The Artist

Room detail, Metropolitan Museum of Art in NYC

Over twelve years ago I met an artist.

What she had was a gift. I never had to tell her what to do. It was like she just knew. Left to create on her own she did the most amazing work.

Today was my last appointment with her. 

My hair stylist is retiring and I am grieving. She was the first and only person to ever take charge of my hair and make it look GOOD. She made me feel better about my hair, about myself. I cannot put into words how important and life changing that was.

When I ask patients what they do, often I’ll get the, “I’m JUST a…. fill in the blank.” Hair dresser, office worker, mail handler, Mom, etc. I hate, hate, hate that phrasing. 

Never doubt that what you do has an impact. No matter what your job happens to be, it matters to someone. 

It matters to me.

Maybe I will find someone just as good. 

Maybe I won’t. 

I loathe this kind of change so it will be a growing experience regardless but for now, I grieve. She was an artist in the true sense of the word and she will be missed.

With a Prayer

St. Patrick's Cathedral in New York City

I have prayed out loud with a few patients over the years at their request. I will admit, however, that I am personally very uncomfortable with public displays of my faith. I am not sure my prayers carry the weight and power that some people believe that they should. I feel somewhat hypocritical for that reason, as if I am selling a faulty product. 

That being said, I do pray privately for patients on a regular basis:

Please, God, protect my patients from my mistakes. Help your love for them to show through me…

When I pray for others, do I believe I am swaying God in any way? Not really. Prayer is not so much about others as it is about me, a sort of mindfulness. I need a reminder that I am a fallible human being and that I must demonstrate compassion to those who are vulnerable. I struggle with that from time to time, just like the next person. 

I could write a book on the various things people do to bargain with their God when they are desperate and in that respect I am just like them. I have my own rituals and my superstitions, my own pleading bargains that I have made. Some may mock me for that. 

Faith, though, keeps me sane. 

And that is good.

Recognizing Patterns

“I did an internet search for my symptoms and after doing a bunch of reading, this is what I think I have….” She pulled a sheaf of papers from her large purse and passed them over to me. 

Erythromelalgia.

I scanned through it quickly.

It wasn’t anything I had ever heard of before, but then her symptoms were not something that I recognized either. Hands that turned red and burned like they were on fire. They got better when she raised them up overhead or ran them under cold water. It had been going on for years. The pain was excruciating and now occurred at a more frenzied rate to the point she was afraid to leave her house.

“I think you might be right,” I told her. 

Now, if I were honest with you and with myself, I would admit that my pride didn’t want her to be right. I wanted to be the hero. I wanted to be the one with the answers, not her and certainly not Dr. Google, but here we were anyway. 

We did bloodwork to make sure it was not caused by something more serious and she started aspirin. Like magic, the pain was gone. Somehow, she still considered me her hero even after I told her I probably never would have figured it out on my own…

Several months later, a new patient showed up in my clinic telling me of the pain she was experiencing in her hands and feet. The pain came and went with no rhyme or reason. It burned terribly, kept her for doing things for fear it would appear.

“Do your hands and feet change colors?”

 “YES! They turn red and I have to elevate them or run them under cold water to get them to stop.” Over the years she saw half a dozen specialists and was diagnosed with all manner of things: Fibromyalgia. Anxiety disorder. Neuropathy. Malingering. 

She cried. She had clearly suffered and I suspect the implication that she was crazy was just as excruciating as the physical pain itself. 

This time I got to be the full on hero. “You are NOT crazy. What you are experiencing has a name and a treatment!”

And by golly, she got better.

I have patients who come in all of the time and say sheepishly, “I know I shouldn’t be reading online but…” 

But what if that first woman had not? 

Maybe I would have referred her to someone who could eventually figure it out. Maybe she would have ended up like the second patient spending years suffering, passed from one specialist to the the next, always told it was all in her head. Then when that second patient showed up, I wouldn’t have had an answer for her, either. 

