Bantha Bowls

 Field of sunflowers against a blue sky. 

It exploded like a gunshot. I screamed, involuntarily. 

My kids screamed in response. 

We all screamed again a few more times for good measure.

I paused for a moment to survey the damage. Chocolate had sprayed everywhere. Chunks of it were in my hair. Bits of balloon shrapnel hung off of the kitchen cabinet and dotted the floor.

One Bantha Bowl had bit the dust. 

Fortunately, we still had six balloons left. Clearly I was going to have to be more careful with the temperature of the chocolate….

Interestingly no one asked me about the Bantha Bowls on my Bridge post. In case you are curious about how to do them, check out this book:

Ice Sabers: Thirty Chilled Treats Using the Force of Your Freezer (Star Wars Cookbook)

It involves coating a water balloon with a bit of oil, then dipping it in melted chocolate. Once the chocolate has cooled and hardened on a cookie sheet long enough, you pop the balloons… Tons of fun science to be had with this project!

Meanwhile, I am going to go back to scraping chocolate off of the ceiling. I am sure to be finding splatters of it in surprise places for the next decade. 

Maybe I can use the bits of toilet paper left after turning my son into a mummy the other day…

The Guest

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The headmaster was standing at the back of the room in his brown suit and brown tie, his arms crossed somberly across his chest. He was a serious man who never joked, never smiled.

I was nervous just looking at him.

It was my second grade class and it was the end of the school year. My teacher, Ms. White, held a sheaf of those wide ruled tan colored notebook papers stapled together in her hands, turning each page slowly as she read from the podium at the front of the class.

They were my papers.

It was my story.

I stole another glance around the room. My classmates watched her with rapt attention, eyes growing wider. They were there in the story, I could see it!

There were dwarves and a wizard and a cave filled with treasure and scary monsters that clung to the dark shadows. I knew the secret, though. It was going to end up with good winning out over evil. Just wait, I smiled to myself.

As she read the last words there was silence. More silence. My heart stood still as the seconds ticked by. Then… everyone clapped, even the somber, frightening man at the back of the class.

He smiled at me!

I had never been recognized by anyone as being good at anything to that point. My handwriting was always awful. I read aloud too fast. My clothes were old, worn hand-me-downs. Mathematics was still a mystery to me. I was quiet as a mouse, never speaking, always invisible.

And so from that day forward I wrote every chance I could get.

I will never win any literary award. I will never have a huge audience. But when I put pen to paper I find my voice. The magic weaves its way through my fingers, taking over…

Thus began my love affair with words.

This was a guest post I did at Kevin Morris’s blog yesterday. Please check him out!

A Bridge

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I pulled to a stop in front of the kids shoe section. Why are kids so rough on shoes? One second they look fine, the next they are falling apart. Maybe it is crappy construction?

My daughter dang near fell out of the cart trying to reach for the pink sparkly shoes that were four sizes too small that had caught her eye. 

“Sweetheart, that’s too small for you.” 

Cue the histrionic wailing. 

I pried the shoes out of her grubby death grip and placed them back on the shelf only to turn around and find my son hanging upside down from the end of the cart.

How the hell did he do that so fast?!?!??!

I dragged him off and put him back on his feet only to discover that my daughter had grabbed another pair of sparkly pink shoes. These were four times too big.

More wailing.

I cursed myself for thinking that taking the two of them shopping for shoes would be a good thing. 

Fool! 

The balance of power was stacked against me…

At that moment I looked up to find a surgeon that I refer to quite a bit staring wide eyed at the insanity. She had been watching the whole spectacle. Her daughter was standing beside her quietly, perfectly well behaved. 

The woman was perfectly coifed and dressed in a chic casual outfit, not an ounce of flab anywhere on her body.

I was dressed in my running clothes: ponytail, hat, wind shorts, tank top, barely any make-up. I was suddenly self conscious about my squishy parts.

Her daughter was clean, dressed adorably in an outfit that matched perfectly.

My daughter looked like a garish, heroin addicted color blind princess. I had let her pick her outfit this morning. At least she felt beautiful as she cowered in the bottom of the shopping cart, making odd frightened bunny sounds.

“Hi!” my son volunteered, recognizing that she and I knew each other. “We made Bantha bowls and blue light-saber ice pops this morning.” He said it matter-of-factly as of it was the most natural thing to say to a woman he had never actually met before.

The woman stared back. Then she laughed. 

And smiled.

All was well in the shoe aisle.

Support

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In my clinic of three physicians, we have three front desk personnel (one handles check in, one check out, and one posts charges), three medical assistants, a referral coordinator, and an office manager.

You may remember the fact that in November the front desk staff was discovered refusing to schedule patients on the Wednesday before Thanksgiving. Instead of firing them as I was encouraged to do, I authorized a final warning which is the step just before firing. It was nearing Christmas, after all…

Within a few weeks, all three resigned. In some ways this was good. It saved us from having to go through HR crap and unemployment filings. 

