Thursday Thoughts From the Throne

Bones at the American Museum of Natural History in NYC
At first I told myself I would NOT write a grumbly post-Halloween post. I held off for a good whole week and a few days but here I am on the toilet stewing about it still and so I feel compelled to just spill my guts, literally and figuratively…

In case you were ever unsure, an adult taking their dog trick or treating is NOT cute if the adult is collecting candy, not wearing a costume, and there are no kids around. If you are an adult who does this, stop. Go ahead and dress up your dog or pup or hamster or whatever pet you can coax into a costume without getting your eyes clawed out and feel free to take a walk through the neighborhood. Show off. Just don’t go begging for candy. 

Second, rollling an infant around in a stroller asking for candy is on par with the pet thing. Sure, they are cute. Feel free to walk around and show them off. But trying to roll a stroller up my front steps is dangerous and we both know that bag of snickers and gobstoppers is not for anyone but you. Buy your own damn candy!

Kids with two bags collecting for a mysterious “ill” sibling…. yeah. If your brother really got sick and you want to do something truly noble, share your own candy half and half. THAT demonstrates love and sacrifice and I won’t be left wondering if that sibling really exists or not as you giggle while walking away with your two heavily laden bags.

And lastly, if you are a kid who shows up at the end of the night when my candy is running low, you may very well end up with a sucker or a box of Nerds because that is all I have left. You don’t like that? Don’t throw the candy on the ground and mutter some expletive as you storm off. I just gave out over 2,000 pieces of candy and you not liking the fact that I am out of chocolate reflects poorly on you, not me.

Ah…. Now that feels better!

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Real Terror Is….

Central Park, NYC

“Mommy, there is a fifth grader at school whose mommy had her when she was thirteen! Maybe I will get lucky and have a baby when I am thirteen. Then I will have someone to boss around.”

“Uh. Sweetheart. You don’t want to have a baby when you are thirteen.”

“Why not?” She was incredulous.

How to communicate that it is a terrible idea without tearing down the other girl’s mommy?

“Because having a baby when you are a teenager is generally frowned upon.” 

“Why?”

“A baby is a lot of responsibility. A lot of dirty diapers. Tons of poop. It is also very, very painful. You want to wait until your body is big enough.”

She was undeterred. “How do you get a baby?” There was silence as I pondered whether or not my six year old daughter was ready to learn the specifics about baby-making when suddenly she brightened up and blurted out, “Drinking alcohol. Is that how you do it?”

“Um. Yes? Sometimes?” My mind wandered to the patient who had recently gone on a so called booze cruise and came back pregnant with triplets…

“Alright!” She smiled sweetly at me, finally satisfied that now she knew the secret and then without missing a beat she said, “I am going to drink some alcohol.”

Dollars and Senseless

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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?

A Mistaken Identity 

Hudson Bay clouds

My heart sank into the floor.

“You did what?”

“I gave the wrong immunization! I didn’t look close enough at the orders.”

The baby ended up getting a double dose of one of the routine childhood vaccinations because my medical assistant gave the wrong combination vaccination and overlapped. It was not a terrible error, as far as medical errors go, and would not cause harm but try to convince a parent who has gone through multiple miscarriages and IVF to get this one beautiful baby boy. It was not a phone call I looked forward to making.

I could ignore that it happened, sweep it under the rug so to speak. Make it disappear. They would never know….

Still it had to be done. They had the right to know. So I did it. I called and explained and reassured. They seemed to take it very well at the time, or so it seemed.

I see FOUR generations of this family. 

Four.

Or rather, saw. 

They left my practice. 

To be honest, if it were my own kid I would have probably not been nearly so nice about it and I would have also taken my kids elsewhere. I am not upset at this family at all. It hurts but I totally get it. 

Trust is gone.

This was the first time an incorrect pediatric vaccination was given by a staff member to my knowledge in my practice. Fourteen years. That means nothing when it’s your kid. One mistake. Made by one of the best medical assistants we have, the absolute last person I would have expected to make an error. She will carry that one around for a very long time. 

