Carried Away

 mirror with a floral hammered silver frame 

For Cinco de Mayo I am going to tell you a story about my first margarita on the rocks…

In medical school I was assigned to the biggest, baddest, meanest resident in existence for my surgery rotation. He had made grown men cry more than once. 

I knew I was screwed.

The other student assigned to this resident was a fellow classmate who was known for smoking tons of weed. I think he is practicing pain management in Colorado now…

At any rate, as the med students assigned to this rotation we were lackeys, doing scut work that no one else wanted to do themselves.

Do what you are told, don’t draw attention to yourself. Stay out of the way. Learn as much as you can.

As it turned out, it was this resident’s last month at the program. He would be leaving for the biggest, baddest trauma surgery program in the country. The perfect match, in my opinion. He had a research project he had to wrap up before he left, however, looking at the use of hyperbaric oxygen in traumatic brain injury. 

You cannot go around bonking people on the head and then dissecting their brains in the name of science, so he was doing the research on rats. He had made a “machine” with a hammer that was supposed to generate a consistent amount of force when it whacked the rats in the head. No matter how many variables you try to control, closed head injuries are still variable. Highly variable. So you have to have a sufficient number of victims to account for that variability.

We spent the month scrubbing in on surgeries and getting yelled at by this guy, but he also made it clear that we had to help him with the rat project. So we anesthetized dozens of rats, bonked them on the head with the hammer machine, treated them with hyperbarics, then euthanized them and harvested their brains. 

I hated every single last minute of it. If there is a hell and I end up there, I imagine there will be an army of rats waiting to eat my face off.

On the last day of the rotation, as I cut out the last brain of the last rat, this scary as hell resident congratulated us on surviving and told us we were the best students he had ever taught. He wanted to take us out for a drink.

So he did.

Now, I had never really been an alcohol drinker. In fact, I had to that point in my life only ever had a single frozen margarita. It had tasted good. When I was asked what I wanted to drink, I picked a margarita thinking I would get one of those nice, delicious, fluffy frozen ones.

“Do you want that on the rocks?”

I did not know what the hell that meant. So I said yes. 

“Give her extra tequila,” my pot smoking friend said. The waiter laughed. My friend laughed. The surgery resident from hell laughed.

That was about 7PM.

By 7:30PM, when I stood to walk out, the world was listing to the left.

Speak Up

  

You are a Jewish physician. A man comes in as a new patient, tattooed head to toe with neo-nazi symbols and swastikas. He makes some hate filled, threatening statements about several ethnic populations, including the Jewish people but does not attack you directly because he does not realize who you are. You are very uncomfortable. 

Should you have the right to refuse to treat him?

Scarfing  

two birds painted on a pink scarf 

“Doc, I think this is the first time I have ever seen you without a scarf!” she exclaimed as I walked into the exam room.

I pondered this for a moment.

She comes in an awful lot. Is it possible that I wear scarves that often? 

It had not really occurred to me before….

I started wearing scarves in earnest after my first child was born. Baby drool and upchuck do not look good on a professional woman but especially not when that woman works in the medical profession. Appearing dirty in any way is an instant black mark against you. With a mere flip and a twist I could hide any stains in a matter of seconds. It saved me more times than I care to admit.

Further, I could conceivably wear the same shirt five days in a row with a different scarf each day and everyone would think it is a completely different outfit… Not that I ever *did* that, you understand. Maybe two days in a week when I could not get laundry done or three days when I was backpacking through Europe. Still, in the event of a collapse of modern society, I have my wardrobe wrapped up. 

Are YOU prepared?

Admittedly, I have a vast collection of scarves that spans decades. I hate to throw them out so they accumulate in my closet even if they are not being actively worn. I even have some ancient silk ones that once belonged to my grandmother…

Now that my kids are well past the spit up phase I think these scarves have become a security blanket I can wear around my neck. I used to hide behind a white coat. Before that, I hid behind a short, red London Fog type jacket with the sleeves pushed up that I wore in all weather, rain or shine, even in 100 degree weather. 

Time to dial back the scarf use, I guess.

He Had Balls

IMG_9171
I don’t remember for sure what grade I was in. Second? Third? All I know was that I was once again standing alone outside at recess, shivering in the cold, watching everyone else play with their friends. I had wanted to play soccer but as they were choosing teams no one picked me. I was left behind at the edge of the field trying to pretend that I didn’t care. 