Interestingly, though, as soon as they were gone our schedules exploded. My partners, who had been struggling to get their numbers up? Yeah, not really a problem anymore.

Following that, one of the other physician’s medical assistants resigned.

Then my medical assistant resigned.

Then the third physician’s medical assistant resigned. 

You can imagine that if even one of those people is gone, it puts tremendous stress on all of the other employees. It is rough for a week or two but drag that out into months, and the pressure is just too much. It creates a snowball effect. Staff members start dropping like flies. 

Then add to that the exploding schedules. It is one thing if you grow/ease into it. To have it suddenly dumped on you? Beyond stressful.

While trying to restaff my clinic over the past six months, I have uncovered some mind boggling things:

First, we are required to use a “recruiter”. I have heard for over two years that there are “problems” and that the system is trying to make it better. It is just getting worse. Turns out the recruiting company is actually only two employees for our entire healthcare system. 85 openings currently. As it turns out, it does not matter if I give them resumes. Hell, it also does not matter if fully qualified people send their CVs in on the website. I have a position that we have been trying to fill for over five weeks now. After beating the bushes, applying pressure, we were finally given four “screened” applicants, of which two were woefully inadequate and one had already taken a job elsewhere. On a hunch, I had my office manager access the applicant pool for our position. 

Over 180 CVs. 

That we are not allowed to touch….

Second, while the tradition is a two week notice when leaving a job, at this pace it takes a couple of months to wait for a suitable applicant to be sent over. Once we offer the position to someone, it takes three weeks for them to clear employment screening. Then there is a full week of training with corporate before they ever end up in our office. Overlap these, and a small office simply cannot function. We are crippled. 

Temp agencies? You are paying $23-25/hr for someone that would have been only $15/hr, someone who is most likely sub par anyway AND when you throw in our overly complicated, counterintuitive system (seriously, it is embarassing) without any formal training? It only makes things worse…

Third big revelation? If we are told the day before a new hire is supposed to start that they did not pass the pre-employment screening, we are screwed. We have to start the process all over again. The job has to be reposted. Have it happen a second time and we are now at four months looking for someone for this particular position. The system works somewhat for large clinics because they have more flexibility. The work of one person divided among seven is much easier to handle than if it is spread between two. 

I have been begging, pleading for help from corporate and none has materialized. 

Yet.

And that, ladies and gentlemen, is only the tip of the iceberg….

Why am I still here? 

I get this question a lot, and I have spent a lot of time thinking about this as I have watched the foundation of the clinic collapsing. It is the same everywhere in corporate medicine. I have seen it as I have interviewed for positions in clinics elsewhere. 

You don’t know what kind of employee you are really getting from a 20 minute interview. Once you have them it is a hell of a time getting rid of the bad ones and retaining the good ones. Being a little clinic required to play by the rules of a giant, out of touch corporation is the way of things. 

Hands tied. 

I am too old to go solo and insurance companies make it difficult to negotiate lucrative contracts as an individual in primary care. Even crappy EHRs are expensive. Malpractice insurance is expensive. All of the increasing government regulations and mandates and certifications are difficult to keep track of: PCM, meaningful use, PQRS, HIPAA, “shared savings”, CLIA, radiology regulations, Medicare guidelines, Medicaid guidelines, ICD-10, OSHA… I know I must be missing some.

What I want to do is just see patients. Patients are what keep me coming back every single day. All of this other stuff, these roadblocks to good care? I don’t want to even have to think about them. But I do. I have to. They make me stew and boil and…. 

Deep breath.

The Blues

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I have a thing for the color blue. 

I love all shades of blue: powder, aquamarine, turquoise, cobalt, electric, midnight, azure, royal, Prussian, sky, ice, baby, Tiffany’s, ultramarine, indigo, navy, steel, slate, cerulean…

Those colors all sound so sexy, so alive to me!

There is a passage in one of Oliver Sacks’ books where he describes the fantastic indigo blue he experienced during an acid trip in his younger years. I don’t personally know anything about acid trips (scout’s honor) but I love, love, love blue. The way he speaks about the color… I feel that when I see blue.

My absolute favorite shade is a deep, rich cobalt, like what you see in the stained glass here from Rouen Cathedral in France. It is also the color of the sky just before sunlight peeks up over the horizon. Seeing it makes me tingle all over. It makes me happy, gives me joy. 

I think I want to redo the windows in my office….

Are there colors you feel the same way about? What are they? 

First Post Challenge (Enhanced*)

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My first post from 2/26/14.  Thank you Edwina’s Episodes for the challenge.  Time travel is fun!

