Scarfing  

two birds painted on a pink scarf 

“Doc, I think this is the first time I have ever seen you without a scarf!” she exclaimed as I walked into the exam room.

I pondered this for a moment.

She comes in an awful lot. Is it possible that I wear scarves that often? 

It had not really occurred to me before….

I started wearing scarves in earnest after my first child was born. Baby drool and upchuck do not look good on a professional woman but especially not when that woman works in the medical profession. Appearing dirty in any way is an instant black mark against you. With a mere flip and a twist I could hide any stains in a matter of seconds. It saved me more times than I care to admit.

Further, I could conceivably wear the same shirt five days in a row with a different scarf each day and everyone would think it is a completely different outfit… Not that I ever *did* that, you understand. Maybe two days in a week when I could not get laundry done or three days when I was backpacking through Europe. Still, in the event of a collapse of modern society, I have my wardrobe wrapped up. 

Are YOU prepared?

Admittedly, I have a vast collection of scarves that spans decades. I hate to throw them out so they accumulate in my closet even if they are not being actively worn. I even have some ancient silk ones that once belonged to my grandmother…

Now that my kids are well past the spit up phase I think these scarves have become a security blanket I can wear around my neck. I used to hide behind a white coat. Before that, I hid behind a short, red London Fog type jacket with the sleeves pushed up that I wore in all weather, rain or shine, even in 100 degree weather. 

Time to dial back the scarf use, I guess.

He Had Balls

IMG_9171
I don’t remember for sure what grade I was in. Second? Third? All I know was that I was once again standing alone outside at recess, shivering in the cold, watching everyone else play with their friends. I had wanted to play soccer but as they were choosing teams no one picked me. I was left behind at the edge of the field trying to pretend that I didn’t care. 

There was nothing else I could do by myself so I stayed to watch with the familiar lump sticking in my throat.

Don’t let them see you cry.

One of the boys left the field and came over to me. I had never really paid much attention to him. Boys had cooties, you see. He was nondescript. Perhaps a bit stocky. Brown hair. Freckles. These things I remember only vaguely. I am not sure we had ever actually spoken directly to each other before.

“You know why they don’t pick you?”

“No.”

“Because they think you don’t know how to play. Do you know how?”

I started to nod my head yes then decided to be honest. “No.”

“I will teach you, then.”

And he did. Over the course of the next few recesses, he taught me the rules, how to kick, head butt… everything. 

He did it in spite of being made fun of by everyone else. He was playing with a girl. 

He was playing with that girl.

They still didn’t pick me for teams. They still all made my life miserable. But now I knew how to play soccer because Craig Mercer taught me. That made me somebody. 

I don’t think we ever really played or talked much together again after that and I don’t remember if I ever said thank you. I have no idea where he is or what his life is like now but I will always, always remember his name.

Scary

 field of sunflowers

“She has never met a stranger, Doc! Trying to teach her to be safe around people she doesn’t know is really hard.”

I laughed as I checked out his daughter’s right ear and then her left with my otoscope then placed the instrument back on the wall rack.

“Yeah, my kids like to wave at scary people at stop lights, and I mean really scary people…,” I caught myself awkwardly after the emphasis.

I glanced over at him quickly to gauge how he took that last statement.

He was a big, burly man with a full beard and multiple nose and lip piercings. He had large black spacers in his ear lobes and tribal tattoos over his arms. He worked as a motorcycle mechanic and his hands were always dirty. Did he wonder if he was someone I would have thought was scary at a stoplight? I am certain he had been treated as if he were by others over the years, probably many times.

What makes someone scary?

To be honest, he would be downright terrifying to me twenty years ago if I met him on the street.  At this point in my life I like to think I know better. Then, I make a stupid comment about waving at scary people at stop lights.

Is it just the unknown? Or is it the simple fact that someone does not look like us?

When I was a little kid I used to sit on the bed in the back of my grandpa’s RV waving at all of the truck drivers that pulled up behind us on road trips. When my parents realized what was happening, I got in trouble. Big trouble. They wanted to make sure I understood that sort of behavior would probably get me killed or raped by some strange man.

Truck drivers are dangerous.

One day in med school I was chatting with a very friendly woman on the psych ward. She was articulate. Bubbly. Kind with the other patients, sort of a mother hen. She was a joy be around. My attending called me over after a few minutes and told me she had gouged out the eyes of her four kids because they had glowed red in a photograph and must have been possessed by Satan. She managed to kill three of them. The fourth child survived. Blind. It shook my confidence. That was not at all what I had expected.