Patients teach me new things every day, sometimes it is something simple… like keeping my pride in check so I can actually hear what patients are saying.

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. 

Impact: Chapter Eight

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*Adult content warning…*

I knew what I needed to do next and it did not make me happy.

Not one bit.

Whipping out the phone, I tapped at it fiercely only to remember that it no longer functioned. It had been years since I had seen an actual payphone anywhere and good luck getting someone to let me “borrow” their phone, especially when I started to explain to him what I needed.

A groan of frustration escaped my lips. I was going to have to go to his office. Or apartment. But no. I needed to keep things professional. It would have to be his office.

I groaned again and chucked the useless thing into the trash can. It made a satisfying crunch against the metal canister as it made impact. I could imagine the spider web of cracks that must now stretch across the screen.

Good.

The sharply dressed middle aged woman walking past me at that very moment paused slightly, looking hard at my contorted face, while clearly debating internally whether or not she should check to see if I was OK. She ended up talking herself out of it, going on her way instead. That was good. I didn’t want to have to deal with a do-gooding stranger’s concern.

What time was it anyway? I glanced around for a clock somewhere, anywhere, and found none. He was a few blocks away. I could get there quickly, certainly before five, if I left now.

I started to walk down Jackson Blvd.

Everett Haydar

My buttocks burned at the thought of his name, feeling the echo of the stinging slap of his hand followed by a lingering caress before the burn of the next strike.

Why does memory have to be so physical?

He was protective but he was also controlling. I was not the naive, docile, sweet woman he wanted from me but he was physically attracted. Very strongly so. As was I. So much so that I was willing to play the role. Those neurochemicals are incredibly hard to resist once you get a taste of them. As such, we pushed and pulled each scrabbling for the upper hand, for control of the relationship, never quite getting what we desired from the other but trying harder and harder still to get it, working up to a fevered pitch that could only culminate in intense lovemaking.

The fact of the matter was that if he started undressing me even now, I would not stop him. I would gladly offer my body up to him. Even now I wanted him to posses me physically. I just could not allow him to possess my soul. I remembered the delicious wetness of him on my thighs afterwards, the heady feeling of power that came from knowing that even while tied up, I could make him do things….

Powerful things.

We were on a dangerous path, he and I. It had to end. We each wanted to believe we pulled the plug but in truth, it was mutual and it hurt in a way I was not prepared to accept. The sting of the memory even now was worse than that of his hand on my backside.

In the end I found that I could not stomach making love to anyone else.

So there had been no one else.

People didn’t like him, people that I knew at least. They did not like how he spoke to me, how he hovered and yet seemed to look through me rather than at me.

What do you like about him, anyway? 

liked having my nipples crushed between his thumb and forefinger but that was not the answer anyone wanted to hear. It was not the kind of relationship I could explain to friends, so they drifted off and away. Here I was in the giant city of Chicago, a place full of people of every type, and I had no one else I could turn to for help.

No one but him.

Maybe he had won our battle of wills, after all?

I stood at the foot of his building, at Wacker Street, squinting to block out the glare of the sun as I looked up to the 62nd floor. Right there at the corner was his office. He had pointed it out to me from the outside one day. A strange mingling of dread and desire rose up from within, making my heart pound and my fingertips tingle as I strode into the lobby working hard to maintain a facade of confidence that I did not feel.

The speed of the elevator always surprised me. 62 floors in as many seconds. The force pressing down on my shoulders always made me feel heavier than I really was.

A trim dark haired woman in a black dress glanced up as I entered the reception area through the thick glass doors. I recognized her.

“Do you have an appointment?”

“No, Laura. No, I don’t have an appointment.”

She sighed and rolled her eyes. “You know he won’t see you.”

The sentence was not even completely out of her mouth before I was down the hall, turning the handle on his office door.

My breath caught.

Him.

There he was, standing at the window looking out over the city, hands clasped behind his back.

