Broken Windows

Broken window at Ellis Island hospital

It irks me beyond measure that my eyes are aging to the point that to read posts from the WordPress app on my phone I now require glasses, that to look at certain skin lesions in clinic I need to run grab the red framed readers that I *affectionately* call my old-lady glasses. Adjusting to this new reality is taking some time. I still find myself stubbornly squinting at the screen as if denial will make it all go away… 

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Friday the 13th

Ellis Island building detail

Every Friday the 13th I tell myself I am NOT going to work. I am so over the bad luck. 

Is it really that much worse than other days? Are people sicker? Is it maybe that everyone is walking around irritable and more afraid than usual and it boils over into how they interact with others? Am I just hypersensitive? Is it a self fulfilling prophecy? 

I dunno. 

All I know is that I don’t want to do it anymore.

Then it sneaks up on me. Every single dang time.

BAM! 

There is nothing to do but just get through it. Buckle down and get it done. 

Survive. 

And we do. 

We always do.

This Friday the 13th it was different, though.

“She looks yellow…” the medical assistant whispered as I pulled up the chart. 

I scanned her info. I’d never seen her before. Hypertension. Diabetes. Cholesterol. Nothing else remarkable.

Knocking authoritatively on the exam room door, I entered.

“Hi! I’m Dr. Denisof. Tell me what’s been going on?” I shook her hand, taking in her appearance. She was quite jaundiced. 

“I don’t know. I woke up this morning and pretty much freaked out when I looked in the mirror.”

“Any other symptoms?”

She shook her head. “Nothing.”

“No fevers? Abdominal pain? Nausea? Diarrhea?” She shook head no each time. 

“Hmmmmm.”

I started examining, working my way from her head down. Eyes, ears, nose, throat all fine. Lungs clear. Heart regular rate and rhythm, no murmurs. 

“Let’s have you lie down.”

She complied.

Her abdomen sounded normal. I pulled off the stethoscope and palpated her abdomen. No masses. Liver felt maybe a bit enlarged. No pain. 

I helped her sit up.

A strange look came over her face and she doubled over, gagging. Blood poured out of her mouth and into her hands, dripping onto her lap.

“Call the ambulance!” I yelled out the door then grabbed an emesis bag, thrusting it under her mouth. She gasped and the vomit stopped for a moment before another retch wracked her body, bringing up more. The room filled with the scent of rust and iron. 

“Need help?” An MA stuck her head in:

“You called 911?”

“Yes ma’am.”

“Can you print a chart summary and her last set of labs for the EMS?”

“Sure thing!”

“And let the other patients know I am going to be running late while we deal with an emergency.”

“No problem.” 

Sirens were audible in the background, growing louder. Having a clinic so near the fire station definitely had its benefits.

Another retch, more blood. 

I put my hand on the patient’s back and looked into her frightened eyes. “You are going to be OK.” She nodded but did not look convinced.

My mind was running through the differential diagnosis. Causes of rapid liver failure, fulminant hepatitis…. infection? Some sort of aggressive cancer? Drugs? A closet alcoholic? 

The sound of a stretcher came from outside the door and two hunky firefighters in dark blue uniforms stepped in. 

“What do we have here?” the tall one asked.

I gave the run down of what I knew, pointing at the bloody emesis bag. 

As I spoke four sets of eyes grew bigger and the firefighters suddenly backed out of the room. 

What the hell?

“Hang on, I’ll be right back,” I told the patient. I left the door cracked so I could hear any more vomiting or any sounds of distress.

One of the men muttered into a radio receiver on his shoulder. The other took a step toward me, his hands raised.

“Doc, we need for you to step back into the room.”

“Why? What’s going on.”

“You are quarantined.”

What?” More sirens. Through the windows I could see police cars racing into the parking lot, surrounding the building.

“Look, no one can leave this clinic. No one. The CDC will be here shortly and they’ll explain everything.”

*****************************************

The above was a bit of fictional doctor horror brought to you by the month of October…

Name Dropping

Interior, B25 Bomber
“Do you want to put on a flight suit?”

My daughter nodded, a grin starting to form. She had not been one bit happy about being dragged to an air show.

“They didn’t make flight suits that fit women so the ladies had to roll up the legs and sleeves to make them fit.” She zipped up the suit, then rolled up the cuffs. “Come on, I’ll show you how to fly!”

She helped my daughter scramble up the wing and into the cockpit and proceeded to explain how the instruments worked, letting her use the pedals and rudder.

“During World War II, women flew planes like this all over and in some cases taught the men how to fly…”

It was a fascinating thing watching the change that come over my daughter. She held her head higher. She seemed more confident. She positively glowed. It was a striking transformation.

The key?

Her brother was not getting to do this.

I used to think that girls just needed the same opportunities as boys but I am thinking that is maybe less true. If her brother had been there he would have commanded all of the attention. She would have faded to the background. She needed her own opportunity, her own experience. My daughter needed the woman in the B-25 bomber to pull her to the side specially and tell her that she flew in this plane all the time, that girls, that women, CAN do amazing things.