Shouldn’t you be able to see the bad in people?

A few years later I handed some medication samples to a man at the clinic. He pointed at my son’s picture on the wall and commented on what a handsome boy he was. I had treated that man for years and thought I knew him pretty darn well. I liked him. It was maybe two weeks later that he was arrested for molesting his two grandchildren and a disabled stepson.

The realization that someone’s appearance cannot tell you who they are throws the whole world off balance. The most dangerous people are the ones with evil you cannot see.

Should I let my kids smile and wave at strangers at a stop light? Hell, I don’t know. I just wish fear did not have to rule so much of our lives. 

The Crevice

Chicago Sky

I am not entirely certain why he comes to see me every year for his physical.

Each visit is exhausting. I make a statement, he argues. I argue back. He has said that he considers himself to be smarter than any physician. I try to show him why he is wrong.

Thrust. Parry. Stab. Duck. Turn. 

I felt I had managed quite well this time, getting through the visit without bloodshed. I was quite proud of myself. 

Relief flooded over me. 

“Well, I am done here. My medical assistant will be in in a few minutes to take you over to the lab.” I smiled to myself as I picked up my computer and started quickly for the door hoping to get there before he said anything else.

“Hey, Doc!” I could sense a sort of glee in his tone.

I cringed inside. I turned around and smiled at him, hoping to show that he was not going to get to me. 

“Yes?” I asked, keeping my tone even.

“I just wanted you to know that you have something stuck in your teeth when you smile.”

I ran the tip of my tongue over the teeth. Sure enough, I could feel a big chunk of the breakfast sausage I had snatched from my daughter’s plate on the way out the door that morning had lodged itself between two teeth in that sneaky crevice right at the gum line. 

Damn it!

He had struck the final blow. 

This time.

Curbside 

looking up st St. Peter's Basilica

Curbside Consult: To ask another physician a question about the management of one of your patients when they are not actively seeing that patient.

In residency I was taught to never curbside another physician. 

Mainly it was presented as a liability and courtesy issue. You don’t ask another physician to take legal responsibility for giving advice on a patient they have not examined and are not receiving payment for… payment that is going to help cover their malpractice insurance in case it is needed, God forbid. In residency I even had physicians refuse to discuss cases that I was referring to them until I had done the referral and they had actually seen that patient in their clinic and if I did ask a question, I had to be very careful how I asked it. They were downright ugly about it at times. I expect it is exceedingly frustrating for them to get asked the same dang questions each year by each new set of residents.

The bottom line when you are in residency for primary care is that specialists just don’t want to see your patients. They are often disagreeable patients and have been fired from other practices (they take their toll emotionally on you and your staff) or they are indigent or on Medicaid or Medicare (unless you are paying residents a tiny pittance as indentured servants you cannot take more than a certain percentage of these patients and still remain a viable business). Often the waiting time to get patients in is months long so you learn to treat a lot of stuff yourself. You eventually get to the point where referring a patient feels like a sign of weakness and you try to avoid it all costs.

Then, you graduate and start practicing in the real world and discover that no matter how good you are at treating something, patients would generally rather see a specialist. As primary care, it is thought by many that you know next to nothing.

The flip of this is that all of a sudden you find that specialists actually want to see your patients. They are nice to you. They say nice things about you to your patients. They may even curbside you for something not in their scope of practice as if you are the expert. Now I have the cell phone numbers of tons of specialists handwritten written on their business cards stashed in my desk. They hand them to me and say, “Call or text anytime!” I still have a hard time believing it and cannot bring myself to ever do it. 

For some, networking like this comes easy. They are very good at it. They build vast collections of people they can consult at any moment and asking for help doesn’t bother them. Not for me, though. This is one of my weaknesses, one of the drawbacks of being a physician who is a closet introvert. Asking for help is painfully difficult. So is ordering pizza by phone.

Until this week.

I had something that I really needed help with, something I had never seen before and could not find the answer to myself. Ultimately doing the right thing by patients has to take precedence over my discomfort. So I phoned a friend, so to speak. I don’t intend to make it a habit, but it was super nice to be able to get good advice quickly without feeling stupid about it.

So thank you. 