So will I.

We can learn from every mistake, can’t we? 

If I told you I had never made a bad call or made a mistake myself I would be lying to you. There is no perfect doctor. Sometimes we lie to ourselves. Sometimes we lie to other people. That is how we keep going each day. We are not perfect. I know each and every mistake I have made over the years and they play in my mind over and over again, their faces pop out at me usually when I am already upset about something else that is unrelated. 

See? You suck, you suck, you suck! 

Why does our brain do that to us? Kick us when we are down?

Sometimes it is hard in the aftermath of a “mistake” to clear the mind and keep focused. There are other patients to see, my family to take care of. Still, I also need time to grieve and process. To forgive myself. To forgive others. I need people around me, my family, to let me do that without trying to “fix” me. Eventually my mind will settle down and move on.

Because life goes on.

It always does.

Fecundity

“Mommy, when I have a little sister, I want to name her Leia.”

“Leia?” I swelled with pride at my young padawan’s name choice.

“No! Not Star Wars. Lee-yah!”

Oh.

“Hey, Mom, I want a little brother…”

Every evening, my daughter says a prayer asking God for a baby sister. Then she punches her brother when he prays for a baby brother.

The kids are ganging up on my poor uterus. What’s left of it, anyway. Between us, I think the hot flashes are its retaliation. The kids just don’t understand, no matter how many ways I try to explain it, that the physiology is impossible and I am not ever adopting another baby. 

No way. 

No how. 

I was asked by DearLilyJune, “In what ways does being a doctor help you in being a mother? Vice versa?” And HotplateKate asked, “As far as questions, mine would be about the struggles you (or others) face combining medicine and motherhood.”

There definitely pluses and minuses. 

For instance, I now understand the funny looks moms gave me when I asked if they were brushing their toddler’s teeth twice a day. Yeah. Twice a day. Hell, once a day is generally all you can manage when you work full time. And you know what? That is just fine. 

Also, I now understand the whole first time mom pathology. I have felt that craziness myself and I am so much more forgiving and patient than I used to be.

When I have a sucky day, I can get some good hugs and kisses that make it 95% better. The kids make enduring the crap so much more worthwhile.

That being said, the kiddos also make things more stressful. I have to pick them up by 5:30 every evening, no matter what is going on at the clinic. I have to get them ready and drop them off every morning. I have no extended family that can help out at this point if the kids are sick or if they are off of school for a holiday. Their father steps in a bunch and is a huge help but there are times he simply can’t.

Why don’t you just get a nanny? I get asked that a lot. To be honest, that is a difficult proposition but even if I could arrange it easily, I want to be a parent. I want to be a mom. So I choose to engage in a precarious balancing act. So far, I am making it work. I love medicine and I love my kids. I am glad that I have enough flexibility that I can do both. 

The Pregnant Pause

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When I was pregnant with my son, I ran away to Switzerland. 

I rode the trains all over the country and climbed to the top of the Klein Matterhorn, keeping track of all of the public toilets along the way.

To be honest, I was terrified. I thought it might be easier in some ways to just die. Not that I had a plan but if I could just die, it would all be over.

Fall asleep and not wake up….

I was not prepared at all for being pregnant. It was the last thing I wanted at that point in my life. I was under a huge amount of personal stress and I worried about whether or not I should even carry on with the pregnancy. As I sat around wracked with indecision, the weeks ticked by…. It was clear I was not going to have a miscarriage.

Then, an early ultrasound determined that the baby might have something wrong with the kidneys and something snapped.

Suddenly, I wanted a baby. I wanted that baby more than I wanted anything else in the entire world.

To get him, though, I was going to have to make some other very major, very painful sacrifices and rather than make them right then, I ran away. 

To Switzerland.

Away from everyone. Away from the pressure, the shame, the fear. Away from everything.

