Code Redhead

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“But my diabetes is doing great, doc.” He shrugged.

The man was a brand new patient. He had stopped his meds on a whim a few years back, deciding that he did not need them. He had not been back to a doctor since then. 

His wife had made him an appointment for a physical, hoping he would start taking care of himself again. At least she cared. She sat in a corner quietly, meekly watching the exchange.

“How would you know? You are not checking your blood sugars, are you?”

“I don’t feel bad.”

“You probably don’t recognize that you feel bad, you have ignored it for so long. Your pee? You are spilling a ton of protein. All if that sugar has poked holes in your filter and you will end up in kidney failure if you keep ignoring it. Try to find a pulse in your feet. It isn’t possible. That is why you no longer have hair below your knees, unless you have started waxing. I bet you also are having some erectile dysfunction…”

“You dye your hair don’t you?” His eyes narrowed.

“Yep. I sure do, covers the grays.”

He leaned back and crossed his arms over his chest, smirking. ” I knew it,” he said to his wife. “Fake red head.” 

“I am going to write a prescription for some diabetes medication, something for your cholesterol, and we have got to get your blood pressure down so I am going to start you on a medication for that, too.”

“Why did you start dying your hair red? That isn’t your natural color is it? We should check your pubic hair, that would tell.” He smirked. “You weren’t getting any sex were you? That’s why you did it…” His smirk turned into a sneer.

He was feeling out of control. He liked being the big boss man, in charge of everything. He had a problem with women. Giving any amount of control to a woman was going to be hard for him. This was his way of trying to wrestle control back, by trying to humiliate me, knock my feet out from under me. I could let this escalate by being rude or defensive back or I could turn it around and make him laugh to diffuse the situation.

“Nah, sex isn’t a problem for me. I get plenty of that. But you are right that men either fear or lust after the hair.” I leaned over to his wife and whispered loud enough so he could also hear, “Either way I get what I want…” I winked at her. Then I turned back to him. “By the time I am through, YOU will fear the hair…” Then I winked at him. 

They both laughed.

Calming the Storm

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“Mommy, are those clouds going to make a tornado?” 

We were coming out of a live production of the Wizard of Oz. Seriously. They had done an *excellent* job with the special effects…

“Yep! Sure looks like there is a tornado coming this way.” I decided to mess with him a bit. There was a huge, ominous wall cloud headed our way. “See? There it is!”

“Mommy? Are you joking?” Panic crept into his voice as he searched my face. “I need for you to tell me you are joking or I am going to start crying.” His voice cracked.

“Oh, baby! Yes. I am joking. But we do need to hurry or we are going to get rained on!” He laughed, relieved.

As he and his sister buckled into their booster seats I checked the weather site on my phone. Tornado. A few miles away. The storm cell was headed our direction.

Great.

Rather than stopping for dinner as is our tradition, we decided to head straight home. I placed a to go order with our favorite dive as we drove. I tried to keep an eye on the weather developing around us during the 45 minute drive, speeding a bit to stay ahead of it. It was looking awfully scary.

We picked up the food and got into the house just as the rain started. Huge, fat drops splashed on our heads as we dashed inside.

Sitting down to eat, the tornado sirens started sounding. The entire family crowded into the little central hallway/room and we closed ourselves up from the world, waiting. 

I looked over and my son was shaking.

We all scooched together and his dad started playing Somewhere Over The Rainbow as performed by IZ (Isreal Kamakawiwo’ole) over and over again until the radar showed the dangerous part of the storm had passed.

Thank you, modern technology.

At bedtime my son gave me a hug and said, “Mommy, I love you but I want daddy to put me to bed.”

“Ok, sweetheart. But why?”

“I love him more. He helped me feel safe.” He gave me a tight squeeze and headed off to read a bedtime story, his little hand in his daddy’s big hand.

Daddy made him feel safe. The world is as it should be…

I Am Love

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A group of nuns stood off to the side, worn out from whatever trials their pilgrimage here had entailed, eyes wide with wonder and awe. Clearly overcome with emotion, one started to sing and then several others followed. Soon, the entire interior space of Saint Peter’s Basilica was swallowed up by the sound of angelic voices lifted in hopeful praise, an offering of sorts…

My heart ached from the beauty and sadness of it all.

God, where are you?

Notre Dame in Paris. Rainy day. Almost no one was there. I was emotional anyway. It was my last day in France and here I was standing in the middle of one of the world’s greatest icons, a place I never thought I would ever visit. As I was putting my camera away to leave, the pipe organ started to play. The richest, most beautiful sounds poured forth and seemed to shake the very foundation my soul…

My heart ached from the beauty and sadness of it all as I sat down and closed my eyes, letting it all wash over and through me.