This post was going to be about how grateful I was for all of the women in the world who take the extra time to help girls understand their history, to understand science, to help them reach their dreams.

And then the Boy Scouts announced girls could join up.

Now, I’ll be honest. I know the Girl Scouts are not all about cookies necessarily but that is what the world knows them for. I never wanted to be in the Girl Scouts as a kid. I didn’t want to have to compete at selling cookies. I wanted to do what the Boy Scouts were doing, having adventures, learning survival skills, but I never wanted to join the Boy Scouts because… boys… ick.

As a parent I have not enrolled my kids in either scout program. I simply don’t have time to be jetting off to two meetings and doing camp outs and projects for two different organizations. So, on some level I see the appeal, having both kids in the same program. But girls need their own space to feel special. Too often they get lost in the male crowd. They need mentoring from strong women.

All of this begs the question, what is wrong with being a girl? Why do we have to be more like the boys? Why can’t we be successful and adventurous in our own right? Why do we have to join the boys?

Why do we have to sell cookies?

I don’t think girls who want to join the Boy Scouts are bad but part of me feels the “allowing” girls thing is a bit insulting and maybe a bit embarrassing. Come, girls, join the BOY Scouts! Is being a girl such a shameful thing? Is being different bad? For all of the emphasis on cookies, perhaps the message is that Girl Scouts have missed the point. They are no longer relevant. 

Taking It

Looking up at the Statue of Liberty

“He just hit on me again…” She shook her head in disbelief as she sat down the phone receiver. “The man comes in with an STD and then wants my phone number so we can hook up after he finishes the medication.”

“Again? Did he hit on you when he was here?”

“Yep. Twice.”

“Was he disrespectful?” I caught myself. What constitutes disrespect? He didn’t call her a cunt or force himself on her but then isn’t continuing to ignore her refusal as sign of disrespect? Particularly given the context.

“I don’t guess so…”

“I can fire him or have the office manager call him up and tell him to stop.”

“No. That will affect our survey results… likelihood to recommend practice and friendliness of the medical assistant….” Her pay raises and evaluations were linked by the healthcare system to those patient satisfaction measures much like 5% of my income depends on meeting certain thresholds for patient satisfaction.

“Well, you already told him no. That’ll affect it, too.”

“True.”

I think back on all of the times I have laughed off unwelcome advances over the years, people who really and truly crossed the line, and I said nothing. I stood tall and laughed it off, not showing my displeasure.

What will he think if I tell him to back off?

“It doesn’t happen often does it?” people ask. 

Depends on if you meet their definition of “pretty” or not. Then there is the question how often is too often? How far is too far?

Admittedly, “Doc, you sure look nice today,” is a far cry from “I’d like to fuck you.” 

Complements are nice. 

Harassment is not.

It isn’t like my medical assistant wears short skirts and low cut blouses. She wears baggy scrubs. I wear professional attire. Pants. A skirt to at least my knees. A blazer. Maybe jeans on a Friday. We don’t flirt with patients. We aren’t asking for it.

In the past, I have considered these sorts of encounters a part of the job. Now I want to tell this man that what he is doing is crosssing a line but is that going too far?Maybe no one ever said anything to him before. Maybe no one ever will. Maybe he will become the president of the United States or a powerful media mogul in Hollywood. Maybe I am just being overly sensitive. 

Thursday Thoughts From the Throne

Clock feature in a small park in NYC

Is the day over? No?

Phew!

Made it. 

My colon has been awfully out of whack this week. So has my running schedule, come to think of it…

So, most of the time I try to avoid talking politics and religion with my patients and my friends. There are only a few trusted people I feel I can have a rational conversation with. Today, though, I ran across one of those people who was trying to convince me that my theology was misguided and that abortion was wrong in all circumstances. Even in the case of an 11 year old girl who was molested by her uncle.

Don’t get me wrong, I like this guy. He is a good man, even if we fundamentally disagree. However, he made a comment about prayer in school that got my dander up. Specifically he said that Christian prayers only should open every school day and that more of it probably would have prevented the Las Vegas shooter from killing all of those people.

Um. No.

I am going to skip the theology question and the abortion issue and hit on that school prayer statement.

Being prayed at is not the thing that prevents hurting people from lashing out. Love does. Good parents who try to do right by their kids and their spouses, fellow human beings who show kindness…. these are the things that prevent damaged people. 

Loving people who need it is awfully darn hard. 

I am not saying don’t pray. Go ahead and pray. I pray. Prayer is powerful. Prayer can help you love, help you find kindness when you don’t think there is any left inside of you. Here’s the thing, though: Don’t you ever think for one minute that your prayer means you have done your duty and your responsibility to other people stops there. No. You have to physically reach outside of yourself and help those around you or you are just saying empty words. 

I used to be that person, the one for whom the world was black and white. No amount of arguing or reasoning could change my mind. I was so full of anger back then. Why doesn’t everyone see the logic that I see? Life had to show me the all of the other shades of gray and the myriad of vibrant colors that make up this world. It had to show me that I am not as smart as I thought I was. 

