Fertility vs. Virility

Gerber Daisy in a pot

“I need help,” she pleaded. “I don’t know where else to turn.” 

“Sure. What do you need?”

“I’m pregnant.”

She was newly married. They were recent college grads, just starting their first jobs and their lives together.

“Congratulations! How exciting!”

Her face crumpled and she began to cry great body wracking sobs. I braced myself. Had he left her? Was she being abused? Was there something wrong with the pregnancy? Had she lost her job somehow?

“My health insurance excludes coverage for birth control. The pills make me so nauseated and the depo provera shot just made me bleed and bleed. I couldn’t afford to pay out of pocket for other forms of birth control. So we used condoms. We tried to be careful.” She whispered hoarsely, “I don’t know what to do.” There was terror in her eyes. “My insurance policy excludes coverage for pregnancy. We made calls. All of the OB’s in the area want at least $10,000 up front in cash. We don’t have that kind of money. We have student loans and a mortgage!”

Could health insurance DO that? Exclude coverage for both pregnancy AND birth control? Oh, yes. Yes they could. And it was always hidden in the fine print. It was the young women starting out in life that didn’t know what to look for, the ones most likely to end up pregnant. 

It made me angry for her. What kind of misogynistic world did we live in where this was allowed? Where women are punished for possessing a functional uterus? The United States of America. The bastion of freedom and democracy.

We talked about her applying for Medicaid. 

It felt wrong, though. A woman… married, employed, insured (sort of, apparently) having to apply for Medicaid. That was not what Medicaid was intended for, was it? Once her dates were calculated, the pregnancy predated her employment contract and would have been considered a preexisting condition anyway, even if she did have pregnancy coverage. No matter what kind of policy she had, she was screwed. Literally and figuratively.

The other thing, which no one talked about out loud, was that the OBs who took Medicaid in the area were typically so awful no one with real health insurance would ever willingly use them. There was a huge stigma attached to it all.

So what happened to her, you ask?

She had an abortion.

Despite what you want to believe, hers was not an isolated story.

What a relief it was when the Affordable Care Act worked to changed that. No matter whatever else you felt about the ACA, it was a powerful step forward for women but even it did not go far enough. We all deserve comprehensive medical care that takes care of our entire bodies, not just the parts that correspond to our male counterparts.

But here we are with some people thinking it would be great to go back to that alternate kind of reality.

Well…

Be careful what you wish for.

Treat Yo’ Self!

Drawing of a human body by a preschooler
Death was approaching over my left shoulder. I could sense it. And yet I was surprisingly calm. It felt surreal. The bit of chicken lodged itself in my esophagus and now I could not breathe. I was going to die in this very hotel room. Tonight. I knew it with a certainty that rivaled the certainty of taxes. It was my time.

Choked to death on Thai chicken curry.

People would judge, wouldn’t they?

Except that I really could breathe. It just felt like I couldn’t. I was not going to die after all unless it was from embarrassment. I imagined the humiliation of that ER trip.

I could not swallow that damn piece of meat down no matter how hard I tried. I could not cough, hork, or vomit it up. I made the most awful gagging, retching noises. I wondered what people passing in the hallway were thinking. 

Fortunately, I was not alone. I rasped the word, “Heimlich!” and motioned at my throat. He complied and in short order the offending bit of Thai chicken curry sailed across the room, bouncing off of a panel of neutral colored drapery, leaving a mark for the next guests to wonder about. 

Sorry about that, housekeeping staff….

From then on, I chewed and chewed and chewed everything, figuring that this happened only because I was a glutton, stuffing my face too fast. I was ashamed. I told no one. 

There were several close calls after.

Fast forward a few months.

Standing at the counter typing clinic notes I felt the wave of nausea hit me again. It had been building for weeks, getting worse every day. Always in the mid morning. But why? Why was this nausea happening? It was not pregnancy, not unless God felt the immaculate conception needed a do-over and since I was no Virgin Mary I figured that was highly doubtful. I draped myself over the counter, holding my head in my hands and closed my eyes until the wave passed. Wow, did my epigastric feel…. odd. What was that sensation? Pain?

