Death by Orthoptera

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One of the conditions of my son getting to have a pet lizard (you can read about that whole debacle here if you have not already) was that he had to feed it.

Lizards eat crickets. And mealworms. Specifically, they like their prey alive and wriggling. If it ain’t fresh, that lizard ain’t eating it. With the amount I have now invested in this dad-gum lizard, it sure as hell better live a good long time.

I hate crickets. Especially those big, black, crunchy ones that can fly at your head or hop onto your leg without warning. Shudder.

So, this mamma doesn’t touch live crickets. Or mealworms.

The problem with having a four year old boy feed live crickets to a lizard?

Crickets hop.

Away.

Very fast.

Each night, at least one out of the three crickets intended for the lizard actually end up tasting freedom again in my living room rather than suffering an early demise as a tasty reptile hors d’ oeuvre.

There are dozens of them roaming my house!!!

I hear them at night, chirping happily. They must be breeding under the couch, behind the curtains, in all of the dark, hidden recesses of this old creaky house.

When they are sufficient in number, I have no doubt they are coming for us…

If this blog ever goes silent, you know why.

Love Transcends

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Early in my career, a mom pulled me aside during a well child visit for her eldest son to ask me an important question.

“Doc, I am pregnant…” She was. “The baby I am carrying has been diagnosed with Trisomy 13.” She paused for effect, searching my face. “He has severe malformations and is not expected to live more than a few hours. We made the decision to not abort when we found out. I want to deliver at the hospital here, but I need a physician who will be the baby’s doctor who will understand and respect our wishes. We do not want aggressive life saving measures. We want to be able to love him and hold him until God takes him from us. I have seen how you interact with my other sons and I thought maybe you might be the one.”

In shock, I quickly agreed. I was flattered, to be honest. (I am special!) This would be easy, a piece of cake.

The weeks passed. I didn’t think about it much until one afternoon I got the call.

The baby was here.

I stood looking down at the child, the little boy, wrapped in blankets in his mother’s arms. I took him from her and peeled back the blankets.

He had severe cleft lip and palate, a single eye lay in the center of his face. His intestines were in a sack outside of his abdominal cavity.

But his cry was a normal baby’s cry.

Hospice was already there. I performed my cursory exam and handed him back to his mother. I could see the love that she had for him as she held him protectively, close to her chest and I began to see him through her eyes. I had to admit that he was strangely beautiful. I wanted to just stand there for hours, gazing on this miracle of life.

What was supposed to take hours, however, dragged on into days. He began having seizures. The hospital wanted to send him home and so I waged battle with administration. It was a tiny hospital. We had no pediatric specialty back-up, so I had to rely on phone consults with the nearest children’s hospital. I felt like I was drowning, in way over my head.

Each day I watched this baby, this life, suffer. I watched the parents, both mom and dad, continue with their patience and unfailing love.

And then, in the middle of the night, I was called to pronounce him dead. It was finally over.

I am still haunted.

But it is not about me, at least not in that way. Each life has a story to tell. Each life carries power and sometimes it hits you from the least expected places.

It was then that I learned a mother’s love transcends everything. Everything. Beauty is in the eye of the beholder and there is nothing like a mother’s eyes.

Escaping the Pain

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The blue eyes flashed, but not with fear.

With anger.

In a second, they were only a blue blur and a memory.

Had he really just bolted?

In another second I had recovered myself enough to give chase.

Through the clinic.

He ran through X-ray, leaving a gowned, nearly naked woman shrieking. He ran through darkened storerooms. Through hallways. He even threw stacks of boxes down in my path, trying to slow me down.

Then he ran into the men’s bathroom, figuring it was the one place the lady doc could not follow.

Wrong.

I knocked to give warning, waiting a few seconds for any indecency from innocent bystanders to get addressed and then entered.

The bathroom appeared empty.

There were no feet peeking out beneath the stalls.

I tried each door, peering into the stall. At the last one I found him, perched atop the toilet. We eyed each other, neither one ready to accept defeat.

“Look, man. You just gotta get the shot. It will hurt but just for a sec and then you can have a sucker. Don’t make me look bad, ok?”

I held out my hand. He reluctantly placed his seven year old hand in mine, realizing he was cornered at last, and I held tight as we walked back to the exam room where mom and the nurse with the needle were waiting….

The Coffee That Never Was

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“Doc, is that coffee on your forehead?” The patient, an older man (read that as still older than me) with spectacles, leaned in closer, squinting his eyes to get a better look.

I touched my forehead unconsciously and winced. Ouch.

He sat back and eyed me suspiciously. “Why do you have coffee on your forehead?”

Yeah, well. About that…

My kids and I had a picnic dinner at the park a few evenings past and then went for a walk down the hike and bike trail.

My son calls it hunting for snakes. He likes snakes.

There were no snakes but we did see a bunny and then caught a grasshopper in a sandwich bag. Fun times.

As twilight started to descend I heard a weird almost dog-like howling not too far off across a field. I didn’t think too much of it, enjoying the sunset and the kiddos. Then the howling got louder and it was clear that there was more than one animal.

Coyotes. In a pack. Seriously?

They were tracking us through the adjacent field.

By the time I realized what was going on we were still about a quarter mile from the safety of the car. I tried to get the kids to “race” back towards the car as a game, not wanting to scare them, but my son kept getting distracted wanting to catch more grasshoppers.

I could hear that those animals were moving fast. I grabbed one kid in each arm and ran like a bat outta hell (admittedly a wild eyed one carrying fifty pounds of kid) back to the car, flung them in, then ran to the driver’s side. In the midst of my trying to scramble in super fast, I slammed my head into the doorframe.

Pain. Searing, blinding pain.

