Wrapped Around My Finger

black and white wedding ring on hand

This is my wedding ring.

Pretty, isn’t it? (Ignore the wrinkly, dried out fingers from repeated hand washing… )

I wear it every day that I am out in public, but especially when I am at the clinic. The fact is, I have to wear something on that finger. Otherwise, I get all manner of awkward questions and comments. 

Here’s the thing that gives me special joy, though:

It’s fake!


Entirely fake.

I had a real ring that I used to wear (rather small and plain by comparison) but my kids stole/played with it when my back was turned while kneading pizza dough. They admit to taking it but swear they have no idea where it is now. Riiiight. I imagine it will resurface as a tiara for Barbie at some point. 

Could I have a “real” one? Sure. But why?

I don’t need a real diamond on my finger to feel loved and cherished. Everything else matters so much more.

Personally, I think it is silly that diamonds, a market that is artificially manipulated to inflate the price, are “forever”. That is a fairly recent invention and I refuse to pander to it. I am not going to spend that kind of money just for convention, particularly when my kids are probably going to try to pilfer this ring, too. I don’t judge others for their diamonds, I just don’t want to take part myself.

By the way, research shows that the more money you spend on your ring or on the wedding, the more likely it is that you will end up in divorce. All of those big diamonds on fingers I used to envy? Not on those fingers anymore. 

AND? I don’t get why you are given the big diamond when you agree to marry someone but when you actually sign your life away by doing the deed itself, you get the band with the tiny diamonds. That seems rather backwards. 

(Please note: All of that doesn’t mean I don’t like jewelry. In point of fact, I love jewelry. I adore it. All kinds. Please feel free to give me jewelry…)

Do I tell people it’s fake if they ooh and ahhhh over it? You betcha. I don’t want anyone thinking I am throwing away their copay on some bit of outrageous bling!


Walking For Granted

leg statues in Chicago

“He seems to be getting along fine on the leg now, but it was pretty mangled when he showed up on our doorstep.” 

The vet picked up the squirming kitten, examining the hindquarters for a moment.

“Yeah, that’s a girl you have there, not a boy.”

Thank goodness we had picked Whiskers for a name. Gender neutral….

“As for the leg, if it injured a growth plate, she might have trouble later on.”

Without even thinking, I nodded and murmured in agreement.

“What? Do you know about growth plates?” His eyes narrowed suspiciously as he looked me over.


I sighed. I was going to have to tell him.

“I am a physician,” I said quickly. “Do you think he… SHE needs an X-ray?”

“Where do you work?” he demanded, ignoring my question.

I told him.

“Say, did you know I had a stroke three years ago? Can’t even tell, can you?” He smiled, then proceded to tell me about the clot buster he had received and how his subsequent therapy had gone in great detail. 

It was a miracle he was even walking, he said….

Surviving a stroke is a big deal. It changes your life forever. I imagine you would want to talk to everyone about it, especially someone in the medical field who might better appreciate how far you’ve come, and so I listened patiently, forgetting all about the X-ray question until I got home again with the kitten in tow.

Oh, well. 

She seemed to be fine for the time being. It was a miracle she was even walking, given her initial injuries. I would just have to make another appointment for her.

This is why I try to keep who I am and what I do for a living quiet when I am out and about in the world. It only serves as a distraction beyond the clinic walls.

Doubling Over


“Good news! We got the results of your coding audit and you missed only three things. Please add a 99214 with a modifier to these three office visits so we can post the charges.” The email went on to list the names and dates of service that I was to address.

I go through this every audit. They always find something to nitpick about every year. One year they tell me to do X. I start doing X. Then the next year they tell me I should never do X, I should be only doing Y. Y was what I had been doing before X. And so on….

I don’t like being wrong. I don’t like making mistakes. I don’t like being told what to do, especially if it is something they are going to change on me next year.

Feeling defensive, I looked back at the visits in question this time.


“No way in hell am I going to add those charges. If coding wants to talk to me about it, I am happy to have a discussion with them but I will not be making these changes to the superbill.”