He chuckled a bit then turned around.

“I’ve been waiting for you.”

And then I knew.

———————————-

Want to know how we got to this point? Check out the other chapters of Impact:

Chapter One

Chapter Two

Chapter Three

Chapter Four

Chapter Five

Chapter Six

Chapter Seven

Monochromatic is Problematic

Boy looking out from a bridge at a world of black and white.
I hit print on the office visit summary.

“Doc, where do your kids go to school?” she asked casually.

I told her where and then explained that I was looking for a new place as they were outgrowing their current school. She mentioned where her kids attended, saying I should look into it.

“It’s strong academically and it is a multicultural place: Indian, Muslim, white, black…”

Yes.

That is what I want. I want my kids to grow up understanding other cultures, not being afraid of them. 

I come from a long long of white trash, the kind of people the US government once wanted to keep out. My grandmother was a Polish immigrant. The rest of me is comprised of little bits from all over the world. Read American history. Over the years it has been the Chinese, the Irish, Polish, the Italians, Jews, Mexicans, Japanese, Catholics, among others, who have been feared, blocked, and vilified. They were stealing jobs, destroying the language and culture, threatening Protestantism…. it was always something. Who among any of us can say we do not have any immigrant blood running through our veins? 

It is the height of arrogance. 

We are too good for the likes of you. 

This is what the Third Reich said about Jews and gypsies and homosexuals. Keeping them out was not good enough. No. Why stop there? Kill them all.

We are forgetting, aren’t we? The survivors are dying and their voices are lost. 

So here I am. Just one little voice but I am telling you and everyone who will listen that I cannot be forced to fear or hate and as such, I do NOT support the current immigration ban. It does not make me feel safer. It makes me more afraid. 

Afraid for our future.

The Cost of Protection

Carved flowers on a Victorian tombstone.
There have been several times over my career that I have had to step in to protect a patient from their family. Each and every time it gets nasty. It takes a certain kind of person to abuse their child or to molest a mentally challenged adult or neglect an elderly person to the point they have maggots in their wounds. Those kinds of people fight and they fight dirty.

I marvel at how some attorneys can look at the facts of a situation and defend it by attacking and terrorizing the physician who had to make the call. It is exhausting and terrifying and can leave you questioning yourself and your judgement throughout the process:

Surprise subpoenas summoning you to appear in court in 60 minutes, requiring you to cancel all of your afternoon clinic appointments at the last minute.

Threats of lawsuits.

Antagonist depositions. 

Lies and accusations made publically.  

Nothing in medical school prepares you for this sort of thing. Physicians have malpractice insurance but this is not malpractice. There is no one to walk you through it unless you hire your own expensive attorney.

Eventually you are vindicated but not before your life is made a holy living hell. It takes a toll on your family and friends as well, as you cannot discuss it with anyone else. The process can drag on for months or even years.

You are isolated and alone.

Fortunately, all of my experiences have been before social media. I have seen, of late, some unbelievably ugly online attacks made on physicians who are only doing their duty and trying to protect the vulnerable. It appalls me how quick the rest of the world is to jump onto the hate the doctor bandwagon when they do not know the whole story. Physicians are not allowed to defend themselves due to privacy laws. The rest of the world will never know the whole story.

What some people seem to forget is that our role as physicians is to assess the situation and make a recommendation. We are required by law to report suspected abuse. We are not omniscient super humans and maybe we don’t always get it right. All we can do is our best. In the end is up to the courts to decide guilt or innocence. 

The price we pay to do so is often very, very high….

Menorrhagia

Light in Boston art museum

She was new to me.

She was mentally challenged although I will admit that I don’t even know what the right PC word is anymore. Clinically I have tons of appropriate labels but speaking to all of you, I don’t know what term to use that will guarantee that I do not offend someone. 

On top of that, she had developed dementia. 

