A Down Sizing

Mission San Jose in San Antonio

I see and touch an awful lot of breasts. 

Just about every “uninhanced” woman on the face of this Earth has one breast that is slightly larger than the other. I certainly do. As I age it becomes more and more obvious… the left is fuller than the right. Every time I put on a bra or look in a mirror, I am acutely aware of it and I wonder if other women notice or care about their subtle discrepancies in size. Not that I would ever bring it up in the clinic, mind you. That would be akin to your beautician asking if you want her to wax your upper lip… creates a paranoia if there was not one there to start with. 

Thankfully, I have never had a man look at my chest and run away screaming.

Every once in a while I come across a patient with a more dramatic mismatching, like the woman with one breast a cup size A and the other one a size DD. It created a serious self esteem issue. She had never had a relationship as she was terrified of anyone see her naked. She stuffed her bra with whatever she could find until someone sewed her a pillow to tuck in there instead.

Hey! Sugery can FIX that for you…

You would think this would be a no-brainer, but no…. Invariably the response from insurance companies on the request for augmentation or reduction is, “Not medically necessary.”

I always wonder who the people are making these decisions. Men? Women? If a man, would a woman make a different decision? Or vice versa?

I know the angst I have had over the years over my slightly different sizes. I cannot imagine the psychological burden carried by these women with their really noticeable differences. So what determines medical necessity? We allow breast reconstruction in breast cancer. Is is “medically” necessary? Maybe not. But it is psychologically necessary. 

So then, what determines something being psychologically necessary? What size disparity is traumatic enough to warrant coverage? One size? Two? Four? How do you measure something so subjective?

And then what else causing cosmetic angst should be covered? I had a mole removed from my face while I was still in med school. Right next to my left nostril. It wasn’t huge in real life but in my brain it covered half my face. Best thing I ever did for myself, getting that sucker whacked off. 

So, what are your thoughts? How is your breast size? What do you think about insurance covering breast augmentation or reduction? 

The Gate Keeper

Door of a San Antonio mission

There was something weird going on. I could not quite put my finger on it. Things just did not add up. I told the attending what I thought.

“Was he really asleep?”

“No.”

“Why did you feel that way? What did you observe?”

He steepled his fingers, elbows on the desk, staring intently at me over the tips. He waited patiently, expectantly for my answer, like Mace Windu the Jedi master. 

Why is he asking me this? 

I thought back to the shackled man in the orange jump suit who had sat in front of me. He was not answering my questions. Then, his head lolled to the side and a soft snore escaped his lips.

“The way his eyes were moving underneath his eyelids, his breathing.”

Back to the Jedi master, I watched his face for a clue. 

Was I right?

“Good work.” He nodded slightly, a subtle tip of his nonexistent hat. “Why did you tell me that you felt he was faking it? You could have just said the interview was cut short because he fell asleep and left it at that. That would have been an easy way out.”

“Seemed important.”

“So then why didn’t you try to ‘wake’ him up? Why did you leave him then?”

“Because he was signaling the interview was over. I didn’t think my pressing him was going to get me any further than I already was.”

“Trust your gut.” He spoke clearly, each syllable measured and distinctly enunciated. I could see that he relished this role of the guru, the sensei. “So then, if he is faking sleep, is he also faking mental illness? Is he really hearing those voices telling him to hurt people?”

“I don’t know. Maybe?” 

“It all paints a picture. Now you have to decide, do we keep him here or send him back to jail?”

Me? I have to decide? I’m the student for crying out loud! I don’t want to be the one to have to decide. But then…. this is what I signed up for. I won’t always get it right. I just have to do my best, right? The universe would sort everything out in the end.

“Well?”

“Send him back.”

He scribbled his signature on the paperwork and it was done.

I carried the weight of that with me for a few days. It was my first taste of what my decisions would mean for lives hanging in the balance.

Did I make the right call?

Later the attending told me that he had seen this fellow multiple times before and each time he presented with a different constellation of psychiatric complaints as an excuse for violent behavior. By then I had decided that forensic psychiatry was most definitely not for me…

The Resurrectionist

Rotting car partially buried in the mud

You clawed your way out
Of a moonlit grave
Through the clods of dirt 
Moistened with your own 
Bloody piss and tears
When he showed up once more,
Hand extended, offering immortality.
He insisted that you believe he
Was the one who loved you and
Raised you up from the dead
Promising, as he had before,
That he would never be 
The one to actually harm you.
And?
Despite everything,
In spite of all of the cuts already made…
You believed.