The office visits in question were yearly physicals. Yearly physicals are considered preventive care by insurance companies and as such, the office visit and routine screening labs are covered at 100% by the insurance company. It is not applied to a deductible. There is no copay, no out of pocket expense. 

A “free” visit.

What the coding people wanted me to do was tack on a routine office visit charge in addition to the physical exam visit charge because I addressed something new, like back pain, or made changes to meds for one of their chronic medical problems, like increasing their blood pressure medication.

The problem with this is that particular charge is not a preventive service. It will go to the patient’s deductible. They will get a bill for another $120-140 (or whatever the contracted rate is for their plan) and for most insurances, that means the patient will be paying that entirely themselves out of pocket until their deductible is met. Meanwhile, I get paid for two office visits in the time slotted for the one.

I have been practicing medicine for over ten years. I have known for a long time that it was within my rights to do this but I rarely chose to except for a handful of times in the most extenuating of circumstances.

Just because we can do something does not mean we should do it.

When I have patients skipping specialist referrals and imaging and labs and meds that they really need because of the increasing costs, it bothers me. I need to make money. I do. I have to be able to purchase supplies, pay my staff, and pay the office rent. I need transportation. My kids need clothes, food, and a roof over their heads. The kids will need to go to college and I will need to retire eventually. I make more than enough for this right now, though. I don’t have to double dip. 

The thing that puzzles me at this point is why is coding making it an issue now, this year? It isn’t anything new. There is a lot of paranoia in the medical world about what the future holds for physicians financially, especially with all of the crappy changes to Medicare reimbursement, and that may be part of the reason corporate is starting to pressure us further to maximize our bottom line. I do have to make money for them to make money, after all.

And then I start to wonder. Is there something they know that I don’t?

Should I be grabbing everything I can now and retire early… get out of this business entirely before it collapses so I can go do volunteer work somewhere I am really needed?


dinosaur skeleton outside the Field Museum in Chicago

“Get your jammies on, please. Bedtime!”

“But mommy, I want to wear this!!!!” 

She was standing in the doorway to her bedroom, hand on her hip, wearing hot pink leggings and a long sleeve Hello Kitty T-shirt.

“Why can’t I sleep in this?”

A thousand retorts flew through my mind, none of them really any good, but at that moment it struck me that this was about control. For both of us.

I want to control you.

The reality is not that pajamas help you sleep better. AND, I had to concede that pajamas would not be not more comfortable than what she was wearing. In truth, I suspect pajamas are actually a plot by the clothing industry to force us to spend more money. Like “girl” toothpaste and “boy” toothpaste…

“Please, mommy?” she pleaded.

So who gets to have control in this situation? Me, because I am the “authority”? Should I enforce the rules because if I let the little things slip, it would pave the way for letting the big things slip? Why IS it a rule, anyway? Should I let it go, choose to pick my battles waiting for something bigger? Is it a better lesson to show we can change stupid rules? 

If I don’t have her change, I can get her down for bed all that much faster…


Screw all of the philosophical mumbo-jumbo. I choose getting to bed. Quickly. Painlessly. 

That is my control.

Maybe I can convince her to wear leggings and Tshirts every day….

A Day of Patient Comments

carvings, Field Museum in Chicago

She looked me up and down disapprovingly. “Doc, that scarf. You need more color. Too much black and brown today.” 

Several hours later, a different patient… Same scarf. “Doc, you look so gorgeous! I adore that scarf!!!”

“Doc, we love your butt! We could just eat that butt up!” From two grown women in with their elderly mother. 

“Oh, Doc, I know it’s a benign skin lesion. I’ve got another one over here. I just wanted you to hold my leg like that. Made my day. My year! I might be old, but I’m not dead…”

“Doc, I am glad to see you don’t drive a sissy sports car!” Yelled across the parking lot by a patient as I was getting out of my big black pick-up truck.

“The only good thing about coming to the doctor is that I get to see you!”

