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?

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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….

Biometrified

Stubborn
The tall, slim receptionist took my information and motioned for me to have a seat. “He’ll be with you in a moment,” she murmured sweetly. 

I settled myself into a nearby chair and pulled out my smart phone. Time to catch up on some blog reading. 

At one point I looked up from a post and saw the woman take a bite of a candy bar. She turned to a coworker standing next to her and whispered loudly, “My biometric screening appointment is in two weeks. I have to start my liquid diet tomorrow. I need that discount!” Her coworker mumbled something inaudibe in commiseration as she munched a largish chocolate chip cookie* then said, “There is no way I will ever have the right waist circumference. I just don’t even bother to try anymore.”

Is a liquid diet healthy when the rest of the year you eat like crap and don’t exercise? Apparently her employer thinks so. 

Many employers appear to think so.

I have serious issues with companies who discount insurance plans based on whether or not an employee falls within an assigned range on their blood sugar, cholesterol, BMI, and blood pressure. Does it really improve health? I am skeptical. 

High cholesterol effects, blood pressure issues, diabetes complications… generally are not going to cause an increase in health expenditures until much later, presumably when patients are retired or no longer employed. So why would their employer care now? Between the two of us, it smacks of a way to force employees to pay for more of their own insurance costs. I wonder how much that saves corporate America? 

So sorry, that’ll be an extra $600 in our pocket. Better luck next time!

It isn’t just that I hate taking the time to fill out the forms for patients, though they are tedious. It feels like a terrible invasion of privacy. Why does an employer need to know if your blood sugar is under 100? What difference does a 102 make to whether or not you can do your job? What does a 102 mean for absenteeism, productivity, customer satisfaction, or anything else they want to measure?

“My employer seems to really care about my health. They gave me a free pedometer!”

“Has that made you walk more?”

“Well, no…”

Each program, it seems, has its own unique set of thresholds… some want a blood pressure under 140/90. Some want a blood pressure of 130/70 or less. Some want a BMI of 25 or less. Others want a BMI of under 30 or even 35. Some don’t care about where you fall, they just want you to submit the numbers. Others want you to enroll in an online health class or two. I have never had a patient come in, however, and tell me that they saw the light after one of those classes and have decided to change their ways.

Many companies require employees to go to a screening at HR rather than heading to their own physician. They have a lay person interpreting those results and giving suspect advice to my patients that can take several office visits to undo. Worse, many patients then believe they then don’t need to do a physical with their primary care physician. I lose my one opportunity each year to catch patients up on their PAPs and mammos and colonoscopies, my one opportunity to screen for depression and to talk about healthy lifestyle.

Here’s another thing, though. There are people who have “high” cholesterol who are in great physical condition otherwise and yet, because their LDL is above a certain point, have to pay considerably more for their health insurance. What difference does an LDL of 148 make when the HDL is terrific and there are no other risk factors for cardiovascular disease? I wouldn’t be putting a healthy 24 year old patient on a statin drug because their LDL is 130 simply to get them below 120 for a better insurance rate. And then there is the issue of diabetes. It is a false perception that diabetes is only about diet and lifestyle. It is a genetic predisposition. Is it fair to punish you because your diabetic parents decided to have children? Ultimately it is a form of genetic profiling and I am surprised no one has made a bigger issue of this. 

We have a version of this for employees of the healthcare system I work for. There are tons of invasive questions about my daily habits and diet and exercise routines that I am required to answer and then I have to submit my screening numbers and measurements electronically to HR in order to receive the discount. We don’t have to meet certain criteria on those numbers… yet. I choose to opt out. I have the financial luxury of being able to do that, paying more for my health insurance. Many people, though, don’t have that ability.

So what are your thoughts?

*Please note, I am not saying here that chocolate OR cookies are inherently evil. In fact, they can be part of a healthy diet.

Deflowering

Close up of a rose
“Who hogs the sheets at night?”

The bride and groom hesitated. A room full of reception guests held their breath waiting for the answer.

Awkward silence dragged on.

“Uh, we don’t know?” The bride offered, finally.

Mercifully the MC seemed to sense the faux pas and appeared set to quickly move on to the next question. The relief in the room was palpable until he got the next question completely out. 

“So who snores the most?”

Another awkward silence. The bride and groom turned to look at each other in disbelief.

Granted, it was a second wedding but there were four (yes FOUR) pastors present at the reception plus two sets of parents in their 70’s and 80’s, deeply religious people. Three fourths of the room sat frowning disapprovingly, their arms crossed. The rest leaned forward grinning in amusement, not wanting to miss a single word. 

Always know your audience….

Thursday Thoughts From the Throne #5

Mission door in San Antonio

I have been pondering this from the toilet for a long time now:

You know what I hate? Items that have what they are emblazoned upon them. Like a pillow that has “pillow” in huge letters written across it. Or a towel that says, “towel”. Granted, before I have enough coffee to clear my sleep deprived brain, towelling off with my pillow after a hot shower is not entirely implausible…. but still. Seems like if I *did* do something like that I would kind of deserve the subsequent damp bedding, you know?

So every morning I blow dry my hair while standing bent over in front of a cream colored canvas “hamper” hamper. I am compelled to roll my eyes at it every morning, although the “hamper” hamper certainly never seems to appear to have its feelings hurt. The effect of eye rolling is dulled somewhat when done upside down. 

