Singing Mammo-gram

Posted on October 4, 2016 by deconstructingdoctor
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Pre-Mammogram Selfie

I had my first mammogram today and you know what?

It wasn’t bad at all.

How many hundreds of mammograms have I ordered over the years?  How many times have I reassured women, it isn’t that bad, without really knowing from personal experience. Now I know and it was no big deal.

I am about a year and half late getting it, though.  That’s not good.  I finally made myself the priority and made the appointment.  I finally took my own advice.  I finally decided to take care of myself by letting someone else take care of me.  Meaning, I went to the doctor.  I was the patient for once.

I have always been a firm believer in prevention.  An ounce of prevention is worth a bird in each bush.  Isn’t that the saying?  I’m really bad at those.  I can’t tell jokes, either.

I always want to be prepared, ready, I want to know what’s coming my way.  I want to face things head on, knowledgeable and aware.  I don’t want to ignore something, waiting around wondering –what’s going on, what’s this lump?

I made the appointment for my physical probably a year ago, but then the doc cancelled.  I made another appointment and then I cancelled that one, something just came up.  Then I just ignored the subsequent onslaught of emails and texts saying you need to reschedule your appointment.  So unlike me.  But also very much like me, because it was about me.

I don’t have time for me.  I know that sounds ridiculous.

When my patients tell me that they don’t have time to exercise, eat right, take care of themselves, I tell them -make time!  Find time!  Carve out a piece for you!  No excuses!

What an ass.

I did it.  I made the appointment.  I had my labs drawn.  I got my mammogram.  My physical.  My flu shot.  I’m ready.  I am prepared.  Now I don’t feel like a hypocrite when I tell my patients to do the same.  Now I can rub it in their faces.  And yours, too.  In a nice way, of course.

Make the time for yourself.  Make the appointment.  Get the test.  It really isn’t that big of a deal.

And now I know.

 

Posted in Advise Humorous, Medical Musings, My Stories | Tagged , , , , , , , , , , , , , , , | 20 Comments

Care-givers and Care-takers

Posted on September 30, 2016 by deconstructingdoctor

HandsJoe always brought Dottie to her visits. He was a doting husband that led her by the arm and placed her safely in the chair in the corner of the room while he sat close by on the exam table.  It was her visit, but she could no longer manage the step up to the table and would likely fall from the height if left to her own devices -so he sat on the table instead.

She had the expression of a porcelain doll.  Emotionless, except for the slightest smile.  Her eyes staring blankly, unblinking.  The Parkinson’s had stolen the quickness of her movement, the rapid fire changes in facial expression we all take for granted that conveys meaning to our words and emotions.  She basically just sat wherever you put her, oblivious.  I would talk with her, looking deep into those emotionless eyes, searching for that spark.

How are you doing, Dottie?

Her eyes would slowly move to lock on mine.  An almost perceptible churning occurring.  Wheels grinding.  Clicks and whirs as her mind would attempt to come to life.

OoooKaaay.

The slowest and most painful ‘OK,’ ever.  What a feat!

Joe mostly spoke.  The visit would have taken a lifetime otherwise.  He was a careful notetaker, likely harkening back to his years as a beat cop.  He pulled out his notebook for my review.  Pages and pages of meticulously recorded bowel movements, urinary output, food intake, medication administration, times of waking and sleeping.  It was all in there.  The minutia of her life, carefully documented.  The painful story of the demise of the wife he once knew tracing all the way back to the beginning.

The visit would always end with Joe apologizing for getting emotional.  Tears in his eyes.  A catch in his voice.  He was losing Dottie.  And he knew it.  As a cop he would show up after the crime.  After the death.  And pick up the pieces.  This was different.  He was living in the middle of an active crime scene that had been in progress for the past 10 years.  It was hard.  He got tired.  He was old.  He had his own health problems.  Sometimes she got combative.  She took a swing at him last night and he had to grab her and hold her arms down until she became limp.  He thinks he may have grabbed her a little too hard.  He thinks he may have left a mark.  He even wrote it down in the notebook.

made a bruise

It was hard to imagine Dottie mustering up that kind of energy as she sat almost catatonic in front of me.    I pulled the sleeves of her shirt upward.  Her left arm had a single bruise like a thumbprint.  I pulled the back of her shirt up, no marks.  I pulled the legs of her pants up, no marks.  Her chest and belly, no marks.  I moved her arms around, feeling down the length of the bones.  No wincing.  She was fine.  My gut said there was no abuse.  Not yet.