Holding back the profanity (the kids were with me after all), I dug out the bag of ice I had packed for drinks and drove home with that pressed against my temple hoping that I would not develop a huge goose egg over my eye.

Good news is, we were not eaten by coyotes.

Bad news is that the knock on my head still hurts and now the bruise is starting to show up brownish-yellow under my make up.

I summoned up my most convincing sheepish look and grinned at the fellow sitting on my exam table.

“Aw, man! Those kids made me splash again. I can’t believe I missed a spot…”

(The picture above is the actual sunset that evening, in case you were curious.)

Relativity

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“You’re fat!”

“Excuse me?” I thought I might not have heard him correctly. I squatted down low, my eyes even with his 3 year old head. I smiled reassuringly. “What did you say? Try again!”

“I said…. You. Are. Fat.” He took special care to enunciate each syllable clearly and then punctuated the statement with an eye roll.

I stood up, taken aback. There was no mistaking that.

“Now, you shouldn’t say that to her!” His mom looked as embarrassed as I felt, redness creeping up her neck and into her cheeks. She leaned over to me and whispered in her Southern drawl, “I’m so sorry.”

And I instantly hated her, I will admit. Here she was, having given birth to a child (I had not) and she was skinny as a toothpick. Next to her, my normal body was fat.

“Look here, you little brat! Your mom is an anorexic anomaly.”

Except I didn’t say that.

Instead I smiled and said, “Guess how many shots you get today?”

(As a side note, I have watched this kiddo grow up over the past ten years. He really is a great kid. But I still hate his mother…well, not her per se, just her metabolism.)

Gargoyle

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“What the F**K are you doing, calling me at 2AM? You are a doctor, take care of the damn patient yourself.” I had steeled myself for the verbal onslaught. I knew it would come. It always did.

“With all due respect sir, this patient’s enzymes are climbing. He has an ST elevation on his EKG and active chest pain that is not responding to morphine or nitroglycerin. Now, as you know, I am just a family practice resident. You are the cardiologist on call. I am begging for your help here because I don’t know what else to do to for this man.” Sometimes meek supplication helped.

“God Damn it!” I held the phone receiver away from my head while he yelled that expletive and the several that followed after. The pain from the verbal attack on my tympanic membrane made me wince.

When the yelling had died down I put the phone back to my ear.

“So does that mean you are coming in?” I said cautiously, trying to keep all trace of emotion from my voice. (Do not show anger. Do not show hope. Do not show relief. Do not show fear.)

“No, I am not coming in, you f***er!”

I sighed.

“Then tell me what I need to do for him until 6AM so that I can document in the chart that I spoke to you and this is what you recommended in lieu of coming in yourself to cath him.”

Silence.

“Hello?”

“Fine. I’m coming. You goddamn better be there waiting for me…”

“Oh, yes SIR. I will be right here. Waiting. Tha-…” The phone was slammed down on the other end, cutting off my reply.

He did eventually show up.

Several hours later, as I was checking on the patient after his heart catheterization and the angioplasty that opened up his blood vessel, he and his wife gushed and gushed about how wonderful the cardiologist was that saved his life. They were so impressed with his bedside manner and his skillfulness as a physician.

I seethed.

Do you even know what it took to get that prima donna here to sully his hands for you?

I said nothing.

Patients deserve to believe their physicians are heroes. Because some actually are…

Giving Head

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Warning: There are countless horrible things physicians encounter as a resident. The following is a particularly disturbing episode involving a stillbirth that you may not want to read. I have changed certain details to maintain privacy.

I had a list, once.

It was a list of things that I wanted to experience and treat as a resident when I would have backup and could ask for help. Things that I wanted to learn how to handle there rather than out in the “real world”.

One was a still birth.

So, one afternoon in my second year, sure enough, a young woman showed up at labor and delivery. Her baby had stopped moving a few days before she said and she was cramping a bit, in early labor.

There was no heartbeat on the Doppler or on the ultrasound. She had been about 27 weeks gestation we estimated.

It was awful telling this young mother that not only had she lost her first baby, but she was going to have to deliver the body. The baby’s father was out of the picture and she had no family in the area. She didn’t want me to call any friends or let anyone know. She intended to go through this by herself.

She also had not really had prenatal care and the hospital anesthesiologists had a barbaric policy at the time that only those who had prenatal care could have an epidural. No matter what. So as we started the pitocin to move her labor along, she had no pain management. Periodically I would hear her cry out in pain. We gave her Demerol, but that was never terribly helpful for anyone, really. I tried to stay with her, but really what she wanted, she said, was to just be left alone. She was grieving so I gave her privacy.

The baby was in breech presentation, so when I called the OB attending (he was not employed by the residency but was rather a private physician in the community who helped out covering OB call periodically) to notify him of the fetal demise and to ask if there was anything I needed to know, anything to expect in case there were any problems, he laughed. “Look, breech is a concern if you are delivering a live baby. Don’t worry about this.”

Hours passed.

At some point the woman started to feel the urge to push but did not tell anyone. Instead she had gotten up to use the bathroom thinking she needed to have a BM. Suddenly I heard terrified screams and sobs from her room. Two nurses and I rushed in. Lying between her legs in the toilet was a body without a head.

That’s right. No head.

While I got her back into the bed, one of the nurses fished the body out of the commode. I did an exam and no head could be found vaginally. A bedside ultrasound confirmed it was still in the uterus along with the placenta. The baby had likely been dead longer than she or anyone had expected and the tissues were friable.

I called the attending in a panic. He started laughing. Laughing! “Girl, I need for you to give me head…” More snickering from him.

Yes. The bastard was making jokes about me performing fellatio on him because of a decapitated baby.

Still, I had to play nice because I needed for him to tell me what to do next.

I hated him. I hated myself. I hated God. I hated that hospital. I hated being a woman.