The Knee Jerk

Fall leaves on a tree
“I’m not reading you an extra story tonight.” The extra story happens so regularly it isn’t really *extra* anymore, but I’m not telling him that…

“Why not, mom?” He sounded hurt. 

“Because you’ve been behaving like a jerk.” It slid out of my mouth without even thinking about it.

“Mommy?” There was a tiny catch in his voice. “Why would you say that? I haven’t been a jerk!” A little sob.

“Yes, you have. You’ve been terribly mean.” Now that it was said, I felt the need to justify it so I went on to list his numerous infractions. It took a while… “You were being mean just to be mean. That’s being a jerk.”

Then the tears began to pour and the sobs wracked his body. “Why would you say that? I’m not a jerk. You should apologize! I wasn’t trying to be mean! You don’t know what I was trying to do.”

“OK, then. Why were you doing it?”

“I don’t know.”

He went on to lash out, beg, demand and cajole me into apologizing. It took me aback, his very emotional response to my very matter-of-fact statement. The truth was, though, I didn’t want to apologize. He had behaved awfully and he needed to know it. 

Didn’t he?

Well, didn’t he?

Or was I being the mean one? 

You are behaving like a jerk…

The truth of the matter is that there are times he has made me terribly angry, when I really wanted to be the bully my father was to me growing up. Not that I acted on that feeling, but it would flare up, the anger, and simmer under the surface until it burned itself out. But not this time. I was not trying to hurt him with those words. I didn’t want to belittle him. I just wanted him to know and I wanted him to understand that there are consequences.

But do I want him to do this to someone else, call them a jerk? No. No, I don’t. 

Little words carry so much weight. It is easy to forget how they can wound. I have never said anything like that to him before, never used the term “jerk” in all of his seven years of existence and in his world, at least right now, my opinion matters most. The apology from me was of paramount importance to him. 

So I did.

I apologized. 

Ornamental

Epstein Barr Christmas tree ornament.
Growing up we had a plastic tree that looked so obviously fake that it was mortifying. So much so, I never invited friends over for the month of December lest word of this “tree” got out to the general public. Hell, I didn’t invite anyone over for January, either, because that sucker was still up into February some years. I swore back then that I would only have a real tree when I was grown up and on my own and I would take it down the day after Christmas.

My first year of medical school, as I began wracking up the close to $100,000 debt for my education, I decided it was time for my first tree. So I went to the local home and garden store, in this case, Home Depot, and found that while I had enough money to buy a tree stand I did not have the money to purchase the actual tree. 

This was a problem.

Instead, I purchased a scrawny, pathetic little thing that measured maybe a foot and a half high for $10. It was a little seedling in a red plastic wrapped pot that was sprayed with glitter on the branch tips. I consoled myself by saying that I could plant it afterward and would not have to live with a murdered tree on my conscience. It was so flimsy, though, that any ornament, even those hollow blown glass balls, sent it drooping, bending over to kiss the tabletop. 

Ultimately, that tree never did get planted. I lived in an apartment after all. There was no place to plant it. While I could have taken it to my parents home and planted it in their yard, that would have required explaining the reality of my first tree to them after my many years of boastful scoffing. So far as they knew, my tree was a magnificent specimen of Yuletide cheer and I was going to keep it that way.

Pride. 

Pride made me kill that tree and after a few months, when it had finally turned all brown and dessicated, I threw it into the back dumpster to hide the evidence.

Incidentally, my parents still use the hideous plastic monstrosity of my childhood. It gets barer every year as bits and pieces fall off but it is still recognizable as a tree. That thing may just outlast us all.

(The photo above is one of the ornaments on my tree. Care to hazard a guess as to what exactly it is? Hint: It is an infectious partical and it cracks me up every time I look at it!)

Outcomes

eileandoonancastle3cropped

His voice shook.

“She’s in ICU. I thought you should know.”

I felt my body grow cold. She and her family had been patients of mine for almost ten years. She was so young. Younger than me, in fact….

“They aren’t sure if she is going to make it.”

“What happened?” It was supposed to be a simple cyst removal.

“Her small intestine was perforated. They have her belly open, said they couldn’t close it yet.”

I had used a new surgeon, someone I had never used before, because the mass was blocking the tube from her kidney to her bladder, causing quite a bit of pain and endangering the kidney itself. She needed surgery quickly and no one that I typically used was available to work her in. 

“That’s just awful. Keep me posted on how she’s doing. I’ll be saying a prayer for her and for you.”

“Thanks, Doc.”

As I hung up, the guilt welled up. I felt personally responsible for the bad outcome, even though my hands weren’t the ones actually in her belly. MY hands had hit the referral button, signed the order. 

She trusted me. 

