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…

Advertisements

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. 

Power Lines

Power lines

“Hey, Doc. Remember me?”

I quickly glanced again at the name on the chart. He was a new patient. His name did not ring a bell. I squinted at his face. Dark beard and hair with some gray in it, a bit shaggy, but fairly well groomed. Lips. No. Then his eyes. I remembered the eyes from somewhere….

My heart caught and my fingertips went numb.

“How do I know you?” I asked, playing dumb. 

I knew good and well who he was. 

He smiled at me. “February 14th, 2016.” He paused a second to let it sink in. “That was the day you found me guilty of aggravated sexual assault and sentenced me to 10 years in jail.”

I quickly tapped a help message on IM to my office manager. 

“I don’t remember…”

“Sure you do, Doc.” He leaned forward close, too close, and spoke again in barely a whisper. “They made a big deal about who you were during jury selection. Got out a bit early. I had very, very good behavior. Not a day went by, though, that I did not think about what I was going to do to you when I got out. I have a very good memory.”

He sat up straight. There was a knock on the door and my office manager popped his head in. 

“This visit is over. Leave,” I rasped, embarrassed that my voice caught in my throat like a frightened fool instead of conveying strength and force. 

Damn.

A look of mock hurt crossed his face and he laughed. “Fine. See you around, Doc.” 

He sauntered out, slowly, pausing before rounding the corner to look over his shoulder and wink.

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

In case it needs clarifying, this IS a work of fiction. 

Games Played

Pelican on the water

“The staff doesn’t like you. They are all scared of you.” She sat across from me, feigning concern.

“Why?” I felt my face redden and struggled to keep the emotion under control.

“They just think you are too demanding. You should stop talking to them. Let me handle it for you so they can be mad at me.” 

Too demanding? I was not being ugly. I just asked the front desk to check on a patient’s insurance coverage. How could that be construed as anything but an honest and necessary question so I could take better care of a patient? 

“If you have a problem, come to me and I will take it to them.” 

And with that I was not supposed to communicate directly with my staff anymore. Because they feared and disliked me. The practice administrator over her and HR supported this she said. 

Whatever. 

My head reeled. She left. I closed the door and had myself a good cry.

Unbeknownst to me, that office manager was telling the staff that she was the boss, not the physicians, that they should stop taking their concerns to us. If there was an unpopular decision the staff was told that it came from the docs even if it didn’t really. If it was something good, she told them that she had done everything in her power get us to reluctantly agree. She lied and lied and lied to the staff about everything.

If you have been reading my blog posts for a few years you may recall the angst of this period of time. How could I be doing the same thing I always did but now all of a sudden everyone thinks I am the bitch from hell? Is it really that I am so evil? Or is it that I am woman and as such people are taking everything I say and do and twisting it into something I am not? If so, why now? 

What was going on?!?!!??!!

I had this niggling suspicion, as my staff continued to leave the clinic one by one, that my office manager was not supporting the physicians or the staff, that there was something else going on to which I was not privy. I reached out to upper management and they listened for a change. Within a couple of months she was gone. It was startling how quickly that occurred. Typically there is a huge HR process and blah, blah, blah. At the time I felt guilty, terribly guilty, blindsiding her with it when HR showed up to escort her out of the building. I worried that I had destroyed her career. 

Yesterday I found out that there was an investigation going on, that each employee who had left the clinic during that period of time was approached by a contracted firm for statements as to why they left. The investigation supported what I was saying which was why upper management moved so quickly. But no one ever told me this occurred. I found this out from one of the employees that we rehired. 

In fact, virtually everyone who has left this clinic has asked to come back at one time or another. On some level I knew it was not really me but how to rationalize that with what I was being told by an office manager that I trusted?

That whole period of time really messed with my head.

Friends and family started to doubt me. Hell, I doubted myself. I questioned my judgement. I questioned everything. In the end I realized that I had to let it go. All I could do was what I thought was right and I found my peace with that. While the maelstrom swirls around me, I can stand upright knowing I am doing right. In that respect the whole experience has been invaluable. I care so much less what people think about me. 

Just do what is right.