This morning I dragged two very cranky children to daycare kicking and screaming. I was running late after fighting with them…potty, dressing, cough medication…and before it was over with each of us was crying, for different reasons. My daughter wanted her blankie. My son wanted to NOT go to “school”. Me, I just wanted to stop feeling like the worst mother ever.

How many other women lived this today?

By the time I got to the office, my first patient had been roomed. Running late REALLY stresses me out. I spent a minute or two trying to choke back the tears and frustration, because let’s face it, no one wants to hear about their doctor’s problems and then ran into the room apologizing and smiling, praying the bloodshot eyes were not terribly noticeable.

Then, my next three patients did not show up.

This does not happen often. Usually I am terribly overbooked, so when I get a no show, I feel…lost

For a whole hour and fifteen minutes I had no patients! I used the time to get caught back up on all of the charting and paperwork that I am responsible for, but in the back of my mind the frustration was mounting. This morning I had felt as if I had incarcerated my children in some awful foreign gulag with strangers that would surely torture them given the opportunity. My son had begged and pleaded with me, sobbing, to stay “Just one more minute, mommy!” My daughter stared at me accusingly with pain in her eyes as big, wet tears of sadness rolled down her cheeks. Why? So I could go to work and do nothing. Never mind the fact that these missing patients may have had mornings like mine, or worse.

I started fantasizing about quitting my job, becoming a stay at home mom. My student loans are paid off. I could do that. For a year.

Then the self pity started. No one understands what I go through every day to be here. They don’t know that I worked until I was 41 weeks pregnant, praying that I did not go into labor earlier because I could not find a locum to cover my practice. They don’t understand when I have to take a day off for family emergencies or a long overdue vacation so I don’t go crazy or for studying to retake my boards (yeah, another ten years gone by). No one cares how little sleep I get, how many hours I work on charting from home, or how hurt I feel when a patient gets ugly with me, or that when they are calling the “on call doctor” that I may be in the middle of cleaning up toddler vomit. Blah, blah, blah.

I need to tell someone!

The truth is that I think we all want our physicians to have it all together. Give me an illusion of a capable individual who has everything in hand any day. Particularly if you are going to be operating on me. I don’t want to know that your are frustrated with your kids or your spouse right before you cut me open to resect my colon cancer. Or before you do a pelvic exam. Or talk to me about my depression.

The afternoon was a whirlwind, running from one room to the next, and kept me from thinking any more until now. The kids are fed and in bed and peace has returned to the house, and to my heart. As I hold my daughter’s little hands as she is drifting off to sleep I remember these important things:

Children make your life terribly complicated. But they also make enduring the other crap in your life much more worthwhile.

A hug and a kiss and an “I love you, Mommy!” can make it all go away better than a martini. Most days. Sometimes I still need that martini. Just not as often.

Being a physician is an honor and a privilege and worth working hard at. I wrestle daily with motherhood and work and how to balance it all. Sometimes I feel guilty that I find my job so fulfilling. Then a patient says, “Thank you!” and gives me a hug and I find peace again.

And now….

The dishes are not going to wash themselves!

*Enhanced because I did not start including photographs for months but I went ahead and added one here.

Shuttered

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I have had a number of nurse practicioner students come through my office over the years. I love to teach even though it is very stressful, patient satisfaction scores drop, and my production takes a hit. 

It is very frustrating, given this, to take on a student weeks from graduation who cannot tell me what is an appropriate oral antibiotic for strep throat or if an EKG is abnormal or not. Worse, they do not seem to care to learn.

After turning down multiple students so far this year, I finally agreed to take on another one a few weeks ago:

“What is your differential diagnosis for chest pain?”

Blink. 

“Tell me the current PAP guidelines.”

Shrug.

“What antibiotic would you choose for community acquired pneumonia?”

Blank stare.

“When do you graduate?”

In a month.

I realize that this may stir some controversy. Let me say that there are some really great nurse practicioners out there. I have met them. I have learned from some of them. There is a great role for NPs. 

Yet, each year the students I am getting sent to me seem less and less equipped to handle the responsibility they are about to assume. There is a wide range of skill level in physicians, too, but it is particularly frightening that these people will be wielding a virtual prescription pad in a matter of weeks. I get students from three different schools and it is not just one that is the issue. It is all three.

I am not sure I can keep doing this…

Happy Dance!

  Little girl picking dandelions. 

After all of the drama of last week, my baby girl is starting dance camp. I am at a loss. I am the antithesis of a dance mom. 

A ponytail every day? I rely on her school teachers for any elaborate hairdos (and yes, I consider a ponytail elaborate). They typically hold beauty shop right after nap time. I always cross my fingers that it lasts through the night well enough that I do not have to redo anything in the morning. 

Is she supposed to wear tights or shorts with that leotard? Seems almost indecent to me.