It was the best time of my life. 

So, Belladonna Took asked about the meaning behind my moniker, my gravatar name…. Victo Dolore. In truth, it has many meanings and I struggled with what to write about it.

There is the Latin meaning: “Pain Conquered.”

There is the historical meaning. Victo Dolore was written on the family crest of Dr. James Simpson. He discovered chloroform and was the first to use it in childbirth. Anesthesia in childbirth is something that is near and dear to my heart.

There is the historical implication. Many opposed the use of anesthesia during childbirth, arguing that women should suffer as much as possible in childbirth as it would bring them closer to God. Some argued that without the great pain involved in bringing babies into the world, mothers would not love their children as much. (It should be noted that these were arguments posed by men.) 

And then, there is the personal meaning. Life is about conquering pain. Sometimes that pain is physical. Sometimes the pain is something more. 

Much more. 

Switzerland helped get my feet back under me. There are plenty of things that have happened in my life that have caused me great pain. There are just as many things that have helped me find my center again. I write about some of those here. If I wait long enough, I can always get up again. Pain diminishes, it never goes away, but we can learn to control how much influence it has on our lives. 

Victo Dolore.

Flashes of Understanding

worn green interior of an old train car

My hands ran over the surface of the baby swing, clearing off the layer of dust. It had been in storage for a few years. Only now, as I was pulling things out for a yard sale, had I seen and touched it again. What I felt, what I saw in my mind, made me pull back in shock.

Memories. Feelings. But not good ones.

I had expected happy, nostalgic baby thoughts to come flooding back. Not this. It is strange and uncanny, how much emotion an object can carry. An inanimate thing creating such a visceral reaction. Boggles the mind.

I am so glad that is over.

It struck me then, right there in my driveway, five years later.

Postpartum depression?

Or something. 

I was not right in the head, I do know that. 

Could it be possible?

I think back on that period now and the stress was overwhelming. I had a locum that was barely competent covering my new practice while on leave. Maternity was going to put my clinic tens of thousands of dollars in the hole. Then, I hired the partner from hell who made every day back a living nightmare until she finally left a year later. Family and social stresses were beyond measure. I remember how erratic and sometimes irrational my behavior was at the time but in the midst of it I truly believed that everything I was doing seemed reasonable and right.

Truthfully, I consider myself to be a fairly strong person. I never even entertained the possibility of something wrong with me emotionally. I am not weak. Nothing like that could ever happen to ME, you understand…..

Which then makes me wonder, who steps in to tell the doctor that she needs help? People around me thought I was crazy, I am sure, but no one took me by the shoulders, looked me in the eye, and said, “Hey, you need help.” 

Would I have even listened?

And, just so you know, in case you were curious, I’m not talking about the colic baby. She came along after, but most definitely before I had “recovered” my faculties. THAT prolonged my issues for sure.

What had I been thinking, believing I could have two under two? How do women with twins survive? I cannot even imagine.

So.

Here we are. I am in a much better place now. Probably. At the very least I am less crazy and that is a thing of beauty.

Let’s see if I can get $5 for that baby swing… To be honest, though, I would be willing to give it away. I don’t ever want to see or touch it again.

Scarfing  

two birds painted on a pink scarf 

“Doc, I think this is the first time I have ever seen you without a scarf!” she exclaimed as I walked into the exam room.

I pondered this for a moment.

She comes in an awful lot. Is it possible that I wear scarves that often? 

It had not really occurred to me before….

I started wearing scarves in earnest after my first child was born. Baby drool and upchuck do not look good on a professional woman but especially not when that woman works in the medical profession. Appearing dirty in any way is an instant black mark against you. With a mere flip and a twist I could hide any stains in a matter of seconds. It saved me more times than I care to admit.

