Getting the Worm

Flowers in the NYC Metropolitan Museum of Art

“Mommy? Can I go potty?” 

Her voice pulled me out of a deep sleep in the midst of a nightmare about a movie set with Nicole Kidman and a patient who ran a telephone ministry dial-a-prophetess line. The movie was to be a psychological thriller. The prophetess had just robbed me of money and souvenirs I had pilfered from the set. I am not sure what a dream like that says about my life right now…

“Sure, baby. You don’t even have to ask, you know.” I have lost count of how many I times I’ve said this to her. 

“Ok!” 

I heard her skip down the hall to the bathroom. I glanced over at the clock. 3AM. I would have groaned out loud but that would have taken too much energy.

A minute or two later…

“Mommy, I wiped but I didn’t flush because I didn’t want to wake anyone up.”

“Thanks, sweetie. Go on back to bed.”

“Ok!”

And I heard her skip back down the hall to her bedroom.

Sleep? For me, it was gone. Just like that I was turned into the early bird. Too bad I don’t like worms.

A Supporting Role

Bridge in NYC

“She just won’t eat healthy stuff! If I give her a cupcake and some broccoli she always eats the cupcake.”

“Think back to when you were eleven. If you have a cupcake and some broccoli in front of you, what do you pick?”

He shrugged. “The cupcake.”

“Right? Me, too. We’re not idiots. We pick what tastes best to us. As kids that’s the sugar. So you cannot put them both in front of her and expect her to pick the broccoli. That’s just cruel. She’s eleven. YOU have to make that decision for her until she is able to make it on her own and that is not going to be for a great many years. Get the cupcakes and junk out of the house. She is beautiful no matter what size she is but you and mom both have diabetes so she is at higher risk herself. Be the parent. Don’t sabotage her. Help her learn healthy habits that will last the rest of her life.”

We had this conversation every summer for five years running. Each year the same thing, like it was her fault. But this time? This time, somehow, was different….

This time he listened.

What made the difference? I don’t know.

It gets discouraging, saying the same things over and over again. There are days when I open my mouth to say, “Stop smoking!” for the millionth time and wonder if there really is any point. You never know, though, when the seeds you sow will fall on fertile ground and take hold. 

The First Lady

Liberty's torch

I put the baby to my breast. She ate greedily. 

So tiny for such a strong suck.

He had not come home yet. He did not know that she was a she and not a he. He would be angry, I knew. Would he let me keep her or would he kill her as he had the other three? Would he beat me as he had before?

Look, she is so beautiful, so perfect! Why can’t you love her?

Why can’t you love me?

The midwife busied herself quietly putting the room back in order. 

He would never pay for a doctor or a hospital. Not for me, he said. I was not worth it. 

A woman. 

A girl.

Someday I would leave him. I would run away. Far, far away. But to where? And they would find me, wouldn’t they? They always did. If I was lucky, they would shoot me where they found me. If not, he would be allowed to stone me to death. He’d like that. Then he could take a new wife. Someone who would give him boys. He never listened to the logic of genetics, that the determining X or Y chromosome actually came from him and from not me. My education, my past… it meant nothing to him. 

Neither did my future. 

No. I will outlive him. I will NOT give him the satisfaction.

The little one scrunched up her tiny baby face and yawned. Enough eating for now, she seemed to say as she looked directly into my eyes and grinned a lopsided baby grin. Then she drifted off into a peaceful slumber.

Born on Independence Day. If I were going to name her I would name her Liberty after the giant statue they tore down decades ago. No woman will stand as a national symbol, they said.  

Now she was gone.

Just like my own Liberty. 

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.

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!

Motherhood Sucks

Looking out of a window in Venice, Italy
I have taken care of all manner of sick people and their unpleasant smells and secretions: purulent drainage, vaginal discharges galore, fecal impactions, decayed appendages, amniotic fluid from strangers, sputum in every color of the rainbow…

But none of that prepared me for the disgusting onslaught that is motherhood. 

Poorly wiped kiddo bums. You know… when they are learning to do it themselves but are not willing to admit they need help. There is nothing like the smell of stale sweaty bum crack poo that has been fermenting all day long on the school playground. I will never understand why my kids had to pop their bums into my face when the odor was the most offensive. Then there is the poop and pee smeared all over the bathroom. MY bathroom. WTF? I have lost track of the number of times I have ended up with their vomit in my mouth!!! Snot. Never ending snot. The forgotten frogs that die in their containers and are found weeks later in a semi-liquified state. That is a sight that cannot be unseen, a smell that cannot be unsmelled.