There was nothing else I could do by myself so I stayed to watch with the familiar lump sticking in my throat.

Don’t let them see you cry.

One of the boys left the field and came over to me. I had never really paid much attention to him. Boys had cooties, you see. He was nondescript. Perhaps a bit stocky. Brown hair. Freckles. These things I remember only vaguely. I am not sure we had ever actually spoken directly to each other before.

“You know why they don’t pick you?”

“No.”

“Because they think you don’t know how to play. Do you know how?”

I started to nod my head yes then decided to be honest. “No.”

“I will teach you, then.”

And he did. Over the course of the next few recesses, he taught me the rules, how to kick, head butt… everything. 

He did it in spite of being made fun of by everyone else. He was playing with a girl. 

He was playing with that girl.

They still didn’t pick me for teams. They still all made my life miserable. But now I knew how to play soccer because Craig Mercer taught me. That made me somebody. 

I don’t think we ever really played or talked much together again after that and I don’t remember if I ever said thank you. I have no idea where he is or what his life is like now but I will always, always remember his name.

Scary

 field of sunflowers

“She has never met a stranger, Doc! Trying to teach her to be safe around people she doesn’t know is really hard.”

I laughed as I checked out his daughter’s right ear and then her left with my otoscope then placed the instrument back on the wall rack.

“Yeah, my kids like to wave at scary people at stop lights, and I mean really scary people…,” I caught myself awkwardly after the emphasis.

I glanced over at him quickly to gauge how he took that last statement.

He was a big, burly man with a full beard and multiple nose and lip piercings. He had large black spacers in his ear lobes and tribal tattoos over his arms. He worked as a motorcycle mechanic and his hands were always dirty. Did he wonder if he was someone I would have thought was scary at a stoplight? I am certain he had been treated as if he were by others over the years, probably many times.

What makes someone scary?

To be honest, he would be downright terrifying to me twenty years ago if I met him on the street.  At this point in my life I like to think I know better. Then, I make a stupid comment about waving at scary people at stop lights.

Is it just the unknown? Or is it the simple fact that someone does not look like us?

When I was a little kid I used to sit on the bed in the back of my grandpa’s RV waving at all of the truck drivers that pulled up behind us on road trips. When my parents realized what was happening, I got in trouble. Big trouble. They wanted to make sure I understood that sort of behavior would probably get me killed or raped by some strange man.

Truck drivers are dangerous.

One day in med school I was chatting with a very friendly woman on the psych ward. She was articulate. Bubbly. Kind with the other patients, sort of a mother hen. She was a joy be around. My attending called me over after a few minutes and told me she had gouged out the eyes of her four kids because they had glowed red in a photograph and must have been possessed by Satan. She managed to kill three of them. The fourth child survived. Blind. It shook my confidence. That was not at all what I had expected.

Shouldn’t you be able to see the bad in people?

A few years later I handed some medication samples to a man at the clinic. He pointed at my son’s picture on the wall and commented on what a handsome boy he was. I had treated that man for years and thought I knew him pretty darn well. I liked him. It was maybe two weeks later that he was arrested for molesting his two grandchildren and a disabled stepson.

The realization that someone’s appearance cannot tell you who they are throws the whole world off balance. The most dangerous people are the ones with evil you cannot see.

Should I let my kids smile and wave at strangers at a stop light? Hell, I don’t know. I just wish fear did not have to rule so much of our lives. 

The Crevice

Chicago Sky

I am not entirely certain why he comes to see me every year for his physical.

Each visit is exhausting. I make a statement, he argues. I argue back. He has said that he considers himself to be smarter than any physician. I try to show him why he is wrong.

Thrust. Parry. Stab. Duck. Turn. 

I felt I had managed quite well this time, getting through the visit without bloodshed. I was quite proud of myself. 

Relief flooded over me. 

“Well, I am done here. My medical assistant will be in in a few minutes to take you over to the lab.” I smiled to myself as I picked up my computer and started quickly for the door hoping to get there before he said anything else.

“Hey, Doc!” I could sense a sort of glee in his tone.

I cringed inside. I turned around and smiled at him, hoping to show that he was not going to get to me. 

“Yes?” I asked, keeping my tone even.

“I just wanted you to know that you have something stuck in your teeth when you smile.”

I ran the tip of my tongue over the teeth. Sure enough, I could feel a big chunk of the breakfast sausage I had snatched from my daughter’s plate on the way out the door that morning had lodged itself between two teeth in that sneaky crevice right at the gum line. 

