Saturday Short

 blackbird on a wire 

“There is a certain relief in change, even though it be from bad to worse! As I have often found in traveling in a stagecoach, that it is often a comfort to shift one’s position, and be bruised in a new place.” – Washington Irving

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Hanging Off The Precipice 

 Man standing on a rock at the beach in Hawaii 

“No worries, Doc. We have her info. We will make sure we get her in ASAP. I promise.”

I had met the patient twice. In less than a week I had diagnosed her with cancer that had metastasized throughout her body and told her that the prognosis was not good.

My next job was getting her into the oncologist STAT. She was hanging over the edge by a thread. Understandable, given the circumstances.

The pleasant voice on the other line, the woman’s helpfulness threw me off. I had been prepared to do battle to get the patient in. Instead there was no resistance. Instead, there was compassion and understanding.

“Ok, but please call me after you get her set up so I can know it got done and when her appointment will be.” So I can raise holy hell when you schedule it for three weeks out…

I was called back within an hour and told that not only had they received the information but they had already called the patient and scheduled her for the next day.

Why do I feel so emotional, like I need to have a good cry? When did I become so jaded that this simple thing feels like a miracle?

THIS is how it should go. It should be that easy to get patients in with specialists. Instead I have to pay a full time employee to fight to get patients seen. 

THIS is how my office should function, too, but it does not. Years of trying to get it there. I feel like a failure.

Locked Out

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I had a meeting with some suits a few days ago. Pretty boys from corporate with their perfectly coifed hair and shiny shoes. 

Never trust a man with perfectly coifed hair and shiny shoes, particularly if they are traveling in groups…

I listened to an hour long presentation about how I need to refer within the system more often. How I need to change diagnosis codes to make my patients look sicker. How they will be providing me with more data about how I am doing with preventive care and blood pressure and diabetes and congestive heart failure for certain insurance payers. 

Look, I don’t even look at the crap you are already sending me and I am performing at the top the system. Save yourself the trouble. I am not going to treat one patient differently than all the rest just because they have a different health insurance.

Then I was told that I have to earn a certain number of “points” by logging into their website once a month, attending pod meetings, reading articles that they determine and answering quizzes so I can prove that I am “engaged” and make “bonuses”.

Why do I get so angry? Why do I let it get to me?

When I am around my family, I am hypersensitive. I am just waiting for someone to do something offensive. And if they do not do anything offensive, I am offended. I WANT to be angry at them, damn it!

I WANT to be angry with the suits. It makes me scowl during their presentations. It makes me open my mouth and say things that they scribble in their notebooks and will take back to corporate so I can be put on a list of those who are not “on board”, marked if you will. 

We need to get rid of her…

Words I used with them: dishonest, unethical, etc. I told them it was shameful to treat employees the way they are, limiting the referral base so much that I cannot get them into a psychiatrist for crying out loud. And they are recruiting more companies to particate in this restricted insurance plan. I told them that my primary responsibility was to the patient, not to the system, that I will not refer to a specialist simply because they were part of the system.

Why can’t I just keep my mouth shut?!??!?

Why?

Jealousy: They are making so much money with just an MBA to sit at a desk with no liability. 

Defensiveness: They are telling me what to do. Who are YOU to tell me how to do my job?

Survival: Every time someone up there comes up with a brilliant new idea, they do not realize or care how much more difficult they are making my job.

Moral Superiority: Monopolies make me uneasy. This is what they want. A monopoly. They are selecting for sheep. Automatons who no longer question, no longer think. Follow a protocol. Do as you’re told. 

My mouth, though, this anger and my subsequent inability to play the game… I am afraid it is going to keep me from ever affecting change.  It makes me want to skip these meetings, avoiding them all completely. It makes me want to disengage.

Dressing Down 

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“Mommy, why is that man not wearing a shirt?!?!??!”

You cannot hear the shock and disdain in my daughter’s voice from the typing here, but believe me, it was there laid on thick and heavy.

“Because he is mowing and he’s hot.” We were walking in the neighborhood before the next round of storms hit. I prayed it would end there.

She pondered that fact for a moment. “Why don’t girls take their shirts off?”

“Girls have boobs. Boys don’t.” I braced myself for the question I was certain would follow, why boys did not have boobs…

“But that man has boobs, mommy.” 

And so he did. 

“Those don’t count,” I whispered.

She formed a silent “O”, as if my response made perfect sense and happily skipped back home, pausing only to jump into all of the puddles in the road on the way.

That evening, watching the old Super Friends cartoon series:

“Mommy, who is that?”

“Wonder Woman! She sure is an amazing super hero, isn’t she?” I was secretly gratified that she could see it was not an exclusive boys club.

“Why isn’t she wearing pants?”

“Those are just really short shorts.”

“No, mommy. Those are panties. You don’t let me wear only panties.” 