Joe needed help.  Before he lost control.  Before Dottie got hurt.  I put eyes in the home.  Nurses.  Physical Therapists.  Occupational Therapists.  Palliative Care.  And eventually Hospice.  Anyone that could help them.  Anyone that could ease their burden.  He told all of them about the night he grabbed Dottie a little too hard.  Guilty conscience, I guess.  He was grateful for their presence.  He could leave to do the shopping,  mow the lawn, have lunch with an old buddy.

He got a break.  She got a break.  And no one got hurt.

 

photo credit  Julia Freeman-Woolpert

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Carnival

Posted on September 26, 2016 by deconstructingdoctor

 

IMG_2863Have you ever noticed that the games at the carnival are rigged?  You play them anyway.  There’s always the chance that you’ll beat the odds.  You’ll be the one walking around with that giant panda bear and the crowds will part and marvel at your greatness.  Yeah, that’s right, my dart throwing skills are legendary, you’ll think to yourself.

I took my kids to the carnival.  Of course, they had to play the games.  When did the games start costing $5 a pop?  I guess I haven’t been to a carnival in a while.

Those carnies, man, what a fascinating crowd!  What it must be like to be a carnie!  What it must be like to have complete and utter control of the game.  Don’t underestimate those people.  All the odds are in their favor and you are the sucker.  The kids played the games and they each won a little toy.  The carnies always let the kids walk away with something.  That’s really sweet.  And brilliant.  Because the kids start believing that they can win.  No one really wins a rigged game.  Unless it’s your rigged game and you’re a carnie.

Somehow medicine became a carnival.  Somehow the insurance companies/hospitals/corporations became the carnies.  Somehow I ended up a dumb kid throwing dull darts at half-filled balloons, hoping for the promise of the big giant panda, but walking away with a small stuffed poop emoji.

From a distance the carnival looks like the place to be, bright lights, loud music, crowds mulling about, the smell of sweet and savory carnival food in the air.  I want to be there.  I want to be where the action is.  The energy.  The vibe.  Back in the day, I’d tease my hair out, wear my cut up jeans and Bon Jovi shirt, and strut around like I owned the place.  I’d check out the guys with long hair, buy some new patches for my jean jacket, and dream of the same time next year when it all rolled back around again.

I wish I didn’t know any different.  I wish I still believed I could win.  Now that I know, if I keep playing the game, what will I become?  I don’t want to play the game, I don’t want to be a carnie, I don’t want to run the carnival.  I want to get off the ride because it’s making me sick.  The rides always do.  I think I’ll just take my stuffed poop emoji home now.  I think I just might need to find a new game in town.  Maybe stop playing games all together.

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Runner’s Low

Posted on September 20, 2016 by deconstructingdoctor

St. Lucia July 2009 091Since my mom passed away, running has been harder for me.  It’s hard to find the time.  It’s hard to get away.  She used to watch the kids while my husband and I went to races.

Plus it’s near impossible to run and cry at the same time.  I learned that after one of my best friends, Carol, died.  It’s like you are having an asthma attack.  You need air to run and when you cry, it’s like your air gets suspended somewhere inside your chest.  It gets held up in the grasp of despair.  Grief.  Sadness.  You hold it in your chest to pay homage to the one that has passed.  Their breath suspended for eternity.  Yours for a brief moment until the force of persistent life draws it back.  Back to life.  From the brink.

In those moments, perpetual movement ceases.  That’s kind of not the goal of running, but it is the goal of death.  Movement ceases.  Breathing ceases.  Existence ceases.  In some ways since my mom died, I haven’t caught my breath entirely.  Somehow it still remains locked up in my chest.  To even begin to run causes my chest to heave, my lungs to constrict, the tears to sit just inside the lids.  Waiting to spill.  Again.  And Again.