I have been back to communicating directly to my staff again for over a year. The practice administrator last week complimented me on my “level of engagement with the staff,” saying that everyone always had positive things to say about me.  

Ok. 

But I am doing the same thing I have always done. Maybe it is just the tequila I keep in my office?

Wavering

Boy making ripples in water of pond with a stick

Last week a physician shadowed me to see if there is anything I or my staff can do differently with my work flow with this new EHR. I was looking forward to having a forum to vent my complaints with the system and hopefully to have a way to fix it but nervous at the same time, not knowing what to expect, worried that they would have suggestions that would make me look a fool.

The physician who happened to come was one that had a hand in writing some of the new EHR templates. I was so disappointed in those templates that between you and me I actually cried in frustration in the first few weeks of our changeover. How could we be expected to do what we needed to do when these were the tools we were given to do it with? I told him that I did not like the templates, that I thought they S-U-C-K-E-D. 

Yes, I used the word sucked and I cringe even now at the recollection. With that one word I dismissed all of the considerable time and effort he had poured into those templates. 

Have you ever been so frustrated and nervous that unreasonable things just flow out of your mouth? 

Of course you have. 

Ever been on the receiving end of someone else’s frustration, as they vented like that? 

Sure you have…

At times, when I feel passionately about something, my filter just ups and disappears. After listening to him tell me that I should hire a staff member to approve or reject all of my refills instead of doing it myself, after having him say that my desire to take and enter my own past medical and surgical histories was a waste of time, after being lectured that writing a narrative history of present illness was silly that I should be clicking buttons instead… I was no longer really hearing his words to me or my own responses back to him. 

But I LIKE doing those things! Interacting with my patients is what makes medicine fun and rewarding for me.

It was not until days later that a realization hit me. He believes this stuff just as passionately as I believe that he is wrong. My response was not just unprofessional, it was mean. I try to have compassion and respect for all of my patients, even the difficult ones, but where was my compassion for him?

You need to be flexible. Medicine isn’t what it used to be. You have to adapt.

I don’t want him to be right. 

I hate that he might be right. 

And so I have spent this past week after reading his write up of our interaction licking my wounds, pondering the next step. What do I do from here?

The first thing, I believe, is to apologize. I don’t know that it will matter to him, but I need to apologize for me. I don’t want to be *that* person, the one who believes their rude behavior is justified.

And then? What then?

There is the question. 

The Knee Jerk

Fall leaves on a tree
“I’m not reading you an extra story tonight.” The extra story happens so regularly it isn’t really *extra* anymore, but I’m not telling him that…

“Why not, mom?” He sounded hurt. 

“Because you’ve been behaving like a jerk.” It slid out of my mouth without even thinking about it.

“Mommy?” There was a tiny catch in his voice. “Why would you say that? I haven’t been a jerk!” A little sob.

“Yes, you have. You’ve been terribly mean.” Now that it was said, I felt the need to justify it so I went on to list his numerous infractions. It took a while… “You were being mean just to be mean. That’s being a jerk.”

Then the tears began to pour and the sobs wracked his body. “Why would you say that? I’m not a jerk. You should apologize! I wasn’t trying to be mean! You don’t know what I was trying to do.”

“OK, then. Why were you doing it?”

“I don’t know.”

He went on to lash out, beg, demand and cajole me into apologizing. It took me aback, his very emotional response to my very matter-of-fact statement. The truth was, though, I didn’t want to apologize. He had behaved awfully and he needed to know it. 

Didn’t he?

Well, didn’t he?

Or was I being the mean one? 

You are behaving like a jerk…

The truth of the matter is that there are times he has made me terribly angry, when I really wanted to be the bully my father was to me growing up. Not that I acted on that feeling, but it would flare up, the anger, and simmer under the surface until it burned itself out. But not this time. I was not trying to hurt him with those words. I didn’t want to belittle him. I just wanted him to know and I wanted him to understand that there are consequences.

But do I want him to do this to someone else, call them a jerk? No. No, I don’t. 