It was an accusation.

“It’s a swimsuit,” I offered.

She shook her head. 

“A ballet leotard?” 

She shook her head again.

“A skirt would get in the way of her high kicks when she is taking out bad guys?”

She formed the silent “O” of understanding and nodded her head solemnly. 

“I can kick bad guys.”

“Sure you can sweetie.”

“So…. can I wear only panties?”

Malpractice

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“There is something else going on, isn’t there?” She was not taking her medication again. She always stopped when something else was going on at home. A breakup. Money trouble. Unemployment. It was a good bet.

“Doc, I can’t do it.” There was a quiet sob.

I looked up from the computer. She had tears streaming down her face again. “Do what?” I had seen the tears before. I felt annoyance rising up inside me. I put the computer down on the counter and handed her a box of tissues. 

Then, the whole bloody mess came spilling out.

Her father had molested her repeatedly for years. In fact, she had been impregnated by him when she was twelve and the baby was put up for adoption. Now, as a young adult with two small children, her father was trying to reinsert himself into her life. Seeking counsel from her pastor she was told she had to forgive him, to allow him back, allow him access to herself and her children. 

If she did not, she would be damned forever.

“I just cannot do it.” She moaned through clinched teeth, “If he touches my kids I will kill him.”

I will help you.

“That is not what forgiveness is.”

“What do you mean?” Her eyes bored into me. 

“That is not Biblical forgiveness, being told you have to allow him back into your life in order to curry favor with God.”

“How…”

“How do I know? How can I question what a pastor says?”

“Yes.”

“I have a personal interest in forgiveness, particularly Biblical forgiveness. Forgiveness is for you, not him or anyone else. It is something that happens inside of you and cannot be mandated by anyone. It does not demand that you maintain any sort of contact with that man and it certainly does not demand that you endanger your kids.”

Her whole life, all of my experiences with her over the years, fell into place. The burden this woman was carrying around, weighing her down… Now some prick involved in spiritual malpractice?

“You ever get counseling?”

“I had to see one that wasn’t worth crap back when it all happened.”

“You need to find a new church.” She nodded as she wiped snot from her nose. “And you need a real counselor.” 

Except that she was at the free county clinic seeing me. She floated from one part time job to the next, no high school diploma. There was no counseling available to her. I still worry about her and where she is now…

Consulted

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“Doc! Before we get your kids, I wanted to talk to you about something…”

The woman pulled me from the front office to one of the side classrooms and proceeded to tell me about the pelvic pain she had experienced since the C-section delivery of her last child a year ago.

“I went to my OB/gyn and all she could say after an ultrasound and CT scan was that she didn’t know what was causing it!” She rolled her eyes. “I am so tired of doctors who don’t know anything. I need for you to tell me what it is. I know I am not your patient but I thought you might have a better idea.”

I just stared, my mind racing. What? I needed to get my kids and get back to the office. I had a patient I had not wrapped up yet who was getting an X-ray…

Quickly I told her that often these things are diagnosed as a process of ruling out things one by one which can be frustrating but it is important nonetheless. Since it was clearly not a gyn cause, she needed to make an appointment with her primary care doctor to look at other causes. 

She was not happy. At all.

Back at the front, I was again stopped by another woman.

“Doc, before I call for your kids this other teacher wanted you to call her.” She pushed a torn piece of notebook paper toward me. The name Ms. Smith and a phone number had been scrawled across it in blue ink. Seriously? She was a preschool teacher but did not have any of my kids in her class.

I stood there and dialed the number on my cell. I waited, growing more impatient as it rang and rang. The X-ray was probably done by now…

“Hello, Doc!” She finally answered. “Thanks for calling me. I had a question about my daughter. I know she isn’t a patient of yours yet, but I was going to bring her in soon…” 

She then proceeded to tell me that her daughter had developed neck pain earlier that day. Worried about meningitis because she read on the internet once that it could cause neck pain, she had taken the girl to an acute care facility (read doc-in-a-box). There they did a chest X-ray for some reason and told mom that her three year old kiddo had pneumonia.

“Did she have a cough or fevers or headache or runny nose?”

“Nope. And the neck pain is completely gone now, too. So my question is, do I give her the antibiotics?”

Was she really intending to bring her child to me soon? Or was she just blowing smoke? Do I even want to have her as a patient? 

“Did you call her primary care doctor to ask them?”

“Well, no…”

“You should.” I wished her well, then turned to the woman who had been standing there listening intently to the conversation. “Could I please have my children now?”

She looked surprised, then seemed to remember. “Oh, sure…. Ok.”

Microscopic Terrors

 Shelf fungus on a tree trunk.
Last night my kids wanted to play with the microscope. My nice microbiology grade microscope. So I pulled it down and they went around the yard picking things to smash between two glass slides.