She ended up making it, but it took a huge toll on her both physically and emotionally and financially. It affected her relationship with her husband. It affected her kids. They had almost lost their mother and it left them all shaken and ungrounded for almost a year. Things are only now starting to look up.

I feel guilty when patients don’t like someone I refer them to. I feel that I have let them down. I feel guilty when I find a cancer, as if somehow it was my fault. I should have prevented it. Maybe I could have found it sooner somehow? And, yes, I feel responsible for surgical errors and outcomes.

So when I tell patients they need to see a different specialist than the one they picked out, I worry how far to push it when they aren’t agreeable. When I know a back surgeon is bad, how much do I tell a patient who is not listening to my gentle suggestions to seek a second opinion elsewhere? Where is the line professionally and legally? 

These are my thoughts on this Monday morning….. 

Impact: Chapter Six

Chicago elevated train.

I awoke to sunlight streaming in through the windows. I stretched lazily. There was nothing more blissful than waking up to bright, warm light on your face after a long shift. This was why I always opened the curtains before crawling under the covers. That, and there was something reassuring about waking up in the night to see the lights of the city outside. It helped with the loneliness.

My shift! OMG.

My heart leapt into my throat and I sat bolt upright in bed. I had picked up an extra shift. I was supposed to work today.

Why hadn’t the alarm gone off?!?!!?!?

I distinctly remembered setting the alarm. Did I do something wrong? The new phone lay on the empty pillow next to me. I snatched it up and after hitting the button over and over again found that it was dead. 

How? 

I checked the power chord. It was plugged into the phone and the wall properly. Last night should have been a clue when email wasn’t working, I realized. I picked up the land line phone beside my bed. I needed to call in but there was no dial tone. I punched a few numbers and clicked the receiver a several times. Nothing. I slammed the receiver down in frustration. 

Skidding to the bathroom, I flipped the light switch but no light. I tried every damn light switch in the apartment but none worked. The clock on the microwave was a black, empty space. The TV would not turn on. Soon it was clear that the power was off completely. 

There hadn’t been a storm, had there? 

I checked out the window. The streets looked dry.

The clock on the wall in the kitchen read 9:18. I wondered if it was right or not but remembered it was battery operated. I was so miserably late and this time I did not have a Good Samaritan excuse. They probably wouldn’t believe me about the power.

I threw on some clothes. I had a habit of sleeping naked. It felt good to strip off all vestiges of the day and lie beneath clean sheets but now I felt terribly vulnerable. 

Exposed.

What was going on?

I would have to sort out everything later. The first order of business was getting to the hospital. 

Brushing my teeth helped. So did splashing water on my face. Quickly, I pulled my hair back into a ponytail. There was no time for make up. I shoved my make-up bag into the satchel next to my computer and headed out the door. Maybe I would have time later to apply something. I didn’t want to scare the patients…

Without my phone, I could not summon Uber. I was going to have to use the train. I zipped around other people as I ran two blocks to the nearest station. I flashed my card at the till but the light did not turn green. I tried again. 

Still red. I was getting frustrated and contemplated just hopping over.

“Hey, lady, do you think you could maybe go through or get out of the way?” The voice behind me was irritated. I turned to see a blond twenty-something in a light gray suit wielding his briefcase with an air of self importance. He glared at me. He was probably running late, too. So was the middle aged woman behind him and the older woman behind her.

“It’s broken.”

He rolled his eyes and reached around me with his card. The light turned green and he pushed past muttering obscenities under his breath.

The woman behind him did the same. I tried my card again but still got a red light. 

Fine.

The bodies behind me were pressing forward. I backed up from the turnstile pushing past the line that had accumulated behind me and did a quick visual search for a kiosk. 

Something was wrong with my card. Maybe I had lost track of how much was on it? I found one of the vending machines and attempted to load more money onto it but the message flashed that the card was invalid. I tried to purchase a regular ticket using my bank card but it said that card was invalid. Then I tried my credit card but received the same message.

Damn it!

Precious minutes were wasting! I fished out some cash and purchased a ticket that way, then made my way to the platform. 

I found a seat in the corner of the train and stewed. How could it be possible that all of my cards were dead? I watched the faces of the other commuters, wondering if any of them was experiencing something similar. No. They all seemed calm.

I decided to distract myself by putting on some mascara and lipstick.

At the next stop a woman settled into the seat next to me. She looked like a talker. I scooted closer to the wall and crossed my arms across my chest, hoping the body language would send the clear message to leave me alone. I couldn’t bury my head in my phone since it wasn’t working. I felt exposed again.

“Good morning!” 

Clearly, she had not gotten the message.

“Morning,” I muttered.

“You look like you are having a bad day.” 

I glanced over at her and raised an eyebrow. 

“My daughter, Cordelia, does the same thing.”

