Daddy

 Father, daughter heart shaped hands. 

“You know, you are super important. In fact, you are the most important relationship she will ever have.” 

He shifted uncomfortably in his chair across the room as I moved around the exam table to check the little eyes, ears, nose, and throat. He had just said that he felt terribly inadequate as a father, like what he was doing, trying to be there for his kids, would not ever make a difference. 

She giggled in spite of her fever when I told her I was going to check her snot boogers. All the little kids do…

“Nah. I’m just her dad,” he said. He cleared his throat quietly. 

“Exactly! You are her dad. You will be the first man who will make her feel beautiful. You will help her determine her self worth and from that, studies show, you will affect who and when she marries, her career success, her likelihood of using drugs or alcohol, and how early she starts having sex.” 

He cleared his throat again, this time more loudly. I looked over at his face. (The LUMP.) He was trying to clear the lump in his throat. There was a sniff, a few blinks. Then the moment was gone.

Do you see that kiddo? He loves you. Always remember that.

I listened to her heart and lungs, then she hopped off the table and climbed into her daddy’s lap where she rested her head on his chest.

“She has pharyngitis. This is probably viral so the focus is on supportive care for now….”

Dreamy

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“Hey, Doc! We’re selling our house. I brought you a flyer in case you are interested.”

He handed me the glossy print out.

Gorgeous photos. Loved the kitchen. The backyard brick oven and pool were a dream come true. That tub in the master bathroom? I could have one hell of a bubble bath in that thing. MmmmHmmm. Yessiree.

I flipped it over to check the price.

$790,000

I could not help laughing. Many people have a very warped sense of how much money I make as a physician. I do well, but not three-quarters of a million dollars worth of home well. Not even close. Sigh.

The property taxes alone made me shudder.

“That is way, way too expensive for my tastes, sir.”

“You sure?” He still sounded hopeful.

“I’m sure.” 

I handed the flyer back to him and we went on to discuss his rectal bleeding…

Standing Taller

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“$380 for nine pills a month is outrageous, Doc!” He was almost shouting into the phone. I held the receiver away from my ear. He had just finished telling my medical assistant that I was lazy. 

“I agree completely, sir.” I took a deep breath and launched into my spiel.

I told him that he needed to check with his insurance company to find out if one of the other erectile dysfunction meds was cheaper. I already knew the answer was no. I had been through this dozens of times with other patients. In fact I had told him this before, several times. Still, he was not going to believe it until he heard it from the horse’s mouth, otherwise in his mind I was just not trying hard enough. 

“I know I am not the only person with insurance from this company in your practice,” he accused.

“You are right. But each major insurance company has dozens of sub policies negotiated by employers. There is no possible way I can know and keep track of them all particularly when they change each year.” 

“I’ll just find myself another doctor…”

What did he want me to say? 

No wait! Don’t go! Please keep verbally abusing my staff for something beyond our control.

I could not blame him for acting like a prick. I understand his frustration, even if it was misdirected. The pharmaceutical companies and the insurance industry were holding his sex life for ransom and it was NOT fair. He was a young man. He had a relationship. He had every right to be angry.

Viagra was first approved by the FDA in 1998 and it is under patent in the US until 2020. There may be a generic available in the US in 2017 but that has been changed before by legal wrangling so I am not holding my breath. Incidentally the generic has been available in dozens of other countries for years.  This fact has caused the price of Viagra to increase streadily to an average of $35-40 per pill in the US, a cost that is not covered by most insurance policies. 

Meanwhile, in the UK a pack of four generic sildenafil costs £1.45, about $2.26…. 

Childhood

 Black and white chains from a swing set set against the sky. 
“You are indeed pregnant.” The girl nodded her head, resigned.

She already knew.

Her mother started sobbing. Great, body wracking sobs with tears streaming down her face.

“Mom. It’s just a baby.” The girl rolled her eyes.

“YOU are just a baby!” Her mother snapped back. “I wanted so much more for you..”

To my right there was gleeful male laughter. I turned around to find the teenage boy sperm donor staring intently at his phone giggling over some apparently hilarious YouTube clip.

“Hey!” I snapped.

No response.

“Hey!” I said louder. Giant red headphones covered both ears. 

Still no response.

I slid my wheeled chair over and covered the screen with my hand, causing him to finally tear his eyes away from the screen to meet mine.

“Take off the headphones and turn off the phone or get the hell out of my office.” I almost shouted.

He shrugged, indicating he didn’t understand what the big deal was, but he lowered the headphones to his neck and tucked the phone reluctantly into his pocket anyway.

“That was incredibly disrespectful.”

“Sorry?” He offered defensively but made it clear he didn’t really mean it.

“Not to me. Disrespectful to the mother of your child.” His eyes widened. “Yes, you are going to be a daddy. Pay attention!” 

He was not cowed. In fact, he developed an almost imperceptible swagger. He had marked his territory in her. 

She was his forever. 

Oh, there would be others. Many others. In fact, I had seen this fellow before, dozens of times, at various stages and various ages. This pregnancy had not been accidental as far as he was concerned. It had been a calloused, calculated move. 

I hated him.

In a matter of minutes, he had pulled the phone out of his pocket and was watching something else, though this time without the headphones and he was careful not to laugh.

They were all out the door after we had discussed prenatal vitamins, finding an OB, and the meds that were off limits during pregnancy.

Happy fifteenth birthday.

