Lifted

IMG_5522

“Doc, something weird just happened.” 

I stopped with my hand on the door handle and turned around, heading back to the rolling stool in the corner by the sink.

Dang. I had almost made it.

“Oh, yeah?” I tried to smile and waited expectantly for him to say he had experienced a run of palpitations as he was sitting there or that he just had a spell of crushing substernal chest pain. If something like that is going to happen it will always be at the very end of the visit when I have already run overtime. 

Still. It must be dealt with.

Always.

“Your hands. They weren’t cold!” He had a funny look on his face as he knit his eyebrows. “Why weren’t they cold, Doc?”

“Oh.” I shrugged, relieved. “Probably because today I am very, very angry at the IT people.”

“Got your blood pressure up?”

“You betcha.” I gave a brief explanation of the printer error which left 3/4 of the staff unable to print documents for patients. It had mysteriously surfaced on a Monday morning and supposedly, no one could fix it. 

I paused in front of the full length mirror in my office before seeing the next patient and realize that I really looked angry, even through the smile plastered on my face. 

If looks could kill those IT people would be dead ten times over.

Bastards.

I closed my eyes and took a deep breath. Exhaled. Again. And then again.

You cannot fix this, either. Getting angry about it won’t make things work faster.

Part of me said, “But I want to be angry! I have every right to be angry!” Another side said, “No, it does NOT feel good! Give it up. Be grateful that you have a job.”

I closed my eyes and made the tension wash away. I willed the arguing voices to shut up.

And then I had an epiphany. This may sound kooky not getting to it until I am almost 42, but here it is:

There will never be a perfect world.

That’s what free will gets ya. Turmoil and drama and instability are the only constant. I keep holding out for when things get better but they won’t ever be better. There simply will never be a day when I don’t have staff errors and patient drama and IT failures and I need to accept that. Humans are by nature unpredictable and unreliable and unstable. The more I try to control the less control I have and the unhappier I become.

I have known this intuitively but it is a far cry from knowing to understanding and an even father leap to acceptance.

So, I squared my shoulders and picked up the computer. I knocked three times on the door of the next exam room. This time, I smiled from the inside as I entered.

We will see how long this lasts…

Well Crafted

 I came across an article the other day that encouraged knitting as therapy. In fact, there are knitting therapy groups popping up all over the place. It is even being advocated for weight loss.

Here is the article if you are interested: The Health Benefits of Knitting

All of this made me laugh out loud because, being a knitter myself, I have recommended knitting to patients as therapy countless times over the years and have pondered starting my own knitting circle at the clinic to teach those who are interested. I would call it my Stitch And Bitch group, because of the history behind the name. 

AND because profanity by itself can be a bit therapeutic in its own right. 

In fact, though, it is not just knitting. I have recommended crafting of all sorts. “Find a constructive hobby where you create!”

It will help. 

Maybe?

To be honest I have only had two people to my knowledge ever take my advice. I taught one how to knit a basic scarf during office visits. It did help, they said, at least it helped until they had made all of their extended family Christmas scarves by July and then gave it up, not wanting to try more complicated projects. Often I get the argument that they don’t know how to start or that they don’t have time or that they could never possibly be any good at it.

No worries. We have pills for that….

I have connected with countless crafters/artists here on WordPress. Knitters, crocheters, woodworkers, photographers, quilters, painters, costumers, artists in other mediums… And I wonder, would they consider it therapeutic for them?

Crafting of various types has gotten me through super rough patches in my life. Making jewelry. Knitting and crochet. Sewing and quilting. I enjoy learning new skills and looking back on the beautiful things that have come from the negativity. The sense of pride I get from finished projects helps lift me up. I wonder if Lego would count as a craft?

Do you craft for therapy? If so, what do you craft? If not, if you were going to pick a crafting therapy, what would you want to try? 

Paved

IMG_2054

“A blank wall of social and professional antagonism faces the woman physician that forms a situation of singular and painful loneliness, leaving her without support, respect, or professional counsel.” Elizabeth Blackwell, the first woman to receive a medical degree in the US, graduating first in her class at Geneva Medical College in New York in 1849.

To all of the women who went before, who fought for their own right to practice medicine making a career in medicine possible for women today…. I salute you.

Happy National Women Physicians Day! 

