boogie

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Dearest Boogie,

I remember the day you came into our lives.  You crept so timid, and hungry into our back yard.   I thought you were a puppy because you were so small, and I thought you were brown because you were so dirty.     We fed you and cleaned you and you became part of our family.

I remember you first trip to the vet when they said, “She has heartworms.  It is going to be expensive to treat,” and we said, “FIX THE DOG.”

Remember the trip to the Grand Canyon with Mommy and Daddy?   Not every dog gets to go to the Grand Canyon.     We took you with us everywhere and I will never regret that time spent with you.

I remember your second trip to the vet when they reminded us that you could get pregnant, and we said, “FIX THE DOG.”

Remember all the things you destroyed?   Those three sets of blinds weren’t too bad, but that garage door was expensive.  How did you eat the wiring out of the wall?  I don’t know how you destroyed a metal panel from your kennel, but you managed handily.  Oh, and thanks for destroying the curtains, downstairs door and carpet at mom’s house.   That was a nice check I had to write.

That is nothing compared to your capacity to hoard hidden foodstuffs.  Remember taking that whole loaf of garlic bread off the counter?  You hid it in Daddy’s closet and he called it your “Strategic Garlic Bread Reserve”.  That wasn’t quite as bad as the time I had a ten pound sack of raw chicken thawing in the sink and came home to NO chicken.    I found raw cutlets shoved under pillows and in laundry hampers for an unfortunately long time.     I was really amazed that you learned how to open the dishwasher so you could use it as a ladder to the countertop.  You were such a smart dog.

Remember how we loved you SO much that two people who swore they would never have children decided to give it a try.    Dearest girl,  I owe my second and third baby to you.   I know there were times that you were a little jealous, but you were such a good big sister.   I love how even when you were dying that you insisted on doing the stairs every night to put them to bed.

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Thank you for sticking with me through both pregnancies and cuddling me at night.   You got up with me every time I had to pee or throw-up and went with me to the bathroom.  I will never forget that kindness my love.

Remember the first time your pancreas flared six months ago?   They said, “We can give her medicine but it is going to be expensive,” and we said, “FIX THE DOG.”

I will miss giving you belly and face rubs.   I will miss feeling your beautiful silky ears.     Remember how you inspired Dr. Pepper to get his own dog and LuckyPup instantly fell in love with you and thought you were his mommy?   I don’t know how I am going to tell LuckyPup about this.   I still haven’t told your sisters.

Remember that phase before having human babies when Mommy wanted to dress you up all the time?  You were so tolerant.

You were our first baby and Daddy’s first dog, and I am pretty sure you were the best dog in the world.

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I am sorry that when they told me yesterday that it was liver cancer, that I couldn’t answer, “FIX THE DOG.”   I am sorry if you suffered a moment longer than necessary because mommy wanted to spend more time with you.   I am sorry that it has been hard for you to eat and drink for the last few days.  We just wanted to spend a few more moments with you, precious girl.  I will always appreciate that couple of days where you felt good and chased the gator like a pup and played with me again.

I know my father in heaven and I will see you again sweet puppy.  Say hi to Papa and Sammy Short Legs Daddy and all the people we love and miss.    I will be with you someday.

 

Love,

Mommy

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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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