So help me, no one said, “Brace yourself…” I would have appreciated some sort of warning. Instead people said, “Savor this time, it is over all too quickly!” 

Not quickly enough, I’ll tell you.

So let this serve as a warning to all of you who are contemplating the beauty of motherhood, thinking of reproducing. Turn back NOW before it is too late. Seriously. 

Fortunately, now that the Ebola threat has passed (for now) I have hazmat stuff from the office that begs to be used. So at least there’s that. 

Good thing they’re still cute.

The Scales

Communicating effectively with others is the key to success. I want my son to get comfortable speaking in front of others so this year I encouraged him to enter a speech competition through his school. 

He worked hard on it.

As parents we all suffer from delusions of grandeur regarding our clearly exceptional progeny but between the two of us, I had no expectations that he was going to win. I just wanted him to participate. I was fully prepared to just celebrate the achievement of his participation.

But then? He was given a red ribbon with “Excellent” emblazoned across it in gold letters. 

At first I was overjoyed. In my day, a red ribbon meant that you placed second. Excellent meant that you did pretty damn good.

Did he really do so well? 

During our practice he struggled with speaking too fast and was not making good eye contact. Was it possible that he listened to me? That he took my advice to heart? To be honest, that would have meant more to me than the ribbon itself.

Eventually I was given his judging forms. There were three judges. Apparently in this private school league they only score as Good, Excellent, or Superior and the kids are not ranked into places at all. Color of the ribbon? Yeah. Meaningless.

WTF?

Two out of the three judges gave my son a Good. Only one gave him an Excellent. From the judges’ notes, he fidgeted, stumbled, had to be prompted, and did not make eye contact. They gave him an Excellent ribbon for that. We worked on all of those things but it was his first competition and he is a first grader so I am not surprised or embarrassed or upset with his performance. I am so very proud that he was brave enough to get up there in front of strangers.

But how can I reinforce to my son that hard work pays off when mediocrity gets him an Excellent rating and a red ribbon? How can I make the point that he should listen to his mama’s advice about eye contact? How can I help him work through rejection and loosing and the unfairness of life while in the safety of childhood before he becomes a fragile adult who is devastated by the realization that the world does not in fact hand out participation trophies? And what about how this demoralizes and minimizes the kids who really did perform exceptionally well? They deserve to feel the full glory of their achievements, don’t they?

I just don’t understand. 

Doctor’s Day

Cute butterfly on a blossom

Doctor’s Day was yesterday. Did you know that?

Caught me completely by surprise.

It used to be a big thing ten years ago. The hospital hung banners up and handed out logo emblazoned umbrellas, bags, pens, and whatnot. My staff signed a big card the office manager picked up and a new potted plant would now sit on my desk. Drug reps dropped off cards and swag. There would be emails celebrating doctors sent from the suits. Well not really from the suits. From their secretaries. The point was, though, you just could not escape what day it was. 

To be honest, all of the hoopla back then made me feel very uncomfortable. 

This is not why I am doing this. I am not here for the accolades or the potted plants and I resent the insinuation that these things matter to me. Please leave me alone.

Each year it is less and less of a big deal. This year? Silence. Not a single frickin word from anyone. In fact, my only clue was a post from someone else on WordPress. 

Yesterday I told a woman she has metastatic ovarian cancer. I told a man that he now has diabetes and we developed a treatment plan together. I did a newborn visit on a precious two week old baby. I cried with a woman over her divorce and saw a man whose mother just died from the same disease he now has. Then I watched the last few minutes of my son’s karate class and picked up cupcakes for my daughter’s class party. 

This is life. My life. Every day. 

And you know what? Despite any bitching and complaining that I do here, I really, really love my job. It is such an honor and a privilege to care for people, to be there when they need help. THAT is what keeps us going… keeps me going.

In truth, I’d do this job for free. Just don’t tell the suits that I said that. 😉

The Longest Ride

Columns on Alamo facade in San Antonio
“MOMMY! He hit me!!!” she wailed.

“No I didn’t!” he hissed back.

They both start hitting each other.

The elevator is full of men and women dressed in suits for some conference or another. Some turn and stare. Some laugh. Some pointedly avoid making eye contact. 

23 floors.

Just when you think they are old enough to get along in public, they prove you wrong. 

Siblings.

Because no one knows how to get under your skin quite like a brother or sister.