“What?” I was puzzled.

“Wrinkles her forehead like you do.”

“Oh.” I hoped the clipped response would shut down the conversation. 

It didn’t.

“I work in real estate as a paralegal. It is the most dreary office ever, so small you would think it had once been a closet. I feel the life sucked out of me a little bit each day.” My brain flashed to the scene in The Dark Crystal where the Skeksis drain essence from the Podlings, leaving them dessicated, mindless zombies. “Where do you work?”

“In healthcare,” I said carefully. Admitting that I was a physician always opened me up to awkward questions.

“Oh how nice! What exactly do you do in healthcare?” She smiled.

“I’m in housekeeping at the hospital.” It was sort of true.

She squinted at me, then laughed. “That’s funny! I would have put you in management. You just never know about people.”

I shrugged.

“I get off up here,” she said, digging her purse. She handed me a business card. “If you ever need to buy some property…” She winked as the train stopped, then was gone.

I tucked the card into my bag next to the accident victim’s card, shaking my head. What a 24 hours this had been. 

The rest of the trip passed in blessed silence. 

At the correct stop, I exited and ran the remaining few blocks to the ER at Northwestern. I stoppped at the nurses’ station to catch my breath and survey the lay of land. I could see they were fully staffed. There was Dr. Prick, I mean Dr. Waters, back again to make everyone miserable. There were three other physicians seeing patients but they and the rest of the staff pointedly avoided making eye contact. I checked the board. I was not on the list for today. Then I realized my name had been erased from the rest of the week, replaced with Dr. Waters’ name. A sense of foreboding came over me.

“Dr. Benton!” It was the ER director, Dr. Boyack. Someone must have alerted him to my presence. “Why don’t you step into my office?”

Oh, god.

I followed him into the tiny office around the corner. He settled himself behind the desk, motioning to the chair across from him. The room was sparsely decorated except for an ivy plant by a window that looked out onto a brick wall and a framed illustration of a busty female robot stood on the corner of the desk. Eccentric was the word for him. He studied me for a moment, probably for dramatic effect, then leaned forward, steepling his fingers in front of his long beard. 

“We have decided to let you go, effective immediately.”

I let out the breath I hadn’t realized I was holding. A million panicked thoughts were racing through my brain. When I didn’t respond, he continued.

“You have excellent patient satisfaction scores. The staff loves you. But we need someone more reliable.”

Wait! I wanted to scream at him. This isn’t fair! But in his defense, I had a habit of running late. Getting used to the unpredictability of Chicago transportation had been difficult. If I had not already established a pattern of behavior, we would not be having this conversation. So instead I just nodded. 

I was not sure this day could get any worse but at least now I had time to figure out what was going on with my bank and credit cards and to try to get the power back on at my apartment. Oh, and the phone. That goddamn stupid phone that I had been forced to get after the men in suits had stolen my original. I fingered the cold screen in my pocket. I wanted to take the cursed thing out and stomp it to pieces right then and there. 

But I didn’t.

He pushed a long, white envelope across the desk. “Your last paycheck. I’ll need your badge and keys.” He smiled sympathetically.

I dug the items out of my bag and dropped them onto his desk, giving a satisfying clang as the metal and plastic hit the fake mahogany surface. I opened my mouth to speak but thought better of it, choosing instead to leave the office without a word. As I reached the door he called out to me.

“Hey, Dr. Benton?” I paused, looking over my shoulder. “Good luck. I have a feeling you are going to need it.”

Chapter One

Chapter Two 

Chapter Three

Chapter Four

Chapter Five

The Day I Stopped Singing

Just like all kids, I had dreams. BIG, big dreams.

For instance, I wanted to be a figure skater for ages. They had beautiful costumes and were so graceful. But then one day I realized that since the freezer in my kitchen was the only time I ever saw ice, and that in itself was rare since the freezer was up high and I was not even in grade school yet, there was no way that was ever going to happen.

Then, I watched the Nutcraker ballet on TV and fell in love with being a ballerina. Those costumes were even better than figure skaters’ and it didn’t require ice. Every year I looked forward to the annual broadcast of that ballet at Christmastime. BUT since my parents thought dancing was sinful and god forbid some man wearing a codpiece touched me there during a lift, my chances of scoring lessons were slim to none. After a few years I gave up on that dream, too.

Then ROCK music came into my life. Well, my parents version of “rock” is not really rock but it was the only thing with a beat of any kind that I was allowed to listen to back then (think Amy Grant before she was “disgraced” or Micheal W. Smith). These were songs that I could feel. I just had to sing to them and I figured I was pretty good at it, too. At least I sounded good in my room with the radio turned up loud. My mother sang solos in church from time to time so it was in my blood, right? All I needed now was to be discovered…

In short order I had my entire career as a vocal star laid out and I took every opportunity that I could to sing in public until one day I recorded myself singing and then played it back. Cue the record scratch. It sounded horrible. Just like that, my music career was over before it had even begun.

