Shush

“There are moments in life when all that we can bear is the sense that our friend is near us; our wounds would wince at consoling words that would reveal the depths of our pain.” – Honore de Balzac

I love this quote right now. I am not going to say anything more, I will just leave you with this tonight.

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The Spread Sheet

The other day I was presented with a spread sheet of all of my referrals, pointing out that my percentage to “network” specialists (doctors who work in the same physician group that I do) was too low and that I should only refer to the network physicians in the future.

This is a new twist to things, one that I find particularly disconcerting, and I wrestled over whether or not to write about it.

First, I am in a practice in an outlying community with a competing hospital just a few miles down the street with great, competent specialists. To refer to network physicians only, I would be asking patients to drive to a large city some distance away, forcing them to deal with the traffic and parking issues that come with that. A fair number of patients are elderly and this is a huge burden for them. Heck, I do everything I can to avoid it myself.

Further, some of the network specialists are not the best choice. They are not the best in their field, or they have office staff that make scheduling appointments difficult, or they are just the wrong personality for a certain type of patient. Some of my patients have very strong opinions about who they see, in network or not. Maybe a family member was cared for by a certain oncologist, or a friend’s knee was replaced by a certain orthopedist. Who am I to say that they cannot see that specialist?

There is the argument that referring to someone that shares the same electronic health record streamlines the process so work up is not duplicated but so many pay no attention to what I have done, even though it is staring them in the face.

But then, I guess what really gets my dander up is that I should be allowed to decide what is best collaboratively with my patients, not required to make choices because someone who is not directly responsible for these patients says it should be so.

Next point: I don’t think as a physician that you should be guaranteed a referral base just by affiliation. That has to be earned by being good at what you do…taking care of my patients so well that they think I am awesome as heck for sending them to you and then communicating back to me in a constructive way.

When I pointed these things out and asked if it was legal or even ethical to make this demand, I was told that So-And-So big group has a 90% internal referral rate. And that makes it ok? That is like saying I should write a certain antidepressant for a patient because “it is the most prescribed.”

I am struggling with what to do. Little indignities like this have added up over time, chiseling away at our autonomy. Where is the line in the sand? Is there a line? Should there be a line? Do patients care?

Immunizations

I am on the front lines of the immunization debate as a primary care physician. Periodically I get questions about whether or not I will allow children in my practice who are not vaccinated or whose parents wish to make up their own vaccination schedule.

My response to them is this:

“You probably don’t want to discuss this with me.”

Invariably there is a shocked look. And then the question, “Why?”

First, let me say that I feel for parents struggling to do what is right by their children. Particularly when it comes to wading through conflicting data about vaccinations and autism and mercury and all manner of crap out there. They are not necessarily trained in evaluation of research. They do not necessarily know where to look for reputable sources. And let’s face it, medical professionals have a lot of mud on their faces as we waffle back and forth on salt, blood pressure control, fat in diets, etc and the pharmaceutical industry itself cannot be trusted.

But I will admit that I am not able to approach the topic free of bias.

Why?

Because my father had polio.

He missed the mass vaccinations in his community by two weeks. He spent almost a year of his life being experimented on in a hospital that would not allow his family to visit except for a few hours once a month. Imagine a second grader coming down with a terrifying illness, realizing that he will never walk properly again, undergoing multiple experimental and painful surgeries at the charity hospital because his family could not afford medical care elsewhere…all of this without getting to have his mother hold him or kiss him and tell him it would be OK.

But he was one of the lucky ones. Do a Google search for iron lung to get a picture of what it was like for others.

Imagine growing up with a man who was consumed by anger and hate and spite as a consequence, so much so that almost every day was a misery.

Was polio to blame?

Yes. Partly.

Over the years I have watched my father tortured and suffering. I felt how it affected myself and my family. There were more victims of polio than the ones who actually had the disease.

My father is not the only one I know who had polio. There are others. Some bore the consequences of their disease with dignity. Some carried the burden, buoyed by anger. But these people are dying off and with them, their stories of the hysteria, the fear, the pain. And then we will all forget.

That is my side of the coin. What is yours?

Bugs

When I was in second grade, I had to put together an insect collection. My father was so frustrated with the fact that I was terrified of the bugs, that he got a particularly frightening one (which happened to be huge and had black and white spots all over it) on the end of a hoe and cornered me behind the front door.

“If you would just stop being so afraid, you could have cool bugs like this for your collection!” he yelled.

This did not help my fear.

Not one bit.