Spread

IMG_2176

“Doc, I want you to check her down there to see if she has ever had sex before. You can do that, can’t you?” He spoke to me outside the exam room. His almost whispered words down there signaled his extreme discomfort with the subject matter, his 14 year old daughter’s lady parts.

“Ugh. Well.” I sighed. “Yes and no. Yes, I can look at her vagina and see if she has a hymen. But its presence or absence alone cannot determine virginity.” I went on to explain why absence of the hymen could occur from active sports, use of a tampon… Hell, she could have even been born that way.

“But we caught a boy in the house when no one else was home. I just need to know I can trust her.”

“I understand, but what if a hymen isn’t there?”

“I’ll kill her!” I could see he was speaking in the metaphorical sense, though still clearly angry.

Did you hear anything I said?

“No you won’t. You will still love her because she is still your little girl.” 

His face softened a bit. “I still want to know.”

“Look, it’s her body. Forcing her to undergo an exam of this nature is akin to rape, even if she is a minor, and it sends the wrong message to her about who is is control of her body. I won’t be the one to do it.”

I always hate being asked to do these things. It makes me feel dirty and ill and twists my insides up into knots.

He couldn’t see it quite yet, but this was not about a boy. Not really. It was so much more…

Your relationship with your daughter is jacked up and you both are lost. You don’t know your way back anymore.

Typically, I get a belligerent verbal attack or threats of leaving my practice if I don’t do what is asked, maybe a report against me to the state medical board. This time, though, he took my offered list of family counselors and actually looked at the names listed there.

Maybe there is hope for these two?

Jumping Back In

  

I had big dreams as a kid. Somehow I just knew I was gonna be somebody when I grew up. I wanted it so badly that I could feel the ache in my toes, the gnawing in my gut… every single day.

Medical school became a reality and I figured I was well on my way. 

After residency, I started a job with a large group of physicians. Within two years I was elected to the executive committee (essentially the clinic’s governing body). A year later I was on the hospital’s quality committee, the hospital executive committee, and then was elected Chief of Family Practice. I was on the Patient Satisfaction committee for the entire system and helped make system wide policy. I had plans. I wanted more. Chief of staff? Board of directors? Yes, please.

Then I got pregnant. 

Pregnancy was NOT in the plan. I never, ever saw myself as a mother. I did not understand those women who were and regarded them generally with scorn and suspicion. I knew that to BE somebody by my current definition I could not also be a mother. If there was one thing medical school taught me, it was how babies were made. I was on the pill and by golly I took it religiously. I tried to avoid sex as much as a married woman could and required the use of condoms whenever I could not.

But that one damn night… 

All it takes is once, folks. Get a little cocky, a little careless, let love/lust get in the way of rational thinking and BAM! You are changing poopy diapers.

I put the positive test in the top drawer of my desk. For weeks between patients I would peek into the drawer and stare at the pink line feeling the panic well up from my uterus.

What was I going to do?

At the time I was practicing both inpatient and outpatient adult medicine and pediatrics. I was there for meconium deliveries and ICU admits at all hours of the night. I worked many Saturdays doing the acute care clinic when I was not on call at the hospital. Then, there were all of those committee meetings.

How would I breast feed? How could I work a sixteen hour day on my feet while 39 weeks pregnant? What about a sick baby or sick toddler? Childcare?

So I walked away from it all. 

I moved to another clinic where I would only do outpatient medicine. I gave up my hospital privileges and committees and meetings and ambitions. I was no longer the Chief of Family Practice. 

At first it felt odd. 

Empty. 

Disconcerting. 

But when my son was born, there was no question I had made the right decision. Evolutionarily speaking, this is why babies are so cute. They HAVE to be to survive. My definition of who I was shifted and interestingly I was at peace with that. 

Mostly.

I hate just griping and complaining. This blog is therapeutic but I like being involved in a solution. Doing something instead of merely pacing the floor, wringing my hands. Now that my kids are older I am ready to get into it all again, just not to the level I was before.

Last year I applied to join the EHR (electronic health record) committee for the system only to find out my arch nemesis was now the gate keeper for all system wide committees. I promptly received a rejection letter hand signed by him with what appeared to be extra flourish (I admit I may have imagined that extra flourish) and I resigned myself to staying involved only at the clinic level until he retired at some unforeseen date many years in the future.