Whoah. 

And just like that, it all dawned on me. 

Acid reflux. A terrible case of GERD. Esophageal structure. Dysphagia. Time to crack out that acid blocker and go see a GI specialist. 

So whenever people say, “You’re so lucky. You can just call stuff in for yourself. You don’t need a doctor!” I roll my eyes. I have no business treating myself or anyone else that I love because you know what? I’m crap at it. When it comes to myself and my family I am just too close to the subject matter to see straight. My family doesn’t even appreciate how dangerous that can be. Instead they get all offended when I refuse to weigh in or offer to take over their medical care.

The physician who treats himself has a fool for a patient.” William Osler

Truth.

Remember that next time you hear about a doctor treating themself or their spouse or their kids except in the direst of circumstances….

Motherhood Sucks

Looking out of a window in Venice, Italy
I have taken care of all manner of sick people and their unpleasant smells and secretions: purulent drainage, vaginal discharges galore, fecal impactions, decayed appendages, amniotic fluid from strangers, sputum in every color of the rainbow…

But none of that prepared me for the disgusting onslaught that is motherhood. 

Poorly wiped kiddo bums. You know… when they are learning to do it themselves but are not willing to admit they need help. There is nothing like the smell of stale sweaty bum crack poo that has been fermenting all day long on the school playground. I will never understand why my kids had to pop their bums into my face when the odor was the most offensive. Then there is the poop and pee smeared all over the bathroom. MY bathroom. WTF? I have lost track of the number of times I have ended up with their vomit in my mouth!!! Snot. Never ending snot. The forgotten frogs that die in their containers and are found weeks later in a semi-liquified state. That is a sight that cannot be unseen, a smell that cannot be unsmelled.

So help me, no one said, “Brace yourself…” I would have appreciated some sort of warning. Instead people said, “Savor this time, it is over all too quickly!” 

Not quickly enough, I’ll tell you.

So let this serve as a warning to all of you who are contemplating the beauty of motherhood, thinking of reproducing. Turn back NOW before it is too late. Seriously. 

Fortunately, now that the Ebola threat has passed (for now) I have hazmat stuff from the office that begs to be used. So at least there’s that. 

Good thing they’re still cute.

Fulfilling

“When was the last time you saw a doctor?”

“Three years ago.” 

I looked at his blood pressure reading and cringed.

“How long have you been out of your blood pressure medication, then?”

“Out? I haven’t been out. My old doctor just kept refilling it.”

Our clinic recently instituted a protocol for allowing staff to authorize patient medication refills. It is a system wide thing, across our healthcare organization, so it is being utilized in every practice. Supposedly it is to free physicians up for more important things, like seeing patients, generating revenue. Isn’t that nice.

I hate it, though. 

I hate the whole idea.

Sure, I have trust issues. That is the first problem: Trusting that staff is always doing the right thing is hard for me in this case because these are drugs. Drugs can kill people if used wrong. Doing my own refills gives me oversight. Then, there is the self importance issue. If a medical assistant can refill meds, then what does my degree really mean? Less then it did before. And most importantly, if I don’t have time to handle simple refills for my patients, then am I too busy? 

I enjoy keeping tabs on my patients, doing their refills. Maybe I am crazy? I really do enjoy it. Taking refills away from me makes me feel less useful, less fulfilled. But I am going to try it. I’ll give it a go for a bit and see…. I don’t want to be labeled an old fogey. Yet. 

Well…. It’s a Deep Subject

Water tower in a storm

It happened suddenly.

I was going along like I always have, working on several posts at once, when BAM! Out of the blue….

The frickin’ well dried up. 

There’s a string of half written posts saved in my que but when I go back and read them, they sound incredibly lame, like something I would roll my eyes over if someone else posted it. Seriously. So embarrassing.

Gah.