Generally, I hate bugs. In particular, I hate crickets and giant cockroaches. My son hates insects, too. Or rather, he likes the idea of them. The reality, not so much.

I was worried that maybe he had picked up on my fear. So in an attempt to show him that they can be fun, I have taken to playing with them, holding them, letting him pet them, naming them, and in some cases making “pets” of them.

I still hate bugs.

He is doing better with them, however.

We have a tarantula named Harry. We feed him crickets. It gives me the willies every time I have to reach into the bucket of live crickets and dig one out. It is crawling around in my HAND! Each time I flip the top of Harry’s house, I am terrified he is going to escape. They can really jump, you know…

Ah, the things we do for our children.

Make Believe

I like to work for a lot of reasons.

This morning as I felt the darkness descending over me, I realized that one of the reasons I enjoy it so much is that I get to focus on someone else’s problems and forget about my own for a bit.

So spontaneous decision…today we are going to the castle to dress like princesses and knights and to hunt dragons. My son hopes that he can get a crossbow (oh dear). My daughter is wanting a flower crown and fairy wand.

We will make our own fairytale and forget about reality for a few hours.

Spontaneity

My kids tell me that they love me. And they give me hugs and kisses. Spontaneously! I don’t even have to ask.

You may say,”Yeah, so frickin’ what?”

The thing is, I have to constantly remind myself to show them affection. Not that I don’t love them. I DO, tremendously. But I did not grow up in a family that showed affection for each other. Even now, when I hug my mother it fees awkward, contrived.

So showing physical affection does not come easily for me. I have points in the day where I force myself stop and give hugs and kisses and I-love-you’s.

It is paying off, though. Hopefully my kids can find something else dysfunctional to grouse about later because by golly it won’t be this….

Adoption

I used to be in this blissfully ignorant category of people who believed that adopted children grew up grateful that they had been saved from less than loving parents or depraved circumstances…rescued if you will. And if they were not grateful, they should burn in hell.

My husband was adopted.

It was not until after we had been married for a number of years that he shared with me the tremendous burden he was carrying around as a consequence. The not knowing who you are. Dealing with the rejection that comes from being given up by your birth mother. The yearning to find out the details but worried about hurting your adopted parents’ feelings and then worrying about rejection again from your birth mother if she doesn’t want to know you now. What if your biological parents are trolls, can you deal with that?

Since then I have come to know many adopted individuals. Every single one of them carries around similar baggage, with different permutations. Even if their childhood was idyllic. Even if their adoptive parents are the most wonderful, saintly people on the face of the earth, these feelings still haunt them.

So, I warn adoptive parents of this now. They stare at me, incredulously. Not many people talk about this. No one typically warns parents. No one tells kids that these will be your feelings. Maybe it won’t happen. Who knows? But being prepared for it is the first step to helping those that it does affect work through it so they don’t spend their lives as tortured souls into adulthood.

Hunger

“The hunger for love is much more difficult to remove than the hunger for bread.” – Mother Teresa

I know this intuitively. We all do. Love is the primary human need, the one thing we are all searching for.

Does anyone ever actually find it? Complete and total, unwavering love and acceptance?

Not from human beings.

We all have conditions applied to our love. Even if those conditions are not really there, we perceive that they are, self impose them. Nothing is ever really given for nothing.

That perception and the loneliness that creeps into our hearts as a consequence is a distraction. It only serves to keep us from focusing on helping others. Is keeps us centered on ourselves and on our own hurts instead of seeing and addressing the hurts of others around us.

So what do you do? You don’t succumb. You fake it until you find it, ministering to others until their joy is reflected in you.

That is the love that heals.

Is This What Jail Feels Like?

There is nothing like taking a computer based exam at a testing facility to make you wonder…

I stood on the square on the floor in front of the camera while I was instructed to pull up my skirt to show my legs, lift up my shirt sleeves to expose my arms, reverse my pants pockets, turn around, lift my jacket to expose my buttocks, reverse my back pockets. Then the wand was swept over me front and back (too bad it was not a magic wand that could shrink those buttocks). I was signed in with my ID and then every ten minutes a staff person walked past looking me to make sure I was not cheating. As if the camera in front of me filming the whole time was not enough.

The check in exposure and sweep procedure had to be repeated for every break. I think I will hold my pee and starve, thank you!

Then, I sat in a tiny cubical for hours and hours with sparse furnishings and very little to do, feeling a bit violated and a bit like a criminal.

Oh, well. Shrug. That is done, moving on!

Woohoo!