God, where are you?

I was the only person left in the room in the ICU. The nurses were busy tending to other patients. The ventilator had been removed. The IV medications were all turned off. There was no family. I held her cold, wrinkled hand for the next two hours until she finally passed away silently into the night. I cracked open the window to let her spirit leave, feeling the cool breeze wash over my face…

My heart ached with the beauty and sadness of her.

God, where are you?

I watched his face as he made love to me in the floor. There was pain there in his eyes. Pain and love and longing and grief and lust. Gripping hands so tightly, afraid the other might slip away and expose our nakedness. A whispered name. Sweat dropped off of his bare chest and onto mine just before ecstasy took over…

My heart ached with the beauty and sadness of that moment, lying there in his arms, feeling loved, knowing that he would not be here tomorrow or ever again.

God, where are you?!?!?

And so I have found that God lives in music. God lives in life and death and in love itself.

My heart aches.

Empathy in Medicine

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Paul Curran does not have a blog per se, but he has guest posted all over the place including at Cordelia’s Mom Still and Willowdot’s and Doobster’s (don’t click the link to Doobster… it will just depress you). He also comments a lot over at Gibber’s place. This man knows an awful lot about an awful lot of stuff. In fact, he is pretty much an expert when it comes to healthcare because he has had to live it, through some very difficult times.

I say all of that to lead up to the questions he asked me on the It’s All An Act post:

Do you think medical school prepares a doctor sufficiently for seeing the big picture – the quality of life of the patient – or do they over-emphasize the technical side of practice? As you can tell from the question, my personal experience is that the medical profession spends too much time on the disease or organ and too little on the patient. How do you feel about that statement? Do you find it a common concern?

My answer:

I agree that there are a fair number of physicians who lack the ability to empathize with their patients. This is probably on par with any other profession but in medicine you feel lack of it more acutely. When a patient is hurting and frightened and confused, more than anything they want someone who can show some degree of compassion.

Why is this so hard for some physicians?

Sometimes it is an issue of survival. Critical care specialists? They are machines. Not very personable. But if I were the one dying, I want that physician on my side even if they are not giving me warm hugs. If you allow yourself to feel everything, you will soon lose yourself to it all. 

Sometimes, the subject matter precludes it. Nephrologists? Numbers. All they care about is numbers. And they are crazy smart, too. But take an astrophysicist and put them in the midst a group of religious fanatics and someone is going to go crazy. Or die. The two cannot coexist. 

Often it is a time issue. In the rush of a busy day it can be hard to slow down and take the time to find that place of empathy. Sometimes it hits me later, long after that patient has left my office, when I have time to process everything. This is one of the reasons why divorce rates are so high among physicians. The job is fast paced and demanding and overwhelming and at the end of the day there has not been enough time to even consider your partner’s needs, much less fullfill them. Patients get lost in that, too.

How do you fix it?

Some will probably disagree with me, but I am not really sure that empathy can be taught. Certain people are born with the ability to place themselves in someone else’s shoes. Some people stumble upon it, often because of finding themselves living through something awful. Others have to be taught how to fake it. 

The market rewards empathy. When I refer patients to specialists, I want someone who first knows their stuff, but secondly someone that the patient will like. I try to match personalities if I can. Not everyone wants a physician who holds their hand. Doing it like that makes me look good. Managing up the other physician doesn’t hurt, either. “This neurologist is just the best there is!” But getting patients in to someone personable is often not possible… those physicians are too busy. High demand. When we have to settle on someone else, I will often tell patients about that physician’s personality… knowing what they are getting into often helps.

What do you all think?

Manipulation

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Your child may have free dress on Tuesday for spring pictures but only if you are purchasing a picture package.

“Mommy!” Long shuddering sob. “We want free dress today!” My son was crying big huge tears. 

I was hoping I could avoid the whole discussion, just ignore it and sneak them to school in uniforms, but apparently it had been emphasized at school the day before. 

If you come to school in your uniform you are being left out! You are a lame loser. Your parents suck.

So that THIS could happen. Hysterics in the kitchen.

“Please, mommy?!?!??” My daughter’s eyes were welling up, too, as she looked up at me, hopeful. “I want to wear a dress! Please?!?!?” Then the screech. You know the one. The shattering glass, maximum ear pain kind of scream.

$22 for the cheapest package. Times two. So they don’t have to wear the uniforms I paid for…

Gah!

I get it. They don’t want to be singled out as the kid with the parent who is cheap. I know what it is like to be picked on and bullied for stupid stuff and a bunch of pre-K kids are not going to understand the absurdity of the economics and social pressure at play here.

So I relent.