After that, I stopped singing in public. I lost my voice so to speak. I would rather stand completely naked in front of a crowded room than to be asked to sing in front of them. I still sing in secret, though… In retrospect, it was the 80’s. The recording device I use using was from the late 70’s. It might not have been my voice that was the problem. Or maybe it was. I am not sure you can be a good judge of your own voice, really.

I say all of that to say that my son has started singing. He has always flat out refused to sing anything except for a few instances of “Twinkle Twinkle Little Star” sung in the darkness of bedtime when he was a toddler. It was like a switch flipped on all of a sudden a few weeks ago and now he is singing with gusto, with passion and emotion. 

As I watch him in the rear view mirror, it is an instant flashback to the time before my own infamous playback. He has a good voice, actually. I hope he sticks with it. I discovered something, too. When I join in with him, he does not scream and clamp his hands over his ears, begging for me to stop.

Now that he has found his voice, I hope he keeps it. It feels good to have someone to sing with…. 

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I always block my ID when calling patients. If I don’t, I start getting direct calls from patients. Those kinds of patient calls are the minority, to be sure, but they are exhausting and disruptive and are sure to occur when I am on the toilet having a rather tough poo (lots of noisy grunting) or whilst in the midst of mind blowing sex (also lots of noisy grunting) or something else equally awkward like changing a high lightbulb while precariously balanced on a ladder (probably also involving lots of noisy grunting).

One consequence of this is that patients don’t answer my calls. I have to leave a message and wait for them to call me back, sometimes an hour later. It happens almost 50% of the time when patients call the answering service, even though they are expecting me to return their call. It occurs 90% of the time when I have to call unsolicited, like when the lab alerts me that a patient’s potassium is 2.3 or their platelet count is 10 or maybe the hemoglobin level is 4.5 (these are very bad things by the way) and I need for them to go to the emergency room.

OR, the patients have the feature activated on their phone that will not allow unidentified callers through. That requires that I call the answering service back, then they have to call the patient and walk them through how to deactivate the phone feature, then call me to let me know I can try the call again. Sometimes that still does not work because they are unable to deactivate the feature and I have to call the answering service to call the patient back for an alternate number. 

What I really, really want is a way to ID myself when calling without showing my phone number. “Dr. Victo, phone number unavailable.” Or some such thing. 

Maybe that already exists and I am just a dork when it comes to telecommunications… 

The Lump

“How long has this been here?”

“I don’t know. Maybe six months.”

“Why didn’t you tell me? You have been in for a head cold and a sprained ankle in the past several months. Why didn’t you bring it up?”

Truthfully, I don’t know why we ask these questions. 

What does it matter in the grand scheme of things, the why? It could be one or several of over a dozen things but knowing why does not change the what or the now. Asking why only makes the patient feel… worse. 

Actually, I do know why we ask. 

It is our way of saying, “Look, if you die, remember it isn’t my fault,” because we feel guilty, somehow. Responsible. It is our way of conveying that we are hurt that you didn’t trust us without saying those exact words out loud. And to be honest, we are in shock, scared, terrified of what this might mean for you. We know the fear and the pain and the hair loss and depression and everything else that may come your way because of this little lump in your breast.

I have been on both sides. 

I can tell you that as the patient I understand the not bringing it up thing. I consciously chose to ignore it myself. Not because I was depressed or was in denial that it was there. It was certainly there. Nor was I lazy. Or ignorant. I knew full well the implications of a slow growing mass in my breast. I simply did not want to know. If it was breast cancer, fine. So be it. It wasn’t going anywhere. Death didn’t scare me. In some ways, I was probably playing chicken with death, with the mass.

Who was going to flinch first, I wondered.

Then one day my own doctor was saying those words to me… “What the hell were you thinking?!?!??!”

And the truth is, I don’t know. 

Please note, that I do not have breast cancer. I’m not dying from anything, not yet anyway. My breast is just fine, thank you! I was just reflecting on this whole phenomenon last night, the ignoring of things we shouldn’t really ignore. 

Trimmings

Want to know why the Saturday after Thanksgiving is not my favorite? 

The Christmas tree.

That’s right, folks. Until they can make a Christmas tree that fluffs itself and a prelit tree that stays lit rather than burning out at the center strip only, the Saturday after turkey day will always be the second worst day of the year. The first worst being the day I have to take all of those dadgum ornaments off and try to cram the well fluffed tree back into its teeny-tiny cardboard box.

Happy holidays… 

The kids just don’t appreciate what I do for them.