Pan, at On The Road Cooking, asked about best patient one-liners. These are a few. I’ve done a bunch of other posts over the years with funny things patients say. While some of the things may seem shocking to you, I am used to it. Provided they are not being ugly, I just let it go. 

Fiction Friday will start next week!

In the Nick of Time

interior, Shed Aquarium in Chicago

It was a lovely spring morning. We were outside on the back porch coloring in a circus themed coloring book. Road construction was going a few streets over and a loud thumping repeated, shaking the ground as the workers broke up the concrete.

“Do you hear the elephants?” I asked.

My toddler son nodded, his eyes going wide.

“I think they are coming here! Let’s get some peanuts to feed them!”

He nodded his blonde head vigorously, grinning from ear to ear.

I ran inside and grabbed a bowl, pouring some peanuts into it. 

Then I saw the cashews. 

I’ll throw some in for fun!

I ran back outside and showed him the bowl of nuts. He grabbed a handful, as did I, and put a single cashew into his mouth. He chewed it, still smiling, and then swallowed.

Within seconds, his face turned ashen and his eyes were vacant. He stared off into nothing and would not respond to me at all. He was breathing was labored. His pulse was thready.

Then the hives appeared all over his body and he started to puke.

My son was having an anaphylactic reaction to cashews. 

He survived.

After that, I purchased an epipen and kept it on hand, just in case. 

He has had subsequent severe reactions to pistachios and kiwis. 

I say all of this to say that when I paid for the epipen the first time, it was $150 for a pair of them. Each year, I buy a new epipen to replace the expired one. Each year, the price goes up. Each year, I never have to use it I am throwing away hundreds of dollars. I hate that. Still. It’s my kid we’re talking about here. What kind of parent complains about spending money to protect their kid, right?

The other day I had a patient tell me that they just could not afford the cost of the epipen for their own son. With their high deductible plan they would be paying over $600 for a medication that they would hopefully never have to use. The price increase didn’t really matter so much to patients until the high deductible plans started to become the norm. The price difference before was picked up by insurance companies. Now, it is the patients getting stuck with it.

Yesterday, I ran across this article from the Washington Post about the soaring cost of epipens. Epipens have been around since 2004 but the cost has increased over 450%.

One quote in particular stood out to me:

Mylan (the manufacturer) itself is tight-lipped about the cost increase, saying only that it “has changed over time to better reflect the multiple, important product features and the value the product provides.”

So just how much are you willing to pay for your child’s life? For any child’s life? For a grown up’s life? Because that is what “value” is referring to here. They are holding my son’s life, your child’s life, for ransom. As for important product features…. it injects epinephrine. With a needle. 

Meanwhile, Heather Bresch, the Mylan CEO who has been with the company through the epipen price hikes, has had a substantial pay increase. Her salary in 2007 was  $2,453,456. Last year it was $18,931,068. Which makes me ask the question, how much money does she need?

Dearlilyjune asked what I thought was the greatest health crisis of our time. This is it. The sky rocketing cost of medical care. Pharmaceuticals. Imaging. Hospitalizations. Charging exorbitant amounts just because they can. There is nowhere quite like healthcare where they have you by the balls. Want to live? Want to have a good quality of life? Great! Pay some fat cat through the nose.

It is the worst in the US right now, but I figure it will be only a matter of time before this sort of thing catches on elsewhere. You cannot argue that the strategy makes money. It’s legal, even if it is unethical. 

Greed is powerful.


There are a surprising number of physicians who blog. I loved this post from Deconstructing Doctor about how it feels to potentially miss something, how it can eat you up, how isolating the medical profession can be. Check her out!


broken-saint-1422381-639x573I don’t always do the right thing.  I don’t always figure it out.  That’s the worst part of this job.  The not being perfect part because not being perfect means I’m flawed and flawed people make mistakes and my mistakes can hurt people.