Life is still teaching me.

Kind of makes me wonder what I will think of this post in ten years…

Dollars and Senseless

IMG_3774

People in the US are used to this sort of thing but I wanted give everyone a peek into the way healthcare is billed:

The price charged to insurance for OR use and three days of babysitting for a ruptured appendix was $42,500.  No ICU. This does not include the surgeon’s fee or the anesthesiologist’s bill or the pathologist’s examinationof the removed offending organ.

The amount actually paid by insurance was $8,950 with an additional $680 of patient responsibility (what the patient has to pay). 

The other over $30,000 was “adjustment”, money that will never be paid by anyone. 

The games we play. 

After the birth of my child, I received a bill from the hospital for my care… over $2,000. There were also bills for the OB, anesthesia, pediatrician, the NICU stay, etc. 

I expected the bills to be high. My baby was worth any price but I still wanted to know what my money was paying for. Being on the physician side of medicine, I don’t often get to see the $ side from the standpoint of a patient so I decided to dig.

What I found most annoying was that the bill was not broken down into anything meaningful, so I requested an itemized bill so I could see the details.

When I reviewed the several pages of information that came a few weeks later, I found several charges for questionable lab tests as well as medications that I was fairly certain I had never received. Propofol, a sedation medication commonly used in ICU… the one that killed Micheal Jackson. Dopamine, a vasopressor that is used in the ICU to keep your blood pressure up. There were a couple of obscure infectious disease tests that there was no reason for me to be tested for. I called the billing number and listed my concerns to the woman who answered.

“So are you requesting a review of the charges?” She sounded astonished.

“Yes. Yes, I am.”

A week or two passed and I received a call that said that over $700 of the charges had been removed but there were still two items that I was disputing, the lab tests that should have never been done, that they were not going to budge on.

“Well, I would like to see proof that they were done and I would like to know why because they do not make any kind of sense.”

“I cannot provide that.”

“Then I would like to request a copy of my records.”

“Ma’am you are more than welcome to request a copy of your medical record. The charge is $4 per page.”

“How big is my record?” 

“I don’t know but I expect probably over 40 pages.”

(Was it really $4/page? Maybe it was less. Were there only 40 pages to the record? Probably there was more. Much more. It was a few years ago, and I don’t remember the details exactly but suffice it to say, the cost was going to be quite high.)

“Can I come by and just review my record?”

“Absolutely not.”

I did some quick math and figured that the disputed charges were less than the cost of the copy of my medical records and I ended up just paying the dang bill as it was.

Fun, huh?

Princess Panties

Doors at St. Patrick’s Cathedral in NYC

“Mommy! You’re wearing princess panties?!??!??” My daughter’s squeal of delight reverberated off of the metal walls of the stall. 

She stared in awe.

The overly crowded movie theater bathroom seemed to fall deathly silent in an instant.

“Shhhhhh!”

“Mommy. They are so beautiful! I want some.” She reached out reverentially to touch them as I hovered over the toilet seat doing my business. I swatted her hand away.

“Not until you are much, much older.”

We washed our hands then headed back out into the hallway where her brother and her dad and the dozens other men were standing, waiting on their female companions.

“Daddy! Daddy!” she called loudly as she skipped happily over to him. “Did you know Mom is wearing princess panties?”

So much for the element of surprise.

And from that moment forward, my lacy underwear was known as “princess panties.”

Flight

Birds in flight inside the American Museum of Natural History in NYC

“I asked her, ‘Aren’t you afraid?’ She touched my face and smiled. ‘No. Not at all.’

‘How can you not have fear?’

‘Because I have you. You are the strongest man I know.’”

He stopped for a moment, emotion stealing his words.

“The tumor doubled in size in 7 days. I don’t know what to do, how to help her… how to let her go.”

I have had so many conversations like this, two just this week. I always marvel at how the afflicted can be so strong, so full of peace and resolve even as those around them are falling to pieces. 

What sets them apart? 

There have been times in my life where I have been so depressed I have prayed to die. 

Please, God, take me in any way that you see fit…

But I was never peaceful about it.

I have fear. So much fear.

Fear of suffering. Fear of the unknown. Fear of the loss of control. Fear of being known for who I really am.

Who am I?

What sets them apart?

How do you come to terms with dying? 

“She says she will see me later, that it isn’t really goodbye.”

Faith.

Is it possible that it is simply faith in love… love which takes many forms… that gives us peace?

Thursday Thoughts From The Throne

Interior chandelier Grand Central Terminal

I spent a few free hours this morning doing some CME (Continuing Medical Education). Part of the requirement was listening to real physicians have “difficult” simulated conversations with “difficult” simulated patients. 

It was awful.

The only redeeming factor is that at least I get to claim two hours of CME credit. Otherwise I would feel I had utterly wasted my time. 

Seriously.

Real life “difficult” patients are not that calm and polite when you are telling them you will no longer give them prescriptions for their controlled substances….