Little words carry so much weight. It is easy to forget how they can wound. I have never said anything like that to him before, never used the term “jerk” in all of his seven years of existence and in his world, at least right now, my opinion matters most. The apology from me was of paramount importance to him. 

So I did.

I apologized. 

Changed

Fall colors on trees in the woods

We had some of our ugliest fights over that very thing.

Knock down, drag out, hurling insults at each other kind of fights. Back when I still saw the world in black and white, he saw gray. That made me see red.

This was long before Hilary. Long before Trump. 

How could I make love to someone who could vote that way? How could I eat and sleep and kiss someone who believed these things?

How?

I decided to take it day by day.

One day became two. Then three. And four…

Eventually I realized that politics didn’t matter so much in the grand scheme of things. Then, not only did I see the black and white and grays, I saw color. Glorious, fabulous color. And more than just red…

Love did that.

We can choose to move past disagreements, choose not to hate, choose to be adults who can love in the face of opposing views. We don’t have to mirror the hate we see in others. 

We can do better.

We will do better. 

Pushing Buttons

“This is none of your business!”

“Ma’am, I am trying to explain your benefits to you so you understand why you have the balance of $32…”

“Shut the F* up! I’m not paying anything. And you, little man, what the hell is your problem?” She turned from the front desk woman she had been yelling at to the office manager who had come to address the commotion.

Admittedly, he is a bit on the short side but who belittles someone to their face because of their height?

He identified himself. “You sounded upset and I thought I would see if I could help.”

“F* off!” She grew redder in the face and threw a clipboard at the check in window. “I am going to report you, you bitch!” Her voice rose, full of venom. “I am going to report the whole lot of you!”

Everyone stared, silent. Shocked. Finally, she turned and stormed out.

Later that day, she called the complaint line and raised holy hell. My staff and office manager were left to defend themselves to the higher ups, as if they were the ones on trial.

We have had a rash of verbally abusive patients over the past couple of months. I am not there to witness the interactions, but I do get to hear about them later in great detail. It is over silly stuff, like having to have a copy of the driver’s license of the person picking up a controlled substance prescription. 

Bullying. Almost daily. From new patients but also from people we have been seeing for years.

I realize that I talk about this sort of thing a lot. Healthcare is a tough field. You’ve got to have a thick skin or it will destroy you. Here’s the thing, though: I am used to these sorts of things happening from time to time, people are scared after all and there is nothing more frustrating than navigating the healthcare system, but I have never, in over twelve years of practicing medicine, ever witnessed the amount of abuse laid down over the past couple of months. I wonder why my staff even comes back every morning for another day of it. I am not sure we can ever pay them enough. The attacks are incredibly mean and ugly, more over the top than I am used to witnessing in past years. People are becoming more abusive, more hateful with each interaction and I don’t know where it is coming from.

If you work in healthcare, you are expected to maintain a perky and yet calm and meek facade at all times. We are to be patient, kind, respectful and never let our emotions show even in the midst of a brutal onslaught. If we crack, even just a little bit, suddenly the whole event becomes our fault. Let me tell you, that it is extremely difficult to maintain calm when you are getting beaten down every single day. I feel for my staff who absorb the brunt of it.

Why is this behavior even necessary? 

Is it a symptom of the political climate right now?

Say Wat?*

Cambodia 041

So, something that I have noticed is this:

Adopted people seem to often carry around a lot of baggage. 

Sometimes it’s obvious from childhood. There are times, though, they don’t even know it is there until they are all grown up.

I have seen this clinically and personally and throughout the blogging world. Even under the best of circumstances, with the best adoptive parents, there is a profound amount of baggage that accompanies adoption.

Who am I, really?

Where did I come from?

Why did she give me away? Didn’t she love me?

Now, let’s say it is an adoption situation where the child was adopted as a baby but the birth mother died and the father was never known. What would be the best approach? When do you tell the kiddo, who has only known you as a parent, about the death? 

It is easier in some ways to simply avoid the topic altogether, isn’t it? There is that temptation to not say a word about adoption and death, let that child go through life thinking they are 100% yours. Decades ago that might have been possible, but in the advent of DNA testing, these secrets never stay buried. I cannot tell you how many times I have had conversations with devastated patients about the seemingly innocuous DNA test done for fun that uncovered a few half siblings or even different parents. 

