To The Rock Star…

Radio City Music Hall in New York City

“Don’t tell Dad I broke the plate, OK?”

“But it was an accident, sweetheart.”

“I know he won’t be mad but I still don’t want him to know.”

He cares what you think about him.

“Mom, I miss dad.”

“He’ll be back before you know it.”

“Can we set a place for him at the table even though he isn’t here?”

“Sure!”

Your presence is missed when you are away.

“Mom, I let her have the rest of my Gatorade even though I really wanted it.”

“Because she wanted it, too?”

“Yeah. It was the right thing to do.”

He is paying attention to the example you set.

So… thank you. Thank you for being such a great dad!

Reflective

Central Park duck pond

“He had an awful lot to say about you.” 

I steeled myself for what was to come. I had no idea how physicians in the group I left perceived me now, almost eight years later.

Eight years? Had it really been that long?

She laughed heartily.

I relaxed.

Her dentist, apparently good friends with the other provider, referred her there for a work up for bone loss he had picked up on dental X-rays. I stumbled upon the visit in her medical record in the EHR when she requested a refill on one of her medications. Aside from the fact that it was a work up I could have easily done and referring her to another primary care provider when she had one already was itself a bit unprofessional, I did not know if she would make her way back to me or stick with him. Patients always loved him. 

So I waited.

“I told him you were my favorite doctor ever. He said you had to be right about everything but he missed working with you.”

Right about everything? Really?

Admittedly there are certain things I do not compromise on. You routinely lose my patient’s vaginal specimens and I will insist that you come and spread your legs for a speculum exam as punishment. Ok, not really that drastic but I take that sort of thing very seriously. Pelvic exams are not just physically uncomfortable, they are emotionally uncomfortable for patients and saying, “just have them come back for a repeat” is not an adequate response when I am dealing with a lost specimen for the fifth time in as many months. I will raise holy hell if I have to. But I am rambling….

It is interesting sometimes to see what people remember or think about me. Sometimes it hurts, though, and most of the time I would just rather not know. Is needing to being right about everything what I wanted to leave him with? 

No. 

Not really.

But it could have been worse. At the end of my tenure at that office there was all sorts of drama, he had been involved in some of that, and I was glad to leave it all behind when I left.

A few weeks later I ran into that same former partner at a restaurant. I was there with my kids to get something to eat after a long, tough Friday. They were beat. So was I. 

He saw me and walked over say to say hello. We chatted for a few minutes about how his kids were all grown up now.

“I used to work with your mom,” he said to my son and daughter. “Do you know what she did?” 

My kids swung their tired eyes over to him and focused on his face, warily. He was a stranger. They were used to strangers addressing their mom in public but were not used to being addressed directly themselves. I again braced myself, not knowing what he would say. 

“She told a bunch of kids at an office picnic that she would pay them $5 if any of them hit me with a raw egg. All of a sudden this whole herd of kids was running at me with eggs in their hands.” My son snickered. “So do you know what I did?” They shook their heads, leaning in close to get the scoop. “I told them I would pay $10 if any of them got her with an egg. They chased her all over that park.”

“Did they get her?” My son asked eagerly.

“Sure did.”

I interjected here. “With ONE egg, alright? Just one.” I held one single finger up for emphasis.

Now? I am a legend as far as my kids are concerned. My son in particular loves pranks. He loves knowing mom does, too. I am grateful to my former partner for giving us that.

Time passes, doesn’t it?

Time heals wounds by bending memories. It tempers recollections and feelings until sometimes bygones truly can be bygones. 

I haven’t played a good prank in years, though. That is drawback to the passage of time. I am getting so awfully dang old!

Undergrounded

New York City skyline

My daughter is about butt height. Stuff her on a rush hour NYC subway train headed to Central Station with farts just waiting happen, and it is the recipe for six year old terror. It struck me that not many kids appeared to ride the subway no matter what time of day but especially not at rush hour.

Now I know why.

To be honest, I was nervous about the subway myself. All of those things people say about it….

Avoid the subway. It’s awful. All that stale urine. So dirty! Everyone is terribly rude. You’ll get mugged or robbed or worse. Just use Uber for crying out loud!

For my daughter, though, the subway was her favorite part of New York City. “It’s fast, mommy.” She sighed, content. “Speed is my life.”

