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I always block my ID when calling patients. If I don’t, I start getting direct calls from patients. Those kinds of patient calls are the minority, to be sure, but they are exhausting and disruptive and are sure to occur when I am on the toilet having a rather tough poo (lots of noisy grunting) or whilst in the midst of mind blowing sex (also lots of noisy grunting) or something else equally awkward like changing a high lightbulb while precariously balanced on a ladder (probably also involving lots of noisy grunting).

One consequence of this is that patients don’t answer my calls. I have to leave a message and wait for them to call me back, sometimes an hour later. It happens almost 50% of the time when patients call the answering service, even though they are expecting me to return their call. It occurs 90% of the time when I have to call unsolicited, like when the lab alerts me that a patient’s potassium is 2.3 or their platelet count is 10 or maybe the hemoglobin level is 4.5 (these are very bad things by the way) and I need for them to go to the emergency room.

OR, the patients have the feature activated on their phone that will not allow unidentified callers through. That requires that I call the answering service back, then they have to call the patient and walk them through how to deactivate the phone feature, then call me to let me know I can try the call again. Sometimes that still does not work because they are unable to deactivate the feature and I have to call the answering service to call the patient back for an alternate number. 

What I really, really want is a way to ID myself when calling without showing my phone number. “Dr. Victo, phone number unavailable.” Or some such thing. 

Maybe that already exists and I am just a dork when it comes to telecommunications… 

The Lump

“How long has this been here?”

“I don’t know. Maybe six months.”

“Why didn’t you tell me? You have been in for a head cold and a sprained ankle in the past several months. Why didn’t you bring it up?”

Truthfully, I don’t know why we ask these questions. 

What does it matter in the grand scheme of things, the why? It could be one or several of over a dozen things but knowing why does not change the what or the now. Asking why only makes the patient feel… worse. 

Actually, I do know why we ask. 

It is our way of saying, “Look, if you die, remember it isn’t my fault,” because we feel guilty, somehow. Responsible. It is our way of conveying that we are hurt that you didn’t trust us without saying those exact words out loud. And to be honest, we are in shock, scared, terrified of what this might mean for you. We know the fear and the pain and the hair loss and depression and everything else that may come your way because of this little lump in your breast.

I have been on both sides. 

I can tell you that as the patient I understand the not bringing it up thing. I consciously chose to ignore it myself. Not because I was depressed or was in denial that it was there. It was certainly there. Nor was I lazy. Or ignorant. I knew full well the implications of a slow growing mass in my breast. I simply did not want to know. If it was breast cancer, fine. So be it. It wasn’t going anywhere. Death didn’t scare me. In some ways, I was probably playing chicken with death, with the mass.

Who was going to flinch first, I wondered.

Then one day my own doctor was saying those words to me… “What the hell were you thinking?!?!??!”

And the truth is, I don’t know. 

Please note, that I do not have breast cancer. I’m not dying from anything, not yet anyway. My breast is just fine, thank you! I was just reflecting on this whole phenomenon last night, the ignoring of things we shouldn’t really ignore. 

Trimmings

Want to know why the Saturday after Thanksgiving is not my favorite? 

The Christmas tree.

That’s right, folks. Until they can make a Christmas tree that fluffs itself and a prelit tree that stays lit rather than burning out at the center strip only, the Saturday after turkey day will always be the second worst day of the year. The first worst being the day I have to take all of those dadgum ornaments off and try to cram the well fluffed tree back into its teeny-tiny cardboard box.

Happy holidays… 

The kids just don’t appreciate what I do for them. 

Micromanaging

My kids love messing around with our microscope. The other day we looked at some stagnant water from a poorly draining flower pot to see what we could see. Using my iPhone at the eyepiece, similar to what I did with the telescope for the Super Moon the other day, I shot a few amateurish images of the protozoa we found.

First was this, what my kids referred to as slugs because of how they moved:


Then, before our eyes, it did this: 


We witnessed the death of the poor microscopic critter, may she rest in peace.

The next photo is of a thing called a rotifer. The flat end looks like it is spinning and they zoom around quite fast…

Kinda makes you want to wash your hands more often, especially after working out in the garden!

The Deviled Inside

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What food do you love the most at Thanksgiving or Christmas, or any other holiday for that matter? What do you look forward to being on the table? 

I don’t really care for turkey or dressing. Or congealed cranberry “sauce” from a can. Green bean casserole? Ick. My personal favorite holiday food is deviled eggs. In fact, I ran an extra four miles this morning just so I could eat 4-5 eggs and not feel guilty about it. Oh, who am I kidding? I will probably try to eat six or more…. Of course, I have to sneak them. Most people judge you for openly putting that many deviled eggs on your plate.

For my international readers who may not know what deviled eggs are exactly, they are hard boiled eggs that are shelled and cut into halves. The yolks are popped out and mashed with mustard and mayonnaise, some salt and pepper, and then piped back into the egg halves. They are then topped with a dash of paprika and a slice of pimento stuffed green olive.

Mmmmmmm…..

There are countless variations out there. Some with bacon. Capers. Dijon. Schiracha. I haven’t met a single one I didn’t like. 

I first discovered deviled eggs when I was a kid. Thanksgiving at my grandmother’s house, to be more precise. She would boil up about three dozen eggs and assemble several platters of deviled eggs, one for the elder adult table, one for the lesser adult table, and one for each of the kids tables. Fortunately, the kids at my kids table hated deviled eggs. More for me….