Her sister spent her entire life as her personal caretaker… never married, never had children. Out of her several siblings, she was the one who stepped up to the plate. She genuinely cared. She had watched countless times as the medical community wrote off her sister. She had watched the untold emotional and physical suffering and she felt the unfairness acutely. 

One of the toughest things to deal with in this population is menstrual problems. Periods by themselves are bad enough when you understand them. Imagine trying to deal with your period when #1 you don’t know why you are bleeding from between your legs and #2 that bleeding is irregular and excessive. 

As a physician, working up menstrual problems is especially hard when you have a grown person who is willing to slug you, who screams and cries and is so terribly, awfully afraid of what you are going to do to her. I don’t believe tying someone down, forcing myself upon them, should be necessary. That sort of thing only exacerbates and perpetuates fear but it took us 45 minutes just to draw her blood. I held her hand. Her sister held her other hand. Two other staff members worked together to do the draw. No one got hurt, most especially the patient, but it took us 45 minutes to get her calm enough to endure four sticks to find a good vein.

In fact, it had been years since anyone had even tried to draw her blood because of how much of a challenge it was. Still, it had to be done. And we did it. But for the rest of the day I was running 45 minutes late. I could not catch up to save my life. 

I cannot go in to each patient afterwards and explain what happened. Patient privacy. Takes too long. Etc. etc. etc. But to all of those patients who graciously accepted my ambiguous apology, thank you. Thank you for not slamming me on patient satisfaction scores. Thank you for giving me the freedom to take care of this one person who really needed me.

You made a difference. 

You helped save a life. 

You are all my heroes and I am lucky to have you as patients.

Hovering

Blimp in the sky
My childhood was tightly controlled. Every aspect of my life was minutely scrutinized and managed. 

I was not allowed to ever spend the night at a friend’s house. I went to a friend’s house once in grade school. Only once. My first sanctioned date was to a church to deliver fruit to shut-ins on Halloween night when I was almost 17. The guy who had asked me out was required to participate in a 30 minute interview process prior to being allowed to drive me less than five miles to the church. That interview ran the gamut from current grades, college plans, statement of faith, general health, etc. Physical contact with members of the opposite sex was strictly forbidden, going so far as not allowing me to give a male friend a platonic hug at his graduation. He hugged first. I guess I was supposed to run away screaming. My punishment for that hug back was to write 1,500 times, “I will obey my mother.” I was a junior in high school. My library books were prescreened before I could check them out until I was 18. I was not allowed to learn to drive until I graduated from high school. Dancing, ear piercing, and make-up were against the rules and the Smurfs were not allowed (Gargamel used magic doncha know). 

So when my kids started playing with the neighbor kids, I found myself hovering. It was suddenly necessary to inspect the yard for mushrooms. Rake leaves. Hunt for pecans. Maybe I’ll just wander around looking disinterested while spying on their conversations. 

What am I afraid of?

I’m afraid that my kids will do something offensive, something that will get them labeled as weird or bullied or worse. I am afraid that someone will hurt them, physically or emotionally or sexually.

But I am also afraid that my kids will be judged unfairly because they are *my* kids. That they will be used as pawns in an attempt to get to me. The whole doctor thing. I have been burned before.

Because of the control I experienced as a kid, it is exceedingly difficult to let go of control of my own kids. It is all I know. BUT as I commented to someone yesterday, I am not raising pets. I am trying to grow a couple of independent human beings. 

My kids make jokes about butts and farts and you find that offensive? Maybe it’s your fault for letting your kids play with mine. Your kids are going to pick on my kiddos? My son and daughter are very, very good at karate. You want our kids to make friends so you can say you hang with the doctor? Well fine. I cannot assume everyone has ulterior motives, can I? I will cut you off if necessary. 

So this weekend when they all started playing together again I forced myself to let it go. I went inside and busied myself making homemade marshmallows. I even closed the back door. 

And you know what? They did just fine without me.