One time I almost missed a lung cancer.  Oh God, the gut-wrenching weekend that I spent after that one.  I must have lost 5 pounds just from the nausea that I felt.  How could I eat?  How could I breathe?  My mind ground the details of the entire chart into a fine powder and then I sifted through that.  Trying to account for every dust particle.  How could I have failed so miserably?  I could have just died.  Truly.  What a miserable wretch I was.

The crazy part is it couldn’t have been helped.

She had lung cancer a decade before.  It came back.  My angst came…

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The Calling

Chicago skyline from Sears Tower in black and white.

She hesitated, staring at the caller ID.

There was only one person who would call her personal phone from that number, from that office, and in actuality she was not sure she wanted to speak to him. She stopped referring patients to him or anyone in his group long ago, specifically to maintain the distance they both needed.

Distance that had persisted until the apparition began to show up, unbidden and unwelcome. Haunting, attacking, cursing, taunting…. trying to drive her over the edge.

Why don’t you just jump? You worthless, crazy whore. Slut. Slut. Evil, insane, unworthy whore.

The phone rang again, vibrating in her hand.

Then again….

You don’t even know me.

She groaned, exasperated with herself because she knew she would answer. Of course she would answer.

She always answered. Curiosity was her nemesis.


There was a pause. She closed her eyes, bracing herself, not sure what would come next.

“I’m sorry,” he said. “I let things get out of hand.” She had not heard his voice in… she couldn’t remember when. “I wanted her to hurt you…. because….” He trailed off into his customary silence. 

He had always wielded his silence like a sword, slicing his way through her. It was one of the things about him that drove her away.

“I know,” she said finally, even though she didn’t know. She didn’t really understand anything. 

Some secrets are best left shrouded in silence.

“It won’t continue,” he said. She could hear that he meant those words.

He might have said more but she wasn’t listening. The truth was she did not need anything more. She didn’t even need the apology. All she needed was for him to be the man she thought he was so she could go on remembering him as she always had…



And very far away.


I am going to do “Fiction Fridays” so expect to see these vignettes and short stories on Fridays in the future! I had to use this one today as I have several posts I am working on but nothing actually finished and publishable to my satisfaction. The start of the school year yesterday plus catching up at work after vacation is kicking my butt!!!

Gravitational Pull 

giant ringed planets hanging from a glass ceiling at Adler Planetarium in Chicago

I like sex. 

I am a really, really big fan of sex. 

Good sex.

With the right person at the right time, an orgasm is the most deliciously exquisite thing you can ever experience.

Jane, though, asked me what I would say to my kids in 10-13 years if they come to me saying they wanted to have sex. 

Several things….

First, I really DO hope my kids feel they can share that with me when the time comes. 

Second, I hope I can be rational about my response. I will admit that I have serious, legitimate concerns about my staying calm.

Third, I hope that someday they get to experience some really great sex.

By the time they are considering sex, they will already be so sick of listening to their doctor mom talking about STDs, after I show them picture after picture after of the ravages of disease, I won’t even have to say anything more about that.

To my daughter I would say that our first time having sex as women is a very emotional act and ties us to that other person forever. The people in between? Meh. That is hit or miss. Choose wisely with this first one because you will have them in your head, and potentially your heart, forever. 

As women, we bear the brunt of childbirth, child rearing, and disease. Engaging in sex is an expression of self sacrifice… symbolically and often literally giving your life and your future to another person. It can be a beautiful thing or it can become a very painful nightmare. 

And I would also advise her that it won’t be fun, that first time. Painful physically, yes, but not fun. She likely will not achieve orgasm, because let’s face it, boys in that demographic are piss poor lovers. She will have way more fun if she waits.

To my son, I would say many of the same things I would say above. I would also tell him that love is not sex and sex is not love. Some girls do things they will regret because they are desperate for love and they don’t understand the difference between the two themselves. 

I would tell him that controlling himself and his desires and urges is a key part of becoming a man. Control is sexy. Strength of character is sexy, sexier even than physical strength. 

I would make sure they both know how to protect themselves properly from pregnancy and disease. Then I would step back and pray that what I have taught them over the years sticks with them and guides them to good choices.