At one point I suggested looking at some tree poop (those long, dangly pollen filled oak things that show up every spring). They were reluctant, as they were in a flower petal and leaf mood, but eventually agreed. I situated the strand on the slide and focused it on the microscope.

What on earth was THAT? Did that speck just wiggle?!?!?

Sure enough, there were dozens of tiny mites scrawling around on the surface, invisible to the naked eye.

The kids were ecstatic!

“Mommy! That looks JUST like an alien!!!!” (Because they have seen so many aliens in real life…)

I want my own electron microscope. Wouldn’t it be so cool to show the kids the depth of beauty living under the surface of what we can’t see?!??!?!

This morning, as I was sitting out on the porch barefoot, eating breakfast with the kids (Mommy thinks crumbs are much more fun outside), I kept feeling itchy, crawling sensations on my feet. Who knows if there really were mites crawling on my toes from that tree poop but my mind and my toes sure were convinced.

Sometimes, perhaps, there are things it is just better not knowing…

Escape Fantasy

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Early release day. Last day of school.

I hate these days. 

I wish I could pick the kiddos up early, do something fun to celebrate. Instead I am stuck at the clinic, seeing patients with a staff that drives me INSANE.  

“Doc, your numbers were down this month, but I see you took a day off…” Cue raised, disapproving eyebrows throughout the room. I throw the stack of financials at them all, watching the papers slide across the table then onto their laps, and scream, “You know what? I am NOT your bitch!” And then I storm out.

It will be a struggle forever. Some days are better than others. Ask me next week and I will be upbeat again.

Today is a bad day.

The photo. Not my house but I sure wish it were. Wouldn’t that be a fun setting for an attic adventure?

Picture Perfect (Reprise)

  

My mother has been steadfastly opposed to mammograms since the beginning of time. Not because she thinks they are useless. Or dangerous. Or because the guidelines are changing. She has refused to get one because I told her to get one.

So, I think about this with my own daughter.

She is absolutely going to roll her eyes over how stubborn I am. She will tell everyone who will listen how I ruined her life or at least how I make it sooooo much more difficult for her. And I imagine, right or wrong, that I will be proud of that fact on some level.

Are we meant to have perfect lives and perfect relationships with our parents? I have maintained that anyone who says that they do is either lying or delusional. We have to be screwed up by our parents to some degree. It makes us interesting.

Which gives some new perspective into my own mother’s crazy decisions. She is loony as hell and that’s OK because it is supposed to be that way.

I thought I would repost this from last year as a follow up to my post yesterday. I think about the things my mother said and did and how they affected me and I worry about my effect on my own daughter quite a bit. Truth is, I cannot be perfect. I cannot save her from all trauma at my own hands. But I can make sure she knows that I love her above all else and pray everything else sorts itself out like it did for me.

I Can’t See You… 

 Purple flower with a smart phone. 

I first realized I was ugly in fourth grade. 

Our class pictures had been sent home. 

My parents rarely, if ever, bought any photos through the school but for some reason they had decided on the class photo that year. For once I had not been singled out as the only kid who did not receive an envelope. I eagerly tore it open so I could get a good look at myself. There were no pictures of me up around the house. No photo albums. I had no idea how I looked on film.

My fantasy was that I was graceful and dainty and beautiful. My face would glow angelicly from the photo paper, offset perfectly by the golden shimmer of my hair. Parents would ask their daughters to tell them who this stunning vision was exactly and demand that they befriend me. My lonely days would soon be over.

That was not my reality.

In fact, I was standing in the back. Tall compared to the other girls, my head and shoulders stuck up awkwardly, towering over the stylish haircuts and ribbon tied pony tales and swirly, lacy dresses. 

My hair was stringy and mousy, in need of a wash. My hair was long, to my waist because I was not allowed to cut it. My smile looked goofy, lopsided and self concious. I was in jeans, wearing a boxy light sea foam green shirt with a white snap front. It had been my favorite at the time. Comfortable. Never mind the fact that it had come from the second hand store like the rest of my wardrobe. I had loved that shirt.

I never wore it again.

My cheeks flushed and eyes stung with shame. The familiar lump caught in my throat.

I wanted to rip up that godawful ugly photo. I wanted to erase myself from everyone else’s pictures. I never wanted to go back to that stupid private school again. 

Everyone had surely seen it.

My mother saw that I was upset. When I told her how embarrassed I was, she shrugged and laughed. “You are just being silly. You are very…” She paused searching for the right adjective, “You are very pretty.” 

What? How could she say that? Pretty? I looked downright mangey. She was certifiably insane. Clearly, I could not trust her.

That was the day that I learned not to believe complements from her or from anyone else. They were meaningless. 

Maybe this happens to us all? There is that moment when the world loses credibility? I felt myself shrink up as I retreated further inside my shell. It would be years before I ever tried to come out again…