Receiving Joy

Cambodia 492

“How many children do you have?” he asked as we rounded a corner. I held onto my hat, wishing that I had a helmet instead.

“None!” I shouted over the rumbling of the motor, my words carried away by the cool morning air as it whipped hair into my face.

“That’s a lot!”

I thought he was being sarcastic.

He thought I had said NINE. I figured it out when he asked their names…

We were on the way to Angkor Wat just after sunrise and I was clinging to the seat of the moped trying not to fall off. I was taking a break from the villages and arsenic and sickness and poverty.

What does this have to do with Thanksgiving, you ask?

I have always hated this holiday. I do. It reminds me of how much everyone in my family hates each other. I find it hard to be joyful, even though I have a ton to be thankful for.

BUT that trip to Cambodia… When I got a glimpse of extreme human suffering and saw that there can still be JOY in hearts and laughter on faces and kindness, something like a bit of family friction gets put into perspective.

So on this day may you all be reminded of your blessings as I am.

Forty-Six And Her

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“Anything new I need to know about you since your last visit?” My fingers hovered over the keyboard, ready to enter the data.

“Uh, yeah.” She pulled out a sheaf of papers. “I discovered that the woman I thought was my adopted mom is actually my biological mom.”

It took a moment for my brain to wrap itself around that juicy tidbit. I stared at her until I realized my jaw had dropped and my mouth was gaping open obscenely.

(Shut your mouth!)

She coughed awkwardly. “My adopted father is not my biological father, though…”

Her hand held the papers out to me. I thumbed through them as she waited. She had had her DNA analyzed. She had a 15% higher chance of cardiovascular disease than the general population. Meh.

The DNA mapping had been her attempt to figure out her medical risk factors. Both her mother and father had been dead for years and she had not been able to find any info on her adoption. No names. No court records.

Now she knew why.

“A man contacted me on Facebook shortly after, saying he thought I was related to him. I matched his DNA closely enough to be a first cousin they said.”

From that info, her sister (now half sister) who is ten years older than her, figured out her biological father was actually a neighbor and former family friend.

So, in the 1950’s, this soap opera went down. Her mother got to keep her baby and her husband but only if she told everyone that the new baby was adopted. My heart ached for everyone involved. Did they love each other or was it a recreational affair? Had he refused to leave his own wife and family? How had she felt being faced with discussing this with her husband? Had she considered an abortion, illegal at the time?

All of this from a simple, innocuous sounding genetic test.

And then I wondered how many other secrets are buried out there? Should those secrets just die? Should they see the light?

Maybe, just maybe, there are more secrets than this world can hold?

Nothing Available…

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My staff asked a couple of months ago if they could take the afternoon before Thanksgiving off, closing the clinic early. I told them no for two reasons: First, we are closed both Thursday and Friday. Adding in another half day is not good for patients. Second, this is the week that teachers get off, so this and Christmas and summer breaks are the only times they can generally get in. I like to try to be available for them.

Suspiciously, the afternoon has remained devoid of patients for myself and the other physician who will be here. When I asked I was told, “Well I guess no one wants appointments then….”

So I had my office manager remind everyone last week that we are indeed open and they needed to schedule accordingly.

Still this morning we had no patients for tomorrow afternoon.

This time I had three secret shoppers call attempting to get appointments. Instead they were told that they could not come in until December because there were no appointments available until then.

I am trying to calm down so that I do not simply fire everyone.

Aw, hell. I just need to fire them.

Baby Jesus’s Little Sister

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My daughter has created a very elaborate mythology surrounding her existence:

“Mommy, I am baby Jesus’s little sister!”

“Really? What was baby Jesus like when he was little?”

“He liked to drink juice from a bottle. He cried a lot, too.”

“I see. How did you end up here with me?”

“Well, the monsters came and took me away. The fairies sliced you open and put me in your tummy to keep me safe. Then, the monsters came back and the fairies had to cut me out again.”

Word to the wise: Discussing C-sections at holiday time with a three year old can be interesting… Sometimes I forget that clinical things I am used to every day sound very different in their world.

Hangry Patients

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A while back I had a patient yell at my staff for telling her she should fast for six hours before her physical.

My response?

“If she is like that when she isn’t starving, I certainly don’t want her here when she is!”

Seriously, though, let’s look at this fasting thing more closely…

I hate fasting, personally. Not so much because I am hungry but rather because it forces me to deviate substantially from my routine. I like my routines. And my coffee. Ever smell coffee but know you can’t have it? Makes me turn into a raving lunatic, so I understand where patients are coming from.

So, the questions is, do you HAVE to be fasting for your physical?

Nope.

You sure don’t.

Gasp! I know right? All this time and NOW we say you don’t have to fast?

Here is the thing. We used to diagnose diabetes based on two fasting blood sugars over 120. The problem was there were actually a number of people who technically probably had diabetes who did not meet that criteria. Now, we can use a thing called the Hemoglobin A1C to diagnose it. This test is a way of estimating your blood sugars over a three month period and it is independent of whether or not you are fasting for the test. If you are not fasting for your physical and your blood sugar is showing elevated? No problem. I slap on a HgA1C and find out the truth.