Further, I could conceivably wear the same shirt five days in a row with a different scarf each day and everyone would think it is a completely different outfit… Not that I ever *did* that, you understand. Maybe two days in a week when I could not get laundry done or three days when I was backpacking through Europe. Still, in the event of a collapse of modern society, I have my wardrobe wrapped up. 

Are YOU prepared?

Admittedly, I have a vast collection of scarves that spans decades. I hate to throw them out so they accumulate in my closet even if they are not being actively worn. I even have some ancient silk ones that once belonged to my grandmother…

Now that my kids are well past the spit up phase I think these scarves have become a security blanket I can wear around my neck. I used to hide behind a white coat. Before that, I hid behind a short, red London Fog type jacket with the sleeves pushed up that I wore in all weather, rain or shine, even in 100 degree weather. 

Time to dial back the scarf use, I guess.

Black And White And Blurry All Over

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There it was. The second pink line.

Pregnant.

My heart sank.

I stood outside the exam room and took a deep breath. She was thirteen. 

She knew as soon as she saw my face when I entered after knocking softly. She started sobbing uncontrollably. Her mother sat in the corner and looked sea sick. She was holding onto the edge of her chair for dear life, knuckles white, waiting for the world to turn upside down and topple her over.

“You are pregnant.”

Her mother dissolved into angry shouts about her whore of a daughter. 

Not an auspicious beginning at all. Babies should be greeted with joy and love and excitement. My heart hurt.

“I know it seems unfair for me to ask, but have you thought about what you want to do with this pregnancy?”

Her mother spoke up before the patient could, her voice charged with bitterness. “She will have this baby and put it up for adoption. She made her bed, now she has to lie in it. We don’t believe in abortion.”

The girl glanced over at her mother then back at me, helplessness in her eyes. Any discussion about other options was met with a stoney glare from her mother. 

She died during the childbirth.

Should she have had an abortion? I don’t know. It is not my place to decide. 

The world used to be a stark black and white for me before medical school and residency. Everyone is welcome to their own personal opinions about abortion. I respect and will defend your right to believe any way you wish. But before you make decisions for anyone else about their access, I implore you to walk with me for a while in the blurry fringes where the gray resides. 

It is such a polarizing subject and it makes me very nervous to speak up on it but I am bothered by some of the political rhetoric of late. I hear the hate spewing forth from both sides of the fence and wonder if and when love will ever win.

Cycling

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My baby girl is turning five soon.

It is bitter sweet. On the one hand, I love watching her grow up, becoming her own woman. Sure, she has already formulated detailed plans to marginalized me and cut me from her life but for now she is still dependent upon me. We have fun together.

On the more sinister side of things, though, now momma needs a new IUD.

(insert groan of agony)

I have dreaded this day since the IUD was placed. I have enjoyed not having periods and not having to worry about pregnancy, having sex whenever I want. 

BUT….

Insurance changes say I cannot see the woman who placed my last IUD (she did a terrific job) and delivered my last baby. I am only allowed to see someone that is employed directly by the corporation I work for. Aside from the fact my patients are not particularly fond of the OB/Gyn’s employed by the system and the fact that I run into these people at meetings, the records will be in the EHR that I and everyone else in the system use every day. 

This makes me exceedingly uncomfortable. 

Intellectually I know that anyone who is messing with my hoo-hah in a clinical setting is not going to remember what it looks like when they run into me at a meeting. They are not going to care if the area is hairy or smooth or if the hair color matches what is on my head, or if I have stretch marks from babies. I also know that, in theory, anyone accessing my chart will be documented and recorded and will have to account for why they are there.

Still. 

How many sexual partners have I had? You can be dang well sure that I am not going to be honest about that question, no matter what the real number is. Am I engaging in risky sexual behavior? If I was, I sure as hell am not going to tell them. What about screening for STD’s? If I were in a situation where that needed to be done, would I be honest about THAT? No frickin’ way.

So, I continue to agonize daily over which physician I will end up have to spread my legs for. 

Decisions, decisions.

At least I have choices. Many women do not.