Fatherless

Rose window example, San Antonio

“Can you tell me anything about your father’s medical history?”

“No. I don’t know him.” He shrugged as if it was no big deal but his voice said otherwise. 

Next patient…. 

“What about your father’s medical history?”

She scrunched up her face. “I think he’s still alive? I don’t know for sure. I never knew him.”

Next patient…

“So your mother is alive and has diabetes. Do you know anything about your father?”

“I’m not in contact with him.” The disdain came across loud and clear in her voice. “I hope he’s dead.”

If fathers ever think they don’t matter, they should sit in my seat and listen to the pain they can generate even when they are not there.

A Virtual Reality Devotional

Stained glass window

The body lies prostrate

On the confessional floor

A weakened avatar

Your closed door

Heartbeat slowed

From afar

Fading finally

Into empty code

Mere tokens

Conquests

Meaningless and broken

Nothing of value

Can be taken

Only the memories of love

Gained and lost

And gained again

Virtual virtue

Virtually gone

And truth now clear

Life

Turned into fear

Death 

A final frontier

Hold your breath

It is not so painless 

As they wanted us

To believe

The Scales

Communicating effectively with others is the key to success. I want my son to get comfortable speaking in front of others so this year I encouraged him to enter a speech competition through his school. 

He worked hard on it.

As parents we all suffer from delusions of grandeur regarding our clearly exceptional progeny but between the two of us, I had no expectations that he was going to win. I just wanted him to participate. I was fully prepared to just celebrate the achievement of his participation.

But then? He was given a red ribbon with “Excellent” emblazoned across it in gold letters. 

At first I was overjoyed. In my day, a red ribbon meant that you placed second. Excellent meant that you did pretty damn good.

Did he really do so well? 

During our practice he struggled with speaking too fast and was not making good eye contact. Was it possible that he listened to me? That he took my advice to heart? To be honest, that would have meant more to me than the ribbon itself.

Eventually I was given his judging forms. There were three judges. Apparently in this private school league they only score as Good, Excellent, or Superior and the kids are not ranked into places at all. Color of the ribbon? Yeah. Meaningless.

WTF?

Two out of the three judges gave my son a Good. Only one gave him an Excellent. From the judges’ notes, he fidgeted, stumbled, had to be prompted, and did not make eye contact. They gave him an Excellent ribbon for that. We worked on all of those things but it was his first competition and he is a first grader so I am not surprised or embarrassed or upset with his performance. I am so very proud that he was brave enough to get up there in front of strangers.

But how can I reinforce to my son that hard work pays off when mediocrity gets him an Excellent rating and a red ribbon? How can I make the point that he should listen to his mama’s advice about eye contact? How can I help him work through rejection and loosing and the unfairness of life while in the safety of childhood before he becomes a fragile adult who is devastated by the realization that the world does not in fact hand out participation trophies? And what about how this demoralizes and minimizes the kids who really did perform exceptionally well? They deserve to feel the full glory of their achievements, don’t they?

I just don’t understand. 

Uncovered

Mission ruins, San Antonio

“Mommy!” my daughter gasped urgently. “Look, she’s a mermaid…” There was reverence and surprise in her voice. 

Imagine meeting a mermaid here!

“Yes, she is…. now, shhhhhh,” I responded.

I held my breath waiting for my little girl with no filter to say something about the woman’s size. She was probably close to 400 pounds and she was wearing a two piece bright purple and turquoise mermaid swim suit like it was the most natural thing in the world.

Mercifully my daughter said nothing more. Instead she snuggled up against me wrapped in her towels and fell asleep, smiling. I am grateful that she and the towels completely cover up my thighs.

I found myself very jealous of that woman. If I could have even half of that confidence, I could… 

But then, I remembered, what I saw was probably only just the tip of the iceberg so to speak. What kind of ugly things had been uttered by people under their breath as she walked by? Was she really, truly confident or was her swim suit an act of defiance, a f**k you to the world wrapped up in flashy purple and turquoise lame fabric? I would never know the reality of what lies beneath.

In contrast to the mermaid, there was a woman who must have been a size 4 standing in the wave pool with a voluminous hot pink coverup who looked so incredibly self conscious and miserable. I felt and understood her pain. She hid her body but did not succeed in hiding her discomfort. 

“Nothing makes a woman more beautiful than the belief she is beautiful.” —Sophia Loren

I looked around me at the hundreds of other men and women, bodies of all shapes and sizes and the swimsuits of all sorts, each one an act of courage. Bacne, surgical scars, stretch marks, cellulite, fat rolls, belly bulges, love handles, etc. all exposed. 

My body is a blessing.