People die.  I know this.  I’ve seen this.  I know how to compartmentalize this.  I thought I would do a better job of this.  In most aspects of my external life, I have.  It’s the moments of being totally alone and inside my head, during the run, that seems to be a place I can’t hold back the grief.  It’s on the run that the emotions spill over.  How silly I must look doubled over on the side of the trail in heaving sobs!

I’d like to untangle the memories of my mom, her death, from my run.  It’s the breath.  The breath is why I can’t do that yet.  She said, I can’t breathe.  And she couldn’t.  She couldn’t breathe.  I breathed for her.  Briefly.  Not for long.  But long enough to know.  My breath would not be enough for her.  I tried to breathe her back to life.  There wasn’t enough breath in me.  Running brings back that memory for me.  All I hear in my ears is my breath.  And it’s never going to be enough.

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Those who can, should teach.

Posted on September 16, 2016 by deconstructingdoctor

library-1480438-640x480I love having students.  I’ve had all kinds.  High schoolers considering a career in medicine.  Premed students applying for medical school.  PA students.  Medical students on a family medicine rotation.

My partner recently asked me if I get paid to have all these students.

Yeah, sometimes, depends on the school, but I don’t take it.

His mouth dropped.  They take so much time, they make you fall behind, you should take the money!

It’s like 500 bucks -tops.  I don’t do it for the money.  I just really like it.  They don’t take that much time.  I don’t fall that much behind.

I have found in life that if you get paid for what you love, it ends up sucking the ever-loving life out of it.  Like being a doctor.  I truly have no idea about what I get paid.  Well, maybe I have a rough idea.  If I counted every penny, calculated how much I could make over every illness, I would be reduced to a sorry SOB who took the joy out of helping others for the love of money.  That’s what the corporations are doing (like the one I work for), but I won’t.  They can’t make me get paid to teach.

I am hanging onto this profession by the tips of my fingernails.  You see, I’m just old enough to know what it was like to have my own practice.  The good old days.  I also made shit money, but it was on my terms.  Teaching somehow transports me back to that time.  I get a little giddy.  I look forward to going to work to share my patients with this eager mind.  I am reminded again about all the incredible saves, finds, close calls.  About the incredible journeys of my patients.  I get to share that with someone who doesn’t know the pitfalls of this career yet.  They are still wide-eyed and eager.  And I remember being like that.

“No where else can you see an 88 year old woman and a 7 year old boy back to back!” my student exclaimed.

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It catches my attention.  He is becoming enlightened.  My wax-on/wax-off training method is paying off.  Daniel-son, now I, Mr. Miyagi, will teach you the crane move on a canoe in a lake.

“You get to think on your feet, always changing gears, always something different!”

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You have mastered the move, now we will go to the tournament.  Your opponents will cheat and play dirty, but you will be victorious.

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“It’s about the relationships.  Family medicine is about the relationships.  I love it.  I want to do what you do!”

That’s when the heavens open up, the angels sing, a dove lands softly on my shoulder, and a rainbow shoots out of my ass.  Yes! Glory! Glory! Hallelujah!

It’s a beautiful career.  It’s a beautiful profession.  I just wish it wasn’t driven by profit-hungry asshats.

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Daniel-son, my work here is done.  I shall retire to my bonsai trees now (not really -my husband says financially I can retire in 14 years -what does he know…).  Carry on without me.  Make a difference.  Fight the good fight.  Go into family medicine.

photo credit:  movie trailer for Karate Kid and m s

 

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The Day After

Posted on September 12, 2016 by deconstructingdoctor

img_3387Sometimes it isn’t until the day after a tragedy that it starts to really sink in.  It’s not until after you close your eyes and your body finally succumbs to sleep.  You awaken in the morning to the stark reality.  It’s true.  It really happened.  You get to make the realization all over again.  Somehow the roots start to take hold.  Before maybe it still could have been a dream.

I always hate it when a movie or story has a dream sequence.  It’s always during that part of the story that just can’t be real, the most horrifying part, the death, the carnage, the loss.  And then the hero wakes up.  None of it was true.  It was all a dream.  Except in life, that never really happens.  The truth is the truth.  You don’t get to shake it off.  You don’t get to say, oh wow, thank God that was just a dream!  No.  Reality is often much worse than that.