I have to iron two sets of dress clothes, write checks and complete order forms in the minimal amount of time we have left for getting ready. We barely made it.

I am so tired of my children being used as pawns at this game, feeling like the school year is booby trapped at every turn. 

“Mommy, you won’t let me sell any of those first aid kits so I can get a keychain! You never let me do anything and I hate you!” I tried to explain after the subsequent time out that the first aid kits were super expensive crap and that it would be unethical for me as a physician to endorse them. 

He still didn’t understand.

I know this is the way of things, that we are only just getting started down this road, that it is pervasive no matter where I send my kids to school, but it does not stop me from wishing that it was not the case.

At least I take better pictures of my kids than their crappy photographer…

Vanilla Protein Drink

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“Hey, Doc! I brought you something special.” He hopped off the exam table and rummaged in a grocery sack that sat in the corner chair. When he moved, the scent of stale cigarettes and dental decay filled the room. He plopped a small cardboard carton on the counter beside me. “It’s a creamy, vanilla protein drink.” 

“Oh. Ok.” I wasn’t sure what to do with it. “Thank you?”

“Listen, baby. Drink it cold, OK?”

“You can’t call me that.” I had already warned him stop at his last visit.

“Why not, baby?”

“I am leaving if you don’t stop.”

“Fine, fine.”

He walked across the room and stood behind me, putting his hand on my low back.

“God, you look great.”

I moved toward the door. “Your blood pressure is awful and it is killing your kidneys.” 

“Look, I don’t really care if I die…”

“So why are you here, then?”

“To get a physical. But I don’t want you to save me.”

“Fine. Stay here. They will be in in a few minutes to draw your blood.” His hand was on my shoulder again. I shrugged it off.

“Thanks, baby!” He called as I closed the door behind me. My last vision was of him reclining with his arms crossed, grinning his semi- toothless grin.

I placed the sweaty carton of “vanilla protein drink” in the wastebasket at the nurses’ station. No way in hell was I putting my lips on that. Not ever.

More Questions!

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Mel (I don’t believe she has a blog) asked a number of questions the other day on my It’s All An Act… post. Here they are:

#1 What would constitute a perfect day for you? Traveling somewhere new, sightseeing with my camera. A close second would be a dark room with a bottle of wine and a few of my terribly sad chick flicks to get me good and depressed enough to write fiction…

#2 If you could wake up tomorrow with a new quality or ability what would it be? The ability to schmooze. I wish I were a better politician.

#3 What would you do if you won the lottery? Quit my job and do volunteer work for indigent patients at a free clinic somewhere that did not have to deal with “Meaningful Use” or insurance or managed Medicare crap.

#4 What was the last book you read? I Need My Monster, by Amanda Noll. (My kids love it.)

There are still quite a few questions left, so stay tuned! 

Burying Old Ideas

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I have an assignment for you good (and bad) people. I wish I could make it manditory, but I can’t. I know it is a pain to click on links and listen to podcasts, but you will not regret taking the time to listen to these two from Freakonomics:

How Many Doctors Does It Take To Start A Revolution (As a teaser, it partly discusses the fact that patients are less likely to die when cardiologists are away at a conference….)

How Do We Really Know What Works In Healthcare? (They share some startling information about the economics of healthcare utilization and reform…)

I am going to leave this up over the weekend and would love, love, love to have a discussion here in the comments for anyone who is interested.

(This was the final day of the Black and White Five Day Challenge, thanks to Cordelia’s Mom, Still. I have to say it was more exhausting trying to figure out who I could pass it on to than actually doing the photos! As for the last nominee, heck… I am gonna tag Gibber.)

Stranger

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Jane from Out of the Rabbit Hole on my It’s All An Act… post last week asked if I could change one thing in the medical field, what would that be? 

No question about it. 

It would be my EHR (electronic health record).

I have spent 8 years in a hell of sorts because of that damn thing. All day long it is a constant onslaught of little annoyances and big annoyances and it never, ever stops. 

It only gets worse.

I tried to get on the EHR committee, but my arch-nemesis is the gate keeper. No go. I even applied for jobs with the company that makes this god-forsaken EHR, to no avail. I looked for another job practicing elsewhere, thinking that a new EHR would be better, but they all sucked just as bad.

Through a strange twist of fate I found out yesterday that we will be getting a new EHR in the next 16 months. THE best one on the market. 

Finally.

After daily suffering day in and day out, grappling with the anger and frustration and not knowing what else I could do about it….

Poof! Gone.

I have spent so much time and energy being angry about it that now I feel… 

LOST.

(This is day #4 of the Black and White Challenge. Yes, that is a huge, life sized dinosaur. I was running as I snapped it. Today I am nominating Dragonflyzia!)