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? 

The Gate Keeper

Door of a San Antonio mission

There was something weird going on. I could not quite put my finger on it. Things just did not add up. I told the attending what I thought.

“Was he really asleep?”

“No.”

“Why did you feel that way? What did you observe?”

He steepled his fingers, elbows on the desk, staring intently at me over the tips. He waited patiently, expectantly for my answer, like Mace Windu the Jedi master. 

Why is he asking me this? 

I thought back to the shackled man in the orange jump suit who had sat in front of me. He was not answering my questions. Then, his head lolled to the side and a soft snore escaped his lips.

“The way his eyes were moving underneath his eyelids, his breathing.”

Back to the Jedi master, I watched his face for a clue. 

Was I right?

“Good work.” He nodded slightly, a subtle tip of his nonexistent hat. “Why did you tell me that you felt he was faking it? You could have just said the interview was cut short because he fell asleep and left it at that. That would have been an easy way out.”

“Seemed important.”

“So then why didn’t you try to ‘wake’ him up? Why did you leave him then?”

“Because he was signaling the interview was over. I didn’t think my pressing him was going to get me any further than I already was.”

“Trust your gut.” He spoke clearly, each syllable measured and distinctly enunciated. I could see that he relished this role of the guru, the sensei. “So then, if he is faking sleep, is he also faking mental illness? Is he really hearing those voices telling him to hurt people?”

“I don’t know. Maybe?” 

“It all paints a picture. Now you have to decide, do we keep him here or send him back to jail?”

Me? I have to decide? I’m the student for crying out loud! I don’t want to be the one to have to decide. But then…. this is what I signed up for. I won’t always get it right. I just have to do my best, right? The universe would sort everything out in the end.

“Well?”

“Send him back.”

He scribbled his signature on the paperwork and it was done.

I carried the weight of that with me for a few days. It was my first taste of what my decisions would mean for lives hanging in the balance.

Did I make the right call?

Later the attending told me that he had seen this fellow multiple times before and each time he presented with a different constellation of psychiatric complaints as an excuse for violent behavior. By then I had decided that forensic psychiatry was most definitely not for me…

The Troll Under My Bridge

Bridge partially obscured by rays of sunlight

“Hey, Doc?”

“Ummmhmmm?” I was trying to figure out what button to push to get his tetanus booster to propagate into the right field of his health maintenance screen. I had a cuss word on the tip of my tongue that really wanted to get said…

“Are you happy?”

That made me stop what I was doing and look up at him. 

People don’t often ask me that question. Most people just assume that I am super happy. I mean, I do have that nice looking fake wedding ring, right? Plus, there is the fact that I work hard to project joy and happiness for my patients. They don’t need me dragging all of my baggage into their office visit. 

But now that the question had been asked I took a momentary inventory of my happiness quotient. Am I stressed? Sure am.

But, am I happy?

Then it hit me. Yes, yes I am happy. Very happy. You know how I know? Generally, I dislike the holidays but this year I find myself looking forward to them. The sound of Jingle Bells does not make me want to strangle some innocent, unwitting fluffy creature. 

I do my best writing from dark places but right now, I don’t want to go there.

So I say all of that to say that while you may read dark things, like yesterday’s mediocre medical poetry, I am not writing them because I am some shell of a person paralyzed by grief who spends the day curled up in a corner thumbing through a lifetime of regrets. Hardly. I have better things to do. And when I do go to dark places it is not because they are my places. Often I borrow them. And I don’t live there. Not for long, at least! Not anymore.

Today, I am happy. 

Today I am thankful. 

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.

Touched

chimney cap shaped like a flute player

I was lying mostly naked on the table. The light from the candles flickered dimly. Soft music floated all around. Gentle hands moved over my very pregnant body, pressing here and there…

Soon, I realized silent tears were leaking from my eyes in a steady stream and it had become hard to breath. I was certain I was not doing a very good job of hiding it but the woman said nothing. She just continued to work.
Meanwhile, I was thinking about and reliving things that I did not want to think about or relive.

It struck me then how much of our sadness, anxiety, loneliness, stress, depression is worn on our bodies in very visible, touchable ways. 

Most people are afraid to touch us or even to really look at us, we are all busy trying to save ourselves, and yet human touch is critical to healing, as the physical and emotional are inextricably linked. 

That being said, I was wholly unprepared for the flood of emotions I experienced with that massage. 

I never went back.

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.

Neurotransmitter


You make me feel pain. You help me remember. You move me from here to there. You control my reflexes. You arouse me. You put me to sleep. You make my heart race and then make it slow down. You even help me to see more clearly. 

You can do so very many things to this body of mine.

But…. you cannot make me hate.

I choose to believe there is good in everyone but before you decide that I am some wonderful, loving human being you should know that I choose to believe this for very selfish reasons. I choose to believe it because I want to believe there is good in me and I choose to believe it because it helps me find peace when dealing with difficult people in my life. 

When faced with these people, I take a step back and ask myself what is their motivation. What are they afraid of? Then, it is no longer about me. 

It is about their fear. 

The bigger the attack, the bigger the fear.

I cannot control what anyone else does to me but I can choose my own response.

I choose not to hate.

Comparing 

zinnia in black amd white

Life is made of joys and sadness. Ignoring the sad, painful times neutralizes the joyful ones.

One of my office managers keeps insisting that we not talk at all about the negatives of our job. He would prefer that the staff and physicians only project happiness, sunshine, and roses at all times. I am not sure that is entirely healthy.

This is the way of life lately. No one wants to hear or even acknowledge the negative. Sadness makes us uncomfortable. It is painful. It is a natural thing to want to avoid it.

