Clouds from an airplane 

“Mommy? Is this water or spit?” She scrunched up her face as I scrubbed her grimy cheek with the damp napkin.

“What?” I tried to sound innocent.

“I said,” she squinted as I moved to her other cheek, “Is this water or spit?”

I sighed then moved to her chin.


“Ok.” I polished off her forehead quickly. “Spit.”




“I was sent to cardiology. Then pulmonology. I had chest X-rays and even a heart catheterization. When those were all negative he said he didn’t know what to do next. So my daughter said I should come see you….”

I nodded.

“The thing is, doc, the pain was only in my lower chest. Now it is also in my upper abdomen and I have nausea. It’s getting worse. Much worse. And the cough has not gone away…”

She was young. She was scared. She had everything to lose.

“Did you have any blood work done?” She had not brought any records with her.


“Any imaging of your abdomen? An ultrasound or a CT scan?”


“Here is the plan: start on an acid reducing medication twice daily. Let’s get some lab work done, including an H. pylori test looking for a bacteria that can increase your risk of stomach ulcers. Back in two weeks. If you are not starting to feel better, we will do some imaging.”

When the labs came back the next day, they looked awful. I already knew what was wrong…


Imaging confirmed. 

“You are amazing, Doc. You figured out in two days what my previous primary care doctor could not figure out in six months….”

I thought for a second about basking in the dubious glory of delivering her death sentence. In fact, I almost hung up the phone, leaving it there. I wanted to be the best, the smart one. Brilliant. The hero.

“Truthfully, I am not special. Anyone would have picked it up at this point. All of the other work up was already done and your symptoms had progressed to the point that it could not be missed. The early stages are tough. The generic symptoms could be almost anything. Your other doctor did all of the right things.”

There was an uneasy silence.

She wanted someone to blame, someone to be at fault, someone to be angry with. I understood. I was taking that away.

“Well, like I said, I am going to make some calls to see if we can get you into one of the experimental studies. I am not sure it is much hope but it is something. I am here if you need anything at all in the meantime…”

Father Apart


My own father and I have a complicated history. He hung the moon for me as a little girl. He played in the floor, tickled, gave me little gifts. We went on “dates” together to get icecream or donuts and hot chocolate.

Then something happened about when I hit first grade. I did not understand it. I blamed myself at first. He became angry. Even violent. He scared me. He stopped showing affection or love or joy. Gone. He was gone. Unreachable. And he never came back. 

We lived in the same house but I barely knew that man. I could not bring myself to call him daddy. He was my father, nothing more. Distance as a means of self preservation, maybe for the both of us?

I wish I could say that I have risen above wanting to have his approval, no longer caring that I don’t have some sort of meaningful relationship with him. Probably, though, that will follow me around for the rest of my days as a sore spot, a gaping hole in my life. And maybe that is good on some level that I do still care, that I have not let anger and hate stamp all of that humanity out of me.

So after my post “Daddy” yesterday, I thought about what I would say to my father now that I am grown if dementia had not already taken a foothold. What did I need from him growing up? What do I wish I had from him now? What do I want other dads to know about their own daughters’ needs?

First: I needed for him to show respect to my mother. (I value her means I value you.)

Second: To show me affection, even when I did not want it. Even when I was not very lovable. Hugs that were not forced or awkward, strong big hugs that can wrap around a stony heart and break down its walls.

Third: I wish he had told me about himself. His past. His hopes and dreams. His insecurities. I think I could have learned a ton from him about love and life if he had just let me in.

Fourth: I wish he had wanted to talk to me about me. My own hopes and dreams, my insecurities. I wish he had known me then, that he knew the woman I am now.

We waited too long to bridge that chasm. Even standing near now, we are never touching, close but not close. Two towers, strong and straight, unbending. Like father, like daughter. Now the man that he was is lost in the fog, slipping away. 


 Father, daughter heart shaped hands. 

“You know, you are super important. In fact, you are the most important relationship she will ever have.” 

He shifted uncomfortably in his chair across the room as I moved around the exam table to check the little eyes, ears, nose, and throat. He had just said that he felt terribly inadequate as a father, like what he was doing, trying to be there for his kids, would not ever make a difference. 

She giggled in spite of her fever when I told her I was going to check her snot boogers. All the little kids do…

“Nah. I’m just her dad,” he said. He cleared his throat quietly. 

“Exactly! You are her dad. You will be the first man who will make her feel beautiful. You will help her determine her self worth and from that, studies show, you will affect who and when she marries, her career success, her likelihood of using drugs or alcohol, and how early she starts having sex.” 

He cleared his throat again, this time more loudly. I looked over at his face. (The LUMP.) He was trying to clear the lump in his throat. There was a sniff, a few blinks. Then the moment was gone.

Do you see that kiddo? He loves you. Always remember that.

I listened to her heart and lungs, then she hopped off the table and climbed into her daddy’s lap where she rested her head on his chest.

“She has pharyngitis. This is probably viral so the focus is on supportive care for now….”



“Hey, Doc! We’re selling our house. I brought you a flyer in case you are interested.”

He handed me the glossy print out.

Gorgeous photos. Loved the kitchen. The backyard brick oven and pool were a dream come true. That tub in the master bathroom? I could have one hell of a bubble bath in that thing. MmmmHmmm. Yessiree.

I flipped it over to check the price.


I could not help laughing. Many people have a very warped sense of how much money I make as a physician. I do well, but not three-quarters of a million dollars worth of home well. Not even close. Sigh.

The property taxes alone made me shudder.

“That is way, way too expensive for my tastes, sir.”

“You sure?” He still sounded hopeful.

“I’m sure.” 