Damn it!

He had struck the final blow. 

This time.

Curbside 

looking up st St. Peter's Basilica

Curbside Consult: To ask another physician a question about the management of one of your patients when they are not actively seeing that patient.

In residency I was taught to never curbside another physician. 

Mainly it was presented as a liability and courtesy issue. You don’t ask another physician to take legal responsibility for giving advice on a patient they have not examined and are not receiving payment for… payment that is going to help cover their malpractice insurance in case it is needed, God forbid. In residency I even had physicians refuse to discuss cases that I was referring to them until I had done the referral and they had actually seen that patient in their clinic and if I did ask a question, I had to be very careful how I asked it. They were downright ugly about it at times. I expect it is exceedingly frustrating for them to get asked the same dang questions each year by each new set of residents.

The bottom line when you are in residency for primary care is that specialists just don’t want to see your patients. They are often disagreeable patients and have been fired from other practices (they take their toll emotionally on you and your staff) or they are indigent or on Medicaid or Medicare (unless you are paying residents a tiny pittance as indentured servants you cannot take more than a certain percentage of these patients and still remain a viable business). Often the waiting time to get patients in is months long so you learn to treat a lot of stuff yourself. You eventually get to the point where referring a patient feels like a sign of weakness and you try to avoid it all costs.

Then, you graduate and start practicing in the real world and discover that no matter how good you are at treating something, patients would generally rather see a specialist. As primary care, it is thought by many that you know next to nothing.

The flip of this is that all of a sudden you find that specialists actually want to see your patients. They are nice to you. They say nice things about you to your patients. They may even curbside you for something not in their scope of practice as if you are the expert. Now I have the cell phone numbers of tons of specialists handwritten written on their business cards stashed in my desk. They hand them to me and say, “Call or text anytime!” I still have a hard time believing it and cannot bring myself to ever do it. 

For some, networking like this comes easy. They are very good at it. They build vast collections of people they can consult at any moment and asking for help doesn’t bother them. Not for me, though. This is one of my weaknesses, one of the drawbacks of being a physician who is a closet introvert. Asking for help is painfully difficult. So is ordering pizza by phone.

Until this week.

I had something that I really needed help with, something I had never seen before and could not find the answer to myself. Ultimately doing the right thing by patients has to take precedence over my discomfort. So I phoned a friend, so to speak. I don’t intend to make it a habit, but it was super nice to be able to get good advice quickly without feeling stupid about it.

So thank you. 

On Stage

  

“Dancers should be in costume with their make up on, ready for the photographer at 7PM.”

Make up?

Make up?

Truthfully, I am not ready for this. I am not ready see what a grown up version of my little girl is going to look like.

Oh, sure, she loves make up, but she still thinks that a beautiful application of lipstick extends about an inch beyond the actual lips, hardly realistic and I am just fine with that.

I was not allowed to wear make up growing up. Even all through high school. None. Now, I had my ways of getting around that, to be sure… For instance, I had art pastels. The colored chalk sticks made great blush and eyeshadow in a pinch. Or black acrylic paint could stand in for mascara (I was too desperate at the time to worry about what that might actually do to my eyeballs). The trick was keeping it subtle so that my parents couldn’t tell and my brothers wouldn’t realize and rat on me but still enough that I did not stand out to my peers as a repressed, prudish freak. A very delicate balance.

I swore through all of that I would not do the same to any daughter of mine.

Then I had one. And now she is five and in dance and has to wear make up!?!??!!?

So now I am left wondering if the whole issue with make up for my own parents was not that it would make me look like a whore, as they said, but rather having to adjust to the reality of their daughter growing up. 

Maybe both.

I am not going to ask them, though.

Excuse me while I go watch some tutorials on dance make-up application.

Yellowed

yellow painted industrial lights on the Eiffel Tower.

He was rude and ugly and had been since the day I met him for the first time… three days prior. I listened to his symptoms and looked at his jaundiced face and I knew. 

I knew.

The whole visit he was antagonistic, questioning my every move, downright insulting me at times, telling me that I did not know what I was doing. I wanted to yell at him to shut up and be nice, to just let me help him, but I knew that he knew that I knew he was dying. 

Bullying me made him feel as if he still had power. 

“I have your results, sir. They confirm what I suspected.”

“You are a stupid bitch.”

I am so very afraid.

“I know this is not something you want to hear and for that I am sorry. Let me set you up with an oncologist and they will take it from here…”