The Boobs Have It

Display in museum in New York City
Do you know how many breasts I have touched? 

Thousands of them.

It is staggering when I reflect upon it. 

So many breasts. So very many. All shapes and colors and sizes. Hairy. Not hairy. Moles and rashes and skin tags galore. Droopy. Perky. Somewhere in between.

During breast exams I have for years and years referred to the exam as the “boob check.” Whenever I made reference to my breasts of anyone else’s I nearly always called them boobs or boobies. 

To be honest, I thought it was cute.

Touching another woman’s breasts makes me uncomfortable, maybe even a bit embarrassed. I feel the same when someone else is looking at or touching mine in a nonsexual, clinical sort of way. So I made fun of breasts and joked about the situation. It took some of the sting out of the situation to act goofy.

One of the many beautiful things about blogging  is that from time to time someone says something that makes me reexamine a part of my life and causes me to make some changes. 

Mark at Exile on Pain Street made a comment on one of my blog posts a while back (ok, maybe it was WAY back in July of 2015) that has stuck with me:

“I hate that word. Boobs…. Boobs sounds comical and crude. It lacks decorum. They’re beautiful! Not something to make fun of.”

This. From a MAN. 

At first, I blew it off. What does he know about women’s bodies anyway? What gives him the right to tell me what is disrespectful about the term boobs. I can can dang well call them anything I want, can’t I? I own a pair after all.

But it ate at me. 

And I felt kind of guilty.

I would take that comment out from time to time and chew on it. The word boob is, after all, another way to refer to someone who is a fool. An idiot. My breasts are way better than that, aren’t they? So are every other woman’s breasts for that matter. They give pleasure. They give life. Right or wrong, so much of who we are as women is wrapped up in these exocrine glands. I would never tell a man to show me his “twig and berries” if I were doing a genital exam. Why do I persist in denigrating the female anatomy during office visits? 

Excellent question.

Yesterday I was telling a woman to change into my lovely blue paper gown so we could do a breast exam when it struck me…

When was the last time I called them boobs?

It had been a long, long time, I realized.

And that made me smile…

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.

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!

Ruined

Ruins of hospital on Ellis Island

He came with her to all of her doctor’s appointments, more than an observer he was involved, concerned, present. He came off as her protector. I thought we were on the same team.

The alcohol was getting worse, though. So was her liver failure.

“Who buys all of the beer she drinks?”

“I do,” she spoke up. “And he does.” 

I glanced over at him.

“Sometimes she makes me.”

“Makes you how exactly?”

“She can get really ugly.” He looked away sheepishly, unable to meet my eye.

“You mean to tell me that all of this time that she has been going to her liver specialist appointments, all of this time that we have been talking about how she needs a complete and immediate cessation of alcohol, all of this time that you have sat in that chair and nodded your head in agreement, you have actually been providing her with the substance that is killing her?”

I wanted to scream at him. What the hell are you doing? Sabotaging her? Murdering her? WTH?

But I don’t know what their life together has been like. Is he the equivalent to a battered woman in an abusive relationship? 

I just don’t know.

So I suggest counseling, giving them contact information for treatment centers, and usher them out the door wondering all the while if I have somehow failed them both.

Dread 

Morgue at Ellis Island hospital

I dread going back to work after being off for a vacation, even if it was only for a few days. 

I know, I know. I’m not alone, am I? 

The thing is, I never know what my in basket is going to look like. After a regular weekend I can walk in to find 50-70 items on my virtual EHR (electronic health record) desktop. After a week of vacation it may be 150 or more. 

Please God, let it be manageable!!!!

When one of my partners is off, it is a full on life/death struggle to keep my head above water and I am certain they have experienced the same frantic craziness trying to keep up with my stuff while I’m out. 

Patients get crabby when their physician is gone and there will invariably be several fires to put out. Did the clinic roof leak again? Did my office manager actually reschedule the patients that I saw were on my schedule last Monday? Did that woman’s MRI get done? What did it show? 

It was not enough that I worried about everything all week. Oh, no. Now I have to face up to it in the morning.

Gah.

I won’t be sleeping well tonight.

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

The photo above is what is left of the morgue inside the ruins of the hospital on Ellis Island. It was a teaching hospital so autopsies were done in this theater. On the left is where the bodies where stored. I took the hard hat tour and got some really great images. I wish I could have gotten to see some of the upper floors, like where the ORs were. Maybe someday…. 

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.

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….

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!