My mother has only come to me once in a dream since she passed away 2 months ago.  She told me everything was OK and then I woke up.  She looked like she did those last moments I saw her as I leaned over her trying to bring her back.  Eyes wild.  Skin pale with a slight sheen of sweat.  Her hair in wild wisps.  She seemed desperate.  I’m OK.  Everything is OK.  She wanted me to believe it.  I tried.  She just didn’t look like herself.

The day after a tragedy is probably one of the longest days on earth.  It feels like walking through thick smoke, breathing in thick dust, feeling the heat of flames licking at your face.  Wandering.  Lost.  Confusion.  Why?  Could I have done something?  Could the tragedy have been stopped?  If only I knew something was wrong.

The need to create order kicks in pretty quick.  The need to DO something propels you forward.  Arrangements need to be made.  Family needs to be called.  The place on the floor where the paramedics worked needs to be cleaned -which then leads to cleaning in general.  Start picking up the pieces.  People will be coming.  Probably should get dressed.  Feed the kids.  Walk the dog.  The world keeps turning.  One breath at a time.  One step at a time.  You move forward trying not to get stuck in the moment.  The worst moment.

I remember when it happened.  I remember feeling this way before.  Before I knew what true loss felt like.  After 15 years, when I stop to consider it, the feelings from that day come rushing back.  I remember the collective cries of a nation.  All at once, no!  This can not be true!  A dream?  A nightmare?  It was no dream.  It was true.  The day after proved the unthinkable.

 

 

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8 Things Only Bloggers (and Blog Readers) Would Understand

Posted on September 11, 2016 by deconstructingdoctor

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I’m celebrating my 75th blogpost!  I started this silly little blog in November 2015.  Why?  I don’t know.  Why not?  Blogging is not for everyone.  For me, I just can’t help it.  I have so much shit to say.  I dream and think in blogposts.  I’ve decided to take a moment, step back a bit from my blog and share a little insight for my readers and fellow bloggers.

  1. Post Anxiety:  I always get a little twinge of “OMG” before I publish a post.  I’m putting myself out there.  Not that a whole lot of people are reading it, but you just never know…How will the post be received?  Will it resonate with the readers?  Will it offend?  Will it make people think?  Will it fall flat?  Will HR call me up and say, for the love of God woman stop this madness or you’re fired!
  2. Photo Shopping:  It’s not just the words that matter, but the accompanying photo.  This is the age of “Flash and Grab.”  On the internet ONLY people.  If you do that in real life you will go to jail.  If your first sentence doesn’t rope them in, the photo will.  I like to take my own photos, but sometimes I just can’t capture the message and I need to “borrow” someone else’s.  Which feels a bit like stealing.  Probably because it is.  I appease my conscience by giving credit to the photographer in my blog.  I’m sure they’d prefer a check for $25, but my undying appreciation will have to do.
  3. A-Musing:  There is nothing better in this world than a good laugh.  Even a chuckle.  That’s pretty good, too.  I like a good, funny, cheeky blog post.  And I like the word cheeky.  That is all.
  4. Over Sharing:  Oh Lord, do we all know people who overshare!  There is an art to “the share.”  You want people to relate to what you are saying by making it personal, but there is a fine line.  For instance, when I took a picture of my husband sitting on the toilet with the cat sitting on his pants between his legs, I didn’t POST that picture, because that is oversharing.  I only described it in great detail on Facebook.  No picture was necessary.
  5. One Post Too Many:  I love my fellow bloggers!  What a wonderful and amazing community!  I even have BFF bloggers that I’ve never met, but I love!  But here’s what kills it for me:  excessive blogging.  When a fellow blogger posts TOO much, I just can’t keep up.  I cannot give you that much attention.  I am acutely aware of this for my own blog.  Nobody wants that much Deconstructing Doctor.  Sometimes they need a break.  They need to go to work.  Make supper.  Spend time with their kids.  Likewise so do I.  So I limit them.  I do it for you.
  6. Monetary Confinement:  Did I fantasize that I could somehow cash in on my wonderful and informative blog?  Did I buy a book called, “Secrets for Blogging Your Way to a Six-Figure Income” and read it cover to cover?  Why yes, I did.  Then I started my blog and I felt that ads for drugs/junk food/hemorrhoid cream just didn’t jive with my sense of integrity.  And I’d probably make $2 a month anyway.  My integrity is worth more than that.  It would take at least a couple hundred bucks.
  7. Pointless:  Somehow my attention span has shrunk to about 500 words.  More than that and I start muttering to myself, get to the point, already.  I am so impatient.  What happened to me?  There should be a point.  And it should be good.  It should be worth my effort.  Because to read more than 500 words requires me to hide in my closet away from my kids so I won’t be interrupted and I can concentrate.  Except now they found my hiding place.
  8. Numbered Lists:  Ef you numbered lists!  17 Ways to Make Him Notice You.  32 of the Funniest Marriage Proposals.  76 Pinterest Fails.  I hate you numbered lists!  I hate that you are not a nice round, whole number, in groups of 10.  Like 10.20.30.  So I am practicing a form of exposure therapy right here, right now by ending this particular list at number 8.  And it’s killing me!
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The Moment