Why? I have asked myself this over and over again. Is it possible that I have simply burned out? Is there just nothing left to say anymore? Am I too happy in my current life to stir up anything angst worthy enough to post? Is it a time issue?

Or is it something else…

And then I realized that just like I had been in the habit of blogging and reading for so long, I was suddenly out of the habit. Do you all know how much time I put into this every day? Newbies have no idea. Then life happened and here I am, weeks later. People are noticing how quiet I have been and honestly I don’t even know what to say to them.

So I don’t say anything at all.

The words are coming back, though. I just have to do things differently in order to preserve my sanity. Please bear with me as I try to figure out exactly what “differently” means….

In the meantime, I am not dead nor have I suffered from some terrible tragedy. My fingers are all intact and I am working my way back. Thank you to everyone who took notice and said something and even to those who didn’t.

I love you all!

Fatherless

Rose window example, San Antonio

“Can you tell me anything about your father’s medical history?”

“No. I don’t know him.” He shrugged as if it was no big deal but his voice said otherwise. 

Next patient…. 

“What about your father’s medical history?”

She scrunched up her face. “I think he’s still alive? I don’t know for sure. I never knew him.”

Next patient…

“So your mother is alive and has diabetes. Do you know anything about your father?”

“I’m not in contact with him.” The disdain came across loud and clear in her voice. “I hope he’s dead.”

If fathers ever think they don’t matter, they should sit in my seat and listen to the pain they can generate even when they are not there.

A Virtual Reality Devotional

Stained glass window

The body lies prostrate

On the confessional floor

A weakened avatar

Your closed door

Heartbeat slowed

From afar

Fading finally

Into empty code

Mere tokens

Conquests

Meaningless and broken

Nothing of value

Can be taken

Only the memories of love

Gained and lost

And gained again

Virtual virtue

Virtually gone

And truth now clear

Life

Turned into fear

Death 

A final frontier

Hold your breath

It is not so painless 

As they wanted us

To believe

Uncovered

Mission ruins, San Antonio

“Mommy!” my daughter gasped urgently. “Look, she’s a mermaid…” There was reverence and surprise in her voice. 

Imagine meeting a mermaid here!

“Yes, she is…. now, shhhhhh,” I responded.

I held my breath waiting for my little girl with no filter to say something about the woman’s size. She was probably close to 400 pounds and she was wearing a two piece bright purple and turquoise mermaid swim suit like it was the most natural thing in the world.

Mercifully my daughter said nothing more. Instead she snuggled up against me wrapped in her towels and fell asleep, smiling. I am grateful that she and the towels completely cover up my thighs.

I found myself very jealous of that woman. If I could have even half of that confidence, I could… 

But then, I remembered, what I saw was probably only just the tip of the iceberg so to speak. What kind of ugly things had been uttered by people under their breath as she walked by? Was she really, truly confident or was her swim suit an act of defiance, a f**k you to the world wrapped up in flashy purple and turquoise lame fabric? I would never know the reality of what lies beneath.

In contrast to the mermaid, there was a woman who must have been a size 4 standing in the wave pool with a voluminous hot pink coverup who looked so incredibly self conscious and miserable. I felt and understood her pain. She hid her body but did not succeed in hiding her discomfort. 

“Nothing makes a woman more beautiful than the belief she is beautiful.” —Sophia Loren

I looked around me at the hundreds of other men and women, bodies of all shapes and sizes and the swimsuits of all sorts, each one an act of courage. Bacne, surgical scars, stretch marks, cellulite, fat rolls, belly bulges, love handles, etc. all exposed. 

My body is a blessing.

“You are the best looking woman out here,” he whispers in my ear as I take off my cover up. I’m not. The mermaid is, but I love that he can make me feel like he believes it is the truth. 

So I decide to walk around like I am, like I really do believe I am beautiful in my deep cobalt blue velvet one piece swimsuit. I don’t like my body but that is OK. I am not this body. I am not this swimsuit. 

I am beautiful.