Here’s the thing, though. The eggs are hard work. I would much rather make a key lime pie with a homemade graham cracker crust and fresh squeezed lime juice from dozens of those teeny, tiny limes without the help of a juicer or garlic press, my finders bloodied from trying to get a tablespoon of zest off of the awkward rinds, than make deviled eggs.* 

Why do I love something so much and yet hate to make it? Dunno, but there it is. Probably a good thing because honestly, I cannot control myself. Twice a year, if I am lucky, I can get my fill.

So, what are YOU eating today?

*I made a key lime pie once and I promise you it will not happen again!

The Troll Under My Bridge

Bridge partially obscured by rays of sunlight

“Hey, Doc?”

“Ummmhmmm?” I was trying to figure out what button to push to get his tetanus booster to propagate into the right field of his health maintenance screen. I had a cuss word on the tip of my tongue that really wanted to get said…

“Are you happy?”

That made me stop what I was doing and look up at him. 

People don’t often ask me that question. Most people just assume that I am super happy. I mean, I do have that nice looking fake wedding ring, right? Plus, there is the fact that I work hard to project joy and happiness for my patients. They don’t need me dragging all of my baggage into their office visit. 

But now that the question had been asked I took a momentary inventory of my happiness quotient. Am I stressed? Sure am.

But, am I happy?

Then it hit me. Yes, yes I am happy. Very happy. You know how I know? Generally, I dislike the holidays but this year I find myself looking forward to them. The sound of Jingle Bells does not make me want to strangle some innocent, unwitting fluffy creature. 

I do my best writing from dark places but right now, I don’t want to go there.

So I say all of that to say that while you may read dark things, like yesterday’s mediocre medical poetry, I am not writing them because I am some shell of a person paralyzed by grief who spends the day curled up in a corner thumbing through a lifetime of regrets. Hardly. I have better things to do. And when I do go to dark places it is not because they are my places. Often I borrow them. And I don’t live there. Not for long, at least! Not anymore.

Today, I am happy. 

Today I am thankful. 

Lichenification

Lichen close up

Reminiscing is a form of masochism

Reliving, savoring, using the pain 

Rubbed over and over and over again

Until the memory is sufficiently buried

Under a thickened, leathery patch

Numbed, no longer holding power 

Peaceful… for a time at least… then

The need to feel alive arises once more

Seeking out the next memory to scratch

* Note, the photo is a picture of lichen, a fungus living symbiotically with an algae as a composite organism. Lichenification is a dermatology term for thickened skin due to repeated scratching, like with eczema. 

Impact: Chapter Five

The Bean in Chicago
I lay there wondering if I would ever be able to breathe again. 

We moved faster and faster.

Faster…

Then suddenly everything stopped.

There was a look of horror on the man’s face right before I connected with him, knocking the air out of my chest. The seconds of weightlessness just beforehand seemed like an out of place dream sequence in slow motion, especially with the startled screams going on in the background. 

I looked down at the man I had landed upon. His nose was broken, blood pouring from it. He wasn’t breathing. It wasn’t my fault, this whole thing, but I felt guilty nonetheless. I saw an arm beside me, impossibly bent with shards of bone protruding from it. At first I thought it was his arm, then realized that it was my own.

Whimpers. Cries for help. 

I could not move. 

What to do next?

I shrugged it off and stood up from the plastic seat, slung my bag over a shoulder, and exited the train.

On the platform people stood waiting to board, avoiding eye contact with everyone else around them… I wondered how many others were having these same images?

The truth was that death followed me. These intrusive scenes popped into my brain at the strangest times. 

What if that taxi cab hops the curb and takes me out?

I used to wonder what was wrong with me. It wasn’t that I wanted to die. One day I realized that maybe it was the opposite. That I wanted to live so much my brain was preparing me for survival by throwing scenarios at me to work through. So I stopped being afraid of it.

I walked the remaining few blocks to my apartment. It was dark and only few people were on the street. Some people were afraid to walk at night in Chicago… the most violent city in the United States. 

My apartment was lonely and I tried to avoid it as much as possible, instead lingering at the hospital for hours after my shift so I could stay around people. 

The key turned in the lock and I moved around flipping on lights. While heating up some ramen with cheese and frozen mixed veggies I paused to check email on the new phone I had picked up on the way home. An alert popped up to say that my password was incorrect. I reentered it and the message popped up again. 

Well. That was weird.

Probably just a bug since the phone was new. It would probably sort itself out in the morning.

I flipped open my laptop and tried to log in that way. No dice. 

Maybe hotmail was down for some reason?

The microwave dinged.

I tried to pull up a movie on Netflix, only it said my account didn’t exist. Hulu and Amazon were the same. I tried to call the hospital, but my phone said no service.

I decided to eat and get some sleep. Tomorrow was another day. I would have to sort it out then. 

Chapter One

Chapter Two

Chapter Three

Chapter Four

Just Super

Super moon via telescope and iPhone

This was my attempt at capturing the Super Moon earlier this week. Keep in mind, it was taken with my iPhone pressed up against the lens of my telescope. Not professional by any means but still pretty nifty… 

I love things like this that remind me how small I really am. Makes things like pesky EHRs seem so irrelevant.