Posted on September 6, 2016 by deconstructingdoctor

telephone-1240655-640x480In retrospect, the moment that I decided to go to medical school happened in our kitchen.  My mother answered the phone back when phones hung on walls.  Back when one phone belonged to everyone in the house.  Back when I was going to be an English teacher.

My dad had been moved to a Rehab facility.  He needed to recover from the spine surgery that he endured after the accident.  That stupid accident, the one where he was volunteering for his church.  Fixing their roof.  And he fell.

My boyfriend at the time would tell me years later that he kept having a recurring dream of that day.  You see, he was there, too, helping my dad.  In the dream, he heard him call his name, saw his hands outstretched, falling, but he couldn’t grab him, his fingers just out of reach, and then he was gone, over the edge of the world.

The moments after the accident are a blur.  ER.  My father on a stretcher.  His face contorted into a Picasso painting of horror from the pain.  And he couldn’t move his legs.  The nurses, the doctor.  Everyone talking, but no one speaking our language.  What is happening?  Lumbar fracture.  Bone fragments.  Spinal cord injury.  Emergency surgery.  Paralysis.  May never walk again.

And then it was over.  Only thing left was to wait.  Wait for healing.  Wait for the swelling to go down.  Wait for the remaining muscles, nerves to reveal themselves.  Wait to discover what was left.  Like the aftermath of an atomic bomb.

So we went home.  And then the phone rang.  My mom grabbed the phone first.

Hello?  This is she.  Silence.  Her face changed.  She looked confused.  Then shocked.  Then angry.  But we have insurance.  Quiet.  Now she is pacing.  Her left hand on her hip.  How dare you call us at our home.  You will get your money when you get it.  My husband just had that surgery and you are calling us for money now?  You should be ashamed of yourself!

And she hung up the phone.  Abruptly.

I have questioned for 20 years, who was on the other end of that phone?  At the time and for many years afterward, I believed it to be the surgeon.  Now that I am a doctor, it doesn’t seem likely.  It was likely the surgeon’s office manager, which happened to be his wife.  I recently asked my mom, do you remember that phone call?  And she didn’t.  She never remembers such things.  The phone call that changed everything for me.

The phone call was the pivotal moment for me because we had never been exposed to the business side of medicine before.  The side that looks for profit.  The side that affords Mercedes and beach houses.  The side that calls a shell-shocked family and demands to be paid for services rendered.  The man that spoke at us more than to us.  The man whose hands meticulously removed bone from my father’s spinal cord, with each delicate movement either saving or severing vital nerve connections.  Nerves that served a bladder, the bowels, the tiny little muscle fibers that collectively provide motion.  The motion in a body that physically labored for his family and without such movement they may lose everything.

He needed to be paid.  And I knew what I needed to do.  I needed to know.  Everything.  I would never be in a position of such fear again.  The not knowing.  And I needed to do it differently.  I would never treat a family with such indifference.  I would never do it for the money.  Maybe I wouldn’t be a Neurosurgeon, but I would be a doctor.  And I would do it better than him.

I wish I could say that wanting to help people, that seeing my father suffer and recover by the great medical care that he received motivated me to want to be a doctor.  In many ways it did.  But it was that asshole surgeon that really lit my fuse.  Doctors should be better than that.  My dad deserved better than that.  I would be better than that.  Wouldn’t I?