Then, an email…

An invitation to join an EHR subcommittee arrived in my inbox last week. Just like that, I am back in the game. Section chief? Board of directors? President of the system? Nah. I don’t want any of that anymore. I just want my voice back. 

Risen (As In Sourdough)

IMG_5623

I had a request for my sourdough cinnamon roll recipe. I have worked on perfecting this for years, though truthfully it has taken years because I only make them only 1-2 times a year. I am not gonna lie, they are an awful lot of work. However, I can safely say they are the best damn sourdough cinnamon rolls you will ever bless your mouth with. 

Victo’s Sourdough Cinnamon Rolls

Ingredients for the dough:

1 1/2 c fed sourdough starter
2/3 c whole milk 
2 Tbsp granulated sugar 
1 1/2 tsp vanilla extract
1 Tbsp butter, melted 
1 tsp salt
2-3 c unbleached white bread flour
1/2 tsp baking soda

Ingredients for the filling:

3 Tbsp melted butter
1/2 c coarse sugar like turbinado
2 tsp cinnamon
1/2 c chopped nuts (pecans or walnuts), optional

Ingredients for the glaze:

1/2 c confectioner’s (powdered) sugar 
1-2 Tbsp milk
1/4 tsp vanilla extract

You want to start at maybe 2PM m-ish the day before. In a large bowl mix together sourdough starter, milk, sugar, vanilla extract, melted butter, salt, and 2 c of flour. Knead this together to form a rather sticky dough. Add up to 1 c more flour if the dough is not holding together into a ball. Do not add too much flour or the rolls will be too dense.

Once the dough is homogeneous (that magical consistency that takes maybe ten minutes of kneading), sprinkle in the baking soda and make sure it is thoroughly incorporated. Roll the dough into a ball and place it in the bottom of a greased bowl. Turn once to coat. Cover the bowl with plastic wrap, and place it in a warm area to rise. 

This first rise should double the dough and can take 2-3 hours. Longer if it is cold, quicker if it is warmer.

When risen, turn it out onto a floured surface and knead it a few times to get rid of bubbles. Then roll the dough into a rectangle measuring roughly 9″ x 18″.

Brush the rolled dough with the melted butter, and sprinkle the entire surface with coarse sugar, cinnamon, and chopped nuts. Make sure you cover the rectangle end to end to make sure the end pieces get filling too.

Starting on one of the long sides of the rectangle, roll the dough into a log. Using thread or dental floss (NOT the mint flavored kind) cut rounds off of the log, and place them into a buttered 9×13 pyrex casserole dish. I usually cut 12-15 rolls.

Cover with plastic wrap and let rise for 2 hrs, then place in the fridge overnight. An hour or two before baking, remove from the fridge and let sit at room temperature until they are about double in size from when you first made them (it will rise some in the fridge overnight so it may not have far to go). Bake at 350 degrees for 20 minutes or until the tops just begin to brown. Don’t undercook them, though… that’s just gross. 

Mix up the glaze and drizzle over the tops of the rolls once they come out of the oven. Serve warm. 

If you are brave enough to try to make them, tell me how it went!

Wired

 birds sitting on power lines 

Sympathetic firing squad
Neuronal translation 
Fear percolated
Beneath the facade
Heart beating faster
Unconsciously related
Ruled by an unseen god

Today’s Mediocre Medical Poetry is brought to you by cocaine, methamphetamine, MDMA, amphetamines, and… sudafed.  If I see one more otherwise healthy young person with “mysterious” blood pressure spikes I just might need to punch something.

Rubbed The Wrong Way

IMG_3992

“Mommy! Look! A genie!!!” My daughter shrieked with surprise and wonder.

“A genie? Where?” my son demanded. Catching sight of the gentleman who had just settled himself by the window in the IKEA cafeteria he exclaimed loudly, “There he is! Mommy, it really IS a genie! Will he give us a wish?”

“He’s not our genie,” my daughter said matter-of-factly, her tone relaying that she wondered how her brother could be so out of touch with genie reality.

The cafeteria at IKEA is loud, despite the abundance of absorbent Swedish meatballs. My kids, however, were louder and I had no doubt the man with the turban and full beard heard every word of their exchange.