The other test in question is the cholesterol panel. The main part of that test, the one we are most concerned with, is the LDL (bad cholesterol) that increases your cardiovascular risk (likelihood of having a heart attack or stroke). My feeling was always that if you were fasting, you were sort of cheating anyway because really how much time do we spend fasting? Our bodies live in the non-fasting realm. The advice to fast was never based on actual scientific data. It was a bunch of doctors who sat around in a conference room somewhere and said, “Hell, it is my professional opinion that we should make everyone suffer!” (Cue curmudgeonly fist slam on the table.)

But research earlier this year shows that the predictive value of your LDL number is not affected by whether or not you were fasting for the test.

“Woohoo!” I hear you say?

Absolutely.

I have now been pinning down patients for their physicals when they come for their first visit in two years when they have a head cold.

“Look, you and I both know you are not going to come back for your physical in a couple of weeks so let’s just do it now…”

The, “But I haven’t been fasting!” excuse no longer flies, people.

And BONUS, my staff no longer has to harass hangry patients into coughing up copays.

And YOU no longer have to starve!

The END.

Stop

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“And my mood was not good from the beginning today when my first consult was for a brain dead baby who was probably abused by the babysitter. Hard to have a good day when a mother thanks you for talking sweetly to her baby when we all know she is already brain dead.”

Remember that just like cops, physicians also see the darkest sides of humanity. We carry it around with us, deep inside. The world does not stop. Not for us, not for them. We have to keep going.

The next consult calls from down the hall….

Big Butts

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Dragonflyzia on my post yesterday “Living In The Shadow” commented, “Pretty… who gets to decides what is or what isn’t?”

I love this simple question.

So…

I was thinking last night that I should probably confess that when I rub my chin thoughtfully during an office visit, it is not because I am trying to look smarter. It is because I just remembered that I forgot to check for whiskers to tweeze the night before. It is impossible to resist the sudden compulsion to make sure none have suddenly erupted and need to be dealt with pronto.

Which brings me to, why do I feel the pressure to do this? Why can’t chin whiskers be beautiful?

Or my patients who want to go through painful procedures to address a few spider veins on their legs so they “can wear shorts again”. Why can’t spider veins be beautiful?

Tanning. My legs are too pasty? That is just a vast conspiracy by the tanning industry to control my mind and body.

Stretch marks should not have to end your bikini wearing days.

And now big butts. NOW they are all of a sudden cute and sexy? Where the hell was that thought during my WHOLE DANG LIFE to this point?!??!? Do you realize how much time and energy I have wasted on self loathing over my “pear shape”? Time that I could have been doing something constructive… like blogging!

Who gets to decide what is pretty and what isn’t?

Really. I want to know.

Whoever you are, I have a very simple message for you:

You suck. Now fix it.

Living in the Shadow

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Putting on my moisturizer with SPF this morning (and the three other dang face creams that go with it) I asked myself:

Why am I doing this, anyway?

Because truthfully, most days this time of year the sunlight never actually hits my face….

Turtle Soup

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“So, young man, what do you want to be when you grow up? A doctor like your mommy?”

The elderly woman smiled down benevolently as my son smiled back up at her.

“No, ma’am! I want to be a turtle.” He was very matter of fact about it.

“Oh, well isn’t that sweet! Turtles are very cute.” Still smiling.

Cue the Ninja attack battle stance complete with threatening scowl.

“Ohhhhh…..” The smile faded away, replaced by a look of pity directed at me. She then turned and busied herself unloading her grocery cart onto the conveyor belt.

Clearly he was one of *those* kids.

If you only knew…

Damn you, Ninja Turtles!!!!!

Better Than That…

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“I have GOT to see the doc. I have an awful boil right here…” He pointed to his left buttock.

It was 5PM. This patient, who had just driven forty minutes from his house to my clinic, had popped in the front door just as the front desk clerk was getting up to lock it.

“I’m sorry, sir. She is leaving for the day.”

“What? You mean I drove all this damn way and you are refusing to see me?”

“Sir, we had no idea you were coming…”

“Is she still here? I want to see her and have her say that she is refusing to see me to my face.”

Voices rose. The patient started shouting.

I waddled to the front. I was nine months pregnant with my daughter. My son was with the sitter and she had somewhere she absolutely had to be. I could not take even the extra 20 minutes to get this fellow incised and drained and on his way. I was already late after working someone else in at the last minute.

I had no choice.

I had to look him in the eye and tell him he was going to have to drive to the ER or the nearby acute care facility to have it addressed.

“Fine! I am going to find another goddamn doctor!” He stormed out, slamming the door.

And he did.

Do I want to be treated as an equal? No. I want to be treated better than that. I want my unique role as an employed caregiver to be recognized, honored, and accommodated.

But most days it just isn’t.

I am luckier than most women, though. I have resources others don’t.

Every day hundreds of thousands of women in the workforce are facing the decision to suffer their employer’s wrath or stay home with a sick kid.

Of eight support staff in my clinic of three physicians, three of those staff members are out with sick children today. That creates some serious hurtin’ in my world.

Why do I always hire young, single women with little kids?!?!!

I sent my son to school yesterday sick. Not contagious sick. Sick with asthma sick. I knew he was starting to not feel well and yet I still sent him on. When I picked him up yesterday evening, he was so short of breath he couldn’t even talk. A breathing treatment and some steroids helped but I felt like a terrible mom, choosing my patients and my job over my own kiddo.

It is a struggle every single dang day.