“You are the best looking woman out here,” he whispers in my ear as I take off my cover up. I’m not. The mermaid is, but I love that he can make me feel like he believes it is the truth. 

So I decide to walk around like I am, like I really do believe I am beautiful in my deep cobalt blue velvet one piece swimsuit. I don’t like my body but that is OK. I am not this body. I am not this swimsuit. 

I am beautiful.

Doctor’s Day

Cute butterfly on a blossom

Doctor’s Day was yesterday. Did you know that?

Caught me completely by surprise.

It used to be a big thing ten years ago. The hospital hung banners up and handed out logo emblazoned umbrellas, bags, pens, and whatnot. My staff signed a big card the office manager picked up and a new potted plant would now sit on my desk. Drug reps dropped off cards and swag. There would be emails celebrating doctors sent from the suits. Well not really from the suits. From their secretaries. The point was, though, you just could not escape what day it was. 

To be honest, all of the hoopla back then made me feel very uncomfortable. 

This is not why I am doing this. I am not here for the accolades or the potted plants and I resent the insinuation that these things matter to me. Please leave me alone.

Each year it is less and less of a big deal. This year? Silence. Not a single frickin word from anyone. In fact, my only clue was a post from someone else on WordPress. 

Yesterday I told a woman she has metastatic ovarian cancer. I told a man that he now has diabetes and we developed a treatment plan together. I did a newborn visit on a precious two week old baby. I cried with a woman over her divorce and saw a man whose mother just died from the same disease he now has. Then I watched the last few minutes of my son’s karate class and picked up cupcakes for my daughter’s class party. 

This is life. My life. Every day. 

And you know what? Despite any bitching and complaining that I do here, I really, really love my job. It is such an honor and a privilege to care for people, to be there when they need help. THAT is what keeps us going… keeps me going.

In truth, I’d do this job for free. Just don’t tell the suits that I said that. 😉

Cash Flow

Fountain at the Alamo in San Antonio

“You tell that doctor to write me a prescription for something affordable!”

*Click*

My medical assistant glanced up at me with a shocked look on her face. There was no need to repeat the conversation. I had heard every word.

“That does not make any kind of sense. It is a generic medication. It should only cost $40. Max. Call his pharmacy and find out what that med is going to cost him there.”

Later in the day I read the computer message that said it was going to cost $340 for a one month supply. Hell. I wouldn’t even pay that. 

I typed out a quick message and routed it back, asking why it was going to cost that much.

It is the brand name. If you want them to fill the generic you have to write for the generic. 

Except that I HAD written for the generic. I always write for generic. 

I sent back a stongly worded message pointing this out and telling them to fill the frickin’ generic. 

This was followed by a string of other patients with similar complaints all from the same pharmacy chain. Insurance companies refusing to cover prescriptions that patients had been getting without issue because the pharmacy chain was filling brand name instead of the generic option. It makes them more money. I would have never known this was occurring if the insurance companies had not denied coverage. 

From a drug coverage standpoint we love to hate on insurance companies but pharmaceutical company and pharmacy shenanigans are one of the reasons healthcare costs in the US are skyrocketing out of control. 

So I tell patients to be aware of what they and their insurance companies are paying for. If there are significant changes, please ask questions. Shop around to other pharmacies. The variability of cost from one pharmacy chain to the other is astonishing. AND, talk to your doctor. The only way I find out about these kinds of things is from patient complaints.

Just maybe don’t yell at my staff… 

Behind Your Back

Detail of building in San Antonio

So. 

One of the biggest time drains in my life is sorting through paperwork from insurance companies telling me that Mr. or Ms. So-and so is not filling their medication and therefore “likely noncompliant”. 

My question to you good people is this:

Do you want your doctor calling you to say your insurance company sent us this message and you need to take your meds, or else? Or do you prefer that we pretend that never came across our desk?

A touch of tenderness

This is a wonderful post about the importance of touch in life and death. Please pop over and read it if you have not done so already.

Sue Vincent's Daily Echo

The Cathedral by Rodin.

My son gleefully squeezed harder at the knotted muscle in my shoulder, with a ‘Now I’ve got you’ as I groaned in agony. We have established and agreed that he has a slightly sadistic tendency where I am concerned. It may have something to do with my knack of getting just the right spot on the painful muscles as we got his body working again. Day after painful day, for months on end. So now it is payback… and he appears to enjoy it. He still manages to lay the blame squarely on my aching shoulders, muttering something that sounds vaguely like ‘hereditary’.

He is a little more squeamish than I. His face screws up in horror as my wrist bones crunch back into place when he applies traction. It is, however, nice to regain freedom of movement occasionally. So I make him do it…

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