Why can’t you just be happy?

The problem is that completely ignoring it promotes isolation. It keeps us from recognizing who is suffering, who is at risk, who needs help. This is a tough job for all involved. What is wrong with acknowledging that so we can all work through it together? 

Am I the only one who feels this way? What is wrong with me?

And it takes away the drive to get better. 

If everyone is happy, why do I have to do it right?

The worst part is that it takes away the celebration of the real triumphs. 

What? Can we BE more happy?

It is OK to feel fear, doubt, sadness, frustration. It is what we do with those emotions that is the key. How do we respond and use them constructively?

I see this in patients, too. So many believe they should not have to feel any negative feelings, that such feelings should be avoided at all costs. 

I know I should still be happy. I am going bankrupt, my wife left me, and my son is in jail, but I should be happy. Everyone tells me I should just be happy. Make me feel happy.

Doc, I am really, really trying to stay positive. I have metastatic cancer and I am in pain all the time and chemo is kicking my butt. Everyone tells me I should stay positive or I won’t beat this but I really just want to cry. I need to cry.

You know what? Being sick sucks. Having cancer sucks. Sometimes life just sucks.

And it should be OK to say it sucks. It should be OK to grieve and be sad and to cry if need be, even if it makes others uncomfortable. 

What we need is balance. Not a cult of happiness.

Frightened

hissing cockroaches
I was asked by dfolstad58 from Life and Random Thinking what irrational fear I possess. As it turns out, I have two.

The first is that I am afraid someone will think I am stupid. It is a deep seated childhood thing that is not going to go away. I am starting to find my peace with that.

The second is cockroaches. But not just any cockroaches. BIG cockroaches. The picture above happens to show a cluster of Madagascar Hissing Cockroaches. In the Southern US we have a cockroach that is a bit bigger than this. They can grow to be the size of your big toe fist foot and they don’t hiss. 

They growl at you.

Now, as you are no doubt well aware, cockroaches are disgusting, even nauseating. They crawl around in sewers, feeding on rotting, fettid debris and God knows what else in your walls. I take one in my house as a personal affront, an assault on the sanctity and cleanliness of my home. This is a big problem because I happen to live in an old house with tons of cracks and crevices and detritus…. a veritable cockroach heaven.

The worst part about a roach of this size is that they squirt and crunch when you step on them. I cannot stand the squirt-and-crunch from any insect, but especially not from a giant, growling cockroach. Fortunately my kids are big enough there is no risk of one of them getting carried off at this point.

Sooooo….

What does an independent, resourceful woman do when she spies one crawling across the floor? 

Her floor? 

First, I let out a good long shriek. I do not know for sure if cockroaches can hear but I like to think of this as a stun tactic.

Then, I grab a glass and turn it over on top of the bastard. Once one of the beasts escaped by throwing itself against the side until the glass toppled over, so for good measure I pile on a couple of good, thick medical school textbooks or perhaps A through J of one of those old encyclopedia sets. You know the ones I’m talking about, right?

And finally? 

I wait. I wait for someone or something that can take it from here. If I shrieked loud enough at the first sighting, often help has already arrived. If I am alone, though…. Sometimes, that wait can last a very long time. Days, in fact. 

In case you were wondering, these cockroaches don’t just give up and die…. Oh, no. I have even had one trick me by playing dead for a few days only to scurry off lightening fast once I removed the glass and tried to sweep the carcass up for disposal. Sneaky buggers.

So there you go. My fears. The fear of being labeled stupid and the fear of cockroaches. I am not sure which is worse…..

The Fast Lane

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Barb Taub asked: Parenting, doctoring, partnering, blogging… My question is how? And I don’t mean in smile modestly, Superwoman kind of way. But more in a what do you get back that makes it worth it to do all those things?We are the lucky ones—your readers/patients/admirers. But what do you get out of all of it?

I am going to start with blogging. What do I get out of blogging? Sanity. And craziness. But mostly sanity. If I did not have a place to put my words where someone would read them, I would go stark raving mad. I was close once. Writing for me is like cutting is for others. The tension builds until I cannot stand it and then I open the wound and bleed all over a page or two. You all save me. Sometimes life hurts so much you have to have somewhere else to put some of that hurt so you can walk away from it. Once I write something here, my fictions or my truths, I can let it go and set it free…. then bury it in other posts until it suffocates and dies. 

I also started blogging to see if I was any good at writing. People close to you will pile all kinds of flattery on you to keep you happy, but strangers? If strangers liked what they read, then maybe I was actually good at it.

I read a post at Barnraised this morning that started off with this: “Have you ever hit a wall? Wishing it could be a mirror that would reflect back into the world everything you know to be true in your soul?” Blogging is my mirror, so I don’t have to hit the wall. 

Parenting. Once you have a kid, as it turns out, you are kinda stuck raising them. The alternative is jail. Avoiding jail is very rewarding in and of itself, but to be honest, my kids have saved me on more than once occasion. The well placed hug, the “I love you, mommy!”, and cuddles…. They are salves for the wounded soul. I dread the time when my kids no longer want to do these things. 

Partnering is a matter of survival. Love aside, I cannot do this alone. I don’t want to do this alone. I have been alone. Alone terrifies me. Also, partnering makes blogging possible. So does a housekeeper.

Doctoring. I love medicine. I love patients. I do NOT like the non-medical and non-patient parts of medicine. Fortunately all of the crap has not crowded out all of the joy. Yet. Yesterday was a particularly tough day at the office. I’ll blog about that soon enough….

So, there it is in a nutshell, folks! Thank you so much for reading and for sticking around.