*Resurrectionists exhumed bodies from fresh graves, then sold those corpses to local anatomists for dissection during the 18th and 19th centuries. They were also known as body snatchers. 

Traveling Through Time

Facade of Mission San Jose in San Antonio
I was not an only child, no matter how hard I prayed for God to take away my siblings. We did not have a lot of money so when we went on vacation all of us were crammed together into tight quarters in the family car. We slept on the floor with family/friends or in sleazy motels (think roaches and cigarette burned coverlets) and survived on McDonalds (you could get a sack of five burgers for five dollars). If we were super lucky, we got to take my grandpa’s motor home and ate hot dogs every day unless it was too wet for a fire, in which case we got spaghetti. 

Oh, there was bickering. Lots and lots of bickering…

Stop poking me!

Mo-ooommmmm! She’s looking at me again!

He’s breathing on me! Make him stop breathing!!!!

My father had a government job and my mother was a stay at home mom. As such, when we went on trips over the summer it was for 2-3 weeks at a time. I travelled all over the US learning things. I don’t think there is a place with educational merit in the continental United States that I have not visited except for things in the state of New York which I was told was “the den of sin and iniquity and the home of  those damn Yankees”. I wanted to see the Statue of Liberty something fierce but as far as my parents were concerned NYC in particular was not worth our time. 

I saw the VLA (Very Large Array) radio telescope years before the movie Contact made it famous. I learned about hydrology from the huge scale mock up of the San Francisco Bay Area complete with working wave maker built in the 1950’s by the Corps of Engineers. I learned about the Civil War at Gettysburg and Texas independence at the Alamo and Washington on the Brazos and fossil dating from Dinosaur Valley and the Petrified Forest. 

There were the obvious places like Yellowstone and Glacier and Mesa Verde. The contrasts of natural and man-made, like the arches in Utah and The Arch in St. Louis. And the obscure, like the Helium monument in Amarillo and what is left of Route 66 (no one cared about that back then).

I have so many good memories of those trips. For all of the bad my parents may or may not have done, they did get one thing right… those family trips. 

Well. Except for New York.

So now, as I am weighing an expensive trip to Disney World with my kids vs a cheap road trip with them somewhere more… interesting, I think about my own childhood. I have the means to make my kids’ dreams come true, if I wanted to, but do I really want to? I never did see Disney World but I think I ended up with something even more magical, an understanding and appreciation of where I came from… my own history and the history of others. That is what I want to pass on. 

So maybe Disney World is better left in our dreams and our imagination?

The Longest Ride

Columns on Alamo facade in San Antonio
“MOMMY! He hit me!!!” she wailed.

“No I didn’t!” he hissed back.

They both start hitting each other.

The elevator is full of men and women dressed in suits for some conference or another. Some turn and stare. Some laugh. Some pointedly avoid making eye contact. 

23 floors.

Just when you think they are old enough to get along in public, they prove you wrong. 

Siblings.

Because no one knows how to get under your skin quite like a brother or sister.

Exposure

Almond tree flowers
What makes a woman report a crime?

I’ve been thinking about this question since my turn with jury duty. There are tons of things that would make me call the police. Theft, causing physical harm to a person or property, cyber bullying, extortion, etc. There are some gray areas, however.

For instance, let’s take a woman who is minding her own business loading groceries into the back of her SUV. A man drives up slowly in the store parking lot and exposes himself to her, his penis waving about in all of its erect “glory”.* What makes her say, “You know what? I’m going to call 911 and report you, you sorry bastard!”

To be honest with myself and all of you, I would not be the woman dialing 911. I’d be shocked and disgusted to be sure, but calling the police? No. Not for this.

Why? 

Shouldn’t I be reporting the guy to keep him from doing this to other women? Isn’t it my civic duty to report it, to protect the public? 

