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.

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…

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.

Fulfilling

“When was the last time you saw a doctor?”

“Three years ago.” 

I looked at his blood pressure reading and cringed.

“How long have you been out of your blood pressure medication, then?”

“Out? I haven’t been out. My old doctor just kept refilling it.”

Our clinic recently instituted a protocol for allowing staff to authorize patient medication refills. It is a system wide thing, across our healthcare organization, so it is being utilized in every practice. Supposedly it is to free physicians up for more important things, like seeing patients, generating revenue. Isn’t that nice.

I hate it, though. 

I hate the whole idea.

Sure, I have trust issues. That is the first problem: Trusting that staff is always doing the right thing is hard for me in this case because these are drugs. Drugs can kill people if used wrong. Doing my own refills gives me oversight. Then, there is the self importance issue. If a medical assistant can refill meds, then what does my degree really mean? Less then it did before. And most importantly, if I don’t have time to handle simple refills for my patients, then am I too busy? 

I enjoy keeping tabs on my patients, doing their refills. Maybe I am crazy? I really do enjoy it. Taking refills away from me makes me feel less useful, less fulfilled. But I am going to try it. I’ll give it a go for a bit and see…. I don’t want to be labeled an old fogey. Yet. 

A Virtual Reality Devotional

Stained glass window

The body lies prostrate

On the confessional floor

A weakened avatar

Your closed door

Heartbeat slowed

From afar

Fading finally

Into empty code

Mere tokens

Conquests

Meaningless and broken

Nothing of value

Can be taken

Only the memories of love

Gained and lost

And gained again

Virtual virtue

Virtually gone

And truth now clear

Life

Turned into fear

Death 

A final frontier

Hold your breath

It is not so painless 

As they wanted us

To believe

A touch of tenderness

This is a wonderful post about the importance of touch in life and death. Please pop over and read it if you have not done so already.

Sue Vincent's Daily Echo

The Cathedral by Rodin.

My son gleefully squeezed harder at the knotted muscle in my shoulder, with a ‘Now I’ve got you’ as I groaned in agony. We have established and agreed that he has a slightly sadistic tendency where I am concerned. It may have something to do with my knack of getting just the right spot on the painful muscles as we got his body working again. Day after painful day, for months on end. So now it is payback… and he appears to enjoy it. He still manages to lay the blame squarely on my aching shoulders, muttering something that sounds vaguely like ‘hereditary’.

He is a little more squeamish than I. His face screws up in horror as my wrist bones crunch back into place when he applies traction. It is, however, nice to regain freedom of movement occasionally. So I make him do it…

View original post 1,189 more words

A Down Sizing

Mission San Jose in San Antonio

I see and touch an awful lot of breasts. 

Just about every “uninhanced” woman on the face of this Earth has one breast that is slightly larger than the other. I certainly do. As I age it becomes more and more obvious… the left is fuller than the right. Every time I put on a bra or look in a mirror, I am acutely aware of it and I wonder if other women notice or care about their subtle discrepancies in size. Not that I would ever bring it up in the clinic, mind you. That would be akin to your beautician asking if you want her to wax your upper lip… creates a paranoia if there was not one there to start with. 

Thankfully, I have never had a man look at my chest and run away screaming.

Every once in a while I come across a patient with a more dramatic mismatching, like the woman with one breast a cup size A and the other one a size DD. It created a serious self esteem issue. She had never had a relationship as she was terrified of anyone see her naked. She stuffed her bra with whatever she could find until someone sewed her a pillow to tuck in there instead.

Hey! Sugery can FIX that for you…

You would think this would be a no-brainer, but no…. Invariably the response from insurance companies on the request for augmentation or reduction is, “Not medically necessary.”

I always wonder who the people are making these decisions. Men? Women? If a man, would a woman make a different decision? Or vice versa?

I know the angst I have had over the years over my slightly different sizes. I cannot imagine the psychological burden carried by these women with their really noticeable differences. So what determines medical necessity? We allow breast reconstruction in breast cancer. Is is “medically” necessary? Maybe not. But it is psychologically necessary. 

So then, what determines something being psychologically necessary? What size disparity is traumatic enough to warrant coverage? One size? Two? Four? How do you measure something so subjective?

And then what else causing cosmetic angst should be covered? I had a mole removed from my face while I was still in med school. Right next to my left nostril. It wasn’t huge in real life but in my brain it covered half my face. Best thing I ever did for myself, getting that sucker whacked off. 

So, what are your thoughts? How is your breast size? What do you think about insurance covering breast augmentation or reduction? 

Showing Up

Empty barn at a livestock show

“Well, at least you will have some time off!”

I marvel at this well meaning sentiment because truthfully, jury duty does not feel like time off. It is more work than my real job.

First, I am spending hours on the computer trying to make sure patients’ results are communicated, orders and refills get sent, questions are answered.  I do this in the mornings before I go to court and at the lunch break if they give us enough time. I have a ton of anxiety… that someone is going to get hurt, that a patient is going to get upset, that a ball will get dropped. The office is terribly short staffed right now and I have to be out next week for my kids’ spring break. My jury summons could not have come at a worse time.

Second, while it is mind numbing, it is necessary to pay attention to everything that is presented so as not to miss the details. Someone’s future hangs in the balance here. It isn’t like I can sit in the jury box tapping away on my phone or reading a good book. I still have to focus on what is being said, boring or not. In the clinic I get to talk, interact with people, use my hands. Here? I am a fly on the wall, watching. Always watching. Never speaking.

My fingers and toes have frostbite. Why the heck do they have to keep the room so cold? So the one big man in robes doesn’t sweat while the rest of us freeze our asses off? A sweater is just not enough. I need a parka.

Here is something else: I don’t like any of my fellow jurors. They are annoying as all get out. What are the odds of selecting a room full of crazies? And what does that say about me, getting picked to sit here with them? Hmmm?

I hate that the judge and the attorneys have made a big deal over what I do for a living. “We have a doctor here, let’s pick on her.” I have to give my employment details on all of the forms. Why is it then necessary to announce to the entire court room who I am, what I do? They did not do that to anyone else. I hate the silly, ridiculous and even inflammatory medical statements people like the bailiff make around me as if they are wanting to goad me into weighing in, handing out free medical advice. It isn’t the free that I mind, it is the fact that I know nothing of their history and we do not have time to do a proper consult about their chronic cough right here, right now. 

This whole experience has been eye opening. 

Rant over. For now.

Chimera

Small white flower bloom

I read the chromosomal analysis.

Partial trisomy of sex chromosome… mosaicism…

Well. What was that going to mean? I needed an answer before I called this baby’s mom. She had been waiting anxiously throughout her pregnancy after the initial testing had showed a probable genetic anomaly. Mosaics are tricky. Some cells are normal. Some are not. The end result can vary. I searched everywhere at my disposal professionally. 

Nothing. 

So then I turned to Google. 

“Likely no developmental delays. No fertility issues. Phenotypically normal appearance.”

I breathed a sigh of relief. I was still sending them to genetics but I wanted to be able to reassure the family if I could. It had been a very emotional pregnancy.

And since then I have been thinking about this more and more.

Now that OB/Gyns are offering, and sometimes pushing, these more advanced genetic tests during pregnancy I wonder what it is going to mean for the babies as they grow up. We would have never known there was an issue genetically for this child 10 years ago. We just would not care. They would have grown up as a “normal” child. Now this kiddo will have “sex chromosome anomaly” hanging around their neck for the rest of their life. 

Is more information really better? Just because we can do something… should we?

Maybe not.