 

Photo credit:  soopahtoe

 

 

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Use the Damn Q-Tip

Posted on September 4, 2016 by deconstructingdoctor

Just not inside your ear canal.

When did Q tips become the enemy of the medical professional?

Never let them use the Q tips in their ears.  It was a cryptic message.  NEVER.  In the ears.  That was day one of medical school.

But I ALWAYS used Q tips in my ears before medical school.  What was so bad about that?  Wasn’t that the purpose of the Q tip?  To clean out all that ear wax?  To dry out the ears after a shower?  Why must I denounce its use now?  What would happen if I didn’t?  Would there be lawsuits?  Would there be injury?

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When reading the back of the box of Q tips, there is no mention of its use in the ears.  That’s funny.  Had I really been using it wrong all this time?  What had my parents done, teaching me such insanity?  You don’t put it inside things, you use to apply stuff, clean stuff, and…..delicately care for sensitive areas on a baby?  Oh dear.  That could be misleading. Is that how the Q tip use in the ear began?  That would be a sensitive area on a baby.

Actually, it wasn’t until the 70’s that the marketing changed.  You could use Q tips in your ears back then.  There must have been injuries and complaints.  That’s when the manufacturer started to denounce its internal use.

So what’s so bad about Q tips in the ears anyway?

  • Ear wax (otherwise known as cerumen) is supposed to be in the ear
  • Because it keeps bugs and other bad stuff out
  • Using a Q tip just pushes cerumen farther back into the ear canal
  • When cerumen pushes against the tympanic membrane (the ear drum), it can decrease hearing
  • If pushed far enough, it can become impacted and also lead to dizziness, vertigo, and pain
  • I’ve had to fish out the fuzzy cottony end of the Q tip from 1 or 2 ears in my lifetime
  • Which means sometimes it can become a foreign body in the ear
  • The manufacturer explicitly says not to use inside the ear
  • But it’s OK to use around the ear

Guess what?  I still use Q tips in my ears.  I’m not ashamed.  I’m really not a big ear wax producer.  I use it to dry out the water in my ears after a shower or bath.  I’ve never had a problem with cerumen impaction or hurting myself after daily Q tip use.  Daily.  Q tip. Use.  That’s right, this is how I choose to live my life people, right on the edge.  I live for danger.

 

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There’s Nothing Easy About Sunday Mornings

Posted on August 31, 2016 by deconstructingdoctor

IMG_0389At least not since I got married and had kids.  I happened to marry a sweet Southern Baptist gentlemen.  And he happened to be reared on church.  A lot of church.  Wednesday nights.  Sunday morning service.  Sunday school.  And then church on Sunday night.  My parents used to just drop me off at church.  I wanted to go because my friends went.  How cool were my friends?  How weird were my parents?  Or was it the other way around?

The limit of my dutiful wife abilities stop at Sunday morning service and now Sunday school.  That’s all I can handle.  That takes us until about 11 o’clock on Sunday morning.  My church friends are all currently eye-rolling right now.  And second-guessing the friendship.  Who complains about how much time they spend at church?  All good Christians go to church.  And they LIKE it.  Ah-hem.  Oh, I mean Amen.

The moment my children entered the world (separated by 2 years), Sunday mornings became my least favorite day/time of the week.  I dreaded it from the moment their little infant cries tore me from the blissful abyss of sleep (at 3am).  Packing bottles, diapers, wipes, more bottles, a change of clothes, pumping before I left so I wouldn’t have to nurse in front of everyone, getting them dressed and timing their feedings/poopings, getting myself ready while they cried relentlessly.  Then we’d arrive at church.

ALL those people.  All those sneezes and coughs and the shaking of hands!  Inevitably the baby would cry, need a bottle, need a change.  I’d miss half the sermon.  Why did we even bother?

My one and only day to sleep in (because my husband signs me up for 5K’s on Saturdays all the time).  To lie around lazily reading the paper, straightening up the house, getting ready for the week to come.  I don’t have that.  Ever.  Sunday is a marathon.  It’s a blur.  When it’s over it’s Monday all over again.

Church.  Something akin to eating one’s spinach.  It’s good for you, but ice cream tastes so much better.  Church is food for the soul.  So I go.  And I’m going to freaking like it.

 

 

 

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