“If it were me, I’d just let your kids sit the whole time,” volunteered a man from Arizona who was riding out to Battery Park with his own son. My son slouched back into his seat, nodding his head vigorously in agreement. I didn’t ask for this man’s advice but he had seen me force my kids to stand while people were entering the car in case our seats were needed. One of the people entering was a heavily pregnant woman and I pointed that out to him more for the benefit of my kids than for him. “Oh. Well. Ok.” 

He shut up after that but the damage was done. An adult had contradicted mom’s unpopular edict. 

On the return trip from the Statue of Liberty my kids grumbled and groaned and rolled their eyes when we all stood to allow a group of elderly women to take our seats.

“Where are you from?” a woman from Greenwich Village asked. We told her. “Thank you for giving up your seat to those women,” she told my kids. “It was very kind.” They beamed. Suddenly they understood. Mom was not just some crazy hack. Being courteous to others really is a good thing. 

When we missed our stop she got off the train herself to point us in the right direction, even though that was not a convenient thing for her.

New York is awesome.

The Tipping Point

Buildings in Philadelphia

“Do you have an appointment?” she asked.

“Nah. I’m just going to sit here until the weather passes,” the man said gruffly. He sat down in the corner out of her line of sight.

She shrugged and slid closed the clear glass window to the waiting room. He didn’t look threatening. Rain was pouring down outside. What did it matter if he sat for a few minutes?

He began talking into his phone loudly, clearly agitated about something. Patients looked at each other quizzically, shifting uncomfortably in their seats. They stole furtive glances at him, watching him mutter into the phone pressed against his face. It was impossible to hear exactly what he was saying between the growls.

When is the nurse going to call me back? Please let it be soon.

As he was talking the phone rang loudly. Clearly, he hadn’t been talking to anyone at all….

Then he stood, yelling into the ringing phone, threatening to kill anyone and everyone. As shaky fingers dialed 911, he bolted out of the door and ran across the parking lot never to be found again.

Perhaps I’m a silly dingbat but people behaving like that never would have bothered me in the past, at least not where I would have taken them seriously. 

Now though? We were all shaken up. I find myself wondering what is lying in wait around the corner of every person’s mind. I get nervous at airports and look over my shoulder at large events. Where is the next explosion going to come from? Who will fire the next bullet? Could I have stopped them?

Fear is sexy. Fear sells. Fear drives a wedge, keeping us from reaching out to help others. Fear protects us. Fear hurts us. Fear is necessary and yet it multiplies and it divides us. 

Part of me wants to just stay home, to never go anywhere anymore and then I remind myself that acts of courage are the only way to really combat fear. Anger only feeds fear. So does isolation. 

And so I get onto airplanes and take my kids to places that probably live as targets in someone else’s mind so that at least for me, fear will not win. 

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.

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.

The Scales

Communicating effectively with others is the key to success. I want my son to get comfortable speaking in front of others so this year I encouraged him to enter a speech competition through his school. 

He worked hard on it.

As parents we all suffer from delusions of grandeur regarding our clearly exceptional progeny but between the two of us, I had no expectations that he was going to win. I just wanted him to participate. I was fully prepared to just celebrate the achievement of his participation.

But then? He was given a red ribbon with “Excellent” emblazoned across it in gold letters. 

At first I was overjoyed. In my day, a red ribbon meant that you placed second. Excellent meant that you did pretty damn good.

Did he really do so well? 

During our practice he struggled with speaking too fast and was not making good eye contact. Was it possible that he listened to me? That he took my advice to heart? To be honest, that would have meant more to me than the ribbon itself.

Eventually I was given his judging forms. There were three judges. Apparently in this private school league they only score as Good, Excellent, or Superior and the kids are not ranked into places at all. Color of the ribbon? Yeah. Meaningless.

WTF?

Two out of the three judges gave my son a Good. Only one gave him an Excellent. From the judges’ notes, he fidgeted, stumbled, had to be prompted, and did not make eye contact. They gave him an Excellent ribbon for that. We worked on all of those things but it was his first competition and he is a first grader so I am not surprised or embarrassed or upset with his performance. I am so very proud that he was brave enough to get up there in front of strangers.

But how can I reinforce to my son that hard work pays off when mediocrity gets him an Excellent rating and a red ribbon? How can I make the point that he should listen to his mama’s advice about eye contact? How can I help him work through rejection and loosing and the unfairness of life while in the safety of childhood before he becomes a fragile adult who is devastated by the realization that the world does not in fact hand out participation trophies? And what about how this demoralizes and minimizes the kids who really did perform exceptionally well? They deserve to feel the full glory of their achievements, don’t they?

I just don’t understand.