I could see in the girl’s eyes that she loved him still, somehow, but that would just be a matter of time…

Sleepless

 Philadelphia building facade. 
Last night someone questioned their self worth, lost in the darkness. Anger and sadness and fear for what the future holds conspired to make sleep impossible. 

I was the cause of that. 

Faced with a decision to hurt one person to save many others, to save myself, what other choice did I have? 

None.

There is no joy in it, only relief in the moving forward.

Upwards

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“Mommy, I don’t want to die!” I could taste the fear in my son’s voice.

“Sweetie, you aren’t going to die.”

“But mommy, little kids die. I’m a little kid.”

Where did this come from, anyway?

I deal with death a lot. I have always been at peace with it in the clinical setting. I grieve, but there is peace.

I attended my first funeral at age four when my little friend from church nursery died from a degenerative neuromuscular disorder of some sort. I had seen her waste away over the months and I remember being terribly sad for her that she could not run or walk or even feed herself anymore. Even then I imagined that she was probably pretty happy about not being in a wheelchair even if she did miss her mommy and daddy. I didn’t cry when she died.

Now, as an adult, with my own mortality creeping up on me, deaths of friends and social acquaintances can hit me pretty hard.

So what to do about my son right now? How honest am I supposed to be with a four year old about death and dying?

I decided on being open about it. “Yes, hon, babies die and little kids die.”

“But mommy, I don’t want to die…” The sob was starting to edge into his voice.

So we talked about dying, how mommy has been with many people, even kids, as they were dying, what happens and why and that one way or another mommy would be with him if that ever happened.

Then, we talked about heaven. Streets paved with gold, pearly gates, mansions…he wasn’t digging it. I thought he might, given the fact he was in the midst of his pirate obsession, but nope. So I told him there would be corn dogs…all of the corn dogs he could eat (with ketchup) if he wanted. That was the ticket. Within two minutes he had relaxed and drifted off to sleep.

So there you have it, folks. Corn dogs. Corn dogs in heaven? I think heaven HAS to be different things for different people. For my son it will have corn dogs.

Do you believe in heaven? What will heaven look like for you? 

If this looks familiar, you are not crazy. It is a rewrite of an old post from last year…

Gates

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I did not sleep well at all last night. It started with a nightmare that my mother found my blog:

I was checking likes and there was a new one I did not recognize. I looked closer at the gravatar picture. It was HER!!!! My heart started pounding. I couldn’t breathe. Bing! There was a new email…

THAT woke me right on up. It felt so real. My inbox was empty, though. Whew! 

Then, I could not shut off my mind. Instead, I was ruminating for hours over a couple of challenging patients, clinic staffing issues, etc.

Coffee isn’t even gonna touch this.

Thank heaven it is only a half day today.

I sure wish I had a gate in my mind, that I close tight when I needed to. I wonder how some people do it. 

What keeps YOU awake at night? Would you mind if your mother found your blog?

Guilty

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I am pretty rigid. 

I like my space. I like my control. I like to think that I don’t need any help taking good care of patients. I think maybe it borders on a bit of snobbery.

I am vocal and opinionated.

So when the powers that be told me that I had to push a little tiny button on the medication list that says I reviewed that patient’s medication list I was scornful.

What difference is that going to make? Clicking a stupid little button is not going to improve my doing something that I already do during every visit. It just adds more gosh darn busy work!

And so I fumed. And I swore under my breath. And I was passive aggressive. And I promised myself that I would stop clicking that stupid little button as soon as they were done tallying for our clinic application for recertification as a Patient Centered Medical Home.

I will only do what actually helps improve patient care.

What I have discovered, as my hand has been forced, is that I am not nearly as good at updating and reconciling the medication lists as I thought I was. 

That being said, worrying about clicking that button and all of the other little buttons in order to meet all of the criteria is distracting. I am more prone to forget to document or address other important things.

So my doctor snob self is going to swallow my pride and keep the medication review button clicking. 

But the rest of it? Nah… Maybe not so much. In the meantime I resolve to be a bit more flexible and open minded!

Staccato

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I watched his hands move up and down the keys of the immaculate black grand piano. He brought forth the notes effortlessly, making sounds that stirred something breathless within me. 

We had both just graduated with undergraduate degrees in genetics. He was leaving in a week to move back to Iran. I was staying on for a few months to finish up a project on pea chloroplasts. After that? I was not entirely sure.

This man, a man who I had not given a second thought until that very moment, was suddenly the most desirable man I knew. It was powerful. It was heady. The swell of the song’s crescendos and decrescendos distorted my reality. I began thinking irrational thoughts. 

How do I keep this music for myself?

He asked me to play a duet with him. I complied. We made beautiful music together, there in that room.

Notes, people. We made beautiful music notes!

I had come to the student center practice rooms with my sheet music intending to practice by myself. We ran into each other there by chance, the last familiar faces left on campus. 

A few hours later, over a cup of coffee, the spell was broken. I felt a deep loss, grief even. I wanted to go back there, back to that piano…

The seductive power of music.

My son started piano lessons last week. Listening to him bang out his first official notes brought to mind this old lost memory from another time. A brief interlude. I had not thought about my friend for years. We never spoke again and I rarely play anymore.

I wonder where he is now? Is he teaching his own son how to play?

I see the piano lessons as an investment in my son’s future happiness. Each Thursday afternoon I will bequeath to him the power to change hearts. 

Please use it wisely, kiddo.