I surely do hate the thing and yet principle dictates that I cannot just toss it out until it wears out. I needed something collapsible and lightweight for lugging large amounts of laundry downstairs (I only do laundry once a week because….laundry) and it was the only option at the time at the local Target store. Mind you, the purchase was made before an Amazon Prime membership opened up a whole new fabulous world of shopping variety delivered to my front doorstep at the touch of a screen. Wicker is cute but it is expensive, heavier, and it dang sure does not last long with repeated trips up and down stairs but you know what? Cream colored canvas “hamper” hampers apparently DO last.

For years. 

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Feel free to join in with your own Thoughts From the Throne. Steve Still Standing did, of sorts. Check it out

And since apparently Thursdays are door days all over the blogosphere, I decided to throw in a door for your viewing enjoyment.

Concierge 

Gerber Daisies

“The letter said I had to pay $2400 each year to remain a patient because from now on he was going to be running a concierge practice. I would still have to use my insurance and pay deductibles and such. He’s a good doctor but I just don’t have that kind of money!” She said it in a way that made it clear the she hoped he would not hold it against her that she would have to find a new doctor. It wasn’t his fault. It was hers…

Trust me, honey, I know him. He doesn’t give a rat’s ass.

I get told all the time that I ought to go into concierge practice. 

But I won’t. 

Not ever. 

The fact is, I would feel like such a sellout, I wouldn’t be able to live with myself.

Why do I hate concierge medicine so much? 

I want to believe that it is because I think healthcare should be equally good for everyone, not better for those who can pay more. Concierge medicine smacks of elitism. Maybe, though, it is because I don’t understand people that have that kind of money, that kind of entitlement. Yes, I have assigned an unfair stereotype, haven’t I? 

Maybe I am simply jealous of them?

And then I wonder at what point do I actually become one of those rich, entitled people? Is it when I become willing to pay the retainer fee? Or some point before? 

Do I have to have gobs of money to be one of them?

Is wearing a large chunk of fake diamond on my finger selling out, too, in a way? I have had it for just over a year now. People treat me very differently when they notice the “rock” on my finger and I have to admit that I like it, I like the deference and I feel dirty because I like it. And then I ask myself WHY does that make me feel dirty and not any number of other things from my checkered past? 

And so I come back to some level of jealousy. 

I am not noble. I am eaten up with jealousy and having to face that every day would be painfully difficult.

That is why I cannot do concierge medicine. 

The Overseers

Through a window at the American Museum of Natural History in NYC

I see your drones flying overhead,
Your truck driving by.
I know you are watching me,
Following my every move… 
Silently waiting 
For the proper time to strike. 
You know my internet searches,
The names of my kids. 
You know my habits 
And my darkest faults. 
Some days you know my secret wishes 
Before I can even get the chance 
To wish them. 
Always there, behind the scenes 
Your satellites measuring my level 
Of devotion. 
Well placed hints, strategic glimpses, 
All forms of intimidation
Meant to remind me that I am yours 
Entirely,
Forever subject
To your every whim.

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If you want to see something fun, zoom in on the bottom left of the photo.

Thursday Thoughts From The Throne #4


Today’s’ thought is brought to you by my upstairs bathroom….

I am a huge fan of grandparents. I really love celebrating Grandparents Day. I do NOT, however, appreciate schools celebrating Grandparents Day by inviting everyone’s grandparents to come for some function or another. 

Here’s why:

  1. They are invariably disorganized.
  2. There are always a fair number of kids whose grandparents are dead or live too far away to come.

My kids are blessed that they have a grandmother who comes to these things but I have each year encountered the kids who don’t, who are stashed in a back room looking forlorn and left out. It tugs at my heart. 

This year my kids were supposed to write letters and make artwork for their grandparents. Earlier this year their PawPaw died. My son’s letter read like this:

Dear grandfather, I wish I could still speak with you. Even if I will not see you, I will always keep you in my heart.

He gave it to his Granny instead. 

It was good on some level, helping the kids work through their grief but I sure do wish the exchange could have been done privately instead of in front of the whole assembly, putting their grief and their grandmother’s grief on display. 

And that is all my butt has time for today!

The Twelfth 

World Trade Center

“Mommy, why are there so many police everywhere?”

I looked around. She was right. They stood on every street corner it seemed, decked out in bulky bullet proof vests. New York City, more than any other city in the world that I have visited, possesses a very visible police force. No longer simply protecting us from each other, they stood ready to protect us from them.

Did it make me feel safer? 

Yes. Yes it did.

I grabbed my daughter’s hand as we crossed the street with the crowd of other people. The Empire State Building rose up in the distance. 

“Are you going to take your kids to the 9/11 museum?”

They are six and seven.

“No. They aren’t ready for that yet.”

I’m not ready for that yet.

I dropped my purse and camera into a bin and wiggled out of my jacket, sending it and my ball cap through the scanner then stepped through the metal detector. The security guard nodded silently. We were free to move on to the next staging area. 

“Mom, why is it that everywhere we go here is like the airport?” my son asked.

In truth this was the forth scanner we had walked through on this trip. Long lines made longer by strict security. Stress. My kids felt it. So did I.

“Some years ago there was an attack on two tall buildings here in New York. They collapsed and thousands of people died. There are people who hate Americans and want to hurt them so the police and all of the security measures are trying to prevent something from happening like that again.”

Watching the towers collapse over and over again on the news feed at the clinic between patients, the world shifted. It wasn’t until the next day, as the dust was settling, that it became apparent just how much it had shifted. 

My kids seemed to take in the information and I braced myself for more questions, for fear, or even tears from my daughter, but there was nothing. 

Nothing.

This is their world. They don’t know what it was like before 9/11, a world where simply being American carried with it a certain degree of power and respect. They didn’t feel that shift. They will only know a September 12th world, a world where they are targets.