“Shush! He is NOT a genie. He’s a Sikh.”

“Not a genie?” My kids echoed, confused.

“He’s a sheik,” my son whispered to my daughter, thinking he had it figured out. “They are rulers, like kings.”

“No. A Sikh, it’s a religion.” I tried to keep my voice low but still loud enough to be heard over the clatter of plates and silverware and the fuss of other people’s children. Just moments before I had been basking in the glow of finally making a trip to IKEA without one kid or the other throwing themselves on the floor kicking and screaming. 

This might actually be worse.

I stole a glance. The man was staring fixedly out of the window, alone at his table. There was no indication on his face that he approved or disapproved. I wondered what it was like being such a visible minority. My kids were surely not the first ones to be shocked by his appearance. I expected that it was highly likely, given the locale, that plenty of uneducated people had said or done some really terrible things. I was curious what he thought about my kids (who had never witnessed someone wearing a real live turban before) thinking he was a genie. It would make ME laugh, but then I am not him. I have not lived his reality in this county.

“What’s a Sikh?” they almost shouted in unison.

“I’ll tell you later,” I muttered, suddenly self conscious about what he would think about my attempt to explain his religion.

I distracted them by pulling out a spelling app on my phone. I save electronics for emergencies and this was an emergency. It worked, thankfully. They were instantly mesmerized by the glow of my screen…

On the long drive home I tried to talk to them about Sikhism, why they don’t cut their hair, what the turbans mean and how important they are. My kids were less curious than I expected about a belief system that is so different from ours. I think the fact that he was not magical and could not grant wishes killed it all. Meanwhile, it occured to me how do you raise culturally sensitivite kids when they are around so little of it? 

Not Too Shabby

IMG_2513

The following was told to me by a forty-something physician who needs his own blog (we’ll call him Trent) and is shared with his permission: 

So I had the afternoon off and a free trial for a gym called Orange Theory Fitness and decided to try it out. It is a group class and they put a heart rate monitor on you. Your pulse shows up on a giant big screen monitor with your name and corresponds to a color. Starts with grey (basically means they think you have your thumb up your ass whistling Dixie), blue means you need to try harder, orange is perfect range of 75 to 90% of max (hence the name Orange Theory) and red means to ease back a bit. You do various weight lifting routines mixed with cardio on treadmill and rowing. It was a very intense workout. 

There were 30 or so people in the class, mostly 20 something hot girls and gay guys (not that there is anything wrong with that, it is just who was there). 

The “teacher” was a 20-something blond, perky typical fitness instructor with a microphone to speak to the class and giant fake boobs. Every five minutes she looks at the big board and praises the oranges by name. I am remaining grey so I push it. 

I am outrunning and outlifting all these 20 somethings!

But the instructor is focused only on the big board. Now she praises the oranges but singles out the greys. “Come on, Trent, you’re not going to get better unless you push it. You can do it.” Finally she comes over to me and asks why I am not trying. She fails to notice the profuse sweating and the fact that my treadmill is going faster than anyone else’s. I tell her while panting that I am on a beta blocker* and that limits my heart rate. “Great job Suzie, Great job Amy,……….” continues and doesn’t seem interested. 

After the class she tells me that I struggled because it was my first time to do the class. She is sure I will do better next time. I again mention the beta-blocker. She cuts me off and says, “You might want to see a doctor.” I shake my head and leave. 

*Beta Blockers are a class of blood pressure medication that slows the heart rate. 

I Need A Wife

IMG_8330

“Mommy, we want daddy to be more like you and you to be more like daddy,” my son said.

We were in the car on the way to school discussing who was going to be picking them up that day (it might be daddy) and that daddy would be making them dinner as per our usual.

“Yeah, mommy,” my daughter sniffed, “be more like daddy. Don’t be like you.”

My heart hurt. There was nothing I could really say to that. My kids recognize that gender roles in our family are different and they do not like it. Short of quitting medicine, this is the way things are, the way they will be.

A mother who practices medicine HAS to have a “wife”, someone who is in charge of the minutia (like birthdays, activities, homework, laundry, dinner, groceries, etc.) and who can be flexible in case of emergencies. I am blessed that I have help. There are tons of working mothers who have no support whatsoever.