I have been thinking about this for some time. Maybe the point is not that there is a “right” way or a “right” time to have that discussion. There is no point in time that would make it all OK and would prevent subsequent life turmoil, so much as simply understanding that life sucks… sometimes it really sucks… and when you cannot make it better you just do your best to support them as they work through it all. Working through the grief and anger and abdandoment issues can be a lifelong process and that is OK.

What are your thoughts?

*This is a wat in Cambodia. A wat is a Buddist temple or monastery.

In Miniature

interior, Colleen Moore's dollhouse

He pushed a slice of pizza on a napkin toward her.

“Eat!” He smiled, encouragingly.

She shook her head no, silently, feeling herself shriveling up inside.

Hunger had been tearing at her insides before… she hadn’t eaten all day… but her appetite had left the moment he had only purchased the one all you could eat buffet instead of two. He had answered the cashier’s quizzical look by saying she was not hungry. At that point, it had not been a lie. Once they reached the table he explained he would share with her off of his own plate. 

Maybe he just didn’t have the money? 

She sure didn’t and she didn’t want to make him feel bad if that were the case.

They were just a couple of college students, after all. Poor college students without parental funding. Her meal plan, the only one she could afford on her scholarship, allowed for five meals a week at the cafeteria. She had used them up earlier. This, right now, was supposed to be her meal for the day. She had been counting on it, counting on him, but she would never tell him this. 

She was too embarrassed. 

The Freshman fifteen had not been a problem.

“Go on. Eat.” He gave her a sharp look of warning, demanding with his eyes that she comply. He was getting angry with her. 

He pushed the pizza closer. 

She was afraid to say anything, worried he would leave her. She had changed everything, defying her parents and convention, because she loved that he had noticed her. She loved him for seeing more in her than she saw in herself. No one had paid a lick of attention to her before. Now she was terrified that she would not be exciting enough, pretty enough, daring enough, or smart enough to hold his attention. 

That was why she had given him her virginity but doing so had only upped the stakes. If he left her now, what would she have left? Nothing. Nothing of value, anyway.

Just fear.

Her fear of being alone eventually overcame her fear of getting caught. Glancing around first to see if anyone was watching, she took a furtive bite, chewing the tasteless mass slowly. She swallowed carefully around the lump in her throat. 

In a matter of seconds the manager was there, glaring down at her. How had he seen?

“You need to leave.”

She looked back across the table for guidance but there was none. He just stared at her, shock playing on his face.

“Now,” the manager said, his voice rising. “What you did is stealing. I could have you arrested.”

She could not find her voice so she grabbed her purse instead, starting to scoot her way out of the booth. 

Other patrons turned to stare.

“Wait. What if I go ahead and pay for her?” He pulled out his wallet and took out some bills, handing them over.

Mollified, the manager took the money and left, shooting her one final dirty look over his shoulder. She could feel his and everyone else’s eyes on her, judging her to be something she was not. 

A thief.

Then again. She had been the one to eat without paying. Not him. 

“You may as well eat now, get our money’s worth,” he said, gesturing dismissively to the salad bar and the line of pizzas laid out on the warmers.

Her head swam.

He’d had the money.

She just hadn’t rated the price of a pizza buffet.

She watched his face as he ate, anger and shame rising up like acid in her chest, burning a hole through her rib cage. 

There were times he could make her feel so cherished, so loved. Then in a flash, in the blink of an eye, he could wipe it all away and make her feel tiny and worthless. It hurt so much more because of all of the opinions in the world, his was the one that mattered the most to her.

This was not her fairytale.

She stood up from the table.

“I want to go home.” 

He didn’t move. 

“I want to go home. Now,” she said, more firmly.

He looked up at her with new eyes.

No words were spoken in the car. He tried to lean in for a kiss as she exited at her dorm but she turned away, slamming the door as hard as she could, hoping it would send the message she was not brave enough to speak with words.

I do not ever want to speak to you again.

That was the first time she left him.