On Stage

  

“Dancers should be in costume with their make up on, ready for the photographer at 7PM.”

Make up?

Make up?

Truthfully, I am not ready for this. I am not ready see what a grown up version of my little girl is going to look like.

Oh, sure, she loves make up, but she still thinks that a beautiful application of lipstick extends about an inch beyond the actual lips, hardly realistic and I am just fine with that.

I was not allowed to wear make up growing up. Even all through high school. None. Now, I had my ways of getting around that, to be sure… For instance, I had art pastels. The colored chalk sticks made great blush and eyeshadow in a pinch. Or black acrylic paint could stand in for mascara (I was too desperate at the time to worry about what that might actually do to my eyeballs). The trick was keeping it subtle so that my parents couldn’t tell and my brothers wouldn’t realize and rat on me but still enough that I did not stand out to my peers as a repressed, prudish freak. A very delicate balance.

I swore through all of that I would not do the same to any daughter of mine.

Then I had one. And now she is five and in dance and has to wear make up!?!??!!?

So now I am left wondering if the whole issue with make up for my own parents was not that it would make me look like a whore, as they said, but rather having to adjust to the reality of their daughter growing up. 

Maybe both.

I am not going to ask them, though.

Excuse me while I go watch some tutorials on dance make-up application.

Yellowed

yellow painted industrial lights on the Eiffel Tower.

He was rude and ugly and had been since the day I met him for the first time… three days prior. I listened to his symptoms and looked at his jaundiced face and I knew. 

I knew.

The whole visit he was antagonistic, questioning my every move, downright insulting me at times, telling me that I did not know what I was doing. I wanted to yell at him to shut up and be nice, to just let me help him, but I knew that he knew that I knew he was dying. 

Bullying me made him feel as if he still had power. 

“I have your results, sir. They confirm what I suspected.”

“You are a stupid bitch.”

I am so very afraid.

“I know this is not something you want to hear and for that I am sorry. Let me set you up with an oncologist and they will take it from here…”

The Organ

  

She glanced furtively around to see if anyone was watching. 

No one.

Her heart pounded and she marveled over the fact that it was still strong enough to do that. She never felt so alive as she did during these moments.

She quietly slipped the bottle of pink glitter into her pocket and walked down three aisles to the crochet hooks. She loitered, pretending to browse until the woman at the knitting needles moved on and rounded the far corner, then slipped three “H” hooks into another pocket.

That’s enough for today.

She shifted the purse she wore over her shoulder, pressing it closer to her body, and strode purposefully to the front of the store.

“Thanks for coming in…,” the cashier called after her as she passed through the sliding doors. Her face was assaulted by the blast of heat that barreled off of the black asphalt as she hurried to her car. 

Goosebumps rose on her arms. 

It was not until she was over halfway home that she relaxed enough to smile. She laughed then rolled down the window. Hot wind whipped through her hair as she tossed the glitter and crochet hooks out the window of her ancient, rusted silver minivan. 

Maybe I should have wiped off the fingerprints? Oh, well. Too late now…

She knew this small fry was not going to be enough for much longer. She ached to try something else.

Jewelry? 

A car? 

No. 

There was something even bigger that haunted her dreams at night…

At the elementary school she joined the long line of soccer moms. She hated this waiting every afternoon. Standing still was torture as the van’s AC barely worked. Eventually, though, her son was scrambling into the vehicle as a teacher closed the door and waved. 

“Hi, mom!” he said as he buckled in.

“Hi, hon!” She smiled into the rear view mirror. “How was your day?”

His excited words swirled around her head, not quite penetrating into her consciousness as she drove home. Her mind was elsewhere as it always was these days.

In the kitchen she poured herself a tall glass of ice water and took her afternoon pills one by one.

She went through the motions of preparing and eating dinner, asking her husband about his day and pretending to be interested. When everyone was in bed she lay awake, her fingers tingling.

The compulsion to take what was not hers. Where had it come from so suddenly?

This heart was not hers. 

The next morning, after dropping the boy at school, she drove to the mall. She walked around and around. Macy’s. Neiman Marcus. Tiffany’s. L’ Occitane. Agent Provocateur. 

Luxuries.

She didn’t really care that she could not afford them. She was just glad to be alive. 

But….

The thrill of the stealing, that she could not resist. Not since the surgery. None of these little luxuries would suffice now. Everyday she loathed who she had become, filled with shame each time she stole. Today she knew what she had to do in order to find peace. 
She lunched alone at La Madeleine, the closest she would ever get to France, then texted her husband to tell him that he would need to pick up their son at school. 