I handed the flyer back to him and we went on to discuss his rectal bleeding…

Standing Taller


“$380 for nine pills a month is outrageous, Doc!” He was almost shouting into the phone. I held the receiver away from my ear. He had just finished telling my medical assistant that I was lazy. 

“I agree completely, sir.” I took a deep breath and launched into my spiel.

I told him that he needed to check with his insurance company to find out if one of the other erectile dysfunction meds was cheaper. I already knew the answer was no. I had been through this dozens of times with other patients. In fact I had told him this before, several times. Still, he was not going to believe it until he heard it from the horse’s mouth, otherwise in his mind I was just not trying hard enough. 

“I know I am not the only person with insurance from this company in your practice,” he accused.

“You are right. But each major insurance company has dozens of sub policies negotiated by employers. There is no possible way I can know and keep track of them all particularly when they change each year.” 

“I’ll just find myself another doctor…”

What did he want me to say? 

No wait! Don’t go! Please keep verbally abusing my staff for something beyond our control.

I could not blame him for acting like a prick. I understand his frustration, even if it was misdirected. The pharmaceutical companies and the insurance industry were holding his sex life for ransom and it was NOT fair. He was a young man. He had a relationship. He had every right to be angry.

Viagra was first approved by the FDA in 1998 and it is under patent in the US until 2020. There may be a generic available in the US in 2017 but that has been changed before by legal wrangling so I am not holding my breath. Incidentally the generic has been available in dozens of other countries for years.  This fact has caused the price of Viagra to increase streadily to an average of $35-40 per pill in the US, a cost that is not covered by most insurance policies. 

Meanwhile, in the UK a pack of four generic sildenafil costs £1.45, about $2.26…. 


 Black and white chains from a swing set set against the sky. 
“You are indeed pregnant.” The girl nodded her head, resigned.

She already knew.

Her mother started sobbing. Great, body wracking sobs with tears streaming down her face.

“Mom. It’s just a baby.” The girl rolled her eyes.

“YOU are just a baby!” Her mother snapped back. “I wanted so much more for you..”

To my right there was gleeful male laughter. I turned around to find the teenage boy sperm donor staring intently at his phone giggling over some apparently hilarious YouTube clip.

“Hey!” I snapped.

No response.

“Hey!” I said louder. Giant red headphones covered both ears. 

Still no response.

I slid my wheeled chair over and covered the screen with my hand, causing him to finally tear his eyes away from the screen to meet mine.

“Take off the headphones and turn off the phone or get the hell out of my office.” I almost shouted.

He shrugged, indicating he didn’t understand what the big deal was, but he lowered the headphones to his neck and tucked the phone reluctantly into his pocket anyway.

“That was incredibly disrespectful.”

“Sorry?” He offered defensively but made it clear he didn’t really mean it.

“Not to me. Disrespectful to the mother of your child.” His eyes widened. “Yes, you are going to be a daddy. Pay attention!” 

He was not cowed. In fact, he developed an almost imperceptible swagger. He had marked his territory in her. 

She was his forever. 

Oh, there would be others. Many others. In fact, I had seen this fellow before, dozens of times, at various stages and various ages. This pregnancy had not been accidental as far as he was concerned. It had been a calloused, calculated move. 

I hated him.

In a matter of minutes, he had pulled the phone out of his pocket and was watching something else, though this time without the headphones and he was careful not to laugh.

They were all out the door after we had discussed prenatal vitamins, finding an OB, and the meds that were off limits during pregnancy.

Happy fifteenth birthday.

I could see in the girl’s eyes that she loved him still, somehow, but that would just be a matter of time…


 Philadelphia building facade. 
Last night someone questioned their self worth, lost in the darkness. Anger and sadness and fear for what the future holds conspired to make sleep impossible. 

I was the cause of that. 

Faced with a decision to hurt one person to save many others, to save myself, what other choice did I have? 


There is no joy in it, only relief in the moving forward.



“Mommy, I don’t want to die!” I could taste the fear in my son’s voice.

“Sweetie, you aren’t going to die.”

“But mommy, little kids die. I’m a little kid.”

Where did this come from, anyway?

I deal with death a lot. I have always been at peace with it in the clinical setting. I grieve, but there is peace.

I attended my first funeral at age four when my little friend from church nursery died from a degenerative neuromuscular disorder of some sort. I had seen her waste away over the months and I remember being terribly sad for her that she could not run or walk or even feed herself anymore. Even then I imagined that she was probably pretty happy about not being in a wheelchair even if she did miss her mommy and daddy. I didn’t cry when she died.

Now, as an adult, with my own mortality creeping up on me, deaths of friends and social acquaintances can hit me pretty hard.

So what to do about my son right now? How honest am I supposed to be with a four year old about death and dying?

I decided on being open about it. “Yes, hon, babies die and little kids die.”

“But mommy, I don’t want to die…” The sob was starting to edge into his voice.

So we talked about dying, how mommy has been with many people, even kids, as they were dying, what happens and why and that one way or another mommy would be with him if that ever happened.

Then, we talked about heaven. Streets paved with gold, pearly gates, mansions…he wasn’t digging it. I thought he might, given the fact he was in the midst of his pirate obsession, but nope. So I told him there would be corn dogs…all of the corn dogs he could eat (with ketchup) if he wanted. That was the ticket. Within two minutes he had relaxed and drifted off to sleep.

So there you have it, folks. Corn dogs. Corn dogs in heaven? I think heaven HAS to be different things for different people. For my son it will have corn dogs.

Do you believe in heaven? What will heaven look like for you? 

If this looks familiar, you are not crazy. It is a rewrite of an old post from last year…