Maybe I am just desensitized from seeing men’s penises every day as part of my job, some of them even erect (nothing funny about that, it is involuntary) that it does not offend me as it should? Maybe I just don’t want to waste more of my time on him. Filing a police report, potentially testifying in court… those things take time. A lot of time. Then there is the added aggravation of having defense counsel work to convince the jury that out of either malice or ignorance I must not have seen what I know I saw… worse, if the jury decided he was not guilty.

So here I am, an educated woman telling you that I would make the conscious decision to not call the police about a man showing off his penis to me in public and I have to be honest with you that after serving as a juror, I think I would be even less likely to do it. 

Call me a coward. 

What prompts another woman make the report, though? What are your thoughts? Would you call 911 if you were the woman? Why or why not? What if you were a man and witnessed this being done to someone else? What if it was done to you? Would you do something different if a friend was with you? What if there were kids around?

*In case you are wondering, this was not the case I served on as a juror.

Power Lines

Power lines

“Hey, Doc. Remember me?”

I quickly glanced again at the name on the chart. He was a new patient. His name did not ring a bell. I squinted at his face. Dark beard and hair with some gray in it, a bit shaggy, but fairly well groomed. Lips. No. Then his eyes. I remembered the eyes from somewhere….

My heart caught and my fingertips went numb.

“How do I know you?” I asked, playing dumb. 

I knew good and well who he was. 

He smiled at me. “February 14th, 2016.” He paused a second to let it sink in. “That was the day you found me guilty of aggravated sexual assault and sentenced me to 10 years in jail.”

I quickly tapped a help message on IM to my office manager. 

“I don’t remember…”

“Sure you do, Doc.” He leaned forward close, too close, and spoke again in barely a whisper. “They made a big deal about who you were during jury selection. Got out a bit early. I had very, very good behavior. Not a day went by, though, that I did not think about what I was going to do to you when I got out. I have a very good memory.”

He sat up straight. There was a knock on the door and my office manager popped his head in. 

“This visit is over. Leave,” I rasped, embarrassed that my voice caught in my throat like a frightened fool instead of conveying strength and force. 

Damn.

A look of mock hurt crossed his face and he laughed. “Fine. See you around, Doc.” 

He sauntered out, slowly, pausing before rounding the corner to look over his shoulder and wink.

*********************************

In case it needs clarifying, this IS a work of fiction. 

Showing Up

Empty barn at a livestock show

“Well, at least you will have some time off!”

I marvel at this well meaning sentiment because truthfully, jury duty does not feel like time off. It is more work than my real job.

First, I am spending hours on the computer trying to make sure patients’ results are communicated, orders and refills get sent, questions are answered.  I do this in the mornings before I go to court and at the lunch break if they give us enough time. I have a ton of anxiety… that someone is going to get hurt, that a patient is going to get upset, that a ball will get dropped. The office is terribly short staffed right now and I have to be out next week for my kids’ spring break. My jury summons could not have come at a worse time.

Second, while it is mind numbing, it is necessary to pay attention to everything that is presented so as not to miss the details. Someone’s future hangs in the balance here. It isn’t like I can sit in the jury box tapping away on my phone or reading a good book. I still have to focus on what is being said, boring or not. In the clinic I get to talk, interact with people, use my hands. Here? I am a fly on the wall, watching. Always watching. Never speaking.

My fingers and toes have frostbite. Why the heck do they have to keep the room so cold? So the one big man in robes doesn’t sweat while the rest of us freeze our asses off? A sweater is just not enough. I need a parka.

Here is something else: I don’t like any of my fellow jurors. They are annoying as all get out. What are the odds of selecting a room full of crazies? And what does that say about me, getting picked to sit here with them? Hmmm?

I hate that the judge and the attorneys have made a big deal over what I do for a living. “We have a doctor here, let’s pick on her.” I have to give my employment details on all of the forms. Why is it then necessary to announce to the entire court room who I am, what I do? They did not do that to anyone else. I hate the silly, ridiculous and even inflammatory medical statements people like the bailiff make around me as if they are wanting to goad me into weighing in, handing out free medical advice. It isn’t the free that I mind, it is the fact that I know nothing of their history and we do not have time to do a proper consult about their chronic cough right here, right now. 

This whole experience has been eye opening. 

Rant over. For now.