And that damn pink ballet shoe? She has one. The other is MIA. I have torn this house apart and turned it all upside down. I am certain it will resurface somewhere obvious. Most likely after the last day of camp…

She has dreamed of this moment since birth. Seriously. She has even gone so far as acting out going to “dance class” every single day after school for months… practicing putting on her leotard and prancing about with her dance bag slung across her shoulder. I am grateful that it is not something dangerous she has her heart set on, like baseball…

I will admit that I am a teensy bit jealous, as I had grand dreams of becoming a prima ballerina myself as a young girl. 

Good luck, my little Bug. I love you!

I See London, I See France… 

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“Doc! Where the hell did you get that skirt?!?!!! That is THE cutest denim skirt I have ever seen.” She held out her bruised and swollen ankle for me to examine.

I told her where the skirt had come from. She winced as I poked and prodded and tested range of motion.

“What’s that? I’ve never heard of this place before. Is it expensive? Remember I can’t afford the expensive stuff you buy. I’m not rich like you doctors….”

“Actually, I am tightwad, cheapskate penny pincher. I bought it on clearance.”

Truth.

In the time it took me to tell her the leg was not broken, she had pulled up the clothing website on her smart phone.

“What size do you wear?”

“I ordered a 12. It’s a bit large so it would sit low on my hips…” 

I lied. That really is my real skirt size and the waistband was not sitting low on my hips. But she didn’t really need to know that, did she?

Nope.

As I handed her the checkout paperwork, she pressed the “Place Order” button and had an identical skirt on its way to her mailbox via priority 2-3 day shipping. 

She really wanted that skirt. I never pay for priority shipping if I can help it!

In fact, the only things I really splurge on are fancy underwear and rarer than I would like trips to Europe. I don’t know if the nice undies make a difference to those people on the other side of the airport scanners but it sure makes me laugh. 

The Pope would blush if he knew what I had worn to the Vatican…

Looking Up

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I had big plans for this week. 

Big, big plans.

On Tuesday I intended to take the kids after work/school to the store to pick out Father’s Day gifts and cards. While there I planned to pick up a bottle of wine and have a glass every evening while their father was out of town this week. 

I miss my wine. 

By golly, a reunion was in order. All week I had anticipated the taste of a nicely chilled Pinot Grigio on the tip of my tongue as that heady, buzzy, relaxed warmth worked its way through the rest of my body…

Then, at noon, I got the call that my daughter was running a fever. With no one I could call in a pinch to get her, I used the lunch hour to pick her up and bring her back to the clinic. She lay still in the floor of my office the whole afternoon while I finished seeing patients.

Mind you, she was NOT ill when I loaded her up in the car that morning, even if the front office personnel at school gave me the suspicious squinty-eye, as if I was one of *those* parents… No. Not this time, people!

By the time I got her home, she was running a temp of 104. I had to cancel clinic the next day because I had no one who could watch her. 

Nooooo, mommy! My throat does NOT hurt!!!!”

A summary of the next 24 hours: Fevers. Fussiness. Refusing to eat or drink. More fevers. More fussiness. Negative flu test. Negative strep test. Negative urinalysis. More fevers. More fussiness. Another negative strep test.

With her finally developing some nasal congestion, I decided that it must be a viral upper respiratory infection. It will go away, I told myself, just be patient.

That’s my baby you’re talking about there!!!

Thursday, she seemed to be doing a bit better and my mother agreed to babysit. She was not entirely comfortable with how high the fever was, still running 103-104’s, but she would do it anyway, she said, since I did not have anyone else to help out.

Thanks, mom.

In the middle of the afternoon, as I was telling a patient that she needed an X-ray, there was a pounding on the exam room door:

“Doc! Your mother called, says that you need to call her immediately, your daughter is very ill!”

Deciphering my mother’s frantic gibberish, I gleaned that the kiddo had vomited blood. How much blood? She could not say.

By the time I got home, there was a pile of bloody paper towels in the floor, complete with a few mid-sized clots. My daughter was laying across a chair in the living room, moaning, her blood crusted nightgown plastered to her feverish body. 

Checking her out, NOW her throat looked awful. NOW her strep test was positive. Fortunately, she did not bleed out. She is on the mend after an antibiotic. 

I learned some important things from this experience:

1. How isolating this job can be. I barely have enough time or emotional reserve left over at the end of the day for connecting with my family, much less socializing with anyone else. As great as my virtual friends are, without a real, live social support network you are screwed.

2. Doctors can get it wrong. Even when we try really, really hard to get it right. Even when we care very, very much for the patients involved. We can still get it wrong.

3. Crazy parents that call over and over again for their kid’s super high fevers? Yeah. Not crazy.

4. I do NOT want to be a single parent. Ever. That plane had better land without incident this afternoon.

5. I still really need that glass of wine…