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. 

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Risen (As In Sourdough)

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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

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“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

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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

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“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.

Unwrapped

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Getting a new patient is sort of like unwrapping a Christmas gift from your weird Great Aunt Esther. It could be something really terrific. OR, it could be a holy nightmare on wheels. 

While healthy people are easy and quick, sick people are interesting. Sick people also come with baggage. Tons of emotional baggage from suffering and often a mistrust of medicine that complicates the myriad of other issues they are dealing with. It takes time to tease through all of that, untangling and unraveling until we have something we can use to knit them back together again.

The problem is that I am trying to squeeze both both types of patients into the same 30 minute slot. No warning. No way to prepare. No way to know if I need extra time or not. And who ultimately pays if I walk into the proverbial train wreck? 

The rest of my patients that day.

So, like yesterday, when I find that a patient I have never met before has been carried in unresponsive by a family member, I like the excitement. By the time we get them stabilized and the ambulance has come to collect them, though, my whole afternoon is shot to hell and patients that did not actually witness the stretcher being wheeled out get testy and irate. They pin my office on Facebook and leave snarky comments about how inconsiderate I am, how they need to charge ME for their time. And all of their friends get to join in on the virtual snark feeding frenzy.

Then, when they get the patient satisfaction survey and it asks them if they were seen within 15 minutes of their appointment time, they will answer with a resounding no. The suits will be angry and will try to dock my pay because I am not meeting their arbitrary goals. 

You know what? Some days, you just cannot win.

My last patient yesterday was glaring at me by the time I got to her. She was a work in, someone who had refused to go to the ER, wanted to see me instead. Staff kept her informed that I was running 45 minutes behind. They offered snacks. Water. Not good enough. 45 minutes in my office is still way cheaper and a lot faster than 4 hours in an emergency room and the quality of care is much, much better than that doc-in-box down the road. And YET…

Healthcare, by its very nature, is unpredictable.

I am sorry, you are going to need to reschedule that heart attack, sir. 

We are creating a whole generation of right now people who believe they are more important than any other patients in the office and it is getting worse every year. That is reinforced by surveys that ask questions that do not have a direct impact on the quality of the care received. Quite frankly, the implication that I am the one at fault makes me very angry and I am tired, just tired tired TIRED of my staff and myself getting yelled at for things like not working someone in who showed up 20 minutes late for no good reason. 

There. Now I feel better. I know none of you good people is responsible for any of this. It just feels good to do some venting. 

LEGO!

  
It has been said that glitter is the STD of the craft world. I would pose that Legos* are a much bigger threat to humanity than glitter. Thanks to my dear, sweet children, they infest every nook and cranny of my house, hiding where I least expect it. I swear they breed and reproduce like rabbits. And unlike glitter Legos hurt like hell if you step on them. Glitter is essentially harmless.

In fact, I don’t need guns for self defense. I have thousands upon thousands of Legos.

But you know what? Legos are also a kind of therapy.

This weekend I spent about 12 hours organizing Lego parts into bins. You know what is sick about that? I really enjoyed it. Lego caters to a specific disorder: people with OCD hoarding issues. 

“Mommy, why are you STILL doing that?” 

“Why can’t you just dump them in that bin, mommy?”

“Why won’t you stop and play with me?”

“Why won’t you stop and eat?”

“Aren’t you thirsty?”

Someday, my children, you’ll be old enough and OCD enough to organize your Legos and THEN you will understand…

*I apologize to Lego purists who are no doubt reading this post, foaming at the mouth and cursing out loud for my use of Legos vs Lego. 

Don’t Shoot

  

I have a gun. 

Actually, I have several guns. 

My father’s way of saying, “I love you,” in my adolescence was by giving me a firearm. It was intended as protection that he himself could not provide, being crippled as he was from polio. As an adult I can understand this. As a teenage girl, though, I was mystified and somewhat frightened.

Growing up, my father was obsessed with guns. He owned dozens of them. He believed there would be a Biblical apocalypse *soon* and had planned accordingly. I made trips with him to the firing ranges. I learned how to take apart and clean a gun. 

And I knew where the survival gear was stashed…. 

Receiving a gun was sort of like a coming of age in my house. Some girls have first communion. Some girls have a Bat Mitzvah. Some, a quinceanera. Me? It was a gun. I was responsible enough to own a gun, to hold life and death in my hands, even if I was not yet allowed to drive.

My senior year of college, my father sold me the old beat up maroon family Doge Shadow. My first car. With it came a loaded .22 pistol wrapped up in a black sock. He showed me where I was supposed to hide it behind the central console. 

I drove around with it for a few days but its presence gave me tons of anxiety, worrying about what would happen if my car was ever searched during a traffic stop.

The irony is that while my father intended for those guns to provide security, they only succeeded in making me feel unsafe. Death was always just a trigger pull away.

So I hid them all. Out of sight, out of mind. 

I could pretend that I was normal. That my family was normal. That my parents were sorta kinda normal.

It worked.

Then a couple of months ago when my parents were coming for a visit, I was told they were bringing an old rifle of mine and several boxes of ammo.

I don’t want that in my house.

The crazy past came barreling into my current life, poking holes in my carefully placed sanity insulation.

And now I write about it…

My kids don’t know I have guns. I am careful. The guns are hidden and locked away, I never talk about them. I don’t want my kids to have to live with the fear that I did, to feel that the world is dangerous and evil enough that we have to have guns to protect ourselves. There is plenty of time for that kind of fear as an adult.

Truthfully, I am conflicted about what to do with the guns long term. I don’t intend to ever use them. Still. They are the only gifts my father ever gave me, the only things that ever showed that he loved or valued me, that I was worth protecting.

So, here I am writing a post about clinging to some dangerous bit of metal as a symbol of love. I realize it is ludicrous that I am even writing these words, but I wanted you to understand why when people talk about gun control and I am nodding my head in agreement, how hypocritical it feels to have all of this lurking in my closet. Guns should be controlled! Get rid of guns! But I am not willing to relinquish my right to cling to mine. 

After chewing on it for a few weeks, though, maybe it’s time to let go….

Trichy

Chicago 024

“I was calling to talk to you about your test results. You have trichomonas, a sexually transmitted disease. You need to take a medication to get rid of it and have your sexual partners treated prior to resuming intercourse in order to prevent reinfection.”

There was silence on the line. I never know how these things will go. Yelling, screaming, sobbing, accusing me of making an error… or stone cold silence. It is always a crap shoot. She had been married for thirty years. I expected it was not going to be pretty.

“Doc, you can’t tell him,” she said finally.

“What do you mean I can’t tell him?”

“My husband. You can’t tell him. Say the medication is for a head cold or something. Just don’t tell him it is for an STD. He will know it was me, that I’ve been cheating on him.”

“He’s your husband but he is also my patient…. I am not here to judge you for having an affair, but I cannot lie about why he is taking a medication. AND this medication is not used for head colds.”

“Fine. But you cannot tell anyone about the test results if I don’t want you to, right? HIPAA laws and all that…”

“Well, let’s talk about that…”

“Wait. Just give me the medication. I will make up something. I promise he will take it.”

“Ma’am…”

“What if I just don’t have sex with him again? It won’t hurt him to not get treated, right?”

So. What would YOU do?