The drive to the bank occured in a trance like state, each turn felt like one she had taken countless times before. 

Maybe he had?

She pulled the toy gun from her son’s bedroom out of her purse in the lobby and asked a clerk to put money into a bag. Her hands shook. Fearful screams rang in her ears as everyone ducked or ran. She turned around to quickly survey the lobby as the woman shoved bills into her sack but a shot exploded into her chest. She realized that her legs would no longer hold her up. 

Where was the pain? Wasn’t there supposed to be pain?

Blood soaked her blouse as she crumpled to the floor. She felt the life seeping out of her.

Someone ran to her side and ripped open the shirt to survey the damage. She could hear someone else calling 911. They could all see the scar that split her in two, the scar from the heart transplant two years ago.

Oh, God.

She felt played.

That was when Jason Lockhart, III died the second time, right there on that same floor. He had died once two years before as he tried to rob that bank and again now in someone else’s body doing the same.

Corsage 

 black and white tiny flowers 

The cluster of tiny white flowers were now brittle and desiccated. The clear plastic box it originally came in served as a protective shrine of sorts. Picking it up out of my cedar chest I could see the cream colored ribbon, two faux pearl tipped straight pins, and the tiny rhinestone heart were still intact.

I had no date.

Each day that crept by I had waited and waited, ticking off each eligible male until it was clear no one would ask me.

Finally I had resigned and purchased the ticket to my senior prom with babysitting money. The dress I picked up for $35 at the Dilliard’s clearance store downtown while my shoes were $25 satin pumps from PayLess. I could not afford to get my hair or make-up or nails done or the shoes dyed to match my dress. In fact, I was not allowed to wear make-up or nail polish, anyway.

Nor was I allowed to drive, for that matter. I was eighteen and still did not even have a learner’s permit. So my parents dropped me off at the venue, a worn out old country club, and picked me up again promptly at 8:30PM because all of my friends had dates and limo rides and there was no way I was going to ask if I could tag along. 

I thought prom was an important rite of passage, that I would regret missing it if I did not attend. In truth, it was a miserable experience.

The corsage was a surprise. 

My brothers pooled their meager resources and purchased it. Remarkably, it matched my dress. Granted, it had been intended for someone else, an unknown relationship that had crumbled right before prom, so the florist sold it for cheap, but still they thought of me and that by itself was remarkable. It helped keep my head held high as I circled the room, looking for someone, anyone to talk to. 

I still rate a corsage, you bastards.

Unexpected kindness is often the best sort. That is why I still keep the reminder of that awful night hidden away deep in my cedar chest. My brothers and I really don’t talk to each other. We keep our distance now as adults, it is more peaceful that way. We are different people with different lives and vastly different values. But once…. once we cared, once we loved each other.

The kindness you show now will be kindness remembered later and may someday form the foundation for a bridge back to each other.

Spectator

 old stadium stands 

“Hey, Doc, everyone here looks different again. What’d you do? Run ’em off?” He was laughing but I really just wanted to scream in frustration.

It is not funny.

One of the most upsetting things I have found blogging about the difficulties I have had with staff turnover is that invariably I get the insinuation or outright accusation that I am doing something wrong, that I must be the problem. 

The reality, as I have mentioned, is that I have very little control. Most days it feels that I am a mere observer, showing up to the clinic to see what new staffing drama unfolds.

Two weeks ago I was told by a VP that there is a 46% turnover for medical assistants and front office staff within the first 90 days of employment across our system. System wide? 

Those numbers make my own clinic problems look so much better.

Why is it so high for our system, though, I wonder? My theory is that corporate makes it very difficult to reward good employees and very difficult to get rid of the bad ones. That magnifies the stress experienced by every single member of the team. 

Here is a 2004 article that cites a 53% average staff turnover in 2 years for medical practices and it mentions that network affiliated practices experience higher turnover than independent physician offices. That was 12 years ago. I wonder what the numbers are like now?

I don’t have any published data as far as our specific organization is concerned. No proof. I just have to take this VP’s word for it. He quoted the same numbers again the other day so maybe it is real.

Sure made me feel a bit better, though, even if it does not really solve my problem. It isn’t really all my fault, after all. There is something wrong with the system….